Tuesday 20 August 2019

Dear Dr Nina: Should my five-year-old have his tonsils removed?

Photo posed
Photo posed

Nina Byrnes

My five-year-old boy has been getting tonsillitis three times a year for the last four years. He continues to eat and drink while sick and is usually better in about three days. He would miss three days of school each time, and I often wonder if I should get his tonsils removed. Do you think it would be of benefit to him? I'm concerned about the effects of all the antibiotics he takes when sick. Are there any downsides to removing his tonsils so young?

Dr Nina replies: An infective sore throat may be associated with fevers, chills, muscle aches and pains and a general feeling of being unwell. You may notice white spots on your tonsils and swollen tender glands in your neck. There may also be symptoms of the common cold, such as a cough and runny nose. The majority of infective sore throats are viral and don't require antibiotic therapy.

The most common cause of bacterial sore throat is Streptococcus and this is sometimes called "strep throat". It's usually quite obvious on physical examination, with swollen tonsils and large collections of pus. There is often a very distinctive smell from the breath called, strep halitosis. This kind of sore throat requires antibiotic treatment. Penicillin in its basic form is very effective but treatment may be required for 10 days to fully eradicate the bacteria. Antibiotics should only be prescribed for bacterial infections.

Most people assume that they have tonsillitis when they have a sore throat and attend the GP expecting to be prescribed an antibiotic. It can be very frustrating if a simple antibiotic doesn't solve the problem and quite worrying when it reoccurs. It is important to know that there are several causes of a sore throat, not all of which require antibiotic treatment.

The pain of a sore throat may be eased by simple painkillers, gargling with salt and water, and by drinking warm drinks or eating cooling foods, such as yogurt and ice pops. If recurrent infectious sore throats occur, it is worth having blood tests and a throat swab taken. Glandular fever is a viral cause of recurrent sore throat that is most common in children and teenagers - however, it can occur at any age. A throat swab can help identify a bacterial cause.

Allergies and hay fever may cause nasal congestion leading to mouth breathing. This may lead to a dry irritated throat. Using antihistamines and nasal sprays may help relieve this and are always worth a try.

If your son is genuinely getting frequent bouts of bacterial tonsillitis and he is missing school regularly, then it may be worth asking your doctor to refer him to see an ear nose and throat specialist. The ENT doctor will examine him and take into account the history of infection before deciding whether or not surgery is appropriate. Surgery will usually be the last option.

If surgery is recommended the surgeon will talk you through all the benefits and risk of the procedure. It is normally a fairly straightforward operation that requires a day or so in hospital. It does require a general anaesthetic, and as with any operation, there is a risk of infection - bleeding or complications of the anaesthetic itself.

Removing tonsils has no negative impact on long-term health. Your son's immune system will still be strong and able to fight off infection. His health may in fact improve as if his tonsils were the cause of recurrent infections of the throat then it is likely that these will no longer occur.

It is a big decision to subject any child to an anaesthetic and surgery so it is important that the decision to operate is based on weighing up the benefits and risk to your child's health and well-being.

Q. My 12-year-old daughter has verrucas from swimming. Should we have them removed or will they go away by themselves?

Dr Nina replies: Verrucae are warts occurring on the soles of the feet. They can be more problematic than other warts as the weight of the body tends to push them into the skin, making them a little harder to treat. Deep verrucae can also cause discomfort in some people.

Most people develop warts at some stage and they are thought to occur in about one in 10 people at any one time. They don’t do any harm, and most will resolve themselves over two years, but they can be unsightly and bothersome.

You should not pick, bite or peel a wart. This increases the chance of spreading the virus to your hands or other parts of your feet. If the verruca is not bothering you it may not need any treatment at all.

Applying duct tape can be an effective treatment. Apply the tape. Leave it for 6 days. Take it off. File the skin then leave it off over night and reapply the next day.

Over the counter products containing salicylic acid are an option. This needs to be applied every 24 hours and the dead skin filed off each day before reapplying.

Your GP may be able to freeze the wart. This is called cryotherapy. It may take several treatments to fully treat the verrucae. Complications include blistering, scarring or changes in skin pigmentation and feeling.

It is important to consider the side effects and consequences of treatment. Those who have diabetes or poor circulation shouldn’t have cryotherapy. Watching and waiting is also a reasonable option if the verruca is small or superficial. Combining cryotherapy with salicylic acid may speed up the treatment process.

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