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Panel releases clinical practice guideline for tonsillectomy in children
Baugh RF. Otolaryngol Head Neck Surg. 2011;doi:10.1177/0194599810389949.
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A panel assembled by the American Academy of Otolaryngology — Head and Neck Foundation recently published a clinical practice guideline for tonsillectomy in children. The guideline’s purpose is to provide clinicians with evidence-based guidance in identifying the best pediatric candidates for tonsillectomy and to provide recommendations for the preoperative, intraoperative and postoperative care of these children.
The panel recommended the following:
- “Watchful waiting” for children with recurrent throat infection who have had fewer than seven episodes in the past year, fewer than five episodes per year during the past 2 years or fewer than three episodes per year during the past 3 years.
- Assessing children who have recurrent throat infection but who do not meet criteria for tonsillectomy for modifying factors that may “favor tonsillectomy” (multiple antibiotic/allergy intolerance, periodic fever, aphthous stomatitis, pharyngitis and adenitis, or history of peritonsillar abscess).
- Asking about comorbid conditions in children with sleep-disordered breathing and tonsil hypertrophy that may improve after tonsillectomy (growth retardation, poor school performance, enuresis, behavioral problems).
- Counseling caregivers of children with abnormal polysomnography who also have tonsil hypertrophy and sleep-disordered breathing about tonsillectomy and its potential to improve health.
- Explaining to caregivers that sleep-disordered breathing may continue after tonsillectomy and may require further treatment.
- Advocating for and educating about pain management.
- Examining the primary and secondary post-tonsillectomy hemorrhage rate, at least annually, for your practice.
The panel also recommended that a single, intraoperative dose of IV dexamethasone should be administered to children undergoing tonsillectomy and recommended against the routine use of perioperative antibiotics in these children.
“The panel offered options to recommend tonsillectomy for recurrent throat infection with a frequency of at least seven episodes in the past year or at least five episodes per year for 2 years or at least three 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 exudates, or positive test for group A beta-hemolytic streptococcus,” according to the guidelines.
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