Tonsillotomy versus tonsillectomy on young children: 2 year post surgery follow-up

Ericsson, Elisabeth; Graf, Jonas; LundeborgHammarström, Inger; Hultcrantz, Elisabeth

doi:10.1186/s40463-014-0026-6

Cited by 29 publications

(30 citation statements)

References 30 publications

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“…This is well in line with several previous studies, 7,21 and a recent metaanalysis comparing improvements in OSA-18 in 20 studies of TE and TT concluded that there was no significant difference. 8 The score of the OSA-18 is not correlated to the severity of OSA and has no diagnostic power, 22 but as a measure of quality of life, these improvements must be considered clinically relevant.…”

Section: Discussionsupporting

confidence: 81%

“…5,6 It has also been shown that ATE and ATT equally improve long-term quality of life after surgery. 7,8 In 2012, a systematic review comparing tonsillectomy (TE) with tonsillotomy (TT) in children with sleep-disordered breathing was published. Of 16 randomized controlled trials (RCTs) included, the conclusion was that TT was equivalent or superior to TE concerning recovery-related outcomes.…”

mentioning

confidence: 99%

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Adenotonsillotomy Versus Adenotonsillectomy in Pediatric Obstructive Sleep Apnea: An RCT

2017

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BACKGROUND: Adenotonsillectomy (ATE) is a well-established and effective treatment of pediatric obstructive sleep apnea (OSA). In recent years, a more conservative method, adenotonsillotomy (ATT), has gained popularity because it is associated with less postoperative morbidity. Yet no previous randomized study has compared these 2 methods regarding their effectiveness in treating pediatric OSA in terms of polysomnographic data, which was the primary aim of this study. The hypothesis was that ATT is noninferior to ATE after 1 year. METHODS: Seventy-nine children, aged 2 to 6 years, with OSA (Apnea-Hypopnea Index [AHI] 5–30) were randomized to ATT (n = 40) or ATE (n = 39). Polysomnography (PSG) and questionnaire OSA-18 were assessed at baseline and 1 year postsurgery. RESULTS: Mean difference between groups in the primary outcome, change in AHI, was 0.83, 95% confidence interval –3.2 to 4.9, not exceeding the noninferiority margin of 5. After ATE, AHI decreased from median 12.7 (interquartile range 8.3–19.1) to 2.0 (1.2–3.1) and after ATT from 15.8 (8.5–21.2) to 4.0 (1.2–5.1). For both groups, significant improvements of PSG and OSA-18 questionnaire outcomes were observed, with no significant differences between groups. Five children (13%) in the ATT group needed repeated surgery for tonsil regrowth and recurrence of OSA. CONCLUSIONS: The results suggest that ATT is noninferior to ATE in treating pediatric OSA regarding PSG outcomes after 1 year. ATT could be considered an alternative to ATE for treatment of pediatric OSA. However, after ATT, there is a nonnegligible risk of recurrence of OSA, and this should be taken into account when selecting surgical method.

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Section: Discussionsupporting

confidence: 81%

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confidence: 99%

Adenotonsillotomy Versus Adenotonsillectomy in Pediatric Obstructive Sleep Apnea: An RCT

2017

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“…However, tonsillotomy exhibited a much higher risk (more than 3-fold) of OSA recurrence compared to tonsillectomy. Furthermore, symptom recurrence is frequent in younger children and may require another surgery within two years after tonsillotomy because of tonsillar tissue regrowth in a proportion of cases [48]. The 2012 American Academy of Pediatrics Guidelines suggested that current data were insufficient to recommend one surgical technique over the other [3].…”

Section: Adenotonsillectomy (Tanda)mentioning

confidence: 99%

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

Gozal

Tan

Kheirandish‐Gozal

2020

JCM

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Treatment approaches to pediatric obstructive sleep apnea (OSA) have remarkably evolved over the last two decades. From an a priori assumption that surgical removal of enlarged upper airway lymphadenoid tissues (T&A) was curative in the vast majority of patients as the recommended first-line treatment for pediatric OSA, residual respiratory abnormalities are frequent. Children likely to manifest persistent OSA after T&A include those with severe OSA, obese or older children, those with concurrent asthma or allergic rhinitis, children with predisposing oropharyngeal or maxillomandibular factors, and patients with underlying medical conditions. Furthermore, selection anti-inflammatory therapy or orthodontic interventions may be preferable in milder cases. The treatment options for residual OSA after T&A encompass a large spectrum of approaches, which may be complementary, and clearly require multidisciplinary cooperation. Among these, continuous positive airway pressure (CPAP), combined anti-inflammatory agents, rapid maxillary expansion, and myofunctional therapy are all part of the armamentarium, albeit with currently low-grade evidence supporting their efficacy. In this context, there is urgent need for prospective evidence that will readily identify the correct candidate for a specific intervention, and thus enable some degree of scientifically based precision in the current one approach fits all model of pediatric OSA medical care.

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“…In several studies, compared with TE, TT has been shown to be associated with a lower risk of postoperative morbidity including postoperative pain and hemorrhage . Furthermore, TT has proven to be as effective as TE in the treatment of upper airway obstruction as measured by both self‐report of symptom relief and polysomnographic outcomes of airway obstruction during sleep . Tonsil regrowth and recurrence of SDB, which may demand reoperation on the tonsils, are known disadvantages after TT …”

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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Tonsillotomy versus tonsillectomy on young children: 2 year post surgery follow-up

Cited by 29 publications

References 30 publications

Adenotonsillotomy Versus Adenotonsillectomy in Pediatric Obstructive Sleep Apnea: An RCT

Adenotonsillotomy Versus Adenotonsillectomy in Pediatric Obstructive Sleep Apnea: An RCT

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

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

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