Insights to Pediatric Tonsillectomies

What are tonsils, anyway?

Let’s begin with a short anatomy and physiology review of the tonsils, and for the sake of being inclusive, let’s discuss the adenoids as well. Tonsils and adenoids are a part of the immune system and the body’s first line of defense. Our tonsils are the two round lumps found in the back of the throat, and our adenoids are located higher up in the throat behind the nose and roof of the mouth. The role of these glands is to sample bacteria and viruses that enter through our mouth and nose and to provide a first line of defense against the external world.

Swollen and enlarged tonsils is a very normal symptom for children to experience from time to time, and typically indicates the immune system is on heightened awareness to protect and clear an infection in the upper respiratory tract. In normal functioning tonsils this enlargement and swelling is transient, with their size decreasing after the body clears the insult it has encountered. Unlike adults a child’s immune system is immature and constantly learning, making it normal for children to have more upper respiratory infections relative to adults. That said, chronically enlarged and habitually infected tonsils can be a sign of underlying dysfunction and can pose secondary health concerns for parents.

When are tonsils problematic?

Chronically enlarged and swollen tonsils can pose secondary health concerns and symptoms such as snoring, frequent waking at night, or difficulty swallowing. In extreme cases tonsils may be large enough to cause obstructive sleep apnea (OSA) when a child is lying down. If your child suffers from any of these symptoms it’s important to have a health care practitioner assess them in the case of more serious pathology.

Uncertain if your child might be suffering from enlarged tonsils? Here are some common symptoms to look for:

  • Mouth breathing

  • Noisy breathing

  • Snoring or snorting at night

  • Restlessness during sleep and/or pausing in breathing for a few seconds at night (possible sleep apnea)

  • Difficulty eating or swallowing, and reduced appetite

  • Chronic runny nose

  • Recurrent ear infections

  • Changes in the ability to talk, loss of voice

Conventional management of enlarged tonsils is limited, with typical recommendations residing at opposite end of the spectrum: watch-and-wait or surgical removal. Tonsillectomies (and tonsilloadenoidectomies, or T&A for short) are one of the most common surgeries performed on children1, however, the number performed has dropped significantly over the past few decades due to the possibility of acute complications from surgery. Approximately one in five children who undergo a tonsillectomy experience a complication such as difficulty breathing or prolonged bleeding1.

Additionally, studies have shown long-term health complications as an outcome from childhood removal of tonsils and adenoids. A study published in 2018 by the Journal of the American Medical Association looked at long-term implications of removing tonsils in childhood. More than one million individuals in Denmark who had tonsils and/or adenoids removed between 1979 and 1999 were followed up to age 30. Results revealed a 2- to 3-fold increase in diseases of the upper respiratory tract, a 17% increase in the risk of general infectious disease, and an overall increase in allergies2.

Taking this study into account, it seems reasonable to follow a watch-and-wait approach. But if you are a parent of a child who suffers from any of the previously mentioned secondary concerns you know firsthand how hard it is to sit back and watch your child experience any level of discomfort. To all of you parents, you’ll be happy to know there is a lot you can do to help improve your child’s sympomts.

Naturopathic management of chronically enlarged tonsils:

Every child has a unique set of circumstances contributing to their state of health including birth history, previous illnesses, diet, environmental exposures, sleep, hydration, genetics, and so much more. Each of these elements needs to be taken into consideration when searching for underlying causes of why a child has chronically enlarged and/or infected tonsils. However, one item we can safely assume these individuals have in common is inflammation. Put simply, inflammation is an immune response and the body’s attempt to protect itself. In the case of chronicinflammation, one or multiple persistent immune challenges may exist. Identifying and removing these insults often can provide significant resolution in symptoms.

Investigation of immune challenges includes looking at both dietary and environmental exposures. Common dietary culprits include dairy and refined sugars, but in some individuals the removal of only these two food sources may not be enough. Looking at an IgG/IgA food sensitivity panel is helpful in these cases as it can target specific foods contributing to an individual’s chronic immune response. Similarly, investigating and removing specific environmental insults such as mold, dust mites, and animal dander can provide significant improvement. Using a HEPA filter in the child’s bedroom and home can be useful to help remove these environmental irritants.

General immune and upper respiratory support through diet and supplements is also necessary. In addition to limiting inflammatory foods it’s important to consume a whole-foods diet rich in vitamins, minerals, antioxidants, protein, and healthy fats. Supplementation with items such as larch arabinogalactans, elderberry, vitamin C, zinc, probiotics, and various homeopathic remedies help support normal immune function and decrease inflammation.

** The above information is for informational and educational purposes only, and is not intended as a substitute for medical professional help, advice, diagnosis, or treatment. If you have concerns about your child’s health, please consult with your doctor for proper assessment and treatment.

RESOURCES:

  1. C McCarthy. Harvard Health Publishing, Harvard Medical School. March 20, 2018. Does your child need a tonsillectomy?

  2. S. Byars, S Stearns, J Boomsma. Association of Long-Term Rick of Respiratory, Allergic, and Infectious Disease With Removal of Adenoids and Tonsils in Childhood. JAMA Otolaryngol Head Neck Surg.July 2018; 144(7):594-603.

  3. https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2683621)

  4. American Academy of Otolaryngology; 2018. Tonsils and Adenoids, Patient Health Information; https://www.entnet.org/content/tonsils-and-adenoids.

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