Tonsillectomy is one of the commonest ENT surgeries done and the school annual vacation period is the season for Tonsillectomies. Hence it is appropriate to discuss about Tonsillectomy this month.

      There is a controversy about Tonsillectomy surgery- "To do or not to do?".

      The Palatine Tonsil popularly known as the ‘Tonsil’ is the largest component of the WALDEYER"S lymphatic system around the aero-digestive entry point, and takes active part in development of immunity against common pathogens and allergens we, especially children encounter with. Every time there is a significant exposure to pathogen, the tonsil reacts and by it self gets infected and causes acute attacks of tonsillitis. But when tonsils themselves become a problem they deserve removal by surgery.

The common indications are:

1. Recurrent attacks of acute Tonsillitis characterised by septic tonsil     causing odynophagia, fever, tender - hypertrophied jugulo -     digastric nodes (I personally take this as hall mark indication )     etcatleast one attack every alternate months.
2. Difficulty in swallowing in children, resulting in poor intake leading     to lack of Weight- Gain.
3. Absentism in school due to repeated illness relating to tonsil     sepsis.
4. Intolerable mouth breathing during sleep due to adenoid     hypertrophy.
5. Tonsil acting as focus of sepsis like in CSOM, Recurrent LRTI,     Pyoderma etc.,
6. An attack of peritonsillar abscess - six weeks after successful     drainage and treatment of Quincy in several cases, not even one     case has come back for Tonsillectomy. This is my experience.

When to do Tonsillectomy

      Ideally, Tonsillectomy is done after treating acute infection, and done electively.
      In young women, Tonsillectomy results in utter dissatisfaction since either chronic sinusitis must be the under lying cause for Tonsillitis, or chronic sinusitis will continue to cause post nasal drip and chronic granular pharyngitis, eclipsing the benefit of perfectly done tonsillectomy.

      The family physician is the right person to advise Tonsillectomy, and the parents of the child are the best judges to decide on Tonsilleetomy.