Abdullah Jan  ( ENT Department, Khyber Medical College, Peshawar. )
Iftikhar Ahmad  ( ENT Department, Khyber Medical College, Peshawar. )

Tonsils are not just easily accessible lumps of lymphoid tissue to be disposed off. They have use­ful function in childhood¹ and theft removal may cause problem later due to lack of immunity². There has been great opposition to the surgical treatment of tonsils. According to Calderoli³, ‘it is an ugly, barbarous, painful, cruel, repulsive, dangerous and largely useless operation much more so than the simple cutting of a dog’s tail”. However inspite of all the arguments and opposi­tions, over 2 million tonsillectomies are done each year in the United States. ³ The management of tonsils and adenoids has always been a controversial issue between phy­sicians and surgeons with both baving firm opinions about their own approaches. The  pae-diatricians. and family physicians however come to an agree­ment with the otolaryngologists in favour of surgi­cal treatment after a careful assessment. It has been estimated that less than one tenth of the total patients examined with a history of sore throat will need surgical treatment. The indication for tonsil­lectomyin this study were recurrent sore throats for at least 2-3 weeks each year, one attack of quinsy and small children under the age of 5, with large tonsils causing nocturnal dyspnoea, general ill health and frequent upper respiratory tract infec­tions.

Out of 73,000 patients with a history of sore throat seen over a period of 8 years, 10,368 were selected for surgical treatment. Of these 9,216 had tonsillectomy and 1,152 had both theft tonsils and adenoid removed under general anaesthesia. The surgical procedure was dissection tonsillectomy and adenoids were removed by currettage. Silk was used for haemostatic ligatures. Antibiotics were routinely used postoperatively. Preoperative investigations included haemo­globin, bleeding and clotting time, ASO titre and urinalysis. Throat swabs and histological examina­tion of tonsils were done in 300 cases. Haemoglobin was less than 12 Gm/Cl! in 12% of cases and 9.2% had leucocytosis. ASO titres above 330 units were found in 31% of cases. The most common organism in throat swabs was Beta haemolytic Streptococcus, followed by Staph aureus, Strep. Viridans, and Neisseria. On histological examination 87.7% had chro­nic tonsillitis, 4.6% actinomycosis, 15% cartilage, and 62% no significant change. Thirteen (0.13%) patients bled postopera­tively and needed resuturing. Few female patients had change in theft speech and nasal regurgitation. All recovered without any treatment. Tho patients with small remnants presented with acute tonsillitis 6 years after tonsillectomy. They were treated with antibiotics and cryosurgery. Some patients presen­ted with hypertrophied lateral pharyngeal bands and patches of hypertrophied lymphoid tissue. Theft main complaints were irritation and dryness of throat and past history of allergy. There were no postoperative deaths in this series.

Tonsillectomy and adenoidectomy are sim­ple, safe and beneficial procedures when done after a careful assessment. With improvements in opera­tive, nursing and anaesthetic skills the operative mortality which was 1 in 10,000 in the United King­dom about 25 years ago has reduced considerably. There were no deaths in the present series. Obser­vations reported before⁵ and in this study assure excellent results if surgery is done after careful assessment and reassessment. Indications for ton­sillectomy and adenoidectomy have also changed. They have no place in the treatment of otitis media. The criterion for benefits or otherwise was a 6 months follow up. Only 36% of patients came for regular postoperative follow up. They had no more attacks of sore throat, they gained weight and some had dramatic improvement in theft temper. Two children under 5 years had tonsillectomy for hyper­trophied tonsil and recurrent upper respiratory tract infection. Both improved and spent the first winter at home with their parents out of steam tent. Similar cases have also been reported by others.^4,5

Authors are grateful to Professor Moham­mad Rafiq Khan and Professor Mohammad Alain Khan for allowing them to review their cases, Mr. Zahoor Ali for typing the manuscript and the junior medical staff and the nursing staff for their help and cooperation.

1. Paradise,J.L., Bluestone, C.D.,Bachman, RZ., Colborn, K., Bernard, B.S., Taylor, F.H., Rogers, K.D., Sthwar­zabach, RH., Stool, S.E., Friday, G.A., Smith, I.H. and Saez, CA. Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials. N. EngI. J. Med., 1984;310:674.
2. Wood, C.B.S. Immunological factors and tonsillectomy. Proc. R Soc. Med., 1973;66:411.
3. Gibb,A.G. Unusual complications of tonsil and adenoid removal. J. Laryngol. Otol., 1969;83:1159.
4. Capper, J.W. and Randall, C. Post-operative haemor­rhage in tonsillectomy and adenoidectomy in children. J. Latyngol. Otol., 1984;98:363.
5. Gibb, A.G. and Stewart, I.A. Hypernasality following tonsil dissection-hysterical aetiology. J. Laryngol. Otol.,1975;89:779.