HEAD AND NECK

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The tonsils constitute a part of the lymphatic, immune system of the organism.  In the same area and having the same function, there are the adenoids, and the lingual tonsils.   During childhood, the tonsils help in the completion and maturity of the immune system, by creating casts for the production of antibodies against harmful germs and bacteria for the organism.  This procedure is considered complete by the end of childhood, when consequently the tonsils gradually regress.

Because of their central position in the entrance of the digestive and respiratory systems, the tonsils often cause problems, which, sometimes, are rather serious.  A main cause of problems from the tonsils is their frequent inflammations.  Another cause of problems has to do with their size.  Many times, however, the problems of the tonsils are magnified by the patient himself, or they are overestimated by the doctor.  Other times, we easily attribute to the tonsils, as if they were scapegoats, several health problems, which in reality have very little or nothing to do with them.  This leads to frequent operations for the removal of the tonsils, without, however, achieving the expected results.

The frequent episodes of acute tonsillitis constitute a strong indication for the removal of the tonsils.  Theoretically, we have to have a frequency of three to four episodes per year, in order to finally choose tonsillectomy.  Of course, we do not only take into consideration the frequency but also the gravity of the episodes and the accessibility to medical services.  The formation of peritonsillar abscess also constitutes a strong indication for tonsillectomy.

Another strong indication for tonsillectomy is the hypertrophy of the tonsils to the degree that it causes snoring and mainly episodes of apnea during sleep.  In this case, we need to look for possible other causes of the obstructive syndrome, in both the oral cavity and the nasal cavity, while quite often the removal of the tonsils is only a part of the treatment.

In the strong indications for the removal of the tonsils we, of course, need to add also the possibility for tumour development, neoplasia.  Contrary to that, there is a large group of obscure symptoms, which should be examined carefully and with great scepticism, before they are attributed to the tonsils.  Frequent pharyngitis, problems with swallowing, intolerance to cold weather, a feeling of easy fatigue, vague pain in the joints or even psychological unbalance, are some of these problems.  The same is true for bad breath, halitosis, which may be caused by the tonsils, without, however, this being the only reason.

Neither the appearance of the tonsils nor the lab exam constitute absolute criteria for resorting to tonsillectomy.  Most of the times the tonsils we remove look normal and only the history shows their pathology.  On the other hand, examinations, such as the antistreptolysin test, known as ASTO, may remain high even after the removal of the tonsils.

Provided we have the correct indications, the age of the patient is not a factor to consider in deciding to proceed with tonsillectomy.  Nevertheless, it is logical that our criteria should be harsher when we deal with young and old ages.  Our reluctance to remove the tonsils in young patients is given.   However, on no occasion has it ever proved that children who have undergone tonsillectomy have any problems with their immune system.  In addition, in our decision, we always take into consideration and the general health condition of the patient.

Tonsillectomy is a simple operation.  What is important is the correct selection of patients.  The complications are minimal.  The patient has to be prepared for a difficult postoperative period with intense pain in swallowing and speech, which will last about a week.  Also, he/she has to be prepared for and have received specific instructions about the possibility of postoperative bleeding