From the Research
Tonsils and ear infections are closely linked due to their anatomical connection, and the most recent evidence suggests that tonsillectomy may be recommended for patients with recurrent ear infections and chronically enlarged tonsils, as indicated by the 2023 study 1. The tonsils are located near the Eustachian tubes, which connect the middle ear to the back of the throat. When tonsils become infected or enlarged (tonsillitis), they can block these tubes, preventing proper drainage of fluid from the middle ear and leading to ear infections (otitis media). This connection is particularly significant in children, whose Eustachian tubes are shorter, more horizontal, and narrower than adults', making them more susceptible to this problem.
Some key points to consider in the management of tonsils and ear infections include:
- The use of a scoring system, such as the Centor, McIssac, or FeverPAIN score, to estimate the probability of bacterial tonsillitis, mainly due to group A streptococcus (GAS) 1.
- The consideration of tonsillectomy for patients with recurrent acute tonsillitis, with indications including ≥7 adequately treated episodes in the preceding year, ≥5 such episodes in each of the preceding 2 years, or ≥3 such episodes in each of the preceding 3 years 1.
- The importance of postoperative pain management after tonsillectomy, with options including acetaminophen, ibuprofen, and narcotics, as well as adjunctive medications such as perioperative dexamethasone, ketamine, and local infiltration of lidocaine into tonsillar pillars 2.
- The potential benefits of adenotonsillectomy (removal of both tonsils and adenoids) for patients with recurrent ear infections and obstructive sleep apnea 3.
Overall, the management of tonsils and ear infections requires a comprehensive approach that takes into account the patient's individual needs and medical history, as well as the most recent evidence-based guidelines and recommendations.