Physical Exam



ENT Clinical Practice Guideline (2011)

  • Episode of throat infection defined as sore throat AND 1 or more of the following:
    • Fever >38.3°C
    • Cervical adenopathy (tender lymph nodes or >2 cm)
    • Tonsillar exudate
    • Positive test for group A beta-hemolytic streptococcus

  • Watchful waiting for recurrent throat infection recommended if:
    • <7 episodes in the past 1 year, OR
    • <5 episodes/year in the past 2 years, OR
    • <3 episodes/year in the past 3 years

  • Consider tonsillectomy for:
    • Recurrent throat infection with a frequency of:
      • 7 episodes in the past year, OR
      • 5 episodes/year for 2 years, OR
      • 3 episodes/year for 3 years
    • Special cases:
      • Recurrent throat infection with multiple antibiotic allergy/intolerance
      • Periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA) syndrome - occurs primarily <5 years old, episodes usually <5 days, recur at regular intervals of 3-6 weeks, and includes acute fever, pharyngitis plus tender cervical LAD, or aphthous ulcers.
        • Steroids cause prompt termination of an episode, the interval between episodes shortens. Cimetidine may be helpful. Tonsillectomy effective.
      • History of peritonsillar abscess
      • Sleep disordered breathing (SDB)
        • Diagnosis of SDB in children may be based on history, physical examination, audio/video taping, pulse oximetry, or limited or full-night polysomnography (gold standard)
          • Tonsillar and adenoid hypertrophy (usually 3-4+) is recognized as the most common cause of SDB in children
          • Obesity plays a key role in some
          • History of snoring neither includes nor excludes SDB, as not all children who snore have SDB
        • SDB may contribute to growth retardation, poor school performance, enuresis, and behavioral problems, and these problems may improve with tonsillectomy
        • Tonsillectomy more effective for SDB in normal weight children (60-70%) vs obese children (10-25%)