Common Indications for Adenoidal and Tonsillar Enlargement Treatment
Obstruction: Adenoidal and tonsillar enlargement causing airway obstruction.
Recurrent Strep Throat: Group A Beta-Hemolytic Streptococcus (GABHS) positive children, especially with comorbidities.
Frequent Tonsillar Infections:
- 7 infections in 1 year
- 5 infections per year for 2 consecutive years
Obstructive Sleep Apnoea (OSA): Enlarged tonsils or adenoids contributing to sleep disturbances.
Suspected Malignancy: When there are concerns about abnormal tissue growth.
Recurrent Quinsy: History of peritonsillar abscesses (Quinsy) even after treatment.
Adenoidal enlargement is diagnosed clinically by your ENT surgeon. Adenoidal removal is indicated within adenoidal tissue occupies greater than > 75% of the nasal pharyngeal space or or due to
recurrent adenoiditis/sinusitis/snotty nose is symptoms or for recurrent ear infection.
Tonsillar enlargement is also diagnosed clinically as indicated if tonsils are grade 3/4 grade 4/4.
Tonsillar enlargement with clear history of obstructive symptoms such as sleep apnoea, sleep
disturbance, difficulty swallowing and gagging I indications for removal of tonsils. Paediatric sleep
questionnaire 21 point scoring system (attached) scores above 8/21 may be a useful guide in
predicting significant obstruction in these children. Suspicion of abnormal enlargement of a
unilateral tonsil on the basis of possible malignancy should also be entertained provided there are
associated B’ symptoms (I E: Night sweats, fevers, lethargy, weight loss)
Tonsil infection especially with strep throat and history of recurrent infection R indication for
tonsillectomy. Current recommendations are if the child has 6-7 infections per year or 5 infections
per year 2 consecutive years, or 3 infections per year for 3 consecutive years should consider
tonsillectomy. Other indications include recurrent quinsy, PAFFA, severe drooling, rheumatic fever
risk group
