Taking tonsils out

September 15, 1992|By Stephanie Shapiro | Stephanie Shapiro,Staff Writer

Nothing seemed to cure Eric Hymel's breathing troubles. The little boy, now 3 1/2 years old, was always congested, spoke unclearly and ate little.

After numerous antibiotic and asthma treatments proved ineffective, his mother Beth Hymel decided to take her son to Dr. John Ruth, an otolaryngologist -- ear, nose and throat doctor -- at Union Memorial Hospital. Dr. Ruth, who is also a head and neck surgeon, found that Eric's adenoids were very large and appeared to be blocking his sinuses.

His tonsils, as well, were unusually large. Remove them both, he advised, because, "six months later he could have a problem with his tonsils and he would have to go through surgery again."

After Ms. Hymel received a confirming opinion from a second specialist, Dr. Ruth removed Eric's tonsils and adenoids. It's been nearly four weeks since the operation, "and he's clear," says the mother of two. And Eric's new-found vitality is a godsend to the Belair resident and CPA:"During tax season, I can't handle his being sick."

At one time, tonsillectomies were a rite of passage for young children, whether or not they showed any symptoms of enlarged infected tonsils. "Classically, families were done at once," Dr. Ruth says. "I think it was just thought that tonsillectomies could play a role in making viral infections less frequent."

Although tonsillectomies and adenoidectomies remain the operations most frequently performed on children, the two elective procedures are now recommended by doctors after careful evaluation on a case-by-case basis.

"We try to stay away from hard and fast rules depending on clinical situations," says Dr. Martin A. Goins III, chairman of the department of otolaryngology at Sinai Hospital. "We always ask parents if episodes are becoming more frequent and/or more severe with age. If the trend is going that way, we know we have to do something."

Before removing tonsils or adenoids, "some [doctors] put patients on long-term antibiotics. . . . In general, it doesn't work," Dr. Goins says.

In some cases, doctors say, the symptoms of enlarged or infected tonsils and adenoids may abate, eliminating the need for surgery.

But, there is "certainly a role for tonsillectomies, for people with frequent recurrent tonsil infections or difficulty breathing," Dr. Ruth says. The same goes for adenoidectomies, he says. "Ear infections can certainly be helped by having adenoids removed."

Tonsils -- the reddish, oval-shaped masses on each side of the throat -- contain lymph tissue that produces antibodies when the body is battling infection. Adenoids, oval pads of tissue located between the back of the nose and the throat, serve the same function. But neither tonsils nor adenoids are vital to good health because their function is duplicated by lymph nodes and lymph tissues "in hundreds of places in the body," Dr. Ruth says.

And, instead of maintaining health, tonsils and adenoids, whether infected or unusually large, can make life miserable.

If children suffer from acute sore throats or a low grade irritation "more than four or five times a year for a couple of years, we recommend a tonsillectomy for chronic tonsillitis," Dr. Ruth says.

Especially large tonsils and adenoids can cause upper airway obstruction that can result in obstructive sleep apnea, a syndrome that causes loud snoring, pauses in breathing and choking noises during sleep. Because children who have sleep apnea must be awakened often to breathe, they may suffer from exhaustion during the day, Dr. Ruth says.

Adenoids can also indirectly block the Eustachian tubes by causing swelling around the tube area, creating a "reservoir of infection," Dr. Ruth says. Often, small children with chronic ear infections receive ventilation tubes for better ear drainage and adenoidectomies in a single operation.

As children get older, tonsils tend to get smaller and less symptomatic, Dr. Ruth says. But adults can also suffer from chronic sore throats and other symptoms of tonsillitis and also may opt for a tonsillectomy, he says.

Young adults, too, are more prone than children to peritonsillar abscess, a potentially life-threatening condition in which infected fluid collects behind the tonsil, Dr. Ruth says. This condition can also require a tonsillectomy, he says.

Because he is so young, Eric Hymel remained overnight at Union Memorial Hospital after having his tonsils and adenoids removed. Most patients still spend the night in the hospital after the same procedures. But increasingly, the two operations are performed on an out-patient basis because of the cost-cutting practices of various health plans.

Although Blue Cross and Blue Shield of Maryland still covers an overnight stay for a tonsillectomy, "many of the smaller companies are requiring [surgery] on an out-patient basis," Dr. Ruth says.

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