Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Tonsillectomy and/or adenoidectomy in children: Indications and contraindications

Jack L Paradise, MD
Ellen R Wald, MD
Section Editors
Morven S Edwards, MD
Glenn C Isaacson, MD, FAAP
Deputy Editor
Carrie Armsby, MD, MPH


Tonsillectomy and adenoidectomy are among the most common surgical procedures performed in children. Adenotonsillectomy is often thought of, and most often carried out, as a single, combined operation; however, in assessing indications for surgery, the two components require consideration individually. The two major categories of indications for tonsillectomy and/or adenoidectomy include obstruction and recurrent infection [1].

The indications and contraindications for tonsillectomy and adenoidectomy are reviewed here. Preoperative and postoperative care, complications of adenotonsillectomy, and the conditions for which these procedures may be indicated are discussed in greater detail separately:

(See "Tonsillectomy and/or adenoidectomy in children: Preoperative evaluation and care".)

(See "Tonsillectomy (with or without adenoidectomy) in children: Postoperative care and complications".)

(See "Adenoidectomy in children: Postoperative care and complications".)


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: Sep 2016. | This topic last updated: Aug 18, 2016.
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 ©2016 UpToDate, Inc.
  1. Ingram DG, Friedman NR. Toward Adenotonsillectomy in Children: A Review for the General Pediatrician. JAMA Pediatr 2015; 169:1155.
  2. Van Den Akker EH, Hoes AW, Burton MJ, Schilder AG. Large international differences in (adeno)tonsillectomy rates. Clin Otolaryngol Allied Sci 2004; 29:161.
  3. 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.
  4. Boss EF, Marsteller JA, Simon AE. Outpatient tonsillectomy in children: demographic and geographic variation in the United States, 2006. J Pediatr 2012; 160:814.
  5. 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.
  6. 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.
  7. 2000 Clinical Indicators Compendium. http://www.entlink.net/practice/products/indicators/tonsillectomy.html (Accessed on June 02, 2010).
  8. Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. Natl Health Stat Report 2009; :1.
  9. 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.
  10. Bhattacharyya N, Lin HW. Changes and consistencies in the epidemiology of pediatric adenotonsillar surgery, 1996-2006. Otolaryngol Head Neck Surg 2010; 143:680.
  11. Baugh RF, Archer SM, Mitchell RB, et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 2011; 144:S1.
  12. Ross RD, Daniels SR, Loggie JM, et al. Sleep apnea-associated hypertension and reversible left ventricular hypertrophy. J Pediatr 1987; 111:253.
  13. Kaemingk KL, Pasvogel AE, Goodwin JL, et al. Learning in children and sleep disordered breathing: findings of the Tucson Children's Assessment of Sleep Apnea (tuCASA) prospective cohort study. J Int Neuropsychol Soc 2003; 9:1016.
  14. Guilleminault C, Khramsov A, Stoohs RA, et al. Abnormal blood pressure in prepubertal children with sleep-disordered breathing. Pediatr Res 2004; 55:76.
  15. Marcus CL, Brooks LJ, Draper KA, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012; 130:576.
  16. 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.
  17. Paradise JL, Bluestone CD, Colborn DK, et al. Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children. Pediatrics 2002; 110:7.
  18. Burton MJ, Glasziou PP, Chong LY, Venekamp RP. Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis. Cochrane Database Syst Rev 2014; :CD001802.
  19. 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.
  20. van Staaij BK, van den Akker EH, Rovers MM, et al. Effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy: open, randomised controlled trial. BMJ 2004; 329:651.
  21. Lock C, Wilson J, Steen N, et al. North of England and Scotland Study of Tonsillectomy and Adeno-tonsillectomy in Children(NESSTAC): a pragmatic randomised controlled trial with a parallel non-randomised preference study. Health Technol Assess 2010; 14:1.
  22. Bluestone CD. Current indications for tonsillectomy and adenoidectomy. Ann Otol Rhinol Laryngol Suppl 1992; 155:58.
  23. Deutsch ES. Tonsillectomy and adenoidectomy. Changing indications. Pediatr Clin North Am 1996; 43:1319.
  24. 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.
  25. Ghorbanian SN, Paradise JL, Doty RL. Odor perception in children in relation to nasal obstruction. Pediatrics 1983; 72:510.
  26. 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.
  27. Demain JG, Goetz DW. Pediatric adenoidal hypertrophy and nasal airway obstruction: reduction with aqueous nasal beclomethasone. Pediatrics 1995; 95:355.
  28. 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.
  29. Ciprandi G, Varricchio A, Capasso M, et al. Intranasal flunisolide treatment in children with adenoidal hypertrophy. Int J Immunopathol Pharmacol 2007; 20:833.
  30. 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.
  31. 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.
  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. Brietzke SE, Shin JJ, Choi S, et al. Clinical consensus statement: pediatric chronic rhinosinusitis. Otolaryngol Head Neck Surg 2014; 151:542.
  39. Ramadan HH, Tiu J. Failures of adenoidectomy for chronic rhinosinusitis in children: for whom and when do they fail? Laryngoscope 2007; 117:1080.
  40. Ramadan HH. Surgical management of chronic sinusitis in children. Laryngoscope 2004; 114:2103.
  41. 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.
  42. Vandenberg SJ, Heatley DG. Efficacy of adenoidectomy in relieving symptoms of chronic sinusitis in children. Arch Otolaryngol Head Neck Surg 1997; 123:675.
  43. Felisati G, Ramadan H. Rhinosinusitis in children: the role of surgery. Pediatr Allergy Immunol 2007; 18 Suppl 18:68.
  44. Brietzke SE, Brigger MT. Adenoidectomy outcomes in pediatric rhinosinusitis: a meta-analysis. Int J Pediatr Otorhinolaryngol 2008; 72:1541.
  45. 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.
  46. Lieser JD, Derkay CS. Pediatric sinusitis: when do we operate? Curr Opin Otolaryngol Head Neck Surg 2005; 13:60.
  47. Cowan MJ, Gladwin MT, Shelhamer JH. Disorders of ciliary motility. Am J Med Sci 2001; 321:3.
  48. Polmar SH. The role of the immunologist in sinus disease. J Allergy Clin Immunol 1992; 90:511.
  49. 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.
  50. 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).
  51. van den Aardweg MT, Schilder AG, Herkert E, et al. Adenoidectomy for otitis media in children. Cochrane Database Syst Rev 2010; :CD007810.
  52. 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. https://effectivehealthcare.ahrq.gov/ehc/products/387/1485/otitis-media-executive-130504.pdf (Accessed on June 01, 2016).
  53. 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.
  54. 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.
  55. 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.
  56. 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.
  57. 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.
  58. 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.
  59. Rosenfeld RM. Surgical prevention of otitis media. Vaccine 2000; 19 Suppl 1:S134.
  60. Smith BE, Kuehn DP. Speech evaluation of velopharyngeal dysfunction. J Craniofac Surg 2007; 18:251.