Prospective study of morbidity after tonsillectomy in children

The role of tonsillectomy for recurrent sore throats in children: a qualitative study

INTRODUCTION

Decisions regarding tonsillectomy for children with recurrent sore throats are mainly based on guidelines that take the number of sore throat episodes into consideration. Anecdotally, parents report a number of additional factors that change after the operation. With this in mind, the first follow up tonsillectomy qualitative study was undertaken to identify what the operation truly offers this group of children.

MATERIALS AND METHODS

Ten families were interviewed between 3 and 14 months after their child's operation. A narrative method was utilised. Interviews with families were transcribed and analysed to identify key themes that had changed due to the operation.

RESULTS

Themes identified included an improvement in general and specific symptoms. Psychosocial aspects such as education, socialising, family consequences and psychological consequences were also important factors that families noticed.

CONCLUSION

Tonsillectomy has much more to offer families and children than an improvement in the numbers of episodes of sore throats and this study could form the basis of a specific quality of life assessment tool.

Tonsillectomy for recurrent sore throats in children: indications, outcomes, and efficacy

OBJECTIVE

To perform a comprehensive narrative review of the literature to provide a better understanding of the indications, outcomes, and efficacy of tonsillectomy for recurrent sore throats in children. This article explores the reasons why there is a lack of robust clinical evidence for its efficacy despite good evidence of positive reported outcomes from parents of children who undergo the procedure.

DATA SOURCES

Articles published between 1960 and July 2013 were searched in PubMed and Cochrane databases.

REVIEW METHODS

A narrative review method was adopted to provide a comprehensive overview of articles. Only individual, interventional studies on children (0-16 years old) undergoing tonsillectomy or adenotonsillectomy for recurrent sore throats with greater than 1 month of follow-up were included.

CONCLUSIONS

The inclusion criteria and outcome measures in the studies were varied, but most investigated changes in symptoms related to sore throats or illness episodes. Quality-of-life tools validated for measuring pediatric outcomes were used in a number of more recent studies. None of the outcome measures were specific for recurrent sore throats in children. No qualitative method designed studies were identified.

IMPLICATIONS FOR PRACTICE

The disparity between parental satisfaction rates and published clinical efficacy can be explained by a lack of parent/child outcome measures specific to tonsillectomy for recurrent sore throats. A more parent/child-centered approach may establish what tonsillectomy could offer this group of children.

Patient attitudes to tonsillectomy

Introduction. Recent changes to primary care trusts' Procedures of Limited Clinical Value (PLCV) policy mean that otolaryngologists must now follow policy rather than exercising clinical judgment when listing patients for tonsillectomy. Objectives. To gauge perception within the general public of when tonsillectomy is acceptable and to compare this to the current policy. Method. All patients or their parents attending the adult and paediatric outpatient ENT departments were asked to anonymously complete questionnaires. Results. One hundred and twenty-five completed questionnaires were collected. Thirty-one percent of respondents thought tonsillectomy should be offered solely on patient request, 19% after one to three bouts, and 35% after four to six bouts of tonsillitis. Only 9% thought the current guidelines were reasonable. Patients who had suffered recurrent tonsillitis or had undergone previous tonsillectomy generally thought tonsillectomy advisable after more bouts of tonsillitis than those who had not. Fourteen patients fulfilled the SIGN guidelines for tonsillectomy for recurrent tonsillitis. Of these, 13 (93%) felt that suffering 4-6 bouts of tonsillitis was reasonable before tonsillectomy. Conclusion. All patients we surveyed who meet the current PLCV and SIGN guidelines regarding the appropriateness of tonsillectomy for recurrent tonsillitis perceive that they are excessive, believing that 4-6 bouts of recurrent tonsillitis are adequate to justify tonsillectomy.

Efficacy of tramadol versus meperidine for pain relief and safe recovery after adenotonsillectomy

BACKGROUND AND OBJECTIVE

Adequate relief of pain after tonsillectomy is a common problem. We compared meperidine and tramadol when given at induction of anaesthesia with respect to their effects on postoperative pain relief and emergence characteristics after adenotonsillectomy in children.

METHODS

Fifty children aged 4-7 yr undergoing tonsillectomy were randomly assigned to receive either tramadol 1 mg kg(-1) (n = 25) or meperidine 1 mg kg(-1) (n = 25) before commencement of the surgical procedure. Anaesthesia was induced with propofol (with cis-atracurium for muscle relaxation) and maintained with sevoflurane in oxygen and nitrous oxide. Postoperative pain was scored by a blinded observer using a facial pain scale in the recovery room at 0 (at arrival of the patient in the postoperative care unit) and at 10, 20 and 45 min thereafter. Agitation scores were also assessed by the same observer at 0 min. Heart rate and mean arterial pressure were recorded at regular intervals. The time to recovery to spontaneous respiration and the incidence of postoperative nausea and vomiting were noted.

RESULTS

Facial pain scale scores were increased in the tramadol group at 0, 10 and 20 min (P < 0.05). No difference was observed in scores at the 45th min postoperation. Agitation scores were higher in the tramadol group than in the meperidine group. No statistical difference was found between the two groups. Heart rates and mean arterial pressures were similar in both groups. The time to recovery to spontaneous respiration was delayed with meperidine compared with tramadol (P < 0.05). The incidence of nausea and vomiting was not statistically different between groups.

CONCLUSIONS

Meperidine was more effective for pain relief and provides better emergence characteristics than tramadol after tonsillectomy in children.

Tonsillectomy: cold dissection versus bipolar electrodissection

OBJECTIVES

to compare the technique and post-operative morbidity of two different tonsillectomy methods: cold dissection and bipolar electrodissection.

MATERIAL AND METHODS

prospective study including children (3> age <14) undergoing tonsillectomy in ORL Department of the main hospital in Azores, Portugal, from September 2000 to March 2001. Patients alternately selected to cold dissection tonsillectomy group (CDT) or bipolar electrodissection tonsillectomy group (BET). Duration of surgery; amount of blood loss; duration of hospitalization; aspect of tonsillar fossa on 10th post-operative day and intensity of pain after surgery were recorded and compared.

RESULTS

Sixty tonsillectomies were performed. Blood loss and duration of surgery were significantly decreased in BET group (P<0.001), but the healing process, directly assessed by the aspect of tonsillar fossa on the 10th day was markedly delayed. The intensity of pain was slightly higher in the BET group compared with the CDT group, and no difference on duration of hospitalization was found between the two groups. Two post-operative hemorrhages occurred (one in each group), and no major complications were registered.

CONCLUSIONS

BET reduces the duration of surgery and amount of blood loss when compared with cold dissection, but post-operative morbidity is increased. We believe the best patient indication for this method are small children where total circulating blood volume is reduced and patients with bleeding disorders.