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No Surgery for Moderate Tonsillitis, New Guidelines Say
Date:1/6/2011

By Ellin Holohan
HealthDay Reporter

THURSDAY, Jan. 6 (HealthDay News) -- Doctors should use antibiotics and a wait-and-see approach when treating repeated throat infections in children and resort to a tonsillectomy only in the most severe cases, new medical guidelines suggest.

A panel of experts formed to address the costs and risks of unnecessary tonsillectomies -- surgical removal of the tonsils -- found that most children with frequent sore throats get better without surgery.

"Tonsillectomy is [one of the] most common childhood operations in the United States, so it's critical for those of us who perform the procedure to know who should get it, and how to manage the patient," said Dr. Lee P. Smith, chief of pediatric otolaryngology at the Steven and Alexandra Cohen Children's Medical Center of New York on Long Island.

The tonsils are walnut-size lumps of lymph tissue at the back of the throat.

The guidelines, published in the January issue of Otorlaryngology -- Head and Neck Surgery, identify appropriate candidates for tonsillectomy who are between the ages of 1 and 18, and they set down a standard of care for those patients.

More than half a million tonsillectomies are performed annually in the United States on children younger than 15. For certain patients -- perhaps those with tonsil-related sleep problems or repeated infections that don't respond to antibiotics -- the operation can improve health and quality of life, the experts say.

But for patients with moderate cases of throat infection, tonsillectomy may be unnecessary and even dangerous, the panel finds. Risks include the possibility of hemorrhage, anesthesia complications, trauma to the jaw, infection, airway damage and, in rare cases, death.

Instead of rushing into surgery, the Academy of Otolaryngology guidelines recommends a cautious approach for children who have had fewer than seven infections during the past
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