Current thinking on tonsillectomy and adenoidectomy.

Tonsillectomy and adenoidectomy, though less frequently performed now than in the 1930s, remain among the most common surgical procedures in the United States. The need for and benefits of tonsillectomy and adenoidectomy have been a source of controversy for several decades. Nonetheless, there are situations in which these procedures definitely are beneficial. Tonsillectomy and adenoidectomy are two distinct procedures with separate indications, and they are performed concurrently only when the specific indications for each coexist. Tonsillectomy is indicated by recurrent tonsillitis, peritonsillar abscess, chronic tonsillitis, tonsillar neoplasm, or tonsillar hypertrophy that is obstructive to the upper aerodigestive tract (respiratory distress, dysphagia, or interference with performance of an adenoidectomy). Adenoidectomy is indicated for nasal airway obstruction due to adenoidal enlargement from hypertrophic or inflammatory processes. Although correlation exists among obstructive adenoids, mouth breathing, and dentofacial anomalies, present evidence is not sufficient to justify adenoidectomy solely on the basis of craniofacial or dentofacial abnormalities. Today, elimination of an occult source of infection (once called focal infection) in patients with disorders such as rheumatic fever or serous otitis media is not a valid indication for either operation. Contraindications to tonsillectomy and adenoidectomy include bleeding disorders, familial anesthetic intolerance, velopharyngeal insufficiency, and concurrent disease that may enhance operative risks. Like all surgical procedures, tonsillectomy and adenoidectomy entail morbidity and risk of mortality. The most frequent complication of these operations is hemorrhage. Risk of mortality is approximately 0.006%. Mortality and morbidity can be minimized by appropriate preoperative evaluation, complete control of the airway with endotracheal anesthesia, and meticulous surgical technique.