Indications for Tonsillectomy in Children

Please note that the following is a general guideline only. For a full assessment, exclusion of any other underlying cause for your symptoms and an individualised treatment approach, you will need to be seen by a qualified specialist.

The above topic was addressed in a  joint Position paper in 2008.  These guide lines were set out by Paediatrics & Child Health Division of The Royal Australasian College of Physicians and The Australian Society of Otolaryngology Head and Neck Surgery

REASONS FOR THE DISCUSSION

It was noted that in Australia and New Zealand only 1 in 7-10 children who could benefit from adenotonsillectomy is being treated.

An increase in access to adenotonsillectomy for children with moderate/severe
obstructive sleep apnoea [OSA] is urgently required. 

Given the potential for permanent long term adverse effects in the younger age group, children under 5 years should be the first target group for increased services

To review medical literature and come up with recommendations for adeno-tonsil surgery. 

The following is the link for the complete article

https://www.racp.edu.au/index.cfm?objectid=B5637C7B-E823-E407-E65AB8D6F27A07BD

RECOMMENDATIONS 

1st Indication is Obstructive Breathing 

Prevalence of the problem
8 -12 per cent of all children are thought to have primary snoring.

Significant upper airway obstruction in children can result in the following 

Medical effects: 
developmental delay, growth failure and heart failure

Cognitive effects:  
verbal and non-verbal intelligence, memory, psychomotor efficiency, attention,
concentration, executive and psychosocial functioning

Behavioral effects:
aggression, hyperactivity, inattention and anxiety; while
learning, memory and executive functioning

Recommendations: 
adenotonsillectomy is the first line of treatment moderate/severe OSA. 

In children OSA is difficult to diagnose. Those children who snore regularly with no apnea noted on sleep studies, may still suffer the above effects of poor sleep. 

For primary snoring, a conservative approach is reasonable, though these children need to be followed up and monitored.  

Cure rates:
Over 90% (80% -97% on various studies)  of the children are likely to be cured. However there is a group of patients who may fail due to underlying other disorders, and they need to be followed up. 

2nd Indication- recurrent acute tonsillitis. 

7 episodes in one year
5 in each year for over two years.
3 per year over 3 years;

An account should be taken of the clinical severity of the episodes
This may result in as little as one less episode of sore throat with fever per year qualifying for surgery

3 rd Indication: Peritonsillar Abscess

Usually if there have been two abscesses it is a definite indication. 

However even one episode of an abscess, with further episodes of tonsillitis should qualify for tonsillectomy. 

Abscess tends to recur in about 20% of the patients.

4th Indication: Suspected Neoplasm – this is an absolute indication fortonsillectomy

This includes 
-If one enlarged tonsil, if there is a short history [2-6 weeks], 
-If the tonsil size is larger than 3 cm, 
-If there is associated significant other neck nodeds
-If the liver or spleen is affected

5th:  Uncommon indication

Because these presentations are uncommon the recommendations are based upon
expert opinion.
o Chronic diphtheria carrier status after failed antibiotic eradication
o Recurrent large tonsilloliths or tonsillar cysts
o Recurrent tonsillar haemorrhage