NHS South East Essex Care and Resource
Utilisation Eligibility Criteria for
Tonsillectomy
Tonsillectomy
Definition
Surgical removal of
tonsil or tonsils
Policy
The following are
recommended as reasonable indications for consideration of
Tonsillectomy in both children and adults, based on the current
level of knowledge, clinical observation in the field and the
results of clinical audit. Patients should meet the following
criteria:
-
Sore throats are due to
tonsillitis;
-
Five of more episodes of sore throat
per year;
-
Symptoms for at least a
year;
-
The episodes of sore throat are
disabling and prevent normal functioning.
OR the patient
(applicable to teenagers or adults only) should have:
-
Intractable cough with a high level of
streptococcal antibody; OR
-
Sever halitosis which has been
demonstrated to be due to tonsil crypt debris.
Note should also be
taken of whether the frequency of episodes is increasing or
decreasing.
The PCT will fund
Tonsillectomy in cases of suspected malignancy.
Tonsillectomies for other indications will need to
be referred to the PCT Special Cases Panel before surgery is
undertaken. Regular audit of the indications for the surgical
procedures carried out should be undertaken.
Rationale
-
Tonsillectomy offers relatively small
clinical benefits compared with non-surgical treatment, measured
best in terms of time off school. The benefit in the year
after the operation is roughly 2.8 days less taken away from
school.
-
Tonsillectomy carries a risk of
mortality estimated to le between 1 in 8,000 and 1 in 35,000
cases.
Evidence
-
A Cochrane systemic review concluded
that: “There is no evidence from randomised controlled trials
to guide the clinician in formulating the indications for surgery
in adults or children”.
-
The frequency of sore throat episodes
and upper respiratory infections reduces with time whether
Adenotonsillectomy has been performed or not.
-
Adenotonsillectomy probably
“gives an additional, but small, reduction of sore throat
episodes, days of sore throat associated school absence and upper
respiratory infections compared to watchful
waiting”.
References
-
Management of sore throat and
indications for tonsillectomy. A national clinical
guideline. SIGN Publication Number 34.
-
Ryan, C. F. Sleep 9: An approach
to treatment of obstructive sleep apnoea hypopnoea syndrome
including upper airway surgery. Thorax 2005;60:595-
604.
-
Cochrane Database of Systematic
Reviews. Adenotonsillectomy for obstructive sleep apnoea in
children.
1. CHOOSE AND BOOK
