Tonsillectomy in Children

Publication Date: January 30, 2019

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

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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)

...Summary of Key Action Statements (KAS)...

...iagnos...


...chful waiting for recurrent throat i...


...roat infection with documentationClinicia...


...for recurrent infection with modifying f...


...sillectomy for oSDBClinicians should ask caregi...


...ons for polysomnography (PSG)Befor...


...recommendations for PSGThe clinician...


7. Tonsillectomy for obstructive sleep apnea...


...ation regarding persistent or recurren...


...ive pain counselingThe clinician should...


...eatmen...

...erioperative antibioticsClinicians sh...

...traoperative steroidsClinicians should admini...

...Inpatient monitoring for children after ton...

...Postoperative ibuprofen and acetami...

...perative codeineClinicians must NOT administe...

15a. Outcome assessment for bleedingC...

...Post-tonsillectomy bleeding (PTB) rateClinicians...


Treatment

Treatm...

...ise Criteria for TonsillectomyHaving tr...


...Role of PSG in assessing high-risk populations b...


...Tonsillectomy and oSDB Caregiver Counseling...


...jective Tonsil Grading Scale


.... Tonsillectomy in Children CPG algori...


Patient Information

...tient Information...

...Tonsillectomy Pain Management For Children:...


...and Airway Obstruction During Sleep Caregiver...