My son, suffering from his tenth bout of strep throat at nine years old, lay feverish and dozing on the doctor’s exam table. I, on the other hand, was staring at my son’s pediatrician with a mix of shock and hope. Shock, because while my son is a rather frequent strep throat patient, he didn’t meet the long-standing criteria for a tonsillectomy. Hope, because as she spoke, a lot of things suddenly became clear. It was obvious that his tonsils do in fact need to come out.
Dr. Jack Paradise perhaps stated the “old” view of chronic strep throat the best, or at least the most famously, when he said “Seven or more in a year, five or more per year for two years, or three or more per year for three years.” These are the absolute indications for tonsillectomy.” Paradise, who was writing for the Interamerican Association of Pediatric Otorhinolaryngology in 1983, and this, for a long time, was the gold standard to describe recurrent strep throat. (His original article can be viewed here http://www.iapo.org.br/manuals/14-1.pdf). My son didn’t come close to meeting these qualifications; the most cases he’d had in a year were three, but that was only once. This year, with its milder winter, he’d only had the one.
But, as I listened to the pediatrician, and got the paperwork for the Ear-Nose-Throat (ENT) specialist referral, I began to put the pieces together. She informed me that there are lots of reasons, besides strep throat, for taking the tonsils out.
- Chronic streptococcus infections.
The most common reason for tonsillectomies is the recurring infection of the group A streptococcus bacterium. Strep throat is a relatively common illness in children and adults, and most cases of strep throat are minor. Strep throat presents with a sore throat, fever of over 100 degrees Fahrenheit, and characteristic white patches on the tonsils and back of the throat. Less common symptoms include nausea, vomiting, and abdominal pain. Treatment of strep throat is the antibiotics amoxicillin or penicillin. While most strep resolves within 10 days of antibiotic use, occasionally rare complications occur.
Complications of Strep throat:
Scarlet fever. Scarlet fever affects children under the age of ten. Its symptoms include a bright red tongue (often called “strawberry tongue” ), fever, sore throat, and rash. Scarlet fever was often fatal before antibiotics were available, since without treatment it can lead to more serious illnesses.
Acute rheumatic fever. Rheumatic fever causes joint pain and swelling, a rash, a high fever and inflammation of and damage to the heart. While more common in children, rheumatic fever can appear at any age after a strep infection. Rheumatic fever has a fatality rate of 5 five percent, making it one of the deadliest preventable childhood illnesses. Three percent of untreated strep infections will develop into rheumatic fever.
Streptococcal toxic shock syndrome, also called TSS. Often associated with tampon use, TSS can also be caused by an untreated strep infection. TSS causes a high fever, over 102 degrees Fahrenheit, sunburn-like rash, low blood pressure, confusion and depression, and ultimately coma and organ failure. Treatment of the disease includes hospitalization and intravenous antibiotic therapy. TSS can be fatal within hours, so some people can die before they seek help. If your child has any of these symptoms, please seek emergency medical help.
Glomerulonephritis, which is a serious kidney disease leading to renal failure, is caused by strep bacteria in the kidneys.
PANDAS syndrome, which stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections, is a theory that exists, linking strep infections to neurological disorders such obsessive-compulsive disorder (OCD) and Tourette’s Syndrome.
To read more about the complications of strep throat, visit the Mayo Clinic’s site at http://www.mayoclinic.com/health/strep-throat/DS00260/DSECTION=complications
2. Constant colds, earaches, and sore throats
Everyone feels miserable when the common cold strikes. But, for some people, it happens all the time. Throat illness is most commonly caused by bacteria, but viruses can also be at fault. Repeated common colds (caused by viruses) can also appear as earaches and sore throats. The job of the tonsils is to filter out bacteria and viruses, but sometimes the tonsils instead turn into reservoirs, where these agents breed.
3. Sleep disturbances and sleep apnea
Sleep apnea is a scary condition characterized by abnormal pauses in breathing during sleep, or nighttime periods of low or no breathing. Often sleep apnea will cause sleep disturbances, but a child doesn’t need to stop breathing to have disturbed sleep. Enlarged or infected tonsils will lead children to sleep with their mouths open, often preventing them from entering into deeper levels of sleep. These children snore, toss and turn, kick, cry out, and wake up often. This leads the children to poor academic focus and afternoon sleepiness at school, as well as general irritability.
4. Cryptic Tonsil
Cryptic Tonsil is a term used to describe the tiny pockets, or pits, often found on the tonsils. These pockets can be troublesome, as they often accumulate things such as food and debris in the throat. This also makes it more likely for the tonsils to become infected, and can cause bad breath and a chronic sore throat. There are other ways to treat cryptic tonsil, but the only sure way is to remove the tonsils.
5. Speech anomalies
Sometimes, seemingly out of nowhere, children will develop a funny way of talking, almost as if there is something in their mouth getting in the way of the words. This strange speech, often called “hot potato mouth” can be caused by a peritonsillar abscess, or a collection of pus beside or behind the tonsil. This abscess can grow quite large and quickly, pushing the tonsil into the middle of the throat, causing difficulty in opening the mouth. It can lead to the infection spreading deep into the neck and obstructing the airway. This condition is sometimes called quinsy and it can be fatal. In fact, George Washington is among people who were thought to have died of quinsy, though there is some argument about the actual cause of death. (to read more about George Washington’s death, see here: http://gwpapers.virginia.edu/articles/wallenborn.html)
6. Attention Deficit Hyperactivity Disorder
The sign that surprised me the most was when the pediatrician mentioned ADHD. The idea is a relatively new one, but many doctors are now looking into the link between large tonsils and ADHD. This could be due to a lack of sleep, Dr. Michael Light states. Children with breathing issues often have sleep issues, and lack of sleep can be a contributor to some children’s attention problems. While this is by no means proven, it is certainly something to take note of if your child has ADHD in addition to some of the other symptoms. To access the article explaining Dr. Light’s findings, see http://www.webmd.com/add-adhd/news/20060403/tonsil-surgery-helps-kids-adhd
The bottom line is, knowledge is your best friend. If you, your child, or someone you know suffers from any of these symptoms, see a doctor. To learn more about the tonsils in general, and the conditions that require a tonsillectomy, see the Mayo Clinic link at: http://www.mayoclinic.com/health/tonsillitis/DS00273
