More than 530,000 children under the age of 15 have their tonsils removed each year. About 80 percent have obstructive sleep problems – snoring, irregular breathing – and the rest are because of infection, according to The American Academy of Otolaryngology-Head and Neck Surgery.
If your child needs his or her tonsils removed, you might be worried about the procedure, the pain, and the recovery. Here, learn about the new way tonsillectomies are done, if it’s right for your child, and the important questions you need to be asking.
The new way tonsillectomies are done
There are several ways doctors remove tonsils, with one of the most common being the electrocautery method. Using a handheld metal probe heated by an electric current, the tonsil tissue is destroyed and bleeding is well controlled. Yet, because heat is used, the soft tissue of the throat is burned, which causes more pain and a longer recovery.
However, within the last 10 years, doctors have been using a less painful method known as PITA—Partial Intracapsular Tonsillectomy and Adenoidectomy. Using a microdebrider, the surgeon “shaves” the tonsils with a rotating blade and uses suction to stop the bleeding.
“The surgeon is removing the tonsils from what we call inside out – from the center of the throat to the side wall,” said Dr. Julie L. Wei, a pediatric otolaryngologist who practices at Nemours Children’s Hospital in Orlando, Fla.
So instead of removing all of the tonsils, about 90 percent are removed, leaving the capsule or outermost layer behind.
“There are lots of benefits to doing a partial,” said Dr. Didier L. Peron, an attending physician at Morristown Medical Center who is board-certified in otolaryngology-head and neck surgery.
For starters, the nerve endings are not exposed and there’s no damage to the arches of the throat. As a result, children experience less pain, a shorter recovery, and the chance of bleeding is reduced.
According to a study in the journal Otolaryngology-Head and Neck Surgery, kids who had tonsillectomies using the microdebrider method stopped taking pain medicine and returned to their normal activities sooner than those who had the electrocautery method.
Another study also found that kids were at less risk for bleeding and dehydration after surgery. Pain can cause children to refuse to eat or drink, and many are re-admitted to the hospital with severe dehydration, according to Peron.
Can tonsils grow back?
Not all children are good candidates for a partial tonsillectomy, particularly for those who have repeated infections like strep throat. If the tissue is left behind, “there’s a concern they can still get strep more, even though they’ve had their tonsils out,” Wei said.
And with any kind of surgery, there are risks, which include removing normal tissue like the uvula.
But perhaps one of the most significant drawbacks is regrowth. “There’s no doubt that occasionally the tonsils keep growing,” said Peron, who explained that the chances are more likely in young kids. He estimated a 10 percent chance that tonsils will grow back for 2- and 3-year-olds.
There’s one caveat to the question of re-growth, however. Often times, a pediatrician will look in a child’s mouth and see the tonsils but not the scar they’re used to seeing with the electrocautery method. They tell the family the tonsils are there, but “they never realized it was 10 times as big three years ago,” according to Wei. The family is lead to believe the tonsils grew back when actually, “it has to do with how it looks. Maybe there’s not that much regrowth at all,” she said.
The best thing to do is to return to the doctor who did the surgery for a proper evaluation. And even if they did grow back, if it’s not causing the child any problems, leave it alone.
Ask the right questions
If your child needs to have his or her tonsils out, be sure to ask the surgeon which technique her or she will be using and why. Also, find out if the bleeding rates are the same or lower than with traditional methods and what the doctor’s experience has been with re-growth.