Removal of almonds often incorrect

Complete removal of almonds often does not make sense

09.05.2013

Removing the almonds completely was a long-standing practice in children who frequently had tonsillitis. Today, doctors know that this is often counterproductive. Not infrequently occur after the removal of the tonsils undesirable complications. One of these is heavy bleeding, which must be stopped. A risk reduction is therefore the partial surgical removal of the tonsils. If only a part of the almond tissue removed, which also reduce the subsequent complication risks, such as the specialist for ear, nose and throat, Prof. Dr. med. Jochen Windfuhr explained at an international medical congress.

It was not so long ago: when children suffered from an inflammation of the almond, they were completely removed. "Bleeding complications after a tonsillectomy, the complete removal of the palatine tonsils, which must be supplied in the operating room, occur in about five percent of all patients," reports the chief physician for ear, nose and throat medicine of the clinics Maria Hilf in Mönchengladbach, Prof. Jochen Windfuhr, today on the sidelines of a Nuremberg congress for ENT medicine. This then common practice is now being gradually revised by the medical profession. „Partial removal can achieve the same healing success while reducing the risk of complication“, explains Windfuhr. Partial removal of the inflamed almond tissue protects the large blood vessels, says the specialist. This creates the effect of less bleeding in the small patient.

Life-threatening complications from bleeding
"Bleeding can become a life-threatening complication at any time and in any patient." Among the risk factors for the occurrence and intensity of postoperative haemorrhages are repeatedly referred to surgical technique, but also patient age, patient gender and anesthetic form. "However, this has not helped us to predict who will bleed from our patients, and the situation is even more complicated for small children because they only tolerate lower levels of blood loss, and it is not always mass bleeding that we fear Sucking bleeding can swallow large quantities of blood unnoticed and then lead to the bubbling vomiting and / or collapse of the cardiovascular system, "says Windfuhr. Therefore, especially in young patients a complete postoperative care after release from inpatient care until complete healing of the wounds is particularly important. "Parents need to know what to do if their child is bleeding."

According to the professor, the number of complete almonds removal in recent years has been decreasing year on year. Between the years 2007 and 2010, but the „Number of partial distances doubled“.

Scientific guidelines on whether an indication exists
Scientifically judged whether the almonds must be removed or not, is now judged essentially much stricter. "International guidelines and, consequently, more and more physicians are based on the results of a 1984 US study that examined the benefits of almond removal for patients aged up to 15 years and is still included in the guidelines," said Windfuhr. Only after a certain number of tonsillitis in children is there any indication for removal. For the decision making a detailed conversation with the parents is essential. "If there are any uncertainties here, the doctors will talk to each other."

For recurrent tonsillitis and respiratory distress removal
According to the Bertelsmann Foundation, two criteria are crucial for the removal of palatine tonsils in children and adolescents. The tonsillitis is constantly recurring and the airways narrow.

But there is an abnormality in the regional differences. According to an in-house study, between 2007 and 2010, 14 out of every 10,000 children in the district of Sonneberg (Thuringia) were deprived of children and adolescents every year. Only in Schweinfurt about 120 kilometers away, with 109 withdrawals, were there almost eight times as many operations. Reason for this are the different evaluation criteria of the treating physicians. „There is no binding recommendation or guideline for palatal surgery“, so the criticism. As the study showed, the place of residence therefore plays a decisive role in removing almonds. If a specialized ENT clinic is nearby, surgery is also more frequent. (Sb)

Also read:
Bad breath due to inflamed tonsils