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Sub-group C (188 Cases).
Tonsils defective and mouth breathing.
Observation Cases.—Only 8.5 per cent, of this sub-group were
observations cases, and of these, 50 per cent, were recommended
operation later. The numbers are too small (16 altogether) to
draw conclusions but the figures conform roughly to those of
Group I (C).
Operation Cases.—Of those operated on 95 per cent, improved.
Only 39 per cent, of those not operated on improved. Of those
recommended operation at a subsequent examination and not
operated on, only 33 per cent, improved. (Numbers here are again
small.) Of the seven cases remaining stationary, four continued
mouth breathing because of a deflected septum, and three took two
years before nose breathing was established satisfactorily.
It was noted in this group that the cases took much longer to
improve without operation than in any of the previous sub-groups.
It seems desirable, therefore, that in this type of case, though
operation is not the only form of treatment, it has to be considered
from the outset as a probable necessity depending largely on the
severity of the nasal obstruction. When this is slight, the child
should be kept under observation for some months, probably a
year.
Sub-group D (70 Cases).
Tonsils defective, enlarged tonsillar glands and mouth breathing.
There were no children recommended for observation in
this group. Operations were performed on 52.8 per cent. Of
these, 97.3 per cent, improved after the operation. Of those
not operated on, 39 per cent, improved.
One child, instead of deriving benefit from the operation,
developed nasal catarrh and bronchitis after it.
As in the sub-group II (C), where the nasal obstruction is slight,
observation should be allowed for a period of about a year. Where
the obstruction is marked, operation should be recommended at
the first inspection.