When do the almonds have to go?

Necessity of almond operation is carefully weighed today

04/24/2014

If the palatine tonsils (tonsils), for example, have to be surgically removed as a result of chronic tonsillitis, the procedure can be very uncomfortable and painful for the patient. In addition, as it often comes to heavy bleeding as a result of surgery, today is carefully considered whether the complete or partial removal of the tonsils is really necessary. Especially in children, this seems to be a sensible approach, because in the first years of life, the tonsils play an important role in the formation of the immune system.

Tonsils are a major part of the immune system
In the so-called „almonds“ (medical: tonsils) are lymphatic organs in the area of ​​the oral cavity and pharynx. The tonsils are a part of the immune system and are particularly important in the first years of life, as it eats or drinks all the substances that the child inhales „filter“ and thereby help the immune system to develop its own antibodies. If, however, pathogens enter the body through the mouth or nose, they can multiply explosively in the tissue of the palatine tonsils and cause an inflammation in the case of insufficiently functioning immune protection. Depending on the form of tonsillitis (tonsillitis) it may result in very different symptoms - typical, however, are fever, fatigue, headache, loss of appetite, difficulty swallowing, sore throat, increased salivation and bad breath. If tonsillitis occurs more frequently in a row, the treatment was usually quick and the tonsils removed surgically, but "today, especially in children, but also in adults, the decision to operate is much more restrained“, said the acting senior physician of the Department of Otolaryngology of Klinikum Großhadern, Klaus Stelter „Mirror online“.

Common complication: severe bleeding as a result of surgery
For the stronger consideration of a complete (tonsillectomy) or partial removal of the tonsils (tonsillotomy) would speak to the physician from today's perspective, several reasons. Central here is the high complication rate, because according to a US study of more than 36,000 outpatients had experienced every fifth in the two weeks after the procedure complications, due to which a new doctor's visit was necessary, so Klaus Stelter on. Although swallowing pain has often been documented here as a complaint, the results would in principle also be transferable to Germany and Austria. Especially problematic here are rebleeding, which in the expert's opinion occur in about six percent of cases in varying degrees after an almond operation. Cooling may help in mild cases, but in some cases, more bleeding may require re-intervention to stop the bleeding. Since this complication usually occurs either on the first or between the fifth and seventh day after the operation, the tonsils would therefore be taken in this country usually inpatient to ensure careful monitoring of patients.

Surgery is associated with severe pain
However, complications are not the only reason why an almond operation is considered more accurately today than it used to be. Because this is still associated with severe pain today, which, for example, lead to the fact that can not be drunk directly after the operation - which can quickly lead to dehydration and circulatory problems. Many patients would rather refrain from eating after the procedure because of the pain, which, according to the experts, is counterproductive, because "the food dissolves [.] The wound coverings, which is very important for postoperative wound healing.“

Almond removal today only after at least seven inflammations within one year
Because of the possible after-effects and the pain, tonsils would therefore generally be removed surgically only if at least five tonsillitis occur in children every year for two consecutive years or at least seven within one year. For a chronic inflammation can lead to a painful abscess in the immediate vicinity of an almond on the one hand, but on the other hand can also follow-on diseases such as rheumatic fever, heart muscle or heart valve inflammation, immune-reactive skin diseases and kidney inflammation develop. Even though the need for surgery is generally being examined more closely, the Bertelsmann Stiftung's "Facts and Figures" report on the removal of palatine tonsils in children and adolescents shows regional differences between the frequency of tonsillectomy in children. For example, between 2007 and 2010, 76,000 out of every 10,000 children and adolescents were taken from almonds each year in Bremen, compared with only 27 out of 10,000 children in Berlin in the same period. In addition, the Foundation was able to identify an even greater discrepancy between the 412 German districts and independent cities, for example, in the city district of Schweinfurt in Bavaria, more than eight times as often as in the not far away district of Sonneberg in Thuringia. These enormous differences could be found in the „Fact check health“ but not only on it
attributed that the clinical pictures occur regionally differently. Rather, the results would suggest that the referring physicians and hospital physicians, as well as the parents or adolescent patients, would rate the conditions regionally differently, and accordingly „come to different decisions regarding the appropriate treatment.“

Even in adults, decisions are made on an individual basis
Even in adults, the decision whether surgery or not depending on the individual case, so Stelter continues. If the symptoms do not resolve themselves within a few days, the ENT specialist can prescribe antibiotics - which, however, can only be effective in the case of bacterial tonsillitis. However, if there is an allergy to several antibiotics or an almond abscess, an OP is usually necessary to prevent health risks and possible sequelae. (No)