Tonsillectomy Guidelines

Indications for Referral

Referral for tonsillectomy should be considered when symptoms significantly impact quality of life, and are associated with recurrent tonsillitis meeting Paradise criteria: ≥7 episodes in the past year, OR ≥5 episodes per year for 2 years, OR ≥3 episodes per year for 3 years, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1
Tonsillectomy may be considered for obstructive sleep-disordered breathing with tonsillar hypertrophy, and for recurrent throat infections meeting Paradise criteria, according to the American Academy of Otolaryngology-Head and Neck Surgery guidelines 1, 2, 3
The American Academy of Otolaryngology-Head and Neck Surgery guidelines emphasize a stepwise approach, starting with conservative measures and reserving surgical intervention for cases where the benefits clearly outweigh the risks, such as when stones are recurrent and large, or conservative measures have consistently failed 1

Tonsillectomy carries significant risks including bleeding, pain, dehydration, and anesthetic complications, which must be weighed against the potential benefits 1
Surgical intervention carries risks including bleeding, pain, dehydration, and anesthetic complications, as emphasized by the 2019 American Academy of Otolaryngology-Head and Neck Surgery guidelines 1

When tonsilloliths are suspected but not visible, imaging such as panoramic radiographs or CT scans may be helpful to confirm diagnosis, and treatment of any concurrent tonsillitis should be done according to established guidelines 2
Patients with tonsil stones may experience symptoms such as bad breath, foreign body sensation in the throat, mild discomfort or irritation, sore throat, and difficulty swallowing 1
For patients where bad breath is the primary complaint, it is essential to rule out other causes of halitosis before attributing it solely to tonsilloliths, and rushing to surgical intervention without adequate trial of conservative measures, aggressive self-removal, misdiagnosis, and overlooking underlying causes should be avoided 2

Conservative measures such as good oral hygiene, saltwater gargles for mild discomfort, over-the-counter pain relievers as needed, and gentle manual removal of visible stones are recommended before considering tonsillectomy, according to the American Academy of Otolaryngology-Head and Neck Surgery guidelines 2, 1
Conservative self-management with good oral hygiene and gentle removal is recommended as the first-line treatment for tonsil stones, reserving tonsillectomy for severe cases, as per the American Academy of Otolaryngology-Head and Neck Surgery guidelines 1
Complete tonsillectomy involves removal of entire tonsil tissue, and cryptolysis techniques, such as laser cryptolysis, are less invasive than tonsillectomy and may be preferable to tonsillectomy in adults 2
The American Gastroenterological Association guidelines also support surgical intervention for pharyngeal abnormalities, such as tonsillolithiasis, when they cause persistent symptoms 4

Monitoring for signs of recurrent tonsillitis that may warrant consideration of tonsillectomy based on Paradise criteria is essential, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1, 5
Treatment of any concurrent tonsillitis should be done according to guidelines, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1
Surgical removal of the remnant tonsillar tissue with the polyp-like lesion is expected to result in resolution of recurrent pain episodes, elimination of tonsillolith formation, improved quality of life, and prevention of potential complications such as abscess formation 1