[Significance of the medical history in decisions on whether tonsillotomy is indicated]

In pre-school children suffering from pure non-inflammatory hyperplasia of the tonsils, tonsillotomy has recently been recommended in preference to tonsillectomy. Absence of inflammatory tonsillitis in the previous medical history is accepted as evidence that tonsillotomy is indicated. In this study, we therefore examine whether and to what degree the medical history correlates with the histological findings.

In a prospective study 59 children admitted to our department for tonsillectomy were each allocated to one of three groups according to how many episodes of acute tonsillitis they had been suffering from per year prior to admission: group 1, 0 episodes of tonsillitis/year; group 2, 1 or 2 episodes/year; group 3, >2 episodes/year. These groups were then compared with the diagnoses yielded by histological examination of the excised tonsils, which were classified into (1) pure hyperplasia; (2) chronic inflammatory tonsillitis; (3) hyperplasia and chronic inflammatory hyperplasia; and (4) chronic inflammation with peritonsillar scarring.

In group 1 (n=23) pure hyperplasia was found in only 2 cases, while the tonsils of all other children were affected by chronic inflammatory tissue changes, either alone or in association with hyperplasia. In groups 2 und 3 most tonsillar specimens showed histological characteristics of chronic inflammation, but non-inflammatory hyperplasia alone was also found in 5 cases.

There is no correlation between the medical history of children undergoing tonsillectomy and the histological diagnosis. In other words, the medical history does not appear to be an appropriate way of reaching a differential diagnosis between non-inflammatory hyperplasia and chronic tonsillitis. This means that tonsillotomy may well leave remnants of chronically inflamed tonsillar tissue in place. Appropriate counselling of the parents seems to be necessary.