Should we really still be taking out tonsils?
New guidelines in other countries are ruling out tonsillectomies except in extreme cases, so
WHEN Nathalie BaileyFitter heard her daughter stir early one morning, it came as no great surprise. Elizabeth, 11, had been feeling unwell and gone to sleep with a sore throat and a slightly raised temperature, the comparatively innocuous symptoms parents up and down the country deal with every day.
But when Nathalie followed her into the bathroom, she found a scene like a horror film. ‘As I approached the bathroom I could hear Elizabeth vomiting,’
says Nathalie, 42, a charity worker.
‘And when I opened the door, I was absolutely horrified. There was blood all over the floor and the toilet. For a second I stood there in a state of shock.’
A dash to a nearby doctor revealed Elizabeth had been suffering with tonsillitis so severe, the tissues had swollen to enormous proportions, become ulcerated and a blood vessel in one of them had burst.
‘I just felt like the worst mother in the world,’ says Nathalie, who is married to property developer Carl, 45, and also has a six-year-old son, Hugo.
With the aid of over-the-counter painkillers and a ten-day course of penicillin, Elizabeth recovered quickly.
But less than a month later, the bug was back and this time her anxious parents rushed their daughter to the GP. Another course of antibiotics followed.
‘When it happened a third — and then a fourth — time in a matter of six months, I started to think: “This is ridiculous”,’ says Nathalie. ‘I really did not want her to have any more antibiotics. I’m a former nurse so I know taking too many can cause drug resistance and risks of side-effects.
‘So I asked her GP if she could have her tonsils out.’
Over recent years the medical trend in some countries has been to avoid tonsillectomies where possible, making some parents concerned that the operation might not be the best option for their child.
But Deirdre Fitzgerald, a Consultant Ear, Nose, Throat & Facial plastic surgeon at Dublin’s Beacon Hospital with a special interest in rhinology and facial plastic surgery, believes this is partially due to cost-saving.
‘For many years health systems have been trying to make a saving on surgery because it is one of the most expensive parts of what any health service will provide,’ she explains. ‘Tonsillectomies are an interesting one because a lot of the lack of effectiveness is based on studies where the evidence has been found to be lacking in long term benefits.
‘But that doesn’t tally with the evidence you have when you meet a patient or the parents of a child who has had it done.
‘In Ireland we try to take best evidence and put it forward so that we are in keeping with the rest of the world in terms of surgery. We are up to speed on our criteria in terms of tonsillectomies which are very strict.’
In fact there are specific reasons why you or your child would be put forward for the operation.
‘For tonsillitis and sore throats you have to have a very specific number of episodes a year before you are considered for surgery,’ Ms Fitzgerald says.
‘Back when our parents were children tonsillectomies were perhaps done routinely, but because we know there is a risk attached to the procedure today we don’t just take them out willy-nilly.
‘We follow several sets of guidelines and we always have our eye to the literature as well. In 2014 the Cochrane Review looked at the low quality of evidence surrounding tonsillectomy but they felt this was secondary to the fact that a lot of children don’t come back for their post operative appointment once they have had their tonsils out because the job is done.
‘So you have to examine why there is a low quality of evidence. Do the health services who say tonsillectomy doesn’t confer benefit take that into consideration or are they just putting it forward because they need to make savings?’
And a study undertaken here by Dr Gerard Thong, an ENT specialist at University College Hospital in Galway, found that those children who suffered from tonsillitis and had them removed had a better quality of life than those who didn’t.
THE report found tonsillectomy ‘to be a procedure of considerable clinical benefit and, therefore, a worthwhile allocation of healthcare expenditure’ but added ‘not every child who suffers from tonsillitis would benefit from tonsillectomy, so parents should consult their general practitioner if they have any question.’
‘There was a huge difference in the quality of life between them to have the surgery and their scores,’ Ms Fitzgerald says.
‘The reasons we carry out tonsillectomies for small children — and in adults to a degree— is for sleep disordered breathing difficulties as they have so much blockage at the back of their airways because of tonsils. And then there are people who get severe tonsillitis that creates absences in the throat. And these are actually life-threatening as they can cause airway obstruction.
‘These are the things we need to take into consideration with each child one by one and each adult one by one and if they need the operation then they will get it as there are indications for it.’
But treating with antibiotics alone could have a long-term impact also, Ms Fitzgerald says.
‘There is an economic impact because of recurrent sore throats because people are missing work because of tonsillitis. Most people who don’t get abscesses in the throat could take antibiotics over a long period of time for their tonsillitis but it’s probably not good for them either. It’s very clear we don’t offer the surgery to everybody as one has to be so careful with the risks of surgery as well.’
There is a long waiting list to have tonsillectomies as small children are the priority and for Elizabeth the day she gets her tonsils out cannot come soon enough.
‘When Elizabeth is ill, she’s really very ill,’ her mum Nathalie insists.
‘She is bed-ridden with a raging temperature, unable to swallow, can barely speak and needs a constant supply of painkillers just to be able to sleep.
‘And she misses out on her football, which she loves.
‘I am well aware of the risks of surgery and I would never do anything that might harm my daughter without good reason.’
Mum-of-two Zoe Willows, 41, knows just how dangerous tonsillitis can be. She suffered repeat bouts of infection every few months throughout her teens and early 20s.
‘It was excruciatingly painful,’ says
Recurrent bouts of tonsillitis can make children very ill
the full-time mum, who is married to food industry executive Guy, 36.
‘I couldn’t swallow, I had big blisters on my tonsils and would always get a fever.’
But it was during a holiday to Mexico in her late 20s that things turned really serious.
Zoe developed tonsillitis once more and went to see a doctor on her final day. ‘He was calling in his colleagues to look because he had never seen anything like it,’ she recalls.
‘I managed to fly home on the same day but that night at home I could not breathe because my throat was so blocked.’
Zoe had developed quinsy, a rare and sometimes fatal complication of tonsillitis, which some medical historians believe was what killed US president George Washington in 1799.
Once the bacterial infection spreads from the tonsils into the wall of the throat, it triggers severe swelling.
Zoe was kept in isolation for four days and booked in for an emergency tonsillectomy. ‘My tonsils were so scarred surgeons had a tough time removing them. I had been suffering problems with them for more than ten years.’
And now? Zoe says: ‘I’m so much better off without them. I do still get the occasional throat infection but they are few and far between.
‘I think many people would be surprised at just how painful severe tonsillitis can be.
‘By the time I eventually had them out, I was in the worst pain of my life.
‘I have had two babies and would rather go through childbirth again than suffer like that.’