Clinical Practice Guideline: Tonsillectomy in Children (Update)

Abstract

Objective. This update of a 2011 guideline developed by the American Academy of Otolaryngology-Head and Neck Surgery Foundation provides evidence-based recommendations on the pre-, intra-, and postoperative care and management of children 1 to 18 years of age under consideration for tonsillectomy. Tonsillectomy is defined as a surgical procedure performed with or without adenoidectomy that completely removes the tonsil, including its capsule, by dissecting the peritonsillar space between the tonsil capsule and the muscular wall. Tonsillectomy is one of the most common surgical procedures in the United States, with 289,000 ambulatory procedures performed annually in children \15 years of age based on the most recent published data. This guideline is intended for all clinicians in any setting who interact with children who may be candidates for tonsillectomy. KAS 14 (Postoperative codeine), and KAS 15a (Outcome assessment for bleeding). (6) Addition of an algorithm outlining KASs. (7) Enhanced emphasis on patient and/or caregiver education and shared decision making.

An epidemiological study of paediatric adenotonsillectomy in Victoria, Australia, 2010‐2015: Changing indications and lack of effect of hospital volume on inter‐hospital transfers

“…The guideline argued for increased access to adenotonsillectomy for children with moderate/severe obstructive sleep apnoea and recommended watchful waiting for recurrent sore throats, unless the Paradise criteria were met: ≥7 episodes in the past year, or ≥5 episodes per year in the past 2 years or ≥3 episodes per year in the past 3 years . These recommendations are strengthened by more recent international guidelines from the United States in 2019 …”

“…Tonsillectomy and/or adenoidectomy (collectively termed adenotonsillectomy) are one of the most common paediatric surgical procedures . Indications for adenotonsillectomy can be categorised into infective and obstructive causes, with recurrent sore throat and obstructive sleep‐disordered breathing (oSDB) being the most common indications …”

“…These studies identified variation in adenotonsillectomy rates, specifically between age groups, sexes and socioeconomic status . Epidemiological data outside of Australia have described a recent increase in adenotonsillectomy rates, concurrent with the rise in surgical treatment for oSDB …”

Adenotonsillectomy and postoperative respiratory adverse events: A retrospective study

“…To limit opioid use during these procedures, nonopioid medications, such as acetaminophen and dexmedetomidine, are being employed more commonly to help control pain and agitation, while potentially minimizing the incidence of PRAEs . The American Academy of Otolaryngology—Head and Neck Surgery has provided recommendations concerning postoperative pain management in their clinical practice guidelines . While many institutions have implemented protocols for caring for patients after AT, these protocols may vary, and reporting of outcomes remains limited.…”

Pediatric pulmonology year in review 2018: Sleep medicine

“…Several guidelines recommend obtaining a PSG before obtaining an AT . The American Academy of Otolaryngology—Head and Neck Surgery (AAO‐HNS), recommends obtaining a PSG in those patients considered high risk for surgical morbidity or those where there is disconnect between patient symptoms and the physical examination . Lam et al explored the predictors for obtaining a PSG before undergoing an AT for treatment of SDB.…”