Tonsillectomy and Rationale for Tonsillectomy

Tonsillectomy is specified for individuals who have experienced more than 6 episodes of streptococcal pharyngitis (confirmed by positive culture) in 1 year 5 episodes in 2 consecutive years or 3 or more infections during 3 years in a row, or chronic tonsillitis or recurrent related state of carrier of streptococcus that did not respond to antibiotics resistant to beta-lactamase. Tonsillectomy can result in children when multiple allergies or antibiotic intolerance are observed, as well as children with periodic fever, pharyngitis and adenitis (PFAPA), aphthous or peritonsillar history . Since the adenoid tissue has a comparative bacteriology with pharyngeal tonsils and due to the fact that adenoidectomy an insignificant and singularity occurs if a tonsillectomy as now is done, most specialists perform an adenoidectomy if adenoids are available and illuminated at the time of tonsillectomy. In any case, this point remains doubtful. Intermittent tonsillitis after tonsillectomy is very rare. Tonsillectomy decreases bacteria sack of Streptococcus pyogenes hemolytic collection (GABHS) and may also allow expansion of alpha-streptococci, which can be defense against GABHS disease. Intermittent tonsillitis is usually due to the re-growth of tonsillar tissue, which is treated by extraction. Tonsillectomy with or without adenoidectomy is the treatment for endless tonsillitis. In cases of special infinite tonsillitis for specialized tonsillectomy contemplations include awareness of greater intraoperative and perioperative drainage, and the awareness that the dismemberment may be more problematic in light of fibrosis and scarring of the tonsil container. 

Tonsillectomy

A study by Wang et al specified that tonsillectomy increases the risk of deep-neck contamination. Using a search in the health insurance research database, the researchers found that patients had a 1.75-fold increased risk of deep-neck infection after undergoing tonsillectomy. A retrospective cohort study on 61,430 patients undergoing tonsillectomy specifies that the use of intravenous steroids on the day of surgery increases the frequency of post-tonsilectomía bleeding in children but not in adults. In the study, Suzuki et al. Found that the reoperation rate for bleeding was 1.2% for children aged 15 or less who received intravenous steroids, versus 0.5% for patients in the same age group who have not. Among patients over the age of 15 however, the reoperation rate was not significantly higher in steroid patients than in controls (1.7% vs 1.4%) .

A review of the literature of De Luca Canto et al showed that the compromise is the maximum Frequent complications in children (9.4%) after adenotonsillectomy, secondary haemorrhage is the second most frequent (2.6%). The authors also found that children who experience adenotonsillectomy, the risk of respiratory complications is 4.9 times higher in patients with obstructive sleep apnea in children who do not, but the risk of postoperative bleeding is lower .

A retrospective study by Spektor et al  points out that the risk of postoperative bleeding in children undergoing tonsillectomy expands when surgery is performed in a child with recurrent tonsillitis (4.5-fold risk) in a child with a deficiency of responsiveness. Hyperactivity disorder (8.7 times higher risk), or in an older child (twice the risk of bleeding in children 11 years and older).