Diagnosis
Tonsillectomy and Polysomnography (PSG)
Î Clinicians should counsel caregivers about tonsillectomy as a means
to improve health in children with abnormal PSG who also have tonsil
hypertrophy and SDB. (R-C)
Outcome Assessment for SDB
Î Clinicians should counsel caregivers and explain that SDB may persist or
recur after tonsillectomy and may require further management. (R-C)
Intraoperative Steroids
Î Clinicians should administer a single, intraoperative dose of intravenous
dexamethasone to children undergoing tonsillectomy. (S-A)
Perioperative Antibiotics
Î Clinicians should NOT routinely administer or prescribe perioperative
antibiotics to children undergoing tonsillectomy. (S-A against)
Postoperative Pain Control
ÎClinicians should advocate for pain management after tonsillectomy and educate
caregivers about the importance of managing and reassessing pain. (R-B/C)
Note: Acetaminophen or ibuprofen appropriate for the child's weight is the recommended
pain regimen unless extraordinary circumstances exist (http://www.fda.gov/drugs/
drugsafety/ucm313631.htm).
Posttonsillectomy Hemorrhage
Î Clinicians who perform tonsillectomy should determine their rate of primary
and secondary posttonsillectomy hemorrhage at least annually. (R-C)
Treatment
Tonsillectomy for SDB
Î Clinicians should ask caregivers of children with SDB and tonsil hypertrophy
about comorbid conditions that might improve after tonsillectomy, including
growth retardation, poor school performance, enuresis, and behavioral
problems. (R-C)
Table 1. Harms and Adverse Events of Tonsillectomy
Morbidity associated with tonsillectomy includes possible hospitalization, risks of anesthesia,
prolonged throat pain, and financial costs.
Primary hemorrhage (within 24 hours of surgery) ranges from 0.2% to 2.2% and the rate of
secondary hemorrhage (more than 24 hours after surgery) from 0.1% to 3.0%
After tonsillectomy about 1.3% of patients experience delayed discharge and up to 3.9% are
readmitted, most often for pain, vomiting, fever, or tonsillar hemorrhage.
Mortality rates range from 1 in 16,000 to 1 in 35,000, with about one-third of deaths
attributable to bleeding and the remainder to aspiration, cardiopulmonary failure, electrolyte
imbalance, or anesthetic complications.
