Tonsillectomy Part 1 - Definition, Indications and Contraindications

🩺 Tonsillectomy – Indications and Contraindications

This is the first part of the Tonsillectomy series. In this post, we will cover:

• What is tonsillectomy
• Indications of tonsillectomy
• Contraindications of tonsillectomy
• Important exam MCQ points and mnemonics

🔹 What is Tonsillectomy?

Tonsillectomy is a surgical procedure for the removal of palatine tonsils.

🔹 Indications of Tonsillectomy

Indications are classified into:

1. Absolute indications
2. Relative indications
3. Tonsillectomy as part of another surgery

✅ Absolute Indications of Tonsillectomy

1️⃣ Recurrent Throat Infections - the most common indication for tonsillectomy.

📌 Paradise Criteria for Tonsillectomy

A child is eligible if they have:

• ≥7 episodes in the past 1 year, OR
• ≥5 episodes per year for 2 consecutive years, OR
• ≥3 episodes per year for 3 consecutive years

What qualifies as a sore throat episode in Paradise criteria of Tonsillectomy?

2️⃣ Peritonsillar Abscess (Quinsy)

3️⃣ Tonsillitis with Febrile Seizures - Common in infants and young children

4️⃣ Tonsillar Hypertrophy Causing:

• Airway obstruction (Obstructive Sleep Apnea)

• Dysphagia

• Speech interference

5️⃣ Suspicion of Malignancy - Unilateral tonsillar enlargement

• Excisional biopsy is performed
  • Children → Lymphoma
  • Adults → Squamous cell carcinoma

⚠️ Relative Indications of Tonsillectomy

1. Diphtheria carriers not responding to antibiotics

2. Streptococcal carriers (source of infection to others)

3. Chronic tonsillitis with halitosis/bad taste unresponsive to medical therapy

4. Recurrent streptococcal tonsillitis in patients with valvular heart disease

🔧 Tonsillectomy as Part of Another Surgery

1. Palatopharyngoplasty for obstructive sleep apnea

2. Glossopharyngeal neurectomy

   • Tonsil is removed to expose glossopharyngeal nerve

3. Styloidectomy in Eagle’s syndrome

   • Tonsillectomy required to access elongated styloid process

What is Eagle's syndrome?

What are the Indications for Unilateral Tonsillectomy?

🤰 If Tonsillectomy needs to be performed during pregnancy, which trimester is ideal for surgery?

❌ Contraindications of Tonsillectomy

🚩 Mnemonic: A B C D E

🅰️ A – Four Contraindications

1. Anemia - Hb < 10 g/dL

2. Acute Infection

   • Risk of:

     • Bronchospasm under anesthesia

     • Increased intraoperative bleeding

3. Aneurysm of Internal Carotid Artery

   • May present as pulsatile tonsil

   • Risk of fatal hemorrhage

4. Age < 3 years

Why is Tonsillectomy contraindicated below the age of 3 years?

🅱️ B – Bleeding Disorders

Not an absolute contraindication

Includes:

• Von Willebrand disease
• Hemophilia
• Sickle cell disease
• Leukemia
• Purpura
• Aplastic anemia

➡️ Surgery can be done after correcting the disorder
➡️ Avoid dissection and snare method due to higher bleeding risk

🅲 C – Cleft Palate / Submucous Cleft

• Avoided due to the risk of velopharyngeal insufficiency

🅳 D – Diseases of Systemic origin which is Uncontrolled

• Diabetes
• Cardiac disease
• Hypertension
• Asthma

➡️ First stabilize patient before surgery

🅴 E – Epidemic of Polio

• Risk of bulbar poliomyelitis
• Virus may enter through surgical site

📌 Key Exam Pearls

• Paradise criteria = most important MCQ

• Unilateral tonsil enlargement → rule out malignancy

• Age < 3 years = relative contraindication

• Avoid tonsillectomy in acute infection

📚 Next Part: Techniques and Methods of Tonsillectomy

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