When do kids need a tonsillectomy?

“Does she need to get those out?” the mother wanted to know. Her 13-year-old had just finished a course of antibiotics for strep throat and within days was back in with another sore throat. The girl gamely put up with her second throat swab in as many weeks. This quick strep result was negative, so it appeared that her initial bacterial infection had cleared and she was now experiencing a new viral illness.

Before answering the mom's question about the need for surgery, I looked back in the chart to review my patient's medical history. The girl had always had moderately enlarged tonsils but was actually a pretty healthy kid, experiencing at most one or two mild throat infections each year.

I asked a few additional screening questions and mom reported that her daughter slept soundly without snoring, restlessness or any long breathing pauses or episodes of apnea. Despite her current uncomfortable throat infection, I observed that the teen also had absolutely no trouble breathing with her mouth closed. Armed with all that information, it certainly seemed like the young lady had no need to part with her tonsils. I reassured the mother and sent the duo on their way with advice about rest and fluids and wishes for a speedy recovery.

According to data from the American Academy of Otolaryngology-Head and Neck Surgery, there has been a significant and continuing decrease in the number of tonsillectomies done in the U.S. since the 1970s. The reason for performing this surgical procedure has also shifted. Several decades ago, 90 percent of children undergoing tonsillectomies did so because of recurrent throat infections, while currently 80 percent of pediatric tonsillectomies are done for obstructive sleep disorders and only 20 percent because of history of infection.

This year, the AAO-HNS published “Clinical Practice Guideline: Tonsillectomy in Children,” authored by a panel of experts including prominent otolaryngologists and pediatric infectious disease specialists. The group notes that tonsillectomy is the second most common outpatient surgical procedure — ear tube placement is No. 1 — with tonsillectomy performed annually on more than 530,000 American children younger than 15.

The AAO panel finds that while evidence appears to support tonsillectomy as an effective treatment for sleep-disordered breathing, controversy still remains regarding surgery versus observation and medical treatment of throat infections.

The guideline authors recommend “watchful waiting” in children who have had fewer than seven throat infections in the past year, or fewer than five episodes per year in the past two years, or fewer than three episodes per year in the past three years.

While making these recommendations, the otolaryngology group recognizes that each patient needs to be treated as an individual and that “guidelines are never intended to supersede professional judgment.” When a child experiences frequent throat infections, but does not meet the above criteria, a tonsillectomy might still be considered if other factors are present such as allergy or intolerance to multiple antibiotics, or episodes of serious peritonsillar abscesses.

• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.