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Original Article
January 2001

Causes of Tonsillar Disease and Frequency of Tonsillectomy Operations

Author Affiliations

From the Departments of Otorhinolaryngology (Drs Mattila and Tahkokallio) and Pathology (Dr Tarkkanen), Helsinki University Central Hospital, Helsinki, Finland; and the National Public Health Institute, Diabetes and Genetic Epidemiology Unit, Mannerheimintie, Finland (Mr Pitkäniemi and Drs Karvonen and Tuomilehto).

Arch Otolaryngol Head Neck Surg. 2001;127(1):37-44. doi:10.1001/archotol.127.1.37

Objective  To characterize the factors that influence the frequency of tonsillectomy and adenoidectomy operations.

Design and Setting  Nationwide questionnaire. Analysis of patients undergoing tonsillectomy or adenoidectomy at Helsinki University Central Hospital, Helsinki, Finland.

Participants  Four hundred eighty-three of 819 individuals randomly selected from the Finnish National Public Registry. Two thousand two hundred thirty-one individuals younger than 30 years who underwent tonsillectomy (888 patients), adenotonsillectomy (294 patients), or adenoidectomy (1049 patients) at Helsinki University Central Hospital from January 1, 1997, through December 31, 1998.

Main Outcome Measures  Age of the individual at the time of operation. Indication for the operation.

Results  The frequency of adenoidectomies was 24% (116 persons) and that of tonsillectomies 8% (39 persons) among the 483 individuals who returned the questionnaire. The frequency of tonsillectomy operations by age was multimodal; the frequency of tonsillectomies increased in preschool-aged children, declined thereafter, and increased again in teenagers. Tonsillar hyperplasia was the most frequent among children younger than 10 years, peritonsillar abscesses among teenagers, and chronic tonsillitis among individuals older than 20 years. The proportion of females was higher than males among teenaged patients. However, the cause and sex distribution could not explain the multimodality in the age-specific frequency. The age-specific frequency of tonsillectomies performed because of peritonsillar abscesses still followed a multimodal distribution.

Conclusions  Factors relating to respiratory tract infections, maturation of the immune system, and the onset of puberty contribute to the cause of tonsillar disease. Distinct indications for tonsillectomy should be defined for preschool-aged children, teenagers, and individuals older than 20 years.