2
Key Points
Î Tonsillectomy is one of the most common surgical procedures in
the United States, with 289,000 ambulatory procedures performed
annually in children <15 years of age based on the most recent
published data.
Î Indications for surgery include recurrent throat infections and
obstructive sleep-disordered breathing (oSDB), both of which can
substantially impact child health status and quality of life (QoL).
Î Although there are benefits of tonsillectomy, complications
of surgery may include throat pain, postoperative nausea and
vomiting, dehydration, delayed feeding, speech disorders such as
velopharyngeal incompetence (VPI), bleeding, and rarely death.
Table 1. Definitions of Words Used in the Guideline
Tonsillectomy A surgical procedure performed with or without
adenoidectomy that completely removes the tonsil, including
its capsule, by dissecting the peritonsillar space between the
tonsil capsule and the muscular wall.
roat infection 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. is includes the terms
strep throat, acute tonsillitis, pharyngitis, adenotonsillitis or
tonsillopharyngitis.
Obstructive sleep-
disordered breathing
(oSDB)
Clinical diagnosis characterized by obstructive abnormalities
of the respiratory pattern or the adequacy of oxygenation/
ventilation during sleep, which include snoring, mouth
breathing, and pauses in breathing. oSDB encompasses a
spectrum of obstructive disorders that increases in severity from
primary snoring to obstructive sleep apnea (OSA). Daytime
symptoms associated with oSDB may include inattention,
poor concentration, hyperactivity or excessive sleepiness.
e term oSDB is used to distinguish oSDB from SDB that
includes central apnea and/or abnormalities of ventilation (e.g.
hypopnea associated hypoventilation).
Obstructive sleep
apnea (OSA)
Diagnosed when oSDB is accompanied by an abnormal
polysomnography (PSG) with an obstructive apnea-hyponea
index (AHI) ≥1. It is a disorder of breathing during sleep
characterized by prolonged partial upper airway obstruction
and/or intermittent complete obstruction (obstructive apnea)
that disrupts normal ventilation during sleep and normal sleep
patterns.
Caregiver Used throughout the document to refer to parents, guardians or
other adults providing care to children under consideration for or
undergoing tonsillectomy.
