Adenoids and Tonsils: When to do the Surgery?

performed in children; but the indications remain controversial. The history of these procedures contribute to this situation. In the past the vast majority of these operations were performed in order to cure recurrent infections, which are much less common today due to the advances in antibiotic therapy. Otolaryngologists and pediatricians must reach a consensus for the indications for surgery in order to better educate patients and improve surgical outcomes1. Primary care physicians (pediatricians) must be able to recognize the patient’s symptoms and signs. If the child is often sick, pediatricians should inquire about the pathology even if the symptoms are not the chief complaint. Often physicians are reluctant to refer patients for surgical evaluation possibly due to the tightening of the criteria for adenotonsillectomy. An additional factor contributing to delays in diagnosis is parental complacency in not recognizing the severity of their child’s symptoms or noncompliance with their physician’s recommendation for surgical referral. When performed for the proper indications, these operations improve quality of life and are sometimes life saving. Currently the most common indication for adenotonsillectomy is enlarged tonsils and adenoids. Adenotonsillitis is the second most common indication. Although studies conducted since the early 1970s have better defined the candidate populations for tonsillectomy and adenoidectomy, many clinicians are unfamiliar or uncomfortable with their results and continue to make recommendations for surgery on the basis on emotion and tradition rather than evidence. Today there are formal indications for adenotonsillectomy, as follows. 1.Enlarged tonsils and adenoids Enlarged pharyngeal lymphoid tissue is the primary cause of sleep-disordered breathing (SDB) in children. Nocturnal symptoms are snoring, mouth breathing, sleep pauses or breath holding, gasping, enuresis and restless sleep. Daytime symptoms may be considered separately to the night time issues and which could be underestimated by the family. During the day, the children present with behavioral problems, morning headache, dry mouth, halitosis, audible breathing, open-mouth posture, hyponasal speech and chronic nasal obstruction with or without rhinorrhea. Adenoids and Tonsils: When to do the Surgery?