#JustIn: AAO-HNF releases updated Pediatric Tonsillectomy Gu
The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNF) has recently updated its 2011 guideline on the care and management of pediatric patients who may be candidates for tonsillectomy. The guideline has been published in the journal Otolaryngology-Head and Neck Surgery.

The guideline update group made strong recommendations for the following key action statements (KASs):

(1) Clinicians should recommend watchful waiting for recurrent throat infection if there have been <7 episodes in the past year, <5 episodes per year in the past 2 years, or <3 episodes per year in the past 3 years

(2) Clinicians should administer a single intraoperative dose of intravenous dexamethasone to children undergoing tonsillectomy

(3) Clinicians should recommend ibuprofen, acetaminophen, or both for pain control after tonsillectomy

The guideline update group made a strong recommendation against 2 actions:-

(1) Clinicians should not administer or prescribe perioperative antibiotics to children undergoing tonsillectomy

(2) Clinicians must not administer or prescribe codeine, or any medication containing codeine, after tonsillectomy in children younger than 12 years.

The guideline update group made recommendations for the following KASs:

(1) Clinicians should assess the child with recurrent throat infection who does not meet criteria in KAS 2 for modifying factors that may nonetheless favor tonsillectomy, which may include but are not limited to multiple antibiotic allergies/intolerance, PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and adenitis), or history of >1 peritonsillar abscess

(2) Clinicians should ask caregivers of children with obstructive sleep-disordered breathing and tonsillar hypertrophy about comorbid conditions that may improve after tonsillectomy, including growth retardation, poor school performance, enuresis, asthma, and behavioral problems

(3) Before performing tonsillectomy, the clinician should refer children with obstructive sleep-disordered breathing for polysomnography if they are <2 years of age or if they exhibit any of the following: obesity, Down syndrome, craniofacial abnormalities, neuromuscular disorders, sickle cell disease, or mucopolysaccharidoses

(4) The clinician should advocate for polysomnography prior to tonsillectomy for obstructive sleep-disordered breathing in children without any of the comorbidities listed in KAS 5 for whom the need for tonsillectomy is uncertain or when there is discordance between the physical examination and the reported severity of oSDB

(5) Clinicians should recommend tonsillectomy for children with obstructive sleep apnea documented by overnight polysomnography

(6) Clinicians should counsel patients and caregivers and explain that obstructive sleep-disordered breathing may persist or recur after tonsillectomy and may require further management

(7) The clinician should counsel patients and caregivers regarding the importance of managing posttonsillectomy pain as part of the perioperative education process and should reinforce this counseling at the time of surgery with reminders about the need to anticipate, reassess, and adequately treat pain after surgery

(8) Clinicians should arrange for overnight, inpatient monitoring of children after tonsillectomy if they are <3 years old or have severe obstructive sleep apnea (apnea-hypopnea index ≥10 obstructive events/hour, oxygen saturation nadir <80%, or both)

(9) Clinicians should follow up with patients and/or caregivers after tonsillectomy and document in the medical record the presence or absence of bleeding within 24 hours of surgery (primary bleeding) and bleeding occurring later than 24 hours after surgery (secondary bleeding)

(10) Clinicians should determine their rate of primary and secondary post-tonsillectomy bleeding at least annually.

Changes from the prior guideline include two consumer advocates added to the update group; evidence from one new clinical practice guideline, 26 new systematic reviews, and 13 new randomized controlled trials; enhanced emphasis on patient education and shared decision-making; the addition of an algorithm to clarify action statement relationships; changes to five of the key action statements (KASs) from the original guideline; incorporation of new evidence profiles to include the role of patient preferences, confidence in the evidence, differences of opinion, quality improvement opportunities, and any exclusion to which the action statement does not apply; and the addition of seven new KASs.

The AAO-HNS is the world's largest organization representing specialists who treat the ear, nose, throat, and related structures of the head and neck. The Academy represents approximately 12,000 otolaryngologist-head and neck surgeons who diagnose and treat disorders of those areas.

Note: This list is a brief compilation of some of the key points included in the guideline document and is not exhaustive and does not constitute medical advice. Kindly refer to the original publication here: https://pxmd.co/Tcz5F
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