Treating tonsillitis

Q: My eight year-old has had four bouts of tonsillitis. Our doctor has told us that if she has another, he’s going to recommend removing the tonsils. I have heard that the surgery is not always successful in preventing sore throats, and I am reluctant to have my daughter undergo surgery.

A: The tonsils are two lymph glands at the back of the throat that help clear the throat of viruses and bacteria. Especially in school-aged children, tonsils, in the process of doing their job, may become infected and cause pain and fever. This is tonsillitis. Most of these infections are viral — rest, fluids and pain control are all that’s needed for recovery.

However, tonsillitis can also be caused by bacteria, usually Group A Streptococcus, hence the name strep throat. Treatment requires 10 days of a penicillin-family drug (or alternative if child is allergic to penicillin). Treating strep is important to prevent serious secondary effects in the heart and joints. To make the diagnosis of strep, a throat swab must be taken. Since there’s danger in giving unnecessary antibiotics, I strongly urge parents to wait for the swab results, which can take about two days. So make certain all your daughter’s infections have been documented with a swab. The distinction is also important because there is no evidence that surgery will decrease tonsillitis caused by a virus. While there’s no absolute number of strep infections that should lead to surgery, if there are six or more in a year, a discussion with a throat specialist (ENT) is probably in order.