Tonsillectomy—Trials and Tribulations

Abstract

IF three quarters of a million young Americans were being subjected each year to a surgical procedure of doubtful benefit at a cost approaching $1 billion and untold cost in pain, suffering, and psychological trauma, the medical profession might expect a torrent of justifiable criticism. To many, this is an accurate description of the basis for controversy over tonsillectomy and adenotonsillectomy. There are zealots on both sides of the issue. Those who consider themselves purists would permit tonsillectomy or adenotonsillectomy only in cases of carcinoma of the tonsil, recurrent peritonsillar abscess, cor pulmonale due to upper-airway obstruction, and dysphagia and weight loss due to digestive tract obstruction. If these criteria were accepted and enforced, the number of procedures performed annually would be less than 1% of the current rate. At the other end of the spectrum are those physicians who are convinced that tonsillectomy and adenotonsillectomy are effective therapeutic and