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August 6, 2007

A University of Michigan Health Minute update on important health issues.

A parent's guide to understanding tonsils and strep

U-M expert explains why removing tonsils can help fight throat infection

ANN ARBOR, MI – Fifteen-year-old Kaci Jawegg’s family knew the signs and symptoms all too well: It would start with itchy ears, followed by a sore and scratchy throat.


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“I would say, ‘oh, here we go again. Everyone’s got to stay away from Kaci or they’ll get sick too’,” recalls Annette Tase of her daughter Kaci’s frequent bouts of strep throat and tonsillitis.

About nine times during her freshman year in high school, Kaci had strep throat – an infection of the throat caused by bacteria called Streptococci – and tonsillitis – a temporary swelling and redness of the tonsils that is usually present with any throat infection.

Frequent school absences caused her grades to slip, and Kaci to miss out on dances and other special school events. That’s when she and her mom made the decision to have Kaci’s tonsils removed before the start of the new school year.

“Having her tonsils taken out will not only make her feel better, but she’ll miss less school and essentially have her life back,” says Annette.

Each year, about 300,000 children and adolescents like Kaci have tonsillectomies – a surgical procedure to remove the tonsils – in hope of reducing the occurrence of chronic throat infections like strep and tonsillitis.

“Taking out your tonsils doesn’t mean that you’ll never have another sore throat, or that you’ll never have another episode of strep,” explains Susan Garetz, M.D., clinical assistant professor in the Department of Otolaryngology at the University of Michigan Health System. “But it’s been shown in children who have recurrent strep that taking the tonsils out will reduce the frequency of those infections.”

So when is a tonsillectomy the right choice for your child? And why are some children more prone to recurrent infections?

To help answer some of those questions, Garetz offers parents a seven-step guide to better understand tonsils, tonsillitis, strep and tonsillectomies.

7-step guide to understanding tonsils and strep

  • What are tonsils? Tonsils are those two masses of tissue in the back of your throat that are supposed to help prevent infection by trapping viruses and bacteria as they enter through the mouth or nose.
  • What causes tonsillitis? According to Garetz, about one-third of sore throats in children are caused by Group A Beta-Hemolytic Streptococci.  Many other infections are caused by viruses.
  • What are the complications to strep infections?  When strep throat isn’t recognized and treated in a timely fashion it may lead to complications, including post-strep glomerulonephritis – damage to the kidneys that can occur after strep throat; rheumatic fever, which often is associated with problems in the joints; or the heart or neurological conditions. Garetz also notes that when strep throat isn’t treated in a timely fashion it may cause an abscess, which is a collection of bacteria or pus-like material near the tonsil that can actually travel further into the neck and down into the chest. If it’s not treated, it can be fatal in some cases.
  • When are strep infections considered recurrent or chronic? Children between the ages of 5 and 10 are typically more prone to recurrent episodes of tonsillitis. “We say an infection becomes chronic when the child has experienced more than seven episodes in one year, or more than five episodes per year in during two consecutive years,” explains Garetz.
  • How does chronic strep impact a child’s quality of life? Children with recurrent step infections can experience painful sore throats, and may miss a lot of school. Chronic infections also can lead to weight loss, since a sore throat can make it difficult and uncomfortable to swallow food.
  • Can tonsillectomies reduce chronic strep infections? A recent study found that children who had their tonsils removed were three times less likely to have an episode of strep than children who did not, says Garetz.
  • Are there risks with tonsillectomies? Tonsillectomy is a surgery done under a general anesthesia, and there are risks involved with any surgical procedure. The biggest risk with tonsillectomies is dehydration following surgery. “Children may have a very sore throat following surgery, making it difficult for them to drink fluids. So it’s very important for parents to make sure their child is getting plenty of fluid after surgery,” notes Garetz.

For more information, visit these Web sites:

U-M Health Topics A-Z: Strep throat

U-M Health Topics A-Z: Viral sore throat

UMHS Health Topics A-Z: Strep test

KidsHealth: Strep screen/Throat culture

American Academy of Otolaryngology – Head and Neck Surgery: Tonsils and adenoids

Written by Krista Hopson

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