1-year follow-up after radiofrequency tonsillotomy and laser tonsillotomy in children: a prospective, double-blind, clinical study

Abstract

In the last decade, tonsillotomy has come into vogue again, whereas the number of tonsillectomies is decreasing rapidly. In a previous study, the tonsillotomy with laser or radiofrequency therapy proved as a safe and effective procedure with minimal pain and hemorrhage. This follow-up study determines which method is more effective with respect to long-term outcome, recurrence of tonsillar hyperplasia and recurrence of tonsillitis. A prospective, randomised, double-blinded controlled clinical study was conducted at the Department of Otorhinolaryngology of the Ludwig-Maximilians-University, Munich, Germany. Twenty-six children with tonsillar hypertrophy were included. Tonsillotomy was performed on one side with monopolar radiofrequency and on the other side with a carbon dioxide laser. Exactly 1 year after the procedure, all 26 patients were documented by digital photography to define a possible recurrence of tonsillar hyperplasia. All parents were asked for occurring tonsillitis and fulfilled the Glasgow Children's Benefit Inventory (GCBI) for health-related quality of life after surgical procedures. In seven children, a slightly visible recurrence of the tonsillar hyperplasia occurred, without any symptoms or correlation to the different methods and sides. One child with recurrent tonsillitis and hyperplasia had to be tonsillectomized 8 months after the initial tonsillotomy procedure. The specimen showed open crypts with bacterial infection in the deep. The GCBI resulted in highly significant benefits of the surgery in all categories and subcategories. In conclusion, both methods, the laser tonsillotomy and the radiofrequency method, were equal concerning the effectiveness and safety after 1 year. Further investigations have to aim at the long-term outcome after tonsillotomy in patients with recurrent infections.

Bipolar-assisted tonsil reduction: a simple and inexpensive tonsillotomy technique

“…With the emergence of such novel techniques, partial removal of the tonsil, "the tonsillotomy", has become popular again, whereas the percentage of classical tonsillectomies is rapidly decreasing. [5] For the treatment of non-inflammatory tonsillar hypertrophy resulting in pediatric obstructive symptoms, tonsillotomy combined with adenoidectomy should be considered as the treatment of choice. [5,6] The recent analyses from the national tonsil register in Sweden demonstrate that tonsillotomy + adenoidectomy has become the most commonly administered surgical procedure in pediatric age group of patients with upper airway obstructive symptoms due to tonsillar hyperplasia.…”

“…[5] For the treatment of non-inflammatory tonsillar hypertrophy resulting in pediatric obstructive symptoms, tonsillotomy combined with adenoidectomy should be considered as the treatment of choice. [5,6] The recent analyses from the national tonsil register in Sweden demonstrate that tonsillotomy + adenoidectomy has become the most commonly administered surgical procedure in pediatric age group of patients with upper airway obstructive symptoms due to tonsillar hyperplasia. [6] Sunnergren et al claim that this paradigm shift results from the findings that tonsillotomy is superior to tonsillectomy by not only concerning the high rates of postoperative symptom relief, but also with reduced need for postoperative analgesia, lower rates of postoperative bleeding and reduced number of postoperative infections.…”

Intra-Capsular Tonsillotomy by Ultrasonic Method

“…It has to be distinguished from physiological pediatric palatine tonsil hyperplasia [7,8] which is not a sign or consequence of recurrent inflammation [9,10]. Also, children with tonsil hyperplasia do not suffer from acute tonsillitis [11,12] or middle ear infections [13].…”

Wieviel Tonsillektomie darf es noch sein?

“…Fest steht aber inzwischen, dass die Teilentfernung bei der kindlichen Tonsillenhyperplasie mit obstruktivem Schlafapnoesyndrom (OSAS) oder Rhonchopathie eine sofortige Verbesserung bringt [29,30,31,32] und dass anamnestische Tonsillitiden in keinem Alter (sechs Monate bis 72 Jahre) als Kontraindikation einer Teilresektion der Tonsillen gesehen werden.…”