The guideline includes the following statements:
a) Watchful waiting for recurrent throat infection: Clinicians should recommend watchful waiting for recurrent throat infection if there have been fewer than 7 episodes in the past year or fewer than 5 episodes per year in the past 2 years or fewer than 3 episodes per year in the past 3 years.
b) Recurrent throat infection with documentation: Clinicians may recommend tonsillectomy for recurrent throat infection with a frequency of at least 7 episodes in the past year or at least 5 episodes per year for 2 years or at least 3 episodes per year for 3 years with documentation in the medical record for each episode of sore throat and one or more of the following: temperature >38.3o C, cervical adenopathy, tonsillar exudates, or positive test for GABHS.
c) Tonsillectomy for recurrent infection with modifying factors: Clinicians should assess the patient with recurrent throat infection who does not meet criteria in Statement 2 for modifying factors that may nonetheless favor tonsillectomy, which may include but are not limited to multiple antibiotic allergy/intolerance, PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and adenitis), or history of peritonsillar abscess. parapharyngeal abscess, severe infection with dehydration requiring IV fluids, or severe infections that may aggravate comorbid conditions (eg, seizure disorder). Children who are at risk for being held back in school due to excessive absences (eg, over ten school days per academic year) may also need consideration.
d) Tonsillectomy for sleep-disordered breathing: Clinicians should ask caregivers of children with sleep-disordered breathing (SDB) and tonsil hypertrophy about comorbid conditions that might improve after tonsillectomy, including growth retardation, poor school performance, enuresis, and behavioral problems.
e) Tonsillectomy and Polysomnography: Clinicians should counsel caregivers about tonsillectomy as a means to improve health in children with abnormal polysomnography who also have tonsil hypertrophy and sleep-disordered breathing.
f) Hypertrophy causing dental malocclusion or adversely affecting orofacial growth documented by orthodontist, maxillofacial surgeon, or dentist.
g) Hypertrophy causing severe dysphagia (particularly when supported by swallow evaluation) or cardiopulmonary complications.
h) Peritonsillar abscess unresponsive to medical management and drainage documented by surgeon, requiring surgery performed during acute stage.
i) Persistent foul taste or breath due to chronic tonsillitis not responsive to medical therapy and for which other causes have been eliminated or treated.
j) Unilateral tonsil hypertrophy presumed neoplastic.
k) Recurrent suppurative or chronic otitis media with effusion: Adenoidectomy alone. Tonsillectomy added requires one of the indications listed above.
l) Chronic sinusitis in pediatric population not responding to maximal medical therapy (eg, appropriately chosen antibiotic, topical nasal steroid sprays, saline irrigations): Adenoidectomy alone. Tonsillectomy added requires one of the indications listed above.