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About this publication
We performed a rapid mapping review of guidelines with criteria for tonsillectomy (removal of tonsils) in recurrent tonsillitis (sore throat). This type of evidence maps and describes narratively the existing research on a specific topic.
There are no national guidelines in Norway describing indications for tonsillectomy, which may lead to geographical variation in treatment options and both over- and undertreatment of patients. The commission was to investigate which guidelines exist internationally and to assess the quality of the guidelines and the evidence on which they are based. The quality of the guidelines was assessed using the AGREE II tool. We included guidelines written in English and Scandinavian languages, published in 2010 or later that had described the method for developing the guideline.
- We found four guidelines that met our inclusion criteria: one from Denmark, one from the USA and two from Germany.
- All guidelines state disease incidence as an important criterion for offering tonsillectomy (minimum 5 to 7 episodes in the last year).
- The events should also preferably be documented in a medical record and accompanied by at least one of the following symptoms: fever, cervical lymphadenopathy, tonsillar exudate or positive culture for group A beta-haemolytic streptococcus.
- We consider the Danish and the American guidelines to be of good quality.
- The evidence base for the recommendations mainly consists of summaries of effect studies that compare surgery with watchful waiting.
Guideline criteria for tonsillectomy are largely based on expert recommendations.