- Tonsillectomy is one of the most common surgical procedures in the United States, with more than 530,000 procedures performed annually in children <15 years.
- Indications for surgery include recurrent throat infections and sleep-disordered breathing (SDB), both of which can substantially affect child health status and quality of life (QoL).
- Children with recurrent throat infections have more bodily pain and poorer general health and physical functioning than healthy children.
- SDB is associated with cognitive and behavioral impairment in children that usually improves after tonsillectomy along with QoL, sleep disturbance, and school performance.
- Throat infection is defined as 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 and acute tonsillitis, pharyngitis, adenotonsillitis or tonsillopharyngitis.
- SDB is characterized by abnormalities of respiratory pattern or the adequacy of ventilation during sleep, which include snoring, mouth breathing, and pauses in breathing. SDB encompasses a spectrum of obstructive disorders that increases in severity from primary snoring to obstructive sleep apnea (OSA).
Watchful Waiting for Recurrent Throat Infection
- Clinicians should recommend watchful waiting for recurrent throat infection if there have been <7 episodes in the past year or <5 episodes per year in the past 2 years or <3 episodes per year in the past 3 years. (R-B/C)
Recurrent Throat Infection With Documentation
- Clinicians may recommend tonsillectomy for recurrent throat infection with a frequency of ≥7 episodes in the past year or ≥5 episodes per year for 2 years or ≥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 >100.94ºF (38.3°C), cervical adenopathy, tonsillar exudate, or positive test for group A β-hemolytic streptococcus (GABHS). (O-B/C)
Tonsillectomy for Recurrent Infection With Modifying Factors
- Clinicians should assess the child with recurrent throat infection who does not meet above criteria for modifying factors that may nonetheless favor tonsillectomy. These may include, but are not limited to, multiple antibiotic allergies/intolerances, PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and adenitis), or a history of peritonsillar abscess. (R-B/C)
Tonsillectomy for SDB
- Clinicians should ask caregivers of children with SDB and tonsil hypertrophy about comorbid conditions that might improve after tonsillectomy, including growth retardation, poor school performance, enuresis, and behavioral problems. (R-C)
Tonsillectomy and Polysomnography (PSG)
- Clinicians should counsel caregivers about tonsillectomy as a means to improve health in children with abnormal PSG who also have tonsil hypertrophy and SDB. (R-C)
Outcome Assessment for SDB
- Clinicians should counsel caregivers and explain that SDB may persist or recur after tonsillectomy and may require further management. (R-C)