Clinical Practice Guideline: Tonsillectomy in Children

Objective Tonsillectomy 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 ton...

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Bibliographic Details
Published in:Otolaryngology-head and neck surgery 2011-01, Vol.144 (1_suppl), p.S1-S30
Main Authors: Baugh, Reginald F., Archer, Sanford M., Mitchell, Ron B., Rosenfeld, Richard M., Amin, Raouf, Burns, James J., Darrow, David H., Giordano, Terri, Litman, Ronald S., Li, Kasey K., Mannix, Mary Ellen, Schwartz, Richard H., Setzen, Gavin, Wald, Ellen R., Wall, Eric, Sandberg, Gemma, Patel, Milesh M.
Format: Article
Language:English
Subjects:
adenotonsillectomy
Adolescent
Child
Child, Preschool
Evidence-Based Medicine
Humans
Infant
Patient Selection
pediatric guideline
Recurrence
sleep disordered breathing
tonsillectomy
Tonsillectomy - adverse effects
Tonsillectomy - methods
tonsillitis
Tonsillitis - surgery
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Summary:Objective Tonsillectomy 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. Purpose The 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. Results The 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-diso
ISSN:0194-5998
1097-6817
DOI:10.1177/0194599810389949