In a discussion with a new patient recently, the typical question came up regarding her child's frequency of infections and general "pattern" of being sick off and on. All to often that is the common situation assumed for a child. When this "pattern" occurs one has to assume that some type of "compromise" is occurring, and in children (and adults) this can often start with CONGESTION.
Over the years I have been in practice, my goal has always been to look for reasons if a child has a history of congestion. There are many important reasons for this. When a child has a history of frequent ear infections one often hears it is due to a child's anatomy. To a large degree that is true. The Eustachian tubes (the inner passage from the middle ear to the back of the nasal pharynx) in a child tend to be somewhat horizontal, where with maturity they become more vertical. The law of gravity does not help a child as much as an adult. Any congestion/blockage of this airway is harder for a child to overcome. Therefore with colds, allergies, and other illnesses causing congestion it is easier for a
child's middle ear (and sinuses due to the smaller anatomical openings) to become filled with fluid and/or become infected. As the child grows up the Eustachian Tube becomes larger and increasingly vertical. One cannot stop the routine number of colds any given child is going to get, it's part of a child growing up and developing there immune system. However it is well known that whenever one has a cold or other infection there is a relative immune suppression for between 2 - 3 weeks. If a child doesn't have a chance to fully clear between infections (i.e. if allergies are active) that child becomes an easier set up for another infection. I was not surprised that this child's previous doctor had not asked about congestion, nor was I surprised when the mother confirmed the child had a history of chronic congestion; as the original question began with one about what to do with the tonsils. Her previous doctor kept mentioning the tonsils and the mother wondered whether they should come out.

In reality I probably see few if any children in whom the question of the "tonsils" comes up who are not allergic to some degree. The tonsils are part of our immune system and are involved in a protective role. Unlike the old days, we do not rush to take tonsils out anymore, as there is significant evidence that if taken out before 5 or 6 years old the chances of allergies later in life increase, but many allergists will say there is no safe dividing line to escape this problem. Likewise, there are now increased questions regarding there function in our immune system long term. As noted above, one of the problems here is that it usually seems that a child who has persistent tonsils has allergies, therefore what comes first "the chicken or the egg?" Many specialists now advice not to remove the tonsils unless they stay chronically enlarged, even between "acute episodes" and become the site and origin of recurrent infections. Since there is so much doubt in this area, I believe it is safer to leave the tonsils in (as part of our immune system) unless there is an absolute need for there removal (and I will only trust the opinion of specialist who I know will evaluate the issue completely).