With over 500,000 tonsillectomies occurring per year in the United States (1), researchers regularly search for opportunities to save the tonsils. Two of the more common reasons that surgeons remove tonsils are recurrent throat infections and sleep-disordered breathing patterns. Like any surgery, multiple complications may occur and thus avoiding the surgery is a better option if possible (1). A variety of attempts, including different nose sprays, have been made to avoid this surgery. Many thought that steroid nasal sprays made a lot of sense with the intent to shrink tonsils. In this study, a simpler approach of a saline nasal spray turned out to be just as effective.
We are all born with tonsils and adenoids in the backs of our throats. These pockets of lymphatic immune tissues sit in a circle around the airway to monitor various particles and microbes attempting to enter our bodies. They serve a function but become an anatomical problem when they grow too large. Given the need for an airway to permit airflow, the increasing size lessens the space for air to pass from mouth or nose into the lungs. When repeated infections continue to increase the size without allowing time for shrinkage, either the sheer fact of repeated infections or the airway blockage gets the attention of parents and the ENT surgeons (Ear, Nose, Throat or otolaryngologists). Then a removal of this immune tissue may be in order.
As their mechanism of action, anti-inflammatory steroids generally lower inflammation and swelling in the areas they are applied. Steroids may be taken by mouth to lower inflammation wherever it occurs in the body or can be applied directly to one area for optimal effect and minimal systemic side effects. Systemically, they can cause high blood sugar, high blood pressure, depressed immune system, poor wound healing, weight gain, and other issues. The hope would be that the steroid would shrink the tonsils by shrinking the pocket of immune system cells, preventing the airway obstruction.
Even with the localized application of steroids, side effects are still possible. Dry nasal passages, irritation, bleeding, and other issues may occur. Researchers wanted to explore whether or not a saline nasal spray to remove antigens from the tonsils and adenoids might be similarly effective with the side effects. They looked at 276 children between the ages of 3 and 12 years old at The Royal Children’s Hospital and Monash Children’s Hospital. The findings published in the JAMA Pediatrics journal was encouraging.
For these 276 children waiting in Australia for the national health service there to work them through the ENT tonsillectomy process, they evaluated if 6 weeks of a saline nasal spray could be a better first line therapy. They compared the saline spray with steroid nasal spray and found that they both lowered symptoms in 40% of patients as well as decreased by half the need for surgery.
Now, getting young children to take any spray up there nose 2 or 3 times a day can be challenging, especially for the young children. Compliance for weeks with even simple therapies can be a challenge. However, telling parents that they may decrease by half the risk of surgery may motivate parents to be creative and diligent. Interestingly, in looking at the side effect profiles, nose bleeds and nasal irritation were actually higher in the saline groups than the steroid groups. Even natural therapies have side effects at times.
For parents considering tonsillectomies for their children, they should ask their pediatrician about 6 weeks of nasal saline spray. Many times, this is an appropriate trial before ENT surgeon referral. Be aware however, that sometimes the problem may already be too severe. Children with severe sleep apnea due to large tonsils and adenoids may have missed their window for this to work
For functional medicine providers, we can be encouraged once again that the simple therapies sometimes are very effective in restoring our patients to healthier more abundant lives.
Alice Baker, Anneke Grobler, Karen Davies, Amanda Griffiths, Harriet Hiscock, Haytham Kubba, Rachel L. Peters, Sarath Ranganathan, Joanne Rimmer, Elizabeth Rose, Katherine Rowe, Catherine M. Simpson, Andrew Davidson, Gillian Nixon, Kirsten P. Perrett. Effectiveness of Intranasal Mometasone Furoate vs Saline for Sleep-Disordered Breathing in Children. JAMA Pediatrics, 2023; DOI: 10.1001/jamapediatrics.2022.5258
Thanks to Science Daily:
Murdoch Childrens Research Institute. “Simple nasal spray significantly reduces snoring and breathing difficulties in children.” ScienceDaily. ScienceDaily, 17 January 2023. <www.sciencedaily.com/releases/2023/01/230117110505.htm>.
- Bohr C, Shermetaro C. Tonsillectomy and Adenoidectomy. [Updated 2022 Aug 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536942/
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.