Background: Adenotonsillar hypertrophy is one of the most common causes of upper airway obstruction in children and the leading indication for otolaryngologic surgery in the pediatric population. While adenotonsillectomy is frequently performed, surgical indication should not rely solely on tonsillar size but on a comprehensive assessment integrating sleep-disordered breathing, recurrent infections, and the impact on growth, behavior, and quality of life. Pediatric otolaryngologists play a key role in interpreting clinical, endoscopic, and functional findings to guide individualized management. A structured, evidence-based decision-making approach is essential to balance risks and benefits, optimize timing of surgery, and avoid unnecessary interventions.

Description: This work is based on a comprehensive review of current evidence and institutional practice guiding the decision-making process in the management of pediatric adenotonsillar hypertrophy at a tertiary pediatric otolaryngology center. The diagnostic pathway and surgical indications were defined through the analysis of international guidelines, institutional protocols, and multidisciplinary evaluation standards. Key assessment tools included detailed medical history, physical examination, and nasopharyngoscopy for upper airway assessment. When indicated, polysomnography and complementary studies such as cephalometry or imaging were incorporated. Clinical criteria considered included the severity of sleep-disordered breathing, infection frequency, comorbidities, craniofacial features, growth and behavioral effects, speech and swallowing alterations, and quality-of-life measures. The resulting framework reflects real-world clinical practice and expert consensus within our pediatric otolaryngology team, outlining decision points for adenotonsillectomy, adenoidectomy alone, or alternative management strategies.

Outcome Objectives: Application of this framework provided a structured and reproducible approach to pediatric adenotonsillar hypertrophy. Integration of clinical, endoscopic, and functional findings improved consistency in surgical indications and reduced unnecessary interventions. Multidisciplinary discussion with pulmonology, speech therapy, orthodontics, and pediatrics optimized individualized management, particularly in complex or borderline cases. The model facilitated early identification of children who benefited from adenoidectomy alone versus those requiring complete adenotonsillectomy.

A structured, evidence-based decision-making model enhances precision and safety in surgical indications for adenotonsillar hypertrophy. By incorporating clinical severity, airway anatomy, and functional assessment, pediatric otolaryngologists can better tailor treatment to each child’s needs. This framework underscores the importance of multidisciplinary collaboration and individualized timing of surgery to improve outcomes and reduce risks. It may serve as a practical reference for standardizing management while maintaining flexibility for patient-centered care.