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105
Enlarged Tonsils and Adenoids. On the question of 'tonsils and adenoids'
we maintain a conservative outlook towards their removal. This is a subject
of vital importance particularly in the case of children and it is absolutely
essential to be quite clear, clinically on the significance of the physiology
and pathology of the ring of lymphatic tissue of which the tonsils and
adenoids are part, surrounding and guarding the entrance to both the chest and
alimentary tract. The wholesale removal of tonsils and adenoids merely on
such grounds as 'enlarged tonsils and adenoids', 'chronic nasal catarrh'
'chronic colds in the head', 'adenoid facies', need only to be
mentioned to be rejected. Lists of rules and indications for the removal of
tonsils and adenoids are clinically meaningless. Every case is a law unto
itself and must be decided on its own merits. It is important, also, to
remember that adenoids and tonsils differ in their pathological effects.
Adenoids can become, when greatly hypertrophied, a 'mechanical' factor in
causing nasal respiratory obstruction, whereas tonsils can be, when clinically
diseased, a source of 'toxaemia'. 'Unhealthy' tonsils and adenoids are
usually the 'sign' of a disease which must be sought elsewhere and removal of
the sign will not cure the disease. There are, however, instances where
removal of adenoids (when they cause nasal obstruction) and, much less
frequently, tonsils (chronically diseased) are clearly indicated and the
results very satisfactory. Nevertheless the operation should be limited to
those cases where the effect of their removal is beyond doubt.
In conclusion the standard of general health of the children seen at the
clinics during the year has been very good. In only a few instances could it
be considered as below normal and it is in marked contrast to, say, 20 years
ago.
Audiometry Scheme
Under the present County arrangements a gramophone audiometrician is
shared between this Area and that comprising the Boroughs of Finchley and
Hendon.
Mrs. Perry, whose appointment was reported in my last annual report,
resigned during the year, and was replaced by Mrs. M. Diffy in October. Die
to this change in staff the initial survey in Finchley and Hendon has taken
longer than anticipated, so that the services of the gramophone audiometrician
were not available at all in this Area during 1954.
Consideration will be given, once the routine audiometry testing of seven
year old children has been brought up-to-date to testing children in 'C'
streams at school to ascertain whether or not their lack of educational
progress may be associated with some degree of deafness.