Bombay Hospital Journal ContentsHomeArchivesSearchBooksFeedback


Home > Table of Contents > General Practitioner's Section
 
 
General Practitioner's Section
 
Indications For Tonsillectomy
O P Kapoor
 

In the past, indication for removal of tonsils included school vacations. Day by day, we are using stricter criteria before the tonsils are removed. This is because often the symptoms of allergic sore throat increase after tonsil surgery.

The following are the indications:

1. A definite history of repeated attacks of acute tonsillitis is a must before tonsils are removed. During such attacks, on examination tonsils look unhealthy and one can demonstrate an exudate on pressing the crypts. ESR or CRP would be raised. Culture should show a positive streptococcus growth. Even such patients getting repeated attacks, can be controlled by long term antibiotic therapy. Thus even repeated attacks of tonsillitis are no longer an absolute indication for tonsillectomy.
2. A patient having huge bilaterally enlarged tonsils (which are nearly meeting each other), along with history of sleep apnoea is an absolute indication.
3. Finally, a unilateral massive enlargement of the tonsil, is also an absolute indication for surgery to exclude lymphoma.

 

 

Venous leg ulcers are best treated at home

Most patients with venous leg ulcer can be managed in the community. Early identification of risk factors, along with a tailored approach with compression bandaging, leg elevation, improved mobility and nutrition, and close supervision by a specialist nurse, are important, say Simon and colleagues. Up to 85% of ulcers are associated with venous hypertension, but surgery on the superficial veins is clearly indicated only for patients with superficial venous incompetence, and antibiotics have little effect on ulcer healing. The authors say that the focus should move from treatment to prevention.


BMJ, 2004; 328 : 1358.