Tonsillectomy-strong indications
1. Carcinoma of the tonsil. The best technique for optimal results from biopsy and staging requires complete removal of the tonsil.
2. Peritonsillar abscess (PTA) . A bacterial abscess, PTA is most often caused by anaerobic organisms. Incision and drainage is mandatory. Recurrent abscess rate is 10% and recurrent abscess may be fatal. Therefore, the tonsil should be removed. This may be done at the time of the initial PTA presentation or may be done electively 6 weeks later.
3. Congestive heart failure. Failure of the right-side of the heart can be caused in young children by a constant upper airway obstruction (SDB/OSA). This is reversed by tonsillectomy.
4. Tonsillitis causing respiratory difficulties, dysphagia, and requiring hospitalization. Any episode of tonsillitis causing respiratory embarrassment, or so severe that hospitalization is required, is best treated by elective tonsillectomy 6 weeks after the episode.
Tonsillectomy-philosophic indications
1. Recurrent tonsillitis. It is currently believed by most otolaryngologists that a patient having four or more episodes of tonsillitis a year for at least 2 years that necessitates their missing 10 or more days a year of school or work will benefit from a tonsillectomy.
2. Sleep disturbances. Sleep disordered breathing/obstructive sleep apnea, and snoring can be caused by upper respiratory tract lymphoid tissues that prolapse into and obstruct the airway during sleep. In these cases, tonsillectomy, adenoidectomy, and even partial palatectomy with uvulectomy (UP3) may improve the airway.
