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Source:

OR Nurse 2015

March 2012, Volume 6 Number 2 , p 16 - 24

Authors

  • Elizabeth Neville Regan MSN, RN
  • Karin Nevius BSN, RN

Abstract

Once performed routinely for patients with recurrent tonsillitis (1.4 million procedures in 1959), tonsillectomy is no longer such a common procedure: just 530,000 patients of all ages had a tonsillectomy (with or without adenoidectomy) in 2006.1,2 The tonsils are a pair of soft lymphatic tissue situated on either side of the oropharynx and are considered part of the lymphatic system (see Anatomy of the oropharynx). This article focuses on tonsillectomy, but the procedure may be performed in conjunction with adenoidectomy.Indications for tonsillectomy have evolved over the years; a recent study found that 58% of patients ages 5 to 13 who underwent tonsillectomy had the procedure done for airway obstruction or sleep apnea, compared with 42% who underwent tonsillectomy for recurrent throat infections, the most common indication for tonsillectomy in the past.1 Additional accepted indications for tonsillectomy include recurrent acute or chronic tonsillitis, peritonsillar abscess, biopsy for neoplasm, and recurrent acute rheumatic fever in patients who are Streptococcus carriers.The effectiveness of nonsurgical treatment of tonsillitis is another reason that fewer children with recurrent tonsillitis are undergoing tonsillectomies. Nonsurgical treatment for children and adults includes intermittent courses of antibiotics, long-term antibiotics, analgesics, and no therapy (due to the child outgrowing the problem of recurrent sore throats). A 2009 review examined four studies comparing tonsillectomy to nonsurgical treatment, and found that severely affected children had one (rather than three) unpredictable episodes of sore throat in the first postoperative year. Total sore throat days for patients treated with tonsillectomy dropped from 22 to 17, with 5 to 7 of those days falling in the immediate postoperative period.3 For these children, the issue appears to be exchanging the uncertainties of the timing of future sore throats with the certainty of a predictable period of

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