Tonsillectomy

Tonsillectomy in Children

(Endorsed, November 2018)

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

Key Recommendations

• Watchful waiting for recurrent throat infection is strongly recommended if there have been fewer than 7 episodes in the past year, fewer than 5 episodes per year in the past 2 years, or fewer than 3 episodes 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 >1 peritonsillar abscess.

• Caregivers of children with obstructive sleep-disordered breathing and tonsil hypertrophy should be asked about comorbid conditions that might improve after tonsillectomy, including growth retardation, poor school performance, enuresis, asthma, 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 obstructive sleep-disordered breathing.

• Caregivers should be counseled that sleep-disordered breathing may persist or recur after tonsillectomy and may require further management.

• Perioperative antibiotics should not be administered or prescribed for children undergoing tonsillectomy.

• Caregivers should be educated about the importance of managing and reassessing pain after tonsillectomy.

• Postoperative pain should be managed with ibuprofen and/or acetaminophen.  Codeine should not be administered or prescribed for children under the age of 12.

See the full recommendation for further details.