New Tonsillectomy Guideline Aims to Identify Best Candidates for Surgery

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By: OSD Staff

Published: 1/10/2011

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Evidence-based recommendations advocate a "watchful waiting" approach to moderate throat infections.


The American Academy of Otolaryngology-Head and Neck Surgery urges patience in the treatment of moderate throat infections in a new multidisciplinary clinical practice guideline.

Tonsillectomy can improve the quality of life in patients who present with 7 documented severe throat infections in the previous year, 5 infections in the past 2 years or 3 infections per year over the last 3 years, notes the guideline, which defines severe infections as those marked by fevers of 101 ?F or higher, swollen or tender neck glands, exudates on the tonsils or positive strep throat tests.

More moderate infections typically resolve on their own and warrant a "watchful waiting" treatment approach, says the guideline, which appears in the January issue of the AAO-HNSF's official scientific journal. In these cases, tonsillectomy should not be performed until a period of observation is completed.

However, the guideline notes that certain factors might still warrant tonsillectomy in patients suffering from moderate infections, including antibiotic allergy or intolerance, a history of peritonsillar abscess, or periodic fevers, aphthous stomatitis, pharyngitis and adenitis (PFAPA syndrome).

The recommendation also directs caregivers to:

  • Administer a single intraoperative dose of IV dexamethasone, which reduces the likelihood of PONV and decreases throat pain and time to resumption of oral intake.

  • Avoid the routine administration of perioperative antibiotics. The report notes that up to 79% of polled otolaryngologists administer antibiotics to reduce post-op morbidity even though clinical research has provided "no evidence to support a consistent, clinically important impact of antibiotics in reducing the main morbid outcomes after tonsillectomy." Any real or theoretical benefit of antibiotics on the recovery of tonsillectomy patients must be weighed against the drugs' costs and potential adverse events they cause, including rash, allergy, GI track upset or diarrhea, notes the recommendation.

  • Educate patients on the importance of post-op care, including drinking plenty of fluids, using acetaminophen or ibuprofen for pain control and alerting physicians if their throat hurts.

  • Discuss with patients' parents the influence large tonsils and adenoids have on sleep-disordered breathing and the resulting behavioral, emotional and daytime functioning problems that might improve after tonsillectomy.

    Richard M. Rosenfeld, MD, MPH, one of the guideline's authors, hopes the report will empower doctors and parents to make the best decisions related to the treatment of throat infections, "resulting in safer surgery and improved quality of life for children who suffer from large or infected tonsils."

    Daniel Cook

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