[Tonsillectomy in childhood: personal considerations]. / La tonsillectomia in età infantile: considerazioni personali.

This paper discusses the personal criteria followed in indicating tonsillectomy and/or adenotonsillectomy in treating a group of 150 children between the ages of 2 and 12 in the ENT Department of the Crobu Hospital of Iglesias where a follow-up was carried out from May 1989 to March 1991. The study analyzes when and under what conditions these surgical procedures are indicated in young patients without recurrent tonsillitis but with obstructive sleep apnea (OSA). The utility of traditional laboratory investigations (such as surface pharyngeal swabbing) in indicating surgical therapy is also evaluated. In concluding, the Authors affirm that recurrent tonsillitis no longer controllable with medical therapy is still the most frequent indication for surgery. In fact, 64% of the children studied belonged to either class TR or ITR in which recurring infection was the primary indication factor. However, respiratory obstruction has recently emerged as a increasingly important factor in indicating tonsillectomy and/or adenotonsillectomy. In fact, 54 children (35.9%) of the 150 studied belonged to class IT or OSA in which tonsillar and/or adeno-tonsillar hypertrophy with obstruction of various degrees was the determining factor in indicating surgical treatment. It appears that in the near future with fewer tonsillectomies being indicated in the case of recurrent tonsillitis, a progressive increase in the number of indications of surgical treatment in cases of obstruction may be expected. The Authors stress, however, the importance of identifying OSA patients because of the cardiorespiratory risks they may encounter during surgery (intubation difficulty found by the anaesthesiologist, tendency towards laryngeal spasms and pharyngeal obstruction in the post-operatory period).