Clinical Practice Guideline: Tonsillectomy in Children.
Developed by the American Academy of Otolaryngology-Head and Neck Surgery and was endorsed with qualifications by the AAFP.
“STATEMENT 1. WATCHFUL WAITING FOR RECURRENT THROAT INFECTION: Clinicians should recommend 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.”
“STATEMENT 2. RECURRENT THROAT INFECTION WITH DOCUMENTATION: Clinicians may recommend tonsillectomy for recurrent throat infection with a frequency of at least 7 episodes in the past year or 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 or more of the following: temperature >38.3°C, cervical adenopathy, tonsillar exudate, or positive test for GABHS”
“STATEMENT 3. TONSILLECTOMY FOR RECURRENT INFECTION WITH MODIFYING FACTORS: Clinicians should assess 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, PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and adenitis), or history of peritonsillar abscess.”
“STATEMENT 4. TONSILLECTOMY FOR SLEEPDISORDERED BREATHING: Clinicians should ask caregivers of children with sleep-disordered breathing and tonsil hypertrophy about comorbid conditions that might improve after tonsillectomy, including growth retardation, poor school performance, enuresis, and behavioral problems.”
“STATEMENT 5. TONSILLECTOMY AND POLYSOMNOGRAPHY: Clinicians should counsel caregivers about tonsillectomy as a means to improve health in children with abnormal polysomnography who also have tonsil hypertrophy and sleep-disordered breathing.”
“STATEMENT 6. OUTCOME ASSESSMENT FOR SLEEP-DISORDERED BREATHING: Clinicians should counsel caregivers and explain that SDB may persist or recur after tonsillectomy and may require further management.”
“STATEMENT 7. INTRAOPERATIVE STEROIDS: Clinicians should administer a single, intraoperative dose of intravenous dexamethasone to children undergoing tonsillectomy.”
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References
http://www.aafp.org/patient-care/clinical-recommendations/all/tonsil.html
http://journals.sagepub.com/doi/pdf/10.1177/0194599810389949