A once ubiquitous operation is still the right choice for some children

Worried because her toddler was a snorer and a mouth-breather, a New Jersey mom visited an otolaryngologist—an ear, nose and throat specialist. “His tonsils are enormous!” the specialist said. The youngster became one of about 500,000children each year in the U.S. who undergo tonsillectomy—an operation to remove the tonsils. It was done almost routinely in the era before effective antibiotics. “But today we’re much more selective about who benefits from the procedure,” says Michael A.Tavill, M.D., an otolaryngologist and head of pediatric ear, nose and throat surgery at Monmouth Medical Center, who does about 500 tonsillectomies a year. The tonsils are masses of lymph-type tissue onboth sides of the back of the throat. The adenoids, which are often removed along with tonsils, are similar masses behind the nose. Both are now believed to play an infection-fighting role. But when they become infected and enlarged themselves, they can cause fever, sore throat, painful swallowing and sleep problems. If this happens to your child a lot, it may be time to consider surgery. These days, Dr.Tavill explains, tonsillectomy is done on an outpatient basis. The operation takes about half an hour, and the child is in the surgery unit as little as two hours before and two hours after. A week of recuperation follows, with pain medication.“ And the old theory of sticking with soft foods or clear liquids for a week or two is out the window,” says Dr. Tavill.

Sore throats became such a sorry routine for Troy Baldwin of Little Silver, now 8, that his pediatrician greeted each call with, “Oh no, Troy, not again!” Then, two years ago, the boy’s tonsils were removed by Monmouth Medical Center’s Michael A. Tavill, M.D. (right).The operation’s side effect? Literary inspiration. With a little help from his mom, Diane, Troy wrote My Tonsil Story, a step-by-step account of his experience, complete with pictures. Conceived as a way to tell his friends what he’d been through, the narrative features several moments of high drama (semi-awake on anesthesia after the operation, Troy yells, “I can’t deal with this. I want my tonsils back!”). But mostly it recounts the experience in simple terms perfect for helping other young tonsillectomy patients understand what they face. That’s why Dr. Tavill is looking for a pharmaceutical sponsor to help publish the book in an interactive form that would allow young readers to follow Troy’s story and also record their own. “We know that kids recover faster when they understand what they’re going through,” says Dr. Tavill. “Troy’s done a great piece of work—something that I think helped him a lot, and that will help many other kids too.” And the verdict on the operation itself? “It absolutely gave him back his life,” says Diane. Apparently that is now enough; Troy reports that he no longer wants his tonsils back.

Time for a Tonsillectomy

Your pediatrician can help you decide if your child’s symptoms warrant investigating the surgical removal of tonsils and adenoids. Signs that the procedures might be needed, says otolaryngologist Michael A. Tavill, M.D., include: recurrent bouts of tonsillitis or strep throat that causes throat soreness and sometimes fever, rash, ear pain and/or decreased energy and appetite which, even with antibiotics, interfere with school and other regular activities• obstructive sleep apnea, marked by heavy snoring or other breathing difficulties, daytime sleepiness or excess irritability. The procedure’s benefits must be weighed against the inconvenience and discomfort of surgery and recuperation and the slight risk that general anesthesia always brings.