Eye, Ear, Nose. ThroatInfectious DiseasesPediatrics


In May, 2019, I wrote a blog about tonsillectomies and the onerous criteria specialty societies required of a patient before it could be done. Ear, nose, and throat surgeons, who do the procedure, declared a child under age 18 years must have seven (7) episodes of tonsillitis in one year, or five (5) episodes a year for two years, or three (3) episodes a year for three years before it is justified to have a tonsillectomy. 

I thought these criteria bordered on cruel child abuse, because I know very few parents who would stand still for their child being sick seven times in one year and missing the number of days of school that could result. Most parents would demand something be done to stop the cycle of repeated sore throats. The experts have continued to recommend these criteria, and they were re-emphasized in the May, 2023 issue of American Family Physician, the professional journal of the American Academy of Family Physicians (AAFP). 

Recently, however, parents received a word of encouragement in an article published in The Lancet, a British medical journal. The statistics reported in the article reinforced the benefit of tonsillectomy for children with frequent sore throats. The study found that for patients with recurrent tonsillitis, tonsillectomy resulted in almost 50% fewer days of sore throats over two years compared to standard, non-surgical treatment—painkillers and antibiotics. That’s good news for parents and children and echoes what I saw in my own patients. Those sickly children who had poor weight gain, a poor appetite, and frequent sore throats, after tonsillectomy transformed into robust and healthy children I rarely saw because they weren’t sick. 

The authors of the study are still worried about the risk of tonsillectomy and offered a disclaimer that emphasized weighing the risks of surgery against the benefits. Having half as many days of sore throat would be a real plus for someone sick with seven episodes of tonsillitis a year so they are probably willing to take the risk. Post operative bleeding is the most troublesome of those risks, but when done by a skillful surgeon who is careful to be sure the surgical site is dry, tonsillectomy should provide benefit to the patient. 

I was not one to recommend a child have his/her tonsils yanked out after one or two sore throats, but I certainly was one who had enough compassion and insight to know when recurrent sore throats and chronic tonsillitis were affecting the child’s school performance and general health. Those kids benefitted from tonsillectomy, and I had no hesitation recommending the procedure. 

Tonsillectomy is not a subject near and dear to the hearts of readers of DrGOpines.com. Few, if any, of us are candidates for this procedure. But our grandchildren and even great grandchildren are, so knowing this information helps us old folks seem like wise sages when our children are in a quandary as to what to do about all those sore throats bothering little Susie. Having this information at hand may ease the mind of a frustrated parent.

References: AFP Clinical Answers: When should tonsillectomy be considered for those with recurrent tonsillitis? Am Fam Phys. 2023  May;107(5):461.

Medical News in Brief: Tonsillectomy Effective for People with Frequent Sore Throats. JAMA 2023 June 20;329(23):2011.

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