tonsillectomy
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Introduction
A surgical procedure to remove the tonsils (a type of lymphoid tissue located in the throat {back of the mouth}).
Indications
- may be appropriate* for those with documented recurrent pharyngitis[5]
- >= 7 episodes in the past year, or
- >= 5 per year for the past 2 years, or
- >= 3 per year for the past 3 years
- fewer episodes of pharyngitis in the short term, but unclear whether benefits persist[5]
- short term benefits in children with obstructive sleep apnea[6]
- oral cancer[3]
* otherwise, the guidelines recommend watchful waiting
History
- clinicians should ask parents & caregivers of children with tonsil hypertrophy & sleep-disordered breathing about comorbid conditions
- growth retardation
- poor performance in school
- enuresis
- behavioral problems
- these problems might improve following tonsillectomy
Diagnostic procedures
- polysomnography for sleep-disordered breathing prior to tonsillectomy in children[2]
Complications
- post-operative nocturnal respiratory insufficiency (1st night) manifested by hemoglobin oxygen desaturation[4]
- 19% increase in risk for upper respiratory tract infection after tonsillectomy;
- 2% increase in infections after adenotonsillectomy[7]
Management
- a single perioperative dose of dexamethasone (0.5 mg/kg; maximum dose, 20 mg) may reduce postoperative nausea & vomiting[2]
- preoperative albuterol helps prevent adverse respiratory events in children undergoing tonsillectomy[8] (28% vs 48%)
- ibuprofen superior to morphine in reducing hemoglobin oxygen desaturation[4]
More general terms
More specific terms
Additional terms
References
- ↑ Baugh RF et al Clinical Practice Guideline: Tonsillectomy in Children Otolaryngology - Head and Neck Surgery 2011, 144(1S) S1, S30 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21493257 <Internet> http://oto.sagepub.com/content/144/1_suppl/S1.full.pdf+html (corresponding NGC guideline withdrawn Nov 2016)
- ↑ 2.0 2.1 2.2 Gallagher TQ et al Perioperative Dexamethasone Administration and Risk of Bleeding Following Tonsillectomy in Children A Randomized Controlled Trial JAMA. 2012;308(12):1221-1226. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23011712 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1362024
- ↑ 3.0 3.1 Deprecated Reference
- ↑ 4.0 4.1 4.2 Kelly LE et al. Morphine or ibuprofen for post-tonsillectomy analgesia: A randomized trial. Pediatrics 2015 Feb; 135:307 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25624387 <Internet> http://pediatrics.aappublications.org/content/135/2/307
- ↑ 5.0 5.1 5.2 Morad A, Sathe NA, Francis DO et al Tonsillectomy Versus Watchful Waiting for Recurrent Throat Infection: A Systematic Review Pediatrics Jan 2017, e20163490 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28096515
- ↑ 6.0 6.1 Chinnadurai S, Jordan AK, Sathe NA et al Tonsillectomy for Obstructive Sleep-Disordered Breathing: A Meta-analysis Pediatrics Jan 2017, e20163491; PMID: https://www.ncbi.nlm.nih.gov/pubmed/28096514
- ↑ 7.0 7.1 Byars SG, Stearns SC, Boomsma JJ. Association of Long-Term Risk of Respiratory, Allergic, and Infectious Diseases With Removal of Adenoids and Tonsils in Childhood. JAMA Otolaryngol Head Neck Surg. Published online June 7, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29879264 https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2683621
Rosenfeld RM Old Barbers, Young Doctors, and Tonsillectomy. JAMA Otolaryngol Head Neck Surg. Published online June 7, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29879278 https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2683618 - ↑ 8.0 8.1 von Ungern-Sternberg BS, Sommerfield D, Slevin L et al Effect of Albuterol Premedication vs Placebo on the Occurrence of Respiratory Adverse Events in Children Undergoing Tonsillectomies. The REACT Randomized Clinical Trial. JAMA Pediatrics. April 22, 2019. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31009034 https://jamanetwork.com/journals/jamapediatrics/fullarticle/2731129