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Clinical Practice Guideline: Tonsillectomy in Children (Update).

Ron B Mitchell1, Sanford M Archer2, Stacey L Ishman3

  • 11 UT Southwestern Medical Center, Dallas, Texas, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|February 26, 2019
PubMed
Summary

This guideline provides updated recommendations for tonsillectomy in children aged 1-18. Key updates include watchful waiting for recurrent infections, specific pain management strategies, and revised indications for polysomnography.

Keywords:
adenotonsillectomychildobstructive sleep apneapolysomnographysleep-disordered breathingtonsillectomytonsillitis

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Area of Science:

  • Otolaryngology-Head and Neck Surgery
  • Pediatric Surgery
  • Evidence-Based Medicine

Background:

  • Tonsillectomy is a common surgical procedure in children.
  • Existing guidelines require updates to reflect current evidence and improve patient care.
  • Multidisciplinary input is crucial for comprehensive guideline development.

Purpose of the Study:

  • To provide evidence-based recommendations for the pre-, intra-, and postoperative care of children undergoing tonsillectomy.
  • To optimize perioperative management and reduce variations in care.
  • To enhance patient and caregiver education regarding tonsillectomy indications and outcomes.

Main Methods:

  • Systematic review of clinical practice guidelines, systematic reviews, and randomized controlled trials.
  • Development of Key Action Statements (KASs) by a multidisciplinary panel.
  • Incorporation of patient preferences and quality improvement opportunities.

Main Results:

  • Strong recommendations for watchful waiting for recurrent throat infections based on episode frequency.
  • Recommendations for intraoperative dexamethasone and postoperative pain management with ibuprofen or acetaminophen.
  • Specific guidelines for polysomnography, inpatient monitoring, and counseling regarding obstructive sleep-disordered breathing.

Conclusions:

  • Updated guidelines emphasize watchful waiting for recurrent infections and specific perioperative care protocols.
  • Strong recommendations against perioperative antibiotics and codeine use in children under 12.
  • Enhanced focus on patient/caregiver education and shared decision-making in tonsillectomy management.