6
Treatment
Table 3. Paradise Criteria for Tonsillectomy
Criterion Definition
Minimum frequency
of sore throat episodes
• Seven or more episodes in the preceding year, OR
• Five or more episodes in each of the preceding two years, OR
• Three or more episodes in each of the preceding three years
Clinical features
(Sore throat plus the
presence of one or
more qualifies as a
counting episode.)
Temperature greater than 38.3°C (>101°F), OR
• Cervical lymphadenopathy (tender lymph nodes or >2 cm),
OR
• Tonsillar exudate, OR
• Positive culture for group A beta-hemolytic streptococcus
Treatment • Antibiotics have been administered in conventional dosage for
proved or suspected streptococcal episodes
Documentation • Each episode and its qualifying features have been
substantiated by contemporaneous notation in a clinical
record, OR
• If not fully documented, subsequent observance by the
clinician of two episodes of throat infection with patterns
of frequency and clinical features consistent with the initial
history*
* is last KAS allows children who meet all other criteria for tonsillectomy except documentation to
nonetheless qualify for surgery if the same pattern of reported illness is observed and documented
by the clinician in two subsequent episodes. Because of this tendency to improve with time, a
12-month period of observation is usually recommended prior to consideration of tonsillectomy as
an intervention.
Table 4. Role of PSG in assessing high-risk populations
before tonsillectomy for oSDB
Role of PSG Rationale
Avoid unnecessary or
ineffective surgery in
children with primarily
nonobstructive events
• Identify primarily nonobstructive events or central
apnea that may not have been suspected prior to the
study and may not benefit from surgery.
Confirm the presence of
obstructive events that
would benefit from surgery
• The increased morbidity of surgery in high-risk
children requires diagnostic certainty before
proceeding.
Define the severity of oSDB
to assist in preoperative
planning
• Children with severe OSA may require preoperative
cardiac assessment, pulmonary consultation,
anesthesia evaluation, or postoperative inpatient
monitoring in an intensive care setting.
Provide a baseline PSG for
comparison aer surgery
• Persistent OSA despite surgery is more common in
high-risk patients than in otherwise healthy children.
Document the baseline
severity of oSDB
• High-risk patients are more prone to complications of
surgery or anesthesia.
