Tonsillectomy in Children - New Guidelines

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Tonsillectomy is one of the most common surgical procedures in the United States, with more than 530 000 procedures performed annually in children younger than 15 years.

Tonsillectomy is defined as a surgical procedure performed with or without adenoidectomy that completely removes the tonsil including its capsule by dissecting the peritonsillar space between the tonsil capsule and the muscular wall.

Clinicians should administer a single, intraoperative dose of intravenous dexamethasone to children undergoing tonsillectomy.

The panel made a strong recommendation against clinicians routinely administering or prescribing perioperative antibiotics to children undergoing tonsillectomy.

The panel made recommendations for:

- 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

- assessing the child with recurrent throat infection who does not meet criteria in the above statement 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

- 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

- counseling caregivers about tonsillectomy as a means to improve health in children with abnormal polysomnography who also have tonsil hypertrophy and sleep-disordered breathing

The panel recommends 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 1 or more of the following: temperature higher than 38.3°C, cervical adenopathy, tonsillar exudate, or positive test for group A b-hemolytic streptococcus.

References:

Clinical Practice Guideline: Tonsillectomy in Children. Otolaryngology–Head and Neck Surgery, 144(1S) S1–S30, 2010 (PDF).

Tonsillectomy May Lead to Weight Gain http://goo.gl/8dgkS

Does Having Your Tonsils Removed Cause Weight Gain? Yes, but we don't know why. NYTimes, 2011.
Effectiveness of adenoidectomy in children with recurrent URTIs: watchful waiting may be better - BMJ http://goo.gl/D9upt
RT @AllergyNet Warning: not for squeamish. Tonsil surgery 1940-60s, suggest read post first: wellc.me/ngRYhW (video)