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Zhou Y, Peng M, Zhou J. Quality of life in children undergoing tonsillectomy: a cross-sectional survey. Ital J Pediatr 2023; 49:52. [PMID: 37143161 PMCID: PMC10161552 DOI: 10.1186/s13052-023-01449-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/28/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The quality of life in children undergoing tonsillectomy remains unclear. We aimed to analyze the current status and influencing factors of quality of life in children undergoing tonsillectomy, to provide useful insights to clinical postoperative care for children. METHODS Children who underwent tonsillectomy in our hospital from June 1, 2021 to October 31, 2022 were selected. The characteristics of children were collected and Paediatric Quality of Life Inventory Version 4.0 (PedsQL™ 4.0) was used for evaluating the quality of life in children. Pearson correlation, univariate and logistic regression analyses were condcuted to evaluate the influencing factors of quality of life in children undergoing tonsillectomy. RESULTS A total of 118 children undergoing tonsillectomy were included. The total score of PedsQL™ 4.0 in children undergoing tonsillectomy was (70.28 ± 13.15). Pearson correlation analyses indicated that age(r = 0.586), courses of tonsillitis(r = 0.595), parental education level(r = 0.612) and monthly family income(r = 0.608) were associated with the PedsQL™ 4.0 total score in children undergoing tonsillectomy (all P < 0.05). Logistic regression analyses indicated that age ≤ 5y (OR = 2.009,95%CI: 1.826 ~ 2.401), courses of tonsillitis ≥ 3years (OR = 2.167,95%CI: 1.688 ~ 2.547), high school of parental education level (OR = 1.807,95%CI: 1.224 ~ 2.181) and monthly family income ≤ 5000 RMB(OR = 2.624,95%CI:2.092 ~ 3.077) were the independent influencing factors of quality of life in children with undergoing tonsillectomy (all P < 0.05). CONCLUSIONS The quality of life of children after tonsillectomy is not high, and the quality of life of children is affected by many factors. Medical staff should take early targeted nursing countermeasures tageted on those influencing factors to improve the quality of life of children.
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Affiliation(s)
- Ying Zhou
- Department of Nursing, Children's Hospital of Nanjing Medical University, No. 72, Guangzhou Road, Gulou District, Nanjing, Jiangsu Province, China
| | - Mingqi Peng
- Department of Nursing, Children's Hospital of Nanjing Medical University, No. 72, Guangzhou Road, Gulou District, Nanjing, Jiangsu Province, China.
| | - Jing Zhou
- Department of Nursing, Children's Hospital of Nanjing Medical University, No. 72, Guangzhou Road, Gulou District, Nanjing, Jiangsu Province, China.
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Wang J, Dang PH, Chang HH, Wang ZH. Subtotal intracapsular tonsillectomy may be the first choice for tonsillectomy in children. J Int Med Res 2021; 49:3000605211011930. [PMID: 33947259 PMCID: PMC8113930 DOI: 10.1177/03000605211011930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate the effect and prognosis of subtotal intracapsular
tonsillectomy. Methods All children (n=162) with tonsillar hypertrophy and chronic tonsillitis were
randomly divided into two groups: tonsillectomy (n=75) and subtotal
intracapsular tonsillectomy (n=87). Tonsillectomy: the tonsillar tissue was
completely removed along with the tonsillar capsule. Subtotal intracapsular
tonsillectomy: 80% to 90% of the tonsils and the complete epithelium of the
tonsillar crypts were removed without damaging the tonsillar capsule. The
Face, Legs, Activity, Cry, and Consolability (FLACC) and parents’
postoperative pain measure (PPPM) scales were used to evaluate postoperative
pain, and the obstructive sleep apnea (OSA)-18 questionnaire was used to
assess the children’s postoperative quality of life. The patients were
followed-up for 2 years. Results 1. The FLACC and PPPM scales indicated that the children’s postoperative pain
after subtotal intracapsular tonsillectomy was significantly less than that
of children undergoing tonsillectomy. 2. The OSA-18 scale scores indicated
that subtotal intracapsular tonsillectomy significantly improved the
children’s quality of life. 3. Two years after subtotal intracapsular
tonsillectomy, no patients required reoperation. Conclusion Subtotal intracapsular tonsillectomy may be the first choice for tonsillar
hypertrophy and chronic tonsillitis patients.
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Affiliation(s)
- Jie Wang
- Department of Otolaryngology-Head and Neck Surgery, The Affiliated Children's Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, 710003, China
| | - Pan-Hong Dang
- Department of Otolaryngology-Head and Neck Surgery, The Affiliated Children's Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, 710003, China
| | - Huan-Huan Chang
- Department of Otolaryngology-Head and Neck Surgery, The Affiliated Children's Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, 710003, China
| | - Zi-Han Wang
- Department of Otolaryngology-Head and Neck Surgery, The Affiliated Children's Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, 710003, China
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Clark ST, Johnston J, Biswas K, Douglas RG. Effect of tonsillectomy on antibiotic prescribing in children. Int J Pediatr Otorhinolaryngol 2020; 138:110338. [PMID: 33152956 DOI: 10.1016/j.ijporl.2020.110338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Tonsillectomy is the second most common surgical procedure performed in pediatric otolaryngology. Multiple courses of antibiotics are usually prescribed prior to surgical intervention. Surgery is indicated when patients reach a certain number of infective episodes, or their obstructive symptoms warrant intervention. Little is known about the role of tonsillectomy on long term postoperative antibiotic use. Recently, our group published a retrospective case series that described the clinical characteristics and outcomes of children under the age of 16 years who underwent tonsillectomy. This study is a follow-up on this previous case series and its purpose is to determine whether tonsillectomy in this group of children led to a reduction in the number of antibiotics prescribed in the year following surgery. METHODS Data were collected from the clinical records departments of two district health boards in Auckland, New Zealand. Hospital morbidity records were reviewed for all children younger than 16 years old, who underwent a tonsillectomy between December 2015 and December 2017 in the Auckland region. All antibiotics prescribed following surgery were obtained from New Zealand's national community prescribing database. RESULTS A total of 1538 children underwent tonsillectomy during the study period. Following surgery, antibiotics were prescribed to 828 (54%) patients at the time of discharge, with an average of 1.2 ± 0.1 courses in the year following surgery. This was significantly reduced compared to preoperative antibiotic intake (3.4 ± 0.1 courses) in the year preceding surgery (p < 0.001). Readmission within 30 days of discharge was not associated with increased antibiotic usage postoperatively. In the two weeks following surgery, 25% of patients were prescribed a course of antibiotics for a presumed postoperative infection. CONCLUSIONS These findings support the benefit of tonsillectomy in reducing antibiotic consumption in the year following surgery. Furthermore, it has highlighted areas of practice, such as perioperative antibiotic prescription, which can be improved to further reduce the prescription of antibiotics for children with tonsillar hyperplasia.
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Affiliation(s)
- Sita Tarini Clark
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - James Johnston
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
| | - Kristi Biswas
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Richard George Douglas
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Kim H, Li SW, Park SM, Kim SK, Hong SJ, Hong SM, Kim YB, Park IS. Feasibility of Powered Intracapsular Tonsillectomy in Pediatric Patients with Tonsil Problem, Including Recurrent Tonsillitis: A Single Surgeon's Experience. ORL J Otorhinolaryngol Relat Spec 2020; 82:335-342. [PMID: 33075791 DOI: 10.1159/000509479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/15/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Powered intracapsular tonsillectomy (PIT) is a technique that protects the tonsillar capsule by using a microdebrider, resulting in faster wound-healing and reduced suffering. Many studies have found PIT to be effective, particularly in pediatric patients with obstructive sleep apnea (OSA). However, previous studies have not included patients with a history of recurrent tonsillitis. OBJECTIVE The aim of this study was to determine the efficacy of PIT in pediatric patients even with a history of recurrent tonsillitis, and therefore, we want to expand the indication for PIT and reveal its safety. METHODS A total of 886 pediatric patients underwent PIT between February 2013 and March 2016. All patients rated their postoperative pain using a visual analog scale (VAS) and completed the Korean obstructive sleep apnea (KOSA)-18 questionnaire for assessment of their quality of life (QOL). There were 539 males and 347 females. Their mean age was 6.2 years (range 2-14 years). The majority (77.7%) underwent the operation for OSA, and the rest (22.3%) had a history of recurrent tonsillitis. To compare the efficacy of PIT with traditional tonsillectomy, we selected 191 patients who underwent extracapsular tonsillectomy (ECT), a conventional technique, during the same time period. The median follow-up period was 16.7 months. During the follow-up period, instances of delayed bleeding and recurrent pharyngitis were monitored. RESULTS In comparison to the patients who underwent ECT, the PIT group showed significantly fewer cases of postoperative bleeding (p = 0.027). Thirteen patients in the PIT group (1.5%) visited the hospital during the follow-up period for pharyngitis, while 8 in the ECT group (4.2%) visited for pharyngitis. The mean postoperative pain score, as assessed by a VAS, was 4.6 ± 3.2, and pain improved within an average of 2.9 days after surgery in the PIT group. The mean KOSA-18 score for the QOL of the patients was 65.9 preoperatively and 35.6 postoperatively in the PIT group. CONCLUSIONS Pediatric tonsillectomy using PIT is valid for reducing postoperative pain and improving the QOL of OSA patients. PIT is also effective and safe for patients with a history of recurrent tonsillitis.
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Affiliation(s)
- Heejin Kim
- Department of Otorhinolaryngology, Head and Neck Surgery, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Sung Won Li
- Department of Otorhinolaryngology, Head and Neck Surgery, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Sung Min Park
- Department of Otorhinolaryngology, Head and Neck Surgery, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Sung Kyun Kim
- Department of Otorhinolaryngology, Head and Neck Surgery, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Seok Jin Hong
- Department of Otorhinolaryngology, Head and Neck Surgery, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Seok Min Hong
- Department of Otorhinolaryngology, Head and Neck Surgery, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Young Bok Kim
- Department of Otorhinolaryngology, Head and Neck Surgery, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Il Seok Park
- Department of Otorhinolaryngology, Head and Neck Surgery, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea,
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Li J, Luo L, Chen W, Zhang J, Deng X, Liao L, Zeng X, Wang B. Application of Coblation Tonsillectomy with Inferior Pole Capsule Preservation in Pediatric Patients. Laryngoscope 2020; 131:1157-1162. [PMID: 32975857 DOI: 10.1002/lary.29089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/18/2020] [Accepted: 08/19/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the application and advantages of coblation tonsillectomy with inferior pole capsule preservation in pediatric patients with tonsillar hypertrophy and recurrent tonsillitis. STUDY DESIGN Retrospective chart review. METHODS A total of 726 children who were diagnosed with either tonsillar hypertrophy or recurrent tonsillitis were included. Children were divided into two groups according to the surgical technique: conventional coblation tonsillectomy and coblation tonsillectomy with inferior pole capsule preservation. The duration of surgery, intraoperative hemorrhage volume, and postoperative pain, as well as postoperative hemorrhage data in the format of time, location, and degree were compared between the two groups. RESULTS Of the 726 children included, conventional coblation tonsillectomy was performed in 320 children, coblation tonsillectomy with inferior pole capsule preservation was performed in 406 children. There were no significant differences in duration of surgery or intraoperative hemorrhage volume between the two groups. Children who underwent coblation tonsillectomy with inferior pole capsule preservation showed a remarkable improvement in postoperative pain on days 3 and 5 postoperatively. Additionally, the coblation tonsillectomy with inferior pole capsule preservation group exhibited a significantly lower total postoperative hemorrhage rate, secondary hemorrhage rate, and hemorrhage rate in the inferior pole compared with that in the conventional coblation tonsillectomy group. During the 1-year follow-up period, no cases of tonsillar re-hypertrophy or recurrent tonsillitis were observed in either group. CONCLUSION For pediatric tonsillar hypertrophy and recurrent tonsillitis, coblation tonsillectomy with inferior pole capsule preservation is a safe and effective technique, capable of reducing postoperative pain and hemorrhage, especially secondary hemorrhage at the inferior pole. LEVEL OF EVIDENCE 3b Laryngoscope, 131:1157-1162, 2021.
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Affiliation(s)
- Jingjia Li
- Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Lixia Luo
- Department of Nosocomial Infection Control, The First People's Hospital of Foshan, Foshan, China
| | - Weixiong Chen
- Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Jianli Zhang
- Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Xuequan Deng
- Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Lieqiang Liao
- Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Xianping Zeng
- Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Bin Wang
- Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, China
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Huoh KC, Haidar YM, Dunn BS. Current Status and Future Trends: Pediatric Intracapsular Tonsillectomy in the United States. Laryngoscope 2020; 131 Suppl 2:S1-S9. [PMID: 32969500 DOI: 10.1002/lary.29108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES 1) To assess the current status of pediatric intracapsular tonsillectomy in the United States, and 2) To apply lessons from the scientific literature and adoption of surgical innovation to predict future trends in pediatric intracapsular tonsillectomy. METHODS This was a cross-sectional survey study and literature review. An anonymous survey was sent to all members of the American Society of Pediatric Otolaryngology (ASPO) to determine current practices in pediatric tonsillectomy. Statistical analysis was performed to compare differences in individuals who perform intracapsular tonsillectomy as opposed to extracapsular tonsillectomy. A literature analysis of the adoption of new technological advancements and innovative surgical techniques was then performed. RESULTS The survey was sent to 540 pediatric otolaryngologists with a response rate of 42%. Of all respondents, 20% currently perform intracapsular tonsillectomy. The primary reason cited for not performing the procedure was concern for tonsillar regrowth. Time in practice, practice setting, and fellowship status was not associated with an increased incidence of intracapsular tonsillectomy. CONCLUSIONS Only 20% of pediatric otolaryngologist respondents in the United States perform intracapsular tonsillectomy. Based on the documented advantages of intracapsular tonsillectomy over extracapsular tonsillectomy and an analysis of adoption of novel surgical techniques, we predict a paradigm shift in the specialty toward intracapsular tonsillectomy. LEVEL OF EVIDENCE 3 Laryngoscope, 131:S1-S9, 2021.
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Affiliation(s)
- Kevin C Huoh
- Division of Pediatric Otolaryngology- Head and Neck Surgery, CHOC Children's Hospital of Orange County, Orange, California, U.S.A.,Department of Otolaryngology- Head and Neck Surgery, University of California, Irvine School of Medicine, Orange, California, U.S.A
| | - Yarah M Haidar
- Department of Otolaryngology- Head and Neck Surgery, University of California, Irvine School of Medicine, Orange, California, U.S.A
| | - Brandyn S Dunn
- Department of Otolaryngology- Head and Neck Surgery, University of California, Irvine School of Medicine, Orange, California, U.S.A
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Varadharajan K, Caton N, Faulkner J, Khemani S. Coblation® intracapsular tonsillectomy in children with recurrent tonsillitis: Initial experience. Int J Pediatr Otorhinolaryngol 2020; 135:110113. [PMID: 32504841 DOI: 10.1016/j.ijporl.2020.110113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/05/2020] [Accepted: 05/10/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The use of Coblation® intracapsular tonsillectomy for the treatment of sleep disordered breathing (SDB)/obstructive sleep apnoea (OSA) has an increasing evidence base. However, the results for tonsillitis as the predominant indication for surgery are not as clear. We present our initial results from 80 paediatric cases undergoing Coblation® intracapsular tonsillectomy for infective indications. METHODS Prospective case series within the secondary care environment, January 2016-July 2018, all with completed follow-up. We utilised the validated T14 tonsil symptom questionnaire pre- and postoperatively and also collected data regarding postoperative complications. RESULTS 80 consecutive patients (age range 2-16 years and mean 7.2 years) undergoing Coblation® intracapsular tonsillectomy (with or without adenoidectomy) predominantly for infective reasons although some also had concomitant adenoidectomy for snoring/sleep disordered breathing were included. Mean follow-up was at 13 months postoperatively. 38 children had tonsillitis (with or without snoring) and 42 children had SDB in combination with tonsillitis. The mean over-all total T14 score was 32.7 preoperatively and 2.7 postoperatively (p < 0.0001). The mean infective score was 22.1 preoperatively and 1.5 postoperatively (p < 0.0001). The mean SDB score was 10.6 preoperatively and 1.5 postoperatively (p < 0.0001). There were no cases of haemorrhage, re-admission or regrowth noted. CONCLUSION Coblation® intracapsular tonsillectomy is a safe and effective technique for treating children with recurrent tonsillitis. Future studies should incorporate longer term follow-up.
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Affiliation(s)
| | - Nadine Caton
- ENT ST7 Maidstone and Tunbridge Wells NHS Trust, UK
| | - Jack Faulkner
- ENT Senior House Officer, Surrey and Sussex NHS Trust, UK
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Kisser U, Lill C, Adderson-Kisser C, Patscheider M, Stelter K. Total versus subtotal tonsillectomy for recurrent tonsillitis - a prospective randomized noninferiority clinical trial. Acta Otolaryngol 2020; 140:514-520. [PMID: 32049573 DOI: 10.1080/00016489.2020.1725112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: For many years experts have called for randomized controlled trials to resolve the question whether tonsillectomy, which is associated with significant comorbidity, can be replaced by partial tonsillectomy in patients with recurrent tonsillitis.Objective: To find out whether subtotal tonsillectomy is a suitable therapeutic alternative to total tonsillectomy in adult patients with recurrent episodes of acute tonsillitis.Material and methods: Study design - Single-blind prospective non-inferiority randomized clinical trial with intraindividual design. Setting - 80 patients were recruited at a tertiary referral center. Subjects - Adult patients with recurrent tonsillitis received total tonsillectomy on one side and subtotal tonsillectomy on the other side after randomization. Main outcome measure was frequency of postoperative tonsillitis on the side of subtotal tonsillectomy and postoperative pharyngitis in the former tonsil area on the side of total tonsillectomy. The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00015628).Results: Within 12 months none of the subjects suffered from recurrent tonsillitis after subtotal tonsillectomy. Subtotal tonsillectomy caused less pain than total tonsillectomy.Conclusion: Subtotal tonsillectomy might be an alternative treatment option associated with lower morbidity than total tonsillectomy in adults with recurrent tonsillitis.
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Affiliation(s)
- Ulrich Kisser
- Department of Otorhinolaryngology, Head and Neck Surgery, University Clinic Halle, Halle, Germany
| | - Claudia Lill
- Department of Otorhinolaryngology, Head and Neck Surgery, Evangelical Hospital, Vienna, Austria
| | | | - Martin Patscheider
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Munich, Munich, Germany
| | - Klaus Stelter
- ENT, Head and Neck Surgery, ENT Center Mangfall-Inn, Rosenheim, Germany
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Çetin YS, Düzenli U. Tonsillotomy versus Tonsillectomy for Chronic Recurrent Tonsillitis in Children. Turk Arch Otorhinolaryngol 2020; 58:30-34. [PMID: 32313892 DOI: 10.5152/tao.2020.4837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2020] [Indexed: 11/22/2022] Open
Abstract
Objective This study was conducted to compare two different surgical methods; partial tonsil resection using the bipolar technique, tonsillotomy (TT), and total tonsillectomy (TE) (blunt dissection) for recurrent tonsillitis in children. The frequency of recurrent throat infections was determined during postoperative follow-up. Methods A total of 393 patients were included in this study. TT was performed on 174 patients (100 males, 74 females) and TE on 219 patients (112 males, 107 females). Following surgery, an analysis was made of treatment outcomes of patients with upper respiratory tract infections. The patients were followed up for 12-48 months. Their parents were also contacted by telephone to determine the frequency of reinfection and their satisfaction with the surgery. Also, parents of the patients completed a questionnaire pertaining to postoperative satisfaction (scale of 1-10). Results In the TT group, 14 (8.1%) patients had recurrent tonsillitis postoperatively. In the TE group, 12 (5.4%) patients required antibiotherapy due to recurrent pharyngitis after the surgery. There was no significant difference between the two groups in terms of the one-year infection recurrence rate after surgery (p=0.281). Three patients (1.6%) in the TT group and 12 (5.4%) in the TE group complained of bleeding within the first 24 hours. The rate of bleeding was significantly lower in the TT group than the TE group (p=0.001). There were no fatalities in either group. Conclusion In both groups, the rate of reinfection accorded with the requirement for postoperative antibiotics. For recurrent tonsillitis, TT was as effective as TE. However, TT was superior in terms of the risk of bleeding.
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Affiliation(s)
- Yaser Said Çetin
- Department of Otorhinolaryngology, Van Yüzüncü Yıl University School of Medicine, Van, Turkey
| | - Ufuk Düzenli
- Department of Otorhinolaryngology, Van Yüzüncü Yıl University School of Medicine, Van, Turkey
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Bystrup A, Lildal TK, Ovesen T. Longterm results after tonsillotomy: outcome, residual symptoms and need for revision surgery. Acta Otolaryngol 2020; 140:58-65. [PMID: 31671015 DOI: 10.1080/00016489.2019.1681592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Tonsillotomy (TT) has gradually replaced tonsillectomy for children with upper airway obstruction during sleep in Denmark. The disadvantage is potential tonsil regrowth.Objectives: To present results on outcome of TT in a Danish hospital setting.Material and methods: Observational cohort study with follow up. All patients were invited for a postoperative examination/telephone interview and to fill in a questionnaire.Results: Medical records from 141 consecutive children up to 12 years of age who underwent TT with or without adenoidectomy in 2015 and 2016 were analyzed. Median follow up time was 33 months (18-41 months), 132 (94%) completed the questionnaire, of which 84 underwent clinical examination. 97% would recommend the procedure. At follow up, a significant reduction of all symptoms was found as well as a significant increase in BMI. Tonsil size ≤ 2 was observed in 81% of patients at follow up. One patient had been referred due to postoperative bleeding. Six patients needed revision tonsil surgery.Conclusion and significance: TT is a safe and effective procedure. However, due to the risk of regrowth of tonsils or recurrent tonsillitis, revision surgery may be necessary, and physicians should pay attention to the risk of recurrence of obstructive symptoms.
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Affiliation(s)
- Anne Bystrup
- The Department of Otorhinolaryngology, Head and Neck Surgery, Regional Hospital Holstebro, Holstebro, Denmark
| | - Tina Kissow Lildal
- The Department of Otorhinolaryngology, Head and Neck Surgery, Regional Hospital Holstebro, Holstebro, Denmark
| | - Therese Ovesen
- The Department of Otorhinolaryngology, Head and Neck Surgery, Regional Hospital Holstebro, Holstebro, Denmark
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Changing trends in pediatric tonsil surgery. Int J Pediatr Otorhinolaryngol 2019; 118:84-89. [PMID: 30594099 DOI: 10.1016/j.ijporl.2018.12.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We analyzed trends in tonsil surgery over a 10-year period in a single tertiary care hospital and evaluated the effects of these changes on use of hospital services and healthcare costs. METHODS This was a retrospective cohort study based on data from databases at the Department of Otorhinolaryngology, Helsinki University Hospital, Helsinki, Finland. Children under 16 years of age with tonsillectomy (TE) or tonsillotomy (TT) performed during 2007-2016 were included in the study. RESULTS In 10 years, 4979 tonsil surgeries were performed on 4951 children: TE in 3170 (64%) and TT in 1781 (36%) children. The total number of tonsil surgeries stayed nearly constant. TT operations commenced in the study hospital in 2009 and from 2012 onwards have been more common than TE procedures. Altogether 279 patients visited the emergency department because of complications; TE patients had 9.0 visits/100 surgeries and TT patients 1.8 visits/100 surgeries. The most common complication was postoperative hemorrhage: 200 cases (6.3%) in the TE group and 11 cases (0.6%) in the TT group. During the two-year follow-up after tonsil surgery the total costs of healthcare services were significantly lower in the TT group than in the TE group. CONCLUSION Considerable changes have occurred in tonsil surgery in children during the 10-year study period; TT is today performed more often than TE. As a consequence, complications, readmissions to hospital, and number of patients treated in the operating room because of postoperative hemorrhage have decreased, lowering the costs of healthcare.
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