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175
has been kept under observation for some time. The percentage
of operations performed (35 per cent.) is roughly similar in both
sub-groups.
These results seem to suggest that the presence of enlarged
glands does not necessarily indicate a more serious defect than when
the tonsils alone are involved.
Sub-group C (107 Cases).
Tonsils defective and mouth breathing.
Observation Cases.—In this section 24.4 per cent, of the cases
were recommended operation subsequently; but of the children
under observation throughout, 58 per cent, improved and 42 per
cent, remained stationary.
Operation Cases.—100 per cent, of the cases operated on improved.
Of those not operated on, in the section where this was the
initial recommendation 54 per cent, improved; whereas, in the
section where the recommendation came as the result of subsequent
observation, failure to have the operation performed resulted in
85 per cent, becoming worse.
As in the previous sub-groups, observation is still advisable
before operation is recommended, although the likelihood of the
condition clearing up is slightly less in this sub-group.
The nasal obstruction producing the mouth breathing was, in
practically all cases, due to adenoidal enlargement. This subgroup
forms only 16.4 per cent, of the cases in Group I and is
smaller than one would have expected considering how prone we
are to suggest that most cases of tonsillar enlargement are allied to
"adenoids." The percentage recommended operation was higher
than in the previous groups; and the number of operations performed
(42 per cent.) was also greater, the need for operation being
more obvious to the parents if mouth breathing is at all marked.
A notable feature of this sub-group is that many of the cases operated
on took a year or more before the mouth breathing ceased. The
children require to be taught to breathe properly, and should be
instructed to do breathing exercises after the operation.
Sub-group D (32 Cases).
Tonsils defective, tonsillar glands enlarged and mouth breathing.