Tonsillectomy - Indications

Indications

Tonsillectomy may be indicated when the patient:

• Experiences recurrent infections of acute tonsillitis. The number prompting tonsillectomy varies with the severity of the episodes. One case, even severe, is generally not enough for most surgeons to decide tonsillectomy is necessary. Paradise in 1983 defined recurrent tonsillitis warranting surgery by the attack frequency standard as "Seven or more in a year, five or more per year for two years, or three or more per year for three years. These are the absolute indications for tonsillectomy''. Currently, according to the current guidelines (2012) of the American Academy of Otolaryngology & Head and Neck Surgery (AAO-HNS), tonsillectomy is indicated as follows: "Clinicians may recommend tonsillectomy 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 one or more of the following: temperature >38.3oC, cervical adenopathy, tonsillar exudates, or positive test for Group A Beta- hemolytic strep."

Most recently, American Academy of Otolaryngology-Head and Neck Surgery Foundation has published clinical practice guidelines. The panel made a strong recommendation for:

1. Watchful waiting for recurrent throat infection 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 episodes per year in the past 3 years;
2. Assessing the child with recurrent throat infection who does not meet criteria in statement 2 for modifying factors that may nonetheless favor tonsillectomy, which may include but are not limited to multiple antibiotic allergy/intolerance, periodic fever, aphthous stomatitis, pharyngitis and adenitis, or history of peritonsillar abscess;
3. Asking caregivers of children with sleep-disordered breathing and tonsil hypertrophy about comorbid conditions that might improve after tonsillectomy, including growth retardation, poor school performance, enuresis, and behavioral problems;
4. Counseling caregivers about tonsillectomy as a means to improve health in children with abnormal polysomnography who also have tonsil hypertrophy and sleep-disordered breathing;
5. Counseling caregivers that sleep-disordered breathing may persist or recur after tonsillectomy and may require further management;
6. Advocating for pain management after tonsillectomy and educating caregivers about the importance of managing and reassessing pain; and
7. Clinicians who perform tonsillectomy should determine their rate of primary and secondary posttonsillectomy hemorrhage at least annually.