Hot tonsillectomy for paediatric obstructive sleep apnoea

Abstract

SUMMARYObstructive sleep apnoea is a common presentation in paediatric ear, nose and tongue (ENT) outpatients. The use of sleep studies is controversial however once a diagnosis has been made, frequently treatment is surgery. Should these patients be operated on as urgent cases? A 5-year-old boy was admitted under the paediatric team with difficultly breathing and desaturations to 77%. The patient had previously been seen by ENT as an outpatient with an 8-month history of obstructive sleep apnoea and was listed for an adenotonsillectomy with the standard waiting time. During this admission he had an emergency adenotonsillectomy. The patient improved immediately with no large desaturations in recovery and normal observations throughout his stay. It is never ideal to do a paediatric emergency operation and we have reviewed the evidence base to answer the question: Should these patients be treated urgently when seen in outpatients?BACKGROUND

Hot or Immediate Tonsillectomy: A Safe and Effective Method for Treatment of Acute Tonsillitis’ Complications

“…14,16 In the group of patients analyzed in the study, most patients were young adults aged from 21 to 40 years old who are professionally active people. These data are consistent with those from the literature 2,3,[5][6][7]12 and that makes problem of PTA treatment economically important. The symptoms reported by patients were typical for throat infections.…”

“…11 However, Albertz et al 13 recommend bilateral tonsillectomy in all cases as a prevention of recurrences, on the basis of their study. Immediate tonsillectomy is especially effective in cases of intratonsillar and posterior abscess, 12 which was confirmed in our study.…”

“…The authors had cases of bleeding (3.6%) and single cases of edema, diarrhea, persisted odynophagia, panic attack, cutaneous rash. 12 No problems with intubation or complications such as haemorrhaging occurred in any of our patients. These results confirm information from the literature according to Berry et al 5 who estimated hot tonsillectomy to be easier than delayed tonsillectomy, especially on the side of PTA.…”

“…3,12,14 This diagnosis requires immediate treatment because of the possibility of infection spread to the parapharyngeal space, retropharyngeal space and floor of the mouth. 15 Continuation of disease leads to the involvement of deep neck spaces and mediastinum, which is a life threatening condition.…”

“…The same author recommends hot tonsillectomy in all patients with recurrent PTA, 6,7 as it may prevent recurrences. 2,12 It is still controversial if this tonsillectomy should be performed on one side only or if it should be performed bilaterally. In our material bilateral tonsillectomy was made in all patients who had indications for tonsillectomy, independent from PTA.…”