Tonsillectomy Workup

Updated: Oct 05, 2017
  • Author: Amelia F Drake, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Workup

Laboratory Studies

Coagulation parameters should be assessed if the patient's history reveals a potential bleeding problem.

The AAO-HNS suggests that all patients receive a basic coagulation workup.

In 1 study, coagulation tests produced abnormal results in 4% of 1706 children. [1] The disturbing factor in this study was that the patient's preoperative history did not help in identifying children with abnormal coagulation. This is a point of ongoing debate.

With a negative family history for bleeding, routine preoperative coagulation studies are not recommended. With a positive family history, a bleeding time or a consultation with a hematologist is prudent.

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Imaging Studies

Imaging studies include plain radiography, CT scanning, and MRI in an appropriate patient with a tonsillar mass suggestive of malignancy.

In addition, a patient with a pulsatile area adjacent to the tonsil should undergo magnetic resonance arteriography (MRA) before routine tonsillectomy to evaluate for an aberrant internal carotid artery.

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Other Tests

Antibodies for streptolysin-O (ASLO) have been studied as possible indicators for tonsillectomy. [2]

  • These antibodies are correlated with previous infection with group A beta-hemolytic streptococcus (GABHS).

  • To the authors’ knowledge, no recent work has been published concerning this issue.

  • When the diagnosis of recurrent GABHS is questioned, high ASLO titers can shed light on the patient's history.

Historically, GABHS cultured on blood agar and use of a Bacitracin disc has been used to identify the most important agent that causes tonsillitis.

  • More recently, several rapid tests for detecting group A streptococcal antigen have been used.

  • The rapid tests are specific but not uniformly sensitive; therefore negative results need to be confirmed with a routine culture.

Several studies have shown a higher-than-expected incidence of allergy in children with adenotonsillar disease. Therefore, evaluation for allergy may be helpful, but only in children with the signs and symptoms of allergic disease.

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Histologic Findings

Histologic examination of the tonsils is unnecessary unless cancer is suspected. If tonsils are asymmetric, they should be submitted separately and examined histologically to rule out cancer.

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