Tonsillitis - Surgery

Were your tonsils removed? If so, how was this decision made (did you have recurrent infections, sleep apnea, etc.)?

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When should the tonsils and/or adenoids be removed?

Tonsillectomy and adenoidectomy are indicated in persons with repeated or persistent infections, particularly if they interfere with everyday activities. The American Academy of Otolaryngology defines repeated infections in children as seven episodes in one year, or five episodes in each of two years, or three episodes in each of three years.

Tonsillectomy and adenoidectomy are also warranted in situations where there is enlargement of the tonsils and adenoids to such an extent that it causes severe sleep problems (snoring and breath holding), sleep apnea, dental abnormalities, and difficulty swallowing. Adenoid enlargement alone, or in combination with tonsillar enlargement, can cause nasal obstruction, recurrent ear infections, or sinusitis. If these conditions are resistant to medical therapy, surgery is indicated.

A significant episode of tonsillitis is defined by one or more of the following criteria: (1) a temperature greater than 101 F (38.3 C); (2) enlarged or tender neck lymph nodes; (3) pus material coating the tonsils; or (4) a positive strep test.

In adults, the severity, frequency, and hardship associated with repeated infections are considered more important than the absolute number. Chronic infections characterized by bad breath and/or tonsillar stones causing significant disability are also indicators for tonsillectomy.

Tonsillectomy and adenoidectomy are strongly considered in those patients who are suffering, or may suffer serious complications of infection. These include peritonsillar abscess, history of streptococcal complications (rheumatic heart disease, glomerulonephritis), or neck abscess. Suspicion of malignancy or tumor is a definite reason for surgery.

In should be emphasized that all decisions for or against removing the tonsils or adenoids are dependent upon the individual patient's particular situation. Additional factors, such as tolerance of antibiotics, concurrent medical problems, school achievement/progress, and family preferences are also important factors in the decision process.

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