Nieman: The removal of tonsils is no longer the first option for children

It was not so long ago that I met a mother who told me that their stay in a hotel did not go well at all. Their daughter apparently snored very loudly and around midnight it became clear that the father, mother and brother would not sleep much – unless they get away from the 10-year-old girl who snores .

The father and brother went to the front desk to ask for another room. A friendly employee suggested a room next door. However, the father declined this offer and asked for a room as far away as possible. The mother is found with the child who snores.

Snoring in children has become much more common over the past two decades. The ever increasing incidence of obesity has contributed to this trend, but it is only one of many factors.

As physicians become aware of new models, there is still a greater need to update clinical practice guidelines. The company has also realized the importance of choosing wisely the indications of surgery, the use of antibiotics and the proper administration of pain treatment.

Earlier this year, the American Academy of Otolaryngology (AAO) released new guidelines on when a child's tonsils should be removed. The previous guidelines had been published in 2011 and it was time to update the recommendations.

Tonsillectomy was a very common surgical procedure. This has now become much less commonplace and this is confusing some parents because when they were children, the tonsils were removed much earlier than today. It takes a lot of education to explain why this is so to help parents adjust their expectations.

Previously, recurrent throat infections were a common pattern of tonsillitis removal. Before surgery, antibiotics were used extensively, but now with increased awareness of how over-consumption can lead to resistant organisms and a better understanding of how antibiotics can disrupt the growth of healthy bacteria in the body. intestine, the wise choice has become the new norm.

The AAO recommends, in its guidelines, to wait under surveillance before the operation. A child who has less than seven episodes of throat infections a year is not eligible for surgery; Fever less than five episodes per year in the last two years, or fewer than three episodes per year in the last three years, are also reasons for delaying surgery.

In addition to the above criteria, the experts suggest that doctors also document temperatures – temperatures above 38.3 ° C (101 ° F), as well as enlarged lymph nodes in the neck and positive specimens for beta streptococcus. -hemolytic group A tonsillectomy more likely.

After the frequency of well-documented infections, the problem of obstructive sleep disorders (OSD) and obstructive sleep apnea will be examined. Children with OSSD should be referred for polysomnography in accordance with AAO. I usually tell my patients that it's easier to enter paradise than to get a sleep study. The waiting list for this procedure is quite long and the cost to do it privately is out of reach for many families.

However, a child who has poor growth, problems with bedwetting and behavior at school due to poor sleep habits will likely be seen a little faster than a child who does not sleep well. kiss only tonsils. They are so huge tonsils that they almost touch each other. Embracing the tonsils can result in the formation of narrow airways to the point that solid foods may become clogged and therefore cause choking, particularly in very young children. The AAO does not specifically discuss the issue of tonsil kisses in detail.

It is unusual to remove the tonsils for nocturnal enuresis. The latter is more often badociated with deep sleep, a family history of wetting the bed at night, a small bladder volume, constipation and the lack of an adequate amount of sleep. antidiuretic hormone.

Perioperatively, the AAO suggests that antibiotics are no longer used. A single dose of an intravenous steroid is still used (dexamethasone) to provide anti-inflammatory effects.

Controlling pain after tonsillectomy involves the use of ibuprofen or acetaminophen, but clinicians are advised not to use codeine or any codeine-containing medication after tonsillectomy .

Bleeding after surgery is closely monitored these days in that surgeons are evaluated according to the frequency of postoperative bleeding. The AAO suggests that this be done on an annual basis.

The story of the child snoring in a hotel and the midnight drama ended well, but I still wonder why the mother had to sleep with the child rather than with the Father. I guess that's perhaps one of the reasons why Mother's Day is such an important event each year.

For more information for parents via podcasts and brochures, I recommend you visit this site: https://www.entnet.org/content/clinical-practice-guideline-tonsillectomy-children-update

Dr. Nieman is a pediatrician in Calgary and the host of a blog article on life medicine. See ww.drnieman.com for more.