Tonsillectomies Aren't Performed Primarily to Treat Throat Infections Anymore
Date Published
Quick answer: adenotonsillectomy (surgical removal of both tonsils and adenoids) is the first-line treatment for obstructive sleep apnea in otherwise healthy children with enlarged lymphoid tissue. Per the American Academy of Pediatrics clinical practice guideline, the surgery resolves OSA in approximately 70-80 percent of these children. Success rates are lower in children with obesity (roughly 50-60 percent resolution), Down syndrome, craniofacial syndromes, or neuromuscular conditions, where residual OSA after surgery is more common and additional treatment may be needed. Pre-operative polysomnography is recommended for children with risk factors for residual disease, severe OSA, or anesthesia risk. Recovery typically takes 7-14 days. A follow-up sleep study 6-12 weeks post-op is recommended for high-risk children to confirm OSA has resolved. Surgery decisions should be made jointly by the pediatrician, ENT surgeon, and pediatric sleep specialist when appropriate.
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.
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).
Are you concerned that you or a loved one may suffer from a sleep disorder like sleep apnea? Request a sleep study or a consultation with a sleep specialist.
Sources:http://www.cnn.com/2017/01/17/health/tonsils-removed-surgery-children-study/index.htmlhttp://pediatrics.aappublications.org/content/early/2017/01/15/peds.2016-3490 http://www.healthline.com/health/tonsillectomy#Overview1 http://www.entnet.org/content/tonsillectomy-facts-us-ent-doctors
Other posts you may find interesting:
- Sleep Disorders Affecting Children; Does Your Child Need a Sleep Study?
- What Causes Sleep Apnea in Children?
- Why Do Kids Like Jahi McMath Need Surgery to Remove their Tonsils for Sleep Apnea?
- Sleepy Students Perform Worse in School
- How to Prepare Your Child for His Sleep Study.
- The Scoop on Sleep Apnea Surgery
Frequently asked questions
In otherwise healthy children with enlarged tonsils, adenotonsillectomy resolves OSA in roughly 70-80 percent of cases per AAP clinical practice guideline data. Success rates are lower (approximately 50-60 percent) in children with obesity, and lower still in children with Down syndrome or craniofacial conditions.
Surgery is recommended for children with documented obstructive sleep apnea (AHI typically 5 or higher on polysomnography) who have enlarged tonsils and adenoids and are otherwise good candidates for elective surgery. Severe cases or cases with anesthesia risk factors warrant pre-operative polysomnography and multidisciplinary planning.
Typical recovery is 7-14 days with pain management, soft diet, and adequate hydration. Pain peaks around days 3-5 then improves. Most children return to school within two weeks. Delayed bleeding between days 5-10 is the most serious complication and is rare but requires immediate medical attention.
A post-operative polysomnogram 6-12 weeks after surgery is recommended for children with risk factors for residual OSA: pre-operative severe disease, obesity, Down syndrome, craniofacial syndromes, or persistent symptoms after surgery. Otherwise healthy children with clear symptom resolution may not need repeat testing.
About 20-30 percent of children have residual OSA after adenotonsillectomy, particularly those with obesity or other risk factors. Treatment options for residual pediatric OSA include weight management, positional therapy, oral appliances, pediatric CPAP under specialist care, or further surgical evaluation.
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