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Indexed/Abstracted in: EMBASE, Scopus
Online ISSN 1827-188X
Department of Otorhinolaryngology, Head and Neck Surgery, Vicenza Civil Hospital, Vicenza, Italy
Tonsillectomy is one of the most frequently performed surgical procedure in children worldwide. “Classical” indications were: recurrent tonsillar infections, tonsillar hypertrophy, peritonsillar abscess, and suspicion of neoplasm. In the most recent years there has been a moving trend towards the prevalent presence of sleep disturbances caused either by tonsils and adenoids hypertrophy, leading to more severe manifestations such as obstructive symptoms, frequently associated to behavioral disturbances. The wide use of antibiotics, in addition, dramatically reduced indications to treat recurrent infectious causes. With the introduction of national guidelines all over the Western world on tonsillectomy in children, supported by authoritative trials, and confirmed by subsequent meta-analyses, both physicians and ear-nose and throat (ENT) surgeons have begun to better recognize and diagnose (i.e, use of polysomnography, flexible endoscopy, laboratory tests) inherent pathologies of the “adenotonsillar district”, leading to an appropriate selection of patient referred to adenotonsillar surgery. This resulted in a dramatic change on surgical indication for adenotonsillectomy in children, moving towards more frequent treatment of adenotonsillar hypertrophy rather infection. Furthermore, tonsillectomy alone resulted as a reduced surgical procedure, associated with a subsequent raise in the removal of both tonsils and adenoids. This paper focuses on the change of indications of surgery of tonsils in children and reports the experience of a large Italian tertiary ENT institution that reveals and confirms those trends evident all over the Western countries. Reported results are here discussed, along with review of the most updated literature on surgical indication for tonsillectomy in children.