American Academy of Otolaryngology Clinical Practice Guidelines

Paradise criteria for tonsillectomy

  • Sore throat frequency 
    • 7 or more per year OR
    • 5 or more in each of preceding 2 years OR
    • 3 or more in each of preceding 3 years
  • Clinical features (sore throat plus one of the following for each episode)
    • Temperature > 38.3 OR
    • cervical lymph nodes > 2 cm OR
    • tonsillar exudate OR
    • +culture for group A strep
  • Treatment
    • antibiotics for proven or suspected strep episodes
  • Documentation
    • each episode and qualifying features OR
    • if not fully documented, subsequent observation of 2 episodes