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• Prerequisites and learning objectives
• Lesson
  • Content
    • 1 - Pathophysiology - General information
    • 2 - Rhinopharyngitis
      • 2.1 - Etiologies
      • 2.2 - Diagnosis
      • 2.3 - Treatment
      • 2.4 - Complications associated with rhinopharyngitis
      • 2.5 - Differential diagnosis
      • 2.6 - Hypertrophy of adenoid vegetations causing recurrent rhinopharyngitis
      • 2.7 - Other factors favoring nasopharyngeal infections
    • 3 - Angina
      • 3.1 - Etiology
      • 3.2 - Clinical diagnosis
      • 3.3 - Bacteriological diagnosis
      • 3.4 - Clinical forms
        • 3 . 4 . 1 - Acute catarrhal angina (or erythematous angina)
        • 3 . 4 . 2 - Angina with purulent exudate (or erythemato-pultaceous angina)
        • 3 . 4 . 3 - Pseudomembranous angina (or false-membrane angina)
        • 3 . 4 . 4 - Ulcerative and necrotic angina
        • 3 . 4 . 5 - Vesicular angina
        • 3 . 4 . 6 - Gangrenous, necrotizing angina
      • 3.5 - Treatment
      • 3.6 - Differential diagnosis of angina
    • 4 - Chronic tonsillitis
      • 4.1 - Chronic tonsillitis in children
      • 4.2 - Chronic tonsillitis in adults
    • 5 - Complications of tonsillar infection
      • 5.1 - Local complications
      • 5.2 - General complications
    • 6 - Tonsillectomy indications
      • 6.1 - Indications
      • 6.2 - Contraindications
  • Key points
  • Teachers version
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• Appendix
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6  -  Tonsillectomy indications

6 . 1  -  Indications

Although tonsillectomy is no longer carried out as frequently as it was in the past, the intervention currently has more accurate and indisputable indications :

• For infection-related reasons:
  • In the case of recurrent acute tonsillitis (whereby the frequency and severity of angina leads to a failure to thrive and falling behind at school - three to four episodes per winter, on two consecutive winters, are part of the commonly accepted schemes) or in the case of chronic tonsillitis in children (tonsillitis with local and regional inflammatory symptoms persisting for 3 months or more, and not responding to appropriate, well-monitored medical treatment).
  •  In the case of general complications (nephritis, post-angina rheumatism), when the tonsils constitute a streptococcal infectious focal site. The intervention must be covered using antibiotics therapy.

• For reasons related to pharyngeal obstruction:
  • in children, hypertrophy of the tonsils may cause pharyngeal obstruction with snoring at night, breathing difficulties at night with dyspnea, sometimes respiratory pauses, restless sleep with nightmares, being woken during the night, and food blockages. This obstruction may lead to failure to thrive, thoracic deformations, or heart problems;
  • in the adult, hypertrophy can cause or facilitate the syndrome of obstructive sleep apnea, with snoring at night and sleep apnea resulting in morning fatigue, daytime sleepiness, morning headaches, and nocturia. The diagnosis of obstructive sleep apnea syndrome is established using polysomnographic sleep recordings.

6 . 2  -  Contraindications

There is no absolute contraindication to adenoidectomy or tonsillectomy.

Relative contraindications should be considered on a case-by-case basis :

• coagulation disorders can, usually, be detected and are not a contraindication when surgery is imperative;
• cleft palates and submucosal divisions must be screened for clinically. They represent a contraindication relative to the adenoidectomy due to the risk of decompensation of potential Velar insufficiency, which could be masked by adenoid hypertrophy. Amygdalectomy is not contra-indicated;
• in case of fever (temperature of >38°C), the intervention should be postponed for a few days.

Existing allergy and asthma are not considered to be contraindications for adenoidectomy or tonsillectomy.

Recovery is obtained within a few days.

To avoid new episodes, cold tonsillectomy is proposed to be conducted after at least 5 to 6 weeks following the phlegmon, but this intervention is no longer performed systematically.