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Childhood surgery not as common anymore
Tonsillectomies aren't a rite of passage anymore.

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Date published: 3/1/2009

BY SUSANNAH CLARK AND JANET MARSHALL

Fifty years ago, it was practically a rite of passage for children to have their tonsils removed.

In 1959, 1.4 million tonsillectomies were performed in the United States, according to Healthline.com.

But by the late 1990s, the number had dropped to about 420,000, the National Center for Health Statistics reports. (More recent statistics aren't currently available from the center.)

The decline reflects a rise in other treatments--there are more antibiotics to treat infections now--and a shift in thinking about when the surgery is really necessary.

"People have gotten smarter in terms of identifying who really needs them out," said Dr. Nariman Dash, an ear, nose and throat specialist in Fredericksburg.

In the past, tonsils were thought to serve no real purpose. When they were enlarged or infected, doctors figured it was best to remove them, Dash said.

Today, a more cautious approach strikes a better balance between respecting tonsils' role in the immune system, and making sure problematic tonsils do come out, Dash said.

LINE OF DEFENSE

Because tonsils act as a first line of defense against germs, Dash said his rule of thumb is to "leave them alone" unless they're clearly causing problems.

Yet tonsillectomies remain one of the most frequently performed major surgeries in the U.S. That's because "at times, they become more of a liability than an asset," says the American Academy of Otolaryngolgy.

Recurrent infections still are grounds for a tonsillectomy. But increasingly, tonsils face the scalpel because of sleep apnea.

A BAD NIGHT'S SLEEP

Snoring, not a sore throat, is often the telltale sign that tonsils need to come out.

Snoring is a key symptom of sleep apnea, in which breathing stops for 10 seconds or more during sleep, said Dr. Maha Alattar, of the Rappahannock Rappahannock Neurology Specialists and Sleep Disorders.

Untreated sleep apnea can cause fatigue and ultimately damage to the heart and lungs.

In adults, obesity is a common cause of sleep apnea. But in children, enlarged tonsils often cause the problem by obstructing the airway.

"The relationship between sleep apnea and and tonsillitis is stronger in children," Alattar said. "Tonsils tend to shrink when you reach adulthood."


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Tonsils are almond-shape masses of tissue in the back of your throat. They help protect you from sickness by trapping germs that come in through your mouth.

Their counterpart, the adenoids, are higher up behind your nose and also help trap bacteria. If you open your mouth widely, you can see your tonsils, but not your adenoids. Often, when a person is suffering from breathing problems or recurrent infections, doctors recommend removing both the tonsils and adenoids.

Sleep apnea, a condition in which people stop breathing for brief periods of time while sleeping, is a main reason doctors recommend tonsillectomies in children these days. Enlarged tonsils can cause it. Symptoms include loud snoring, mouth breathing and restless sleep.

A pause in snoring, followed by a "big catch-up snore," is a classic sign of sleep apnea, said Dr. Nariman Dash, a local specialist.

Parents should consult a physician if they think their child has sleep apnea. Helpful information can be found at lpch.org by typing "obstructive sleep apnea" into the search box.