Indications of Pediatric Tonsillectomy

Gysin, Claudine

doi:10.1159/000342329

Cited by 20 publications

(16 citation statements)

References 51 publications

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“…The main objective of this study was to characterize the expression of PD-1 and PD-1L on B and T lymphocytes as well as the frequency of B and T cells in tonsillar tissue during chronic antigenic stimulation accompanying chronic or recurrent tonsillitis. The tonsillitis in most of cases is a result of viral pharyngitis, and approximately 15 % of the cases are evoked by bacterial infection with β-hemolytic streptococci [ 1 ]. The tonsillectomy is a routine procedure to treat hypertrophied tonsils, and it is one of the most often performed surgeries during childhood [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Recurrent viral and bacterial infections are the major underlying causes of tonsillitis, which typically is a self-limiting localized inflammation of the oropharynx. These infections upon continuous antigenic stimulation could induce histomorphological and functional changes in the tonsils, making tonsillectomy necessary [ 1 ]. The tonsils play a key role in host defense against invading antigens of the upper respiratory tract being a site of residence of the intraepithelial immunoglobulin-producing B cells that represent approximately of 50 % cells [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Accumulation of CD5+CD19+ B lymphocytes expressing PD-1 and PD-1L in hypertrophied pharyngeal tonsils

et al. 2015

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Programmed death-1 (PD-1) is one of the most important inhibitory co-receptors expressed predominantly on activated T and B lymphocytes whose expression could be sustained by permanent antigenic stimulation accompanying chronic or recurrent tonsillitis. The expression of PD-1 and PD-1L was analyzed using flow cytometry on hypertrophied tonsils collected from 57 children. We observed high expression of PD-1 and PD-1L on certain lymphocytes subpopulations of hypertrophied tonsils; among T cells, the expression of PD-1 on protein level was higher on CD4+ cells (70.3 %) than on CD8+ cells (35 %). Interestingly, a limited expression of PD-1 was observed on CD19+ B lymphocytes (6.5 %), while CD5+CD19+ B cells overexpressed PD-1 (52.5 %). Moreover, the expression of PD-1L was also higher on CD5+CD19+ B cells (16.5 %) than on CD19+ B cells (3.5 %) and on CD4+ T cells (20 %) than on CD8+ T cells (10 %). PD-1 and PD-1L expressions correlated only on CD5+CD19+ cells. In conclusion, high expression of PD-1 and PD-1L on T and B cells could represent hallmark of immune system adaptation to chronic antigenic exposition in patients with tonsillitis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Accumulation of CD5+CD19+ B lymphocytes expressing PD-1 and PD-1L in hypertrophied pharyngeal tonsils

et al. 2015

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“…Tonsil surgery is common in the pediatric population, with the most common indication being sleep‐disordered breathing (SDB) due to tonsil‐related upper airway obstruction . Traditionally, tonsillectomy (TE) (complete removal of the tonsils) with or without adenoidectomy (A) (TE±A) has been the tonsil surgery of choice for this indication .…”

Section: Introductionmentioning

confidence: 99%

Morbidity after pediatric tonsillotomy versus tonsillectomy: A population‐based cohort study

2018

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Objectives/Hypothesis: To compare and evaluate morbidity following pediatric tonsillectomy (TE) and tonsillotomy (TT) performed due to tonsil-related upper airway obstruction.Study Design: Retrospective population-based cohort study based on data from the Swedish National Patient Register (NPR).Methods: All patients aged 1 to 12 years who were registered in the NPR between January 1, 2007 and December 31, 2015, and who underwent an isolated tonsil surgery (AE adenoidectomy) for the sole indication of upper airway obstruction were included. Postoperative morbidity within 30 days of surgery, including readmission due to hemorrhage and return to theater (RTT), was evaluated and compared between the two groups. A forward stepwise multivariable logistic regression analysis was used to identify independent predictors of postoperative morbidity.Results: In total, 35,060 patients were included in the study, 23,447 of whom underwent TT and 11,613 of whom underwent TE. Readmission due to postoperative hemorrhage, RTT, readmission due to any reason, and contact with healthcare were all less common after TT than after TE. Readmission due to postoperative hemorrhage was significantly more common after TE (2.5%) than after TT (0.6%) (odds ratio: 3.91, 95% confidence interval: 3.20-4.77).Conclusions: This study showed that TT is associated with a statistically significantly lower risk of postoperative complications than TE when performed in children to correct tonsil-related upper airway obstruction. Statistically significant differences were found for all outcome variables, namely, readmission to hospital due to bleeding, RTT, readmission due to any reason, and postoperative contact with healthcare for any reason.

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“…At the beginning of the twentieth century, in the preantibiotic era, infection or recurrent tonsillitis was the main indication for tonsil surgery 9. Following the introduction of antibiotics in the 1950s, the number of TEs decreased dramatically over the following decades 10…”

Section: Introductionmentioning

confidence: 99%

Trends and changes in paediatric tonsil surgery in Sweden 1987–2013: a population-based cohort study

et al. 2017

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ObjectivesThe objective of this study was to longitudinally describe the history of tonsil surgery in Swedish children and adolescents regarding incidence, indications for surgery, surgical methods and the age and gender distributions.SettingA retrospective longitudinal population-based cohort study based on register data from the Swedish National Patient Register (NPR) and population data from Statistics Sweden.ParticipantsAll Swedish children 1–<18 years registered in the NPR with a tonsil surgery procedure 1987–2013.Results167 894 tonsil surgeries were registered in the NPR 1987–2013. An increase in the total incidence rate was observed, from 22/10 000 person years in 1987 to 47/10 000 in 2013. The most marked increase was noted in children 1–3 years of age, increasing from 17 to 73/10 000 person years over the period. The proportion children with obstructive/sleep disordered breathing (SDB) indications increased from 42.4% in 1987 to 73.6% in 2013. Partial tonsillectomy, tonsillotomy (TT), increased since 1996 and in 2013 55.1% of all tonsil procedures were TTs.ConclusionsThere have been considerable changes in clinical practice for tonsil surgery in Swedish children over the past few decades. Overall, a doubling in the total incidence rate was observed. This increase consisted mainly of an increase in surgical procedures due to obstructive/SDB indications, particularly among the youngest age group (1–3 years old). TT has gradually replaced tonsillectomy as the predominant method for tonsil surgery.

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Indications of Pediatric Tonsillectomy

Cited by 20 publications

References 51 publications

Accumulation of CD5+CD19+ B lymphocytes expressing PD-1 and PD-1L in hypertrophied pharyngeal tonsils

Accumulation of CD5+CD19+ B lymphocytes expressing PD-1 and PD-1L in hypertrophied pharyngeal tonsils

Morbidity after pediatric tonsillotomy versus tonsillectomy: A population‐based cohort study

Trends and changes in paediatric tonsil surgery in Sweden 1987–2013: a population-based cohort study

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