Today, we Parents Ask Expert Dr. Adam Friedman, an Ear, Nose, and Throat Specialist answers this commonly asked question:



Q: What is Tonsilitis and What Should We Do About it?

A: The tonsils are located in the back of the throat.  There is one tonsil on either side of the uvula, which is the thing that dangles down from the middle of the soft palate, and, often times, they are the source of infections in the throat.  When the tonsils become infected they typically swell to 2-3 times their normal size, become red, and exude thick, yellow mucus.  Symptoms of infection include fever, severe sore throat, pain with swallowing, muffled voice, and refusal by your child to eat or drink.  Additionally, you may note that the lymph nodes or “glands” in your child’s neck are enlarged and tender.  Tonsillitis is often viral but can also be caused by a number of bacteria, including “strep”, and frequently requires treatment with an antibiotic.

It is not unusual for children to have a few episodes of tonsillitis over the course of their lifetime and most pediatricians and family practice physicians are very good at diagnosing and treating this problem appropriately.  As an Otolaryngologist (E.N.T. specialist), however, I typically see children who have been referred to me for evaluation of chronic or recurrent tonsil problems.  Frequently, the child’s doctor has referred the patient to me because they believe a tonsillectomy (removal of the tonsils) is indicated.  In these cases, there are a few criteria based on the frequency and severity of the infections that we look at to determine if a tonsillectomy is, in fact, necessary.  If the child meets the following criteria, then we consider performing a tonsillectomy:

1.     7 infections in a single year

2.    5 infections per year for 2 years in a row

3.    3 infections per year for 3 years in a row

4.    Greater than 2 weeks per year of missed school or activity due to infections

5.    Chronic infections which never seem to resolve

6.    Complications from infections such as formation of an abscess, febrile seizures, difficulty swallowing, difficulty breathing, etc.

These criteria are not the absolute final word in the decision process but are useful to help guide families and their doctors.  It is important to look at these criteria in conjunction with the overall health of your child and then make a decision as to how to proceed. 

Tonsillectomy is one of the most commonly performed surgical procedures in the United States each year.  Tonsillectomies are performed under general anesthesia and most children go home the day of surgery.  The procedure is performed through the mouth and there are no cuts or bruises on the face.  Patients typically have a sore throat after surgery and your physician will probably elect to keep your child out of school for 1-2 weeks post-operatively. 

There are many common misconceptions that tonsillectomy is “risky” or that removal of the tonsils results in weakening of the immune system.  These beliefs are simply not true.  In fact, numerous studies have shown an improvement in the quality of life for both children and their parents following tonsillectomy.  Most doctors and parents of children who have suffered from chronic tonsil problems would agree that an appropriate tonsillectomy can be a life-changing procedure that can dramatically improve a child’s health and well-being.