Tonsillectomy & Adenoidectomy
There is a lot of controversy
regarding tonsillectomy surgery. One group of
physicians say that the tonsils should not be
touched and ENT surgeons advise tonsillectomy.
A Knowledge of anatomy of the tonsil may clear many
doubts. Tonsils have 15-20 spaces built in them
called crypts. The bacteria can stay in these crypts
for months or years untouched by systemic
antibiotics. When the environment is conducive, the
bacteria multiply and infect the whole tonsil, when
we call it a tonsillitis.
The basic function of the tonsil is sampling of
bacteria and virus that are present in ingested
food. Similarly the Adenoids which are present at
the back part of the nose trap bacteria and virus
which are inhaled through the nose. With samples
trapped by both tonsils and adenoids the immune
system produces antibodies. This function is
important in the first 4 years of life, after which
the other organs such as bone marrow, spleen etc
take over this function. For this reason the tonsils
are compared to policemen guarding the throat. But
when the policemen guarding the throat, start
stealing, the good health of the child, they should
be removed. The tonsils and adenoids can be removed
safely after the age of 4 years.
There is no particular advantage in removing the
tonsils by laser or radiofrequency. Any knife which
does not produce bleeding means it is burning or
destroying all the tissues in the vicinity. More
tissue destroyed will produce more pain and
morbidity. Cold steel instruments are still the best
for tonsillectomy. The recovery is faster.
Adenoidectomy should be performed with the aid of
endoscopes. Always confirm with your doctor whether
he is doing endoscopic adenoidectomy. Complete
removal of adenoids are possible only with
endoscopes and remnants left behind when they are
removed blindly with curette alone.