Tonsillectomy and Adenoidectomy and Myringotomy With Tube Insertion

Eric D. Baum, MD* 1. *Clinical Instructor, Department of Surgery (Otolaryngology), Yale University School of Medicine, New Haven, Conn. After completing this article, readers should be able to: 1. Recognize disease states associated with adenotonsillar hypertrophy and infection. 2. Understand the indications for, general surgical approach to, and complications of adenotonsillectomy. 3. Discuss the role of myringotomy and tube insertion in the management of middle ear disease. 4. Be familiar with common complications after myringotomy and tube insertion. A variety of head and neck problems are seen frequently in general pediatric practice, and issues related to adenotonsillar disease and middle ear disease are among the most common causes of these visits. Sleep-disordered breathing, a range of disorders that includes primary snoring and obstructive sleep apnea syndrome (OSAS), is strongly related to adenotonsillar hypertrophy. Recurrent and chronic pharyngitis are addressed less commonly surgically than in past decades but still are important causes of morbidity in children. Myringotomy with tube insertion is one of the most common surgical procedures performed on Americans and is an important tool in the management of chronic middle ear disease in the pediatric population. The superior part of the pharynx contains a ring of lymphoid tissue roughly extending from the level of the skull base in the posterior portion of the nose down to the level of the larynx. Centered superiorly on the posterior wall of the nasopharynx are the pharyngeal tonsils, commonly known as the adenoids or adenoid pad. The two palatine tonsils (generally termed only “tonsils”) are situated on either side of the oropharynx. Inferiorly, near the base of the tongue and more inferior portions of the pharyngeal walls are the lingual tonsils. Disease states associated with these different aggregations of tissue often are affected by their precise anatomic location. …