Indications for Tonsillectomy

Who should do tonsil surgery?

In the photograph above, the surgical field photograph (bottom photograph) is seen after the tonsillectomy operation performed on a patient with tonsils large enough to touch each other (kissing tonsils - upper photograph). After the tonsils were removed, the anterior and posterior plicae were sutured with absorbable suture.

In the last published guide, the patients who should undergo tonsillectomy (indications for tonsillectomy) are as follows:

- Recurrent tonsillitis

. Inflammation of tonsils 7 times a year and more
. Inflammation of the tonsils at least 5 times in each year in the last 2 years
. At least 3 times each year in the last 3 years to have tonsillitis

Among the children in this group, especially with throat cultures, surgery can be planned at an earlier stage in case of throat infections due to A ß-hemolytic streptococcal bacteria despite treatment.

This long-term indication of recurrent throat infections can be changed to the following three conditions:

1. Multiple antibiotic allergies (as a complication of tonsillitis)

2. In the presence of a specific clinical picture such as PFAPA (periodic fever, aphthous stomatitis, pharyngitis and adenitis). In this picture, tonsil and nasal surgery is the most effective treatment (recurrent episodes of severe tonsillitis and antibiotics are not enough, cortisone fever drops dramatically).

3. Peritonsillar abscess. In this case, inflammation accumulates in the range outside the tonsils. Because this risk of recurrence may cause a more serious and more serious infection than tonsillitis, tonsillectomy can be planned earlier.

- Sleep breathing disorders

In the photo above, in the patient who underwent tonsillectomy + adenoid removal surgery, the red arrows indicate the tonsils and the blue arrow indicates the adenoidectomy specimen.

Especially in patients with large tonsils, symptoms such as sleep apnea, snoring and decrease in sleep quality may occur. In children with sleep apnea syndrome, unlike adults, the disease is usually caused only by tonsil and adenoid enlargement. Therefore, sleep test (polysomnography) is not always necessary in children with witnessed sleep apnea and sleep breathing disorder. Tonsillectomy and adenoidectomy operations are planned together in children with tonsil hypertrophy and adenoid enlargement during the examination.

In addition to the cases presented above, where tonsillectomy is necessary, tonsil surgery is performed for diagnostic purposes, especially in adult patients, if there is significant asymmetry between the tonsils and this asymmetry increases over time.

Source: AAO – HNS Guidelines for Children and Adolescents - http://www.aafp.org/afp/2011/0901/p566.html

On this website, you can read articles previously prepared by Dr. Murat Enöz about tonsillectomy. >> https://www.ent-istanbul.com/search?q=tonsillectomy

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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