Clinical Guidelines For Tonsillectomy in Children Published

This month, the American Academy of Otolaryngology-Head & Neck Surgery published clinical guidelines for tonsillectomy in kids. No big surprises in the guidelines, but everything is nicely summarized in one document.

In summary:
• Strong recommendation that clinicians should administer a single, intraoperative dose of intravenous dexamethasone to children undergoing tonsillectomy.
• Strong recommendation against clinicians routinely administering or prescribing perioperative antibiotics to children undergoing tonsillectomy.
• Recommendations for:

1. watchful waiting for recurrent throat infection if there have been fewer than 7 episodes in the past year or fewer than 5 episodes per year in the past 2 years or fewer than 3 episodes per year in the past 3 years
2. assessing the child with recurrent throat infection who does not meet criteria in statement 2 for modifying factors that may nonetheless favor tonsillectomy, which may include but are not limited to multiple antibiotic allergy/intolerance; PFAPA (periodic fever, aphthous stomatitis, pharyngitis and adenitis); or history of peritonsillar abscess
3. asking caregivers of children with sleep-disordered breathing and tonsil hypertrophy about comorbid conditions that might improve after tonsillectomy
4. counseling caregivers about tonsillectomy as a means to improve health in children with abnormal polysomnography who also have tonsil hypertrophy and sleep-disordered breathing
5. counseling caregivers that sleep-disordered breathing may persist or recur after tonsillectomy and may require further management
6. advocating for pain management after tonsillectomy and educating caregivers about the importance of managing and reassessing pain
7. clinicians who perform tonsillectomy should determine their rate of primary and secondary post-tonsillectomy hemorrhage at least annually.

References:
Clinical Practice Guideline: Tonsillectomy in Children. Otolaryngology– Head and Neck Surgery 144(1S) S1–S30