Experts call for more children to have tonsils removed – as study shows the surgery reduces behavioral problems and even blood pressure

Doctors are calling on more parents to have their children's tonsils surgically removed to improve their sleep and quality of life and reduce their risk of heart disease in the future.

Researchers from Brigham and Women's Hospital and the Harvard Pilgrim Health Care Institute found that when children underwent tonsillectomies to remove the two oval pads of tissue at the back of the throat, the quality of their sleep improved, as did their levels of daytime sleepiness and behavior.

The children who underwent the procedure were also more likely to have lowered blood pressure and less likely to have signs of progressive disease than children who retained their tonsils.

A tonsillectomy is one of the most common procedures in children and teens, with more than 530,000 procedures performed each year. It is typically performed to improve breathing problems during sleep and/or to eliminate recurring bacterial tonsil infections.

Children who had their tonsils removed showed better behavior, although there was no difference in the hand and finger coordination tests. Sleep quality, including symptoms of snoring and apnea, also improved in children who underwent tonsillectomy, as did their overall well-being

The Massachusetts researchers wanted to determine how tonsillectomy at a young age might affect brain development, sleep, behavior and quality of life.

Of 459 children ages three to 13 with mild sleep-disordered breathing — defined as habitual snoring without frequent breathing interruptions — doctors followed 395 of them for a year after their enlarged tonsils were removed.

Those who had their tonsils removed showed better behavior, although there was no difference in hand and finger coordination tests.

Sleep quality, including symptoms of snoring and apnea, also improved in children who underwent tonsillectomy, as did their overall well-being.

After twelve months, the adenotonsillectomy group had a greater drop in blood pressure than the group that chose to wait and see what happened.

During a tonsillectomy, doctors place a tool in the child's mouth to cut or shave away the tonsils. They can also use a method called cautery to burn them.

The entire procedure takes only 20 to 30 minutes but requires the child to undergo general anesthesia.

However, no stitches are usually required and the child can go home the same day.

Tonsils are part of the body's immune system. They work like lymph nodes, filtering germs from the nose and mouth to protect the rest of the body from infections.

They can grow so large that it becomes difficult to breathe.

The procedure is not without risks of complications, the most common of which are breathing difficulties after the operation, which occurs in one in ten patients, and bleeding, which occurs in one in twenty patients.

But they can also become infected themselves, leading to swelling, sore throat, difficulty swallowing, fever, enlarged lymph nodes in the neck and a sore voice.

Parents and pediatricians have long known that high-quality sleep between nine and 14 hours is crucial for a child's neurological development, which affects mental health and behavior and leads to poorer cognitive function and concentration problems at school.

Poor sleep hygiene during childhood is also linked to metabolic disorders, including obesity and type 2 diabetes.

Doctors will generally consider a tonsillectomy medically necessary if the patient has had at least seven tonsil infections in one year.

Dr. Susan Redline, a sleep medicine expert at Harvard University and co-author of the study, said: 'Our data suggest that for children without symptoms other than snoring, it is reasonable to monitor them over time without excessive to undergo surgery.

'On the other hand, our data suggest that for children who have problems with sleep disturbances, daytime sleepiness and behavioral problems, surgery may be a very reasonable option, even if a sleep study shows that they do not often experience apneas (or temporary pauses in breathing) .'

The team will continue their research by looking at the long-term effects of undergoing a tonsillectomy in childhood.

Dr. Redline said: 'Our team is very interested in the longer-term follow-up of children.

'There are open questions about the impact of tonsil removal over a child's life, as well as its impact on trajectories of growth and development beyond one year of age.'