[Indications for tonsillectomy in childhood from the current viewpoint]

Any discussion of tonsillectomy must necessarily be based on the function and pathophysiology of the palatine tonsils. Their unique anatomic structure illustrates their main immunological function: to recognize and process the transgressors from the environment, to transfer the resulting immunological information to the entire lymphatic system and, therefore, to contribute to the immuno-defensive mechanism of the infant organism. In spite of the abundance of lymphocytes of the T- and B-type in the reticular zone of their epithelium, the tonsils seem to be dispensable because the lympho-epithelial tissue of the pharyngeal mucosa has the same immunological function and, moreover, tonsillectomy does not result in any persistent immunologic defect. However, tonsillectomy in infants up to an age of 4 years should be recommended with great reluctance if at all, since up to this age the tonsils play an important part in the immunological "learning process". Some bacterio-virological aspects are equally important for the indication of tonsillectomy in individual cases as the differentiation between chronic and recurrent tonsillitis. In the treatment of the secondary cervical lymphadenitis, too, such differentiation is mandatory. Chronic tonsillitis in terms of a "focal disease" is a rare event in infants, and tonsillectomy is recommended only in such exceptional cases where recurrent streptococcal infections resulted in rheumatism or glomerulonephritis.