From the Guidelines
Tonsillectomy is primarily indicated for recurrent tonsillitis, defined as seven or more episodes in one year, five episodes per year for two consecutive years, or three episodes per year for three consecutive years, as well as for obstructive sleep apnea confirmed by sleep study or clinical evaluation, according to the most recent guidelines 1. The indications for tonsillectomy can be broken down into several key areas, including:
- Recurrent tonsillitis, with specific frequency criteria as mentioned above
- Obstructive sleep apnea, which should be documented by overnight polysomnography (PSG) 1
- Peritonsillar abscess that recurs or fails to resolve with antibiotics
- Suspected malignancy
- Tonsillitis causing febrile seizures or carditis
- Chronic tonsillitis unresponsive to antibiotics
- Dysphagia due to tonsillar hypertrophy
- Halitosis specifically from tonsil crypts It's essential to note that the decision to perform a tonsillectomy should be based on a thorough evaluation of the patient's condition, including their medical history, physical examination, and diagnostic test results, as outlined in the clinical practice guideline 1. The procedure involves complete removal of the palatine tonsils under general anesthesia, with typical recovery taking 10-14 days, and patients should expect significant throat pain requiring narcotic pain medication for 7-10 days, as well as the need to maintain hydration while avoiding hard or spicy foods 1. In terms of specific recommendations, clinicians should recommend tonsillectomy for children with obstructive sleep apnea (OSA) documented by overnight polysomnography (PSG) 1, and should also consider tonsillectomy for recurrent throat infection with a frequency of at least 7 episodes in the past year, 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 one of the following: temperature > 38.3°C (101°F), cervical adenopathy, tonsillar exudate, or positive test for group A beta-hemolytic streptococcus 1. Additionally, clinicians should administer a single intraoperative dose of intravenous dexamethasone to children undergoing tonsillectomy 1, and should arrange for overnight, inpatient monitoring of children after tonsillectomy if they are <3 years old or have severe obstructive sleep apnea (OSA; apnea-hypopnea index [AHI] >10 obstructive events/hour, oxygen saturation nadir <80%, or both) 1.
From the Research
Tonsillectomy Indications
- Recurrent tonsillitis is a common indication for tonsillectomy, with studies showing significant improvements in disease-specific quality of life after surgery 2, 3, 4
- The Scottish Intercollegiate Guideline Network (SIGN) criteria for tonsillectomy include three or more episodes of tonsillitis per year, despite adequate medical treatment 3
- Tonsillectomy may also be effective in treating obstructive sleep apnea (OSA) in adults with large tonsils, with significant reductions in apnea-hypopnea index and improvements in daytime sleepiness 5
- In children, tonsillectomy is often performed for recurrent tonsillitis or OSA, and anesthesiologists should be aware of the potential for difficult airway induction in patients with sleep-disordered breathing 6
Specific Patient Groups
- Adults with recurrent tonsillitis may experience significant improvements in quality of life after tonsillectomy, including reduced morbidity and decreased use of medical resources 3, 4
- Children with OSA undergoing tonsillectomy may require more airway intervention during induction, and anesthesiologists should consider polysomnography (PSG) data in conjunction with clinical characteristics to ensure an optimal postoperative course 6
Surgical Outcomes
- Total tonsillectomy and partial tonsillectomy may have similar outcomes in terms of reducing the frequency of tonsillitis, with partial tonsillectomy potentially offering less pain and reduced postoperative bleeding 2
- Tonsillectomy has been shown to improve overall quality of life, including physical and mental health, in patients with recurrent tonsillitis 2, 3, 4