Children's Health

Tonsillectomy is a common surgery, but it is not done nearly as often as in the past. Tonsillitis that is caused by a virus usually goes away by itself. Most parents are able to treat their child’s tonsillitis with over-the-counter medicines and home treatments. But surgery may be the right choice for some children who get tonsillitis many times a year.

Think about the following when making your decision:

• Tonsillectomy may be no better than taking a wait-and-see approach for children who only have a few throat infections a year.
• Your child may benefit from surgery if he or she is missing a lot of school because of repeated throat infections or has trouble sleeping because of enlarged tonsils that may block his or her airway. Talk with your doctor about the possible benefits of surgery for your child as well as the costs and risks of the procedure.
• Tonsillectomy may reduce how often your child gets throat infections. But even without surgery, tonsillitis will probably occur less often as your child gets older.
• For some children, tonsillectomy can greatly improve quality of life. Enlarged tonsils can block your child's upper airway and cause snoring, a stuffy nose, and breathing problems. Surgery can help relieve these problems.
• Doctors don't all agree on how many throat infections in a year point toward the need for tonsillectomy. But a general guideline is 5 or more cases of tonsillitis in a single year or at least 3 to 4 cases a year for several years in a row. Any decision about surgery should be made with your doctor and based on your own child's health and well-being.

What is a tonsillectomy?

Tonsillectomy is surgery to remove the tonsils. It's a common surgery, especially in children, but it is not done nearly as often as it used to be. Tonsillectomy may reduce how often your child gets throat infections. But even without surgery, tonsillitis will probably occur less often as your child gets older.¹

Your child will get a general anesthetic and will be asleep during the surgery. Your child may go home on the day of the surgery, or he or she may stay in the hospital overnight. Tonsillectomy is usually performed by an otolaryngologist, a doctor who specializes in ear, nose, and throat problems.

Your child may have a lot of ear and throat pain for up to 2 weeks after surgery. A fever up to 102F is also common. Your child may also have bad breath for up to 2 weeks.

After surgery, your child will feel tired for several days and then slowly become more active. Your child should be able to go back to school or day care in 1 week and return to full activities in 2 weeks.

Who should have a tonsillectomy?

Doctors usually only advise surgery to remove tonsils when a child has repeated infections of the tonsils that are causing serious problems or are affecting a child's quality of life. Any decision about surgery should be made with your doctor and based on your child's health and well-being.

Tonsillitis caused by a virus usually goes away by itself. It will probably occur less often as your child gets older. Researchers in one study found that surgery is no better than taking a wait-and-see approach for children who get tonsillitis less than 3 times a year.² Your child may benefit from surgery if he or she is missing a lot of school because of repeated throat infections or has trouble sleeping because of enlarged tonsils.

Doctors don't all agree on how many throat infections in a year point toward the need for tonsillectomy. But a general guideline is 5 or more cases of tonsillitis in a single year, or at least 3 to 4 cases a year for several years in a row.

Some of the serious medical problems that may mean your child should have a tonsillectomy are:

• Tonsillitis that lasts longer than 3 months, even with medicine.
• Blocked air passages, which can lead to sleep apnea.
• Trouble swallowing.
• Tonsils that bleed heavily.

Talk with your doctor about the possible risks and benefits of surgery for your child as well as the costs and risks of the procedure.

What are the risks of tonsillectomy?

The risks include some bleeding after surgery. This is common, especially when the healed scab over the cut area falls off. Other risks are much less common. They include more serious bleeding and problems from the anesthesia during surgery. Death during surgery is very rare.

Very young children, under age 5, may get upset by being in a hospital.

What are the benefits?

For some children, surgery can greatly improve quality of life. Enlarged tonsils can block your child’s upper airway and cause snoring, a stuffy nose, and mouth breathing. Tonsillectomy can help relieve these problems.

Children who have a tonsillectomy because of repeated infections may have fewer and less severe infections for at least 2 years after the surgery. But over time, many children who do not have surgery also have fewer throat infections.

In some cases when a child keeps getting strep throat infections, especially if the infections cause other problems, surgery may be the best choice.

What else can you do to treat tonsillitis?

Watchful waiting is a wait-and-see approach to treating tonsillitis. If it seems that your child is getting fewer throat infections over time, he or she won't need surgery. If your child keeps having infections that are getting in the way of daily life, you and your doctor can decide what to do next.

There are a few things you can do to help your child feel better at home. Over-the-counter medicines (such as acetaminophen) and frozen treats such as Popsicles can help relieve a sore throat. Gargling with warm salt water every few hours can also relieve throat pain. Make sure your child gets plenty of rest.

If you need more information, see the topic Tonsillitis.

Your choices are:

• Schedule a tonsillectomy for your child.
• Treat tonsillitis with medicines and home treatment.

The decision whether to have your child have a tonsillectomy takes into account your personal feelings and the medical facts.

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about tonsillectomy for your child. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

*NA=Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to choose or not choose tonsillectomy.

Check the box below that represents your overall impression about your decision.

Citations

1. Paradise JL, et al. (2002). Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children. Pediatrics, 110(1): 7–15.

2. Van Staaij BK, et al. (2004). Effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy: Open, randomised control trial. BMJ, 329(7467): 651.