Tonsillectomies: Updated guidelines for surgery and care

Doctors now recommend limiting who gets the surgery and how they manage pain

Pediatrician checking tonsils of a little patient in hospital room.

Tonsils don’t change. How we treat problems associated with them, however, continues to evolve.

The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), also known as the Ear, Nose, and Throat (ENT) Academy, regularly publishes updated evidence-based guidelines. These guidelines, most recently updated in 2019, are designed to help guide physicians and patients on ENT procedures, including tonsillectomy in children.

Tonsillectomy is the surgical removal of tonsils. Adenoidectomy, the surgical removal of the adenoids, is often done in combination with tonsillectomy.

It is a very common surgical procedure in the United States. According to the AAO-HNS, there were approximately 289,000 tonsillectomies in children under the age 15 in 2017. This is down from an estimated 530,000 in 2009.

Who needs a tonsillectomy?

“This reduction is likely a result of us as an ENT specialty better identifying who we should really be offering surgery,” said Dr. Sean Johnson, a specialist in head and neck surgery at Sanford Health’s Ear, Nose and Throat Clinic. “An appropriately selected patient is one who will have an improvement in their symptoms following surgery that time alone would not address.”

Today tonsillectomy in children is most commonly completed to address symptoms of obstructive sleep apnea (OSA). Sleep apnea in children can contribute to school problems, behavioral problems, and overall reduced functioning.

Symptoms include loud snoring, pauses in breathing, and even bed wetting. In these children, tonsils and adenoids are often enlarged and can obstruct the oral and nasal airways. Ultimately, in appropriately selected patients, tonsillectomy and adenoidectomy can be very effective treatment.

Recurrent sore throats

Infections are the second-most common indication for tonsillectomy. For recurrent sore throats, Academy guidelines suggest adherence to the Paradise Criteria, which stipulates:

  • Seven episodes of sore throats in the last year
  • Five episodes in each of the last two years
  • Three episodes in each of the last three years

Evidence shows children who qualify under any of these criteria are much more certain to improve following tonsillectomy.

While tonsillectomy can be very effective for appropriately selected patients, there are risks. These include a severe sore throat that can last from one to two weeks. Bleeding, though rare and very rarely serious, can also accompany treatment.

“If you are concerned about your child’s tonsils, I recommend first a discussion with your family practice physician or pediatrician,” Dr. Johnson said. “If medical management is not effective or feasible, then tonsillectomy may be an appropriate next step.”

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Posted In Children's, Ear, Nose & Throat

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