Tonsillectomy, the removal of the palatine tonsils, has three principal
1. Recurrent attacks of tonsillitis (typically Streptococcal).
2. Enlarged tonsils causing obstruction of the airway, which may be the
cause of Obstructive Sleep Apnoea – recurrent airway obstruction at
night – and this has serious effects on health and wellbeing.
3. Possible malignant disease in the tonsils – typically squamous carcinoma
For many years the UK guidance on tonsillectomy for tonsillitis has been only to
consider surgery in those with attacks of at least moderate severity (several
days’ duration) per annum, for > 1 year – the SIGN guidance summarises the
current consensus 1:
Patients should meet all of the following criteria:
•sore throats are due to tonsillitis
•five or more episodes of sore throat per year
•symptoms for at least a year
•episodes of sore throat are disabling and prevent normal functioning
Those with very frequent infection (>8 per annum) or who are hospitalised with
extremely severe tonsillitis or peritonsillar abscess (quinsy) may seek
intervention within a year of symptom onset. Very similar guidance has evolved
independently in the USA and Australia.
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