ENT Surgery: Tonsillectomy
High-Yield Revision for NEET PG
Tonsillectomy is one of the most common ENT procedures. Mastery of indications and post-operative complications is essential for board exams.
1. Indications (Paradise Criteria)
For recurrent tonsillitis, the Paradise criteria remain the standard:
- ≥ 7 episodes in 1 year.
- ≥ 5 episodes/year for 2 consecutive years.
- ≥ 3 episodes/year for 3 consecutive years.
- Absolute indication: Obstructive Sleep Apnea (OSA) or suspected malignancy (asymmetry).
2. Complications
| Type | Key Details |
|---|---|
| Primary Hemorrhage | Within 24 hours, usually due to surgical site or technique issues. |
| Secondary Hemorrhage | 5–10 days post-op; due to sloughing of the eschar (most common). |
3. NEET PG High-Yield Pearls
- Blood Supply: The tonsillar branch of the facial artery is the primary blood supply. The most common site of bleeding is the tonsillar bed.
- Nerve Supply: Referred otalgia (ear pain) after tonsillectomy occurs due to shared innervation via the Glossopharyngeal nerve (CN IX) (Jacobson’s nerve).
- Contraindications: Bleeding disorders (e.g., hemophilia) or active acute tonsillitis (except for abscess).
- Positioning: Usually performed in the Rose position (neck extended) or supine with a shoulder roll.