Does Removing Kids’ Tonsils Help Prevent Strep Throat?

The deal with repeat strep throat infections in kids

Tonsils, the two fleshy masses in back of the throat, are considered “gate-keepers” for screening bacteria and viruses entering the nose and mouth. While they can play a role in the local immune system, on occasion they can become a reservoir for bacteria and cause problems of their own. Infections like recurrent strep are a major reason parents ask pediatric ear, nose and throat (ENT) doctors, “Does my child need their tonsils removed to help with these repeat strep infections?”

The answer isn’t simple. Here are some factors to consider and questions to ask yourself.

1. My child gets strep throat several times a year. Should they have their tonsils removed?

There are many things that go into that decision. The frequency and severity of infections are two very important things to consider. There are well established guidelines for the number of strep throat episodes per year for which tonsillectomy may be beneficial. Ultimately, it is a decision between you and your doctor. The risks and benefits to tonsillectomy are outlined below.

Benefits of tonsillectomy

If your child meets the guidelines, they may have fewer strep infections over the next several years.
If your child snores or has been diagnosed with sleep apnea, removing tonsils might also help with that.

Risks or cons of tonsillectomy

Bleeding: with any surgery, there is a risk of bleeding. While the risk of bleeding after tonsillectomy is low, in some cases patients may need to return to the operating room for this reason.
Pain: the recovery from a tonsillectomy can be challenging. There is often a bad sore throat for up to 2 weeks. It can be uncomfortable for your child to talk, swallow or eat until the wounds heal.
Missed school days: expect about a week at home.
Missed sports: expect two weeks out of sports, gym, and recess.

Tonsillectomy is often an outpatient procedure, meaning your child can go home the same day.

2. Is tonsillectomy for strep throat considered an elective surgery?

Yes, a tonsillectomy is elective (optional) for repeat strep throat. You and your doctor will decide if it is the right choice for you.

Other indications for tonsillectomy may include loud snoring with disrupted sleep (obstructive sleep apnea), an abscess or infected fluid collection around your tonsil, recurrent fevers, and rarely tonsil stones.

3. Can kids still get strep throat after they’ve had their tonsils removed?

After a tonsillectomy, it is less likely for a person to have step tonsillitis. However, it is still possible.

4. What else can you do to prevent repeat strep throat infections besides antibiotics and removing tonsils?

A. Always, always prioritize hygiene. The best thing that you can do is to wash your hands. This helps to decrease the spread of all infections. Also, sanitizing bathroom surfaces and covering your coughs and sneezes helps. There is one extremely important step —changing your child’s toothbrush on day 2 of antibiotics.

B. Are they a strep carrier? Your child could be what ENTs and infectious disease specialists call a “chronic strep carrier.” So if your child tests positive repeatedly, but has no symptoms, it means they simply “carry” the bacteria. In these cases, you usually don’t need to aggressively treat strep throat or remove your child’s tonsils. You can “watch and wait” if your doctor is on board.