When Does a Tonsillectomy Become Necessary for a 7-year-old?

Factual Questions
1

Knowing, of course, that SDMB is hardly a substitute for a doctor, you all have some wise thoughts.

Family doc and local ENT suggest tonsillectomy/adenoidectomy for my 7-year-old, who gets more than her share of ear/strep infections. Paranoid mother (mine, i.e. her grandmother) thinks that you should get six opinions before any surgery. I am, of course, ignorant.

Anyone have a good site or perhaps some personal experience on the pros and cons and indications for the procedure? Neither doc is saying it’s an immediate medical necessity so it’s just a question of the expected benefit from the procedure versus the likelihood of problems if you just tough it out.

Thanks in advance.

JohnW77707

2

God, are they still doing tonsillectomies?

FWIW, about 35 years ago two docs recommended mine come out. My mom refused.

My mom was right. I haven’t had strep throat in, oh, about 34 1/2 years.

But of course, YMMV.

3

I still have my tonsils. And I get strep throat and throat infections all the freakin’ time. My family doctor told me my tonsils act like a barrier and if I had them removed, I’d actually be worse off. The specialist said my tonsils are tortured and best removed.

So I’m interested in any input, too.

4

Here are two reputable opinions not too different from each other:

Generally recognized criteria for tonsillectomy due to repeated strep infections consists of four infections a year for three years, five a year for two years, or seven in one year.
http://www.findlayent.com/pediatrc.htm

or
MANAGEMENT OF SORE THROAT AND INDICATIONS FOR TONSILLECTOMY

Referral criteria for tonsillectomy:
The following are recommended as reasonable indications for consideration of tonsillectomy in both children and adults, based on the current level of knowledge, clinical observation in the field and the results of clinical audit. Patients should meet all of the following criteria:

sore throats are due to tonsillitis
five or more episodes of sore throat per year
symptoms for at least a year
the episodes of sore throat are disabling and prevent normal functioning.

Otolaryngological assessment
A six month period of watchful waiting is recommended prior to tonsillectomy to establish firmly the pattern of symptoms and allow the patient to consider fully the implications of operation.

Once a decision is made for tonsillectomy, this should be performed as soon as possible, to maximise the period of benefit before natural resolution of symptoms may occur.
http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=1067&sSearch_string=

It can still be a helpful procedure. And no, the tonsils are generally not saving a person from a worse infection. They can serve as a reservoir for the dreaded Strep type A infection, which can damage the heart and kidneys.

QtM, MD

5

First, I am not a doctor, just a mom. I’m relating my own experiences and not giving medical advice.

There was a time (in my youth, when dinosaurs ruled the earth) when doctors believed that tonsils somehow caused sore throats, since after tonsilectomies kids got fewer sore throats. Later, it was found that the rate of infections was the same in those who kept the tonsils and that the supposed cause and effect was a mirage.

From what I’ve heard, two of the valid situations when they should be removed are (1) if the tonsils themselves (not the throat or middle ear) have repeated infections, or (2) if they have become so enlarged that they impair breathing or swallowing. I have also heard of a very few cases where it was definitively determined that the tonsils were harboring a secret stash of strep germs that weren’t being killed off by antibiotics, and this was causing repeated strep throats.

Many children in the early school years get repeated sore throats and ear infections. If the throat culture shows strep, docs usually prescribe an antibiotic to prevent the strep from causing scarlet fever and/or heart valve infections. When my kids got earaches and if the doctor could see that there was an infection there, he generally prescribed antibiotics as well, since it’s kind of difficult to get a culture from behind the eardrum. Some of my co-workers now tell me that another procedure these days is inserting a tiny tube in the eardrum so that fluid drains instead of contributing to an infection.

My kids got tons of sore throats (a few of which turned out to be strep) and approximately a million ear infections. At least it seemed that way at the time. The number of both of these gradually decreased until by about 6th grade onward they rarely had any. Neither had a tonsillectomy and both are absolutely fine now. But that’s just my experience with a sample size of exactly two.

I would definitely suggest asking your doctors to explain exactly why they feel a tonsillectomy is warranted, and what they expect to happen if it isn’t done. If they can’t explain further than “it will keep her/him from getting sore throats,” I’d be suspicious. I would probably get a second opinion also before proceeding.

As far as possible problems, AFAIK complications from tonsillectomy are quite rare. I had mine out when I was a teenager, and they used a local anaesthetic since it is safer. I found the whole process horrible. The sore throat afterward is pretty nasty, too. But I didn’t have any medical complications. That’s another “ask the doctor” question, but I’d be surprised if the rate of complications wasn’t vanishingly tiny.

6

My experience: from when I was 4 to when I was 6 I was sick. all. winter. Brutal sore throats and ear aches. Oh, the ear aches. I don’t know how many nights I cried myself to sleep. And naturally I missed a lot of school when I got to be that age.

I was constantly on antibiotics, pretty much every variety that existed, it seemed like. Getting a teaspoon of vile pink liquid from the bottle refrigerator was a ritual every morning.

At first, my pediatrician told my mother that in this day and age (the Brave New World of the late 70’s / early 80’s) we do not perform tonsilectomies; we treat tonsilitis with antibiotics.

When I was six and, with the coming of the first snows, the sore throats and ear aches were back full force, he finally relented, and I had my tonsils and adenoids removed.

After that, i was healthy as a horse. I got the odd sore throat, naturally, but not the months-long suffering I experienced before. I have not had an ear ache since the tonsils were yoinked. If you get ear aches, or your are the parent of a child who gets them, I’m sure you can appreciate the gratitude I feel as I type that.

7

When I was younger I suffered from repeated sore throats, but at that time doctors were being advised not to do them unless absolutely necessary, so I continued to suffer. Then my problems cleared up, but I was left with two huge tonsils. Jump forward to age 25, when I get a horrible chronic bacterial infection in my tonsils that only clears on the most expensive antibiotics (and I had no health insurance), and recurs as soon as I stop taking them. I finally get the expensive surgery after months of agony, and believe me, the surgery for adults is a lot worse than for kids (as my doctor and nurses testified).

My advice: go ahead and get the tonsillectomy/adenoidectomy now…things can only get better! Your doctors know what they are talking about. I talked to several doctors and two ENTs before getting mine…they are seeing a lot of adults my age who should have gotten them out when they were younger, and the general opinion, I gather, is now swinging back to take them out when you are young if there is a consistent problem.

8

I’d rely on the post from Qadgop the Mercotan, noting the following:

the episodes of sore throat are disabling and prevent normal functioning

and his last sentence.

Coincidentally when I was a child I was at the point of having a tonsillectomy due to repeat infections. My mother and the doctor agreed that if I had another infection in the next few months they’d be lopped out. I never had another infection again. Basically the same thing happened with my eldest son, at the time we were contemplating surgery the problem just went away.

Good luck.

9

Before I was born, they used to do tonsilectomies at the drop of a hat. Then they decided they were doing too many, and when I was growing up the trend was to leave them in unless absolutely necessary to take them out. Now they’ve decided that that they went a little too far and probably weren’t taking out as many as maybe they should have. How old your doctor is, and when they were trained, may have a large influence on where they make their decision.

Personally, I suffered through sore throat after sore throat and my doc never seemed to make too much of it. Finally (at the age of 25), frustrated, I made an appointment on my own to an ear nose and throat specialist, who took one look at my tonsils and said “yep, these need to go.” Once they were out my sore throat problems went away.

My wife was very similar. She had hers out at about the age of 30 and had suffered for years with sore throats.

10

I wouldn’t get six opinions before a surgery, but I would suggest one more. I think that you should always get two opinions before surgery unless it is the emergency type. In this case I don’t think that the EMT’s opinion really counts. Can you get her to a pediatrician?

11

My 7-year-old daughter has had a run of strep infections this year, and so has my 4-year-old son. Among the four of us we’ve had about 17 cases since Christmas. Prior to that, strep was rare in our family, although my daughter had scarlet fever once at about 3 years old.

Our pediatrician recommends a tonsillectomy for both. He said that the crypts in the tonsils :confused: can harbor the bacteria even after successful antibiotic therapy. We have an appointment with an ENT (not until August, he’s a busy guy) to get his opinion.

There is also the possibility that one or both children are being exposed to carriers. At one point we thought our son was a carrier. He was treated slightly more aggressively. Then we all four got throat cultures on the same day and all four tested negative. Three weeks later my daughter had strep again.

I am personally extremely conservative about surgery; although tonsillectomies were once considered routine, surgery is surgery and difficult for both child and parent.

12

That would be ENT, an otolaryngologist (Ear, Nose and Throat). So that opinion would actually carry a lot of weight. We have a pediatric ENT; he “installed” tubes in my son’s ears a while back.

13

Ack!! I am stupid and can’t read.

Family doctor and ENT sounds like two good opinions to me.

14

More anecdotal evidence here.
When I was a kid, I got terrible, horrible tonsilitis on a regular basis. Everyone (including me) wanted to yank out my tonsils, but never got a chance since they were nearly always inflamed :smack:. Cut to the end - I grew out of it. Don’t remember having more than a couple of sore throats since I was about 8-ish. Personally, I don’t mess with any kind of surgery unless it’s necessasry, but if your child’s quality of life is damaged by this, then go for it. Either way, you should always get a second (or third) opinion before any surgery. Good luck!

15

This is only my personal experience, but if I had it to do over, I would have wanted them out as a child. I had them out when I was 23, and it was a horrible experience - from what I understand it is much easier to get them out as a child.

I agree, if it is affecting his life significantly, get them out. I am so much healthier and feel so much better now with them out. It is surgery, but then it’s over with. There is no need for him to keep on suffering if it is to that point. If it were my kid, I would go for it, knowing what I went through for years and them finally ended up getting them out anyway. Maybe he’ll grow out of it, but what if he doesn’t?

I agree not to rush into needless surgery, but I was on the other side of it (not getting necessary surgery), and to me that was worse. Go to an ear, nose, throat specialist and see what he/she says.

16

Sorry - I just saw the ENT clarification so you’ve already been to one. With that recommendation I would go for it.

17

I just searched Cecil’s columns and was astonished that he never addresses WHY we have tonsils! Why do we have those oft-infected lumps of flesh at all? What purpose do/did they serve?

18

By the way, don’t ever let your instincts be squelched by the string of letters after a person’s name. Not everyone applies their best professional knowledge consistently.

Of course, I am sure crappy doctors are the exception; my family has certainly been blessed with wonderful caring, compassionate doctors, who knew their stuff but also were willing to say when they weren’t sure.

On a single case, you can get varying opinions even from doctors with similar credientials. And they might both present equally valid treatment options! Get the opinions and educate yourelf, but don’t be afraid to let your own judgment enter into the final decision.

19

My doctor said the same thing about us kids and refused to take out anyones tonsils.

My childrens doctors said the same thing, no one in my family has their tonsils out.

He said there was a reason for tonsils, and that reason was not just to make a car payment for the doctor. He does not believe in any opeation unless it is needed.

P.S. We never get strep thoats or infections anymore.

I personally knew 8 men who have had/died of Hodgkins disease, and all of them had their tonsils out when they were young. They all died between the ages of 42-52. Now, everytime I hear of someone with Hodgekins disease, I ask if they ever had their tonsils out, in nearly every case, they did. There was a study linking Hodgekins disease and tonsils, but I dont have it anymore(this was before the internet)

20

In an era where tonsillectomies were routinely performed, it’s hardly f*cking surprising that people with another disease entirely had had tonsillectomies.