Treating Tonsillitis in Kids
I am Dr. Mellema, I grew up in Willmar, Minnesota, lived there for most of my life and then ended up going away for college and training and did my residency out in Cincinnati, Ohio. Then moved back to the area and practiced there for 14 years and now I've been here in Brookings for the last few months doing ENT here.
What are tonsils?
Tonsils basically are part of the lymphatic system. The tonsils themselves, usually if they're functioning correctly don't pose a problem to most people, but the problem occurs with some people who have chronic infections where they just seem to pick up these recurrent strep tonsillitis episodes. And strep is really the one that's gonna be the most important because strep itself can cause other problems as far as inflammation of the heart valves and other things that can be much more detrimental to your overall health.
What is tonsillitis?
Tonsillitis typically is going to be actually inflammation of the tonsils by definition but usually that's gonna be manifested by kids who are...you know, usually they don't feel well. They usually have a sore throat, oftentimes they may have some pretty bad breath, fevers often over 102, and most of the kids will have some lymphadenopathy. Basically swelling of lymph nodes in the neck along with swelling of the tonsils themselves. And in those situations, oftentimes in step tonsillitis, they'll see pus or purulent exudate was what we like to call it, just basically a white, shaggy mucus across the tonsils. And usually the best way to actually know if it's strep or not is going to be a culture. A lot of doctors including myself are sometimes guilty of seeing it and feeling like we should just treat it but the recommendations are still that we should get a culture and find out, "Is this exactly strep or is this something different?"
So, people who are getting recurrent tonsillitis episodes, usually our academy recommends at least three infections a year for three years in a row, five or more two years in a row, or seven or more in one year. If you're in that category, then the thought is that this is probably enough of a problem that it's not gonna away, it's gonna keep causing you to miss work or school and may actually affect your overall health in other ways as well with your kidneys or your heart potentially, in rare circumstances. So, in those situations, its felt that it probably makes more sense to get rid of the tonsils and hopefully prevent further infections.
When is snoring a concern in children?
The actual most common reason we take out tonsils now is because they're too large in children and they're causing difficulty with sleep. A lot of kids that have heavy snoring that can be because the tonsils and adenoids are overly large. And if you remove the tonsils and adenoids in a normal sized child who has large tonsils and snores, about 80% of the time, the snoring will go away. So, it's very successful in kids. Unfortunately, it's not nearly successful in adults. Most of the adult's snoring is due to multiple levels, not just the tonsils and very rarely the adenoids because adult adenoids usually have kind of resorbed by that time.
For the most part, it could be something where if the parents have noticed some behavioral problems, they're very tired or hyperactive, they don't sleep well, very restless sleep, kind of weird positioning where the people very often will describe them hyper-extending their neck to try to get themselves comfortable at night. You know, a lot of these little clues come into play, and so most of the time it's based on the history of the family has noticed some pretty heavy snoring. So, in those cases, we don't usually require a sleep study. We would go more to...if the child has very large tonsils and the family is seeing problems, then we would consider tonsillectomy. Kids three and up is typically the safest time to do tonsillectomy. There's little increased risk of breathing troubles if you're under three, so kids who are less than three years old that we look at tonsillectomy for, we usually have to keep them in a hospital for observation.
When is a tonsillectomy recommended?
Tonsillectomy would usually be recommended if you're talking about children who have large tonsils, heavy snoring, and sleep disturbance would be, like I was mentioning before, the most common reason tonsillectomy. Because of recurrent infection and you're usually...the standard is gonna be three strep tonsillitis episodes a year for three years or more, five or more two years in a row, or seven or more in one year. There's also some people who will get an abscess of the tonsil and that's a little bit controversial about how many abscesses you need to look at before you consider tonsillectomy. Some would say after one it's reasonable to do it. Certainly after two you would often recommend tonsillectomy. And then those people who have tonsil stones or tonsil calculi that are bothersome enough to them to really adversely affect their quality of life, those people would also be potential candidates for it.
How is a tonsillectomy performed?
What we usually use here is going to be either the Coblator or the PEAK plasma knife. Both of those instruments are these advanced energy delivery systems. And the way they work is supposed to be creating an electrical current through sodium ions and by doing that, they create plasma. It effectively dissolves or melts the tissue and allows you to peel the tonsil out away from the muscle that it's embedded in without as much bleeding hopefully and not as much damage to the underlying tissue, which then usually means that the recovery is a little easier.
How long is the recovery following tonsillectomy?
Usually, by the end of a week to a week and a half in children, they're really completely back to normal. Adults, there's some lingering effects for several weeks where they kind of feel like things are tight or yawning feels weird, but as far as the overall pain, even adults almost always two weeks is the maximum that you'll see with it.
What results can a patient expect following a tonsillectomy?
So, after tonsillectomy, once everything is healed, it should be fairly unnoticeable from a healthy, normal feeling throat to post-tonsillectomy throat. However, in kids oftentimes, their voice will be a little different as far as pitch because there's more space in the throat. It's changing the resonance chamber size, and swallowing in smaller children oftentimes is actually improved. We do see some kids who almost have almost an oral aversion. They don't wanna swallow solids as much because the tonsils have been such a problem to get past. So, that should be improved.
Why do you recommend a tonsillectomy at Brookings Health System?
You're going to have the availability of the same technology that you'd get anywhere in a larger center but close to home with decreased pain and hopefully an easier recovery process, especially in a more familiar surrounding.