Paradise Criteria for Tonsillectomy
Evidence-based criteria for tonsillectomy in recurrent tonsillitis. Requires ≥7 episodes in 1 year, ≥5/year for 2 years, or ≥3/year for 3 years.
Score interpretation
Paradise criteria not met. Tonsillectomy not indicated at this time.
→ Conservative management. Analgesia for episodes (paracetamol / ibuprofen). Antibiotics for documented GAS tonsillitis (phenoxymethylpenicillin 10 days). Monitor frequency. Reassess annually. Safety net.
Criteria approaching threshold. Tonsillectomy may be beneficial but is not yet mandatory.
→ ENT referral for further assessment. Discuss risks (primary/secondary haemorrhage ~3%) and benefits. Watchful waiting appropriate if episode frequency declining. Antibiotic prophylaxis not routinely recommended.
Paradise criteria met. Tonsillectomy is indicated.
→ Refer to ENT for tonsillectomy. Pre-operative blood tests (FBC). Inform patient about post-operative pain (up to 2 weeks), secondary haemorrhage risk (days 5–10). NSAIDs may increase bleeding risk — use paracetamol only post-operatively in some units.
Interpretation bands for the Paradise Criteria. Apply clinical judgement and local guidance.
References
- Paradise JL et al. Efficacy of tonsillectomy for recurrent throat infection in severely affected children. N Engl J Med. 1984.
- NICE NG34. Tonsillectomy for recurrent tonsillitis in children. 2020.
Related
Curated clinical cross-links plus same-class fallbacks.
- Adult Upper Airway Obstruction (Stridor) · DAS 2015 unanticipated difficult airway; RCEM
- Epistaxis Management · ENT-UK / NICE
- Acute Otitis Media · NICE NG91 2018
- Tonsillitis and Sore Throat · NICE NG84 2018
- Benign Paroxysmal Positional Vertigo · NICE CG124 / AAO-HNS Guidelines
- Acute Rhinosinusitis · NICE NG79 2017 / EPOS 2020
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.