INDICATIONS AND CONTRAINDICATIONS OF TONSILLECTOMY

INDICATIONS AND CONTRAINDICATIONS OF TONSILLECTOMY

Indications:

I. Local:

  1. Chronic tonsillitis: Patients having recurrent attacks of acute tonsillitis of more than 4-6 attacks per year.
  2. Peritonsillar abscess (Quinsy): 4 -6 weeks after drainage of the Quinsy, tonsillectomy is advocated.
  3. Sleep apnoea syndrome due to enlarged tonsils.
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4. Tonsillar cyst– Tonsillar cysts are characterized by a squamous epithelial lining with underlying follicular lymphoid tissue. 

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5. Tonsillolith- Tonsil stones or tonsilloliths are hard white or yellow formations that are located on or within the tonsils. It is common for people with tonsil stones to not even realize they have them. Tonsil stones are not always easy to see and they can range from rice-sized to the size of a large grape. Tonsil stones rarely cause larger health complications. However, sometimes they can grow into larger formations that can cause tonsils to swell, and they often have an unpleasant odour.

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6. Suspected foreign body in the tonsil.

7. Malignancy of the tonsil.

8. As an approach for styloid process excision.

II.  Focal:

  1. Persistent enlarged jugulodigastric lymph nodes.
  2. Chronic otitis media where the infection travels in the middle ear via the Eustachian tube.

III. General:

  1. Rheumatic heart disease.
  2. Glomerulonephritis.
  3. Rheumatic arthritis.
  4. Urticaria.
  5. Failure to thrive in children.

Contraindications:

Local:

  1. Acute tonsillitis: Active infection of the tonsils or upper respiratory tract infection increases the risk of hemorrhage and pulmonary complications due to general anesthesia.

General:

  1. Age: Tonsillectomy is not done before 5 years of age due to:
    • Immune functions of the tonsils.
    • Blood loss that may occur during the surgery can cause hypovolemic shock.
  2. Anaemia.
  3. Tropical eosinophilia.
  4. Poliomyelitis: Tonsillectomy increases the risk of bulbar poliomyelitis.
  5. Active tuberculous infection.
  6. Oral contraceptives: They increase the chances of deep vein thrombosis and hence must be stopped prior to surgery.

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