My 8 year old son has been sick off and on again for about a year now. His syptoms very with a combination of any of the following at any given time, swollen glands, headaches, stomach ache, red throat, white spots on his tonsils and/or fever. His Dr. has diagnosed him with tonsilitis each time and taken strep cultures, which have all come back negative. The Dr. says it is standard practice to not remove the Tonsils unless my son exhibits 6 bouts of Strep within a years time. I am conserned with the discomfort my son sees to be having at least every 3 weeks. His Dr. does prescribe antibiotics which do seem to help until the next time. Is there any threat to my son's health by allowing this illness to go on, as it does reappear on an almost regular basis? And is there any problem with my son being on antibiotics on and off again like this?
Reply: -------------------------
It is true that one of the more common indications for tonsillectomy is documented recurrences of strep throat (4-6 episodes/yr or 8 episodes/2yrs) however, this is not the only situation in which tonsillectomy is an appropriate consideration. It is important to note that strep screens or throat cultures for strep are not infallible. Furthermore, streptococcus is not the only bacteria that can cause tonsillitis - if rapid strep screens are the only test performed non-strep bacterial tonsillitis will not be picked up. It is apparent that your physician considers your child to have a bacterial infection causing tonsillitis since he prescribes an antibiotic. If it is typical for your child to respond promptly with antibiotic therapy, then this is further support of bacterial tonsillitis. The frequency with which your child is experiencing symptoms, the character of the symptoms described, and the description of the appearance of the tonsils during acute illness strongly suggest a diagnosis of chronic tonsillitis even if strep has not been identified. While greater attention and concern is paid to strep infections because of the potential complications (heart and kidney problems) that can occur with strep, most physicians who treat children would consider tonsillectomy for your child given the history you have provided even though there has been no documentation of strep throat. In fact the history you have provided would meet criteria established by the American Academy of Otolaryngology Head and Neck Surgery for consideration of tonsillectomy. As in all cases, the potential benefit of any medical treatment must be weighed against the potential risk - furthermore it is important to understand that for a particular disease and a particular treatment, not every individual will have the same risk/benefit profile. You might consider requesting a referral to an otolaryngologist for another opinion.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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