Paradise Criteria for Tonsillectomy

📌 Paradise Criteria for Tonsillectomy

Paradise criteria is a high yield viva and theory topic used to decide which children with recurrent sore throat are eligible for tonsillectomy.

The most common indication for tonsillectomy is recurrent tonsillitis / recurrent sore throat, and Paradise criteria helps standardize this decision.

What is Paradise Criteria?

Paradise criteria defines the minimum number of documented sore throat episodes required to consider tonsillectomy in a child.

Minimum Frequency of Sore Throat Episodes

A child is eligible for tonsillectomy if any one of the following is present:

• ≥ 7 episodes in the past 1 year
• ≥ 5 episodes per year for 2 consecutive years
• ≥ 3 episodes per year for 3 consecutive years

➡️ This is the minimum frequency requirement.

🚩 Quick Mnemonic - 7-5-3 rule

• 7 in 1 year
• 5/year for 2 years
• 3/year for 3 years

How is a “Sore Throat Episode” Defined in Paradise Criteria for Tonsillectomy?

Each episode must be documented and should include:

• Sore throat
• PLUS at least one of the following four features:

1. Fever - ≥ 38.3°C (101°F)

2. Cervical lymphadenopathy

   • Tender lymph nodes
   • OR lymph node size ≥ 2 cm

3. Tonsillar exudate

4. Positive Group A Streptococcal culture

⚠️ Parental history alone is NOT sufficient — proper documentation is mandatory.

📌 Key Exam & Viva Points

• Paradise criteria applies mainly to children
• Used in recurrent tonsillitis
• Episodes must be documented
• Sore throat alone is not enough
• Requires associated systemic or local signs