---
title: "Tonsillectomy Part 1 - Definition, Indications and Contraindications"
description: "ENT notes on Tonsillectomy - Definition, Indications, Contraindications."
source: "The ENT Resident"
author: "Dr. Mausumi Das"
canonical_url: "https://www.theentresident.com/ent-notes-lectures/tonsillectomy-indications-definition-contraindications"
categories: ["Pharynx", "Short Questions in ENT", "Surgery", "Mnemonics in ENT"]
video: "https://www.youtube.com/watch?v=Es72mlEg1F0"
image: "https://media.theentresident.com/og-images/tonsillectomy-indications-definition-contraindications.png"
---

# Tonsillectomy Part 1 - Definition, Indications and Contraindications

ENT notes on Tonsillectomy - Definition, Indications, Contraindications. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=Es72mlEg1F0

## 🩺 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 

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### 🔹 What is Tonsillectomy?

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

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### 🔹 Indications of Tonsillectomy

Indications are classified into:
1. **Absolute indications**
2. **Relative indications**
3. **Tonsillectomy as part of another surgery**

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#### ✅ 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

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#### ⚠️ 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**

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#### 🔧 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?

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### ❌ Contraindications of Tonsillectomy

>🚩 Mnemonic: **A B C D E**

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#### 🅰️ 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?

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#### 🅱️ 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

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#### 🅲 C – Cleft Palate / Submucous Cleft

- Avoided due to the risk of **velopharyngeal insufficiency**

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#### 🅳 D – Diseases of Systemic origin which is Uncontrolled

- Diabetes
- Cardiac disease
- Hypertension
- Asthma

➡️ First stabilize patient before surgery

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#### 🅴 E – Epidemic of Polio

- Risk of **bulbar poliomyelitis**
- Virus may enter through surgical site

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### 📌 Key Exam Pearls

- Paradise criteria = **most important MCQ**

- Unilateral tonsil enlargement → **rule out malignancy**
- Age < 3 years = **relative contraindication**
- Avoid tonsillectomy in **acute infection**

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📚 **Next Part:**  
[Tonsillectomy Techniques - Hot & Cold Methods](https://www.theentresident.com/ent-notes-lectures/tonsillectomy-techniques-methods.md)

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## About This Note

This free ENT note on Tonsillectomy Part 1 - Definition, Indications and Contraindications was written by Dr. Mausumi Das and is paired with a corresponding video lecture.

Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/tonsillectomy-indications-definition-contraindications

When citing or referencing this content, please credit The ENT Resident and link to the canonical page above.

## Related Notes by Category

- Pharynx: https://www.theentresident.com/ent-notes-lectures/category/pharynx.md
- Short Questions in ENT: https://www.theentresident.com/ent-notes-lectures/category/short-questions-in-ent.md
- Surgery: https://www.theentresident.com/ent-notes-lectures/category/surgery.md
- Mnemonics in ENT: https://www.theentresident.com/ent-notes-lectures/category/mnemonics-in-ent.md

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