NEWS

Is your child a candidate for a tonsillectomy?

Diana Rossetti

Remember when having a tonsillectomy was a childhood rite of passage?

But then, for a number of years, we didn’t hear much about tonsillectomies.

Now, pediatricians are talking more about tonsillectomies and the criteria that helps them decide whether a young patient should see an otolaryngologist, commonly known as an ENT, or ear, nose and throat specialist.

The tonsils are three masses of lymphoid tissue -- the lingual tonsil, the pharyngeal or adenoid tonsil and the palatine or fascial tonsil. Lymphoid tissue is part of the body's immune system that helps protect it from bacteria and other foreign entities.

“When I was in private practice, my rule of thumb was six or more strep infections in one calendar year,” said Dr. Michael McCabe, a pediatric hospitalist with Perinatal & Pediatric Services at Aultman Hospital.

“What happened eons ago was that strep throat could turn into rheumatic fever (which damages the heart and kidneys). So to prevent rheumatic fever, they got rid of the tonsils. They didn’t have good data, and it made sense at the time, but some of the kids were no better off after the surgery.”

Pediatrician Meena Rawal of The Pediatric Center concurred with McCabe’s criteria.

“Tonsils are good for the immune system, but when they get infected, you may get white pus. Sometimes you can get a cobblestone of allergies and postnasal drip, usually with odor, that affect them,” Rawal said. “Kids with large tonsils, they snore and that can be another reason to see the ENT. The young ones usually take about a week of recuperation (after a tonsillectomy). A lot of parents can push for it but we go with the indicators.”

SURGERY CAN HELP

When 5-year-old Erika Witter began to exhibit hearing problems, her mother, Linda Witter, a medical assistant, took her to otolaryngologist Charles Bogdan of Ohio Head & Neck Surgeons.

“She had fluid behind both eardrums. And he said, ‘See how she’s breathing with her mouth open?’ She also snored. He thought the best thing was to take her tonsils and adenoids out,” Witter said.

On June 20, Erika underwent the same-day surgery at Aultman Hospital, and her mother was amazed by her resiliency.

“She slept most of the time right after, but when she woke up, she wanted a ham sandwich. But I gave her Popsicles, and she just drank a lot of fluids. No ice cream because it causes phlegm,” her mother said. “All I had to give her was Advil. I was amazed how she sleeps way better and doesn’t snore. And she can hear. She used to turn the TV real loud, and when she talked on the phone, she kept saying, ‘Huh?’ That’s all gone now.”

Witter’s nephew, also 5, had his tonsils removed because they interfered with his breathing.

One of Witter’s colleagues, Jennifer Dillon of Bolivar, had a daughter with the same hearing problems.

“My husband, Shawn, last summer told me that Abbey would not hear him when he would call her to come in from playing. I told him she’s just being selective,” recalled Dillon, a registered nurse.

“When she went in for her 5-year-old appointment in September, she failed the hearing test in her right ear.”

Abbey was given an antibiotic first to determine if she had an ear infection. She failed a second test and was referred to Dr. Bogdan, who practices at Mercy Medical Center and Aultman Hospital and is on the teaching staff of University Hospitals in Cleveland.

“He took one look at her tonsils and adenoids and told me they were blocking off her hearing. He also noted dark circles under her eyes. And said she just wasn’t getting air through,” Dillon said.

All that changed after her surgery Dec. 28, Abbey’s mother said, and a follow-up hearing test was normal.

“Now this is a child who never had an ear infection, a sore throat or a strep throat,” Dillon said.

The 4 1/2-year-old daughter of Dr. Richard Cooper of Astute Medical Associates also achieved relief from airway obstruction through tonsillectomy.

“I look at it from a unique perspective because my brother is an ear, nose and throat surgeon,” Cooper said. “Today, we have better surgical techniques and better anesthesia across the board so I felt good going into it.”

THEY NEVER REALLY WENT AWAY

While Bogdan said tonsillectomies have never completely moved out of the mainstream of common surgeries, he pointed to additional reasons that youngsters have tonsils removed today. And, just as important, there is a good reason we have them.

“Tonsils tend to be underrated with regard to their importance in a patient’s physical exam,” he explained. “It is the only area where you can look at the lymph system, the back of the throat, where you can actually see. We take tonsils out for a large variety of reasons. By looking at the tonsils, you can make a diagnosis of recurrent infection or tonsils that obstruct. When you see kids in the 4 to 8 age group who start having ear problems, it is usually a sign that something is blocking the Eustachian tube connecting the ear to the nose. Adenoids sit up behind the nose. We normally take out adenoids with the tonsils unless there is a problem with the palate.”

Tonsils that are too large can pose a variety of problems, said McCabe.

“Tonsils and adenoids are a type of tissue that will grow in size almost faster than the face grows in size because the body needs them for protection. There is a growth curve, and tonsils have an early spike, but it levels off,” he explained. “If you have a child with lots of sinus and ear infections, sometimes they get in the way. If you have these big boulders in the back, you can’t swallow, taste is affected and nutrition is a big thing for kids. We already know that toddlers are not the most enthusiastic eaters. If it’s not fun to swallow anything, it may be hard to get that child off milk or pudding to eating textured food likes fruits and vegetables. And what’s more crucial, if you talk to any parent, than sleep?

“If your child snores worse than his grandfather, he actually could have obstructive sleep apnea. They could wake up irritable, they get run down and get sick more often. It is a vicious quality of life cycle.”

Every surgeon has a slightly different approach to tonsillectomies.

“There are 100 different ways to take tonsils out and they all hurt. To a certain extent, the variation could be in the amount of blood loss and minor changes in the amount of pain. Everybody asks about lasers but they also increase risk for a basic surgery,” Bogdan said, adding that he and his own three children have undergone tonsillectomies. “Tonsils tend to be underrated, also, for the risk involved (in surgery). Adults will ask, ‘Why do I need 10 to 14 days off work?’ It is uncomfortable and there tends to be a risk of a bleeding issue. And it is true that adults have a harder time with it than kids. But if it is necessary, there is a real difference once it’s over.”

Canton (Ohio) Repository

Reach Diana Rossetti at (330) 580-8322 or diana.rossetti@cantonrep.com.