For children during the 1940s, 1950s, and 1960s, a tonsillectomy almost amounted to a rite of passage. Each year, nearly 1 million American children had their tonsils removed. The two oval-shaped masses of lymphatic tissue that sit on each side at the back of the throat serve as a first line of defense against bacterial or viral invaders. But when they repeatedly get infected, they can cause bedeviling sore throats and spiking fevers.
Today, about half as many tonsillectomies (530,000) are performed on children annually. NYU Langone Hospital—Brooklyn does about 60 cases each year. Surgeons are more conservative because of the potential risks of general anesthesia and postoperative bleeding. Some patients experience complications that require hospitalization or another surgical procedure. “We’re more conscientious about selecting patients,” explains Kim Baker, MD, who joined NYU Langone Hospital—Brooklyn in August as director of pediatric otolaryngology–head and neck surgery (ENT). “These procedures are not one for all and all for one.”
In deciding whether or not surgery is necessary, Dr. Baker considers the patient’s history. “A candidate for a tonsillectomy is someone with chronic disease,” she says, “such as a high number or frequency of infections, or symptoms of sleep-disordered breathing or obstructive sleep apnea. One or two uncomplicated infections a year is not enough to justify surgery.” Occasional bouts of tonsillitis, notes Dr. Baker, can be successfully treated with antibiotics.
Some clinicians advocate a partial tonsillectomy, leaving behind about 10 percent of the tissue to reduce the risk of bleeding, pain, and dehydration, and to speed up recovery. This technique is more commonly performed on children with sleep-disordered breathing or obstructive sleep apnea, but some practitioners use it for recurrent tonsillitis, as well. “The benefits,” says Dr. Baker, “must be weighed against the risk of leaving behind a small amount of tissue that can regrow and lead to recurrent symptoms.”
Even when a tonsillectomy is the best solution, it’s less traumatic than it used to be. Seth Kaplan, MD, recently appointed chief of otolaryngology–head and neck surgery at NYU Langone Hospital—Brooklyn to lead an expansion of services in this area, notes that modern surgical techniques, such as electrocauterization (controlled tissue burning) and coblation (radio-frequency tissue reduction), not only minimize pain, but reduce the odds that tonsils will grow back. Dr. Kaplan recommends that patients and their parents carefully weigh the benefits and risks after discussing them with their surgeon.