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Clinical Practice Guideline: Tonsillectomy in Children (Update)-Executive Summary.

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

|March 29, 2019

Summary

This updated guideline offers evidence-based recommendations for tonsillectomy in children aged 1-18. It emphasizes watchful waiting for recurrent infections and specific criteria for surgical intervention, including for sleep-disordered breathing.

Keywords:

adenotonsillectomy child obstructive sleep apnea polysomnography sleep disordered breathing tonsillectomy tonsillitis

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Area of Science:

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

Background:

Tonsillectomy is a common pediatric surgical procedure.
Previous guidelines for tonsillectomy care were updated in 2011.
This update addresses pre-, intra-, and postoperative care for children aged 1-18.

Purpose of the Study:

To provide evidence-based recommendations for tonsillectomy in children.
To optimize perioperative management and reduce variations in care.
To improve clinician and caregiver education on tonsillectomy indications and outcomes.

Main Methods:

Multidisciplinary guideline update group including various medical specialists and consumer advocates.
Systematic review of new evidence, including clinical practice guidelines, systematic reviews, and randomized controlled trials.
Development of key action statements (KASs) with strong recommendations and recommendations.

Main Results:

Strong recommendations include watchful waiting for recurrent throat infections based on episode frequency, use of intraoperative dexamethasone, and postoperative pain management with ibuprofen/acetaminophen.
Recommendations cover assessing modifying factors for tonsillectomy, polysomnography for obstructive sleep-disordered breathing, and counseling on potential persistence of issues post-surgery.
Strong recommendations against perioperative antibiotics and the use of codeine in children under 12.

Conclusions:

Updated guidelines provide clear actions for managing children undergoing tonsillectomy.
Emphasis on shared decision-making, patient education, and specific criteria for surgical intervention.
Focus on optimizing outcomes and minimizing risks associated with tonsillectomy in pediatric patients.