Resident Pearls: Pediatric Otolaryngologists Share Tips for Safer, Smarter Tonsillectomies

Tonsillectomy is a rite of passage in otolaryngology— one of the most common pediatric surgeries, and often one of the first operations a junior resident gets to perform (Laryngoscope. doi:10.1002/lary.28427). But despite its frequency, the procedure carries real risks, particularly when it comes to post-operative bleeding (StatPearls. https://tinyurl.com/3xwmkdzj; World J Clin Cases. doi:10.12998/wjcc.v9.i7.1543). That’s why mastering this deceptively routine surgery early in training is so important, and medical educators must balance ensuring optimal patient outcomes with allowing junior residents to gain essential surgical experience.

To support this learning curve, pediatric otolaryngologists from around the globe shared their go-to tonsillectomy tips and pearls for resident trainees. Their advice—candid, practical, and grounded in years of experience—highlights not only what residents need to know, but what they need to feel confident in the OR. This article brings together the top themes that emerged from their responses, drawn from a larger international survey on tonsillectomy practices. Consider it a global mentorship session, boiled down to its essentials.

Materials and Methods

The advice comes from 64 pediatric otolaryngologists who responded to a global survey conducted in 2024. The survey ran for six weeks from April 4 to May 16, 2024, and was developed by specialists from Canada, the U.S., Australia, and the U.K. Participation was voluntary, anonymous, and conducted via a secure online platform hosted by Lawson Health Research Institute. The inclusion criteria required participants to be pediatric otolaryngologists proficient in reading and writing English. Recruitment occurred through an international WhatsApp group of 293 verified pediatric otolaryngologists, whose identities were confirmed by group administrators. The diversity of participants’ countries of origin contributed to a sample that was reasonably representative of the target study population. As described by Braun and Clarke (Qual Quant. doi:10.1007/ s11135-021-01182-y), two of the authors (G.S. and V.N.) followed six systematic stages of thematic data analysis. Direct quotations that supported coded themes were reported. Survey results were double-coded and reviewed, and inconsistencies were discussed to increase intercoder reliability. Of the 132 total participants (45.1% response rate), 64 respondents (48.4% of respondents, 21.8% response rate overall) answered the open-ended question, “What is your top tonsillectomy tip/pearl you would tell a student or resident trainee?” The goal? To collect wisdom from the field and pass it down to the next generation of ENT surgeons. What emerged were four central themes: 1) Emphasis on Safety and Emergency Preparedness, 2) Conservative Patient Selection and Surgical Approach, 3) Adaptation and Openness to Innovation, and 4) Expanding the Circle of Care. Let’s dive into the advice, straight from the surgeons who know this operation best.