Dr Abdul Aleem Abdul Kadar, MBBS (Dow), FRCS (Ed) – Specialist ENT Surgeon at City Hospital, says: ‘You are right – we did used to take out tonsils for tonsillitis more frequently. But now with advances in antibiotics and better contact between GPs and patients, it’s no longer something that is done all the time.
The main reason we remove tonsils now is due to their enlargement, which usually happens alongside enlargement of the adenoids; the adenoids and tonsils are basically the same tissues at different locations.
Although there is no scientific study conclusively showing this, the climate in the UAE does seem to affect the size of a child’s tonsils and adenoids. They frequently outgrow the size of the space allotted to them and get too big. They can then cause the child to suffer from breathing difficulties at night, which results in persistent ‘mouth breathing’. Mouth breathing is not healthy – it bypasses the air optimization process in the nose. Children with enlarged tonsils or adenoids are often, symptomatically very slow eaters because they can only breathe through their mouth – when you are eating, that’s tricky.
Therefore, if enlargement is the main problem, and the child is not sleeping or eating properly, we do advise the removal of the tonsils/adenoids, because keeping them in place can potentially affect a child’s overall development.
‘If, however, infection rather than size is the main problem, we adopt a ‘watch and wait’ approach. Children usually start getting throat infections when they start nursery, as they are being exposed to lots of new germs. The infection rate tends to peak around the ages of four to six, and very often a child will grow out of having infections.
The criterion for a tonsillectomy is between four and six attacks each year, for two consecutive years. The medical history is very important: they have to earn surgery! If the child is missing a lot of school, and parents don’t want them to keep having courses of antibiotics, then they may make the choice to have the child’s tonsils removed. But there is no right or wrong answer in this case. The child could just as likely grow out of having infections in another year, and then the surgery would not be required anyway.
Sometimes, however, repeated infection in childhood can cause scarring of the tonsils. Scarred tonsils are smaller and non-functional and may need removal if they’re causing repeated infections. So, when it comes to a tonsillectomy, there are lots of variables and questions to ask.
‘The procedure itself is very simple, and takes a surgeon around 15 to 30 minutes to perform. We excise the tonsils, then seal off the blood vessels – the throat tends to be very raw afterwards. An overnight stay is definitely recommended because it’s important to observe the effects of surgery and a general anaesthetic on a young child for at least 24 hours after such a procedure. I don’t agree with the practice of carrying out tonsillectomies at a day clinic – especially for young children.
Post-operative recovery usually takes between six to 10 days. Adequate hydration and ample calorific intake is vital for speedy recovery, and a child can generally return to school a week after surgery. We do, however, advise parents against taking their children to crowded places like malls during that period of time, as the throat is still sensitive and should not be exposed to infection.’