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Tonsils rarely need to come out

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Zepeda, April
Thursday, June 21, 2012
Tonsils rarely need to come out
Research suggests surgery offers little benefit, except in certain severe cases
By Theresa Goffredo, Herald Writer


Dr. Megan Westbrook, a pediatrician at The Everett Clinic, says sleep apnea, severe snoring, difficulty breathing or swallowing, or constant throat infections that don't respond to antibiotics are signs that a child may need a tonsillectomy.
It is difficult to fathom that children underwent tonsillectomies 3,000 years ago.

According to an online encyclopedia, that's how long tonsils -- those vestigial pieces of tissue in the back of the throat -- have been removed in surgical procedures. If you call using a blunt hook a form of surgery.

Over the years, the popularity of tonsillectomies has waxed and waned. During the 1950s, for instance, having your tonsils out as a child was almost a rite of passage.

Since then, the procedure has been scrutinized and studied, with today's consensus being that tonsillectomies should be a last resort, except in severe cases.

"We definitely do not do them as often," said pediatrician Megan Westbrook with The Everett Clinic. "My understanding is it used to be so many children got them, whether they had severe throat infections or not, and for not very stringent reasoning back in the1950s."

Then the operation fell out of favor, almost completely, for a while.

Recently, there's been an uptick in the procedure, Westbrook said.

But Westbrook adds a big "however" right here.

The "however" is followed by what Westbrook recites as recent research that calls into question the necessity of a tonsillectomy.

One study took two groups of children, one that had the the surgery and one group that did not have the surgery.

What they found was little difference in the number of throat infections between either group the following year. So it came down to the question, Why are we doing this?

"They didn't really find any difference with the surgery," Westbrook said.

That evidence, along with the fact that as kids grow older, their tonsils regress, leads to less need for tonsillectomies.

There are those severe cases Westbrook cautions parents to watch for.

Those cases include a child suffering from sleep apnea or severe snoring, or having difficulty breathing or swallowing.

Or the child may be a candidate for the surgery if he or she is suffering from constant throat infections -- strep infections -- throughout the year that don't seem to respond to antibiotics.

Another consideration is if the child has tonsil abscesses or is a carrier of strep and is making other members of the family sick, Westbrook said.

As a pediatrician, Westbrook said she doesn't see many children a year who fit these criteria for a tonsillectomy.

Tonsils function like a lymph node in the body, capturing bad bacteria. Once the tonsils are gone, the body's other lymph nodes take over that job.
So the body doesn't really need tonsils, much like a body doesn't need an appendix.

Today, removing an appendix has come a long way, sometimes involving just a few slits, Westbrook said.

Tonsillectomies have come farther than the early days. But still.

"There is no eloquent way to do it," Westbrook said of removing tonsils. "And recovery takes at least several days with eating ice cream and drinking juice."

Dr. Westbrook
Learn more about Dr. Megan Westbrook from The Everett Clinic in this video: http://tinyurl.com/drwestbrook.