Tonsils stand like two sentinels on either side of the pharynx, the middle portion of the throat. They defend the body against germs or other dangerous substances that try to enter our body through the mouth or nose. They try to trap these germs inside their structure and then with the help of lymphatic cells, of which the tonsils are made, procide protective antibodies.
These antibodies circulate in the blood and fight those intruders which somehow manage to bypass the tonsils. The antibody forming tissue is present in the other parts of the body also, but in the shape of the tonsils, it forms the first line of defence of the body.
During childhood, the body is exposed to many germs for the first time, and needs to be protected against them. In this process of protecting the body, the tonsils work vigorously and in some children get unduly enlarged.
Whether the enlarged tonsils should be removed or not is a controversial question; still more controversial is whether the tonsils should be removed in a child who has some allergic manifestations such as cough and wheeze. There are three different views available on the subject.
1. That tonsils act initially as the site and subsequently as a source of infection in the body. Their removal would favourably influence the course of asthma or even prevent its occurence in a susceptible individual.
2. That tonsils perform an important function in preventing the spread of infection from the nose and throat into the bronchi and the lungs. Their removal, therefore, would lead to a mild asthma developing into a severe one or might even precipitate asthma in a susceptile individual.
3. That the presence or the removal of tonsils makes no difference to the allergic state of an individual. The removal of tonsils can, therefore, neither prevent asthma nor precipitate its onset.
Allergic children are, no doubt, more susceptible to infections, particularly those of the throat and if the infection localised in the tonsils appears again and again, it may be that the tonsils need to be removed. But removal of the infected tonsils should be done with the understanding that it may have no effect upon the asthma which the child is suffering from.
At best, the removal of an infected tonsils may do away with one factor which may, indirectly, have something to do with the aggravation or precipitation of asthma, but it does not touch the basic factor of allergy in the child. Until this is investigated and tackled properly, symptoms of asthma may continue to appear. A comparative study of asthmatic children whose tonsils had been removed and those in whom they were allowed to remain, showed no statistical difference in the severity of the symptoms of asthma; both groups showed the same percentage of mild, moderate and severe case of asthma.
Even those who advocate that surgical removal of the tonsils (tonsillectomy) in asthma patients proves useful, agree that the benefits derived from tonsillectomy are greater in the first postoperative year than in the second. If tonsils are the cause of trouble in asthma patients, one would expect the improvement in symptoms to increase rather than decrease as time passes.
Thus we see that there is no difference in the indications for removal of the tonsils in asthmatic or non-asthmatic children and these indications are :
□ Chronic infection of the tonsils and adenoids.
□ Marked enlargement of tonsils and adenoids, causing interference in breathing and swallowing.
□ Recurrent ear infections.
An asthmatic child with merely enlarged tonsils needs to be investigated for allergy on the same lines as any other asthmatic patient. The cause of allergy, whether inhalant or ingestant, must be found out, and then either eliminated from the diet or submitted to proper hyposensitization, provided the child is cooperative.