Powered Intracapsular Tonsillotomy and Adenoidectomy in Infants ≤36 Months Compared to Older Children: A Retrospective Analysis

Abstract

Objectives: To evaluate the safety and outcomes of powered intracapsular tonsillotomy and adenoidectomy (PITA) for the treatment of sleep disordered breathing in infants up to 36 months of age compared to older children. Methods: This retrospective analysis included children who underwent PITA from 2013 to 2019 at a single tertiary care medical center. The patients were divided into 2 groups: up to 36 months, and 36 to 72 months. The data were collected from electronic medical records and from a telephone survey based on a modified version of the OSA-18 questionnaire. Post-operative complications, and short- and long-term outcomes were compared. Results: A total of 48 patients met the inclusion criteria for the main study group (up to 36 months of age). They were compared to 59 children 36 to 72 months of age. There were no differences in subjective outcomes between age groups ( P = .65). There were no differences in the frequency of post-operative complications between age groups ( P = .8) or in the number of hospitalization days ( P = .91). Conclusion: The short- and long-term outcomes and safety of PITA for the treatment of sleep disordered breathing in infants up to 36 months of age are similar to those of older children.

Reconsidering routine admission for children under age 3 undergoing partial tonsillectomy: A prospective study

“…reported the safety of PT in 226 children, and found no statistically significant differences in pain, oral intake or complications, between the younger children (n = 38, less than 3 years old) vs older. Stahl et al [ 9 ] reported no difference in postoperative complications in children younger than 3 years old (n = 48) to older children (n = 59).…”

“…The recommendation of inpatient monitoring for young children is supported by previously published studies that showed a high rate of respiratory complications in children younger than 3 years old and weight less than 14 kg, after total tonsillectomy [ 5 – 7 ]. However, two published retrospective studies comparing the safety and outcomes of PT in children younger than 3 years old versus older children, showed no increased post-operative complications in either group [ 8 , 9 ]. These published cohorts warrant questioning the safety of PT in children younger than 3 years old and differentiating between PT and total tonsillectomy.…”

Intracapsular tonsillectomy: setting a new standard

“…Another retrospective study compared ICT outcomes over a 7-year period between patients younger than 36 months ( n = 48) and those aged 36−72 months ( n = 59) [16]. There were no differences in subjective outcomes between the age groups and, importantly, zero returns to the operating room for hemorrhage.…”

“…Rates of symptomatic regrowth did not differ between the groups, but these were among the highest published in the recent literature. The younger cohort was followed for an average of 3 years while the older group was followed for nearly 2 years, and revision surgery was performed in 4.2% and 3.4%, respectively [16].…”