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Tonsils and Adenoids: An Update

Pediatricians frequently face the decision of whether to recommend that a child undergo a tonsillectomy, an adenoidectomy, or both. The reputation and the indications for these procedures have evolved over the years and continue to evoke controversy. The total number of tonsillectomies and adenoidectomies performed in the United States has decreased substantially over the past 30 to 40 years, although the proportion of procedures performed for obstructive sleep apnea (OSA) has increased. We will address the indications (Table), techniques, and complications of tonsillectomies and adenoidectomies, as well as current ideas concerning OSA.

The palatine tonsils, adenoids, and lingual tonsils comprise a circle of lymphoid tissue in the nasopharynx and oropharynx, sometimes referred to as Waldeyer ring (Fig. 1). Although this tissue is immunologically active, no postoperative immune deficits generally have been acknowledged other than an increased risk of complications from polio¹ prior to the availability of polio vaccines.

Clinical Aspects

The most common problems attributed to the tonsils and adenoids are recurrent infection and OSA, or its milder manifestation, adenotonsillar hypertrophy with obstruction. Chronic middle ear disease can be related to adenoid pathology.

OBSTRUCTIVE SLEEP APNEA

OSA either is becoming more common in children or is being recognized more frequently. Sleep disturbances, cor pulmonale, pulmonary hypertension, and congestive heart failure are potential complications of OSA.

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