1
|
Piitulainen JM, Uusitalo T, Sjöblom HM, Ivaska LE, Jegoroff H, Kauko T, Kokki H, Kytö E, Mansikka I, Ylikoski J, Jero J. Intracapsular tonsillectomy in the treatment of recurrent and chronic tonsillitis in adults: a protocol of a prospective, single-blinded, randomised study with a 5-year follow-up (the FINITE trial). BMJ Open 2022; 12:e062722. [PMID: 36104143 PMCID: PMC9476145 DOI: 10.1136/bmjopen-2022-062722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION The standard surgical treatment for recurrent or chronic tonsillitis is extracapsular tonsillectomy. Recent studies show that intracapsular tonsillectomy has the potential to reduce the postoperative morbidity of patients undergoing tonsil surgery. The Finnish Intracapsular Tonsillectomy (FINITE) trial aims to provide level I evidence to support the hypothesis that the recovery time from tonsil surgery can be reduced with intracapsular tonsillectomy. Additionally, from this trial, major benefits in quality of life, reduction of postoperative complications, treatment costs and throat symptoms might be gained. METHODS AND ANALYSIS The FINITE trial is a prospective, randomised, controlled, patient-blinded, three-arm clinical trial. It is designed to compare three different surgical methods being extracapsular monopolar tonsillectomy versus intracapsular microdebrider tonsillectomy versus intracapsular coblation tonsillectomy in the treatment of adult patients (16-65 years) suffering from recurrent or chronic tonsillitis. The study started in September 2019, and patients will be enrolled until a maximum of 200 patients are randomised. Currently, we are in the middle of the study with 125 patients enrolled as of 28 February 2022 and data collection is scheduled to be completed totally by December 2027. The primary endpoint of the study will be the recovery time from surgery. Secondary endpoints will be the postoperative pain scores and the use of analgesics during the first 3 weeks of recovery, postoperative haemorrhage, quality of life, tonsillar remnants, need for revision surgery, throat symptoms, treatment costs and sick leave. A follow-up by a questionnaire at 1-21 days and at 1, 6, 24 and 60 months will be conducted with a follow-up visit at the 6-month time point. ETHICS AND DISSEMINATION Ethical approval was obtained from the Medical Ethics Committee of the Hospital District of Southwest Finland (reference number 29/1801/2019). Results will be made publicly available in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT03654742.
Collapse
Affiliation(s)
- Jaakko Matias Piitulainen
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, Turku, Finland
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Tapani Uusitalo
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, Turku, Finland
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Henrik M Sjöblom
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, Turku, Finland
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Lotta E Ivaska
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, Turku, Finland
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Henri Jegoroff
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Tommi Kauko
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, Turku, Finland
| | - Hannu Kokki
- School of Medicine, University of Eastern Finland, Joensuu, Finland
| | - Eero Kytö
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, Turku, Finland
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Iisa Mansikka
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, Turku, Finland
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Jenni Ylikoski
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, Turku, Finland
- Otorhinolaryngology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Jussi Jero
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
2
|
Houborg HI, Klug TE. Quality of life after tonsillectomy in adult patients with recurrent acute tonsillitis: a systematic review. Eur Arch Otorhinolaryngol 2022; 279:2753-2764. [DOI: 10.1007/s00405-022-07260-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022]
|
3
|
Sakki AJ, Roine RP, Mäkinen LK, Sintonen H, Nokso-Koivisto J. Impact of tonsillotomy versus tonsillectomy on health-related quality of life and healthcare costs in children with sleep-disordered breathing. J Laryngol Otol 2021; 136:1-22. [PMID: 34819188 DOI: 10.1017/s0022215121003832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectiveThis study aimed to explore health-related quality of life and use of healthcare services and ensuing costs before and after tonsillotomy in children with sleep-disordered breathing and to compare the results to an earlier cohort of children who had undergone tonsillectomy.MethodChildren undergoing tonsillotomy answered the 17-dimensional, standardised health-related quality of life instrument questionnaire and a questionnaire on use of healthcare services and sick leave before and after surgery. Costs of specialist care were obtained pre- and post-operatively. The data were compared with similar data collected previously from children with tonsillectomy.ResultsTonsillotomy improved mean total health-related quality of life score significantly at 6 and 12 months. Healthcare costs and number of sick-leave days diminished significantly from 3 months pre-operatively to 12 months after surgery. Tonsillotomy had similar positive effects compared with tonsillectomy regarding health-related quality of life and healthcare costs.ConclusionTonsillotomy improves health-related quality of life in children with sleep-disordered breathing and reduces healthcare service needs and sick leave similarly to tonsillectomy.
Collapse
Affiliation(s)
- Anniina J Sakki
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Risto P Roine
- Helsinki and Uusimaa Hospital Group, Group Administration, Finland and University of Eastern Finland, Department of Health and Social Management
| | - Laura K Mäkinen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Johanna Nokso-Koivisto
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| |
Collapse
|
4
|
Ostermann T, Park AL, De Jaegere S, Fetz K, Klement P, Raak C, McDaid D. Cost-effectiveness analysis for SilAtro-5-90 adjuvant treatment in the management of recurrent tonsillitis, compared with usual care only. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:60. [PMID: 34538271 PMCID: PMC8451093 DOI: 10.1186/s12962-021-00313-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/30/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose Antibiotics are one possible treatment for patients with recurrent acute throat infections (ATI), but effectiveness can be modest. In view of worries over antibiotic resistance, treatment pathways that reduce recurrence of ATI are essential from a public health perspective. Integrative treatment strategies can be an option but there is still a high demand to provide evidence of their cost effectiveness. Methods We constructed a 4-state Markov model to compare the cost-effectiveness of SilAtro-5-90 as adjuvant homeopathic therapy to care as usual with care as usual alone in reducing the recurrence of ATI for children and adults with suspected moderate recurrent tonsillitis. The analysis was performed from a societal perspective in Germany over a 2-year period. Results are reported separately for children < 12 and for individuals aged 12 and over. The model draws on evidence from a multi-centre randomised clinical trial that found this strategy effective in reducing recurrence of ATI. Costs in 2019 € and outcomes after 1 year are discounted at a rate of 3% per annum. Results For adults and adolescents aged 12 years and over, incremental cost per ATI averted in the adjuvant therapy group was €156.64. If individuals enter the model on average with a history of 3.33 previous ATIs, adjuvant therapy has both lower costs and better outcomes than care as usual. For children (< 12 years) adjuvant therapy had both lower costs and ATI than care as usual. The economic case is stronger if adjuvant treatment reduces surgical referral. At a hypothetical cost per ATI averted threshold of €1000 probabilistic sensitivity analysis suggests Silatro-5-90 has a 65% (adults) and 71% (children) chance of being cost-effective. Conclusion Our results indicate the importance of considering homeopathy as adjuvant therapy in the treatment of ATIs in individuals with recurrent tonsillitis from a socio-economic perspective. Further evaluation should assess how differences in uptake and sustained use of homeopathic adjuvant therapy, as well as changing patterns of antibiotic prescribing, impact on cost effectiveness. Supplementary Information The online version contains supplementary material available at 10.1186/s12962-021-00313-4.
Collapse
Affiliation(s)
- Thomas Ostermann
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Sabine De Jaegere
- Deutsche Homöopathie-Union, DHU-Arzneimittel GmbH & Co. KG, Ottostraße 24, 76227, Karlsruhe, Germany
| | - Katharina Fetz
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Petra Klement
- Deutsche Homöopathie-Union, DHU-Arzneimittel GmbH & Co. KG, Ottostraße 24, 76227, Karlsruhe, Germany
| | - Christa Raak
- Institute of Integrative Medicine, Witten/Herdecke University, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| |
Collapse
|
5
|
Alm F, Lööf G, Blomberg K, Ericsson E. Establishment of resilience in a challenging recovery at home after pediatric tonsil surgery-Children's and caregivers' perspectives. PAEDIATRIC & NEONATAL PAIN 2021; 3:75-86. [PMID: 35547595 PMCID: PMC8975210 DOI: 10.1002/pne2.12051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/13/2021] [Accepted: 04/25/2021] [Indexed: 12/29/2022]
Abstract
The objective of this study was to explore children's and caregivers’ experiences and management of postoperative recovery at home after tonsil surgery. The study had an explorative qualitative design with an inductive approach. Twenty children (5‐12 years of age) undergoing tonsillectomy or tonsillotomy with or without adenoidectomy participated along with their caregivers in semi‐structured interviews at a mean time of 28 days after surgery. The interviews were analyzed with content analysis. One main category emerged from the interviews: children and caregivers struggle to establish resilience in a challenging recovery. The families’ resilience relied on their situational awareness and capacity to act, which in turn formed a basis for the ability to return to normal daily life. Children and caregivers described the recovery as an evident interruption of daily life which had an impact on the children's physical and psychological well‐being. Both children and caregivers described the pain as a central concern. The families used different pharmacological and complementary strategies to manage the pain, which in some cases were complex. Some families said that the analgesics were insufficient in preventing breakthrough pain, and spoke about a lack of support as well as inadequate and contradictory information from healthcare staff. Caregivers also expressed uncertainty, ambivalence, or anxiety about the responsibility associated with their child's recovery. To optimize and support the recovery after tonsil surgery, it is crucial to obtain knowledge of children's and caregivers’ perspectives of postoperative recovery at home. The results indicate that the postoperative period included several troublesome experiences for which neither the children nor the caregivers were informed or prepared. The experience of pain was significant, and often complex to manage. To increase families’ resilience, the information provided by healthcare professionals needs to be broadened. Multidisciplinary teamwork is necessary to achieve this goal.
Collapse
Affiliation(s)
- Fredrik Alm
- Department of Anaesthesia and Intensive Care School of Health Sciences Faculty of Medicine and Health Örebro University Örebro Sweden
| | - Gunilla Lööf
- Department of Paediatric Anaesthesia and Intensive Care Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm Sweden
| | - Karin Blomberg
- School of Health Sciences Faculty of Medicine and Health Örebro University Örebro Sweden
| | - Elisabeth Ericsson
- School of Health Sciences Faculty of Medicine and Health Örebro University Örebro Sweden
| |
Collapse
|
6
|
Sakki AJ, Mäkinen LK, Kanerva M, Nokso-Koivisto J. Monopolar tonsillotomy versus cold dissection tonsillectomy in children: Prospective study on postoperative recovery. Int J Pediatr Otorhinolaryngol 2021; 141:110513. [PMID: 33234329 DOI: 10.1016/j.ijporl.2020.110513] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To compare postoperative self-reported recovery results with monopolar tonsillotomy and cold dissection tonsillectomy in children. To evaluate the feasibility of the monopolar technique in tonsillotomy. METHODS Children <12 years undergoing tonsillotomy or tonsillectomy between April 2018 and March 2020 who (with a caregiver) were willing to participate in a two-week follow-up formed the study group. They filled in a questionnaire about pain-related outcomes, return to normal activities, weight changes, complications, and length of home care. RESULTS Altogether 166 patients were recruited; 103 (62%) returned the questionnaire. The first pain-free day with tonsillotomy was day 5 and with tonsillectomy day 11. After tonsillotomy, patients returned to normal activities faster, e.g. they were able to eat normally 6.5 days earlier than tonsillectomy patients. During the first postoperative week weight dropped after tonsillectomy, but not after tonsillotomy. The length of home care was 6 days with tonsillotomy and 10 days with tonsillectomy. The incidence of postoperative hemorrhage (including minor bleedings at home) was 14% after tonsillotomy and 32% after tonsillectomy. Hemorrhages needing interventions were 0% with tonsillotomy and 2% with tonsillectomy. CONCLUSION Children operated on with monopolar tonsillotomy recovered faster and had less postoperative hemorrhage than those undergoing tonsillectomy. They were able to return earlier to daycare/school and their caregivers back to work. Recovery results with monopolar tonsillotomy were equal to other tonsillotomy techniques reported in the literature, hence the monopolar technique can be considered an alternative method to perform tonsillotomy.
Collapse
Affiliation(s)
- Anniina J Sakki
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Laura K Mäkinen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mervi Kanerva
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Johanna Nokso-Koivisto
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| |
Collapse
|
7
|
Blackshaw H, Springford LR, Zhang LY, Wang B, Venekamp RP, Schilder AG. Tonsillectomy versus tonsillotomy for obstructive sleep-disordered breathing in children. Cochrane Database Syst Rev 2020; 4:CD011365. [PMID: 32347984 PMCID: PMC7193676 DOI: 10.1002/14651858.cd011365.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Obstructive sleep-disordered breathing (oSDB) is a condition encompassing breathing problems when asleep due to upper airway obstruction. In children, hypertrophy of the tonsils and/or adenoids is thought to be the commonest cause. As such, (adeno)tonsillectomy has long been the treatment of choice. A rise in partial removal of the tonsils over the last decade is due to the hypothesis that tonsillotomy is associated with lower postoperative morbidity and fewer complications. OBJECTIVES To assess whether partial removal of the tonsils (intracapsular tonsillotomy) is as effective as total removal of the tonsils (extracapsular tonsillectomy) in relieving signs and symptoms of oSDB in children, and has lower postoperative morbidity and fewer complications. SEARCH METHODS We searched the Cochrane ENT Trials Register; Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The search date was 22 July 2019. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing the effectiveness of (adeno)tonsillectomy with (adeno)tonsillotomy in children aged 2 to 16 years with oSDB. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods and assessed the certainty of the evidence for our pre-defined outcomes using GRADE. Our primary outcomes were disease-specific quality of life, peri-operative blood loss and the proportion of children requiring postoperative medical intervention (with or without hospitalisation). Secondary outcomes included postoperative pain, return to normal activity, recurrence of oSDB symptoms as a result of tonsil regrowth and reoperation rates. MAIN RESULTS We included 22 studies (1984 children), with predominantly unclear or high risk of bias. Three studies used polysomnography as part of their inclusion criteria. Follow-up duration ranged from six days to six years. Although 19 studies reported on some of our outcomes, we could only pool the results from a few due both to the variety of outcomes and the measurement instruments used, and an absence of combinable data. Disease-specific quality of life Four studies (540 children; 484 (90%) analysed) reported this outcome; data could not be pooled due to the different outcome measurement instruments used. It is very uncertain whether there is any difference in disease-specific quality of life between the two surgical procedures in the short (0 to 6 months; 3 studies, 410 children), medium (7 to 13 months; 2 studies, 117 children) and long term (13 to 24 months; 1 study, 67 children) (very low-certainty evidence). Peri-operative blood loss We are uncertain whether tonsillotomy reduces peri-operative blood loss by a clinically meaningful amount (mean difference (MD) 14.06 mL, 95% CI 1.91 to 26.21 mL; 8 studies, 610 children; very low-certainty evidence). In sensitivity analysis (restricted to three studies with low risk of bias) there was no evidence of a difference between the groups. Postoperative complications requiring medical intervention (with or without hospitalisation) The risk of postoperative complications in the first week after surgery was probably lower in children who underwent tonsillotomy (4.9% versus 2.6%, risk ratio (RR) 1.75, 95% CI 1.06 to 2.91; 16 studies, 1416 children; moderate-certainty evidence). Postoperative pain Eleven studies (1017 children) reported this outcome. Pain was measured using various scales and scored by either children, parents, clinicians or study personnel. When considering postoperative pain there was little or no difference between tonsillectomy and tonsillotomy at 24 hours (10-point scale) (MD 1.09, 95% CI 0.88 to 1.29; 4 studies, 368 children); at two to three days (MD 0.93, 95% CI -0.14 to 2.00; 3 studies, 301 children); or at four to seven days (MD 1.07, 95% CI -0.40 to 2.53; 4 studies, 370 children) (all very low-certainty evidence). In sensitivity analysis (restricted to studies with low risk of bias), we found no evidence of a difference in mean pain scores between groups. Return to normal activity Tonsillotomy probably results in a faster return to normal activity. Children who underwent tonsillotomy were able to return to normal activity four days earlier (MD 3.84 days, 95% CI 0.23 to 7.44; 3 studies, 248 children; moderate-certainty evidence). Recurrence of oSDB and reoperation rates We are uncertain whether there is a difference between the groups in the short (RR 0.26, 95% CI 0.03 to 2.22; 3 studies, 186 children), medium (RR 0.35, 95% CI 0.04 to 3.23; 4 studies, 206 children) or long term (RR 0.21 95% CI 0.01 to 4.13; 1 study, 65 children) (all very low-certainty evidence). AUTHORS' CONCLUSIONS For children with oSDB selected for tonsil surgery, tonsillotomy probably results in a faster return to normal activity (four days) and in a slight reduction in postoperative complications requiring medical intervention in the first week after surgery. This should be balanced against the clinical effectiveness of one operation over the other. However, this is not possible to determine in this review as data on the long-term effects of the two operations on oSDB symptoms, quality of life, oSDB recurrence and need for reoperation are limited and the evidence is of very low quality leading to a high degree of uncertainty about the results. More robust data from high-quality cohort studies, which may be more appropriate for detecting differences in less common events in the long term, are required to inform guidance on which tonsil surgery technique is best for children with oSDB requiring surgery.
Collapse
Affiliation(s)
- Helen Blackshaw
- evidENT, Ear Institute, University College London, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Laurie R Springford
- evidENT, Ear Institute, University College London, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Lai-Ying Zhang
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Betty Wang
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Roderick P Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Anne Gm Schilder
- evidENT, Ear Institute, University College London, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
- Julius Center for Health Sciences and Primary Care & Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| |
Collapse
|
8
|
Amin N, Lakhani R. Intracapsular versus extracapsular dissection tonsillectomy for adults: A systematic review. Laryngoscope 2019; 130:2325-2335. [PMID: 31782813 DOI: 10.1002/lary.28435] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Tonsillectomy is an extremely common ENT surgical procedure. There is a growing interest in the role of intracapsular dissection tonsillectomy (ICDT) due to reported reduced perioperative complications. We aim to compare the outcomes associated with ICDT versus traditional extracapsular dissection tonsillectomy (ECDT) in the adult population. METHODS Systematic review of all randomized controlled trials (RCTs) comparing ICDT and ECDT for all indications in the adult population. Electronic searches performed through CENTRAL, PubMed, Ovid EMBASE, Web of Science, ClinicalTrials.gov, and WHO ICTRP. Review Manager 5.3 (RevMan 2014) was used to carry out the meta-analysis. RESULTS Nine RCTs were included with a total of 11 reports with mean age of 23.9 years including 181 patients who received ICDT compared to 176 patients receiving ECDT. We found statistically significant reduced postoperative pain and analgesia requirement as well as a reduced rate of secondary postoperative bleeding in patients undergoing ICDT versus ECDT. There appears to be no significant difference in controlling recurrent tonsillitis between the ICDT and ECDT groups. CONCLUSION Across the recorded outcomes we noted no clear benefit to performing ECDT over ICDT and evidence suggests high patient satisfaction with ICDT. Laryngoscope, 130:2325-2335, 2020.
Collapse
Affiliation(s)
- Nikul Amin
- ENT Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Raj Lakhani
- ENT Department, St George's University Hospital and Epsom Hospital, London, United Kingdom
| |
Collapse
|
9
|
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.
Collapse
|
10
|
Wong Chung JERE, van Benthem PPG, Blom HM. Tonsillotomy versus tonsillectomy in adults suffering from tonsil-related afflictions: a systematic review. Acta Otolaryngol 2018; 138:492-501. [PMID: 29241412 DOI: 10.1080/00016489.2017.1412500] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Tonsillotomy has emerged as an alternative for tonsillectomy in treating patients with tonsil-related afflictions. Tonsillotomy provides favourable outcomes in children, but treatment of choice in adults remains unclear. This systematic review sought to evaluate the current literature on the efficacy and adverse events of tonsillotomy compared to tonsillectomy in adults. METHODS A Medline and Cochrane search was conducted for randomized clinical trials (RCTs) and cohort studies comparing tonsillotomy to tonsillectomy in adults. Risk of bias was assessed. Outcome measures were efficacy of the procedure in resolving the initial tonsil-related symptoms (tonsillitis, obstructive sleep apnoea, tonsil stones, halitosis, dysphagia), procedure-related complications, recovery time, post-operative use of analgesics, patient satisfaction, and operating time. RESULTS In total nine papers were included. These trials had a high risk of bias and the inter-comparability of results was poor. The reported studies found generally a similar efficacy for both interventions. With regard to pain, the use of analgesics, patient satisfaction and operation time, the results were generally in favour of tonsillotomy. Post-operative haemorrhages were more frequent after tonsillectomy. CONCLUSION Current evidence suggests an equal efficacy of tonsillotomy and tonsillectomy in adults and a preference for tonsillotomy in terms of pain, analgesics use, patient-satisfaction, operation time and post-operative complications.
Collapse
Affiliation(s)
- Justin E. R. E. Wong Chung
- Department of Otolaryngology Head and Neck Surgery, University Medical Center Leiden, Leiden, The Netherlands
- Department of Otolaryngology Head and Neck Surgery, HagaZiekenhuis, the Hague, The Netherlands
| | - Peter Paul G. van Benthem
- Department of Otolaryngology Head and Neck Surgery, University Medical Center Leiden, Leiden, The Netherlands
| | - Henk M. Blom
- Department of Otolaryngology Head and Neck Surgery, University Medical Center Leiden, Leiden, The Netherlands
- Department of Otolaryngology Head and Neck Surgery, HagaZiekenhuis, the Hague, The Netherlands
| |
Collapse
|
11
|
Torretta S, Rosazza C, Pace ME, Iofrida E, Marchisio P. Impact of adenotonsillectomy on pediatric quality of life: review of the literature. Ital J Pediatr 2017; 43:107. [PMID: 29178907 PMCID: PMC5702149 DOI: 10.1186/s13052-017-0424-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 11/13/2017] [Indexed: 12/11/2022] Open
Abstract
Adenotonsillectomy (ADT) is one of the most widely used procedures in the treatment of paediatric recurrent acute tonsillitis (RAT) and obstructive sleep apnoea syndrome (OSAS), both of which have significant repercussions on the patients' quality of life (QoL). The purpose of our review of literature was to highlight the great variety of tools that are currently used to evaluate QoL in children, to examine data available on their efficacy and the feasibility of their use in daily clinical practice, and to determine possible limitations related to an indirect and subjective assessment of QoL in children.Although the use of different parameters makes it difficult to compare the published studies, an analysis of the evidence currently available in the literature suggests that ADT has a generally positive impact on the QoL (especially in case of OSAS). It also highlights the importance of combining tonsillectomy and adenoidectomy in the treatment of OSAS, and documents the comparability of tonsillectomy and tonsillotomy in improving obstructive symptoms. In conclusion, our findings suggest that literature supports that ADT is associated with positive changes in QOL; however further studies using comparable standardised criteria are necessary to confirm the size and duration of this benefit.
Collapse
Affiliation(s)
- Sara Torretta
- Department of Clinical Sciences and Community Health, University of Milan; Otolaryngological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20100, Milan, Italy.
| | - Chiara Rosazza
- Department of Pathophysiology and Transplantation, University of Milan; Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Elisabetta Pace
- Department of Pathophysiology and Transplantation, University of Milan; Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisabetta Iofrida
- Department of Clinical Sciences and Community Health, University of Milan; Otolaryngological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20100, Milan, Italy
| | - Paola Marchisio
- Department of Pathophysiology and Transplantation, University of Milan; Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
12
|
Jäckel MC. [The new guideline "Treatment of Inflammatory Diseases of the Palatine Tonsils - Tonsillitis" : Impact in clinics and surgeries]. HNO 2017; 64:667-70. [PMID: 27393293 DOI: 10.1007/s00106-016-0206-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- M C Jäckel
- HNO-Klinik, Helios Klinikum Schwerin, Wismarsche Str. 393-397, 19049, Schwerin, Deutschland.
| |
Collapse
|
13
|
Wittlinger J, Stankovic P, Girrbach U, Gradistanac T, Güldner C, Teymoortash A, Hoch S, Günzel T, Wilhelm T. Hyperplasia and the degree and activity of inflammation in chronic recurrent tonsillitis: a histopathological study. Eur Arch Otorhinolaryngol 2017; 274:2927-2932. [PMID: 28439693 DOI: 10.1007/s00405-017-4575-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/17/2017] [Indexed: 11/28/2022]
Abstract
Postoperative haemorrhage following tonsillectomy occurs in 5.98% of all cases with up to 10 deaths reported annually in Germany. When comparing tonsillectomy (TE) and tonsillotomy (TT), the same long-term frequency of ENT infections is displayed in children and young adults. However, taking postoperative haemorrhaging into account, TT is more favourable. Chronic tonsillitis is one of the most common indications for TE in the adult population; however, a histopathological characterization may reveal objective criteria and provide a foundation for routinely performing TT in adults too. Three essential parameters hyperplasia (HP), grade of inflammation (GOI) and activity of inflammation (AOI), which are responsible for, and associated with a clinically relevant disease were histopathologically examined in the tonsils of 100 adult patients with chronic recurrent tonsillitis. The parameters were analysed and compared separately in the pharyngeal and basal parts of the tonsils as well as in three sections (upper and lower pole of the tonsil, middle part) as this may influence the indication for TT. The comparison of the basal and pharyngeal portions displayed a significant difference in the GOI and the HP in all three sections: grade 2 HP as well as GOI were more commonly found in the basal than pharyngeal portions (p > 0.001). AOI (grade 2) displayed the same properties in the middle section (p < 0.002), but did not reach statistical significance in the cranial and caudal sections (p = 0.107 and p = 0.186). An overabundance of grade 1 GOI, AOI, and HP was seen in the pharyngeal sections. The results show that two out of three relevant parameters that demonstrate histopathological changes in recurrent inflamed tonsils have a significantly stronger presence in the basal section of the tonsil as opposed to the pharyngeal section. The processes initiated by inflammation next to the surface responsible for a clinically relevant recurrent tonsillitis seem to cause stronger reactions in the deep follicular portion of the tonsils.
Collapse
Affiliation(s)
- Jan Wittlinger
- Department of Otolaryngology, Head/Neck and Facial Plastic Surgery, Sana Kliniken Leipziger Land, Rudolf-Virchow-Strasse 2, 04552, Borna, Germany
| | - Petar Stankovic
- Department of Otolaryngology, Head/Neck and Facial Plastic Surgery, Sana Kliniken Leipziger Land, Rudolf-Virchow-Strasse 2, 04552, Borna, Germany
| | - Ulrike Girrbach
- Institute of Pathology, University Leipzig, Leipzig, Germany
| | | | - Christian Güldner
- Department of Otolaryngology, Head and Neck Surgery, Philipps-University Marburg, Marburg, Germany
| | - Afshin Teymoortash
- Department of Otolaryngology, Head and Neck Surgery, Philipps-University Marburg, Marburg, Germany
| | - Stephan Hoch
- Department of Otolaryngology, Head and Neck Surgery, Philipps-University Marburg, Marburg, Germany
| | - Thomas Günzel
- Department of Otolaryngology, Head and Neck Surgery, Borromäus Hospital, Leer, Germany
| | - Thomas Wilhelm
- Department of Otolaryngology, Head/Neck and Facial Plastic Surgery, Sana Kliniken Leipziger Land, Rudolf-Virchow-Strasse 2, 04552, Borna, Germany.
| |
Collapse
|
14
|
Rubinstein BJ, Derkay CS. Rethinking surgical technique and priorities for pediatric tonsillectomy. Am J Otolaryngol 2017; 38:233-236. [PMID: 28117117 DOI: 10.1016/j.amjoto.2017.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 01/17/2017] [Indexed: 11/29/2022]
Abstract
The past 100years have witnessed dramatic shifts in the concept of ideal surgical goals and operative technique in tonsil surgery. Surgeons are reviving a technique of intracapsular tonsillectomy with increasing precision thanks to modern technology. With intracapsular tonsillectomy, pediatric patients recover faster, use less pain medication, and have a lower risk of dehydration and hemorrhage. Various considerations will dictate the adoption of this technology in the coming years. This current review explores concepts and controversies surrounding tonsillectomy with a focus on quality improvement.
Collapse
Affiliation(s)
- Benjamin J Rubinstein
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, 600 Gresham Drive Suite 1100, Norfolk, Virginia 23507, USA.
| | - Craig S Derkay
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, 600 Gresham Drive Suite 1100, Norfolk, Virginia 23507, USA.
| |
Collapse
|
15
|
Crowson MG, Ryan MA, Rocke DJ, Raynor EM, Puscas L. Variation in tonsillectomy rates by health care system type. Int J Pediatr Otorhinolaryngol 2017; 94:40-44. [PMID: 28167009 DOI: 10.1016/j.ijporl.2017.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 01/07/2017] [Accepted: 01/10/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze variation in tonsillectomy procedure rates between health care system types around the world. STUDY DESIGN International database analysis. METHODS The 2015 Organization for Economic Co-operation and Development (OECD) Health Statistics surgical procedures database was used to ascertain tonsillectomy procedure volumes for 31 countries. Each country's health system type and structure were classified by overall system type, and by health care regulation, financing, and provision methods. Each system type and structure variable were compared using the rate of tonsillectomy procedures per 100,000 citizens. RESULTS 10.5 million tonsillectomy procedures completed between 1993 and 2014 were analyzed. Overall, social health insurance system types had higher total tonsillectomy rates versus other health care system types (p < 0.05 for each comparison). Health systems with private care provision had a higher procedure rate versus state provided care (159.1 vs. 131.1 per 100,000 citizens; p = 0.002). Health care systems with societal regulation and financing had a higher procedure count versus state regulated or financed care (regulation 193.3 vs. 139.7 per 100,000 citizens, p < 0.0001; financing 168.2 vs. 135.0 per 100,000 citizens, p = 0.0004). CONCLUSIONS The volume of tonsillectomy procedures is associated with a health care system's overall structure, regulation, financing, and provision methods. International health care systems with state mediated provision, regulation, and financing had lower tonsillectomy rates versus systems with private provision, and societal regulation or financing. Further study is needed to determine differences in indications for tonsillectomy between countries, but these results underscore potential variation in health care delivery in different systems.
Collapse
Affiliation(s)
- Matthew G Crowson
- Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Marisa A Ryan
- Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, NC, USA
| | - Daniel J Rocke
- Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, NC, USA
| | - Eileen M Raynor
- Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, NC, USA
| | - Liana Puscas
- Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
16
|
Papaspyrou G, Linxweiler M, Knöbber D, Schick B, Al Kadah B. Laser CO 2 tonsillotomy versus argon plasma coagulation (APC) tonsillotomy: A retrospective study with 10-year follow-up. Int J Pediatr Otorhinolaryngol 2017; 92:56-60. [PMID: 28012534 DOI: 10.1016/j.ijporl.2016.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 11/04/2016] [Accepted: 11/07/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Tonsillotomy is increasingly gaining acceptance as the treatment for tonsillar hyperplasia resulting in obstructive symptoms. The aim of this study was to compare the long-term results of CO2 laser tonsillotomy with those of argon plasma coagulation (APC) tonsillotomy. METHODS The data of 64 children, aged 2-10 years (mean 4.7 years), treated in the Department of Otolaryngology, Head and Neck Surgery, in Homburg, Germany with APC (36 patients) or CO2 laser (28 patients) for tonsillar hyperplasia between June 2004 and December 2004 were available for analysis. RESULTS Forty-five (APC: 26 patients, CO2: 19 patients) of the 64 patients (70.3%) could be contacted and were available for follow-up in a telephone survey conducted 10 years after surgery. The mean operation time was 17 min (range 10-25 min) in the APC group and 23 min (range 13-32 min) in the CO2 group (p = 0.0003). No case of intra- or postoperative bleeding was documented. One minor intraoperative complication in the form of a superficial lip burn was documented in the APC group. During the minimum 10 years of follow-up, 1 patient treated with APC underwent a surgical revision because of tonsillar regrowth, whereas in the group of patients treated with CO2, no surgical revision was needed. Regarding the parents' assessment of their children's symptoms, 89.4% of the parents of the CO2 laser group and 84.6% of the parents of the APC group reported that the overall long-term operation results of their children to be "very satisfying." Regarding complications, the need for secondary tonsillectomy, and parents' satisfaction, no statistically significant differences were found. CONCLUSIONS Both CO2 laser tonsillotomy and APC tonsillotomy are safe procedures leading to very satisfying results with respect to intra- and postoperative complications.
Collapse
Affiliation(s)
- Giorgos Papaspyrou
- Department of Otorhinolaryngology, University Medical Centre, Homburg, Saar, Germany.
| | - Maximilian Linxweiler
- Department of Otorhinolaryngology, University Medical Centre, Homburg, Saar, Germany
| | - Dirk Knöbber
- Department of Otorhinolaryngology, University Medical Centre, Homburg, Saar, Germany
| | - Bernhard Schick
- Department of Otorhinolaryngology, University Medical Centre, Homburg, Saar, Germany
| | - Basel Al Kadah
- Department of Otorhinolaryngology, University Medical Centre, Homburg, Saar, Germany
| |
Collapse
|
17
|
Senska G, Atay H, Pütter C, Dost P. Long-Term Results From Tonsillectomy in Adults. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:849-55. [PMID: 26763379 DOI: 10.3238/arztebl.2015.0849] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 09/09/2015] [Accepted: 09/09/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Tonsillectomy is performed more than 400 000 times in the European Union each year, making it one of the most common operations. Nonetheless, there have been only a few long-term studies of quality of life after tonsillectomy. METHODS In 2004, data on the quality of life after tonsillectomy were obtained from adult German-speaking tonsillectomy patients by means of the Glasgow Benefit Inventory and a questionnaire specifically designed for that study. The present study concerns the further followup of these patients, sometimes many years later. 114 patients with recurrent tonsillitis were included in this descriptive study. RESULTS Of the 114 patients, 97 (85%) provided further data at 14 months, and 71 (62%) at ca. 7 years. The Glasgow Benefit Inventory revealed postoperative improvement of quality of life at 14 months and at 7 years, with median values of 16.67 points (quartile 11.11/25) and 13.89 points (quartile 8.33/25) (p=0.168). The mean number of annual episodes of sore throat fell from 10 preoperatively to 2 postoperatively (p=0.0001). The number of visits to the doctor, the intake of analgesic drugs and antibiotics, and the number of medical absences from work also declined significantly over the period of observation. CONCLUSION Tonsillectomy was associated with a longlasting improvement of health and quality of life, and with lower utilization of medical resources. The 62% response rate at 7 years leaves the question open whether patients with a favorable postoperative course may have been more likely than others to participate in the study.
Collapse
Affiliation(s)
- Götz Senska
- Department of Otorhinolaryngology, Head and Neck Surgery, Marienhospital Gelsenkirchen GmbH, Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen
| | | | | | | |
Collapse
|
18
|
Lourijsen ES, Wong Chung JERE, Koopman JP, Blom HM. Post-operative morbidity and 1-year outcomes in CO2-laser tonsillotomy versus dissection tonsillectomy. Acta Otolaryngol 2016; 136:983-90. [PMID: 27224472 DOI: 10.1080/00016489.2016.1183040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE In this study a type of partial tonsil surgery, CO2-laser tonsillotomy, was compared to regular tonsillectomy. The effectiveness and post-operative recovery rate of both interventions in adult patients was assessed by using a questionnaire. STUDY DESIGN Prospective follow-up non-randomized cohort study. METHOD One hundred and seven adults were included; 46 tonsillectomies and 61 tonsillotomies were performed. Patients in the tonsillectomy group underwent general anaesthesia, while tonsillotomy was performed in an ambulatory setting with local anaesthesia. Post-operative questionnaires were administered by mail after 2 weeks, 6 months, and 1 year to assess recovery rate and symptom recurrence. RESULTS In total, 72.5% of patients were cured from their initial symptoms after tonsillotomy. Three patients (7.5%) required re-surgery for their initial complaints. After tonsillectomy, 97.2% of patients were cured. Both groups showed equally high satisfaction scores after treatment. Post-operative evaluation after 2 weeks showed a mean pain-intensity score of 5.4 (Visual Analogue Scale 0-10) after tonsillotomy and a mean pain-intensity score of 7.7 after tonsillectomy. The post-operative use of analgesics was twice as long in the tonsillectomy group compared to the tonsillotomy group and the tonsillectomy group required twice as many days for full recovery. After tonsillectomy a higher rate of major post-operative haemorrhage was seen. CONCLUSION CO2-laser tonsillotomy is associated with a shorter and less painful recovery period. Both surgical methods are equal in terms of long-term satisfaction, although tonsillotomy comes with a higher recurrence rate of mild symptoms. A strict pre-operative patient selection for CO2-laser tonsillotomy is necessary.
Collapse
Affiliation(s)
| | | | - Jan Pieter Koopman
- Department of Otorhinolaryngology, HagaZiekenhuis, the Hague, the Netherlands
| | - Henk M. Blom
- Department of Otorhinolaryngology, HagaZiekenhuis, the Hague, the Netherlands
| |
Collapse
|
19
|
|
20
|
Clinical practice guideline: tonsillitis II. Surgical management. Eur Arch Otorhinolaryngol 2016; 273:989-1009. [DOI: 10.1007/s00405-016-3904-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 01/13/2016] [Indexed: 12/25/2022]
|
21
|
Wang H, Fu Y, Feng Y, Guan J, Yin S. Tonsillectomy versus tonsillotomy for sleep-disordered breathing in children: a meta analysis. PLoS One 2015; 10:e0121500. [PMID: 25807322 PMCID: PMC4373680 DOI: 10.1371/journal.pone.0121500] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/01/2015] [Indexed: 11/20/2022] Open
Abstract
Objectives Tonsillotomy has gained popular acceptance as an alternative to the traditional tonsillectomy in the management of sleep-disordered breathing in children. Many studies have evaluated the outcomes of the two techniques, but uncertainty remains with regard to the efficacy and complications of tonsillotomy versus a traditional tonsillectomy. This study was designed to investigate the efficacy and complications of tonsillotomy versus tonsillectomy, in terms of the short- and long-term results. Methods We collected data from electronic databases including MEDLINE, EMBASE, and the Cochrane Library. The following inclusion criteria were applied: English language, children, and prospective studies that directly compared tonsillotomy and tonsillectomy in the management of sleep disordered breathing. Subgroup analysis was then performed. Results In total, 10 eligible studies with 1029 participants were included. Tonsillotomy was shown to be advantageous over tonsillectomy in short-term measures, such as a lower hemorrhage rate, shorter operation time, and faster pain relief. In long-term follow-up, there was no significant difference in resolution of upper-airway obstructive symptoms, the quality of life, or postoperative immune function between the tonsillotomy and tonsillectomy groups. The risk ratio of SDB recurrence was 3.33 (95% confidence interval = 1.62 6.82, P = 0.001), favoring tonsillectomy at an average follow-up of 31 months. Conclusions Tonsillotomy may be advantageous over tonsillectomy in the short term measures and there are no significant difference of resolving obstructive symptoms, quality of life and postoperative immune function. For the long run, the dominance of tonsillotomy may be less than tonsillectomy with regard to the rate of sleep-disordered breathing recurrence.
Collapse
Affiliation(s)
- Hui Wang
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China, 200233
| | - Yangyang Fu
- Department of Otolaryngology, Dalian Municipal Central Hospital, 826 Xinan Road, Dalian, 116033 China
| | - Yanmei Feng
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China, 200233
| | - Jian Guan
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China, 200233
| | - Shankai Yin
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China, 200233
| |
Collapse
|
22
|
Deak L, Saxton D, Johnston K, Benedek P, Katona G. Comparison of Postoperative Pain in Children with Two Intracapsular Tonsillotomy Techniques and a Standard Tonsillectomy: Microdebrider and radiofrequency tonsillotomies versus standard tonsillectomies. Sultan Qaboos Univ Med J 2014; 14:e500-e505. [PMID: 25364553 PMCID: PMC4205062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/07/2014] [Accepted: 05/28/2014] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES The aim of this study was to compare the duration and severity of postoperative pain for two different tonsillotomy techniques (radiofrequency [RF] and microdebrider [MD]) with the standard tonsillectomy. METHODS This non-randomised retrospective study, carried out from February 2011 to September 2012, investigated 128 children in two independent centres: Heim Pál Children's Hospital in Budapest, Hungary, and Muscat Private Hospital in Muscat, Oman. Those undergoing conventional tonsillectomies acted as the control group. One centre tested the MD technique (n = 28) while the other centre tested the RF technique (n = 31). RESULTS The pain-free period after the tonsillotomies was similar between the two techniques and ranged up to three days. Other indicators of pain resolution, like the use of a single analgesic, reduced night-time waking and the time taken to resume a normal diet, were also similar for the two groups. However, patients benefited significantly from having a tonsillotomy rather than a tonsillectomy. CONCLUSION The partial resectioning of tonsillar tissue using the MD and RF techniques showed promising outcomes for a better postoperative quality of life when compared to a traditional tonsillectomy. In this study, the results of both the MD and RF tonsillotomy methods were almost identical in terms of the duration of postoperative pain and recovery time.
Collapse
Affiliation(s)
- Levente Deak
- Department of Ear, Nose & Throat, Al Zahra Hospital, Dubai, United Arab Emirates
| | - David Saxton
- Department of Ear, Nose & Throat, Al Zahra Hospital, Dubai, United Arab Emirates
| | - Keith Johnston
- Department of Anaesthesia & Critical Care, Muscat Private Hospital, Muscat, Oman
| | - Palma Benedek
- Department of Oto-Rhino-Laryngology & Bronchology, Heim Pál Children’s Hospital, Budapest, Hungary
| | - Gábor Katona
- Department of Oto-Rhino-Laryngology & Bronchology, Heim Pál Children’s Hospital, Budapest, Hungary
| |
Collapse
|
23
|
Nokso-Koivisto J, Blomgren K, Roine RP, Sintonen H, Pitkäranta A. Impact of tonsillectomy on health-related quality of life and healthcare costs in children and adolescents. Int J Pediatr Otorhinolaryngol 2014; 78:1508-12. [PMID: 25023455 DOI: 10.1016/j.ijporl.2014.06.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 06/11/2014] [Accepted: 06/14/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Tonsillectomy is a common surgical intervention in children, but its efficacy is under debate. We studied whether tonsillectomy is a cost-effective intervention with a positive impact on health-related quality of life (HRQoL). METHODS Children (aged 7-11 years) and adolescents (aged 12-15 years) undergoing tonsillectomy answered the 17D or 16D HRQoL questionnaires before tonsillectomy and at 6 and 12 months postoperatively. At the same time-points, data on the use of healthcare services and school absenteeism were collected by questionnaire. RESULTS Altogether 49 children and 42 adolescents returned all HRQoL questionnaires. Tonsillectomy improved the mean total HRQoL score clinically and statistically significantly in both children (from 0.935 at baseline to 0.958 at 12 months, p = 0.002) and adolescents (from 0.930 to 0.957, p = 0.004). The mean direct self-reported healthcare service costs diminished after tonsillectomy in both groups. The mean number of days on sick leave due to oropharyngeal problems during the preceding 3 months decreased from the preoperative 4.6 days to postoperative 0.5 days (p < 0.001) in children, and from 4.9 days to 0.8 days (p < 0.001) in adolescents at 12 months. CONCLUSIONS Tonsillectomy improves HRQoL in both school-aged children and adolescents and reduces healthcare service needs and school absenteeism due to oropharyngeal symptoms.
Collapse
Affiliation(s)
- Johanna Nokso-Koivisto
- Department of Otorhinolaryngology, Helsinki University Central Hospital, P.O. Box 220, 00029, HUS, Helsinki, Finland.
| | - Karin Blomgren
- Department of Otorhinolaryngology, Helsinki University Central Hospital, P.O. Box 220, 00029, HUS, Helsinki, Finland.
| | - Risto P Roine
- Helsinki and Uusimaa Hospital Group, Group Administration, P.O. Box 705, 00029 HUS, Helsinki, Finland.
| | - Harri Sintonen
- Department of Public Health, Hjelt Institute, P.O. Box 41, 00014, University of Helsinki, Helsinki, Finland.
| | - Anne Pitkäranta
- Department of Otorhinolaryngology, Helsinki University Central Hospital, P.O. Box 220, 00029, HUS, Helsinki, Finland.
| |
Collapse
|
24
|
Windfuhr JP, Savva K, Dahm JD, Werner JA. Tonsillotomy: facts and fiction. Eur Arch Otorhinolaryngol 2014; 272:949-969. [DOI: 10.1007/s00405-014-3010-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 03/13/2014] [Indexed: 11/30/2022]
|