Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Tonsillectomy and adenoidectomy in children: Indications and contraindications

INTRODUCTION

Tonsillectomy and adenoidectomy are common surgeries in children. The two major indications for these procedures are, respectively, obstruction and infection involving the upper respiratory tract and the deglutitory pathway.

An overview of the epidemiology and the indications and contraindications for tonsillectomy and/or adenoidectomy are presented below. Preoperative, intraoperative, and postoperative care and complications are discussed in detail separately. More detailed information regarding the conditions for which these procedures may be indicated is provided separately. (See "Tonsillectomy and/or adenoidectomy in children: Preoperative and intraoperative care" and "Tonsillectomy (with or without adenoidectomy) in children: Postoperative care and complications" and "Adenoidectomy in children: Postoperative care and complications".)

EPIDEMIOLOGY

Tonsillectomy is among the most commonly performed operations in children. The frequency with which tonsillectomy is performed varies from country to country and region to region [1-3]. The variation appears to be related to differences in the medical practice of general practitioners, pediatricians, and otolaryngologists in the management of recurrent tonsillitis and other conditions affecting the upper airway [4]. Patient/family factors and preferences may also influence the decision [5].

In the United States, the number of tonsillectomies has declined progressively since the 1970s [6,7]. Reports suggest that the decline has mainly involved tonsillectomies performed for infectious indications, while the number of tonsillectomies performed for obstructive indications may have actually increased [8,9]. In 2006, an estimated 530,000 tonsillectomies (with or without adenoidectomy) and 132,000 adenoidectomies (without tonsillectomy) were performed in children younger than 15 years of age [7]. Most of these operations are performed as ambulatory, same-day procedures [7].

The rates for specific procedures vary depending upon age and sex. Tonsillectomy alone is performed infrequently in children younger than three years of age, whereas adenoidectomy alone is performed infrequently in individuals older than 14 years of age. The rate of adenoidectomy is about 1.5 times as high in boys as in girls, whereas the rate of tonsillectomy is about one-third higher in girls than in boys [5,7].

                       

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jul 2014. | This topic last updated: Jul 22, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Van Den Akker EH, Hoes AW, Burton MJ, Schilder AG. Large international differences in (adeno)tonsillectomy rates. Clin Otolaryngol Allied Sci 2004; 29:161.
  2. Blair RL, McKerrow WS, Carter NW, Fenton A. The Scottish tonsillectomy audit. Audit Sub-Committee of the Scottish Otolaryngological Society. J Laryngol Otol 1996; 110 Suppl 20:1.
  3. Boss EF, Marsteller JA, Simon AE. Outpatient tonsillectomy in children: demographic and geographic variation in the United States, 2006. J Pediatr 2012; 160:814.
  4. Capper R, Canter RJ. Is there agreement among general practitioners, paediatricians and otolaryngologists about the management of children with recurrent tonsillitis? Clin Otolaryngol Allied Sci 2001; 26:371.
  5. Lock C, Wilson J, Steen N, et al. Childhood tonsillectomy: who is referred and what treatment choices are made? Baseline findings from the North of England and Scotland Study of Tonsillectomy and Adenotonsillectomy in Children (NESSTAC). Arch Dis Child 2010; 95:203.
  6. 2000 Clinical Indicators Compendium. http://www.entlink.net/practice/products/indicators/tonsillectomy.html (Accessed on June 02, 2010).
  7. Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. Natl Health Stat Report 2009; :1.
  8. Erickson BK, Larson DR, St Sauver JL, et al. Changes in incidence and indications of tonsillectomy and adenotonsillectomy, 1970-2005. Otolaryngol Head Neck Surg 2009; 140:894.
  9. Bhattacharyya N, Lin HW. Changes and consistencies in the epidemiology of pediatric adenotonsillar surgery, 1996-2006. Otolaryngol Head Neck Surg 2010; 143:680.
  10. Baugh RF, Archer SM, Mitchell RB, et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 2011; 144:S1.
  11. Ramos SD, Mukerji S, Pine HS. Tonsillectomy and adenoidectomy. Pediatr Clin North Am 2013; 60:793.
  12. Jakins PS. Remarkable increase in bodily growth following the removal of tonsil and adenoids. J Laryngol Rhinol Otol 1893; 7:427.
  13. ROCHE AF. THE INFLUENCE OF TONSILLECTOMY ON GROWTH AND CALORIC INTAKE. J Pediatr 1964; 65:360.
  14. Jeyakumar A, Fettman N, Ambrecht ES, Mitchell R. A systematic review of adenotonsillectomy as a risk factor for childhood obesity. Otolaryngol Head Neck Surg 2011; 44:154.
  15. Czechowicz JA, Chang KW. Analysis of growth curves in children after adenotonsillectomy. JAMA Otolaryngol Head Neck Surg 2014; 140:491.
  16. Clayburgh D, Milczuk H, Gorsek S, et al. Efficacy of tonsillectomy for pediatric patients with Dysphagia and tonsillar hypertrophy. Arch Otolaryngol Head Neck Surg 2011; 137:1197.
  17. Roland PS, Rosenfeld RM, Brooks LJ, et al. Clinical practice guideline: Polysomnography for sleep-disordered breathing prior to tonsillectomy in children. Otolaryngol Head Neck Surg 2011; 145:S1.
  18. Paradise JL, Bluestone CD, Bachman RZ, et al. History of recurrent sore throat as an indication for tonsillectomy. Predictive limitations of histories that are undocumented. N Engl J Med 1978; 298:409.
  19. Paradise JL, Bluestone CD, Bachman RZ, et al. Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials. N Engl J Med 1984; 310:674.
  20. Paradise JL, Bluestone CD, Colborn DK, et al. Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children. Pediatrics 2002; 110:7.
  21. Bluestone CD. Current indications for tonsillectomy and adenoidectomy. Ann Otol Rhinol Laryngol Suppl 1992; 155:58.
  22. Deutsch ES. Tonsillectomy and adenoidectomy. Changing indications. Pediatr Clin North Am 1996; 43:1319.
  23. Group A streptococcal infections. In: Red Book: 2012 report of the committee on infectious diseases, 29th ed, Pickering LK (Ed), American Academy of Pediatrics, Elk Grove Village 2012. p.668.
  24. Ghorbanian SN, Paradise JL, Doty RL. Odor perception in children in relation to nasal obstruction. Pediatrics 1983; 72:510.
  25. Sclafani AP, Ginsburg J, Shah MK, Dolitsky JN. Treatment of symptomatic chronic adenotonsillar hypertrophy with amoxicillin/clavulanate potassium: short- and long-term results. Pediatrics 1998; 101:675.
  26. Demain JG, Goetz DW. Pediatric adenoidal hypertrophy and nasal airway obstruction: reduction with aqueous nasal beclomethasone. Pediatrics 1995; 95:355.
  27. Criscuoli G, D'Amora S, Ripa G, et al. Frequency of surgery among children who have adenotonsillar hypertrophy and improve after treatment with nasal beclomethasone. Pediatrics 2003; 111:e236.
  28. Ciprandi G, Varricchio A, Capasso M, et al. Intranasal flunisolide treatment in children with adenoidal hypertrophy. Int J Immunopathol Pharmacol 2007; 20:833.
  29. Zhang L, Mendoza-Sassi RA, César JA, Chadha NK. Intranasal corticosteroids for nasal airway obstruction in children with moderate to severe adenoidal hypertrophy. Cochrane Database Syst Rev 2008; :CD006286.
  30. Chadha NK, Zhang L, Mendoza-Sassi RA, César JA. Using nasal steroids to treat nasal obstruction caused by adenoid hypertrophy: does it work? Otolaryngol Head Neck Surg 2009; 140:139.
  31. Paradise JL, Bluestone CD, Carrasco NM. Nasal obstruction due to adenoid hypertrophy two year course with and without adenoidectomy. Abstracts. 18th Annual Meeting of the Ambulatory Pediatric Assoication, New York City, April 25, 1978. p.43.
  32. Joshua B, Bahar G, Sulkes J, et al. Adenoidectomy: long-term follow-up. Otolaryngol Head Neck Surg 2006; 135:576.
  33. Solow B. Upper airway obstruction and facial development. In: The biological mechanisms of tooth movement and craniofacial adaptation, Davidovitch Z (Ed), The Ohio State University College of Dentistry, Columbus 1992. p.571.
  34. Linder-Aronson S. Adenoids. Their effect on mode of breathing and nasal airflow and their relationship to characteristics of the facial skeleton and the denition. A biometric, rhino-manometric and cephalometro-radiographic study on children with and without adenoids. Acta Otolaryngol Suppl 1970; 265:1.
  35. Linder-Aronson S. Effects of adenoidectomy on dentition and nasopharynx. Trans Eur Orthod Soc 1972; :177.
  36. Oulis CJ, Vadiakas GP, Ekonomides J, Dratsa J. The effect of hypertrophic adenoids and tonsils on the development of posterior crossbite and oral habits. J Clin Pediatr Dent 1994; 18:197.
  37. Linder-Aronson S, Woodside DG, Hellsing E, Emerson W. Normalization of incisor position after adenoidectomy. Am J Orthod Dentofacial Orthop 1993; 103:412.
  38. Ramadan HH, Tiu J. Failures of adenoidectomy for chronic rhinosinusitis in children: for whom and when do they fail? Laryngoscope 2007; 117:1080.
  39. Ramadan HH. Surgical management of chronic sinusitis in children. Laryngoscope 2004; 114:2103.
  40. Don DM, Yellon RF, Casselbrant ML, Bluestone CD. Efficacy of a stepwise protocol that includes intravenous antibiotic therapy for the management of chronic sinusitis in children and adolescents. Arch Otolaryngol Head Neck Surg 2001; 127:1093.
  41. Vandenberg SJ, Heatley DG. Efficacy of adenoidectomy in relieving symptoms of chronic sinusitis in children. Arch Otolaryngol Head Neck Surg 1997; 123:675.
  42. Felisati G, Ramadan H. Rhinosinusitis in children: the role of surgery. Pediatr Allergy Immunol 2007; 18 Suppl 18:68.
  43. Brietzke SE, Brigger MT. Adenoidectomy outcomes in pediatric rhinosinusitis: a meta-analysis. Int J Pediatr Otorhinolaryngol 2008; 72:1541.
  44. Buchman CA, Yellon RF, Bluestone CD. Alternative to endoscopic sinus surgery in the management of pediatric chronic rhinosinusitis refractory to oral antimicrobial therapy. Otolaryngol Head Neck Surg 1999; 120:219.
  45. Lieser JD, Derkay CS. Pediatric sinusitis: when do we operate? Curr Opin Otolaryngol Head Neck Surg 2005; 13:60.
  46. Cowan MJ, Gladwin MT, Shelhamer JH. Disorders of ciliary motility. Am J Med Sci 2001; 321:3.
  47. Polmar SH. The role of the immunologist in sinus disease. J Allergy Clin Immunol 1992; 90:511.
  48. American Academy of Family Physicians, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics Subcommittee on Otitis Media With Effusion. Otitis media with effusion. Pediatrics 2004; 113:1412.
  49. National Institute for Health and Clinical Excellence. Surgical management of otitis media with effusion in children. 2008. www.nice.org.uk/nicemedia/pdf/CG60NICEguideline.pdf (Accessed on November 08, 2012).
  50. Paradise JL, Bluestone CD, Colborn DK, et al. Adenoidectomy and adenotonsillectomy for recurrent acute otitis media: parallel randomized clinical trials in children not previously treated with tympanostomy tubes. JAMA 1999; 282:945.
  51. Paradise JL, Bluestone CD, Rogers KD, et al. Efficacy of adenoidectomy for recurrent otitis media in children previously treated with tympanostomy-tube placement. Results of parallel randomized and nonrandomized trials. JAMA 1990; 263:2066.
  52. van den Aardweg MT, Schilder AG, Herkert E, et al. Adenoidectomy for otitis media in children. Cochrane Database Syst Rev 2010; :CD007810.
  53. Berkman ND, Wallace IF, Steiner MJ, et al. Otitis Media With Effusion: Comparative Effectiveness of Treatments.Comparative Effectiveness Review No. 101. Agency for Healthcare Research and Quality 2013. http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=1485&pageaction=displayproduct (Accessed on May 29, 2013).
  54. Gates GA, Avery CA, Prihoda TJ, Cooper JC Jr. Effectiveness of adenoidectomy and tympanostomy tubes in the treatment of chronic otitis media with effusion. N Engl J Med 1987; 317:1444.
  55. Hammarén-Malmi S, Saxen H, Tarkkanen J, Mattila PS. Adenoidectomy does not significantly reduce the incidence of otitis media in conjunction with the insertion of tympanostomy tubes in children who are younger than 4 years: a randomized trial. Pediatrics 2005; 116:185.
  56. Koivunen P, Uhari M, Luotonen J, et al. Adenoidectomy versus chemoprophylaxis and placebo for recurrent acute otitis media in children aged under 2 years: randomised controlled trial. BMJ 2004; 328:487.
  57. Mattila PS, Joki-Erkkilä VP, Kilpi T, et al. Prevention of otitis media by adenoidectomy in children younger than 2 years. Arch Otolaryngol Head Neck Surg 2003; 129:163.
  58. Rosenfeld RM. Surgical prevention of otitis media. Vaccine 2000; 19 Suppl 1:S134.
  59. Smith BE, Kuehn DP. Speech evaluation of velopharyngeal dysfunction. J Craniofac Surg 2007; 18:251.