Tonsillectomy in 2005
ABSTRACT During the past years, the number of tonsillectomies (only palatine tonsils are taken off) has decreased, indications for surgery have changed. A multi-disciplinal group of paediatricians tried to elaborate the state of the art in the field. Tonsils are the first line defense of high respiratory tract. The immune functions of their lymphoid tissue are multiple: mucosal antigens capture, presentation to lymphocytes, antigens specific proliferation of lymphocytes T and B, differentiation of lymphocytes in effectors lymphocytes and immune lymphocytes. Epithelial cells on the tonsils' surface express non-specific defense. These facts explain partly tonsils' hypertrophy. Tonsillectomy has no general immune consequences. In 2002, in France, 75,000 tonsillectomies were realized, of which 90% were in children. Tonsil's hypertrophy is the major indication, mandatory when sleep apnoeas exist. The main historical tonsillectomy indication for recurrent tonsillitis should decrease due to a more precise diagnostic (rapid test at bed site), an efficient antibiotics therapy and better care for pain. Other indications are scarce. Surgery, feasible from 9 months of age, requires a brief general anaesthesia and has very few contra-indications. The technique, operator dependent, relies on his experience. The only potentially severe complication is an haemorrhage due to scab fall between the eighth and twelfth days. It requires explanation and a written note given to parents. The possibility of lack of feeding and voice modification, usually transitory, should be known. Multiple consequences of tonsillectomy especially allergy have been alleged. Since the years 1980, it is well established that pre-existing allergy or asthma are not a contraindication. More, its deleterious impact on allergic children has not been demonstrated. Last, a gain of weight post-tonsillectomy is possible and could become a risk if excessive.
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ABSTRACT: Introduction: Quality assurance in health care involves the evaluation of outcomes, cost-benefit ratios, and access to the delivery system. This literature review was undertaken to clarify the incidence of serious posttonsillectomy complications to better understand the outcome component of quality assurance. Material and Methods: A Medline review was undertaken using the key word 'tonsillectomy' AND each of the following: 'serious', 'complications' and 'review'; 'meta-analysis', 'Cochrane'; 'life-threatening', 'death' and 'disability'. Results: 454 articles were identified with the following search items in combination with 'tonsillectomy': 'serious' (154), 'complications', 'review' (24), 'meta-analysis' (38), 'Cochrane' (43), 'life-threatening' (87), 'death' (91), 'disability' (17). Sixty-seven articles described a complication rate and were therefore eligible for review: 22 case reports, 9 case series, 2 questionnaires and 33 studies with a more or less precise complication rate were obtainable. Most articles (n = 30) reported the rate of posttonsillectomy hemorrhage with a considerable range. Fifteen articles reported the incidence of death, which ranged from 1:7,132 to 1:170,000 and almost always resulted from excessive hemorrhage. All other complications were mentioned in case reports. Conclusion: The most common postoperative complication of tonsillectomy is bleeding. However, the incidence varies considerably across studies depending on the study design, follow-up and definition of postoperative bleeding. Other serious adverse events, such as neurological disabilities, emphysema (with or without pneumomediastinum), or vascular problems outside the neck are infrequent.ORL 01/2013; 75(3):166-73. DOI:10.1159/000342317 · 0.67 Impact Factor
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ABSTRACT: Bilateral hypertrophy of the palatine tonsils can be either an acute or chronic a condition. Chronic hypertrophy is now more and more frequent, and it usually affects children of less than five years of age who otherwise may not have pharyngitis often. The etiology and pathogenesis of tonsillar hypertrophy are not clear. Two hypotheses are currently the most accepted: the first, the deleterious effects of pollution, and the second, inflammation in the upper airways. When ventilation is affected, particularly during sleep, corticoids are the recommended treatment for the acute form and tonsillectomy for the chronic form. It should be noted that that intervention has no immunoallergic consequence, even in very young infants.Journal de Pédiatrie et de Puériculture 03/2008; 48(2):91-94. DOI:10.1016/j.allerg.2008.01.006