Clinical Practice Guideline: Tonsillectomy in Children

Abstract

The panel made a strong recommendation that clinicians should administer a single, intraoperative dose of intravenous dexamethasone to children undergoing tonsillectomy. The panel made a strong recommendation against clinicians routinely administering or prescribing perioperative antibiotics to children undergoing tonsillectomy. The panel made recommendations for (1) 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; (2) assessing 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, periodic fever, aphthous stomatitis, pharyngitis and adenitis, or history of peritonsillar abscess; (3) asking 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; (4) counseling caregivers about tonsillectomy as a means to improve health in children with abnormal polysomnography who also have tonsil hypertrophy and sleep-disordered breathing; (5) counseling caregivers that sleep-disordered breathing may persist or recur after tonsillectomy and may require further management; (6) advocating for pain management after tonsillectomy and educating caregivers about the importance of managing and reassessing pain; and (7) clinicians who perform tonsillectomy should determine their rate of primary and secondary posttonsillectomy hemorrhage at least annually. The panel offered options to 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 1 or more of the following: temperature >38.3°C, cervical adenopathy, tonsillar exudate, or positive test for group A β-hemolytic streptococcus.

Identificação de fatores de risco para apneia obstrutiva do sono após adenotonsilectomia: estudo piloto

“…Com a realização da AT, ocorre importante melhora da qualidade de vida e também dos sinas/sintomas originados pelo distúrbio obstrutivo respiratório na criança 10,11,13,22,23,25 . No presente estudo, foi verificada a frequência de AOS grave em 40% antes da cirurgia e de 10% após o procedimento, constatando assim, a necessidade do acompanhamento longitudinal desses pacientes, não sendo unânime a melhora das crianças em toda a sua sintomatologia.…”

Assessment of quality of life before and after an adenotonsillectomy among children with hypertrophic tonsils and/or adenoids

“…Such difference could have been to the fact that some of the domains evaluated by the survey could have definite changes at the time of surgery or, if reversible, some changes would require more than 6 months for domains to return to a normal score. 21 One of the strengths of this study is that the control group and the sample were homogenous, which favored the comparison of the scores obtained in the post-surgery surveys. The diagnosis of rhonchopathy and sleep apnea might be underestimated in the pediatric population.…”

Tonsillotomy: it's time to clarify the facts

“…The patients may become symptomatic with excessive sleepiness, inattention, poor concentration, or hyperactivity during daytime. According to the latest statement of the American Academy of Otolaryngology-Head and Neck Surgery, TE still plays a major role to resolve SDB related to tonsillar hypertrophy in children [5]. Morbidity following TE is widely determined by pain and significant limitations in activity and diet.…”

“…While the best method to avoid surgical complications is not to operate, this is not an option for upper airway obstruction caused by tonsillar hypertrophy. TE, however, is acknowledged to control SDB in only 60-70 % of children with significant tonsillar hypertrophy, emphasizing the multifactorial background of this disease [5].…”