Two new medical reviews suggest that more kids could benefit from having their tonsils removed if tonsillectomy guidelines were less stringent.
Currently, surgery qualifications require that a child must have many recurring throat infections within a short span of time or severe sleep disturbances, said Dr. Sivakumar Chinnadurai, a co-author of the reviews.
An evaluation of current medical evidence suggests more kids would receive significant short-term improvement in their daily life if the guidelines were relaxed, said Chinnadurai, a pediatric otolaryngologist with Vanderbilt University Medical Center in Nashville.
Chinnadural and his team found that children, who underwent a tonsillectomy even when they did not meet the guidelines, experienced nearly half as many sore throats. They also missed fewer days of school and were less likely to need extra medical care.
The benefits seemed to apply only to the first couple of years following surgery. By the third year, there was no clear benefit in terms of the number of sore throats, said Chinnadural. The benefits after the first couple of years following surgery, however, were impressive.
"The decision about whether those children should have tonsillectomy for that temporary benefit is really tied to what those children need or what they're suffering with," Chinnadurai said. Kids who miss a lot of school or need frequent trips to the doctor due to sore throats could benefit from the surgery, he said.
There's an even clearer benefit for kids whose sleep is disturbed due to inflamed tonsils, Chinnadurai said.
"In a child with a diagnosis of sleep apnea, we can see a benefit in sleep-related quality of life," he said. The kids get better sleep, and thus exhibit better everyday behavior and pay more attention in school.
Better sleep in children with sleep apnea can improve many aspects of their daily
Guidelines say a tonsillectomy to treat throat infections is justified if a child had seven or more sore throats during the previous year; five or more sore throats two years running, or three or more sore throats for three years in a row, according to the background notes.
The researchers decided to review whether the throat infection guidelines are too stringent, ruling out patients who potentially could benefit but don't meet the high threshold of recurring infections, Chinnadurai said.
There aren't strong guidelines regarding the use of tonsillectomy to treat sleep disorders, so the doctors reviewed the evidence to see whether the surgery outperformed so-called watchful waiting -- monitoring the situation.
The study results showed "there may be new evidence that supports expanding the criteria and opening up the procedure to more individuals," said Dr. Alyssa Hackett, an otolaryngologist with the Icahn School of Medicine at Mount Sinai in New York City.
"In the right child with the right indications, these are really wonderful procedures that can be life-changing for both the child and the family," said Hackett, who wasn't involved with the new research.
Although the findings were positive, Chinnadural and Hackett both warned against automatically choosing a tonsillectomy when a child has a sore throat.
"Though a tonsillectomy is low-risk, it is not risk-free, and those risks need to be weighed against the benefits for each individual child," Chinnadurai said.
"We're talking about a child who has significant sleep-related issues," Hackett said. "We don't want people to say my child snores, they need to have their tonsils out. That's not what this study says at all."
Parents should discuss the risks and benefits of a tonsillectomy with their pediatrician if they are concerned about the amount of sore throats their child has, or if sleep apnea is diagnosed.
The two reports were published online in the journal Pediatrics.