From the Guidelines
Tonsillectomy is indicated for children with recurrent throat infection, defined as 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, cervical adenopathy, tonsillar exudate, or positive test for group A beta-hemolytic streptococcus, as recommended by the 2019 clinical practice guideline 1. The indications for tonsillectomy can be summarized as follows:
- 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, cervical adenopathy, tonsillar exudate, or positive test for group A beta-hemolytic streptococcus 1
- Obstructive sleep-disordered breathing (oSDB) with tonsillar hypertrophy, where clinicians should ask caregivers about comorbid conditions that may improve after tonsillectomy, including growth retardation, poor school performance, enuresis, asthma, and behavioral problems 1
- Obstructive sleep apnea (OSA) documented by overnight polysomnography (PSG), where clinicians should recommend tonsillectomy 1 The procedure and postoperative care are crucial for a successful outcome, including:
- Perioperative pain counseling to manage posttonsillectomy pain 1
- Administration of a single intraoperative dose of intravenous dexamethasone to children undergoing tonsillectomy 1
- Arrangement for overnight, inpatient monitoring of children after tonsillectomy if they are <3 years old or have severe obstructive sleep apnea (OSA) 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 2, 4
- Other guidelines, such as the Danish and Paradise guidelines, also exist, but the best predictive parameters for improved throat-related quality of life (TR-QOL) after surgery are still being evaluated 4
- 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
- Subtotal tonsillectomy may be an alternative treatment option associated with lower morbidity than total tonsillectomy in adults with recurrent tonsillitis, with less postoperative pain and no recurrent tonsillitis within 12 months 6
Specific Indications
- Recurrent acute tonsillitis: defined as three or more episodes of tonsillitis per year, despite adequate medical treatment 2, 4
- Obstructive sleep apnea (OSA) with large tonsils: tonsillectomy may be effective in reducing apnea-hypopnea index and improving daytime sleepiness 5
- Poor disease-specific quality of life: tonsillectomy has been shown to improve quality of life in patients with recurrent tonsillitis 2, 3, 4
Evaluation of Guidelines
- Currently used guidelines for tonsillectomy in adults with recurrent acute tonsillitis may be too restrictive, with significant improvements in TR-QOL seen in patients who do not meet these guidelines 4
- Preoperative TOI-14 score and number of tonsillitis episodes with physician verification within the previous 12 months are predictive parameters for improved TR-QOL after tonsillectomy 4