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    Paradise Criteria for Tonsillectomy in Children

    Predicts which patients with recurring sore throat will benefit from tonsillectomy.
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    INSTRUCTIONS

    Use only in patients aged 1-18 years in whom tonsillectomy is being considered. Do not use in children with diabetes mellitus, cardiopulmonary disease, craniofacial disorders, congenital anomalies of the head/neck, sickle cell disease or other coagulopathies, or immunodeficiency disorders.

    When to Use
    Pearls/Pitfalls
    Why Use

    • Children with recurrent tonsillitis aged 1-18 years in whom tonsillectomy is being considered.

    • Do not use in children with diabetes mellitus, cardiopulmonary disease, craniofacial disorders, congenital anomalies of the head/neck, sickle cell disease or other coagulopathies, or immunodeficiency disorders.

    • Does not apply to tonsillotomy, intracapsular surgery, or other partial tonsil removal techniques (lack of evidence and long-term follow-up).

    • Should not be used if symptoms occurred over the course of <12 months , as efficacy of tonsillectomy in this situation has not been studied and some children may have spontaneous resolution.

    • Documentation of tonsillitis is extremely important. Before the Paradise Criteria were developed, a study showed that over the course of 1 year, only 17% of patients with recurrent pharyngitis (≥7 episodes in one year, 5 in each of two consecutive years, or 3 in each of three consecutive years) had adequate documentation and confirmation of their clinical course (Paradise 1978).

    • In children with repeated Group A beta-hemolytic strep infections, it may be helpful to test for a carrier state to confirm that episodes are due to strep throat and not concurrent viral infection.

    • From MDCalc exclusive interview with Dr. Paradise: "The criteria apply only to children whose indications for tonsillectomy would be based solely on recurrent episodes of throat infection. Children who have obstructive sleep-disordered breathing because of excessively large tonsils constitute a separate group for whom tonsillectomy is clearly indicated."

    Tonsillectomy may provide benefits, but the risk of complications is not insignificant. This criteria helps clinicians identify which patients will most benefit from tonsillectomy.

    Clinical features of an episode

    Sore throat plus ≥1 feature qualifies as an episode:

    Number of episodes
    Treatment
    Documentation

    Diagnostic Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights

    Advice

    • If a patient meets the appropriate criteria, then tonsillectomy is recommended due to a modest reduction in the frequency and severity of recurrent throat infection for up to 2 years following surgery.

    • If a patient does not meet the criteria, watchful waiting is recommended. The goal is to avoid surgery and the risk of complications in children who will likely derive no benefit from the procedure.

    Critical Actions

    • In certain situations, children mildly or moderately affected by sore throat may benefit from tonsillectomy. This includes patients with multiple antibiotic allergies, peritonsillar abscess, and history or family history of rheumatic fever.

    • Children who do not meet the criteria but who are affected by tonsillar hypertrophy and/or sleep-disordered breathing may also benefit from tonsillectomy. This is especially true if they suffer from comorbid conditions, including behavioral problems, poor school performance, nocturnal enuresis, and/or growth retardation.

    Content Contributors
    • Christian Hietanen, DO
    About the Creator
    Dr. Jack L. Paradise
    Are you Dr. Jack L. Paradise?
    Content Contributors
    • Christian Hietanen, DO