Third most common surgery in children younger than 15 years in the United States.

Adenotonsillectomy accounts for more than 500,000 procedures annually in the United States.

Pediatric conslectectomy is the first line surgical treatment for children with obstructive sleep disordered breathing or recurrent throat infections.

More than 530,000 procedures performed annually, primarily for throat infections and sleep disordered breathing.

An overuse procedure for throat infections, and under use for sleep disordered breathing.

Guidelines suggest that a tonsillectomy be considered after at least several episodes of documented sore throat in the preceding year, at least 5 episodes over each of the proceeding 2 years, or at least 3 episodes in each of the previous 3 years.

In addition to a be above fever exceeding 38.3°C, cervical lymphadenopathy, tonsillar exudate, or a positive culture for group A beta hemolytic Streptococcus should be documented for each episode.

The above criteria are not met tonsillectomy offers little benefit over watchful waiting.

Risks of tonsillectomy include hospitalization, risk of anesthesia, prolonged bleeding, and prolonged throat pain, dehydration, and respiratory failure.

Associated with post-operative bleeding incidence of 2%-7%.

Adult tonsillectomy recommended for recurrent tonsillitis, chronic tonsillitis, or the streptococcal carrier state.

Adenotonsillectomy complications include aspiration, pulmonary edema, dehydration, nausea vomiting, and hemorrhage.

Rarely associated with mortality: often from secondary bleeding leading to aspiration and cardiac arrest.

In a study of 504, 262 pediatric tonsillectomies mortality occurred in .007%: 28. 9% head disordered breathing, two. 8% had a complex chronic condition most commonly neurologic-Brain malformations, mental retardation, cerebral palsy, muscular dystrophies and technology dependent tracheostomy, ventriculoperitoneal shunt, and gastrostomy tubes.

Perioperative corticosteroids commonly given to children undergoing tonsillectomy to reduce postoperative nausea and vomiting, and does not increase bleeding events (Gallagher TQ et al).

Ultrarapid metabolizers of CYP2D6 may increase risk for codeine overdose following adenotonsillectomy.

The Childhood Adenotonsillectomy Trial (CHAT) demonstrated that compared to watchful waiting, surgical treatment for the obstructive sleep apnea syndrome on school age children did not significantly improve attention or executive function, but did reduce symptoms, improve secondary outcomes of behavior, quality-of-life, and polysomnographic findings (Marcus CL et al).

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