Clinical Practice Guideline: Tonsillectomy in Children

Otolaryngology - Head and Neck Surgery - Tập 144 Số S1 - 2011
Reginald F. Baugh1, Sanford M. Archer2, Ron B. Mitchell3, Richard M. Rosenfeld4, Raouf S. Amin5, James Burns6, David H. Darrow7, Terri Giordano8, Ronald S. Litman9, Kasey K. Li10, Mary Mannix11, Richard H. Schwartz12, Gavin Setzen13, Ellen R. Wald14, Eric M. Wall15, Gemma Sandberg16, Milesh M. Patel17
1Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA
2Division of Otolaryngology–Head & Neck Surgery University of Kentucky Chandler Medical Center Lexington Kentucky USA
3Cardinal Glennon Children’s Medical Center Saint Louis University School of Medicine St Louis Missouri USA
4Department of Otolaryngology, SUNY Downstate Medical Center and Long Island College Hospital, Brooklyn, New York, USA
5Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
6Department of Pediatrics, Baystate Children's Hospital, Springfield, Massachusetts, USA
7Department of Otolaryngology Eastern Virginia Medical School Norfolk Virginia USA
8Division of Otolaryngology The Children’s Hospital of Philadelphia Philadelphia Pennsylvania USA
9Department of Anesthesiology and Critical Care University of Pennsylvania School of Medicine Philadelphia Pennsylvania USA
10Sleep Apnea Surgery Center East Palo Alto California USA
11James’s Project Wayne Pennsylvania USA
12Advanced Pediatrics Vienna Virginia USA
13Albany ENT & Allergy Services, PC Albany New York USA
14Department of Pediatrics, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, USA
15Qualis Health Seattle Washington USA
16The Cochrane ENT Disorders Group Oxford United Kingdom
17American Academy of Otolaryngology—Head and Neck Surgery Foundation Alexandria Virginia USA

Tóm tắt

Objective

Tonsillectomy is one of the most common surgical procedures in the United States, with more than 530 000 procedures performed annually in children younger than 15 years. Tonsillectomy is defined as a surgical procedure performed with or without adenoidectomy that completely removes the tonsil including its capsule by dissecting the peritonsillar space between the tonsil capsule and the muscular wall. Depending on the context in which it is used, it may indicate tonsillectomy with adenoidectomy, especially in relation to sleep‐disordered breathing. This guideline provides evidence‐based recommendations on the preoperative, intraoperative, and postoperative care and management of children 1 to 18 years old under consideration for tonsillectomy. In addition, this guideline is intended for all clinicians in any setting who interact with children 1 to 18 years of age who may be candidates for tonsillectomy.

Purpose

The primary purpose of this guideline is to provide clinicians with evidence‐based guidance in identifying children who are the best candidates for tonsillectomy. Secondary objectives are to optimize the perioperative management of children undergoing tonsillectomy, emphasize the need for evaluation and intervention in special populations, improve counseling and education of families of children who are considering tonsillectomy for their child, highlight the management options for patients with modifying factors, and reduce inappropriate or unnecessary variations in care.

Results

The panel made a strong recommendation that clinicians should administer a single, intraoperative dose of intravenous dexamethasone to children undergoing tonsillectomy. The panel made a strong recommendation against clinicians routinely administering or prescribing perioperative antibiotics to children undergoing tonsillectomy. The panel made recommendations for (1) watchful waiting for recurrent throat infection if there have been fewer than 7 episodes in the past year or fewer than 5 episodes per year in the past 2 years or fewer than 3 episodes per year in the past 3 years; (2) assessing the child with recurrent throat infection who does not meet criteria in statement 2 for modifying factors that may nonetheless favor tonsillectomy, which may include but are not limited to multiple antibiotic allergy/intolerance, periodic fever, aphthous stomatitis, pharyngitis and adenitis, or history of peritonsillar abscess; (3) asking caregivers of children with sleep‐disordered breathing and tonsil hypertrophy about comorbid conditions that might improve after tonsillectomy, including growth retardation, poor school performance, enuresis, and behavioral problems; (4) counseling caregivers about tonsillectomy as a means to improve health in children with abnormal polysomnography who also have tonsil hypertrophy and sleep‐disordered breathing; (5) counseling caregivers that sleep‐disordered breathing may persist or recur after tonsillectomy and may require further management; (6) advocating for pain management after tonsillectomy and educating caregivers about the importance of managing and reassessing pain; and (7) clinicians who perform tonsillectomy should determine their rate of primary and secondary posttonsillectomy hemorrhage at least annually. The panel offered options to recommend tonsillectomy for recurrent throat infection with a frequency of at least 7 episodes in the past year or at least 5 episodes per year for 2 years or at least 3 episodes per year for 3 years with documentation in the medical record for each episode of sore throat and 1 or more of the following: temperature >38.3°C, cervical adenopathy, tonsillar exudate, or positive test for group A β‐hemolytic streptococcus.

Từ khóa


Tài liệu tham khảo

Cullen KA, 2009, Ambulatory Surgery in the United States, 2006

10.1177/000348949009900305

10.1001/archotol.126.1.45

10.1016/j.otohns.2006.12.029

10.1001/archotol.133.10.974

10.1001/archotol.131.1.52

10.1097/01.mlg.0000217542.84013.b5

10.1016/j.ijporl.2005.10.020

10.1001/archotol.131.4.308

10.1001/archotol.130.2.190

10.1001/archotol.128.5.489

10.1097/00005537-200310000-00003

10.1542/peds.2005-1067

10.1542/peds.2005-1837

10.1016/j.jvoice.2008.01.008

10.1016/j.ijporl.2008.05.019

10.1177/000348940611500509

Martens PJ, 2006, Health status and healthcare use patterns of rural, northern and urban Manitobans: is Romanow right?, Healthc Policy, 2, 108

10.1093/bja/88.1.72

10.1542/peds.110.1.7

10.1046/j.1365-2273.2001.00485.x

10.1016/0165-5876(93)90004-M

10.1016/j.otohns.2009.01.044

10.5694/j.1326-5377.1992.tb121463.x

10.1164/rccm.200604-577OC

10.1136/adc.68.3.360

10.1542/peds.2004-1256

10.1097/01.MLG.0000163762.13870.83

10.1001/archotol.126.4.494

10.1097/00005537-200410000-00032

10.1056/NEJM198403153101102

10.1016/j.otohns.2009.01.043

10.1016/j.otohns.2006.02.033

10.1159/000108366

10.1016/j.otohns.2004.09.007

10.1002/lary.5541121413

10.1097/00007611-198804000-00023

Colclasure JB, 1990, Complications of outpatient tonsillectomy and adenoidectomy: a review of 3,340 cases, Ear Nose Throat J, 69, 155

10.1016/0196-0709(91)90149-A

10.1001/archotol.1992.01880090056017

10.1016/0165-5876(87)90088-7

Royal College of Surgeons of England.National prospective tonsillectomy audit: final report of an audit carried out in England and Northern Ireland between July 2003 and September 2004. May 2005.http://www.entuk.org/members/audits/tonsil/Tonsillectomyauditreport_pdf. Accessed February 3 2010.

10.1016/j.amjoto.2006.10.016

10.1177/019459987908700201

10.1016/S0194-5998(98)70376-6

10.1016/j.otohns.2007.11.024

10.1016/S0025-7125(05)70088-2

Jung KY, 1996, Age‐related changes of IgA immunocytes and serum and salivary IgA after tonsillectomy, Acta Otolaryngol Suppl, 523, 115

Brandtzaeg P, 1987, Immunology of the Ear, 63

10.1016/j.ijporl.2003.08.018

Friday GA, 1992, Serum immunoglobulin changes in relation to tonsil and adenoid surgery, Ann Allergy, 69, 225

10.1007/BF00181969

Paulussen CCJ, 2000, Adenoids and tonsils, indications for surgery and immunological consequences of surgery, Acta Otorhinolaryngol Belg, 54, 403

10.1016/j.ijporl.2003.07.017

10.1016/j.otohns.2008.11.024

BellussiL BusoniP CamaioniA et al.Appropriateness and safety of tonsillectomy and/or adenoidectomy.http://www.snlg‐iss.it/cms/files/LG_en_tonsillectomy_2008.pdf.2008;1‐43. Accessed October 5 2009.

Scottish Intercollegiate Guidelines Network (SIGN).Management of sore throat and indications for tonsillectomy: a national clinical guideline.http://www.sign.ac.uk/pdf/sign117.pdf.Edinburgh Scotland:SIGN;2010;1‐38. Accessed June 7 2010.

NHS Evidence – Cancer Cancer Specialist Library search strategies.http://www.library.nhs.uk/cancer/Page.aspx?prv=y&pagename=CSLSEARCHS. Accessed October 5 2009.

HigginsJPT GreenS eds.Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2[updated September 2009].The Cochrane Collaboration;2009.www.cochrane‐handbook.org.

10.7326/0003-4819-139-6-200309160-00013

10.1186/1472-6947-5-23

10.1542/peds.2004-1260

Eddy DM, 1992, A Manual for Assessing Health Practices and Designing Practice Policies: The Explicit Approach

10.1001/jama.287.5.612

10.1503/cmaj.061292

10.1056/NEJM197802232980801

10.1136/bmj.38210.827917.7C

10.1002/14651858.CD001802.pub2

10.1016/j.otohns.2008.12.013

10.1136/adc.2003.047530

10.1046/j.1365-2273.2000.00402.x

10.1016/S0165-5876(02)00128-3

10.1017/S0022215107001557

10.1016/S0140-6736(72)93028-0

10.1016/S0030-6665(20)31660-1

10.1056/NEJM196004072621401

American Academy of Pediatrics. Group A streptococcal infections, 2009, 2009 Redbook—Report of the Committee on Infectious Diseases, 616

Donn AS, 1991, Do children waiting for tonsillectomy grow out of their tonsillitis?, N Z Med J, 104, 161

10.1111/j.1749-4486.2007.01578.x

10.1111/j.1651-2227.2009.01554.x

10.1016/j.jpeds.2007.03.015

10.1016/j.jpeds.2009.02.038

10.1097/01.moo.0000162259.42115.38

10.1288/00005537-199508002-00001

10.1016/S0165-5876(00)00447-X

10.1016/S0165-5876(03)00158-7

10.1164/ajrccm.153.2.8564147

10.1378/chest.108.3.610

10.1542/peds.2004-0730

10.1016/S0031-3955(16)36806-7

10.1016/j.otohns.2009.01.008

10.1164/rccm.200206-613OC

10.1164/ajrccm.164.4.2101127

10.1177/000992288802700709

10.1016/j.otohns.2004.04.015

10.1542/peds.102.5.1178

10.1542/peds.102.3.616

10.1016/j.otohns.2007.11.003

Aydil U, 2008, Obstructive upper airway problems and primary enuresis nocturna relationship in pediatric patients: reciprocal study, J Otolaryngol Head Neck Surg, 37, 235

10.1067/mpd.2003.158

10.1016/S0165-5876(01)00463-3

10.1016/S0022-5347(05)00935-3

10.1016/j.ijporl.2006.01.011

10.1136/adc.2008.141192

10.1097/01.MLG.0000181516.65577.94

10.1016/j.otohns.2005.05.040

10.2310/7070.2007.0013

10.1017/S0022215106002027

10.1016/j.otohns.2004.02.004

10.1001/archotol.1995.01890050023005

10.1097/MLG.0b013e318123ee56

10.1542/peds.109.4.704

10.1164/ajrccm/146.5_Pt_1.1235

10.1378/chest.125.3.872

10.1002/ppul.20236

10.1016/j.ijporl.2004.11.016

10.1542/peds.111.1.e17

10.1001/archpedi.158.2.153

10.1001/archotol.125.3.353

10.1164/ajrccm/146.5_Pt_1.1231

10.1016/S0165-5876(00)00338-4

10.1542/peds.113.2.351

10.1093/sleep/24.7.823

10.1136/adc.86.1.34

10.1016/j.jpeds.2006.08.067

10.1164/rccm.200710-1610OC

10.1016/j.otohns.2010.02.012

10.1542/peds.113.1.e19

10.1213/01.ane.0000244318.77377.67

10.1097/00000542-200202000-00015

10.1097/00000542-200309000-00013

10.1002/ppul.20195

10.1097/00000542-200605000-00026

10.1001/archotol.132.5.476

10.1001/archotol.1997.01900050067009

10.1001/archotol.1996.01890200003001

10.1016/j.otohns.2008.12.038

10.1001/archotol.130.8.917

10.1097/00000542-199607000-00002

10.1213/00000539-199403000-00010

10.1213/00000539-199209000-00006

10.1097/00000539-199909000-00022

10.1097/00000542-200004000-00012

10.1213/00000539-200102000-00022

10.1097/00000539-199611000-00004

10.1001/archotol.1996.01890140007003

10.1097/00000539-199807000-00013

10.1016/j.ijporl.2007.04.015

10.1016/0165-5876(96)01388-2

10.1001/jama.2008.794

10.1097/00005537-200110000-00008

10.1093/bja/ael256

10.1002/14651858.CD003997

10.1067/mhn.2000.111354

10.1038/sj.bjp.0701211

10.1038/clpt.1990.132

10.1016/0304-3959(93)90146-G

10.1111/j.1460-9592.2004.01262.x

10.1213/01.ane.0000263276.52287.3b

10.1016/j.otohns.2005.11.010

10.1007/BF03021038

10.1213/00000539-200103000-00015

10.1001/jama.2009.576

10.1001/archotol.1986.03780060022002

10.1016/S0165-5876(99)00228-1

10.1016/j.ijporl.2004.01.010

10.1002/14651858.CD005607.pub3

10.1097/01.MLG.0000163749.77019.8F

10.1016/j.otohns.2008.10.043

10.1016/j.otohns.2005.12.016

10.1016/j.amjmed.2010.02.004

10.1177/1367493509344821

10.1111/j.1744-6155.1998.tb00217.x

10.1093/jpepsy/21.5.683

10.1016/j.ijporl.2008.07.004

Hollis L, 1999, Perioperative local anaesthesia for reducing pain following tonsillectomy, Cochrane Database Syst Rev

10.1111/j.1744-6155.2007.00111.x

10.1016/j.ijporl.2005.11.015

10.1016/j.ijporl.2007.04.010

10.1016/j.ijporl.2008.10.014

10.1016/j.ijporl.2004.03.012

10.1016/j.ijporl.2010.01.018

10.1016/0165-5876(93)90046-6

10.1016/j.pmn.2006.09.005

10.1542/peds.2008-3529

10.1016/j.pmn.2007.07.002

Warnock FF, 1998, The painful (and costly) facts about children’s tonsillectomy day surgery, AARN News Lett, 54, 17

10.1177/136749350000400301

10.1177/1367493507079558

10.1097/AJP.0b013e3181b85f98

10.1002/14651858.CD007806.pub2

10.1016/j.pain.2004.03.008

10.1097/00005537-200011000-00011

10.1002/14651858.CD001547.pub2

10.1093/bja/aef284

10.1111/j.1399-6576.2001.450203.x

10.1056/NEJMc0904266

10.1097/00000542-199902000-00014

10.1097/01.mlg.0000227530.64179.1f

10.1016/S0194-5998(98)70107-X

10.1097/00000542-200306000-00030

10.1002/14651858.CD003591.pub2

10.1001/archotol.1996.01890210017004

10.1097/00005537-199702000-00006

10.1016/S1526-5900(03)00558-3

10.1046/j.1460-9592.1998.00768.x

Bean‐Lijewski JD, 2007, Post‐tonsillectomy pain management in children: can we do better?, Otolaryngol Clin North Am, 137, 545

10.1016/j.pedn.2004.01.009

10.1016/S0882-5963(97)80075-9

10.1053/eujp.2001.0326

10.1093/jpepsy/jsm073

10.1111/j.1460-9592.2010.03281.x

10.1001/archotol.126.6.718

10.1001/archotol.133.11.1091

10.1258/002221505774481336

10.1002/14651858.CD002211

10.1111/j.1749-4486.2006.01162.x

10.1017/S0022215106000120

10.1016/j.otohns.2004.08.008

Gendy S, 2005, Tonsillectomy—cold dissection vs. hot dissection: a prospective study, Ir Med J, 98, 243

10.1097/01.mlg.0000161361.66191.60

10.1016/S0194-59980300729-0

10.1002/14651858.CD004619.pub2

10.1016/j.otohns.2005.11.005

10.1016/j.otohns.2007.05.003

10.1001/archotol.129.10.1086

10.1213/00000539-200301000-00015

10.1016/j.ijporl.2005.09.021

Clavisi O, 2000, Does antibiotic and or steroid therapy reduce pain and secondary hemorrhaging after tonsillectomy?

Thông tin
Thông tin xuất bản

Otolaryngology - Head and Neck Surgery

Tập 144 Số S1

Thông tin tác giả