Overgrown tonsils – cut or not?

Proven content

Tonsillectomy, i.e. removal of the palatine tonsils, is one of the most frequently performed ENT procedures. In children who often suffer from strep throat, it can bring significant improvement. Nevertheless, there are still doubts as to whether the tonsils, which are part of the immune system, should be removed in the youngest patients, whose immunity is still maturing. How is it really? Should overgrown tonsils be cut?

Overgrown problem

Bożena would answer this question without hesitation: yes. He knows almost everything about overgrown tonsils, especially the angina that preceded them. Her son suffered from them regularly from the age of 6 months. A month, not a year, although doctors said it was impossible, because purulent angina is very rare in infants.

– 41 ° C fever, diarrhea, vomiting, constant crying – this was the scenario I had every three weeks until my son was 9 years old. The organism – still on antibiotics – devastated, immunity – zero – lists Bożena, the author of the blog Mama Trójki.

When the little one was 1,5 years old, he was hospitalized with dehydration caused by persistent ailments, invariably accompanying angina. For doctors it was “just” another complication of a bacterial infection, no one was interested in the problem of a child tired with diseases. This state of affairs lasted until Bożena’s son entered the second year of primary school. Although he “started” it was too big a word – the angina, repeated as clockwork every three weeks, and the weakness caused by it, effectively prevented me from attending lessons. It was then that the boy once again found himself with a high fever on the night shift.

– The doctor said my son had almonds to be cut. He asked if he was often sick. His surprise that no one had proposed this procedure before was enormous. The son’s almonds were so overgrown that in their natural state, without infection, the throat hole was the size of a 10-cent coin, when purulent angina came, this opening became much smaller – recalls Bożena.

When the diagnosis was confirmed by another doctor, recommending quick action for fear of the risk of otitis media, Bożena started a fight to keep her son healthy for nearly two months, which we had to wait for the procedure. Managed to. The laser surgery to remove the tonsils went without complications, the boy vomited a little after anesthesia, but he bravely endured the procedure and convalescence.

Effect?

– Nine years have passed, my son was ill maybe twice. It is a pity that he was diagnosed so late, it would spare us so many unnecessary diseases – says Bożena.

Useful and … trouble

The tonsils – small organs made of lymphoid tissue located on both sides of the throat (between the back of the tongue and the tab of the tongue) – are called the first barrier against microbes. All this thanks to the antibodies produced in them, necessary for the proper development and functioning of the immune system. They spend their “five minutes” in the first years of a child’s life, when the insufficiently developed immunity is not yet able to cope with recurrent respiratory infections.

When talking about tonsillectomy, we usually mean the removal of the palatine tonsils (tonsillectomy), which should be distinguished from the so-called excision. the third adenoid (adenoidectomy), i.e. the pharyngeal tonsil, which grows larger in childhood and disappears in most cases completely in adulthood.

Both types of tonsils can become dangerously overgrown. Under normal conditions, this phenomenon is harmless (in children, the tonsils grow physiologically in the first months of life), but sometimes the overgrowth is so large that it causes bothersome symptoms and ailments, and can also lead to serious complications.

– Increased incidence of infections of the upper and lower respiratory tract, abnormal craniofacial development – malocclusion, adenoid face (gawk), nasal septum deviation, paranasal sinus development disorders, greater tendency to asthma, night apnea, ear complications, with chronic otitis media at the forefront, which may lead to hearing loss – lists Dr. Piotr Wójtowicz, MD, PhD, from the Department of Otolaryngology, Department of Dentistry, University of Warsaw.

It was the latter problem that nearly 4,5-year-old Hania encountered at the pediatric otolaryngology ward. The doctor recommended the removal of the overgrown adenoid after ear infection, snoring and hearing impairment twice within two months. The treatment ended – as in the case of Bożena’s son – with complete success.

– For about eight months before the tonsillectomy, it was terrible – at least once a month there was an antibiotic and most of the time she stayed at home – admits Anna, Hania’s mother. – Since the surgery, my daughter has never had an antibiotic, maybe two colds and nothing else – she adds.

Delete or not?

Since tonsillectomy gives such spectacular results, why are there doubts about the legitimacy of the procedure even among doctors?

– In the case of pharyngeal adenoids, general practitioners who do not know all the consequences of leaving the third tonsil are usually opposed to the procedure. The truth is also that hospitals are terribly obstructive and so that parents do not fuss about waiting too long for the procedure, they are told what they would like to hear: that surgery is not necessary yet, etc. – explains Dr. med. Krzysztof Jach, otolaryngologist, head and neck surgeon.

“First of all, you have to separate the problem of the pharyngeal and the palatine tonsils,” notes the drug. med. Dorota Kotowska. – I very rarely excise the palatine tonsils in children – only in the case of recurrent angina, possibly peritonsillar abscesses or general complications. I approach the issue of tonsillectomy very individually. In addition to the size of the tonsil, the age of the child is important, as well as its general condition, how often it is ill, etc. When qualifying for the procedure, I always take into account the parents’ opinion. The only time I strongly recommend that you have the pharyngeal resection is the pressure on the Eustachian tube and the accumulation of fluid in the middle ear, which is otitis exudate. This could lead to problems with the middle ear and hearing in the future, she adds.

In the opinion of Dr. med. Elżbieta Oziębło, otolaryngologist, when choosing a method of proceeding, one should always take into account all clinical aspects, intensity and duration of ailments.

– Surgical treatment allows you to achieve good, and sometimes the best results. Children with pharyngeal lymphatic hypertrophy should be surgically treated. By performing adenoidectomy and tonsillotomy, the obstruction to swallowing and breathing is removed. Unblocking the nasopharynx unblocks the Eustachian tube. Middle ear ventilation is restored, the tympanic cavity is drained, hearing is improved and proper speech development is possible. Sleep and CNS control are improved, which results in the end of bedwetting, she explains.

– The cases that cannot be treated conservatively must be treated surgically, eg if we treat the obstructed nasopharynx with stimulus drugs, “rinsing” etc., such a child must be qualified for surgery. Time passes quickly in a child and the developing tendency to serious complications must not be tolerated. I am in favor of surgical treatment, whenever there are indications – adds Piotr Wójtowicz, MD, PhD.

Tonsil removal procedure – the most important information

The procedure for removing or reducing the overgrown tonsils is performed under general anesthesia. The child’s stay in the hospital usually lasts three days: on the first day, the necessary examinations are performed, and on the second day, the procedure is performed, after which the little patient is monitored. If there are no complications, the child goes home on the third day. Parents must be aware, however, that complications may occur after the procedure. Postoperative bleeding is the most common, sometimes there is a subglottic edema associated with intubation.

Convalescence lasts from several to several days. During this time, the child may complain of a sore throat, sometimes in the first days after the procedure, there are also low-grade fever and weakness. Recommended diet – liquid, semi-liquid, mushy, rather cool, without spicy and sour spices.

The tonsillectomy procedure is reimbursed, however, waiting for a child to be admitted to the ward lasts from several to several months. In one of the hospitals in Krakow, the first available dates are only for the first quarter of 2017, except for urgent cases considered by the medical commission on an ongoing basis. In private medical facilities, the cost of tonsillectomy surgery ranges from PLN 1800 for tonsillectomy to even PLN 3000 for tonsillectomy.