Treatment
Table 2. Paradise Criteria for Tonsillectomy
a
History of sore throat episodes
• ≥7 episodes in the preceding year OR
• ≥5 episodes in each of the preceding 2 y OR
• ≥3 episodes in each of the preceding 3 y
Clinical features
Sore throat plus at least one of these features:
• Temperature >100.94ºF (38.3°C)
• Cervical lymphadenopathy (tender lymph nodes or >2 cm)
• Tonsillar exudate
• Positive culture for GABHS
Treatment
Antibiotics had been administered in conventional dosage for proved or suspected
streptococcal episodes
Documentation
• Each episode and its qualifying features had been substantiated by contemporaneous
notation in a clinical record OR
• If not fully documented, subsequent observance by the clinician of 2 episodes of throat
infection with patterns of frequency and clinical features consistent with the initial
history
b
a
Paradise JL, Bluestone CD, Bachman RZ, et al. N Engl J Med. 1984;310:674-683.
b
is last statement 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 2 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 3. Summary of Evidence-Based Statements
Point of Care (Evidence-Based Statement) Statement Strength
Surgical indications and planning
Watchful waiting R-B/C
Recurrent throat infection with documentation O-B/C
Tonsillectomy for recurrent infection with modifying factors R-B/C
Tonsillectomy for SDB R-C
Tonsillectomy and PSG R-C
Outcome assessment for SDB R-C
Perioperative care
Steroids S-A
Antibiotics S-A against
Postoperative care
Pain control & caregiver education R-B/C
Posttonsillectomy hemorrhage R-C
