Dr Phil Kieran: Should my son get his tonsils taken out?
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Recurrent tonsillitis can be a real pain in the neck. The tonsils sit in the back of the throat and form part of a ring of immune tissue surrounding the upper openings of the oesophagus (food pipe) and trachea (windpipe).
These tissues have lots of crevices and folds to increase their surface area and can enlarge as needed. Unfortunately, these features can cause problems for some people. The crevices can create places where bacteria can hide, and the enlargement, when active, causes pain, difficulty eating or talking, and recurring illness.
Years ago, the bar for removing tonsils was much lower as they were seen to cause many problems and of little use to the body, but nowadays, doctors are slower to remove them.
Although tonsillectomy is relatively safe and routine, with surgery, there is a risk of complications. These include significant bleeding, which happens in about 3% of cases, and small risks associated with anaesthetic and pain post-surgery.
The frequency of significant infections gives critical medical information. As a rough rule of thumb, we would consider removing the tonsils if a patient gets more than seven infections in one year, five annually over two years or three annually over three years.
In your son’s case, there are two alternatives to be considered before going for surgery. Swabbing of the tonsils to check which strain of bacteria is responsible and what antibiotics it is sensitive to may show that a less commonly used treatment might settle everything down. If this doesn’t work, an ENT specialist may recommend a prolonged course of low-dose antibiotics for one to three months. Either of these drug treatments may help prevent recurring infections. Also, as we get older, particularly as we go through puberty, the rates of tonsillitis naturally drop, so he may find that he 'outgrows' his tonsillitis in the next year or two.
No doubt you already know what to look out for with tonsillitis, but differentiating viral tonsillitis, which shouldn’t be treated with antibiotics, from a bacterial one, which should, can be tricky. In general, if the child has a sore throat, red tonsils with white or cream spots on them, tenderness in their glands in the neck when you touch them, and no cough, it's probably bacterial tonsillitis
and warrants antibiotics. However, if a child develops a cough with tonsillitis, it is more likely to be a viral infection. In the case of a viral infection, giving them pain relief, ensuring they stay hydrated, and allowing them to rest are the best treatments.
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