Tonsillectomy Guidance in

Children
Chris Rusius
Paediatric Training
19 April 2022
 30 mins to cover…

• Where the tonsils are

• Why we take tonsils out
• The guidelines
• How we do tonsillectomies
• What to expect
Where are the tonsils?
Why do we take tonsils out?
What do the guidelines say?
Where did the guidelines come
from?
 EBI Guidance
• Evidence Based Interventions Programme
• Clinical Initiative
• AoMRC, NHS England, NHS Improvement, NHS
Clinical Commissioners, NICE…

• Reduce unnecessary interventions

– Evidence Based
– Appropriate
 EBI Guidance
• Only applies to patients with recurrent
tonsillitis

• Does not apply to:

– OSA
– ? Cancer
– Recurrent Quinsy
– Emergencies
 Tonsillectomy for Recurrent Sore Throat
(SIGN)
• ≥7 episodes of acute tonsillitis in the previous YEAR
• ≥5 episodes of acute tonsillitis in the previous 2 YEARS
• ≥3 episodes of acute tonsillitis in the previous 3 YEARS
AND:
– Episodes are DISABLING
– Episodes PREVENT NORMAL FUNCTIONING
– They should be documented, clinically significant and adequately treated
 Tonsillectomy for Recurrent Sore Throat
(EBI)
• ≥7 episodes of acute tonsillitis in the previous YEAR
• ≥5 episodes of acute tonsillitis in the previous 2 YEARS
• ≥3 episodes of acute tonsillitis in the previous 3 YEARS
AND:
– Episodes are DISABLING
– Episodes PREVENT NORMAL FUNCTIONING
– They should be documented, clinically significant and adequately treated

• Also consider the following indications at a lower threshold

– Renal disease 2⁰ acute bacterial tonsillitis
– Severe guttate
– Metabolic disorders requiring good oral intake
– PFAPA (periodic fever, apthous stomatitis, pharyngitis, cervical adenitis)
– Immune deficiency
 Tonsillectomy for Recurrent Sore Throat
(NE/NC CCG)
• ≥7 episodes of acute tonsillitis in the previous YEAR
• ≥5 episodes of acute tonsillitis in the previous 2 YEARS
• ≥3 episodes of acute tonsillitis in the previous 3 YEARS
AND:
– Episodes are DISABLING
– Episodes PREVENT NORMAL FUNCTIONING
– They should be documented, clinically significant and adequately treated
– Every episode treated with ANTIBIOTICS
 Other Tonsillectomy Indications (EBI)

• OSA (Adults)
• Sleep disordered breathing (children)
• Suspected Cancer
• Recurrent Quinsy
• Emergency Presentations
 Tonsillectomy for Sleep Apnoea
• PATIENT IS A CHILD AND HAS BEEN DIAGNOSED
WITH OBSTRUCTIVE SLEEP APNOEA

• Patient is an adult, has been diagnosed with

obstructive sleep apnoea with tonsillar
enlargement, and trials of continuous positive
airway pressure (CPAP) and the use of
mandibular advancement devices are
unavailable or unsuccessful
 Tonsillectomy for the
treatment of halitosis
associated with tonsilloliths
will not be routinely funded
How do we remove tonsils?
What should the patient expect?
Summary
Any questions?