What are tonsils?

Tonsils are a body of lymphoid tissue located on either side at the back of the throat. Their main function is to act as filters to trap potentially harmful organisms. Since they play such an important role in the immune system of a child, careful consideration should always be given before having them surgically removed.

Why is surgical removal of tonsils so common?

From the 1930s through the 1960s, the surgical removal of tonsils (referred to as a tonsillectomy) was almost considered as routine, particularly among middle-class children. One of the reasons for this was because they were considered to be useless organs and were regarded by some elements of the medical profession as being sites of infection, rather than barriers against infection.

Ear, nose and throat (ENT) surgeons now rarely perform routine tonsillectomies on children who suffer from swollen tonsils. It is only after a recurrent pattern of problems - such as persistent and painful ear infections or recurrent bouts of acute tonsillitis - that surgery will be considered. In fact, tonsillectomies on children under the age of five are now very rare in Irish hospitals.

How do tonsils work?

Most people believe that enlarged tonsils are actually infected, but the ironic thing about tonsils is that they enlarge to keep the child well. During early childhood strong defences are needed against upper respiratory infections and it is at this stage in a child’s growth and development that the tonsils (and adenoids) enlarge to meet this challenge.

Most parents will notice that their child’s tonsils become very swollen during a bad cold, but by swelling up they are actually doing their job by preventing viruses penetrating further down the throat to the bronchi or even the lungs. Even though they are obviously swollen, the tonsils will rarely be sore and they should revert to their normal size when the flu-like symptoms subside.

What is tonsillitis?

Tonsillitis is the name given to the inflammation of the tonsils, which can be caused by a variety of viruses and bacteria. Tonsillitis is very often acute, with symptoms presenting themselves in a matter of hours. Apart from swollen and inflamed tonsils and a very raw, red throat, children with acute tonsillitis will often complain of flu-like aches and pains, fever and perhaps vomiting.

Is it infectious?

Tonsillitis is very infectious because the victim is actually breathing out germs with every breath. Therefore, it is worthwhile to keep other small children, and particularly babies, away from the infected child for the first couple of days, at least. A baby cannot actually catch tonsillitis but the germs which are around may set off another form of upper respiratory infection since the immune system of a small baby is very susceptible to infection.

What other infections can tonsillitis lead to?

One of the most common infections triggered off by acute tonsillitis is infection of the middle ear. If this infection is caused by the organism known as streptococcus it can lead to complications of the kidney or the heart and is potentially serious. These complications are very rare in modern times.

Sore throats are common in children. If a doctor confirms a bacterial tonsillitis, a course of antibiotics will usually be prescribed. Painkilling drugs, such as liquid paracetamol, should also be given regularly.

If a child suffers from persistent tonsillitis and resulting ear infections, a GP will usually make the decision to refer him to an ear, nose and throat surgeon for further consultation. It is the ENT surgeon who will make the final decision as to whether the tonsils should be surgically removed or not.

What are the guidelines for surgery?

While each case is treated on an individual basis, the general guidelines governing the surgical removal of tonsils are:

  • Five or more episodes of tonsillitis in one year, or
  • Three or more episodes of tonsillitis per year over a 2-year period, or
  • Tonsillitis that refuses to respond to antibiotics, or
  • Persistent and severe tonsillitis.
  • Development of an abscess around the tonsils (quinsy).

How is the operation performed?

A tonsillectomy is a relatively routine and simple surgical procedure, but it is somewhat unpleasant for the patient as there is almost always some visible bleeding from the raw wound in the throat and considerable soreness.

While tonsillectomies are rare among adults, they are often recommended for people who suffer from acute tonsillitis, ear infections and breathing difficulties. Children who suffer from problems related to their tonsils very often find that these problems recur in their teenage years, and this can lead to a recommendation that they have them surgically removed. Again, the success rate of the operation is very high.

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