Tonsillectomy in Children

- Clinical Indicators for Monitoring

1. Frequency-based Assessment:

Ensure that clinicians recommend watchful waiting for recurrent throat infection based on the specified frequency criteria: <7 episodes in the past year, <5 episodes per year in the past 2 years, or <3 episodes per year in the past 3 years.

2. Intraoperative Dexamethasone Administration:

Monitor if clinicians administer a single intraoperative dose of intravenous dexamethasone to children undergoing tonsillectomy.

3. Pain Control Recommendations:

Verify that clinicians recommend ibuprofen, acetaminophen, or a combination of both for pain control after tonsillectomy.

4. Avoidance of ASOT Testing:

Confirm that clinicians refrain from ordering the antistreptolysin-O titer (ASOT) for acute and recurrent tonsillitis/pharyngitis, as it is deemed not valuable.

5. Comorbidity Assessment for Sleep-disordered Breathing:

Ensure that clinicians inquire about comorbid conditions related to obstructive sleep-disordered breathing in children with tonsillar hypertrophy, including growth retardation, poor school performance, enuresis, asthma, and behavioral problems.

6. Polysomnography Referral and Advocacy:

Monitor whether clinicians appropriately refer children for polysomnography before tonsillectomy based on age or the presence of specific comorbidities, and advocate for polysomnography when the need for tonsillectomy is uncertain or when there is discordance between examination and reported severity.

These indicators cover a range of key recommendations from the guidelines, ensuring proper adherence and patient care.

Updating the guideline

To keep these recommendations up to date and  ensure  its validity it will be periodically updated. This will be done whenever a strong new evidence is available  and  necessitates updation.

Research Needs

1.Investigate the treatment of recurrent throat infections by tonsillectomy versus antibiotics/watchful waiting (<12 and >12 months) using a multicenter randomized controlled trial design.

2. Assess the immunologic role of the tonsils and, specifically, at what point the benefits of tonsillectomy exceed the harm, using a biomarker approach.

3. Determine the cost-effectiveness (direct and indirect) of different tonsillectomy techniques.