It has become less routine to remove tonsils and adenoids during childhood because surgeons today are taking a more conservative approach to performing routine surgeries, notes Dr. Scott Kay of of Princeton Otolaryngology Associates.
A generation ago, nearly every child had their tonsils removed. It was just part of childhood. But, in recent years, doctors have become more selective about removing this lymphatic tissue that lives inside your mouth.
Following, Dr. Scott Kay, a board-certified ear, nose and throat (ENT) specialist and founder of Princeton Otolaryngology Associates, answers common questions to help patients decide whether the tonsils and adenoids should stay — or go.
Tonsils, Dr. Kay explains, are similar to lymph nodes but are located in the back of the mouth, rather than inside the body. Adenoids are a patch of tissue that sits at the very back of the nasal passage.
While tonsils and adenoids are thought to help fight infection, Dr. Kay said they may have outlived their usefulness.
“They are supposedly the first line of defense in upper respiratory tract infections,’’ Dr. Kay explained. “But, in my opinion, I don’t think they serve a significant purpose, especially since they can get infected and make you sick.’’
What Are the Symptoms of Tonsil and Adenoid Difficulty?
“Tonsils have ridges and crypts (small pits), nooks and crannies, like an English muffin,’’ Dr. Kay explained. “They shed epithelial cells into these crypts and bacteria like to feed on those cells. If the bacteria are particularly bad, like strep, you can get recurring infections.’’
This condition is known as tonsillitis. In addition to recurring strep infections, symptoms may include swelling of the tonsils, a white or yellow coating on the tonsils, a slight change in the voice due to swelling, sore throat sometimes accompanied by ear pain, painful swallowing, swollen glands in the neck, fever and bad breath.
Ear infections, on the other hand, are typically caused by adenoids. Children are especially prone to ear infections caused by adenoids, which are positioned right behind the eustachian tube. When children are exposed to viruses they weren’t previously exposed to, the adenoids become chronically inflamed. That inflammation spreads to eustachian tubes, which block the ears from ventilating, allowing fluids to build up. Adenoids also can cause nasal obstruction
There are clear signs indicating a patient should consider a tonsillectomy, including more than six bouts of tonsillitis in one year or more than nine bouts in three years.
Despite all these risks, it has become less routine to remove tonsils and adenoids during childhood. That, Dr. Kay explained, stems from the fact that surgeons today are taking a more conservative approach to performing routine surgeries.
“If you’re doing operations without indications, the chances of complications are high,’’ Dr. Kay explained. “Generally, the trend has moved away from routinely removing tonsils and adenoids as it used to be.’’
That said, Dr. Kay frequently sees college-age patients who need tonsillectomies.
“College age is a big time for tonsil infections because of the high incidence of communicable disease in the dormitory setting,’’ Dr. Kay said.
The good news is that there are clear signs indicating a patient should consider a tonsillectomy, including more than six bouts of tonsillitis in one year or more than nine bouts in three years. Recurring strep infections are always an indication of tonsilitis, while recurring peritonsillar abscess, an infection between the tonsil and the pharynx, is a serious condition that can be life-threatening.
“This type of infection needs to be drained,’’ Dr. Kay explained. “If you have it more than one time, that would be an indication to have the tonsils removed.’’
Mononucleosis and obstructive sleep apnea may also be signals that the tonsils are causing problems.
“If a child is witnessed as having obviously trouble breathing at night, that child could be suffering from obstructive sleep apnea and should be evaluated,’’ Dr. Kay said.
The great news is that once tonsil or adenoid surgery is completed, nearly 100% of patients no longer experience recurring infections.
Dr. Kay’s Approach to Evaluating and Treating Tonsillitis
When Dr. Kay first sees a patient — child or adult — for recurring problems that may stem from the tonsils and adenoids, he takes a comprehensive medical history, including identifying the number of infections a patient has suffered and the patient’s sleep patterns. A thorough physical examination is conducted, in which Dr. Kay examine both the tonsils and adenoids.
Depending on the findings, he may recommend antibiotics or steroids. For serious, chronic conditions, surgery is typically the best treatment choice.
Tonsillectomies are performed under general anesthetic. In the vast majority of cases, both the tonsils and adenoids are removed. Once the surgery is complete, Dr. Kay typically injects the muscles with long-acting anesthetic so that the patient can go home to begin the recovery process without significant pain.
Typically, younger patients recover in five days or so. For patients older than 13 or 14, it can take 10 days for patients to be able to eat normally and they may experience pain for a few weeks, but the operation is just as safe for older patients as it is for children.
“A huge falsehood is that tonsillectomies are more dangerous for adults and that’s not true,’’ Dr. Kay said. “Recovery takes a little longer, but the procedure is not more dangerous.’’
While bleeding is the most common complication of tonsillectomies, it is extremely rare, with a tiny percentage of cases requiring a second visit to the operating room. Dehydration is a risk, since drinking can be uncomfortable after the operation. However, this can usually be managed with the appropriate pain medications.
“I have my patients taking Tylenol or Advil on a regular basis after surgery,’’ Dr. Kay said.
The great news is that once the surgery is completed, nearly 100% of patients no longer experience recurring infections.
“It is a great operation in the sense that it always takes care of the problems that the tonsils and the adenoids were causing,’’ Dr. Kay said. “So, if a patient is having these types of problems, there is a solution. The first step is to seek out the advice of an ENT.’’
For more information about the evaluation and treatment of tonsillitis and related conditions,
and other services provided by Princeton Otolaryngology Associates, or to make an appointment to see Dr. Kay at the practice’s Monroe or Plainsboro offices, call 609-445-4445 or visit drscottkay.com.
