Efficacy of Powered Intracapsular Tonsillectomy and Adenoidectomy

Abstract

PITA cures otherwise healthy children with obstructive sleep apnea of moderate severity, at least in the short-term, as documented by postoperative polysomnography. Improvements in quality of life measures, as documented by changes in OSA-18, were seen in all children as well.

Tonsillotomy: it's time to clarify the facts

“…A simultaneous adenoidectomy was an exclusion criterion for some authors [27,30], performed in every single patient [16] [17] who postulated that success is defined by an AHI \ 1. Moreover, a definition of short-term and long-term success needs to be clarified [15]. Mangiardi et al [49] addressed the validity of home PSG, since none of his 30 patients had an AHI \ 1 after TE or microdebrider-SIPT.…”

“…Microdebrider, coblation or bipolar scissors/forceps were applied in the different intervention groups [14,15,17,18,. The decision, how much to resect from the tonsil and succeed in avoiding perforation of the capsule is widely based on the experience of the surgeon.…”

“…Antibiotics and steroids were given for at least 5 days [15, 18, 24, 31, 34, 35, 37, 38, 41, 43-45, 47, 48, 52] including intraoperative administration of dexamethasone or a nonspecified steroid [48] in all but three studies [15,24,41]. With one exception [24], all studies analyzed Class II procedures.…”

“…Other authors counted the bouts of tonsillitis and excluded patients with more than three episodes of tonsillitis per year [15,34] or indication for TE as suggested by Paradise et al [43,64]. In the large patient population analyzed by Schmidt et al [50], patients with a history of tonsillitis were included as in other studies [17,38,47].…”

“…The results were confirmed with the first large retrospective study in 2003 by Koltai et al [14] who used a microdebrider as surgical instrument. However, in a small pediatric patient population, a significant impact of ''intracapsular tonsillectomy'' on OSA-albeit not successful in all patients-was proven by means of polysomnographic studies [15][16][17] and better OSA-18 Scores [18]. Numerous studies have proven the benefits of intracapsular procedures but failed to replace the role of TE at least in relation to SDB.…”