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Should my son have his tonsils removed?
Q: Because my 3-year-old has sleep disturbances due to enlarged tonsils and adenoids, an ear, nose and throat specialist suggests I may want to have them removed. I asked my family physician for a second opinion and she also says the decision is up to me. I know that most parents want to be involved in such decisions, but I wish the doctors would just tell me what to do! This is major surgery and I want to be sure the benefits outweigh the risks. What specific risks are involved? And, if I proceed with surgery, what can I expect in the hospital and during recovery?
A: Linda, it can be difficult to make a decision about surgery. Although it might feel like you just want the doctors to tell you what to do, it sounds like you’d be happiest if you had all the information about the risks and benefits of the surgery so you could make the right decision.

Your son’s condition is fairly common and affects approximately 2 percent of young children. The tonsils and adenoids are lymph tissue in the back of the throat and nose, and are part of the immune system that helps the body fight off infection. Preschool-age children have relatively large tonsils and adenoids and small airways. When your child is lying down, his enlarged tonsils and adenoids partially block his airway and disturb his breathing and sleep—this is known as “obstructive sleep apnea.”

When your son sleeps, you may hear him make many unusual sounds, such as snoring with pauses in which he stops breathing and snorts and petrolps for breath. These breathing disturbances can disturb his sleep. Children with obstructive sleep apnea are also more likely to have problems with daytime behaviour and learning, as well as growth. When the condition is severe and goes untreated, it can even cause heart problems.

Doctors recommend surgery (known as adenotonsillectomy) to remove the tonsils and adenoids if they are very enlarged and are causing obstructive sleep apnea. Some doctors will make the diagnosis based on your reports of your child’s symptoms and an exam; others will also conduct a sleep study, where the child’s breathing is recorded while he sleeps in a laboratory.

Adenotonsillectomy is generally considered a minor surgery. Children 3 years or older, who are otherwise healthy, can usually leave the hospital the same day of the surgery. Children under 3 with other health problems are usually monitored in the hospital overnight.

As with any surgery, there are risks associated with adenotonsillectomy, although they’re low. There is always a very small risk of complications with anesthesia and bleeding after surgery. The most common problem is that children tend to have a sore throat and difficulty eating during the week after surgery. But with liquids, soft foods and extra attention, most children recover quickly without any problems. Studies have found that surgery resolves the sleep disruption in over 80 percent of children with obstructive sleep apnea, and many children have a growth spurt afterward as well.

Be sure to ask your ear, nose and throat surgeon about the risks and benefits of surgery, how to prepare your child, how long he will be in the hospital, what will be done during surgery and what to expect during recovery. Ask the doctor for a full explanation as well as written information, if you feel you need it. It is good that you requested a second medical opinion, although you might want to get the second opinion from another ENT specialist, if one is available, rather than your family physician, who may not be specialized in this area. Even after getting all the information, it can still be hard to make a final decision. Many parents find it helpful to ask the doctor, “If this were your child, what would you do?”