QUESTION: My son has constant sore throats. Should we consider having his tonsils removed?
ANSWER: It is important to discover the underlying cause of these constant sore throats.
The most serious cause is an infection with a bacteria, called group A betahemolytic streptococcus (GABS). This type of bacterial infection is less common than viral infections such as a cold.
There is only one way to confirm a GABS infection, sometimes called “strep throat.” The doctor must perform a throat swab which is sent to a lab where it is cultured for analysis. In other words, a physician can’t simply look at a child’s throat as to make a diagnosis.
Confirmed cases are treated with antibiotics. If GABS is left untreated or undiagnosed it may lead to complications such as rheumatic fever or post-streptococcal glomerulonephritis, a serious kidney infection.
Ear, nose and throat experts recently published a position paper on when it is appropriate to remove tonsils: If a child has more than seven episodes of GABS a year, then a tonsillectomy is appropriate; if there are five infections a year for two years in a row; or if there are three infections a year for three years in a row.
Tonsillectomies now are the second most common surgical procedure after the placement of tubes for recurrent middle ear infections. In the earlier part of the 20th-century tonsillectomies were the No. 1 reason for surgery in childhood.
Mouth-breathing due to enlarged tonsils or allergies can lead to sore throats. Usually these children don’t have a history of unusually frequent viral or bacterial infections. If they also suffer from sleep disordered breathing (where they may pause to breathe during their sleep) then a surgeon will consider doing a tonsillectomy – especially if there are related problems such as lack of concentration at school, fatigue, anxiety and chronic headaches.
Send pediatrician Peter Nieman your questions at firstname.lastname@example.org. He will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.
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