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Role of subtotal tonsillectomy (‘tonsillotomy’) in children with sleep disordered breathing

Published online by Cambridge University Press:  26 November 2013

J M Wood ,
M Cho  and
A S Carney
J M Wood
Affiliation:
Flinders ENT, Department of Surgery, Flinders University and Flinders Medical Centre, Australia
M Cho
Affiliation:
Medical School, Flinders University, Adelaide, South Australia, Australia
A S Carney*
Affiliation:
Flinders ENT, Department of Surgery, Flinders University and Flinders Medical Centre, Australia
*
Address for correspondence: Prof A Simon Carney, Flinders ENT, Dept of Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia5042 Fax:+61 8204 7524 E-mail: simon.carney@flinders.edu.au
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Abstract

Introduction:

Sleep disordered breathing in children causes disturbance in behaviour and also in cardiorespiratory and neurocognitive function. Subtotal tonsillectomy (‘tonsillotomy’) has been performed to treat sleep disordered breathing, with outcomes comparable to established therapies such as total tonsillectomy or adenoidectomy. This review critically assesses the role of subtotal tonsillectomy in a paediatric setting.

Method:

The Medline database (1966 to October 2012) was electronically searched using key terms including subtotal or intracapsular tonsillectomy, tonsillotomy, tonsillectomy, paediatrics, and sleep disordered breathing.

Results:

Eighteen papers were identified and reviewed. Subtotal tonsillectomy would appear to have an efficacy equal to that of total tonsillectomy for the treatment of sleep disordered breathing, and has significant benefits in reducing post-operative pain and analgesia use. Subtotal tonsillectomy patients appear to have less frequent post-operative haemorrhage compared with total tonsillectomy patients.

Conclusion:

In children, subtotal tonsillectomy is associated with fewer post-operative complications whilst having a comparable effect in improving sleep disordered breathing, compared with total tonsillectomy.

Keywords

TonsillectomySleep Disordered BreathingSleep ApneaPediatrics
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 128 , Supplement S1 , January 2014 , pp. S3 - S7
Copyright
Copyright © JLO (1984) Limited 2013 

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References

1Hoban, T, Chervin, R. Sleep-related breathing disorders of childhood: description and clinical picture, diagnosis and treatment approaches. Sleep Med Clin 2007;2:445–62CrossRefGoogle Scholar
2Goldstein, NA, Fatima, M, Campbell, TF, Rosenfeld, RM. Child behaviour and quality of life before and after tonsillectomy and adenoidectomy. Arch Otolaryngol Head Neck Surg 2002;128:770–5CrossRefGoogle ScholarPubMed
3Montgomery-Downs, HE, Crabtree, VM, Gozal, D. Cognition, sleep and respiration in at-risk children treated for obstructive sleep apnoea. Eur Respir J 2005;25:336–42CrossRefGoogle ScholarPubMed
4Kohler, MJ, Lushington, K, van den Heuvel, CJ, Martin, J, Pamula, Y, Kennedy, D. Adenotonsillectomy and neurocognitive deficits in children with sleep disordered breathing. PLoS One 2009;4:e7343CrossRefGoogle ScholarPubMed
5Kennedy, JD, Blunden, S, Hirte, C, Parsons, DW, Martin, AJ, Crowe, E et al. Reduced neurocognition in children who snore. Pediatr Pulmonol 2004;37:330–7CrossRefGoogle ScholarPubMed
6Suen, JS, Arnold, JE, Brooks, L. Adenotonsillectomy for treatment of obstructive sleep apnea in children. Arch Otolaryngol Head Neck Surg 1995;121:525–30CrossRefGoogle ScholarPubMed
7Mitchell, RB, Kelly, J, Call, E, Yao, N. Quality of life after adenotonsillectomy for obstructive sleep apnea in children. Arch Otolaryngol Head Neck Surg 2004;130:190–4CrossRefGoogle ScholarPubMed
8Harris, M-A, Coates, H, Harari, M, Kennedy, D, Lannigan, F, Richmond, P et al. Indications for Tonsillectomy and Adenotonsillectomy in Children: A joint Position Paper of the Paediatrics and Child Health Division of The Royal Australasian College of Physicians and The Australian Society of Otolaryngology, Head and Neck Surgery. Sydney: Royal Australasian College of Physicians and Australian Society of Otolaryngology, Head and Neck Surgery, 2008Google Scholar
9Mink, JW, Shaha, SH, Brodsky, L. Making sense out of the tonsillectomy literature. Int J Pediatr Otorhinolaryngol 2009;73:1499–506CrossRefGoogle ScholarPubMed
10Isaacson, G, Parikh, T. Developmental anatomy of the tonsil and its implications for intracapsular tonsillectomy. Int J Pediatr Otorhinolaryngol 2008;72:89–96CrossRefGoogle ScholarPubMed
11Lantsov, AA, Kovaleva, LM. A method of organ-preserving tonsillectomy [in Russian]. Vestn Otorinolaringol 1993;5–6:39–42Google Scholar
12Koltai, PJ, Solares, CA, Mascha, EJ, Xu, M. Intracapsular partial tonsillectomy for tonsillar hypertrophy in children. Laryngoscope 2002;112:17–19CrossRefGoogle ScholarPubMed
13Solares, CA, Koempel, JA, Hirose, K, Abelson, TI, Reilly, JS, Cook, SP et al. Safety and efficacy of powered intracapsular tonsillectomy in children: a multi-center retrospective case series. Int J Pediatr Otorhinolaryngol 2005;69:21–6CrossRefGoogle ScholarPubMed
14Acevedo, JL, Shah, RK, Brietzke, SE. Systematic review of complications of tonsillotomy versus tonsillectomy. Otolaryngol Head Neck Surg 2012;146:871–9CrossRefGoogle ScholarPubMed
15Walton, J, Ebner, Y, Stewart, MG, April, MM. Systematic review of randomized controlled trials comparing intracapsular tonsillectomy with total tonsillectomy in a pediatric population. Arch Otolaryngol Head Neck Surg 2012;138:243–9CrossRefGoogle Scholar
16Tal, A, Bar, A, Leiberman, A, Tarasiuk, A. Sleep characteristics following adenotonsillectomy in children with obstructive sleep apnea syndrome. Chest 2003;124:948–53CrossRefGoogle ScholarPubMed
17Nieminen, P, Tolonen, U, Löppönen, H. Snoring and obstructive sleep apnea in children: a 6-month follow-up study. Arch Otolaryngol Head Neck Surg 2000;126:481–6CrossRefGoogle ScholarPubMed
18de la Chaux, R, Klemens, C, Patscheider, M, Reichel, O, Dreher, A. Tonsillotomy in the treatment of obstructive sleep apnea syndrome in children: polysomnographic results. Int J Pediatr Otorhinolaryngol 2008;72:1411–17CrossRefGoogle ScholarPubMed
19Friedman, M, Wilson, M, Friedman, J, Joseph, NJ, Lin, H-C, Chang, H-W. Intracapsular coblation tonsillectomy and adenoidectomy for the treatment of pediatric obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg 2009;140:358–62CrossRefGoogle ScholarPubMed
20Cantarella, G, Viglione, S, Forti, S, Minetti, A, Pignataro, L. Comparing postoperative quality of life in children after microdebrider intracapsular tonsillotomy and tonsillectomy. Auris Nasus Larynx 2012;39:407–10CrossRefGoogle ScholarPubMed
21Wood, JM, Harris, PK, Woods, CM, McLean, SC, Esterman, A, Carney, AS. Quality of life following surgery for sleep disordered breathing: subtotal reduction adenotonsillectomy versus adenotonsillectomy in Australian children. A N Z J Surg 2011;81:340–4CrossRefGoogle ScholarPubMed
22Hultcrantz, E, Linder, A, Markström, A. Tonsillectomy or tonsillotomy? A randomized study comparing postoperative pain and long-term effects. Int J Pediatr Otorhinolaryngol 1999;51:171–6CrossRefGoogle ScholarPubMed
23Chang, KW. Intracapsular versus subcapsular coblation tonsillectomy. Otolaryngol Head Neck Surg 2008;138:153–7CrossRefGoogle ScholarPubMed
24Wilson, YL, Merer, DM, Moscatello, AL. Comparison of three common tonsillectomy techniques: a prospective randomized, double-blinded clinical study. Laryngoscope 2009;119:162–70CrossRefGoogle ScholarPubMed
25Windfuhr, JP, Chen, YS. Post-tonsillectomy and adenoidectomy hemorrhage in nonselected patients. Ann Otol Rhinol Laryngol 2003;112:63–70CrossRefGoogle ScholarPubMed
26Blakley, BW. Post-tonsillectomy bleeding: how much is too much? Otolaryngol Head Neck Surg 2009;140:288–90CrossRefGoogle ScholarPubMed
27Perkins, JN, Liang, C, Gao, D, Shultz, L, Friedman, NR. Risk of post-tonsillectomy hemorrhage by clinical diagnosis. Laryngoscope 2012;122:2311–15CrossRefGoogle ScholarPubMed
28Sarny, S, Ossimitz, G, Habermann, W, Stammberger, H. Hemorrhage following tonsil surgery: a multicenter prospective study. Laryngoscope 2011;121:2553–60CrossRefGoogle ScholarPubMed
29Lowe, D, van der Meulen, J, Cromwell, D. Key messages from the National Prospective Tonsillectomy Audit. Laryngoscope 2007;117:717–24CrossRefGoogle ScholarPubMed
30Evans, AS, Khan, AM, Young, D, Adamson, R. Assessment of secondary haemorrhage rates following adult tonsillectomy – a telephone survey and literature review. Clin Otolaryngol Allied Sci 2003;28:489–91CrossRefGoogle ScholarPubMed
31Hultcrantz, E, Ericsson, E. Pediatric tonsillotomy with radio-frequency technique: less morbidity and pain. Laryngoscope 2004;114:871–7CrossRefGoogle Scholar
32Ericsson, E, Graf, J, Hultcrantz, E. Pediatric tonsillotomy with radiofrequency technique: long-term follow up. Laryngoscope 2006;116:1851–7CrossRefGoogle ScholarPubMed
33Colen, TY, Seidman, C, Weedon, J, Goldstein, NA. Effect of intracapsular tonsillectomy on quality of life for children with obstructive sleep-disordered breathing. Arch Otolaryngol Head Neck Surg 2008;134:124–7CrossRefGoogle ScholarPubMed
34Stelter, K, Ihrler, S, Siedek, V, Patscheider, M, Braun, T, Ledderose, G. 1-year follow-up after radiofrequency tonsillotomy and laser tonsillotomy in children: a prospective, double-blind, clinical study. Eur Arch Otorhinolaryngol 2012;269:679–84CrossRefGoogle ScholarPubMed
35Franco, RA Jr, Rosenfeld, RM, Rao, M. First place – resident clinical science award 1999. Quality of life for children with obstructive sleep apnea. Otolaryngol Head Neck Surg 2000;123:9–16CrossRefGoogle ScholarPubMed
36Bennhoff, DF. Partial tonsillectomy revisited and role for mini-tracheotomy revisited. Arch Otolaryngol Head Neck Surg 2003;129:500Google ScholarPubMed
37Hopkins, FE. Recurrence of the tonsil after excision. Trans Am Laryngol 1899;1:124–34Google Scholar
38Çelenk, F, Bayazit, YA, Yilmaz, M, Kemaloglu, YK, Uygur, K, Ceylan, A et al. Tonsillar regrowth following partial tonsillectomy with radiofrequency. Int J Pediatr Otorhinolaryngol 2008;72:19–22CrossRefGoogle ScholarPubMed
39Sorin, A, Bent, JP, April, MM, Ward, RF. Complications of microdebrider assisted powered intracapsular tonsillectomy and adenoidectomy. Laryngoscope 2004;114:297–300CrossRefGoogle ScholarPubMed
40Eviatar, E, Kessler, A, Shlamkovitch, N, Vaiman, M, Zilber, D, Gavriel, H. Tonsillectomy vs. partial tonsillectomy for OSAS in children – 10 years post-surgery follow-up. Int J Pediatr Otorhinolaryngol 2009;73:637–40CrossRefGoogle ScholarPubMed
41Zagolski, O. Why do palatine tonsils grow back after partial tonsillectomy in children? Eur Arch Otorhinolaryngol 2010;267:1613–17CrossRefGoogle ScholarPubMed