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Complete removal of the tonsils is often not sensible
Removing the tonsil completely has long been common practice in children who often suffer from tonsillitis. Today doctors know that this is often counterproductive. It is not uncommon for unwanted complications to arise after the tonsils have been removed. One of them is heavy bleeding that needs to be stopped. The partial surgical removal of the tonsils therefore represents a risk reduction. If only part of the tonsil tissue is removed, the later complication risks also decrease, as the specialist for ear, nose and throat customer, Prof. Dr. Jochen Windfuhr explained at an international medical congress.
Not so long ago: If children suffered from tonsillitis, they were completely removed. "Bleeding complications after tonsillectomy, the complete removal of the tonsils, which have to be treated in the operating theater, occur in about five percent of all patients," reports the chief physician for ear, nose and throat medicine at the Maria Hilf clinic in Mönchengladbach, Prof. Jochen Windfuhr, today on the verge of a Nuremberg congress for ENT medicine. This practice, which was common at the time, is now gradually being revised by medical professionals. "Partial removal can achieve the same healing success and at the same time reduce the risk of complications," explains Windfuhr. If the inflamed tonsil tissue is partially removed, the large blood vessels are spared, according to the specialist. This creates the effect that there is less bleeding in the little patients.
Life-threatening complications from bleeding "Bleeding can develop into a life-threatening complication at any time and in any patient." Surgical technique, but also patient age, patient gender and form of anesthesia are repeatedly mentioned among the risk factors for the occurrence and intensity of postoperative bleeding. "So far, however, this has not helped us predict who will bleed from our patients. The situation is more complicated for young children because they only tolerate small amounts of blood loss. It is not always mass bleeding that we fear, even with so-called Leakage bleeding can swallow large amounts of blood unnoticed and then lead to gushing blood vomiting and / or collapse of the cardiovascular system, "says Windfuhr. Therefore, especially in young patients, complete postoperative care is particularly important even after discharge from inpatient care until the wounds have completely healed. "Parents need to know what to do if their child bleeds."
According to the professor, the number of complete removals of almonds has declined year by year in recent years. Between 2007 and 2010, however, the “number of partial distances doubled”.
Scientific guidelines whether there is an indication Scientifically assessed whether the tonsils have to be removed or not is essentially much more strictly assessed today. "International guidelines, and consequently more and more doctors, are based on the results of a study from the USA from 1984, which examined the benefits of tonsil removal for patients up to 15 years of age and is still taken into account in the guidelines," said Windfuhr. Only after a certain number of tonsillitis in children is there an indication for removal. A detailed discussion with the parents is essential for decision-making. "If there are any uncertainties here, the doctors exchange information."
Repeated tonsillitis and shortness of breath Removal According to the Bertelsmann Foundation, two criteria are important for the removal of tonsils in children and adolescents. The tonsillitis repeats itself continuously and the airways narrow.
However, there is a striking difference in the regional differences. According to an in-house study, between 2007 and 2010, children and adolescents in the Sonneberg district (Thuringia) had 14 out of 10,000 children removed from their tonsils each year. Only in Schweinfurt, about 120 kilometers away, there were almost eight times as many operations with 109 withdrawals. The reason for this are the different evaluation criteria of the treating doctors. "There is no binding recommendation for action or guideline for tonsil surgery", the criticism. As the study showed, the place of residence plays a decisive role in whether the tonsils are removed. If there is a specialized ENT clinic nearby, surgery is also more common. (sb)
Bad breath due to inflamed tonsils