Luebeck, Germany (dpa) – When a child complains of a sore throat and swallowing pains and is running a temperature of 38.8 degrees centigrade the chances are it has tonsillitis.
In the past, doctors recommended a tonsillectomy straight away, but nowadays a few cases of acute tonsillitis alone are not considered sufficient grounds for tonsils removal.
“Above all, this is just a sign that the body’s immune system is putting up resistance,” said Stephan Remmert, leading senior medic at the ear, nose and throat (ENT) clinic at Luebeck University in northern Germany.
But a tonsillectomy is still recommended for patients who suffer five or six bouts of tonsillitis a year with fever and swollen lymph nodes. Frequently infected tonsils do more damage than good to the immune system, warned Professor Reinhard Kau, director of the ENT department of Krefeld Clinic. Constant infections can also damage the heart and kidneys, he said.
A few decades ago, medical opinion was to take out tonsils as quickly as possible. “My own father, who was a registered ENT doctor, used to take out four or five patients’ tonsils before regular morning surgery,” said Professor Kau.
But today doctors take a different view. Paediatricians in particular have long pointed out the important role played by the tonsils in immune defence. “Tonsillitis can now be treated with antibiotics much more effectively,” said Barbara Marnach, a health insurance representative.
However, experts still differ over how long patients should remain in hospital after a tonsillectomy. Removing a person’s tonsils is a minor operation that takes only 10-15 minutes. But patients traditionally stay in hospital one to two weeks afterwards.
However the MT health insurance company, based in northeastern Germany, last April launched a five-year pilot project in which people have their tonsils removed as out-patients, meaning they return home on the same day. “After just one year, we have already found that this is easily possible,” said Harald Quednau of the TK.
Yet many ENT specialists oppose sending patients home directly after the operation. “There is a risk of post-operative haemorrhage which is greatest on the sixth day after the operation,” said Professor Remmert.
Professor Kau agreed: “The wound takes two weeks to heal. In the first week at least, it cannot be ruled at that it might open up again.” In children in particular, there is a risk that bleeding is not noticed quickly enough.
A child might simply swallow the blood. These cases could be life- endangering. Although such complications are rare, they could lead to a child’s death of disablement, he said.
