The removal of the tonsils is an ancient procedure, but along with this ancient procedure there is a seemingly never-ending debate: when should the tonsils be removed?
In 30 A.D., the Roman nobleman Annus Cornelius Census wrote a medical encyclopedia, De Re Nedicina) (in Latin), which was widely printed in Florence after 1478 and is still a classic in the study of Western medical history. According to this medical classic, tonsillectomy was already a common procedure in the time of Census. Of course, tonsillectomy at this time was still a partial excision. In the late 19th and early 20th centuries, it was noticed that the remaining tonsil tissue would grow back and the infection would not go away, so the entire tonsil and its envelope were removed, which is basically the modern tonsillectomy.
With the development of modern immunology, it was found that the tonsils have certain immune functions, and the surgical removal of the tonsils may have an impact on the body’s resistance, so the number of tonsillectomies decreased significantly for a period of time, and the essence is still the same: whether tonsillectomy should be performed in the face of specific cases.
Modern tonsillectomy has clear indications: 1, recurrent acute tonsillitis, or has caused parapharyngeal or peripharyngeal abscesses; 2, excessive tonsil hypertrophy, preventing swallowing, breathing and pronunciation; 3, lymph node enlargement in the angle of the jaw for unknown reasons; 3, diphtheria with bacterial conservative treatment is ineffective (now rare); 4, tonsil tumors or keratosis; 5, antecedent surgery for stem amputation; 6 Chronic rhinosinusitis – sinusitis suspected to be caused by tonsillitis; 7. “Focal tonsillitis”.
However, for most people’s awareness, the current indications for tonsillectomy are still mainly limited to the basic tonsil lesions such as recurrent inflammation and excessive hypertrophy of the tonsils. This is what we clinically refer to as “focal tonsillar “In this way, the tonsils can be removed as a possible focal point for these diseases to control the progression of these diseases or to reduce the chance of acute attacks, and to assist the relevant departments in the treatment of these diseases.
Of course, to perform tonsillectomy under such indications, besides a better communication with patients and their families and detailed information about the disease, it is more important to choose the appropriate time for surgery and grasp the more strict indications. For rheumatic heart disease and rheumatoid arthritis, early surgery is generally recommended. For acute nephritis, although surgery is not contraindicated in the early stage, it may lead to “provocation” phenomenon: a transient increase in red blood cells and protein in the urine or an increase in tubular pattern after surgery, so it is generally recommended to operate when the nephritis is basically restored to stability and the urine routine examination is close to normal. Hematologic disease also requires surgery in remission. For patients with hypothermia, a comprehensive examination is needed to rule out other causes before considering tonsillectomy. For chronic nephritis, renal insufficiency, bronchial asthma, etc., surgery and timing need to be chosen more carefully.
Of course, the interpretation of indications may vary slightly from one physician to another for specific cases. However, as physicians generally give treatment opinions based on the analysis of the disease itself, whether to operate or not still needs to be combined with the patient’s own opinion. In general, it is important to oppose both the “harmlessness of surgery” and the blind palliative attitude towards chronic tonsillitis, regardless of the indications for removal.
From my personal point of view, the assessment of whether to remove the tonsils is based on the above-mentioned 7 points, on this basis, combined with the patient’s age and other circumstances, and give advice: if the patient is young, considering that the tonsils have a certain physiological function, the patient may no longer develop because of further growth, development and physical improvement, the choice of surgery should be “strictly “If the patient is an adult, considering that the physiological function of the tonsils is basically decreasing and lost, and the tonsils themselves should be atrophied but cannot be atrophied because of chronic inflammation, the surgical choice should be “lenient”, especially for some young women with recurrent inflammation of the tonsils before marriage and childbirth. The surgery should be chosen “leniently” to avoid the dilemma of giving or not giving medicine to the doctor when the tonsils are acutely inflamed after pregnancy, and to make the pregnant woman and her pregnant baby in an embarrassing situation.
Most patients have a fear of tonsil surgery. In fact, with the advancement of surgery and anesthesia technology, tonsillectomy is less painful and has fewer complications, so it can be said that tonsil surgery is a technically mature and time-tested procedure, so this should not be a consideration for surgery or not.