Clinical Practice Guideline: Tonsillectomy in Children

Author:

Baugh Reginald F.1,Archer Sanford M.2,Mitchell Ron B.3,Rosenfeld Richard M.4,Amin Raouf5,Burns James J.6,Darrow David H.7,Giordano Terri8,Litman Ronald S.9,Li Kasey K.10,Mannix Mary Ellen11,Schwartz Richard H.12,Setzen Gavin13,Wald Ellen R.14,Wall Eric15,Sandberg Gemma16,Patel Milesh M.17

Affiliation:

1. Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA

2. Division of Otolaryngology-Head & Neck Surgery, University of Kentucky Chandler Medical Center, Lexington, Kentucky, USA

3. Cardinal Glennon Children’s Medical Center, Saint Louis University School of Medicine, St Louis, Missouri, USA

4. Department of Otolaryngology, SUNY Downstate Medical Center and Long Island College Hospital, Brooklyn, New York, USA

5. Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA

6. Department of Pediatrics, Baystate Children’s Hospital, Springfield, Massachusetts, USA

7. Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, Virginia, USA

8. Division of Otolaryngology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

9. Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

10. Sleep Apnea Surgery Center, East Palo Alto, California, USA

11. James’s Project, Wayne, Pennsylvania, USA

12. Advanced Pediatrics, Vienna, Virginia, USA

13. Albany ENT & Allergy Services, PC, Albany, New York, USA

14. Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA

15. Qualis Health, Seattle, Washington, USA

16. The Cochrane ENT Disorders Group, Oxford, United Kingdom

17. American Academy of Otolaryngology—Head and Neck Surgery Foundation, Alexandria, Virginia, USA

Abstract

ObjectiveTonsillectomy 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. Depending on the context in which it is used, it may indicate tonsillectomy with adenoidectomy, especially in relation to sleep-disordered breathing. This guideline provides evidence-based recommendations on the preoperative, intraoperative, and postoperative care and management of children 1 to 18 years old under consideration for tonsillectomy. In addition, this guideline is intended for all clinicians in any setting who interact with children 1 to 18 years of age who may be candidates for tonsillectomy.PurposeThe primary purpose of this guideline is to provide clinicians with evidence-based guidance in identifying children who are the best candidates for tonsillectomy. Secondary objectives are to optimize the perioperative management of children undergoing tonsillectomy, emphasize the need for evaluation and intervention in special populations, improve counseling and education of families of children who are considering tonsillectomy for their child, highlight the management options for patients with modifying factors, and reduce inappropriate or unnecessary variations in care.ResultsThe panel made a strong recommendation that 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 (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. The panel offered options to 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 1 or more of the following: temperature >38.3°C, cervical adenopathy, tonsillar exudate, or positive test for group A β-hemolytic streptococcus.

Publisher

SAGE Publications

Subject

Otorhinolaryngology,Surgery

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