My child has excessively large tonsils, do they need to be removed?

One of the most frequent inquiries made to ENT specialists by parents of children 1 – 8 years of age is their concern about the abnormally large size of their child’s palatine tonsils, or commonly known as tonsils. Although the indications for the removal of angina are very specific and the number of patients who end up having surgery is very small, many parents bring their children to specialists for surgery under the pretext that “they have large tonsils”.

It should be made clear that the size of the tonsils is not an indication for surgery. Therefore, if the child does not suffer from any other type of pathology, such as infections, colds, persistent snoring with breathing stops while sleeping…, no matter how big the tonsils are, there is no reason to perform surgery.

There are cases in which it is necessary to evaluate in a particular way to see if the child is a candidate for surgery, this happens when the child suffers from repeated tonsillitis, delayed body development, malnutrition…, in addition to severe snoring with respiratory arrest (sleep-apnea).

Diagnosis for removal of tonsils

Before giving the green light to perform a tonsillectomy, blood tests must be performed in which proteins are measured, the value of which increases in situations of repeated infections (tonsil or any other part of the body). If these values are high, then there is a risk that the patient will develop infections in other parts of the body (heart, kidneys, spine) after 15-20 years, so in these cases the patient should undergo surgery.

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There is only one situation in which the patient should be operated without a previous history of infections: when the patient snores at night and also makes long respiratory stops. In general, the parents tell the doctor about it without the need for the doctor to ask, since these respiratory stops are very noticeable and the patient usually presents symptoms of poor night rest (daytime sleepiness, attention deficit, poor school performance…). In such a situation it is indicated to remove the tonsils, to avoid possible serious complications (cardiac arrest, pulmonary hypertension…), regardless of whether the patient presents other symptoms.

Lastly, it should be noted that whenever the removal of the tonsils is considered, it should also be assessed whether the vegetations (adenoidectomy) should also be removed in the same surgical procedure, since in many cases both tonsils and vegetations are enlarged. In order to make a decision, other symptoms and signs must be evaluated.