Do the benefits outweigh the risks?
Around 1000 B.C.
That’s around the time tonsillectomies, the surgical removal of the tonsils, begun. One of the most common surgeries today, tonsillectomies are a routine surgical procedure used to fix repeated infection of the tonsils or big tonsils that cause difficulty breathing, sleeping problems or block the food passage. Although it dates back to ancient times, the procedure still comes with risks. You may be worried about news reports of weight gain, pain and even anesthesia-related deaths after surgery. However, serious complications after a childhood tonsillectomy are actually quite rare.
It is better to undergo the procedure as a child, as the risk of complications is dramatically less than that in adults; studies show about twenty percent of adults face complications after the surgery. Our kids consistently experience an easier recovery, so if tonsils are causing problems, it is recommended to get them removed sooner rather than later. According to Cook Children’s Otolaryngologist Dr. Natalie Roberge, the ideal time to remove problematic tonsils is between the ages of three and 12.
There are many different reasons one may consider scheduling a tonsillectomy for their child. Dr. Natalie Roberge says the most common reason tonsils are removed is for sleep apnea, when a child cannot breathe well at night. “This can slow down development and growth and even impact behavior during the day when the child is not well rested,” Roberge says. The second most common reason to remove the tonsils is recurring tonsil infections, such as six to seven in one year or four per year for three years in a row. Some less common causes include tonsil infections that do not respond to appropriate antibiotic therapy, a tonsil mass, tonsil stones and even bad breath.
“We could literally hear his snoring across the house,” explained mother of two Jennifer Creecy. Over the last year, Jennifer’s youngest son, Bradyn, has had chronic coughing and snoring, and needed at least 12 hours of sleep to feel rested. Jennifer’s oldest son experienced the same symptoms and previously received a tonsillectomy with Dr. Roberge. From past experience with her oldest son, mom knew something was up, so she packed up again to visit Dr. Roberge, this time with her youngest boy. Mom and Dr. Roberge decided surgery would be the best option for him, and although Bradyn initially said, “But I like my tonsils,” he is now experiencing a pleasant, speedy recovery full of milkshakes for dinner, all the Jell-O jigglers he can eat, movies and even swimming! Less than a week after surgery, Jennifer and her husband were happy to see Bradyn’s shining, rested face waking them up bright and early each morning.
All surgeries come with their own risks and benefits, and a tonsillectomy is no exception. Not every child should have the surgery; those with a bleeding disorder should explore alternatives with their doctor. However, according to Dr. Roberge, complications for a tonsillectomy are rare, with the most common being bleeding after surgery. “In general, yes, there is a small risk of bleeding in the very few percentage points. It tends to happen a week or so after the surgery when scabs come off. In most cases, kids can gargle with ice cold water to shrink up the blood vessels and stop the bleeding; very rarely does a child have to go back to surgery.” Only in very rare cases are complications beyond discomfort, bleeding and infections seen. These are typically heavily publicized cases, giving the perception that a tonsillectomy is very dangerous. In reality, it is unusual to be out of school more than a few days.
If your child’s tonsils are causing problems but a tonsillectomy isn’t recommended for their particular situation, there are other ways tonsils can be removed or reduced in size. For example, intracapsular tonsillectomy is a technique used to remove the majority of the tonsil instead of the entire tonsil itself. This method can result in less post-operative pain and bleeding, but can also increase risk of infection or the tonsils growing back. According to Dr. Roberge, what is most important is that the surgeon be experienced and comfortable with the tools used for the method chosen.
At your pre-operative appointment, be sure to ask questions until you are comfortable with the process. The day of the appointment, Dr. Roberge says “kids are given a dose of relaxing medicine and able to go off to sleep without any shots or needles.” After the 15-30 minute surgery, your child will wake up with you by their side and most likely be released within hours-- occasionally the next morning-- once any complications are ruled out and pain is under control. Overall, tonsillectomies are a very safe procedure. Your biggest challenge may just be coming up with two weeks of a soft food menu! (Dr. Roberge recommends Popsicles, Jell-O, soft noodles and mashed potatoes.)