Cases requiring tonsillectomy: (1) recurrent episodes of chronic tonsillitis; (2) those with a history of peri-tonsillar abscess; (3) those with excessive tonsillar hypertrophy that hinders swallowing and inhalation; (4) patients with rheumatic fever, nephritis, arthritis, rheumatic heart disease, etc., in which the tonsils are suspected to be the focal point; (5) unexplained long-term low-grade fever and the presence of chronic tonsillitis; (6) various benign tonsillar tumors (in case of malignant tumors, the medical history should be carefully selected).
Tonsillectomy can significantly improve the quality of life of patients with chronic tonsillitis, mainly because before the surgery the tonsils had to be attacked more than 3-6 times a year, each attack had to delay 2 weeks of school or life, and antibiotics had to be applied, which was costly. These conditions improve significantly after the surgery. Therefore, for patients who need tonsillectomy, they should still listen to their doctors and undergo surgery.
So, why do you as an ENT surgeon remove your tonsils? There must be one or more of the above situations, where the tonsils and adenoids are not only no longer useful, but also very harmful, so we mostly discuss whether to remove the tonsils in such cases. It is a big misconception. In fact, every otolaryngologist is of the opinion that “if you can do it without cutting, you should do it later, but if you have to do it, you should do it as soon as possible”.
Secondly, is it true that the immune function of children decreases after removal of tonsils and adenoids? Since the 1990s, a large number of foreign and domestic clinical basic studies have shown that there is no significant difference between the immune function in the near and long term after removal of tonsils, while for children with long-term recurrent tonsillitis, the immune index is enhanced after removal. Too much foreign literature has pointed out that children show a significant decrease in IgA, IgG, and IgM within 1 month after surgery; in other words, the immune function decreases at this time. However, after 2 months postoperatively, IgA first rebounded and gradually returned to preoperative levels. At 6 months after surgery IgG and IgM also gradually recovered. In other words, 2 months after surgery, the immune function declined and reached the bottom, and then gradually rebounded and reached the preoperative level by 6 months after surgery. Many scholars in China have also studied the “long-term changes of immune function from childhood to adulthood after removal of tonsils and adenoids”, and concluded that except for the enlargement of the pharyngeal cavity and a slight increase in the incidence of pharyngitis after tonsil removal, there is no difference between the immune indexes and the control group (i.e. normal people). This indicates that the removal of tonsils and adenoids has no significant effect on the immunity of the human body in the future. It was further found that in children with recurrent acute tonsillitis, timely removal of tonsils resulted in a significant increase in the immune indexes compared with those before surgery, indicating the necessity of timely removal under certain circumstances.
We have already come to the conclusion that the removal of tonsils and adenoids has little effect on the immune function of children, what is the reason for this? In fact, there are many lymphatic organs in the human pharynx, including tonsils, adenoids, pharyngeal lateral cords, tongue root tonsils, pharyngeal lymphatic follicles, pharyngeal bullae tonsils, etc. They are arranged in a circular pattern in the pharynx – called the inner ring, in addition to the outer ring of lymph, all of which are immune organs of the human body. The human body is adaptable, so the change in immune function after removal of the tonsils is not significant.
To summarize my personal opinion, normal or physiologically enlarged tonsils and adenoids do not need to be removed, and this need not be discussed; while tonsillar abscesses, benign tonsillar tumors, and tonsillar keratosis must be removed as soon as possible, and this need not be hesitated. For pathological hypertrophy of tonsils or focal tonsils, conservative treatment should be considered first, but if it is ineffective, timely surgery should be considered, and this common childhood disease cannot and should not be treated as a cured disease.