(RxWiki News) There has been an update to the guidelines for surgical removal of the tonsils.
The American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF) has published new guidelines for the surgical removal of the tonsils, a procedure known as a tonsillectomy. These updated guidelines focus on children (1 to 18 years old).
These updated guidelines are meant to replace the 2011 guidelines.
This type of surgery is one of the most common procedures in children under 15 in the United States. Kids who have ongoing throat infections or obstructive sleep-disordered breathing (oSDB) are candidates for tonsillectomy. oSDB is a general term for breathing trouble during sleep.
This surgery can improve the child’s quality of life because it can reduce the number of throat infections and help with oSDB. However, this procedure is not without risks. These risks may include throat pain, nausea, and even speech disorders or bleeding.
The changes to the guidelines call for more screening and post-operative management. Five key action statements were changed from the original guidelines. Seven were added.
The changes to the 2011 recommendations were minor. “Watchful waiting” is now a stronger recommendation in comparison to the 2011 guidelines. Watchful waiting is recommended for patients if there have been fewer than seven episodes in the past year, fewer than five episodes per year in the past two years or fewer than three episodes per year in the past three years. Other changes include offering pain counseling and education after surgery and the strong recommendation against antibiotic use during or after the surgery.
Some of the new key action statements include the following:
- Inpatient monitoring for children after surgery. This includes overnight post-op monitoring. This recommendation is most important for patients younger than 3 or those with sleep apnea. Detecting problems through observation early on can lead to earlier treatment and improved safety.
- Ibuprofen and acetaminophen are safe and adequate for pain management. Opioids are not recommended.
- Codeine products are not recommended in patients younger than 12.
- Doctors are advised to contact patients after the procedure to check for bleeding.
Tonsillectomies can have benefits for patients. However, not all patients are good candidates. The new guidelines emphasize the importance of screening to prevent unnecessary surgery. Unnecessary surgery to remove the tonsils can lead to potential complications and be costly. Sleep studies can help screen patients for surgery because they can help identify patients who can benefit from this surgery.
The development of these new guidelines was funded and sponsored by the AAO-HNSF. One of the guideline authors was an AAO-HNSF employee, another author was a consultant for Medtronic, and another was a salaried employee at Bonner University Medical Group and received an Arizona Nexus research grant. The authors disclosed no other funding sources or potential conflicts of interest.