Key Points
Î Tonsillectomy is one of the most common surgical procedures in the United
States, with more than 530,000 procedures performed annually in children
<15 years.
Î Indications for surgery include recurrent throat infections and sleep-
disordered breathing (SDB), both of which can substantially affect child
health status and quality of life (QoL).
Î Children with recurrent throat infections have more bodily pain and poorer
general health and physical functioning than healthy children.
Î SDB is associated with cognitive and behavioral impairment in children that
usually improves after tonsillectomy along with QoL, sleep disturbance,
and school performance.
ÎThroat infection is defined as sore throat caused by viral or bacterial infection
of the pharynx, palatine tonsils, or both, which may or may not be culture
positive for group A streptococcus. This includes the terms strep throat and
acute tonsillitis, pharyngitis, adenotonsillitis or tonsillopharyngitis.
Î SDB is characterized by abnormalities of respiratory pattern or the
adequacy of ventilation during sleep, which include snoring, mouth
breathing, and pauses in breathing. SDB encompasses a spectrum of
obstructive disorders that increases in severity from primary snoring to
obstructive sleep apnea (OSA).
Diagnosis
Watchful Waiting for Recurrent Throat Infection
Î Clinicians should recommend watchful waiting for recurrent throat infection
if there have been <7 episodes in the past year or <5 episodes per year in
the past 2 years or <3 episodes per year in the past 3 years. (R-B/C)
Recurrent Throat Infection With Documentation
Î Clinicians may recommend tonsillectomy for recurrent throat infection with
a frequency of ≥7 episodes in the past year or ≥5 episodes per year for 2
years or ≥3 episodes per year for 3 years with documentation in the medical
record for each episode of sore throat and one or more of the following:
temperature >100.94ºF (38.3°C), cervical adenopathy, tonsillar exudate, or
positive test for group A β-hemolytic streptococcus (GABHS). (O-B/C)
Tonsillectomy for Recurrent Infection With Modifying Factors
Î Clinicians should assess the child with recurrent throat infection who does
not meet above criteria for modifying factors that may nonetheless favor
tonsillectomy. These may include, but are not limited to, multiple antibiotic
allergies/intolerances, PFAPA (periodic fever, aphthous stomatitis,
pharyngitis, and adenitis), or a history of peritonsillar abscess. (R-B/C)
