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Your Child

Should More Kids Have Their Tonsils Removed?

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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

lives.

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.

Story source: Dennis Thompson, https://consumer.healthday.com/kids-health-information-23/tonsillitis-news-669/should-more-kids-have-their-tonsils-out-718738.html

Your Child

Tonsillectomy: Risky for Some Kids With Sleep Apnea

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A tonsillectomy is the primary treatment suggested for children with sleep apnea. For a majority of children, it works well to alleviate their sleeping problems. However, for some children that have a tonsillectomy to treat sleep apnea, they are more likely to suffer breathing complications afterwards according to a new study.

Researchers found that across 23 studies, about 9 percent of children undergoing a tonsillectomy developed breathing problems during or soon after the procedure. But the risk was nearly five times higher for kids with sleep apnea, versus other children.

While some children may be at a higher risk for breathing difficulties, the researchers said that parents shouldn’t be scared of the procedure for their child, but should be extra vigilant about watching their little one for symptoms of respiratory distress, particularly during the first 24 hours after the procedure.

"After they go home, parents should be attentive for breathing problems. That includes checking on your child while he or she is sleeping, at least for the first 24 hours," said Dr. David Gozal, chief of pediatrics at the University of Chicago.

"In most instances, nothing will happen," Gozal said. "But it's important for parents to be aware that tonsillectomy can have [complications], like any other surgical procedure."

The study also noted that physicians should be aware that children with sleep apnea have higher odds of respiratory complications, such as low oxygen levels in the blood, during and shortly after the procedure.

Anywhere from 1 percent to 5 percent of children have obstructive sleep apnea, a disorder in which tissues in the throat constrict during sleep, causing repeated pauses in breathing. Loud snoring is the most obvious symptom, but daytime sleepiness and attention problems are also red flags.

In children, sleep apnea often stems from chronic inflammation in the tonsils and adenoids, infection-fighting tissues in the back of the throat and nasal cavity. So surgery to remove the tissue is often recommended.

In the United States, about half a million children have a tonsillectomy each year, and sleep apnea is the most common reason why, Gozal said.

Because sleep apnea keeps children from sleeping well, they can become irritable and develop attention and behavior problems in school.

The procedure is often effective: Studies show that around 80 percent of kids see their symptoms go away or substantially improve.

The findings are based on 23 studies that looked at tonsillectomy complications. Overall, Gozal's team found, the most common issues included "respiratory compromise," bleeding, pain and nausea.

Four of the studies differentiated kids having surgery for sleep apnea from those having it for recurrent tonsil infections. Across those studies, children with sleep apnea were five times more likely to have respiratory complications.

On the other hand, they were at lower risk of bleeding -- for reasons that are unclear, Gozal said.

Gozal had another piece of advice for parents: "If tonsillectomy is being recommended to treat sleep apnea, make sure your child really has sleep apnea."

Loud snoring and daytime grogginess are symptoms, but the only definitive way to diagnose sleep apnea is through an overnight stay in a sleep lab, Gozal said.

Source: Amy Norton, http://www.webmd.com/children/news/20150921/tonsillectomy-for-sleep-apnea-carries-risks-for-some-kids-study

 

 

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