Treating troublesome tonsils

This story first appeared in Healthy You - July 2025, The Gazette’s quarterly health publication.

If you are a parent who is constantly at the doctor’s office with your child with yet another sore throat, it may be time to talk to a doctor about long-term solutions.

Dr. Jasmine Hernandez is an ear, nose and throat specialist at Mercy Cedar Rapids and works with pediatric patients for tonsillectomies, a fairly simple and common procedure that removes the tonsils at the back of the throat to address a variety of issues.

“With children, we are actually talking about their removal of tonsils and adenoids,” Hernandez said. “Those are the same kind of tissue at the back of the throat. They are part of the immune system. And as children get older, they tend to get enlarged with recurrent viral and bacterial illnesses, such as upper respiratory infections, as well as with allergies, which can cause irritation.”

She said that leads to a few reasons for removing tonsils, including recurrent strep infections. “Strep infections are one of the indications for removal, because when the tonsils are colonized with bacteria even after multiple courses of antibiotics, the infection just kind of pops back up over and over.”

But a recurrent sore throat isn’t the only cause for concern. Hernandez said another big reason for removing tonsils and adenoids in children is sleep issues. “This is what we call sleep disorder breathing, which can be periods of loud snoring, as well as pauses in breathing. It's essentially the equivalent of sleep apnea for adults.”

Hernandez said that some pediatric patients she sees have already been diagnosed with sleep disordered breathing before she sees them in clinic. If not, they can order a sleep study to help get a diagnosis.

As for age, Hernandez said it can vary. “It can really happen at any age, but tonsils do tend to start becoming enlarged at about three years of age. So that is when we get a lot of children who begin to have sleep issues.”

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Patients often come to Hernandez and her team through a referral from a pediatrician, but parents who have concerns can contact them directly as well. “Parents can call to schedule to have their children seen by us for concerns,” she said. “Big issues are loud snoring, so much that you can hear your child through a closed door. Sometimes you'll have the cutest kid in the world, but they sound like an old man when they are asleep, with really loud snorting and pauses in breathing.”

“Parents might also consider if they are feeling like their child is just not waking up very well,” she added. “If they don’t seem refreshed or are having frequent nighttime awakenings. They might need naps more frequently than other kids their age, for example. The big concern is that they are not getting good quality sleep, and that can lead to behavior issues, as well as difficulties with focusing. That's the big thing that we're trying to prevent.”

The tonsillectomy procedure itself is simple, Hernandez said. “When we remove tonsils and adenoids in children, they can be up and about and sometimes bouncing around like nothing happened at all soon after. Obviously something did happen, so there will be some pain associated with it.”

Tonsillectomies are a routine, common procedure that typically take about 30 minutes to perform under general anesthesia. Most patients leave the hospital the same day, but with very young children or some patients with severe sleep apnea or other health conditions, they may stay overnight.

“After surgery, our nursing staff makes sure that you’re able to tolerate some food, and then they send you home with some pain medication, as well as indications for a soft diet for two weeks to help decrease the risk of a tonsil bleed while the back of the throat is healing,” Hernandez said.

While it is easier to remove tonsils in younger patients, Hernandez did note they don’t just remove tonsils to prevent problems down the line, per say. “We still need to have an indication to remove them.”

“Universally, adults hate having their tonsils out,” Hernandez added. “One of those reasons, I think, is because in younger kids … it's just a really clean surgical plane. They haven't had a lot of infections or inflammation there, and the older you get, the more likely you have some natural scarring around the tonsils.”

Hernandez said that long-term studies have not found significant negative health effects on children who have had their tonsils and adenoids removed, especially where removing them for recurrent infections was the case. “They may even be healthier after removing tonsils and adenoids,” she said.

In terms of caring for your tonsils in general, Hernandez said that good oral hygiene is important, as is treating allergies if that is something your child deals with. “Decreasing inflammation in the throat in general is good.”

If your child needs to have a tonsillectomy, parents should not be too worried.

“Overall, it’s a fairly straightforward procedure that can be really helpful to children and to some adults to have it done,” Hernandez said. “Recovery takes about a week, but then afterwards, most people really appreciate having their tonsils out.”