PEDIATRICS UP-DATES: Indication for Tonsillectomy (+/– Adenoidectomy)

Indication for Tonsillectomy (+/– Adenoidectomy):

Absolute Indications

• Moderate to severe obstructive sleep apnea

• Suspicions of tonsillar malignancy, including posttransplant lymphoid proliferative disorder (PTLD)

Relative Indications

• Mild obstructive sleep apnea

• Recurrent tonsillitis—must meet criteria:

–– Frequency:

◦◦ Seven or more episodes in 1 year

◦◦ Five or more episodes per year for 2 years

◦◦ Three or more episodes per year for 3 years

• Associated with one or more of the following:

–– Temperature > 38.3 ° C (101 °F)

–– Cervical lymphadenopathy

–– Tonsillar exudate

–– Positive test for GABHS

• Chronic tonsillitis unresponsive to antimicrobial therapy

•  Severe halitosis

•  Peritonsillar Abscess (greater than one episode)

• PFAPA syndrome (periodic fever, aphthous ulcers, pharyngitis, cervical adenitis)

• PANS/PANDAS syndrome: a controversial indication (pediatric acute-onset neuropsychiatric syndrome/pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection)

Indication for Adenoidectomy Alone

• Moderate to severe nasal obstruction with persistent symptoms

• Refractory chronic sinusitis

• Recurrent acute otitis media or otitis media with effusion in a child who had prior tympanostomy tubes that have now extruded (e.g., repeat surgery when indicated would consist of adenoidectomy plus myringotomy ± insertion of ventilation tube) and is over 4 years of age