If GABHS tonsillitis recurs frequently (> 6 episodes per year, > 4 episodes per year for 2 years, or > 3 episodes per year for 3 years), or if the acute infection is severe and persists despite treatments, tonsillectomy is frequently considered. Obstructive sleep apnea, recurring peritonsillar abscess, and cancer suspicion are among the other reasons for tonsillectomy. Individual decisions should be made depending on the patient's age, various risk factors, and infection recurrence response.
Tonsillectomy is performed using a variety of successful surgical procedures, including electrocautery dissection, microdebrider, radiofrequency ablation, and sharp dissection. When the eschar detaches, significant postoperative bleeding happens in around 2% of patients, usually within 24 hours following surgery or after 7 days. Bleeding patients should be taken to the hospital. If bleeding persists when the patient arrives, he or she is usually checked in the operating room, and hemostasis is achieved. Patients are monitored for 24 hours after any clot in the tonsillar fossa is removed. Patients who get excellent preoperative hydration, perioperative antibiotics, analgesics, and corticosteroids may require postoperative IV rehydration in as low as 3% of cases.
Points to Remember
Pharyngitis is easily diagnosed clinically, although testing is likely to be required only in 25 to 30 percent of cases to determine if it is caused by streptococcal infection (ie, strep throat).
Although some experts recommend evaluating all children using a fast antigen test and sometimes culture, clinical factors (modified Center score) can aid to select patients for additional testing or empiric antibiotic treatment.
For streptococcal pharyngitis, penicillin remains the medication of choice; cephalosporins or macrolides are alternatives for individuals allergic to penicillin.
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