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Tonsillectomies aren't a rite of passage anymore.
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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."