Important Points about the AAO-HNS Tonsillectomy Guideline
• Most children with frequent throat infection get better on their own;
watchful waiting is best for most children with <7 episodes in the past year, 5
per year in the past 2 years, or 3 per year in the past 3 years. Severe throat
infections are those with fever of >=101, swollen or tender neck glands,
coating on the tonsils, or a positive test for strep throat.
• Tonsillectomy can improve quality of life and reduce the frequency of severe
throat infection when there are at least 7 well-documented episodes in the past
year, 5 per year in the past 2 years, or 3 per year in the past 3 years.
• Children with less frequent or severe throat infections may still benefit
from tonsillectomy if there are modifying factors, including antibiotic
allergy/intolerance, a history of peritonsillar abscess, or PFAPA syndrome
(periodic fever, aphthous stomatitis, pharyngitis, and adenitis).
• Large tonsils can obstruct breathing at night, causing sleep-disordered
breathing (SDB), with snoring, mouth breathing, pauses in breathing, and
sometimes sleep apnoea. Physicians should ask parents of children with SDB and
large tonsils about problems that might improve after tonsillectomy, including
growth delay, poor school performance, bedwetting, and behavioural problems.
Although most children with SDB improve after tonsillectomy, some children,
especially those who are obese or have syndromes affecting the head and neck
may require further management.
• Physicians should give a single, intravenous dose of dexamethasone during
tonsillectomy to reduce pain, nausea, and vomiting after surgery.
• Physicians should not routinely prescribe antibiotics to improve recovery
following tonsillectomy surgery, because medical studies show no consistent
benefits over placebo and there are associated risks and side effects.
• Physicians should educate parents about the importance of managing and
reassessing pain after tonsillectomy. Strategies include drinking plenty of
fluids, using acetaminophen or ibuprofen for pain control, giving pain medicine
early and regularly, and encouraging their child to tell them if their throat
hurts.
SOURCE: American Academy of Otolaryngology -- Head and Neck Surgery
Information Courtesy : Dr PP Devan
