Paradise Criteria for Tonsillectomy
frequency of sore throat episodes
||7 or more
episodes in the preceding year, OR
||5 or more
episodes in each of the preceding 2 yrs
||3 or more
episodes in each of the preceding 3 yrs
features (sore throat plus the presence
or more qualifies as a counting episode)
38.3o C, OR 101o F
lymphadenopathy (tender lymph nodes or >2 cm), OR
culture for group A b-hemolytic streptococcus
been administered in conventional dosage for proved or
and its qualifying features had been substantiated by
contemporaneous notation in a clinical record, OR
||If not fully
documented, subsequent observance by the clinician of 2
episodes of throat infection with patterns of frequency and
clinical features consistent with the initial history
causing upper airway obstruction (sleep apnea) View
(trouble swallowing), sleep disorders, or cardiopulmonary
complications. Usually, removal of both the tonsils and
adenoids are indicated.
unresponsive to medical management and
drainage documented by surgeon, unless surgery performed during acute
View Tonsillectomy Surgery Video
View Drainage Surgery Video
4. Streptococcal Carrier: Chronic or recurrent tonsillitis associated with the
streptococcal carrier state and not responding to beta-lactamase-resistant
5. Unilateral Enlargement: Unilateral tonsil
presumed euplastic. Although without other indications (abnormal
appearance, physical examination, symptoms or history) most asymmetries can
be followed conservatively.
acute otitis media
chronic serous otitis media.
Adenoidectomy should not be performed with the insertion of the first set of
myringotomy (ear) tubes
unless there is another
indication for adenoidectomy besides chronic
However, repeat surgery for chronic
should consist of
(with or without
myringotomy (ear) tube placement.)
Other Indications - (Poorly Validated as of January 2011):
(enlargement) causing dental malocclusion or
adversely affecting oral-facial (mouth-face) growth documented by
2. Persistent foul taste or breath due to chronic tonsillitis not
responsive to medical therapy.
Describing Tonsillar Size
Brodsky Grading System
0: Tonsils within the tonsillar fossa.
1: Tonsils just outside of the tonsillar fossa, <=25% of the
2: Tonsils occluding 26 to <=50% of the oropharyngeal width.
3: Tonsils occluding 51 to <75% of the oropharyngeal width.
Grade 4: Tonisl occluding greater than 75% of
the oropharyngeal width.