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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.

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