Removal of the tonsils in childhood

Operations are not always necessary

Annually about 26 in Germany. 000 almond operations on children aged performed up to 14 years. It is thus one of the most common procedures in this age group. Whether an operation is necessary and whether a complete removal or a reduction of the tonsils is always necessary, the attending otolaryngologist must decide individually. Because especially in a complete removal threatening complications such as bleeding that can be life-threatening.

"Bleeding complications after a tonsillectomy, the complete removal of the tonsils, which must be supplied in the OP, occurring at about five percent of all patients," explains Professor Dr. med. Jochen Wind Fuhr, head physician of the clinic for ear, nose and throat medicine clinics Maria Hilf in Mönchengladbach. "This may develop at any time and in any patient in a life-threatening complication." Among the risk factors for the occurrence and severity of postoperative bleeding are surgical technique repeatedly, but also known as patient age, patient sex, and type of anesthesia. "This has us but not so far helped to predict who will bleed from our patients. In young children, the situation is further complicated because they tolerate only lower amounts of blood loss. And it is not always mass bleeding that we fear. Even in so-called blood oozing large amounts can be swallowed unnoticed, then for a surge-like blood vomiting and / or collapse of the cardiovascular system lead, "said Wind Fuhr. Why was particularly in young patients a complete postoperative care after discharge from inpatient care until complete healing of wounds especially important. "Parents need to know what to do when their child is bleeding," adds Windfuhr.

A significant decrease in the frequency of surgery

The scientific assessment of whether the tonsils have to be removed at all is now being assessed much more strictly and has led to a significant reduction in the frequency of operations: "International guidelines and consequently more and more doctors are based on the results of a study from the USA from 1984, which examined the benefits of tonsillectomy for patients up to the age of 15 and is still taken into account in the guidelines to this day," says Windfuhr. According to this study, there is only an indication for tonsillectomy in childhood after a certain number of recurring tonsillitis. However, current guidelines also point out that the individual circumstances of the patient must be taken into account. If, for example, there are multiple antibiotic allergies that make inflammatory therapy impossible, the indication is justified. But tonsillectomy is also helpful for other diseases, such as tonsil abscesses or PFAPA syndrome, a rare fever.” A detailed discussion with the parents is essential for the decision-making process. "If there are any uncertainties, the doctors exchange information with each other," explains Windfuhr.

The attitude towards removing the tonsils from children has changed a lot in the last ten years: While the complete removal of the tonsils used to be recognized as routine therapy for a wide variety of diseases, since the late 1990s partial removals, tonsillotomies, have increasingly been performed. With this technique, the surgeon preserves the tonsil capsule and protects the larger supplying vessels. As a result, the risk of bleeding is significantly lower and the patient has less and less pain. "If the tonsils are too big, this leads to a narrowing of the airways, especially in our small patients. This has a significant impact on the quality of sleep in the affected children, who therefore benefit significantly from the reduction of the tonsils,” explains Windfuhr.

Source: Nuremberg [ DGHNO ]