Quando vanno tolte le tonsille?


Nel post di qualche giorno fa sulle tonsilliti non ho volutamente parlato della terapia chirurgica della tonsillite, ovvero dell’intervento di tonsillectomia, proprio per l’obiettivo che avevo di scrivere un post specifico sull’argomento. L’intervento di rimozione delle tonsille si chiama appunto tonsillectomia, ed è uno degli interventi chirurgici più frequenti in età pediatrica. In Italia se ne effettuano circa 50.000 all’anno.
Pur essendo un intervento semplice e di routine, la rimozione delle tonsille e non è esente da rischi per lo più legati all’assistenza anestesiologica e al decorso post-operatorio; la mortalità postoperatoria invece per fortuna è rarissima (1 caso ogni 10.000-35.000).
Ma quando vanno tolte le tonsille?Oggi, l’asportazione delle tonsille è meno diffusa di un tempo grazie a un miglioramento delle conoscenze sulla patologia adenotonsillare e delle capacità di diagnosi; è stata pertanto ridiscussa l’utilità del trattamento chirurgico nei bambini.
Nei bambini si opta per l’intervento chirurgico solo se sono presenti problemi di ostruzione delle vie respiratorie e disturbi respiratori durante il sonno dovuti all’aumento del volume delle tonsille e/o delle adenoidi (ipertrofia). In questo caso il bimbo presenta difficoltà di respirazione dal naso o roncopatia (russamento) talora associato alle apnee notturne. Se esistono questi sospetti è necessario eseguire la polisonnografia notturna. 

Altre indicazioni chirurgiche sono oggi molto dibattute e comprendono le tonsilliti acute ricorrenti (più di 4-5 episodi di tonsillite all’anno in età scolare e più di 6-7 episodi in età pre-scolare); la febbre mediterranea ricorrente (sindrome PFAPA) o altre indicazioni, rare ma importanti, come l’ascesso peritonsillare e l’ipertofia tonsillare asimmetrica con sospetto di patologia maligna. Nel bambini la tonsillite è spesso accompagnata dall’adenoidite, infiammazione delle adenoidi che causa ostruzione nasale. Adenoidi e tonsille vengono in molti casi tolte insieme. Al contrario, nei bambini con ostruzione respiratoria nasale e tonsille solo lievemente ipertrofiche e senza frequenti infezioni si tende a rimuovere solo le adenoidi, perché l’operazione è meno invasiva e con meno strascichi.





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