Tonsillectomies Aren't Performed Primarily to Treat Throat Infections Anymore

Thirty years ago, about 90% of tonsillectomies in children were done for recurrent throat infection; now it is about 20% for infection and 80% for obstructive sleep apnea (OSA).

What is a tonsillectomy?

A tonsillectomy is a surgical procedure to remove the tonsils. Tonsils are two small glands located in the back of your throat. Tonsils house white blood cells to help you fight infection, but sometimes the tonsils themselves become infected.

location of the tonsils

Tonsillectomies have historically been performed primarily as a result of recurrent throat infections in children. A recent study published in the journal, Pediatrics, compared the outcomes in two groups of children who had suffered from at least three through infections in the previous one to three years. One group had tonsillectomies and the other did not. The data from the study showed that the number of sore throats or infections decreased in both groups. In the first twelve months there was a greater decrease in the number of sore throat days, clinician contact, diagnosed infections and school absences in the group that had tonsillectomies. However, the “quality of life was not markedly different between groups at any time point.”

The authors of the study discuss limitations in the methods available to categorize infection/sore through severity. They concluded that there is moderate evidence that the surgical procedure reduced short-term infections, but may not have any effect in reducing long-term infections, missed school or quality of life.

Today, tonsillectomies are performed for often to treat obstructive sleep apnea (OSA).

In the United States, the number of tonsillectomies has declined significantly since the 1970s, though it varies from region to region. Most tonsillectomies are performed once a child has a diagnosis of obstructive sleep apnea.

What causes obstructive sleep apnea in children?

It is estimated that 2-3% of children suffer from sleep apnea. Obstructive sleep apnea is the partial or complete closure of the airway during sleep that results in a reduction of airflow. The most common cause of childhood OSA is having overly large tonsils and adenoids (a soft mass of tissue located just behind the uvula) that block off the airway during sleep. Tonsillectomy cures sleep apnea in 80-90% of children.

How is sleep apnea different for children from adults?

For the most part, any snoring or gasping for air in a child indicates a health risk. In fact, while an adult with up to five apneas per hour is considered to be normal and would NOT have a diagnosis of sleep apnea, in children, as little as one apnea per hour is sufficient for a diagnosis of sleep apnea (read more about apneas and AHI here).

Unlike adults, surgical treatment for children with sleep apnea is almost always successful. But there are cases when surgery does not work and other treatment is needed. For some children, weight loss and/or CPAP therapy can treat sleep apnea (read more about CPAP for children here).