Kids' tonsillectomies make more sense for sleep apnea than strep throat

Portrait of Asian child sleeping on the bed (Kenishirotie)

Children who have their tonsils removed to treat chronic throat infections or breathing problems during sleep may get more short-term symptom relief than kids who don't get tonsillectomies, two recent studies suggest.

Over time, however, the benefits of surgery for chronic streptococcal throat infections appear to go away. Three years after tonsillectomies, children who had these procedures had roughly the same number of throat infections as kids who didn't get their tonsils taken out, one of the studies in Pediatrics found.

"Tonsillectomy, while very common and generally safe, is not completely without risk," said Dr. Sivakumar Chinnadurai, senior author of the strep throat study and a researcher at Vanderbilt University Medical Center in Nashville, Tennessee.

"The recognition of risks, and the knowledge that some patients' infection rate improves over time has led to (strep) infection being a much less common indication for tonsillectomy than it was in the past," Chinnadurai added by email. "While tonsillectomy remains one of the most common surgeries performed in the United States, the main indication for children has switched to obstructed breathing."

To assess the potential for tonsillectomies to help kids with chronic strep infections, Chinnadurai and colleagues examined data from seven previously published studies of children who had experienced at least three strep infections in the previous one to three years.

Four of the studies in the analysis randomly selected kids with chronic strep infections to get tonsillectomies or no surgery, and a fifth study followed children who got one of these options but not as part of a trial.

Overall, kids who got tonsillectomies for chronic sore throats or strep had fewer infections and doctor visits and missed less school in the first year after surgery than children who didn't get operations.

But most of the studies in the analysis included kids with a history of mild to moderate infections and found the limited benefits of surgery diminished with time. That may be at least in part because some children get fewer infections as they get older.

One limitation of the analysis is that much of the included research lacked data on the severity of symptoms, making it hard to determine if a subset of children with particularly serious cases of strep might get more benefit from surgery, the authors note.

With chronic obstructive sleep-disordered breathing, or sleep apnea, the benefits of tonsillectomies seemed clearer in a second study in Pediatrics. But limited long-term follow-up made it hard to rule out the possibility that the benefits would subside with time.

For the sleep apnea study, researchers examined data from 11 previously published studies that generally followed kids for up to one year.

Compared to kids who didn't get surgery, children who had tonsillectomies had greater improvements in sleep-related quality of life and in negative behaviors that are worsened by apnea such as anxiety or mood swings, the analysis found.

"These effects are most significant in children with mild to moderate sleep apnea, where the average improvement could represent a complete cure of the problem," said Dr. David Francis, senior author of the sleep apnea study and also a researcher at Vanderbilt University.

"While a significant improvement was seen with more severe cases, it was not large enough to suggest a total cure in all patients," Francis added by email. "In those more severely affected, there is a significant benefit from tonsillectomy, but families and health care providers should work together to understand what other factors may be at play."