Adherence to International Guidelines in Pediatric Tonsillectomy: A National Survey among Brazilian Otolaryngologists

The present study aimed to evaluate the adherence of Brazilian otolaryngologists to key recommendations from contemporary international tonsillectomy guidelines, particularly the 2019 Clinical Practice Guideline by Mitchell et al. To evaluate how Brazilian otorhinolaryngologists perform tonsillectomies and manage potential postoperative complications. An online questionnaire was developed and completed by otorhinolaryngologists affiliated with relevant medical associations. Revealed that 40.4% of surgeons had over 20 years of experience, indicating substantial expertise. Primary indications for tonsillectomy included snoring, hypertrophy, and recurrent tonsillitis. Diagnostic criteria for acute bacterial tonsillitis and obstructive sleep apnea were analyzed, with 35% of respondents considering episode frequency a key criterion. Polysomnography was requested in specific cases, reflecting concerns about respiratory severity. The present study provides the first comprehensive analysis of the adoption of international guidelines for tonsillectomy in Brazil. We conclude that, although the Brazilian otolaryngology community has adopted key recommendations regarding diagnosis and postoperative care, deeply entrenched deviations persist in technical aspects and intraoperative medication. These latter aspects represent opportunities for educational interventions, resource mobilization, and the development of adapted national guidelines that take local realities into account, with the ultimate goal of standardizing and improving the quality of care for all children undergoing tonsillectomy in the country.