In-depth

When do enlarged tonsils justify tonsil surgery?

The tonsils are located on either side of the throat. Enlarged tonsils can cause discomfort during sleep. The disruption to sleep, in this context, involves snoring and mouth breathing simultaneously and sometimes interrupted breathing (apnoea) or snoring in combination with waking-up frequently and restless sleep. Night sweats and abnormal sleeping positions, such as with the neck bent backwards, occur often and a number of children wet their beds at night. Such sleep disorders causing reduced sleep quality, in turn, affect life during the part of the day we are awake in various ways, e.g. in the form of excessive daytime sleepiness, deviance, such as mood swings, hyperactivity, asthenia, attention and concentration problems or increased oppositional defiant disorder symptoms and aggressive behaviour symptoms. All of this, in turn, has an impact on the quality of life of children and young people.

Enlarged tonsils can also affect the ability to speak, chew and swallow. If the throat feels tight, it can lead to problems eating particularly chewy food, it can make having to swallow small amounts necessary and it can mean that mealtimes take much longer than normal. This, in turn, can cause problems when it comes to maintaining a normal weight in relation to age. Children with enlarged tonsils most often breathe through an open mouth, drooling can occur and several speech functions can be affected. The speech often sounds thick and slurred. The articulation of consonant sounds made at the front of the mouth is negatively affected, as is the voice. Mouth breathing, which is caused by enlarged tonsils and adenoids (the glands behind the nose) can negatively affect the maxillofacial development of small children.

When do throat infections justify tonsil surgery?

Tonsillitis is a tonsil infection caused by bacteria or viruses. The tonsils become red, swollen, it hurts when swallowing and, in most cases, there is fever. Headaches, aches up towards the ears and stomach aches are also common. If you experience frequent relapses of tonsillitis, it can affect your daily activities causing a reduced quality of life. In the event of considerable discomfort as a result of repeated episodes of tonsillitis despite adequate treatment (3-4 relapses over the course of a year), a tonsil operation may be considered.

What is the difference between operating on “the whole” or “part” of the tonsil?

Tonsil surgery can be performed in two fundamentally different ways. The whole tonsil can be removed (tonsillectomy) or the size of the tonsil can be reduced (tonsillotomy). The guidelines are that repeated tonsillitis can justify a tonsillectomy. A tonsillotomy is often performed when the tonsils are enlarged and are judged to cause obstructed breathing during sleep. A tonsillotomy causes less pain, has a lower risk of bleeding and enables a quicker return to normal activity. With a tonsillotomy, there is a small risk of the symptom-generating regrowth of the remaining part of the tonsil. The assessment of which surgical procedure is best for the child in question is made by the doctor who will perform the operation.

When are the adenoids behind the nose operated on?

In those cases where children are operated on because their tonsils are enlarged, the size of their adenoids (the glands behind the nose) is also assessed. If the adenoids are enlarged, then they are also removed. This operation doesn’t cause the child too much extra discomfort.

What is the National Quality Registry for Tonsil Surgery?

The National Tonsil Surgery Register in Sweden measures quality in connection with tonsil operations. The purpose of the Tonsil Surgery Registry is to improve the care provided. The National Tonsil Surgery Register is funded by the government and the Swedish Association of Local Authorities and Regions and was established in 1997.

Data from hospitals with regard to indications, surgical procedures and surgical and coagulation techniques is assembled in the Quality Registry. 30 days after the operation, information is obtained from the patient about, for example, complications such as post-operative bleeding, infection and pain and how adequate the patient information was. Six months after the operation, the patient is asked to answer a questionnaire, where the degree of symptom relief is requested.

It is of great importance that the patients/close family and friends for child patients answer the two questionnaires in order to be able to analyse what gives the best results and develop the care provided. Read more about the tonsil registry and open comparisons across the country concerning tonsil surgery.

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