In the clinic, we often encounter parents asking whether to remove the tonsils, and they include both those with recurrent inflammation of the tonsils and those with tonsillar hypertrophy that interferes with sleep.
Indications for tonsillectomy in children: â‘ The most common is tonsillar hypertrophy, which leads to obstructive sleep apnea hypoventilation syndrome (OSAHS), or prevents the child from swallowing and vocalizing.
(ii) Chronic tonsillitis.
(iii) relatively rare tonsillar keratosis and benign tumors, among other causes.
The following is my opinion on tonsillectomy in children.
1. The effect of tonsil removal on immune function.
The tonsils have certain immune functions. It is reported that the antibodies related to cellular and humoral immunity will decrease after tonsillectomy, but they are still within the normal range and will generally recover after six months. As the first barrier of the oropharynx against the invasion of germs, when the tonsils are removed, the lymphoid tissue in the back wall of the pharynx acts as a second barrier and takes on more responsibility when the germs come, leading to more pronounced symptoms of pharyngitis in a few children, such as sore throat, dry throat and throat clearing. Of course, we have not yet found any cases in which the removal of tonsils alone led to systemic symptoms such as immune disorders.
2. Control of indications for tonsillectomy in children.
For tonsillar hypertrophy, if it seriously affects sleep, swallowing or vocalization, there is no doubt that it should be removed. However, sometimes there are cases that can be cut or not, such as OSAHS. If parents are hesitant and do not consider the cost and time of hospitalization, it is recommended to remove only the adenoids and not the tonsils temporarily, and then hospitalize and remove them if the sleep relief is not satisfactory later.
For chronic tonsillitis. My experience is that if the tonsils become inflamed more than 6 to 8 times a year for two years, then removal can be considered. If each attack is mild and there are no other complications, you can observe and not operate for the time being.
3.Monopolar electric knife tonsillectomy.
Tonsillectomy in children is generally performed using general anesthesia with tracheal intubation. The surgical methods are: the traditional peeling method, the monopolar electric knife resection method, and the plasma knife resection method, and the latter two methods are better. Our department has been using the electric knife excision since eight years ago, the advantages of which are little or no intraoperative bleeding, reduced chance of postoperative bleeding, and significantly shorter intraoperative time. Plasma knife resection, the advantages of the same as the electric knife, the disadvantage is the high cost. At present, our department generally adopts the monopolar electric knife to remove tonsils.
4. About partial tonsillectomy.
For the tonsils that are particularly enlarged (degree III), they can be partially removed, and the surgical methods are plasma and laser. At present, only a few hospitals in China do partial tonsillectomy. There are many cystic branches and cryptic foci in the tonsil parenchyma, which are easy for bacteria to stay and multiply. Partial removal may destroy its normal structure and may lead to more chances of tonsil infection. I have seen children with partially excised tonsils in my clinic who have more enlarged tonsils and extensive cauliflower-like protrusions. In my personal opinion, complete removal is recommended for hypertrophy due to chronic tonsillitis. If it is a simple hypertrophic, convex type III tonsil that parents are eager to keep and are willing to take the risk of future hypertrophy and recurrent infection of the remnant tonsils, then partial removal may be an option.