Tonsillectomy / Adenoidectomy INDICATIONS

ABSOLUTE INDICATIONS — Absolute indications mandating tonsillectomy and/or adenoidectomy consist of the following:

• Extreme obstruction of the nasopharyngeal or oropharyngeal airways by adenoids, tonsils, or both
• Tonsillar obstruction of the oropharynx that interferes with swallowing
• Malignant tumor of the tonsil (or suspicion of malignancy)
• Uncontrollable hemorrhage from tonsillar blood vessels

CONDITIONAL INDICATIONS — The principal indication for elective tonsillectomy is recurrent infection

Tonsillectomy — Conditional indications for tonsillectomy (with or without adenoidectomy) may include

●Recurrent acute throat infections.***

●Chronic tonsillitis unresponsive to antimicrobial treatment.

●Tonsillar obstruction that alters voice quality.

●Halitosis, refractory to other measures.

●More than one episode of peritonsillar abscess or peritonsillar abscess in a child with substantial history of recurrent throat infection.

●Chronic pharyngeal carriage of group A beta-hemolytic streptococci if the carrier is in close contact with a person who has had rheumatic fever or lives in a household in which infection occurs frequently and eradication has been refractory to other measures.

●Syndrome of periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA syndrome) unresponsive to conservative treatment.

***Recurrent infections

• ≥3 episodes in each of three years, ≥5 episodes in each of two years, or ≥7 episodes in one year.
• Each qualifying episode characterized by at least ONE of the following:
• Oral temperature ≥101ºF (38.3ºC)
• Enlarged (>2 cm) or tender anterior cervical lymph nodes
• Tonsillar exudate
• Positive culture for group A beta-hemolytic Streptococcus
• Apparently adequate antibiotic therapy administered for proven or suspected streptococcal episodes.
• Each qualifying episode confirmed by examination with the clinical features described in a clinical record at the time of occurrence, or if not fully documented, subsequent observance of two episodes of throat infection with patterns of frequency and clinical features consistent with the initial history.

Conditional indications for adenoidectomy in children include:

·         Moderate nasal obstruction caused by adenoidal hypertrophy with persistent symptoms

·         Refractory chronic sinusitis

·         Recurrent acute otitis media (AOM) or chronic otitis media with effusion (OME) in children who have undergone tympanostomy tube insertion and whose tubes have been extruded