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All About Tonsils

by Sue Hubbard, M.D.

Over the span of my pediatric career, I literally have looked in thousands of throats and one thing that I do know: tonsils come in many shapes and sizes.  Scroll down and check out the photos I just took in my office.

Tonsillar tissue is considered a “secondary lymphoid organ” and is most active in children between the ages of 4–10 years.  As children go through puberty, the tonsils begin to shrink , as I like to say,” some things get bigger while tonsils get smaller” and by adulthood the tonsils are so small that they are often difficult to visualize.

The most common complaint about tonsils relates to sore throats and pain with swallowing.  While many parents say their child was diagnosed with “tonsillitis” that does not really tell you what caused the inflammation of the tonsils, in other words it is not a diagnosis.

Respiratory viruses are one of the most common causes of viral tonsillitis (and you know there are tons of those) with Group A strep being the most common cause of a bacterial tonsillitis.  Mononucleosis caused by Epstein Barr virus also causes a painful tonsillitis and is often seen in the teenage population (this is why mono is called the kissing disease), although mono is not exclusive to the teen age group.

Recurrent “tonsillitis” associated with painful sore throats and large tonsils is often the reason parents ask about tonsillectomy for their child. While tonsillectomy was “almost routine” 30-40 years ago, the recommendations for tonsillectomy have continued to change since the 1970’s.  Even so there are still over a half a million tonsillectomies performed each year in the U.S.  The newest guidelines published in January by the American Academy of Otolaryngology, provide updated recommendations as to when tonsillectomy might be recommended.

The new guidelines state that children should have at least seven episodes of throat infections in a year (both viral and/or bacterial) or at least five episodes each year for two years, or three episodes annually for three years before they are surgical candidates.

All of these infections should be documented by a physician and not just by parental report.  The expert physicians who worked to draw up the new guidelines stress that “children who have fewer episodes really aren’t going to see a lot of benefit” and these new recommendations help to minimize the risks (infection and bleeding) and pain of the procedure in children.

As with many things in medicine, things change, hopefully always to improve the outcome of the patient. These recommendations also included guidelines for tonsillectomy for sleep disordered breathing, more on that another day.

That’s your daily dose for today.  We’ll chat again tomorrow.



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