How often is too often? Recurrent tonsillitis in children
Not every sore throat is bacterial tonsillitis; many episodes are viral and resolve without antibiotics. What counts for the assessment are documented episodes with fever, coating on the tonsils and a medical examination — not every sore throat.
The guide is the number of medically documented episodes in twelve months: with fewer than three episodes the course is observed. With three to five episodes per year, tonsil removal can be discussed if this pattern persists for more than one year. From six episodes in twelve months it is often recommended. What matters is the overall course, for example missed school days or repeated courses of antibiotics.
- Fever, sore throat, coating on the tonsils
- Swollen neck lymph nodes, difficulty swallowing
- Repeated antibiotic courses, frequent missed school days
- In children under three, always seek medical assessment
Tonsil reduction or tonsil removal?
When very large tonsils with obstructed breathing, snoring or swallowing problems dominate, tonsillotomy (partial tonsil reduction) is usually considered: only the protruding part is removed and the bleeding risk is lower than after complete removal.
When very frequent, medically documented infections dominate, complete removal (tonsillectomy) is assessed. Both procedures are performed in a hospital under general anaesthesia; which route fits depends on the findings, and no particular outcome can be promised.
What happens in the practice?
I examine the mouth, throat, nose and ears; if symptoms occur at night the adenoids (polyps) are assessed as well, since they are often involved. A swab, hearing test or referral is arranged where needed.
We then discuss whether monitoring, conservative treatment or a hospital appointment is the appropriate next step.