Deciding whether to remove tonsils looks different for a young child than for an adult. In this video, ENT surgeon Dr John Charles Hodge explains the indications for a tonsillectomy, the risks that shape the decision, and the less painful alternative for some children.
What is tonsillitis?
Tonsillitis is an infection and inflammation of the tonsils, the two pads of tissue at the back of the throat. When infections keep coming back, removing the tonsils (a tonsillectomy) may be recommended.
Key points from the video
- Pain and bleeding drive the decision. The main risks after a tonsillectomy are pain and bleeding. Both are lower in young children and increase with age, from around a 1% bleed rate in toddlers to around 10% in adults.
- Adults decide for themselves. For adults it is an informed, adult to adult conversation, and the threshold can be lower, for example after a severe episode or when other health problems such as heart or kidney issues are involved.
- Guidelines for children. As a rule, a tonsillectomy is considered for children who have seven episodes of tonsillitis in a year, five a year for two years, or three a year for three years.
- Full tonsillectomy for recurrent infection. An extracapsular tonsillectomy removes the whole tonsil and is usually the right choice for frequent, recurrent tonsillitis.
- Partial tonsillectomy for snoring. An intracapsular tonsillectomy shrinks large tonsils in children who snore. It hurts much less, the bleed rate is negligible, and it leaves functioning tonsil tissue behind.
Video transcript
Hi, my name is John Charles and I’m an ear, nose and throat doctor, and I’m here to talk to you today about tonsillitis and the indications for a tonsillectomy. They’re different between kids and adults.
If you look at the consent process for a tonsillectomy, you get the college guidelines. There are four pages, but basically it comes down to two things. The landscape is absolutely dominated by pain postoperatively, and also bleeding. The younger you are, the less pain you get and the less bleeding you get, and that increases, both from a pain point of view and a bleeding frequency point of view, as you become an adult. So from a 1% bleed rate as a two-year-old, all the way through to a 10% bleed rate as an adult.
The issue is obviously, as an adult, if you bleed you’ve got much more reserves to deal with that. Whereas when you’ve got a young child who’s maybe two and weighs 20 kilos, if they lose 500 mls of blood, that’s a really significant event.
So in adults, it’s an adult to adult conversation. It’s informed consent. You can have one bad episode a year, every year, and I’ll be very happy to take the tonsils out. You can have two episodes and end up in intensive care, and obviously that’s really significant. Or if you’ve got problems with your kidneys or your heart, then you can have your tonsils taken out.
As a child, we’ve got to make the decision for them. So as a rule, we talk about seven episodes of tonsillitis in a year, five episodes per year for two years, or three episodes per year for three years. As the child gets older and the impact on things like school gets more important, we can accept fewer episodes, and also that chronicity shows you that this is probably going to keep on going.
Now, that’s very much what we call an extracapsular tonsillectomy, so taking the whole tonsil out, which is probably what you should do if you’re getting recurrent, frequent tonsillitis. In other videos on my blog I’ll talk to you about an intracapsular tonsillectomy, which is an operation more for kids who’ve got snoring, so big tonsils, where you can shrink them down. The advantage is that it hurts much, much less, around two days of pain, so they’re back to school much quicker. The bleed rate is negligible. So it’s much, much safer, it works as well, and it leaves behind functioning tonsil tissue. Obviously that’s critical in children in particular, where the evidence is probably that you do need your tonsils. They still have a healthy function, whereas in adults that’s probably less critical.
Hopefully you found that helpful. Thank you.
Talk to Dr Hodge about tonsillitis
If you or your child are dealing with recurring tonsillitis and would like to discuss whether a tonsillectomy is right for you, book an appointment or get in touch with the rooms.
This information is general in nature and is not a substitute for personalised medical advice. Please speak with your GP or specialist about your individual situation.