Tonsillectomy in Children
Key Points
Key Points
- Tonsillectomy is one of the most common surgical procedures in the United States, with 289,000 ambulatory procedures performed annually in children <15 years of age based on the most recent published data.
- Indications for surgery include recurrent throat infections and obstructive sleep-disordered breathing (oSDB), both of which can substantially impact child health status and quality of life (QoL).
- Although there are benefits of tonsillectomy, complications of surgery may include throat pain, postoperative nausea and vomiting, dehydration, delayed feeding, speech disorders such as velopharyngeal incompetence (VPI), bleeding, and rarely death.
Table 1. Definitions of Words Used in the Guideline
| Tonsillectomy | 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. |
| Throat infection | Sore throat caused by viral or bacterial infection of the pharynx, palatine tonsils, or both, which may or may not be culture positive for group A streptococcus. This includes the terms strep throat, acute tonsillitis, pharyngitis, adenotonsillitis or tonsillopharyngitis. |
| Obstructive sleep-disordered breathing (oSDB) | Clinical diagnosis characterized by obstructive abnormalities of the respiratory pattern or the adequacy of oxygenation/ventilation during sleep, which include snoring, mouth breathing, and pauses in breathing. oSDB encompasses a spectrum of obstructive disorders that increases in severity from primary snoring to obstructive sleep apnea (OSA). Daytime symptoms associated with oSDB may include inattention, poor concentration, hyperactivity or excessive sleepiness. The term oSDB is used to distinguish oSDB from SDB that includes central apnea and/or abnormalities of ventilation (e.g. hypopnea associated hypoventilation). |
| Obstructive sleep apnea (OSA) | Diagnosed when oSDB is accompanied by an abnormal polysomnography (PSG) with an obstructive apnea-hyponea index (AHI) ≥1. It is a disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation during sleep and normal sleep patterns. |
| Caregiver | Used throughout the document to refer to parents, guardians or other adults providing care to children under consideration for or undergoing tonsillectomy. |
Table 2. Summary of Key Action Statements (KAS)
...le 2. Summary of Key Action Statem...
...agnosi...
...Watchful waiting for recurrent throat infection...
...hroat infection with documentationClinicians may r...
...my for recurrent infection with modifying...
...ctomy for oSDBClinicians should ask caregivers o...
.... Indications for polysomnography (PSG)Before p...
...al recommendations for PSGThe clinician should a...
...Tonsillectomy for obstructive sleep apnea (OSA...
...ation regarding persistent or recurrent oSDBC...
...erioperative pain counselingThe clinicia...
...atment
...ive antibioticsClinicians should NOT admini...
...ve steroidsClinicians should adminis...
...patient monitoring for children after tonsill...
...ive ibuprofen and acetaminophenClinicians...
...toperative codeineClinicians must NOT admi...
...5a. Outcome assessment for bleedingClinicia...
...tonsillectomy bleeding (PTB) rateClinicians shou...
Treatment
...eatment
...dise Criteria for TonsillectomyHav...
...f PSG in assessing high-risk populations befor...
...e 5. Tonsillectomy and oSDB Caregiver Couns...
...1. Subjective Tonsil Grading Scale...
.... Tonsillectomy in Children CPG algorithm...
Patient Information
Patient Information
...Post Tonsillectomy Pain Managemen...
...Tonsillectomy and Airway Obstruction Duri...