Tonsillectomies - To do or not to do

Tonsillectomies have long been the 'bread and butter' of the ENT surgeons. When they are indicated, they are a great help for the kids and parents, however it has been seen that a lot many tonsillectomies are NOT NECESSARY!So how do we decide when a tonsillectomy is indicated?A tonsillectomy is generally done for recurrent 'sore throat' or throat infections.

However in most children it has been shown that there is no significant decrease in the number of Upper respiratory infections (URI) after undergoing tonsillectomies (Sept 11, 2004, BMJ).

Only those children who get a documented (seen by a doctor, preferably)attack of URI of 6-7 times in 1 year, or 5 episodes per year for 2consecutive years, or 3 episodes per year for 3 consecutive years shouldprobably be taken up for tonsillectomy.

Among other reasons for tonsillectomies would be extremely large tonsils interfering with sleep (Obstructive Sleep Apnoea) detected by snoring, irregular sleep, daytime sleepiness, and mouth breathing. Also if a child has very severe URI's with long lasting symptoms tonsillectomy may be undertaken sooner.

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Label: Let us first begin by asking the basic question:

Why Choose A Pediatrician To Care For Your Child?

The role of a pediatrician involves all of the following:

• Screening and evaluating babies and children for appropriate growth and development, and assessing abnormalities and disabilities, if any.
• Vaccination of babies and children, and advice about specific diseaseprevention.Advice on feeding, diet, food supplements, and other nutrition concerns.
• Assessing illnesses and treating them, including admission to hospitalisation for serious diseases. Coordination of care for children receiving treatment from different specialists, and responsibility for the child's overall health.
• Health education for the family.

Pediatricians have the most comprehensive medical trainingto respond to these needs.

How Are Pediatricians Trained?

A Pediatrician is a 'qualified' Child Specialist. In India this means that after doing his basic MBBS (5 years) a pediatrician has to undergo an additional training (for 2-3 years, on-the-job training) in dealing exclusively with children. This residency training prepares pediatricians to help meet the needs of healthy children in such areas as normal growth, development, nutrition and behavior. After completing the training an exam needs to be passed to become a Pediatrician. A normal physician has less pediatric training than pediatricians, and may not be able to provide the same quality of care to a child as a pediatrician. Some pediatricians have additional subspecialty training beyond residency.In the next part we will discuss the 'ideal qualities' to look for in a pediatrician!

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• Young adolescents (11-12 years of age)
• Adolescents at high school entry or 15 years of age (whichever comes first) for those who have not previously been vaccinated
• All college freshmen living in dormitories
• Other groups at high risk such as those with underlying medical conditions or travelers to areas with high rates of meningococcal disease

The recommendations will help prevent meningococcal disease, a potentially fatal bacterial infection. Although rare, meningococcal disease is dangerous because the disease progresses rapidly, and within hours of the onset of symptoms it may cause permanent disability or death.

Meningococcal disease is the most common cause of bacterial meningitis in U.S. toddlers, adolescents and young adults. Symptoms include high fever, headache, stiff neck, confusion, nausea, vomiting and exhaustion, and a rash may appear. Lifestyle factors thought to contribute to the disease include direct contact with an infected person, e.g., exchanging saliva, often through kissing; crowded living conditions, e.g., dormitories; and active or passive smoking. Vaccination is the best method of preventing meningococcal disease.

Meningococcal infections can be treated with drugs such as penicillin. "Still," says AAP President Carol Berkowitz, MD, FAAP, "about one in every ten people who get the disease dies from it, and many others are affected for life. That is why preventing the disease through use of meningococcal vaccine is important for the high-risk groups."

The Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP) determined that establishing the target age at 11 years may give lasting immunity through college. Studies have determined that the disease peaks in 16- to 18-year-olds, supporting vaccination of 15-year-olds.

More information on the vaccine can be found at the AAP Web site at http://www.aap.org/ and ask for online medical consultation at http://www.simplyanswer.com/

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