Recurrent tonsillitis

[Losingplot]

DD7 has it for the third time in three months. Not sure if it’s viral or bacterial this time but she’s been swabbed & we’ve been given antibiotics. Asked for an ENT referral but was told they can’t do much at this stage as it’s not bad enough for surgery. Would you try to see a private ENT now? Or wait & hope it’s ok & try again for an ENT if she gets it again? Or something else?

As it stands she wouldn’t qualify for a tonsillectomy so no real point in seeing a private ENT if I’m honest. The criteria is very strict nowadays and they have to meet it in order for the GP to even refer. DD’s ENT told us that it was 9 confirmed cases (i.e seen by GP and given antibiotics) in a year or 5 per year for 2 years running in order to meet the guidelines for removal. Although tonsillitis is awful and I do feel for your DD 3 cases in 3 months isn’t particularly bad. It’s not an operation to take lightly so best avoided if at all possible, recovery isn’t pleasant and the risk of a potentially serious post-op bleed is always there - unfortunately we experienced it first hand!

DD had 9 cases in 3 months, it had effectively become chronic and resistant to antibiotics hence the ENT agreed it was best to remove them. We are fortunate to have private health insurance so it all happened quite quickly - first case of tonsillitis in December and had them out in April

This is awful and potentially dangerous advice. Only do this if you fancy ending up in hospital..

Absolutely ridiculous advice. Push them OP. Are they giving her same treatment each time? Penicillin? Obv not working, ask for a second antibiotic alongside. I had 8 cases in less than 8 months, was metronidazole alongside that actually shifted it.

Thanks everyone. It’s been the same antibiotic each time so that might be something to discuss.
Is it the case that the ENT basically decides on a tonsillectomy or nothing? I was hoping there might be more options than that.

What antibiotic is it? Our ENT advised that co-amoxiclav was the best when it comes to tonsillitis but isn’t often prescribed by GPs. They kept giving DD penicillin alone which didn’t work at all

Its
Phenoxymethylpenicillin. I’ll look into the other one. Thank you.

Yep - that’s the one that the GP kept giving DD which led to the infection embedding and becoming chronic. ENT said it’s not the best for tonsillitis at all. Definitely push them for something else

My daughter had her tonsils removed privately after getting tonsillitis on a monthly basis. She probably had it about 6 times in the year we asked for the referral and then she had quinsey. It did take a bit of pushing to get the referral but I think it's easier than getting an NHS one. I must say it was the best thing we ever did for her. The recovery was straight forward and she's been so much healthier ever since. We were very conflicted and worried about putting her through an operation but I am so glad we did.

I used to get it as a child. Not had it for years. And then this year had it twice! What is in the air?

If you get an ENT referral go in prepared. They will do it if don't meet the criteria if argued on other grounds. Take a list of how affecting her life. How many rounds of antibiotics, doctors visits, days off school, holidays/ events missed etc.

Sorry, another question…what if it’s viral not bacterial? Then antibiotics won’t work but would surgery, is that right?

Yes antibiotics won't work for viral so if it's repetitive the best option is surgery.

I am afraid I had to become that mum to get an ent referral. Being so ill constantly means they have no time to recover and it really impacts their wellbeing and ability to attend school. You do have to push I am afraid. Definitely take the advice above re antibiotics. Both my dc had theirs out by the time they were 4. For both it was positive.

Thanks so much. I feel much clearer about what the options are now.

Strange how they managed to give you antibiotics 3 times without telling you the name of the bacteria: Strep A - notifiable disease. So the GP should have informed you, notified the PHE, then PHE should have notified you about it, about prevention and treatment - this is what public health is for. So did this happen? Did PHE contact you 3 times?
Strange though, because most cases of tonsillitis are viral. Covid can be linked to it , especially in children, researchers found years ago very clear heavy covid viral load in the removed tonsils . When this is the case any civilized country made sure its children are vaccinated against covid: UK did the exact opposite and was happy to promote endless infections, instead of vaccines, NHS never asked children to even test when covid positive because they simply didn't care.
https://www.mayoclinic.org/diseases-conditions/tonsillitis/symptoms-causes/syc-20378479

https://pubmed.ncbi.nlm.nih.gov/37737615/

Known for years in other countries: ''Tonsils are major sites of persistence of SARS-CoV-2 in children''
Strange how NHS didn't yet notice how many sick children have repeated tonsillitis since the start of the pandemic
This shows damaged immunity. Strange how they didn't think about Sarscov2 famous for lowering immunity (it takes up to 6 months for immunity to be restored). Did they think to check his immunity?

Instead of normalizing sickness, maybe they should try to find out what caused it: there are tests to check if the immunity is too low: ''Testing for an antibody deficiency (or humoral immune function)The standard screening tests for humoral immune function start with measuring immunoglobulin (Ig), or antibody, levels in the blood serum. These consist of IgG, IgA, IgM, and sometimes IgE levels. The results must be compared to age-matched controls.
https://primaryimmune.org/understanding-primary-immunodeficiency/diagnosis/laboratory-tests#:~:text=The%20standard%20screening%20tests%20for,tests%20for%20specific%20antibody%20production.

For children repeatedly sick, immune deficiency tests exist, not to be confused with immunology tests when they check for a specific virus.

In my mind normalizing repeated illness is never an ethical solution. Why do we need medicine - to teach us to accept it, or to find the cause, to learn about prevention and real treatment? Treatment for a virus is antiviral, not used int he UK though for some strange reasons, despite being standard medicine in America https://www.telegraph.co.uk/global-health/science-and-disease/at-least-550-million-of-covid-drugs-wasted-in-the-uk/

America: '' Your healthcare provider may give you antibiotic medicine for tonsillitis caused by bacteria. He or she may give you antiviral medicine to treat tonsillitis caused by a virus.'' What was the name of the bacteria they found?

I was told recently by 2 different people that they have stopped removing tonsils in children with recurrent tonsillitis because they found that any infections were stopping at the tonsils, and once removed infections were moving further down the body making it more dangerous. One friend didn’t actually believe her GP so she asked a doctor from back home (she’s originally from another country) and was told the exact same thing. Another friend said the only way her son could get it done was privately.

Our experience of tonsillectomy due to recurrent tonsillitis has been nothing like this. DD had severe tonsillitis every other week with a raging fever, completely unable to function, losing weight and a real shell of her former self due to constantly being so ill. Once she had them removed within a few weeks she was back to being a normal 19 year old. It’s been 18 months now and the only time that she has been sick since was with Covid in the summer, she hasn’t even caught a single cold or anything at all this winter so actually an improvement on a typical year.

https://www.england.nhs.uk/wp-content/uploads/2023/10/decision-support-tool-making-a-decision-about-recurrent-tonsillitis-in-children-and-adults.pdf Is this their solution to the inhumanely long ENT lists:more than 52 weeks waiting lists- that's the way to bring them down for sure! Despite the NHS guidelines for ENT referrals being 18 weeks? Normalizing illness and reducing access to care will definitely make NHS efficient again! Tonsils are the site for many infections: a real doctor would think about how to reduce infections, not how to normalize them

@goldenretrievermum5 I would hope that if one of my kids kept getting it then we’d have the option to remove them too. But unfortunately it doesn’t appear to be an option on the NHS now! I really suffered when I was young and had them out. No further problems. And getting it as an adult sounds awful. It’s such a shame that it’s so difficult to request now.

The criteria for removal is a lot stricter than it used to be but in itself this isn’t a bad thing. I’d question even a private consultant who didn’t follow the NICE guidelines as tonsillectomy isn’t something to take lightly. At least where we are (NI) kids who qualify are regularly referred for tonsillectomy on the NHS and do receive it, albeit after a period of time spent on waiting lists of course

Are there any other issues that might point to a tonsillectomy eg snoring and tiredness even when not ill (possible sign of sleep apnoea)

Unlike pp I do think private ENTs will perform tonsillectomy at a lower “bar” than on the NHS. Sad to say this but I believe the NHS criteria are based partly on budget restrictions, so only the worst cases are treated, not purely medical evidence.

My DD was treated by a (very good and well respected) private ENT who is also an NHS consultant. He uses the exact same criteria for his patients on the NHS and in private hospitals - not to follow the research based NICE guidelines would be doing people an injustice and I would avoid a consultant who didn’t. DD had to have 9 cases of tonsillitis that year before he would consider taking them out, just like on the NHS. Unnecessary surgery is good for nobody

Ok. In France (for example) the bar is lower - 5 cases in one year. In Germany it is 6 cases. I don’t believe French and German children are medically different from British. Of course “unnecessary surgery” is a bad thing but views on when surgery becomes necessary will vary.