Tonsillectomy

A tonsillectomy is the excision of one or both tonsils. It may be considered for patients who have recurrent symptoms of tonsillitis that do not become less common with time and for whom there is no other explanation for the recurrent symptoms. (1)

Note:

• there is evidence from a study by Van Staaij and colleagues (2) that immediate surgery (adenotonsillectomy) did not reduce episodes of fever, throat infections, upper respiratory tract infections, and health related quality of life
  • study randomising 300 children aged 2-8 years with these symptoms to adenotonsillectomy or watchful waiting
  • median follow up period of 22 months
    • adenotonsillectomy was more effective in children who had three to six throat infections than in those who had up to two
    • twelve children had complications after surgery

In its guideline for children aged 1-18 years, the American Academy of Otolaryngology-Head and Neck Surgery recommends watchful waiting for recurrent throat infection if there have been fewer than seven episodes in the past year, fewer than five episodes per year in the past 2 years, or under three episodes per year in the past 3 years (3)

Reference:

1. Georgalas CC, Tolley NS, Narula PA. Tonsillitis. BMJ Clin Evid. 2014 Jul 22;2014:0503.
2. Van Staaij et al (2004). Effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy: open, randomised controlled trial. BMJ;329:651
3. Mitchell RB, Archer SM, Ishman SL, et al. Clinical practice guideline: tonsillectomy in children (update). Otolaryngol Head Neck Surg. 2019 Feb;160(suppl 1):S1-42.