Tonsils · Observe vs Tonsillectomy

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Recurrent pharyngitis (Paradise)? OSA/hypertrophy? Other
   Recurrent throat infections meeting criteria? OSA/hypertrophy? Other indications?
   • Recurrent throat infections meeting Paradise (≥7/yr or ≥5/yr × 2 yr or ≥3/yr × 3 yr) → Meets Paradise → tonsillectomy
   • OSA/sleep-disordered breathing + tonsil (adenoid) hypertrophy → OSA + hypertrophy → adenotonsillectomy
   • Below Paradise, mild symptoms → Not met → observe
   • Recurrent peritonsillar abscess/suspected tumor (asymmetry)/PFAPA/multiple drug allergies → Other indications → individualized tonsillectomy
2. [End] Not met → observe
   Below the Paradise criteria, mild symptoms → watchful waiting (avoid surgery with no benefit); document episode frequency/features in case criteria are met.
3. [End] Meets Paradise → tonsillectomy
   Meets Paradise criteria → tonsillectomy (cold instrument/electrocautery/coblation); watch for postoperative bleeding (primary <24 h, secondary 5–10 days).
4. [End] OSA + hypertrophy → adenotonsillectomy
   OSA/sleep-disordered breathing + tonsil (adenoid) hypertrophy → adenotonsillectomy (first-line for pediatric OSA); PSG assessment, prioritize those with comorbidities.
5. [End] Other indications → individualized tonsillectomy
   Recurrent peritonsillar abscess, suspected malignancy (asymmetry/rapid growth → send for pathology), PFAPA, multiple drug allergies, history of rheumatic fever → individualized tonsillectomy.

Source guidelines & references

• Tonsillectomy in children (AAO-HNS 2019; Paradise criteria)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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