“The seeds of great discoveries constantly germinate around us, but only then do they take root in our lives when the soil in our minds has been prepared” (Joseph Henry 1797-1878).  

This saying of the great scientist physicist most “accurately” characterizes the development and implementation by V. Mayer of the pharyngeal tonsil (GM) removal method in the daily practice of ENT doctors. This “discovery” of the Danish scientist prepared the very “ground” in the minds of 19th-century colleagues and became the starting point of the era of the total war of otolaryngologists with GM.     

The role of the pharyngeal tonsil (GM) – (adenoid vegetation) can be compared with the thymus gland (thymus), but in the 19th century the physiologist anatomist (Wilhelm Gies) and the doctor (Frederick Theodor Schmidt), for the first time (in 1861), discovered an accumulation of lymphoid tissue in nasopharynx (similar to the crown of a cockscomb, in the form of uneven grooves) – characterized them as a “painful swelling.” Unfortunately, at that time they could not correctly assess the physiological significance of this organ and its functional role in the child’s body. 

  In 1867, the Danish doctor Wilhelm Mayer, having discovered a tumor-like tissue in the patient’s nasopharynx that seemed to him like “earthworms,” also saw them as an “enemy” and for this reason decided to remove them. To do this, he designed a special ring-shaped curette knife, with which the GM was scraped out through the nasal passage in the form of an experiment, thereby opening the “gateways” for further experimentation to remove the pharyngeal tonsil. Subsequently, he also developed several more varieties of tools to perform this operation. For these services, at the end of the 19th century, by “admirers-fans” of such a “medical” direction, a monument was erected to him. 

 The scientific error of W. Mayer, in the account of the pathology of the lymphopharyngeal ring, was transformed into a pseudoscientific doctrine and, rooted in the minds of his contemporaries, was the beginning of almost two centuries of struggle with the pharyngeal tonsil, as an enemy of a child’s body. During this period, the active opposition of the global medical community against the physiology of GM, dozens of methods and devices for its removal have been developed. 

Adeno Tomia (story) 

  In 1879, Mayer’s pupil and follower of his idea of ​​“ridding” the body of GM, Victor Lange, performed this operation with a special curette through his mouth. Subsequently, Beckman proposed a special set of tools for removing GM.Adenotomes, special forceps, sharp spoons, curettes, shavers, etc. All these scientific and creative studies of otolaryngologists were aimed: not at curing and restoring the physiological function of GM, but at its removal. To mask their unlawful and inappropriate clinical actions, colleagues developed a special scenario for the diagnostic “horror”: malocclusion, chicken breast, nocturnal enuresis, etc. To reduce the protective and barrier function of GM, as well as its physiological significance in the development and formation of the child’s immunity, instead of the anatomical term (Tonsilla pharynge), a new name was invented – Adenoids. Thus, a bogeyman of the enemy of a child’s body was created from GM – and for the clinical aggravation of the diagnosis, the very notorious “degrees” of the magnitude were invented. Despite, that metrological standards and the anatomical criterion for the magnitude of adenoid vegetation (as, incidentally, of other human organs) do not exist; then, in order to justify their actions to remove GM, they came up with a “classification” of adenoid vegetation as an “enemy” in degrees – I, II, III. The doctor defines and evaluates all these so-called “degrees” according to his personal perception, therefore one doctor can put the 1st – 2nd degree, and the other 3rd or 4th. The criterion of “objectivity” of these “conclusions” are only the subjective feelings of the doctor. The subjectivity of establishing these “degrees” is obvious, because metrology of the magnitude of GM is carried out “by eye”, according to the popular image and standard: “… to the knee and below the knee” and does not cause anything but laughter. In fact, there are no “DEGREES” in the anatomical examination of this body, 

 “DEVELOPMENT OF SURGERY” – according to the methods of removing GM, it intensively “developed” every year: what otolaryngologists did not “think of” in order to deprive the child of the immune defense of the nasopharynx. They developed dozens of various tools and devices for removing adenoid vegetation, some doctors removed the GM with a special “grater”, burned them with lapis, alkalis, chromic and other acids – even “scratched” them with their nails ie GM has been declared as an “unnecessary” and “harmful” organ – a merciless war and are still “fighting” for its destruction in every possible way. 

  To date, the following types of surgeries and methods for the removal of GM (adenoids) already exist: 

– electrocautery adenotomy; 

– cold plasma adenotomy (cobalt); 

– laser destruction adenotomy (selective-basal), which leads to deep scarring of the nasopharynx; 

– vacuum adenotomy; 

– ultrasound adenotomy (leading to the defeat of all cells of the nasopharyngeal mucosa); 

– shaver (microdebridor) adenotomy (“shaving” the nasopharyngeal mucosa to the muscle layer); 

– partial adenotomy, etc. 

  Similar “healing” approaches are applied to the tonsils – the main lymphatic collector of the oropharynx. Treatment of chronic tonsillitis, mainly, otolaryngologists try to carry out radically, i.e. by removal of the tonsils – or subtotal tonsillotomy. Unfortunately, many ENT departments (especially for children) have turned into “Adenotonzillary abortions.” Moreover, after the endotracheal tube was invented in 1921, adenotonsillectomy was started from an early age (2 to 3 years) under anesthesia and thereby drove the problem of treating a child’s lymphopharyngeal ring into a corner; declaring, GM and palatine tonsils, a total war – to destroy. Many doctors made the decision: instead of adequate conservative treatment, use only surgical – an adenotonsillectomy operation. Currently, the most common operations in children in the world are adenotomy and tonsillectomy! Until now, otolaryngologists are in search of “new surgical methods”, as well as the development of “all kinds of” devices – to remove the pharyngeal and palatine tonsils …  

 Adenotomy – (removal of GM) – STOP! 

  According to ICD-10, chronic adenoiditis is an inflammatory process of the pharyngeal tonsil, which is a fragment of a common infectious and allergic disease of the entire lymphopharyngeal system of the child’s body and is characterized by a permanent inflammatory process in the lymphoid tissue of the nasopharynx. Given that the pharyngeal tonsil – tonsilla pharingea is located in the upper part of the pharynx – hence the anatomically sound name for this disease should be – Epipharyngitis. The long-term clinical practice of the Healthi Tonsils ENT Center confirms that chronic tonsilloid adenitis is a hereditary, pathogenetically functional-linked disease and, nosologically correct, it should be called: Chronic Tonsillo-Epipharyngitis (TEF). Chronic epipharyngitis (inflammation of GM) always develops against a background of chronic tonsillitis, 

  GM itself, regardless of its anatomical structural form and size, is extremely rarely the cause of difficult nasal breathing. Assumptions about the complete “filling” of the nasopharynx of GM – most often appear due to the overdiagnosis of some doctors, like other “fantasies” about the formation in the child (supposedly due to hypertrophy of the GM) – a pathological chest (chicken breast), as well as developmental disorders facial skeleton, malocclusion, anemia, enuresis, etc. The nature of the development of the child’s body does not provide for clogging of the choanal holes with the lymphoid tissue of the pharynx i.e. GM, therefore, with any inflammation – there is always a gap between the choanas and GM. 

  Naturally, during the period of the disease (inflammation of um) there is an increase in its volume (like any other organ during the period of inflammation), but it does not radically affect the difficulty in nasal breathing. As a rule, the cause of difficulty in nasal breathing, even with the so-called “adenoiditis”, is not the “degree of magnitude” of the GM, but swelling of the nasal passages and an increase in the volume of the nasal concha, as well as the mucopurulent discharge that fills the nasal passages. The structural form (appearance) of a GM is always individual, because the size and shape of this lymphoid organ is genetically determined, as is the size and shape of the external nose, auricles, etc. Therefore, it is not correct to standardize GM by “dimensional degrees” as an organ, all the more so since there is no metrological criterion or anatomical standard for parameters of the magnitude of GM. 

  In practice otolaryngologist frequent GM, ” to grow camping ” on the back of the throat – below the soft palate at the same time, absolutely – without impeding normal nasal breathing. Therefore, the notorious degrees of the magnitude of GM described in the manuals on otorhinolaryngology are I, II, III, etc. nothing more than the subjective “notions” of doctors, mainly in order to justify the need for surgical intervention on the pharyngeal tonsil, as well as to intimidate parents with the “irreversibility” of the process of increasing GM and to obtain their consent to this operation – the removal of GM (adenotomy).    

The pharyngeal tonsil (adenoid vegetation) is a structured lymphoid tissue that, prior to the puberty period, is involved in the formation of local humoral immunity. Along with palatine tonsils, GM forms LEGS and performs not only the function of lymphopoiesis, but also is a kind of antiviral and antibacterial barrier (nasopharyngeal biofilter) in a child. 

 GM is a very important physiological substance of the nasopharynx of the child’s body; its functional-secretory, as well as morphological role has not yet been fully studied. Therefore, any unreasonable type of surgical intervention on the lymphopharyngeal ring of a child is fraught with physiological and functional decompensation, i.e. Operation “adenotomy” simply cripples the nasopharynx as a functional and structural formation of the child’s body. 

  The uselessness of the aforementioned operation – “adenotomy” – is evidenced by the facts of repeated and even triple its implementation. It is pointless to remove the lymphoid tissue of the nasopharynx, i.e. GM, which the child’s body always tries to restore – due to its compensatory-regenerative capabilities. A doctor who decides to perform such an operation without vital signs for the child, and even more so when he does it again, goes against the natural development of the child’s body and thereby harms him, violating the basic medical commandment – noli nocere! (do no harm!). 

At the Helse Tonsills ENT Center, a conservative method for treating GM inflammation (regardless of the “degree” of its magnitude) and the duration of the disease is successfully used. Since one of the reasons for the ineffectiveness of the use of antibacterial drugs in the treatment of chronic epipharyngitis is the biofilm that forms on the surface of the GM. In our clinic, a special elastic instrument (probe-massager) was developed, which is used to massage GM, in order to destroy the integrity (fragmentation) of the structure of biofilms and, after elimination of the purulent-mucous contents of the nasopharynx, the introduction of special. Phytobalm. This manipulation is performed 6-8 times, depending on the severity of the pathological process in GM.