Tonsillectomy and Adenoidectomy Guidelines

Indications for Surgery

The American Academy of Otolaryngology-Head and Neck Surgery recommends tonsillectomy for recurrent throat infections and sleep-disordered breathing, which can significantly impact morbidity, mortality, and quality of life 1
Tonsillectomy is indicated for sleep-disordered breathing (SDB) and obstructive sleep apnea (OSA) in children, with a significant impact on morbidity, mortality, and quality of life 1, 3
Combined tonsillectomy and adenoidectomy is recommended for sleep-disordered breathing with both tonsillar and adenoidal hypertrophy, which can cause significant respiratory distress 1, 3

Primary hemorrhage occurs in 0.2% to 2.2% of cases, while secondary hemorrhage occurs in 0.1% to 3% of cases, with hemorrhage being the most frequent complication and accounting for approximately one-third of tonsillectomy-related deaths 3, 4, 5
Operative complications include trauma to teeth, larynx, pharyngeal wall, or soft palate, with a risk of difficult intubation, laryngospasm, and laryngeal edema 3, 4
Postoperative complications include pain, nausea, vomiting, dehydration, referred otalgia, postobstructive pulmonary edema, velopharyngeal insufficiency, and nasopharyngeal stenosis 3, 4, 5
Mortality rates for tonsillectomy are estimated to be 1 per 2,360 in inpatient settings and 1 per 18,000 in ambulatory settings, with historical estimates ranging from 1 in 16,000 to 1 in 35,000 4, 5

The American Academy of Otolaryngology-Head and Neck Surgery recommends administering a single, intraoperative dose of intravenous dexamethasone to reduce postoperative pain and nausea, and avoiding routine perioperative antibiotics as they provide no significant benefit 1, 6