Our Summary

This research paper updates a 2011 guideline from the American Academy of Otolaryngology-Head and Neck Surgery Foundation on how to care for children aged 1-18 years who may need a tonsillectomy. Tonsillectomy is a surgery where the tonsils are completely removed and is quite common in the United States.

The guideline is aimed at all healthcare professionals who may treat children who could need a tonsillectomy. The aim is to improve the quality of care for these children and provide clear advice on how to do this. This includes advice on when a tonsillectomy may be needed, how to manage care before, during and after the surgery, and how to educate the families of these children.

The recommendations include waiting and watching for recurrent throat infection if there have been fewer than 7 episodes in the past year, or fewer than 5 per year in the past 2 years, or fewer than 3 per year in the past 3 years. Other recommendations include giving a single dose of intravenous dexamethasone during surgery and recommending ibuprofen, acetaminophen, or both for pain control after the surgery.

The guideline advises against the use of perioperative antibiotics and the use of codeine or any medication containing codeine in children under 12 years. The guideline also outlines the circumstances in which tonsillectomy may be recommended for recurrent throat infection.

Changes from the previous 2011 guideline were also highlighted, including increased emphasis on patient and caregiver education and shared decision-making.

FAQs

  1. What are the updated recommendations for when a tonsillectomy may be needed in children?
  2. What medications are recommended for pain control after a tonsillectomy, according to the updated guidelines?
  3. What changes were made from the 2011 guideline for tonsillectomy in children?

Doctor’s Tip

One helpful tip a doctor might tell a patient about adenoidectomy is to make sure to follow all pre-operative instructions provided by the healthcare team, such as fasting before the surgery and avoiding certain medications. It is also important to discuss any concerns or questions with the healthcare team before the procedure to ensure a smooth and successful recovery. Additionally, following post-operative care instructions, such as taking prescribed medications and avoiding certain activities, can help promote healing and reduce the risk of complications.

Suitable For

Patients who are typically recommended for adenoidectomy include those with recurrent throat infections, sleep-disordered breathing, chronic sinusitis, and chronic otitis media. Adenoidectomy may also be recommended for patients with obstructive sleep apnea, nasal congestion, and speech or swallowing difficulties. Additionally, patients with recurrent or persistent adenoiditis may also be candidates for adenoidectomy.

Overall, the decision to recommend adenoidectomy should be based on the individual patient’s symptoms, medical history, and overall health. It is important for healthcare professionals to carefully evaluate each patient and consider the potential benefits and risks of adenoidectomy before making a recommendation for surgery.

Timeline

Before adenoidectomy:

  1. Patient experiences recurrent throat infections or difficulty breathing through the nose.
  2. Consultation with an otolaryngologist to determine if adenoidectomy is necessary.
  3. Pre-operative evaluation and preparation for surgery.
  4. Surgery is scheduled and patient is informed about what to expect during and after the procedure.

After adenoidectomy:

  1. Patient undergoes surgery to remove the adenoids.
  2. Post-operative care includes pain management, rest, and monitoring for any complications.
  3. Patient may experience throat pain, nasal congestion, and ear pain in the days following surgery.
  4. Follow-up appointments with the otolaryngologist to ensure proper healing and recovery.
  5. Patient gradually resumes normal activities and symptoms improve over time.

What to Ask Your Doctor

Some questions a patient should ask their doctor about adenoidectomy include:

  1. Why do I need an adenoidectomy?
  2. What are the risks and benefits of having an adenoidectomy?
  3. What are the alternatives to having an adenoidectomy?
  4. What is the recovery process like after an adenoidectomy?
  5. How long will it take for me to fully recover from the surgery?
  6. Are there any restrictions or special care instructions I need to follow after the surgery?
  7. What kind of pain management options will be available to me after the surgery?
  8. How often will I need to follow up with you after the surgery?
  9. Are there any potential long-term effects or complications associated with having an adenoidectomy?
  10. How will having an adenoidectomy impact my overall health and quality of life?

Reference

Authors: Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, Friedman NR, Giordano T, Hildrew DM, Kim TW, Lloyd RM, Parikh SR, Shulman ST, Walner DL, Walsh SA, Nnacheta LC. Journal: Otolaryngol Head Neck Surg. 2019 Feb;160(2):187-205. doi: 10.1177/0194599818807917. PMID: 30921525