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Current indications for (adeno)tonsillectomy in children: a survey in The Netherlands
E H van den Akker1, A G M Schilder, Y J M Kemps
1Department of Otorhinolaryngology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands. e.h.vandenakker@wkz.azu.nl
Insights
Tonsillectomy indications in children vary, with recurrent tonsillitis and enlarged tonsils being common reasons. General practitioners and ENT surgeons consider various factors beyond sleep apnea when deciding on tonsil surgery.
Area of Science:
- Otolaryngology
- Pediatric Surgery
Background:
- Tonsillectomy is a frequent pediatric surgical procedure.
- Current indications for pediatric tonsillectomy lack extensive study.
Purpose of the Study:
- To determine the current indications for tonsillectomy in children under 15.
- To compare the perspectives of Dutch ENT surgeons and general practitioners (GPs) on these indications.
Main Methods:
- A prospective study over 8 months.
- Data collected from 18 ENT surgeons and 210 GPs via standard questionnaires.
- Questionnaires completed for 349 children undergoing tonsil surgery.
Main Results:
- Recurrent tonsillitis and enlarged tonsils were key indications cited by both groups.
- Non-specific symptoms like listlessness and poor appetite were also considered important.
- Obstructive sleep apnea, though present in many, was less frequently cited as a primary surgical indication.
- GPs placed higher importance on otitis media and hearing loss compared to ENT surgeons.
Conclusions:
- Indications for pediatric tonsillectomy extend beyond widely accepted reasons like recurrent tonsillitis and obstructive sleep apnea.
- A broader range of factors influences the decision-making process for tonsil surgery in the Netherlands.
Objective:
Despite the fact that (adeno)tonsillectomy is one of the procedures most frequently performed on children, studies of current indications are scarce. The purpose of this study is to determine the indications for (adeno)tonsillectomy in children younger than 15 years of age according to Dutch ENT surgeons and general practitioners (GPs).
Methods:
During a period of 8 months, 18 ENT surgeons in seven ENT practices and 210 referring GPs filled out standard questionnaires for 349 children listed for tonsil surgery.
Results:
Apart from recurrent tonsillitis (ENT: 40%, GP: 35%), findings such as enlarged tonsils (ENT: 42%, GP: 24%) and tonsillar crypt debris (ENT: 29%, GP: 17%) and non-specific symptoms such as listlessness (ENT: 28%, GP: 19%) and poor appetite (ENT: 28%, GP: 16%) were considered important criteria for surgery. Symptoms of obstructive sleep apnea were present in 25% (ENT) and 6% (GP) of patients but were considered indicative for surgery in only 11% (ENT) and 4% (GP). In contrast to ENT surgeons, GPs considered otitis media and hearing loss relatively important for (adeno)tonsillectomy.
Conclusions:
Apart from the generally accepted indications such as recurrent tonsillitis and obstructive sleep apnea, other indications play an equally important role in the decision to perform tonsil surgery in The Netherlands.