Our Summary

This research paper provides an update to a 2011 guideline by the American Academy of Otolaryngology-Head and Neck Surgery Foundation on the care and management of children aged 1 to 18 who are being considered for a tonsillectomy. The procedure, which removes the tonsils, is one of the most common surgeries in the United States, particularly for children under 15.

This guideline has been created to help improve the quality of managing children who might need a tonsillectomy. It aims to educate healthcare professionals, patients, and caregivers about when a tonsillectomy is necessary and what to expect from the procedure. It also provides advice on managing the care of children before, during, and after the operation and highlights additional considerations for children with certain health conditions.

Important recommendations include delaying surgery if a child has had fewer than seven throat infections in a year or fewer than five per year in the last two years. It also recommends giving a single dose of a specific drug during the operation and using ibuprofen, acetaminophen, or both for pain control after the operation.

Before the procedure, clinicians should refer children with sleep disorders for overnight sleep studies, particularly those with obesity, Down syndrome, craniofacial abnormalities, neuromuscular disorders, sickle cell disease, or mucopolysaccharidoses.

The paper strongly advises against the use of antibiotics or codeine for children undergoing tonsillectomy. It also emphasizes the importance of managing pain after the operation and of monitoring children who are younger than three years old or have severe sleep apnea overnight after the procedure.

The guideline was updated to include new evidence and changes in clinical practice since the last version. It included contributions from a range of medical professionals as well as two consumer advocates.

FAQs

  1. What is the purpose of the updated guideline for tonsillectomy by the American Academy of Otolaryngology-Head and Neck Surgery Foundation?
  2. What are some of the important recommendations included in the updated guideline for children who are being considered for a tonsillectomy?
  3. Why does the guideline recommend against the use of antibiotics or codeine for children undergoing tonsillectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about tonsillectomy is to make sure to follow all pre-operative instructions given by the healthcare team. This may include fasting before the procedure, avoiding certain medications, and arranging for someone to drive you home after the surgery. By following these instructions carefully, you can help ensure a smooth and successful recovery.

Suitable For

Patients who are typically recommended for a tonsillectomy include those who have frequent throat infections, obstructive sleep apnea, or difficulty breathing due to enlarged tonsils. Children with recurrent or chronic tonsillitis, tonsil stones, or difficulty swallowing may also be candidates for the procedure. Additionally, children with certain health conditions such as obesity, Down syndrome, or neuromuscular disorders may benefit from a tonsillectomy to improve their overall health and quality of life. It is important for healthcare professionals to carefully evaluate each patient’s individual circumstances and consider the potential risks and benefits of the procedure before making a recommendation for a tonsillectomy.

Timeline

Before the tonsillectomy procedure, a child may experience recurrent throat infections or sleep-disordered breathing. They may undergo diagnostic tests such as overnight sleep studies, especially if they have certain health conditions.

After the tonsillectomy, the child can expect to experience pain, which can be managed with ibuprofen, acetaminophen, or a combination of both. Antibiotics and codeine are not recommended for pain management. It is important to monitor younger children and those with severe sleep apnea closely after the procedure. Follow-up care and monitoring may be necessary to ensure proper healing and recovery.

Overall, the guideline provides recommendations for healthcare professionals, patients, and caregivers to ensure the best possible care and outcomes for children undergoing tonsillectomy.

What to Ask Your Doctor

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

  1. Why is a tonsillectomy being recommended for me or my child?
  2. What are the risks and benefits of having a tonsillectomy?
  3. Are there any alternative treatments or options to consider before proceeding with a tonsillectomy?
  4. What is the recovery process like after a tonsillectomy?
  5. How long will it take to fully recover from the procedure?
  6. Are there any specific complications or side effects I should be aware of?
  7. How will pain be managed after the surgery?
  8. Will there be any dietary or activity restrictions following the tonsillectomy?
  9. How often will follow-up appointments be needed after the procedure?
  10. Are there any specific signs or symptoms to watch for that may indicate a complication after the surgery?

By asking these questions, patients can ensure they have a clear understanding of the procedure and what to expect before, during, and after a tonsillectomy.

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(1_suppl):S1-S42. doi: 10.1177/0194599818801757. PMID: 30798778