Do you think you need your (or your kid’s) tonsils out?


More than 530,000 tonsillectomies are performed annually on US children.  The American Academy of Otolaryngology-Head and Neck Surgery has provided an evidence-based (meaning there is good research) guide to identify patients who may most benefit from tonsillectomy.

You may ask. . . why not just take out the tonsils?  Risks and benefits need to be weighed.  There is risk with every surgery, infection and bleeding are the most common.  So, a patient needs to show benefit before risk should be taken.

Tonsillectomies are performed for two main reasons: to prevent strep throat and to minimize sleep-disordered breathing.

The “Paradise Criteria”  justifies tonsillectomy–depending on a minimum number of  infections.

  • 7 sore throat episodes (described
    below) in the past year or
  • 5 episodes in each of the previous two years or
  • at least 3 episodes in each of the previous three years.

“Sore throat episodes” requires at least one of the following

  1. fever more than 100.9 degrees Fahrenheit,
  2. tender lymph nodes in the
    neck, measuring  more than 2 cm in size,
  3. visible pus on the tonsils,
  4. “positive” strep throat culture.

These “sore throat episodes” must be documented in the
medical record.

So, as a family physician, I conscientiously keep up with my
subspecialists guidelines and refer patients to surgeons as needed. Of course, antibiotics should be given for any (suspected or) proven case of streptococcal pharyngitis.

Hope this helps.

About drlesliegreenberg

I have been practicing as a family physician for over 20 years--as both an educator of physicians and clinician. From infancy to the elderly, I perform obstetrics and general medicine. I love my career and am passionate about my field of knowledge and my patients. Follow me on Facebook at Leslie Md Greenberg Medical Disclaimer The content of this website is provided for general informational purposes only and is not intended as, nor should it be considered a substitute for, professional medical advice. Do not use the information on this website for diagnosing or treating any medical or health condition. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.
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