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[Tonsillectomy in childhood: personal considerations]
Insights
Recurrent tonsillitis remains the primary reason for tonsillectomy in children. However, obstructive sleep apnea (OSA) is an emerging indication for this surgery, requiring careful patient assessment due to potential surgical risks.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Sleep Medicine
Background:
- Tonsillectomy and adenotonsillectomy are common surgical procedures in children.
- Indications for these surgeries have historically centered on recurrent tonsillitis.
- Obstructive sleep apnea (OSA) is increasingly recognized as a significant indication.
Purpose of the Study:
- To analyze the criteria for tonsillectomy/adenotonsillectomy in children aged 2-12.
- To evaluate the role of recurrent tonsillitis versus obstructive sleep apnea in surgical indications.
- To assess the utility of traditional diagnostic methods.
Main Methods:
- Retrospective study of 150 children (ages 2-12) undergoing tonsillectomy/adenotonsillectomy.
- Follow-up conducted from May 1989 to March 1991.
- Analysis of indications based on recurrent tonsillitis and/or obstructive sleep apnea.
Main Results:
- Recurrent tonsillitis was the primary indication in 64% of cases (Class TR or ITR).
- Obstructive sleep apnea due to tonsillar hypertrophy was the determining factor in 35.9% of cases (Class IT or OSA).
- A shift towards obstruction as a primary indication is anticipated.
Conclusions:
- While recurrent tonsillitis remains the most frequent indication, obstructive sleep apnea is a growing factor.
- Identifying OSA patients is crucial due to potential perioperative cardiorespiratory risks.
- Future trends suggest an increase in tonsillectomies for obstruction-related indications.
Abstract:
This paper discusses the personal criteria followed in indicating tonsillectomy and/or adenotonsillectomy in treating a group of 150 children between the ages of 2 and 12 in the ENT Department of the Crobu Hospital of Iglesias where a follow-up was carried out from May 1989 to March 1991. The study analyzes when and under what conditions these surgical procedures are indicated in young patients without recurrent tonsillitis but with obstructive sleep apnea (OSA). The utility of traditional laboratory investigations (such as surface pharyngeal swabbing) in indicating surgical therapy is also evaluated. In concluding, the Authors affirm that recurrent tonsillitis no longer controllable with medical therapy is still the most frequent indication for surgery. In fact, 64% of the children studied belonged to either class TR or ITR in which recurring infection was the primary indication factor. However, respiratory obstruction has recently emerged as a increasingly important factor in indicating tonsillectomy and/or adenotonsillectomy. In fact, 54 children (35.9%) of the 150 studied belonged to class IT or OSA in which tonsillar and/or adeno-tonsillar hypertrophy with obstruction of various degrees was the determining factor in indicating surgical treatment. It appears that in the near future with fewer tonsillectomies being indicated in the case of recurrent tonsillitis, a progressive increase in the number of indications of surgical treatment in cases of obstruction may be expected. The Authors stress, however, the importance of identifying OSA patients because of the cardiorespiratory risks they may encounter during surgery (intubation difficulty found by the anaesthesiologist, tendency towards laryngeal spasms and pharyngeal obstruction in the post-operatory period).