HEALTH MATTERS: Major changes in dealing with tonsils, adenoids in childrenDr. Wynne answers the question: I know that tonsillectomy is no longer routinely performed in children as it was when I was a child. But what about children who have such enlarged tonsils and adenoids that they obstruct breathing?
By: Dr. Joshua Wynne, Grand Forks Herald
Q. I know that tonsillectomy is no longer routinely performed in children as it was when I was a child. But what about children who have such enlarged tonsils and adenoids that they obstruct breathing?
A. You are quite right that there has been a major change in the way we deal with the adenoids and tonsils in children—no longer are they almost routinely removed. But tonsillectomy remains a very common surgical procedure, with more than half a million performed each year in the United States.
In children with recurrent throat infections or such severe enlargement that they have trouble breathing, especially when sleeping, tonsillectomy and adenoidectomy continue to be performed routinely, but, maybe, no longer. A study of almost 500 such children with obstruction during sleep showed that children who had the operation did not improve mental functioning or attention span over time compared with children who did not have the surgery, although children who had the operation felt better overall.
Part of the reason that the results of the operation were more modest than perhaps expected may have been because almost half of the children who did not have the operation showed a similar degree of improvement in obstructive sleep patterns, perhaps because their airway grew as they matured. Since so many affected children improved without surgery and didn’t appear to suffer any long-term deleterious effects, it is probably reasonable to use just medical therapy initially and reserve surgery for those children who do not improve during a period of observation.
Q. I have diabetes and my physician assistant has strongly urged weight reduction and increased exercise. While both make sense, do they really reduce my risk of long-term complications?
A. The answer, unfortunately, is yes and no. First of all, there is no question that weight reduction and increased activity will make your diabetes easier to control and your blood pressure lower. This may well mean fewer medications and lower medical costs for you, less likelihood of needing insulin injections, less chance of developing sleep apnea, and a better overall feeling of health.
On the other hand, a just-completed large trial found that an intensive program of weight reduction and increased physical activity had no favorable long-term (that is, over about 10 years) impact on cardiovascular complications like heart attack and stroke even though participants on average lost about 13 pounds during the study.
While such benefits may accrue over a longer period than the 10 years in this study, it was disappointing the study found various heart and vascular complications were not clearly improved by intensive weight loss and increased activity. Does this mean you shouldn’t lose weight or exercise? Certainly not, as the benefits just outlined are real and important. But it is important that we as health care providers are straight with our patients as to what they can—and can’t—expect from a given treatment regimen.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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