New clinical guidelines on tonsillectomies in children published

I find that most parents and many primary care physicians are confused about when a child should and should not be considered for a tonsillectomy. The CNN “The Chart” blog is reporting that, according to Richard M. Rosenfeld, MD, MPH, of SUNY Downstate Medical Center, “over half a million tonsillectomies are done every year in the United States.”

Dr. Rosenfeld also pointed out that the “associated morbidity, and the availability of hundreds of randomized clinical trials evaluating associated interventions create a pressing need for evidence-based guidance to aid clinicians,” Medscape reported.

Therefore, he helped author a new guideline that “offers evidence-based recommendations on identifying children who are the best candidates for tonsillectomy, and on preoperative, intraoperative, and postoperative care and management.”

The guideline, published in Otolaryngology–Head and Neck Surgery, includes other objectives as well, including “improving counseling and education for families, describing management options for patients with modifying factors, reducing inappropriate or unnecessary variations in care, and discussing the significant public health implications of tonsillectomy.”

Notably, the “guidelines update a set of clinical indicators for tonsillectomies published in 2000 by the American Academy of Otolaryngology, which suggested that doctors could consider taking out the tonsils if a child had at least three cases of swollen and infected tonsils in a year,” WebMD reported.

“The new guideline, however, says that kids should have:

  • at least seven episodes of throat infection, such as tonsillitis or strep throat in a year, or
  • at least five episodes each year for two years, or
  • three episodes annually for three years, before they become candidates for surgery,
  • and that those infections should be documented by a doctor, rather than just reported by parents.”

According to experts, “the idea…was to reserve surgery only for the most severely affected, because the surgery can rarely have serious complications including infections and serious bleeding.”

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