"Because of stringent tonsillectomy guidelines some kids who could benefit from tonsil removal surgery arent getting it two new reviews suggest. To qualify for the surgery a child must have many recurring throat infections within a short span of time or severe sleep disturbances said Dr. Sivakumar Chinnadurai a coauthor of the reviews. An evaluation of current medical evidence suggests more kids would receive significant shortterm improvement in their daily life if the guidelines were relaxed said Chinnadurai a pediatric otolaryngologist with Vanderbilt University Medical Center in Nashville. Children experienced nearly half as many sore throats when they underwent a tonsillectomy even if they didnt meet the guidelines Chinnadurai and his colleagues found. The kids also missed fewer days of school and were less likely to need medical care. However this strong benefit only applies to the first couple of years following surgery Chinnadurai said. By the third year there was no clear benefit in terms of the number of throat infections. Also there was limited research on longterm results. The decision about whether those children should have tonsillectomy for that temporary benefit is really tied to what those children need or what theyre suffering with Chinnadurai said. Kids who miss a lot of school or need frequent trips to the doctor due to sore throats could benefit from the surgery he said. Theres an even clearer benefit for kids whose sleep is disturbed due to inflamed tonsils Chinnadurai said. In a child with a diagnosis of sleep apnea we can see a benefit in sleeprelated quality of life he said. The kids get better sleep and thus exhibit better everyday behavior and pay more attention in school. The medical approach to treating tonsil infections has evolved over recent decades. Tonsillectomy is the third most common surgery performed on U.S. children with  such procedures completed each year according to the American Academy of Otolaryngology  Head and Neck Surgery.  Thirty years ago nine out of  tonsillectomies in children were performed to treat recurring throat infections. These days the procedure is done  percent of the time for infections and  percent of the time for sleep problems according to the academy. Swollen tonsils can block the airway during sleep causing breathing problems that range from simple snoring to obstructive sleep apnea the researchers said in background notes. Guidelines say a tonsillectomy to treat throat infections is justified if a child had seven or more sore throats during the previous year five or more sore throats two years running or three or more sore throats for three years in a row according to the background notes. The researchers decided to review whether the throat infection guidelines are too stringent ruling out patients who potentially could benefit but dont meet the high threshold of recurring infections Chinnadurai said. There arent strong guidelines regarding the use of tonsillectomy to treat sleep disorders so the doctors reviewed the evidence to see whether the surgery outperformed socalled watchful waiting  monitoring the situation. The study results showed there may be new evidence that supports expanding the criteria and opening up the procedure to more individuals said Dr. Alyssa Hackett an otolaryngologist with the New York Eye and Ear Infirmary of Mount Sinai in New York City. In the right child with the right indications these are really wonderful procedures that can be lifechanging for both the child and the family said Hackett who wasnt involved with the new research. If you need your appendix out you need your appendix out Hackett said. But for the tonsils and adenoids there are great qualityoflife benefits that are evident for the surgery but no child has ever died because they havent gone through the surgery. Adenoids glands at the roof of the mouth are often removed along with tonsils.  Still Chinnadurai and Hackett warned against automatically choosing the surgery for every sore throat. About  percent of kids who undergo the procedure experience bleeding during the twoweek recovery period Hackett said. Though a tonsillectomy is lowrisk it is not riskfree and those risks need to be weighed against the benefits for each individual child Chinnadurai said. Were talking about a child who has significant sleeprelated issues Hackett said. We dont want people to say my child snores they need to have their tonsils out. Thats not what this study says at all. The two reports were published online Jan.  in the journal Pediatrics. More information For more on tonsillectomy visit the American Academy of Otolaryngology  Head and Neck Surgery httpjournals.sagepub.comdoifull.. SOURCES Sivakumar Chinnadurai M.D. MPH pediatric otolaryngologist Vanderbilt University Medical Center Nashville Alyssa Hackett M.D. otolaryngologist New York Eye and Ear Infirmary of Mount Sinai New York City Jan.   Pediatrics online"