INTRODUCTION

The surgical removal of the tonsils and adenoids of children has generated considerable controversy among health professionals for many years. The often indiscriminate resort to these operations during the early and middle decades of the 20th century [1-3] led many pediatricians to oppose their performance under any and all circumstances. Nonetheless, the operations have retained support throughout the professional and lay communities for a number of reasons:

• Many clinicians remained convinced, based on their training, experience, or evidence from clinical trials, that the operations were efficacious in relieving certain recurrent or persistent upper-respiratory and middle-ear disorders.
• It became clear that extreme hypertrophy of the adenoids, tonsils, or both, could so obstruct the upper airway as to result in alveolar hypoventilation and cor pulmonale, and also that these conditions responded promptly to surgical removal of the offending tissue.
• Many orthodontists have believed, based on limited evidence, that chronic upper airway obstruction results in abnormal craniofacial and dental growth — the "adenoid facies" — and that this too can be modified favorably by adenoidectomy or adenotonsillectomy.
• Many parents of children who underwent surgery reported satisfactory resolution of their children's presenting problems and a decrease in school absence.

An overview of the indications, contraindications, complications, and adverse effects associated with tonsillectomy and adenoidectomy will be presented below. More detailed information regarding the conditions for which these procedures may be indicated is provided separately. (See appropriate topic reviews).

EPIDEMIOLOGY

Tonsillectomy is among the most commonly performed operations in children. The frequency with which tonsillectomy is performed varies from country to country and region to region [4-6]. The variation appears to be related to differences in the medical practice of general practitioners, pediatricians, and otolaryngologists in the management of recurrent tonsillitis and other conditions affecting the upper airway [7]. Patient/family factors and preferences may also influence the decision [8].

In the United States, the number of tonsillectomies has declined progressively since the 1970s [9,10]. Reports suggest that the decline has mainly involved tonsillectomies performed for infectious indications, while the number of tonsillectomies performed for obstructive indications may have actually increased [11,12]. In 2006, an estimated 530,000 tonsillectomies (with or without adenoidectomy) and 132,000 adenoidectomies (without tonsillectomy) were performed in children younger than 15 years of age [10]. Most of these operations are performed as ambulatory, same-day procedures [10].