Tonsils removal exposes children to asthma

Tonsils and adenoids removal in children is supposed to end persistent earaches and sore throats. But what if the surgery puts a child at risk of developing lung problems, sinusitis and asthma?

A new research shows that children who have had their tonsils or adenoids removed are more likely to develop lung problems, sinusitis, asthma and conjunctivitis, often called ‘pink eye’.

Many Kenyan children nowadays undergo surgery to remove tonsils and adenoids, surgeries that cost about Sh240,000 in private hospitals. Tonsils and adenoids are located in the throat and behind the nose. They can be infected, becoming painful and swollen with pus.

But the researchers from the University of Melbourne say paediatricians should use a wait-and-see approach in less severe cases instead of putting the children at risk of developing upper respiratory tract ailments, asthma, flu, pneumonia and chronic obstructive pulmonary disorder, a disease that is already affecting thousands of poor Kenyans exposed to firewood fumes.

‘’These lymphatic organs (adenoids and tonsils), especially during sensitive ages when the body is developing play important roles in the development and function of the immune system. It is important to consider long-term risks when making decisions to perform tonsillectomy or adenoidectomy,’’ said Dr Sean Byars who led a team that reviewed 1.2 million children under nine from Denmark who had the procedures, then followed them up until the age of 30.

In Kenya, Dr Amit Shanker, who treats diseases of the ear, nose and throat at Aga Khan University Hospital says recurrent infections are common among children who are allergic and have poor immune functions but parents should not jump for surgery because many children get better over time.

How do you know your child needs surgery?

‘’For tonsillectomy (removal of tonsils), a child should have had at least seven episodes in the previous year, at least five episodes in each of the previous two years or at least three episodes in each of the previous three years.

“For adenoidectomy (adenoids removal), we look at the severity of symptoms like snoring, mouth breathing, ear infections and sleep disturbances which are not managed well with medications,’’ he said.

However, there are chronic cases that require immediate surgery. If the enlarged adenoids choke a child’s airway, causing sleep disturbances, a condition known as obstructive sleep apnea, surgery should be done even if the infections are not frequent.

Antibiotic resistance

Dr Shanker adds that initial infections of the two organs which cause sore throats, ear pain and fever, can be very well treated with drugs but if they occur often, there is a high chance of getting antibiotics resistance, especially if the children use over-the-counter medicines.

However, the head and neck surgeon says he has not seen complications in children whose tonsils and adenoids have been removed.

‘’On the contrary, the surgery gets rid of chest issues as upper airway obstructions get relieved,’’ he said.

The two organs help the body to fight infections but the doctor adds that they not major in the immune system.

After surgery, a tonsil never regrows but adenoids can regrow if they are not extracted completely.

‘’It is true they protect a child from localised bacterial infection in the nose and throat but it’s kind of redundant.

“Adenoids disappear from the body after adolescence and the tonsils regress in size as one ages,’’ he said.

But even in cases where the surgery is necessary, it has risks.

‘’There are risks of bleeding and wound infections. But bleeding can be minimised nowadays with the use of newer technologies like Coblation,’’ the doctor said.

Removal of both organs cost Sh160,000 to Sh180,000 but the Coblation technique is more expensive ranging from Sh240,000 in private hospitals.