October 19

When Should Tonsils Be Removed?

When you or a child is not sleeping well, has chronic allergies, presents with hyperactivity, and also has had a few tonsil infections, the tonsils may be impacting the ability to breathe. Medically, the threshold for recommending a tonsillectomy is 7 infections during a year. However, for those who have less than that number and whose tonsils are blocking the airway, it may be time for removal and expansion to open the airway as much as possible. So when should tonsils be removed? The answer is it depends.

What are Tonsils & Their Role in Our Health?

Tonsils are a first-line immune response to pathogens entering the body through the mouth and nose. They play a very important function in our early lives. They are a small pair of glands located at the back of the throat. As we grow, they typically shrink. As they protect the body, they tend to have inflammation for the first few years of life. Then, they settle down as the child ages. However, some tonsils become so inflamed that they block the airway and make it difficult to breathe. This struggle causes us to miss out on healthy, rejuvenating sleep and air that is essential to overall well-being. 

Mouth Breathing & Sleep Apnea’s Effect On the Tonsils

Oftentimes, sleep apnea, mouth breathing, and enlarged tonsils go hand in hand. Mouth breathing, by nature, causes the mouth to dry out and the tonsils and adenoids to enlarge. When the tonsils are larger than they should be, they partially block the airway, which leads to obstructive sleep apnea and trouble breathing. Over time, the blockage can also lead to changes in the craniofacial (upper and lower jaws) growth and can have major impacts on health and growth.

Seeing a myofunctional therapist for evaluation of the tongue’s posture, if there is a high or low palate, and if there’s an anterior open bite (where the front teeth don’t touch), can address some of the problems. When the tonsils and adenoids are so large that they affect the airway, it may be best to remove them.  

When Should Tonsils Be Removed

An Ear, Nose, and Throat (ENT) doctor or an airway specialist will examine the airway and determine if the tonsils need removal. In most cases, a tonsillectomy will only occur if the enlarged tonsils are also accompanied by other issues. Those issues include things such as recurrent strep throat or obstructive sleep apnea. If that’s the case, the best course of action is to remove the tonsils to clear up space for the airway.

Two of the most common signs indicating a need for tonsil removal include:

Recurrent strep throat

Some of the symptoms of strep throat are: a painfully sore throat often accompanied by redness and puss on the tonsils and can include a fever, stuffy or runny nose, with swollen neck lymph nodes. You have chronic tonsillitis when you have 7 infections during a year, 5 infections per year for 2 consecutive years, or 3 infections per year for 3 consecutive years. Most ENT doctors will recommend a tonsillectomy for treatment of chronic tonsillitis. However, if someone does not meet the number of infections but still having other health issues, there may be an airway disorder at play. 

Obstructive sleep-disordered breathing

Obstructive sleep apnea is a type of sleep-disordered breathing that is more than just loud snoring. It is a stop-and-start breathing pattern several times during the night. It leads to serious health issues, including weight gain, pulmonary hypertension, behavioral problems, and trouble paying attention. When the tonsils are larger than they should be, it can block the airway and cause obstructive sleep apnea. In this case, it’s not uncommon for an individual to also be suffering from other things like chronic allergies and an excessive stuffy nose.

When tonsils are constantly larger than they should be and majorly affecting the airway, it can cause major problems. They need to be removed first before any myofunctional therapy or a frenectomy takes place. After that, the tongue can learn to rest in its proper place. And, a frenectomy can occur if needed. The tongue thrust will only improve if steps are taken in the correct order, since the core, underlying reason is because of the tonsils’ size. 

Regardless of the reason, it’s important to assess frequently swollen tonsils that are blocking the airway as soon as possible. Airway restrictions can cause short-term and long term health issues. Getting treatment quickly is the best way to start on the road to better breathing.  

It is important to note that in kiddos that have had their tonsils removed, many will require some type of orthodontic expansion to address the root cause of ‘why’ they became enlarged!  

A dentist trained in evaluating the airway can assist with this.  It’s important to note that all providers’ training is different. You may require multiple opinions to feel comfortable with the treatment recommended!

Schedule An Appointment With Bloom Center for Sleep and Airway Health 

When the airway is open and functioning as it should, we can sleep better and live a healthier life overall. Do you think you or your child may have an airway problem that involves the tonsils? Should the tonsils be removed? Schedule a consultation or virtual appointment with Dr. Liz Turner at the Bloom Center for Sleep & Airway Health. She will assess your unique situation.


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