Controversial problems in adenotonsillectomy.

It is doubtful that the tonsils or adenoids contribute sufficiently to immunity or to hematopoiesis to warrant withholding adenotonsillectomy when there is need for the operation. Focal infection, rheumatic fever and allergic disease must be evaluated in the individual case. A seldom discussed reason for operation is the prophylaxis or treatment of malformation of the nose, sinuses, mouth and jaw. Well defined indications for adenotonsillectomy include frequent occurrence of infection, peritonsillar abscess, cervical lymph node disease believed caused by tonsillar infection, otitis media, and hypertrophy sufficient to embarrass swallowing or breathing. The operation may also be indicated in certain cases of impaired hearing, halitosis, or anorexia, and sometimes for carriers of diphtheria. Psychic trauma can be obviated by proper preparation of a child for the operation he is to undergo. There is a good evidence of evidence of relationship between recent adenotonsillectomy and infection with poliomyelitis-and a good deal of evidence to the contrary. Nationwide rules cannot be established on the basis of the evidence presented thus far. Since in many cases it is unwise to put off adenotonsillectomy, each case in each community in each season must be evaluated separately.