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Lao J, Jian F, Ge R, Wu S. Tonsillectomy Versus Tonsillotomy in Pediatric Sleep-Disordered Breathing: A Systematic Review and Multi-subgroup Meta-analysis. Laryngoscope 2024. [PMID: 39295458 DOI: 10.1002/lary.31776] [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: 04/10/2024] [Revised: 08/25/2024] [Accepted: 09/03/2024] [Indexed: 09/21/2024]
Abstract
OBJECTIVES To evaluate the potential of tonsillotomy (TT) as an alternative to tonsillectomy (TE) for treating children with obstructive sleep-disordered breathing (oSDB). DATA SOURCES Two independent reviewers searched PubMed, the Cochrane Library, Embase, and additional sources to identify controlled studies comparing TT versus TE in pediatric patients with oSDB. REVIEW METHODS We evaluated post-surgery symptom relief, and short- and long-term postoperative benefits for children. Fixed-effect meta-analysis, sensitivity analysis, and subgroup analysis were conducted. RESULTS In our analysis of 32 studies with 9,430 children, the analysis revealed TT group had a similar therapeutic effect on improvement of OSA-18 as TE group (MD = 5.20, 95% CI: -32.67 to 43.07, p = 0.96). In terms of short-term outcome, the days to return to normal diet for TT group were shorter than that for TE group (MD = -2.49, 95%CI: -3.57 to -1.28; p < 0.001), less analgesics use (MD = -3.19, 95% CI = -3.44 to -2.93, p < 0.001), and lower postoperative secondary bleeding (RR = 0.33; 95%CI: 0.23 to 0.47; p < 0.001). But the risk of reoperation (OR = 8.28; 95%CI: 2.66 to 12.64; p < 0.001), oSDB recurrence (OR = 2.16; 95%CI: 1.20-3.86; p = 0.01), and postoperative infection (OR = 1.82; 95%CI: 1.34 to 2.47; p < 0.001) in TT group was significantly higher than that in TE group. CONCLUSIONS Tonsillotomy reduces postoperative pain and bleeding, speeding up recovery for children with oSDB, and improving their quality of life. Yet, the risk of recurrent infections from residual tonsil tissue, which may require reoperation, calls for a careful evaluation of the procedure's short-term gains against its long-term risks. LEVEL OF EVIDENCE NA Laryngoscope, 2024.
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Affiliation(s)
- Jiahong Lao
- E.N.T. Department, The 3rd Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Feitong Jian
- E.N.T. Department, The 3rd Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Rongrong Ge
- E.N.T. Department, The 3rd Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shuo Wu
- E.N.T. Department, The 3rd Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- School of Biomedical Engineering, Sun Yat-Sen University, Shenzhen, China
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Soaper AL, Li C, Willging JP. When Should We Recommend Intracapsular Tonsillectomy in Pediatric Patients? Laryngoscope 2024; 134:3423-3424. [PMID: 38545635 DOI: 10.1002/lary.31427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/07/2024] [Accepted: 03/19/2024] [Indexed: 07/13/2024]
Affiliation(s)
- Ashley L Soaper
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Carol Li
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jay Paul Willging
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Jaensch SL, Cheng AT, Waters KA. Adenotonsillectomy for Obstructive Sleep Apnea in Children. Otolaryngol Clin North Am 2024; 57:407-419. [PMID: 38575485 DOI: 10.1016/j.otc.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Obstructed breathing is the most common indication for tonsillectomy in children. Although tonsillectomy is performed frequently worldwide, the surgery is associated with a number of significant complications such as bleeding and respiratory failure. Complication risk depends on a number of complex factors, including indications for surgery, demographics, patient comorbidities, and variations in perioperative techniques. While polysomnography is currently accepted as the gold standard diagnostic tool for obstructive sleep apnea, studies evaluating outcomes following surgery suggest that more research is needed on the identification of more readily available and accurate tools for the diagnosis and follow-up of children with obstructed breathing.
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Affiliation(s)
- Samantha L Jaensch
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Sydney Medical School - Northern, L7 Kolling Building RNSH, Reserve Road, St Leonards, NSW 2065, Australia
| | - Alan T Cheng
- Discipline of Child and Adolescent Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia; Department of Ear Nose & Throat Surgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia
| | - Karen A Waters
- Discipline of Child and Adolescent Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia; Respiratory Support Services, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia.
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Timashpolsky A, Aggarwal A, Ruiz R, Devine C. Intracapsular Versus Total Tonsillectomy in Patients with Trisomy 21. Laryngoscope 2024; 134:2430-2437. [PMID: 37971150 DOI: 10.1002/lary.31169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/26/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Intracapsular tonsillectomy and adenoidectomy (iTA) has become a popular alternative to extracapsular tonsillectomy and adenoidectomy (TT) for the treatment of pediatric obstructive sleep apnea (OSA) due to improved recovery and fewer complications. The objective of this study was to compare surgical recovery and impact on OSA of iTA versus TT in patients with Trisomy 21 (T21). METHODS This is a case series with chart review of all T21 patients who underwent iTA or TT at our institution between July 1, 2015 and August 15, 2022. Data collected included demographics, comorbidities, preoperative sleep studies, intraoperative data, complications and recovery, postoperative sleep studies, and follow-up data. RESULTS There were 62 (21.7%) patients who underwent iTA and 224 (78.3%) patients who underwent TT. The iTA group had significantly lower pain scores (p < 0.001), decreased use of narcotics (p < 0.001), shorter length of stay (p = 0.003), and faster return to oral intake (p = 0.01) during their postoperative hospital admission, and fewer 30-day complications (p = 0.009) compared to the TA group. Both groups showed significant improvements in their sleep studies. For 41 (66.1%) of iTA patients who had follow-up, median follow-up was 1.8 years and for 169 (75.4%) TT patients, median follow-up was 2.6 years. At follow-up, 21 of 41 (51.2%) iTA patients and 83 of 169 (49.1%) TT patients exhibited OSA symptoms (p = 0.084) and tonsillar regrowth was not significantly different between the two groups (p = 0.12). CONCLUSION Patients with T21 experience less pain and fewer postoperative respiratory complications from iTA than from TT. The short-term impact of iTA versus TT on OSA, as measured by poysomnography, does not differ between the two techniques. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2430-2437, 2024.
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Affiliation(s)
- Alisa Timashpolsky
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Ashna Aggarwal
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Ryan Ruiz
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Conor Devine
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
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Bassett E. Intracapsular tonsillectomy: setting a new standard. Curr Opin Otolaryngol Head Neck Surg 2023; 31:403-406. [PMID: 37820084 DOI: 10.1097/moo.0000000000000935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
PURPOSE OF REVIEW Tonsillectomy is one of the most common surgical procedures performed on children in the United States. Since 2002, the intracapsular technique has been studied as a safer and less painful alternative to total tonsillectomy. Concerns have been raised, however, as to the potential for regrowth and long-term outcomes regarding this technique. RECENT FINDINGS Studies support the use of intracapsular tonsillectomy in the management of sleep disordered breathing, including in syndromic populations, as well as for tonsillitis. In addition, safety profiles continue to be improved over that of extracapsular dissection. While the incidence of regrowth ranges depending on the study and duration of follow up, it remains acceptably low. The most consistent independent risk factor for revision surgery includes young age. SUMMARY While total tonsillectomy is more thoroughly studied historically, an important absence in the literature is a definitive superiority over the intracapsular technique. With continued high-level studies, as well as additional examination of long-term outcomes, we should continue to see greater acceptance of intracapsular tonsillectomy as a standard of practice in a vulnerable population.
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Stahl A, Dagan O, Nageris B, Biadsee A, Ebner Y. Powered Intracapsular Tonsillotomy and Adenoidectomy in Infants ≤36 Months Compared to Older Children: A Retrospective Analysis. Ann Otol Rhinol Laryngol 2022:34894221129017. [PMID: 36217953 DOI: 10.1177/00034894221129017] [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: 11/15/2022]
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.
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Affiliation(s)
- Avishai Stahl
- Department of Otorhinolaryngology - Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Or Dagan
- Department of Otorhinolaryngology - Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel
| | - Benny Nageris
- Department of Otorhinolaryngology - Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ameen Biadsee
- Department of Otorhinolaryngology - Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Ebner
- Department of Otorhinolaryngology - Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel
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Nguyen BK, Quraishi HA. Tonsillectomy and Adenoidectomy - Pediatric Clinics of North America. Pediatr Clin North Am 2022; 69:247-259. [PMID: 35337537 DOI: 10.1016/j.pcl.2021.12.008] [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] [Indexed: 10/18/2022]
Abstract
Tonsillectomy and adenoidectomy are among the most commonly performed major pediatric operations in the United States, with more than 500,000 procedures performed annually. This procedure can be performed with or without adenoidectomy. These procedures were traditionally performed for recurrent tonsillitis; however, the vast majority of tonsillectomies are currently performed for obstructive symptoms. When performed for appropriate indications, tonsillectomy and adenoidectomy can greatly improve a child's quality of life and general health. Given the prevalence of these conditions and subsequent surgical procedures, evidence-based recommendations are regularly evaluated and updated. As such, familiarity with these guidelines is necessary for pediatric practitioners. This review summarizes the indications, complications, and outcomes for tonsillectomy and adenoidectomy, as well as provides a brief overview of operative techniques.
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Affiliation(s)
- Brandon K Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, 90 Bergen St, Ste 8100, Newark, NJ 07103, USA
| | - Huma A Quraishi
- Pediatric Otolaryngology, Joseph M. Sanzari Children's Hospital, 30 Prospect Ave. WFAN Bldg 3rd Floor, Hackensack, NJ 07601, USA.
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Considerations in Surgical Management of Pediatric Obstructive Sleep Apnea: Tonsillectomy and Beyond. CHILDREN 2021; 8:children8110944. [PMID: 34828657 PMCID: PMC8623402 DOI: 10.3390/children8110944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 11/17/2022]
Abstract
Obstructive sleep apnea (OSA) is an increasingly recognized disorder with a reported incidence of 5.7% in children. Tonsillectomy (with or without adenoidectomy) in pediatric OSA in otherwise healthy non-obese children has a success rate of approximately 75%. However, the cure rate reported for all children undergoing tonsillectomy varies from 51% to 83%. This article reviews the history of tonsillectomy, its indications, techniques, various methods, risks, and successes. The article also explores other surgical options in children with residual OSA post-tonsillectomy.
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