Clinical Practice Guideline

Tonsillectomy

Tonsillectomy in Children

(Endorsed With Qualifications, April 2012)

The guideline, Tonsillectomy in Children, was developed by the American Academy of Otolaryngology-Head and Neck Surgery and endorsed with qualifications by the American Academy of Family Physicians.

Key Recommendations

  • Watchful waiting for recurrent throat infection is recommended if there have been fewer than 7 episodes in the past year or fewer than 5 episodes per year in the past 2 years or fewer than 3 eipsodes per year in the past 3 years.
  • Tonsillectomy may be considered for recurrent throat infection with a frequency of at least 7 episodes in the past year or at least 5 episodes per year for 2 years or at least 3 episodes per year for 3 years with documentation in the medical record for each episode of sore throat and 1 or more of the following: temperature > 38.3°C, cervical adenopathy, tonsillar exudate, or positive test for group A beta-hemolytic streptococcus.
  • The child with recurrent throat infection who does not meet the criteria above should be assessed for modifying factors that may nonetheless favor tonsillectomy, such as multiple antibiotic allergy/intolerance, PFAPA (periodic fever, aphthous stomatitis, pharyngitis and adenitis), or history of peritonsillar abscess.
  • Caregivers of children with sleep-disordered breathing and tonsil hypertrophy should be asked about comorbid conditions that might improve after tonsillectomy, including growth retardation, poor school performance, enuresis, and behavioral problems.
  • Caregivers should be counseled about tonsillectomy as a means to improve health in children with abnormal polysomnography who also have tonsil hypertrophy and sleep-disordered breathing.
  • Caregivers should be counseled that sleep-disordered breathing may persist or recur after tonsillectomy and may require further management.
  • Caregivers should be educated about the importance of managing and reassessing pain after tonsillectomy.

 

Qualifications

  • Four of the ten recommendations were upgraded based on lower-level evidence. These include recommendations 4, 5, 6 and 10 in the guideline and concern sleep-disordered breathing comorbidities, abnormal polysomnography, and physician hemorrhage rate comparisons.

These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These guidelines are only one element in the complex process of improving the health of America. To be effective, the guidelines must be implemented.