There’s an interesting post on the New York Times’ health blog, Well, this week that talks about tonsillectomies. Normally here at SleepBetter we don’t write about this type of surgery, but there’s been an interesting side-effect that’s developed from the reduction in the number of tonsil removals in the United States … and it relates to sleep.
Not all that long ago, tonsillectomies were almost a rite of passage. After a couple of cases of strep throat or tonsillitis, tonsils were removed. Doctors have observed since then, however, that many children grow out of the tendency to get throat infections with or without tonsillectomies. As a result, the number of tonsillectomies performed has dropped.
This is where the unintended side-effect comes in. Many children have over-sized tonsils … so over-sized in fact that they can obstruct breathing when the child is trying to sleep — creating sleep apnea. In years past, these cases wouldn’t have been noticed very often because most children had their tonsils removed. From the New York Times:
Some behavioral issues, including some attention problems, can be traced to a lack of deep, restful sleep. A child suffering from obstructive sleep apnea will not simply grow out of it, said Dr. Kasey Li, a surgeon at Stanford University. Even if the tonsils do become less problematic at puberty, as sometimes happens, the child’s development will have been affected.
For problems short of obstructive sleep apnea, “the advice to parents is, if you’re even the least bit unsure, don’t do it — it’s an elective surgery, don’t worry about it, you can always re-address it,” Dr. Rosenfeld said. “There’s very little harm to some watchful waiting till things sort themselves out.”
Parents should also know that in a significant number of children, the breathing problems — and everything that follows from disordered sleep — may persist even after the operation and need further treatment.
So the tonsillectomy, once routine, now requires a nuanced diagnosis. It may improve quality of life for some children, but there are limits to what it can accomplish — with sleep issues and behavior problems, and with recurrent infections.