Indications for Tonsillectomy and Adenoidectomy Surgery

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Paradise Criteria for Tonsillectomy	View Abstract
Criterion	Definition
Minimum 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
Clinical features (sore throat plus the presence of one or more qualifies as a counting episode)	Temperature > 38.3^oC, OR 101^o F
	Cervical lymphadenopathy (tender lymph nodes or >2 cm), OR
	Tonsillar exudate, OR
	Positive culture for group A b-hemolytic streptococcus
Treatment	Antibiotics had been administered in conventional dosage for proved or suspected
Documentation	Each episode 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

2. Hypertrophy causing upper airway obstruction (sleep apnea)  View Abstract   View Abstract, severe dysphagia (trouble swallowing), sleep disorders, or cardiopulmonary complications.   Usually, removal of both the tonsils and adenoids are indicated.

3. Peritonsillar abscess unresponsive to medical management and drainage documented by surgeon, unless surgery performed during acute stage. 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 antibiotics.

5. Unilateral Enlargement:    Unilateral tonsil hypertrophy presumed euplastic. Although without other indications (abnormal appearance, physical examination, symptoms or history) most asymmetries can be followed conservatively.   View Abstract

Adenoidectomy Alone:

1. Recurrent acute otitis media or 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 otitis media. However, repeat surgery for chronic otitis media should consist of adenoidectomy with myringotomy (with or without myringotomy (ear) tube placement.)   View Abstract

Other Indications - (Poorly Validated as of January 2011):

1. Hypertrophy (enlargement) causing dental malocclusion or adversely affecting oral-facial (mouth-face) growth documented by orthodontist.
2. Persistent foul taste or breath due to chronic tonsillitis not responsive to medical therapy.

Describing Tonsillar Size
Brodsky Grading System

Grade 0: Tonsils within the tonsillar fossa.

Grade 1: Tonsils just outside of the tonsillar fossa, <=25% of the oropharyngeal width.

Grade 2: Tonsils occluding 26 to <=50% of the oropharyngeal width.

Grade 3: Tonsils occluding 51 to <75% of the oropharyngeal width.

Grade 4: Tonisl occluding greater than 75% of the oropharyngeal width.

View Abstract

In a 2003 survey of otolaryngologist a little over half would perform an adenoidectomy alone in children with small tonsils, large adenoids and obstructive sleep apnea (severe airway obstruction) and about half would take out both the tonsils and adenoids. In children with symptomatic ( snoring, mouth breathing ) large adenoids having incidental asymptomatic large adenoids, most otolarygnolgists would remove only the adenoid but a little under half would remove both the adenoid and tonsils. View Abstract

Adenoidectomy for the treatment of otitis media in children under the age of 2 years has not been found to be beneficial by Mattila et al. View Abstract