**1.2.2 Relative<sup>3</sup>**

	- Seven episodes in 1 year
	- Five episodes/year for 2 consecutive years
	- Three episodes/year for 3 consecutive years
	- Two weeks of missed school or work in 1 year
	- Peritonsillar abscess
	- Dysphagia due to tonsillar hypertrophy.

The indications for tonsillectomy have dramatically changed and are today more clearly defined. Geographical variations in the incidence of tonsillectomy are recognized and, although most of this variation may only reflect varying attitudes between physicians, there is little doubt that geographical variations in pathology are partly responsible5.In adults, the most common indication is recurrent acute tonsillitis5. However the most common indication in children is obstructive sleep apnea. Patients with a prior history of recurrent tonsillitis and prior peritonsillar abscess may be more likely to develop another peritonsillar abscess and are candidates for tonsillectomy.

## **2. History**

Tonsillectomy has been performed by otolaryngologists, general surgeons, family practitioners and general practitioners. However, in the past 30 years the recognition for the need of standardization of surgical technique resulted in a shift in practice patterns so that it is almost exclusively performed by the otolaryngologists.

The first known removal of tonsils dates back to the first century AD, when Cornelius Celsius in Rome used his own finger to perform it6.The earliest description of the procedure was by Paul of Aegina in 625. The early instruments that were used for tonsillectomy were actually first developed for removal of the uvula. Phillip Syng invented what would become the forerunner for the modern tonsillotome.Not until the mid 18th century did Caque of Rheims performs tonsillectomies on a regular basis. Since then several different techniques have been used for tonsillectomy.

However, the difficulties encountered by surgeons, especially in controlling the perioperative bleeding, were a major drawback .It was only 1909,when Cohen adopted suture ligation of bleeding vessels to control the hemorrhage, that tonsillectomy became a common practice in hospitals 7.

Sixty years later Haase and Noguera8, introduced the use of diathermy and the concept of electro-dissection was first described by Goycolea6 in 1982 using monopolar diathermy.10 years later Pang9 reported the first electro-dissection tonsillectomy using the bipolar forceps technique.
