The procedure should only be decided upon when there is an indication. The myth about the tonsils as protectors of the lower respiratory tract still exists, but it is only partly true.
Tonsils, tonsils or tonsils are synonyms for lymphatic tissue located at a strategically important place called the aerodigestive junction, i.e. the junction of the respiratory and digestive systems.
Although when tonsils are mentioned, the first thing that comes to mind is the palatine tonsils or tonsils, there are four other tonsils. These are the so-called third tonsil or tonsil of the nasopharynx and two tonsils around the mouth of the Eustachian tubes (also in the nasopharynx, and they are in contact with the mentioned third tonsil) and the sixth tonsil, that is, the lingual tonsil that starts from the root of the tongue and descends towards the lower pharynx.
The aforementioned aerodigestive junction is the place where the greatest intake of various antigens, viruses and bacteria occurs in the first years of life. Each new antigen is registered in this immunologically active tissue, and for each subsequent encounter with it, an immune pattern of defense against that antigen should be built. In other words, this is where the immune system learns to recognize “attackers”.
Absolute and relative indications for the procedure
Tonsillectomy or surgical removal of the tonsils is the most frequently performed surgical procedure in history, and it has remained so until today, although the number of procedures is decreasing. According to the Croatian guidelines for tonsillectomy, there are absolute and relative indications.
Absolute indications are:
- recurrent tonsillitis, five or more times a year
- permanent airway obstruction by hypertrophic tonsils
- complications of tonsillitis such as peritonsillar abscess or sepsis
- obstructive syndrome with sleep apnea
- suspicion of a malignant disease
Among the relative indications are chronic tonsillitis, that is, tonsils that are chronically changed and often cause a sore throat and bad breath due to the accumulation of food in the niches that exist on their surface. This is, as a rule, an indication for adults.
Another relative indication is a bad bite that requires the wearing of orthodontic braces, and for this the absolute patency of the upper airway is required so that the child can ideally breathe through the nose even with the mouth closed.
Only bacterial tonsillitis is counted
For the first indication, i.e. five or more tonsillitis per year, it should be known that only tonsillitis that is proven or probably bacterial is counted.
More than 80% of sore throats are caused by various viruses. Even healthy children, who can have up to eight acute infections of the upper respiratory tract per year (including inflammation of the tonsils), are mostly sick with some respiratory viruses. Those viral inflammations of the tonsils are not counted in the quota of five or more tonsillitis per year.
The operations are no longer the same
The trend of tonsillectomy has been on the decline in recent decades. The reason for this is a change in medical approaches in the wake of minimally invasive medicine, but primarily a change in the pathology of the population.
For example, thirty years ago in Croatia, the most common indication for tonsillectomy was recurrent streptococcal angina; 80 to 90% of children were tonsillectomy for this indication. Today, the leading indication is permanent airway obstruction; therefore, large tonsils that are not inflamed, but interfere with the child’s normal breathing, and often the swallowing of solid food.
It is precisely for this reason that the procedure itself changes. Thus, a large part of the former tonsillectomies, i.e. operations in which the entire tonsillar tissue was removed, has today been replaced by tonsillotomy. This procedure removes only that part of the tonsillar tissue that protrudes beyond the palatal arches. In this way, the obstruction of breathing is solved, but there is still enough immune-competent tissue that performs its defensive role.
When to decide on surgery?
The procedure should only be decided upon when there is an indication. It used to be the opinion that the tonsils of the nasopharynx should not be removed before the age of two, and the palatine tonsils before the age of three. Of course there may be a reason to do it before that age, though not as often.
When there is an indication for surgery on only the third tonsil (the tonsil of the nasopharynx, i.e. the tonsil that is behind and above the soft palate and is not visible when the child opens the mouth), only that tonsil is removed. If there is an indication for palatal tonsil surgery, the third tonsil is always removed “as a package”. The third tonsil normally disappears spontaneously during puberty, unlike the palatine tonsils, which shrink but do not disappear.
The real truth about tonsils and lower respiratory tract protection
The myth of the tonsils as protectors of the lower respiratory tract still exists, and it is partly true. But it has not been proven that the child will get frequent bronchitis and pneumonia after tonsillectomy.
Namely, tonsils have their immune value until about the seventh year of life, after which they turn into connective tissue that no longer produces antibodies and has no immune value.
Of course, this is not a reason to remove them, but it is good to know in understanding the myth about their “lifelong” importance for the defense of the lower airways.
Recovery after the procedure
The post-operative course for a completely removed palatine tonsil lasts two weeks and is always painful, especially in adults. Often there is reflex pain in the ears, which has nothing to do with an ear infection, but with the fact that the same nerve innervates both the pharynx and the middle ear.
In those 14 days after the operation, the beds are covered with cheesy deposits that are fibrin and are typical in the healing of the mucous membrane. There is also unpleasant breath from the mouth, which is related to the healing process, but also to the type of diet.
During this period, the food should be mushy or ready-made preparations containing the necessary energy-electrolyte ingredients should be taken. In the first days after surgery, it is necessary to take analgesics – paracetamol and ibuprofen in combination.
Find more professional advice at the polyclinic for the diagnosis and treatment of ear, nose and throat diseases and for minimally invasive aesthetic surgery of the head and neck in Alba Rubra.
This text was created in collaboration with portal “ADIVA – your portal for health”
