The human body is a complex and efficient machine. Our immune system are a crucial line of defense to protect our body from infections, and includes our skin and white blood cells. In the case of our airways, tonsils and adenoids play a role in our immune system by fighting infections.
So what are tonsils and adenoids, and what do they do? Tonsils are soft pieces of lymphatic tissue located at the back of the throat (pharynx). Adenoids are located at the roof of the mouth, close to where your nose connects to your throat. Both tissue masses help fight infection by "sampling" bacteria and producing antibodies.1 The first response to this information might be, "Why would we remove tonsils and adenoids if they help fight infection?! We need all the defense we can get to fight infections, right?!"
Tonsillectomy is one of the most common surgical procedures in the U.S., with over 530,000 procedures performed annually in 2011 in children under 15 years old.3 Tonsils and adenoids can become more of a liability than an asset when they become enlarged, potentially contributing to an obstructed airway and sleep-disordered breathing. Recurrent tonsillitis is an inflammation of the tonsils, and at one time was considered to be the primary catalyst for a tonsillectomy in children. As it stands today, about 20% of tonsillectomies are performed for recurrent infection, and 80% for obstructive sleep problems, such as, obstructive sleep apnea (OSA).2
Given this statistic on why tonsils and adenoids are removed, let's examine what this means for you and your children. Tonsillectomies for recurrent tonsillitis are effective at reducing the number and severity of sore throats in children.2 While it is great news that removing tonsils reduces the chance for recurrent infection, resulting in less missed school days and repeated trips to the doctor, that is only a small part of the more compelling aspect of the story.
Sleep-disordered breathing, from a caregiver perspective, is not linked to tonsillectomy and adenoidectomy as often as we may think. Symptoms of sleep-disordered breathing include behavioral issues, learning difficulties, bedwetting, obesity, and the obvious snoring.4 Parents may attribute these symptoms to normal behavioral growing pains, or other conditions, overlooking the possibility that sleep-disordered breathing may be the source of them all. If parents knew that a very common, relatively simple procedure could potentially resolve all of these issues, the why question has been answered!
As ENTs continue to provide quality care to their patients with continued improvements on guidelines for tonsillectomy and adenoidectomy, it's important to be as informed as possible before you visit the doctor. Armed with the proper knowledge of what our tonsils and adenoids do, and why we have them removed, parents can make informed decisions about their children's health.
No matter how statistically safe a procedure has proven to be, every surgery has risks. Post Tonsillectomy Hemorrhage (PTH) is a potentially serious complication that has been reported in literature for both adult and pediatric patients. It is reported to occur following use of COBLATION devices as well as following the use of other surgical devices and methods. Before making any surgical decision, you should speak with your doctor about any potential risks.
COBLATION wands are contraindicated for use in patients with cardiac pacemakers or other electronic device implants.
* Compared to monopolar dissection, based on analysis of eight randomized clinical trials.
Harley Jr., Earl H., John T., Mike and Hanson, Beate. Coblation Dissection Versus Monopolar Dissection - A systematic Review and Meta-Analysis. 2016; Data on file with Smith & Nephew, PN 91999 Rev A.
Woloszko, Jean, and Gilbride, Charles. Coblation Technology: Plasma Mediated Ablation for Otolaryngology Applications. Proceedings of SPIE. 2000, Vol. 3907.