Frequency and Criteria for tonsillectomy in adult patients
After having analysed the BMJ article entitled “Recurrent pharyngo-tonsillitis”1, we would like to share our experience in regards to the topic.
For a period of 20 years or more, in my medical practice as an ENT specialist, I have observed the changes in criteria that have ocurred about tonsillectomy either in children and adults since the 80s. From 6 tosillectomies carried out weekly in adult patients as an average in our ENT department the figure has declined markedly in such a way that in the latest years tonsillectomies have been performed once or twice a month in adolescents or early adults ( tonsillectomies due to malignant tumors were not included) and we wonder what has been happening.
The answer could be so simple as the controversial points that appear in medical literature with more specific and rigurous indications, consolidation of antibiotic therapy and better knowledge of the immunological role of the tonsils, aspects that have influenced our work, which uses as surgical considerations the recommendations of the guidelines of good clinical practice, guidelines that have been applied in our teaching hospital since the year 2000 and that state as criteria for tosnsillectomy the following:
1-Recurrent infections of acute tonsillitis (5-7 episodes)characterized by fever, poliarthralgias, antibiotics use and medical assistance for a one-year-peroid.
2- Tonsils hypertrophy causing swallowing, respiratory or phonological disorders.
3- Peritonsil abscess which depends on the patient’s age, family history.
These aspects depend on the medical staff experience and medical literature, but without a concluded scientific evidence that assess the efficacy of tonsillectomy. 2,3
It is routine to explain to patients the symptoms they can suffer after tonsillectomy is performed, which include irritation , pharyngeal discomfort for a certain period of time, laryngo-pharigeal-gastric reflux, environmental irritations and the presence of a hypertrophic mucus as a defense response to different noxas including the psychosomatic aspect of the patient.
Therefore, we believe that the staff related to this medical topic must continue searching for the best decision to take all factors into account in the management of the adult patient with recurrent tonsillitis who looks for medical assistance in our outpatient department.
1-Little,P. Recurrente phryngo-tonsillitis. BMJ 2007;334:909 doi:10.1136/bmj.39184.61049.80
3-Cenjor. C, Ramos A, García-Rodríguez A. Documento de consenso sobre tratamiento antimicrobiano de la faringoamigdalitis. Acta Otorrinolaringol Esp 2003;(54):369-383.
Competing interests: No competing interests