The number of tonsillectomies performed on children in the U.S. is on the rise following a 30-year decline, say experts. When the number peaked at about 1.5 million tonsillectomies a year, the surgery was done largely to treat recurring throat infections such as strep throat. But studies led doctors to question its effectiveness.
Today, about 530,000 tonsillectomies are performed each year on children younger than 15, primarily to treat obstructive sleep apnea, according to the American Academy of Otolaryngology (AAO) [1]. And, once again, the treatment is sparking a debate.
Successful Treatment Option
“A growing body of evidence indicates that tonsillectomy is an effective treatment for sleep apnea,” says the AAO guidelines released in 2011, the first official recommendations on tonsillectomy published in the U.S. Many doctors agree.
“Enlarged tonsils and adenoids obstruct the airway when sleeping, and therefore are the most common cause of sleep-disordered breathing in children,” said Steven Fletcher, M.D. [2], an ear, nose and throat physician, affiliated with Baptist Health hospitals. “Worried parents can hear their children snoring, gasping and stopping breathing throughout the night.”
Because sleep apnea disturbs sleep patterns, the disorder often causes excessive daytime sleepiness, behavior problems, mood swings and concentration problems, explains Dr. Fletcher. As many as 1 to 3 percent of otherwise healthy preschool-age children have obstructive sleep apnea.
Dr. Fletcher and surgeons from around the country performing tonsillectomies and adenoidectomies to treat the disorder are experiencing excellent outcomes. Children who have had surgery showed significant improvements in their sleep, which in turn led to improved energy level, behavior and quality of life.
“During follow-up visits, children are healthy, happy and energetic,” said Dr. Fletcher. “And parents are relieved that their child is sleeping through the night. Many parents say they have a totally different child.”
Tragedy Raises Concerns
Experts concerned about the rising rate of tonsillectomies say there isn’t enough evidence to prove that the surgery should be the first choice of treatment for sleep apnea. Many point to a recent tragedy as a reminder that tonsillectomy is not a minor, trivial procedure but a serious surgery.
Jahi McMath, age 13, of Oakland, Calif., suffered sudden bleeding from her nose and mouth and cardiac arrest after having surgery to remove her tonsils to improve her sleep apnea. She is connected to a ventilator and has been declared brain-dead.
With this in mind, parents probably could use some help in deciding whether surgery is the best treatment option.
Tonsillectomy remains the most commonly performed surgery for children, and tonsillectomy-related deaths are very rare, say experts.
“A tonsillectomy is surgery performed under anesthesia and, as with any surgery, there are risks,” added Dr. Fletcher.
A national study published in Pediatrics [3] revealed the most common complication associated with the surgery is severe bleeding, which is experienced by about 3 percent of patients. This is followed by vomiting and dehydration at 2.2 percent, and pain and infection, affecting a little less than 1 percent.
In some cases of mild sleep apnea, changes in daily activities or habits might be an effective treatment strategy. Lifestyle changes, sleep modifications, allergy sprays and medications or a continuous positive airway pressure (CPAP) mask worn at night may restore regular breathing during sleep. However, many children have trouble tolerating CPAPs, says Dr. Fletcher.
Following additional guidelines from the AAO [4], physicians may refer young patients to pre-tonsillectomy sleep studies. Sleep studies are accurate tests for diagnosing sleep apnea and findings can be used to help identify the best treatment option. However, they may not be necessary in some cases of obstructive sleep apnea, says Dr. Fletcher.
“Severely enlarged tonsils and adenoids are a physical obstruction that clearly can be detected during a physical exam,” Dr. Fletcher said. “This is a condition that doesn’t improve.”
Children with sleep apnea become adults with sleep apnea. The disorder can be a lifetime problem that poses additional risks as people age. And young children, says Dr. Fletcher, tolerate the surgery much better than adults.