Our Summary

This research paper is an updated 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 to have their tonsils removed (tonsillectomy). Tonsillectomy is a common surgery in the US, especially for children under 15 years old.

The aim of this guideline is to improve the quality of care for these children by providing clear and practical recommendations for healthcare providers. This includes when to consider tonsillectomy, how to manage the surgery and aftercare, and how to communicate effectively with families about the procedure.

The guideline suggests that doctors should wait and see if a child’s throat infections become less frequent before recommending tonsillectomy. If a child has their tonsils removed, they should be given a specific type of medication (dexamethasone) during the operation and painkillers (ibuprofen, acetaminophen, or both) afterwards.

It also advises that children with certain conditions - such as obesity, Down syndrome, or sickle cell disease - should have a sleep study done before tonsillectomy. This is to check for sleep-disordered breathing, which can improve after tonsillectomy.

The guideline strongly advises against giving children antibiotics before or after tonsillectomy, and against giving them any medication containing codeine.

Overall, the guideline emphasizes the importance of good communication and shared decision-making between doctors and families.

The updated guideline incorporates new research and includes input from a wider range of experts, including two patient advocates. It also includes an easy-to-follow flowchart of the key recommendations.

FAQs

  1. When should a doctor consider recommending a tonsillectomy for a child?
  2. What medications are suggested for a child undergoing a tonsillectomy according to the updated guidelines?
  3. Why does the guideline suggest a sleep study for children with certain conditions before a tonsillectomy?

Doctor’s Tip

One helpful tip a doctor might give a patient about tonsillectomy is to stay hydrated and drink plenty of fluids after the surgery to help with healing and prevent dehydration. It’s important to avoid rough or scratchy foods that can irritate the throat, and to stick to soft, easy-to-swallow foods like smoothies, soup, and yogurt. It’s also important to follow post-operative care instructions carefully, including taking pain medication as prescribed and avoiding strenuous activities for a certain period of time. If any concerning symptoms such as excessive bleeding, fever, or difficulty breathing occur, it’s important to contact your doctor immediately.

Suitable For

Patients who are typically recommended for tonsillectomy include:

  1. Children who have frequent or severe throat infections (tonsillitis) that do not respond well to antibiotics.
  2. Children with obstructive sleep-disordered breathing, such as obstructive sleep apnea, which can be improved by removing the tonsils.
  3. Children with recurrent or chronic tonsillitis, defined as several episodes of throat infection per year for multiple years.
  4. Children with complications of tonsillitis, such as peritonsillar abscess or rheumatic fever.
  5. Children with an underlying condition that may benefit from tonsillectomy, such as obesity, Down syndrome, or sickle cell disease.
  6. Children with significant enlargement of the tonsils that causes difficulty breathing or swallowing.
  7. Children with persistent foul taste in the mouth or bad breath despite good oral hygiene, which may be due to chronic tonsillitis.
  8. Children who may benefit from tonsillectomy for reasons other than those listed above, based on individual circumstances and consultation with a healthcare provider.

It is important for healthcare providers to carefully evaluate each patient and consider their individual circumstances before recommending tonsillectomy. Shared decision-making with the patient and their family is crucial in determining the best course of treatment.

Timeline

Before tonsillectomy:

  • Child experiences frequent throat infections or sleep-disordered breathing
  • Doctor considers tonsillectomy as a treatment option
  • Child may undergo a sleep study if necessary
  • Doctor discusses risks and benefits of surgery with child’s family
  • Surgery is scheduled and child prepares for the procedure

After tonsillectomy:

  • Child receives dexamethasone during the operation
  • Child is given painkillers (ibuprofen, acetaminophen, or both) for pain management
  • Child may experience throat pain, difficulty swallowing, and bad breath in the days following surgery
  • Child should avoid certain foods and activities to aid in recovery
  • Child should follow up with doctor for post-operative care and monitoring

Overall, the child and their family should be well-informed about the procedure and have clear instructions for post-operative care to ensure a smooth recovery.

What to Ask Your Doctor

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

  1. Is tonsillectomy the best option for my child’s condition?
  2. What are the potential risks and complications of the surgery?
  3. How long will the recovery process take?
  4. What type of pain management will be used during and after the surgery?
  5. Are there any specific precautions or instructions for aftercare?
  6. Will my child need a sleep study before the surgery?
  7. Are there any alternative treatments or therapies that could be considered?
  8. How many tonsillectomies have you performed, and what is your success rate?
  9. Will my child need to stay overnight in the hospital?
  10. How soon after the surgery can my child resume normal activities, such as school and sports?

It is important for patients to have open and honest communication with their doctor to ensure they have a clear understanding of the procedure and what to expect before, during, and after the surgery.

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