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Published on: November 6, 2019
Child behavior and quality of life before and after tonsillotomy versus tonsillectomy
Elisabeth Ericsson1, Inger Lundeborg, Elisabeth Hultcrantz
1Department of Nursing Science, School of Health Sciences, Jönköping University, Sweden. elisabeth.ericson@hhj.hj.se
Insights
Intracapsular tonsillectomy/tonsillotomy (TT) with Radiofrequency surgery results in less pain and morbidity compared to regular tonsillectomy (TE) in young children. Both procedures significantly improve quality of life and behavior, making TT a suitable option for treating tonsillar hypertrophy.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Sleep Medicine
Background:
- Tonsillar hypertrophy and obstructive sleep-disordered breathing are common in preschool children.
- Recurrent tonsillitis can also impact a child's health and well-being.
- Surgical intervention is often considered to alleviate these conditions.
Purpose of the Study:
- To compare intracapsular tonsillectomy/tonsillotomy (TT) with Radiofrequency surgery versus regular tonsillectomy (TE).
- To evaluate postoperative pain, morbidity, and changes in sleep behavior, quality of life, and surgical benefits.
- To determine the optimal surgical approach for young children with tonsillar hypertrophy.
Main Methods:
- A randomized controlled trial involving 67 children aged 4.5-5.5 years with tonsillar hypertrophy and obstructive sleep-disordered breathing.
- Children were randomized to either TT (n=35) or TE (n=32) using Radiofrequency surgical technique.
- Validated surveys (OSA-18, CBCL, GCBI) were used to assess quality of life, behavior, and surgical benefits before and after surgery.
Main Results:
- The TT group experienced significantly less postoperative pain and required fewer painkillers compared to the TE group.
- Both TT and TE demonstrated significant improvements in obstructive sleep apnea (OSA-18) scores and Child Behavior Checklist (CBCL) scores.
- No significant differences were observed between TT and TE in snoring, ENT infections, or Glasgow Children's Benefit Inventory (GCBI) scores at six months post-surgery.
Conclusions:
- Intracapsular tonsillectomy/tonsillotomy (TT) with Radiofrequency surgery offers reduced pain and morbidity compared to conventional tonsillectomy (TE).
- Both surgical techniques provide comparable long-term benefits regarding snoring, infections, quality of life, and behavior.
- TT is a recommended treatment option for preschool children with tonsillar hypertrophy and obstructive sleep-disordered breathing due to its favorable pain profile.
Objectives:
Compare two techniques for pediatric tonsil surgery with respect to postoperative pain and morbidity and changes in sleep behavior, health related quality of life (HRQL) and benefits due to surgery.
Methods:
67 children (4.5-5.5 years) with tonsillar hypertrophy and obstructive sleep-disordered breathing with or without recurrent tonsillitis were randomized to either regular tonsillectomy (TE) (n=32) or intracapsular tonsillectomy/tonsillotomy (TT) (n=35) with Radiofrequency surgical technique (ellman Int.). Before TT/TE, the parents completed a validated Quality of Life survey of pediatric obstructive sleep apnea, the OSA-18 (Obstructive Sleep Apnea-18) and a standardized assessment of their children's behavior with the Child Behavior Checklist (CBCL). Six months after surgery, the parents repeated these measurements, and assessed the health related benefits of the surgery using the Glasgow Children's Benefit Inventory (GCBI).
Results:
In the TT group, the children recorded less pain from the first day after surgery onwards, used fewer doses of painkillers and were pain-free 3 days earlier than the children in the TE group. Six months after surgery, there were no significant difference between TT and TE with regard to snoring and ENT-infections. The differences in the total scores and in all the individual domains between the initial OSA-18 and post-surgery scores were all significant (P<0.0001). The improvement in the total problem score measured with CBCL was also significant (P<0.01) and there was no difference between the TT and TE children. The improvements in all subscores of the GCBI indicated a significant health benefit of both TT and TE.
Conclusions:
TT with RF-surgery causes less pain and postoperative morbidity than regular TE and has an equal effect on snoring and recurrent infections. Pre-school children with tonsillar hypertrophy and obstructive sleep-disordered breathing all show an impact on HRQL and behavior before surgery and improve dramatically just as much after TT as after TE. Therefore TT would be considered for treatment of small children.
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