To remove or shrink tonsils? What’s the best solution for my child?

My name is DR JC Hodge and I’m an ENT specialist from South Australia. I’m here to talk to you about tonsillar shrinkage or debulking or a tonsillotomy. The question you need to ask yourself as a parent, as a clinician, is “Why should I leave some tonsil behind? Why should I shrink tonsils?”

Well, there’s lots of reasons. The first is that it’s safer. So if you shrink tonsils, only 0.1 percent bleed over a two week period compared to a comparable group who have had their tonsils taken out, up to 3 to 5 percent. So that means if you’re a country patient, you don’t need to hang around Adelaide for one to two weeks. You can basically head home.

Secondly, it hurts much much less so two days of Panadol tops is all you need and that means, that once the pain settles, you go back to your usual activities. And for children it means back to school and less time-off work for parents. And no need to take drugs that thin the blood such as Nurofen or stronger painkillers with their side effects such as Tramadol and Endone which are often needed  for up to about ten days post tonsillectomy.

Thirdly, it works as well. So the data for snoring is that shrinking tonsils versus taking them out makes no difference. There’s also really good data coming out in the States and the UK now that tonsillar shrinkage is an effective tool for chronic, recurrent tonsillitis.

The other question is, “Do we need our tonsils?” and we used to, you know, I grew up training saying to parents that you don’t need your tonsils. What I should have said is that I don’t know whether you need two tonsils because there’s been a really good study here out of Melbourne, 1.2 million children followed for 30 years in Denmark and it showed that if you had your tonsils taken out as a child, there’s a threefold increase rate in respiratory issues as an adult. So it has an effect. There’s no doubt about that. So leaving behind a functioning normal tonsil tissue, especially in this times of a Covid pandemic, is probably a good thing.

Now, the bad. There’s always bad and the only really downside that I can think of in this technique is a regrowth rate of 2 percent which I only see below the age of four. I’ve never seen it above the age of  four. Now if that happens and if you have done it when you were a child, in which this happens, then you can still repeat the safest procedure.

And that’s what we do for adenoids and once it grows back, in two percent of cases, I just shrink them again. No one’s had their adenoids taken out. So I guess the question you should be asking yourself as a parent, as a clinician, is “Do I actually need to take this kid’s tonsils out?” Something to think about.

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