Should we really take those tonsils out?! (A naturopathic consideration of tonsillectomy.)

Is your child snoring? Perhaps waking unrefreshed? Maybe even gasping for air in the night? Any of these problems may be met with a prescription for a tonsillectomy. Other indications for the surgery include difficulty swallowing, chronic or recurrent infection of the tonsils, tonsillar swelling that may be cancerous, and others. You may be wondering – “is there a natural alternative to surgery?”

What is a tonsillectomy?

Tonsillectomy is a surgery that removes the tonsils. It is sometimes called a Tonsillectomy Adenoidectomy (or T&A for short) since the adenoid is generally removed at the same time, though the adenoid is really just a tonsil. This is typically an outpatient surgery.

What medications are involved in a T&A?

This is a major surgery, so it is performed under general anesthesia. Anesthesia is considered generally safe for children over 3 years of age, however it can have unwanted side effects (dizziness, nausea, vomiting, airway swelling, heart and blood pressure irregularities, and others). Also, more studies are needed to truly understand any impact it may have on the developing brain.

After surgery, pain must be controlled, and controlled well in order to keep your child eating and drinking. Otherwise, your child can become dehydrated, lose weight, and suffer from infection at the operation site. Tylenol is typically used to control the pain, but it may be used in conjunction with codeine. Codeine has its own set of risks that are also beyond the scope of this article, but are quite concerning (think trouble breathing and risk of addiction). The FDA issued a black box warning restricting the use of codeine in kids after a tonsillectomy, but unfortunately, it is still being used. Tylenol is not without its faults; see this article for more information.

Finally, antibiotics are also used after the operation to prevent infection. Unfortunately, we are learning that we’re in quite dire straights due to the over-prescription of antibiotics by doctors and their overuse in animal husbandry. Potential antibiotic side effects include diarrhea, allergic reaction, and rash. Antibiotics kill good gut bacteria; once dismissed as an insignificant side effect, this is now, thankfully, under close scrutiny (think intestinal disease, immune system dysfunction, asthma, obesity, to name a few). Looking beyond self, worldwide antibiotic resistance is a reality that is only worsening.

What are the tonsils and the adenoid?

The tonsils and the adenoid are masses of tissue that help prevent infection of the gastrointestinal and respiratory tract. They are part of the immune system. The adenoid is actually a tonsil. The tonsils are visible in the back of the throat, on either side, and are often quite large in kids. The adenoid is not visible as it is above and behind the soft palate.

Why are they taken out?

The tonsils and adenoid sometimes enlarge. When they do, they can cause obstruction of the airway. This obstruction can lead to snoring and difficulty breathing. The idea is that if it’s swollen and therefore causing blockage, it should be removed. There are many cases where the case is cut and dry. There are other cases where the evidence for surgery is weak, or the symptoms not so bad that surgery is needed eminently.

How do I know whether to do the surgery?

You must find a doctor you trust. It starts with the pediatrician; a thorough and experienced pediatrician won’t refer you to an ear nose and throat (ENT) doctor unless she is pretty sure your child needs the surgery. That’s because she knows that since ENT doctors do the surgery frequently, they are generally quick to recommend it. If your pediatrician refers you to an ENT, ask a lot of questions.

• Why do you think we need to go to the ENT?
• Why does my child need surgery?
• How eminently does my child need surgery?
• Do we have some time to try other avenues before resorting to surgery?

Ask the same questions of the ENT, with the addition of these:

• How often do you do this surgery / how many times have you done this surgery?
• What are the risks of the surgery?
• What are the risks of the anesthesia?
• What do you prescribe post surgery for pain?
• Do we have to use antibiotics post surgery? Which antibiotic will you use and what’s its side effect profile?

UPDATE June 11, 2018:

A study that was just released shows that having a tonsillectomy as a child increases the risk for respiratory, infectious, allergic, and other diseases. The study examined the records for over 60,000 children who had the procedure before age 10, and compared them with the records of children who kept their tonsils. They found that the kids who had tonsillectomies were 2 to 3 times more likely to suffer from respiratory disease. There were smaller, but significant, increases in the risk for other diseases. While this study does not prove that the procedure caused the increase in risk, it does certainly highlight the need to exercise caution in choosing the treatment. It may be that the diseases manifesting later in life for these kids are in fact an extension of the same disease process that caused them to need the surgery in the first place (which is why naturopathic medicine can be so helpful here). The study authors write in JAMA Otolaryngology  “Our results raise the important issue of when the benefits of operating outweigh overall short- and long-term morbidity risks.”

What is the role of naturopathic medicine?

Naturopathic medicine can by all means prevent your child from needing surgery, HOWEVER, if the case is severe there may not be time. Be judicious. If your pediatrician and ENT both recommend immediate surgery, do it. Otherwise, find out how much time they think you have.

Naturopathic medicine can be used in any case from the time the pediatrician makes the referral to the ENT until the visit with the ENT, or even until right before the surgery; be sure to keep a close eye on tonsil size (take a picture) and symptoms so that you can report back to the pediatrician and ENT and possibly postpone or cancel the surgery.

There is no one size fits all approach.

As always, naturopathic medicine is tailored to the child. However, there are some basic ideas that apply to most if not all cases. Determine if your child has any of the following (the odds are enormous that at least one is present):

• Environmental allergies – dust, mold, hay fever / seasonal
• Food allergies or food intolerances – for more information on the difference, and how to check for them, see this article

You can ask your pediatrician for help diagnosing and managing environmental and food allergies. You’ll need a naturopathic doctor to help you diagnose and manage food intolerance. It can be difficult to find food intolerance, but once you do, it can make an enormous difference in the case. For reference, check out this ebook.

The elimination of allergies is essential to the case.

Also, the immune system will likely need some fine tuning. Herbs and supplements can be especially helpful here.

Helpful adjuncts may include:

• Body work: cranio-sacral therapy, lymphatic massage, etc
• Contrast hydrotherapy to the throat and jaw area or constitutional hydrotherapy

Case study:

I once saw a 6-year old girl who had been advised to do a T&A non-urgently. There was no pressing danger of low oxygen levels, but the tonsils were rather enlarged and snoring was occurring. There were no other symptoms to help point me in the right direction, other than possible mild to moderate constipation. Since we had the luxury of time and the absence of obvious allergy symptoms, I forewent testing. I had the girl eliminate dairy entirely because dairy is such a frequent culprit in these types of cases. I saw her again after 2 weeks and she was over 50% improved in terms of symptoms but her tonsils were still enlarged. I added some herbs and probiotics, had her stay off dairy, and did some cranio-sacral therapy. After another 2 weeks, she was 100% improved, and the tonsils had shrunk down to a reasonable size.

Final notes:

Keep in mind that tonsilar swelling is an indication of immune dysfunction in the body. Taking the tonsils out may not eliminate the underlying problem. Identifying and addressing the underlying issue could help ensure improved health for a lifetime. On the other hand, do NOT put off a life saving procedure!