January 4, 2011
Guideline For Tonsillectomy In Children
(Ivanhoe Newswire) -- A tonsillectomy is a 3,000-year-old surgical procedure that has just received it's first multidisciplinary clinical practice guideline, which provides evidence-based recommendations on the pre and postoperative care and management of children aged 1 to 18 years under consideration for the operation. It also addresses practice variation in medicine and the considerable public health implications of tonsillectomy.
Tonsillectomy, one of the most common surgical procedures in the United States "“ with over 530,000 procedures performed annually in children under 15 years old "“ is the surgical removal of the tonsils, two oval-shaped pads of tissue at the back of the throat "” one tonsil on each side. A tonsillectomy was once a common procedure to treat infection and inflammation of the tonsils (tonsillitis). Today, a tonsillectomy is usually performed when tonsillitis occurs frequently or doesn't respond to other treatments. A tonsillectomy may also be necessary to treat breathing and other problems related to enlarged tonsils and to treat rare diseases of the tonsils.
The chief function of this guideline is to provide clinicians with evidence-based guidance in identifying children who are the utmost candidates for tonsillectomy. Secondary objectives are to optimize the perioperative management of children undergoing tonsillectomy; emphasize the need for evaluation and intervention in special populations; improve counseling and education for families of who are considering tonsillectomy for their child; highlight the management options for patients with modifying factors; and to reduce unacceptable or pointless variations in care.
Key points made in the Guideline:
1. Most children with frequent throat infection get better on their own; watchful waiting is best for most children with less than seven episodes in the past year, five a year in the past two years, or three a year in the past three years.
2. Severe throat infections are those with fever of 101 or higher, swollen or tender neck glands, coating (exudate) on the tonsils, or a positive test for strep throat.
3. Tonsillectomy can improve quality of life and reduce the frequency of severe throat infection when there are at least seven well-documented episodes in the past year, five a year in the past two years, or three a year in the past three years.
4. Children with less frequent or severe throat infections may still benefit from tonsillectomy if there are modifying factors, including antibiotic allergy/intolerance, a history of peritonsillar abscess (collection of pus behind the tonsil), or PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis, and adenitis).
5. Large tonsils can obstruct breathing at night, causing sleep-disordered breathing (SDB), with snoring, mouth breathing, pauses in breathing, and sometimes sleep apnea (pauses more than 10 seconds).
6. Doctors should ask parents of children with SDB and large tonsils about problems that might improve after tonsillectomy, including growth delay, poor school performance, bedwetting, and behavioral problems.
7. Although most children with SDB improve after tonsillectomy, some children, especially those who are obese or have syndromes affecting the head and neck (e.g., Down), may require further management.
8. Doctors should give a single, intravenous dose of dexamethasone (a steroid medicine) during tonsillectomy to reduce pain, nausea, and vomiting after surgery.
9. Doctors should not routinely prescribe antibiotics to improve recovery following tonsillectomy surgery, because medical studies show no consistent benefits over placebo and there are associated risks and side effects.
10. Doctors should educate parents about the importance of managing and reassessing pain after tonsillectomy. Strategies include drinking plenty of fluids, using acetaminophen or ibuprofen for pain control, giving pain medicine early and regularly, and encouraging their child to tell them if their throat hurts.
SOURCE: Otolaryngology "” Head and Neck Surgery, January 2010