Tonsillectomy

 Indications for tonsillectomy:
Infections:
1. Recurrent acute tonsillitis - more than 6 episodes / year or 3 episodes / year for more than 2 years.
2. Recurrent acute tonsillitis associated with other conditions like :
    Cardiovascular disease associated with recurrent streptococcal tonsillitis.
    Recurrent febrile seizures.
3. Chronic tonsillitis that are unresponsive to medical management and associated with halitosis, persistent sore throat and cervical adenitis.
4. streptococcal carrier state unresponsive to medical treatment.
5. Quinsy
6. Tonsillitis associated with abscessed nodes.
7. Infectious mononucleosis with severely obstructing tonsils that is unresponsive to medical management.

Obstruction:
1. Sleep apnoea
2. Adenotonsillar enlargement associated with cor pulmonale, and failure to thrive
3. Dysphagia
4. Speech abnormalities (Rhinolalia clausa)
5. Cranio facial growth abnormalities
6. Occlusal abnormalities

 Other causes

1. Embedded foreign body
2. Tonsillar cysts
3. As a surgical approach to other structures like
    Styloid process
    Glossopharyngeal nerve
    Parapharyngeal space

Surgical indications for adenoidectomy:
Infections:
1. Purulent adenoiditis
2. Adenoid hypertrophy associated with
    CSOM with effusion
    Chronic recurrent acute otitis media
    CSOM with perforation
Obstruction:
1. Excessive snoaring
2. Sleep apnoea
3. Adenoid hypertrophy associated with
    Corpulmonale
    Failure to thrive
   Dysphagia
   Speech abnormalities
Others:
Adenoid hypertrophy associated with chronic sinusitis

Dissection and Snare method:  This is the commonly used method to perform tonsillectomy today.  The tonsil is dissected along with its capsule and lifted out of its bed.  It is ultimately removed using a tonsillar snare which is also known as the Eve's snare. Snaring the tonsil has a distinct advantage. Since the tonsil is crushed before it is cut, bleeding is minimised. At this juncture it must also be pointed that blood supply to the tonsil reaches it through its lower pole. The advantage of this method is that the procedure is safe, bleeding is less and the tonsil can be removed in toto without any remnants. The patient is put in Rose position. This position owes its name to a staff nurse by name Rose who suggested this position to the surgeon. In fact it must be called as Sister Rose position. In this position both the head and neck are extended. This is done by keeping a sand bag under the patient's shoulder blade.

Advantages of Rose position:

1. There is virtually no aspiration of blood or secretions into the airway.

2. Both hands of the surgeon are free. This position helps in proper application of the Boyles Davis mouth gag.

3. The surgeon can be comfortably seated at the head end of the patient