Wann eine Indikation zur Operation der Gaumenmandeln bei Kindern und Erwachsenen mit
rezidivierender akuter Tonsillitis (RAT) besteht, ist immer noch Gegenstand der Diskussion.
Ziel des Beitrags zum Facharztwissen ist es, auf Basis aktueller Studien und der neuen
S3-Leitlinie Tonsillitis eine Übersicht zur evidenzbasierten Entscheidungsfindung
für eine optimale Diagnostik und Behandlung der RAT zu geben.
Abstract
When surgery on the palatine tonsils is indicated in children and adults with recurrent
acute tonsillitis (RAT) is still the subject of debate. The aim of this article on
specialist knowledge is to provide an overview of evidence-based decision-making for
optimal diagnosis and treatment of RAT based on current studies and the new S3 guideline
on tonsillitis. The diagnosis of a new episode of acute tonsillitis / sore throat
should always include a classification with a scoring system (Centor, McIssac, FeverPain
score) to assess the likelihood of bacterial tonsillitis, mainly due to group A streptococci
(GAS). In unclear cases, a point-of-care test (POCT) for a GAS smear is helpful. Accurate
counting of episodes is important in patients with RAT, as the cumulative frequency
is the most important marker for or against tonsil surgery to date. In addition, a
specific quality of life questionnaire should be used for each episode. Conservative
symptomatic treatment of an episode includes a combination of paracetamol and/or non-steroidal
anti-inflammatory drugs. If there is a high probability of bacterial tonsillitis,
especially in high-risk patients, antibiotic treatment is initiated directly or by
delayed prescription. Tonsillectomy is indicated and highly effective if the patient
had ≥7 adequately treated episodes of RAT in the previous year or ≥5 such episodes
in each of the previous two years or ≥3 such episodes in each of the previous three
years. Whether a tonsillotomy is equivalent to a tonsillectomy in these cases will
only be answered once the TOTO study has been completed. Standardized pain management
is an essential part of the operation, as most patients are likely to experience severe
postoperative pain. Nowadays, evidence-based treatment of patients with RAT is readily
available.
Schlüsselwörter
Tonsillitis - Halsschmerzen - Pharyngitis - Lebensqualität - Tonsillektomie - Tonsillotomie
- evidenzbasierte Medizin - Antibiotika - klinische Studien
Keywords
Tonsillitis - sore throat - pharyngitis - quality of life - tonsillectomy - tonsillotomy
- randomized controlled trial - antibiotics - evidence-based medicine
