Review of indications and outcomes of tonsillectomy in children

Objective. To provide a systematic review of current data on the indications and clinical outcomes of tonsillectomy in children with various ENT and systemic conditions.
Material and methods. A comprehensive analysis of 62 publications (1960–2025) was conducted, including RCTs, cohort studies, reviews, and case reports. Sources were retrieved from PubMed, eLibrary, and bibliographies. Included were pediatric patients (0–18 years) who underwent tonsillectomy or adenotonsillectomy. The review covered both standard (recurrent tonsillitis, OSA) and rare indications (PFAPA, IgA nephropathy, psoriasis, SCCUP), complications, and long-term outcomes.
Results. The most common indications remain recurrent tonsillitis and obstructive sleep apnea syndrome (OSAS). Tonsillectomy in PFAPA achieves sustained remission in up to 90% of cases. In IgA nephropathy, tonsil removal is associated with decreased proteinuria and slowed disease progression. In Down syndrome, the effectiveness is limited by persistent airway obstruction and higher risk of respiratory complications. Hemorrhage remains the main surgical risk (1–4.5%), particularly in infectious indications; OSAS patients more frequently experience respiratory issues. Rare but serious complications include aspiration, velopharyngeal insufficiency, and death (<0.001%).
Conclusion. Tonsillectomy in children is a proven and effective intervention for well-established indications. The highest evidence supports its use in recurrent tonsillitis, OSAS, and PFAPA syndrome. In systemic diseases (e.g., IgA nephropathy, psoriasis), a multidisciplinary approach is essential. Careful preoperative risk assessment and individualized surgical strategy enhance safety and improve clinical outcomes.
Keywords: tonsillectomy, adenotonsillectomy, pediatric otorhinolaryngology, recurrent tonsillitis, obstructive sleep apnea syndrome, PFAPA syndrome, IgA- nephropathy
Conflict of interest. The authors declare that there is no conflict of interest.
Funding. The study has not received any funding.