AAO-HNSF Release New Guidelines for Pediatric Tonsillectomy

The American Academy of Otolaryngology—Head and Neck Surgery Foundation has updated its 2011 guidelines on the care and management of pediatric patients who are candidates for tonsillectomy.

For the update, a panel representing the fields nursing, anesthesiology, consumers, family medicine, infectious disease, otolaryngology–head and neck surgery, pediatrics, and sleep medicine was convened. They reviewed the results of a literature search which included 1 new clinical practice guideline, 26 new systematic reviews, and 13 new randomized controlled trials.

Based on their review, changes were added to the 2011 guidelines, including:

• Watchful waiting for recurrent throat infection in pediatric patients with <7 episodes in the past year, <5 episodes per year in the past 2 years, or <3 episodes per year in the past 3 years, has been upgraded to a strong recommendation.
• Children with obstructive sleep-disordered breathing should be referred for polysomnography if they are under 2 years old, are obese, or have Down syndrome, craniofacial abnormalities, neuromuscular disorders, sickle cell disease, or mucopolysaccharidoses.
• Tonsillectomy should be recommended for children with obstructive sleep apnea confirmed by overnight polysomnography.
• Ibuprofen, acetaminophen, or both should be recommended for pain management following tonsillectomy, and codeine should not be given to children under 12 years old.

The full guidelines are published in Otolaryngology–Head and Neck Surgery.

—Michael Potts

Reference:

Mitchell RB, Archer SM, Ishman SL, et al. Clinical practice guideline: tonsillectomy in children (update) [published online February 5, 2019]. Otolaryngol Head Neck Surg. https://doi.org/10.1177/0194599818801757.