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tonsillectomy

A surgical procedure to remove the tonsils (a type of lymphoid tissue located in the throat {back of the mouth}). Indications: - may be appropriate* for those with documented recurrent pharyngitis [5] a) >= 7 episodes in the past year, or b) >= 5 per year for the past 2 years, or c) >= 3 per year for the past 3 years d) fewer episodes of pharyngitis in the short term, but unclear whether benefits persist [5] - short term benefits in children with obstructive sleep apnea [6] - oral cancer [3] * otherwise, the guidelines recommend watchful waiting History: - clinicians should ask parents & caregivers of children with tonsil hypertrophy & sleep-disordered breathing about comorbid conditions a) growth retardation b) poor performance in school c) enuresis d) behavioral problems - these problems might improve following tonsillectomy Special laboratory: - polysomnography for sleep-disordered breathing prior to tonsillectomy in children [2] Complications: - post-operative nocturnal respiratory insufficiency (1st night) manifested by hemoglobin oxygen desaturation [4] - 19% increase in risk for upper respiratory tract infection after tonsillectomy; - 2% increase in infections after adenotonsillectomy [7] Management: - a single perioperative dose of dexamethasone (0.5 mg/kg; maximum dose, 20 mg) may reduce postoperative nausea & vomiting [2] - preoperative albuterol helps prevent adverse respiratory events in children undergoing tonsillectomy [8] (28% vs 48%) - ibuprofen superior to morphine in reducing hemoglobin oxygen desaturation [4]

Related

palatine tonsil (faucial tonsil, tonsilla)

Specific

adenotonsillectomy

General

ENT surgery; otorhinolaryngologic surgery; ear, nose & throat surgery oral surgery

References

  1. Baugh RF et al Clinical Practice Guideline: Tonsillectomy in Children Otolaryngology - Head and Neck Surgery 2011, 144(1S) S1, S30 PMID: 21493257 http://oto.sagepub.com/content/144/1_suppl/S1.full.pdf+html (corresponding NGC guideline withdrawn Nov 2016)
  2. Gallagher TQ et al Perioperative Dexamethasone Administration and Risk of Bleeding Following Tonsillectomy in Children A Randomized Controlled Trial JAMA. 2012;308(12):1221-1226. PMID: 23011712 http://jama.jamanetwork.com/article.aspx?articleid=1362024
  3. Deprecated Reference
  4. Kelly LE et al. Morphine or ibuprofen for post-tonsillectomy analgesia: A randomized trial. Pediatrics 2015 Feb; 135:307 PMID: 25624387 http://pediatrics.aappublications.org/content/135/2/307
  5. Morad A, Sathe NA, Francis DO et al Tonsillectomy Versus Watchful Waiting for Recurrent Throat Infection: A Systematic Review Pediatrics Jan 2017, e20163490 PMID: 28096515
  6. Chinnadurai S, Jordan AK, Sathe NA et al Tonsillectomy for Obstructive Sleep-Disordered Breathing: A Meta-analysis Pediatrics Jan 2017, e20163491; PMID: 28096514
  7. Byars SG, Stearns SC, Boomsma JJ. Association of Long-Term Risk of Respiratory, Allergic, and Infectious Diseases With Removal of Adenoids and Tonsils in Childhood. JAMA Otolaryngol Head Neck Surg. Published online June 7, 2018 PMID: 29879264 https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2683621 - Rosenfeld RM Old Barbers, Young Doctors, and Tonsillectomy. JAMA Otolaryngol Head Neck Surg. Published online June 7, 2018. PMID: 29879278 https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2683618
  8. von Ungern-Sternberg BS, Sommerfield D, Slevin L et al Effect of Albuterol Premedication vs Placebo on the Occurrence of Respiratory Adverse Events in Children Undergoing Tonsillectomies. The REACT Randomized Clinical Trial. JAMA Pediatrics. April 22, 2019. PMID: 31009034 https://jamanetwork.com/journals/jamapediatrics/fullarticle/2731129