For decades, millions of children across the world have undergone surgery to remove their tonsils and adenoids. These lymphatic tissue structures, strategically positioned in the nose and throat respectively, help to trigger a first-line immune response to clear them from the body.
Ever since, the medical community has long believed that their absence does not significantly impact adult health, and so many doctors opt to relieve children of the persistent throat pain and ear infections that accompany such inflammation by cutting out the source.
But a pioneering study published in the Journal of the American Association of Medicine (JAMA) Otolaryngology-Head & Neck Surgery suggests that this widespread practice could be setting children up for more illnesses later in the future.
The research team after comparing subjects who had their tonsils or adenoids removed before age nine to control found that those who underwent tonsillectomy were three times more likely to suffer from common colds and other respiratory diseases.
The removal of the tonsils or adenoids in the throat also increased the chances of allergic conditions and infectious upper respiratory tract diseases – including asthma, cold, influenza, and pneumonia, among others – in the following years.
Certainly, in some instances, there may be a need to remove tonsils when they cause health issues in children, said Dr Ayotunde Fasunla, an Ear, Nose and Throat (ENT) Physician at the University College Hospital (UCH), Ibadan, Oyo State.
According to him, “tonsils are only removed when it is causing problems; problems such as infections, inability to sleep well (obstructive sleep apnea), when it has cancer or is a source of arthritis or other problems in the body such as the heart and kidneys.”
When enlarged, the tissues can block the airway and cause sleep-disordered breathing, or sleep apnea. Because tonsils and adenoids may shrink over time, the troubles are temporary for some children. For others, surgery may be required to remove them.
However, Dr Fasunla declared that the removal of tonsils or adenoid is not recommended for every child. “We usually look at what the child has and weigh its benefits against the surgery before we eventually decide to remove the tonsils in them,” he stated.
Tonsils (and adenoids) can grow large enough to block the airway, making it difficult to breathe. This can be especially noticeable when a person is lying down, such as during sleep, when gravity brings the tonsils down onto the airway.
This leads to a condition called obstructive sleep apnea (OSA), which can be serious and lead to health and behavioural problems in children.
When it comes to suspected sleep apnea, the warning signs can manifest as irritability, trouble focusing and poor school performance. The impediment can impact the child’s quality of life.
Sometimes, tonsils are removed because of chronic infection. Missing a lot of school classes when sick can create problems with learning. It can also create a big strain on the family who has to find care for the child during frequent infections.
The researchers at the University of Melbourne had examined medical records of approximately 1.2 million Danish individuals whose health had been followed from birth to age 10, and in some cases, up to age 30.
And surprisingly, the analysis indicated that many of the troublesome symptoms of tonsillitis and adenoiditis that removal surgeries aim to ameliorate – breathing problems and chronic ear or sinus inflammation – often return soon after the operation.
The study suggested that shorter-term benefits of these surgeries may not continue up to the age of 30 apart from the reduced risk for tonsillitis (for all surgeries) and sleep disorders (for adenoidectomy or adenoid removal).
Instead, the longer-term risks for abnormal breathing, sinusitis and middle ear infection were either significantly higher after surgery or not significantly different.
They, however, suggested that removing the tonsils in the first decade of life may harm the development of the immune system and open the door to future disease, urging paediatricians to limit their use of tonsillectomies as far as possible.
Moreover, Dr Fasunla said the possibility of a tonsil removal in children having a long-term health risk is understandable considering the importance of the tonsils and adenoids in the body’s immune responses and development.
“The truth of the matter is that infections and allergy are related to white blood cells in the body. The white blood cells will develop in any of this direction; either to take care of the infection or to predispose you to become an allergic person.
“So, someone who has not been having an infection before the tonsils are removed may have an increased risk. But that does not mean that once the tonsil is removed, the person must have an infection or become an allergic person. The truth of the matter: the other factors need to be considered before one can say for instance that this child that will eventually develop asthma.”
What is more, he said the practice of removing uvula, a small fleshy finger-like flap of tissue hanging in the back of the throat is both unnecessary and wrong.
He declared that many children that had undergone the procedure carried out clandestinely by some traditional healers had died from its complications, such as bleeding and infection.
But most of the traditional healers cash on public ignorance to make money while ignoring the risks associated with the practice. There is a widespread belief among some parents that the uvula is the culprit when children suffer bouts of fever and cough.
Some other people ask for its removal because they feel that the uvula is too long. Others say it is causing pain. While some people say because it is touching the base of their tongue, its been irritated and responsible for the infection. They then turn to traditional healers, who cut out the organ and discard it in a ritual.
But “it is not the uvula that is causing the infection. If for example, a fish bone gets stuck in it, it can build nodes of infection and as such become infected. Antibiotic is then given to take care of it. However, more often than not a pain in the uvula could be from an infected tonsil or pharynx,” he stated.
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