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TONSILLECTOMY                                    125

short and inadequate, so that it may be necessary to modify the adenoid
removal to achieve a functional improvement in speech (p. 134). The large
pedunculated tonsil has a different effect on speech in that the soft palate can
move freely but the tonsillar bulk makes the child talk as if he had something
in his mouth, and removal of the tonsils will cure this.

It has been said in other chapters, and it must be repeated, that tonsillectomy
has little or no effect on allergy. It will not prevent hay fever or cure nasal
allergy, nor will it cure the majority of cases of bronchospasm. It may help the
allergic patients by improving the general health of the child if septic tonsils
are removed. In any analysis of postoperative results from the operation the
least benefit occurs in allergic patients, generally because the parents expect
too much. If surgery is recommended in such cases the parents must under-
stand that the operation is being done on account of tonsillar sepsis, and that
n9 other results are to be expected.

/ It is true that hearing loss may improve following the removal of tonsils and
especially adenoids (p. 321). This will occur if the hearing loss is conductive
and is due to catarrh or infection in the auditory (Eustachian) tube or middle
ear. The operation has no effect on other forms of deafness, so that if a history
of deafness is obtained the tympanic membranes must be examined and
audiometry carried out. Should the deafness be sensorineural over the whole
range of hearing or confined to the high tones, or should severe or total
deafness be found in one ear or both, either congenially or as a result of
mumps or meningitis or head injury, no improvement can follow operation on
the tonsils, and the parents must be so informed.

The classic history of tonsillar sepsis in children is of frequent sore throats
which affect the general health of the child. There may be abdominal pains
from mesenteric adenitis, a poor appetite which persists between attacks, a
loss of energy and a disinclination for games and a change of temperament
leading to tantrums or crying for little reason in a child who was formerly
free from these. There may be frequent colds or sore ears.

There is a popular belief that tonsils should never be removed before a
certain age on the basis that the child will grow out of the succession of sore
throats. It is true that the frequency of tonsillitis diminishes the older the
child becomes, but each case must be judged on its merits. There can be little
justification for delaying surgery until a certain birthday if the child is having
repeated severe tonsillitis which affects the general health. On the other hand,
there is equally no ground for recommending surgery unless the criteria in the
history or on clinical examination are fulfilled. In the latter -case, when sore
throats are few or slight, it is wiser that the child should be kept under
Ľobservation at regular intervals until either the attacks stop or they become
more severe and more frequent. Some paediatricians advise long-term
antibiotics in such cases.

There is the case in which, without any previous history of tonsillitis, a child
develops several attacks in rapid succession and usually in spite of one or more
antibiotics having been given on each occasion. This history suggests a virus
infection which persists unaffected by therapy. In some such cases the tonsils
will show minute yellow spots in the crypts between attacks and in this event if
there is constitutional upset tonsillectomy gives good results. If, on the
other hand, the tonsils appear clear and the child's general health is good,
it is better to temporize and to review the position at intervals, and there