Sunday, February 22, 2009

Reasons for tonsillectomy

The commonest reasons for tonsillectomy are:
1. recurrent or chronic infections of the tonsils. Most physicians and insurance companies think that at least three documented tonsil infections despite medical therapy are necessary before tonsillectomy should be considered. It is helpful also to document the presence of Group A strep bacteria using cultures or swabs. Sometimes patients get bad breath (halitosis) from food and bacteria that trapped in the outer lining of the tonsils.
2. obstructive sleep apnea. The symptoms are snoring and daytime fatigue.
3. asymmetric tonsils. The commonest cause by far is scarring from recurrent infections. However if there is growth, then there is a slight chance a tumor could be growing inside. The same applies to large lymph nodes in the neck itself. Removal of the tissue for pathologic examination should be considered to be certain.
4. peritonsillar abcesses. There is a potential space between the muscles of the pharnyx and the tonsils. Rarely severe tonsil infections invade this space, may cause one-sided swelling of the tonsils, difficulty swallowing, difficulty speaking, and the uvula pushed to one side. The old name for this is "quincy."

The number of tonsillectomies has dropped sharply for several decades before rebounding mildly in the last decade. Before antibiotics became available, recurrent tonsillitis was common. Tonsillectomy was and is an effective therapy. Now we have better diagnositc tools (strep throat tests) and medications (antibiotics, anti-allergy), so fewer people develop recurrent tonsillitis. The recent rise is from better diagnosis of obstructive sleep apnea and despite medical treatments. Otolaryngologists are the only surgeons that do tonsillectomies. More information is here.

If you have questions about tonsillectomy, ask your doctor...

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