“My son snores very loudly.”
“My child stops breathing when sleeping.”
“My daughter’s tonsils are huge.”
“My child has yellow stones coming out of his tonsils.”
“My child has frequent sore throats and strep infections.”
These are common complaints and concerns heard by pediatric ear, nose and throat specialists from parents and caregivers. Much of the confusion stems from what tonsils and adenoids are and what purpose they serve. After all, since their removal is quite common, do we even need them?
Tonsils and adenoids are tissues that belong to the lymphatic system in our body. The tonsils are located in the back of our mouth, forming a small ball on each side. Adenoids are tissues located behind the nose that are not seen by the naked eye. Tonsils and adenoids are part of several hundred similar tissues in our head and neck that help to fight infections, yet we can live normally without them when they become the source of harm or illness.
There are two main reasons why doctors recommend surgical removal of tonsils and adenoids. One of the most common reasons is when the tonsils and adenoids grow large and obstruct breathing and oxygen during sleep, causing what is known as Obstructive Sleep Apnea (OSA) or Sleep Disorder Breathing (SDB).
Children with OSA commonly present with open-mouth breathing, loud snoring, gasping while sleeping, interrupted sleep and tossing and turning in bed. Other nighttime sleep complaints may include bed wetting or excessive sweating. Daytime symptoms include hyperactivity, irritability, poor performance in school and behavioral issues.
An overnight sleep study in a sleep center can be done to confirm the diagnosis of sleep apnea. However, the symptoms are often seen by physicians as an indicator to surgically remove the tonsils and adenoids.
The second common reason for removal is frequent infections of the tonsils, known as chronic tonsillitis. The most common offending bacteria in tonsillitis is Streptococcus Pneumoniae. This infection used to be a serious condition before the availability of antibiotics. Without medication, the infection could spread from the tonsils to the heart, joints or the rest of the body, leading to rheumatic heart disease, a serious and potentially fatal condition.
Any child or patient who has had seven or more episodes of tonsillitis in one year, five episodes for two years or three episodes yearly for three years is a candidate to have their tonsils and adenoids surgically removed. Other reasons to consider removal of tonsils are frequent yellow stones, tonsillar abscesses, tonsillar tumors or rare illnesses such as periodic fever aphthous stomatitis pharyngitis cervical adenitis (PFAPA) and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).
Removal of the tonsils and adenoids is a surgery for children. It is the second-most common surgical procedure performed under general anesthesia in children, with more than 500,000 tonsillectomies and adenoidectomies performed annually. The improvement in perioperative care and anesthesia, as well as advances in technology and physician skills, has made this surgery safe and effective.
Risks of surgery may include minor bleeding, which occurs in 2 percent to 3 percent of patients, dehydration and voice changes. It is very rare to have any serious side effects or major bleeding.
The surgery is usually performed in an outpatient center, where the patient is observed for several hours before being discharged. Patients are given pain killers and antibiotics after surgery and are encouraged to drink plenty of fluid to avoid dehydration. Patients may have pain for one to two weeks with slight chance of bleeding after surgery, so parents are encouraged to stay home with their children during that time to ensure they stay properly hydrated, have pain management and no side effects.
Your child is your life. If your child is showing symptoms, do not hesitate to contact your doctor and see a pediatric ear, nose and throat specialist. Tonsils may give your child serious health or behavioral problems that could be solved in a one-hour surgery. You’d be surprised at how significant and immediate improvement can be.
Ramzi Younis, M.D., is a pediatric ear, nose and throat specialist at UHealth – the University of Miami Health System, who specializes in snoring and sleep apnea disorders and pediatric tonsils and adenoid diseases. For more information, visit UHealthSystem.com/patients/pediatrics.