Tonsillectomy and AdenoidectomyIt is estimated that around a million patients have a Tonsillectomy or Adenoidectomy or combinations (T and A) in thiscountry each year. Obviously this procedure has a large impacton the health of many of our children, as well as on our healthcare budget.The question of tonsils and whether patients should keepthem or lose them has divided physicians for years. Needless tosay many articles have been written on the subject and a numberof serious studies have been performed to try and determine who,if anyone, should get their tonsils out. The adenoids areclosely related to the tonsils and their importance in causingdisease has also been carefully studied. It is well known that the tonsils and adenoids are closelyrelated to ear disease in children with recurrent tonsillitisand ear infections. Research performed in the 60's and 70'sshowed that some children carry large numbers of disease causingbacteria in their throat. It was found that performing aTonsillectomy and adenoidectomy reduced the number of dangerousbacteria in these children. The most obvious change in throatbacteria was a reduction in the number of children who carriedStrep. It is important to remember, however, that viruses arefelt to be as important in recurrent tonsillitis as bacteria andthese were also reduced following tonsillectomy. The immunological systems of children with recurrent tonsildisease have been shown to maintain higher than normal levels ofantibodies. Following removal of the tonsils and adenoids theseantibody levels return to normal Adenoids are known to cause other problems besides recurrentinfections. They are located behind the nose, "above and behind"the soft palate. If they are enlarged they can block the nasalairway and prevent the child from breathing through his nose.Unfortunately, this "mouth breathing" has been associated withabnormal jaw growth. These children frequently require bracesand palate expanders to correct this problem. Modern orthodontists are aware of this problem and refer these forimprovement of nasal breathing before applying the mouthappliance. Adenoids are located next to the tube which lets air behindthe eardrum (the eustachian tube). If they block this tube, thechild will have trouble with fluid behind the ear, and possiblyear infections. This is an important problem because the eardrumis like a bass drum in that if you fill it with fluid it will notwork. Children with this problem have a hearing loss which canaffect their language development. Fortunately it is easilytreatable. The operation "Tonsillectomy and Adenoidectomy" has been asubject of controversy for years. The frequency of this operation has varied with the fashion of the times. I think that medical treatment should bedirected by knowledge and common sense, not by fashion.Obviously if a patient is not having trouble with his tonsils, they should be leftalone. If a patient does have problems with recurrent episodesof tonsillitis (more than three or four a year), or complicationsof enlarged adenoids (including ear disease or nasal obstruction)then that patient needs treatment. Dr. Douglis is a Board Certified specialist in Otolaryngology Head and Neck Surgery (Ear, Nose, and Throat). He attended the University Of Maryland School Of Medicine and completed his specialty training at the University of Maryland Hospital in Baltimore, Maryland. He has practiced medicine in Montgomery County Texas and the Houston area since 1982.
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