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Published on: November 6, 2019
Efficacy of tonsillectomy for pediatric patients with Dysphagia and tonsillar hypertrophy
Daniel Clayburgh1, Henry Milczuk, Steve Gorsek
1Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. clayburg@ohsu.edu
Insights
Tonsillectomy significantly improves swallowing quality of life, diet tolerance, and weight in children with dysphagia due to tonsillar hypertrophy. This surgical intervention is an effective treatment for pediatric swallowing difficulties.
Area of Science:
- Pediatric Otolaryngology
- Swallowing Disorders
- Quality of Life Research
Background:
- Tonsillar hypertrophy can cause dysphagia in children, impacting their quality of life.
- The effectiveness of tonsillectomy for this condition requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of tonsillectomy in treating pediatric dysphagia linked to tonsillar hypertrophy.
Main Methods:
- A prospective cohort study was conducted in a pediatric otolaryngology practice.
- Eighty-five children (aged 2-14) were divided into dysphagia and control groups.
- Swallowing Quality of Life (SWAL-QOL) scores, diet consistency, and weight percentile were assessed pre- and post-tonsillectomy.
Main Results:
- Tonsillectomy improved SWAL-QOL scores, regular diet tolerance, and weight percentile in the dysphagia cohort at 1 month post-surgery (P < .001).
- The control group also showed significant improvements in SWAL-QOL, diet tolerance, and weight percentile post-tonsillectomy (P < .001).
Conclusions:
- Dysphagia from tonsillar hypertrophy is a notable issue in children, even those without primary swallowing complaints.
- Tonsillectomy effectively enhances swallowing-related quality of life, dietary intake, and weight in pediatric patients.
Objective:
To determine the effectiveness of tonsillectomy for the treatment of dysphagia related to tonsillar hypertrophy.
Design:
Prospective cohort study.
Setting:
Tertiary care pediatric otolaryngology practice.
Participants:
Eighty-five children aged 2 to 14 years referred for tonsillectomy owing to dysphagia related to tonsillar hypertrophy (dysphagia cohort) or for other indications (control cohort).
Interventions:
Swallowing Quality of Life (SWAL-QOL) dysphagia questionnaires were administered at the initial clinic visit, on the day of surgery, and at 1 month and 6 months after surgery. Patients were weighed on the day of surgery and at 1 month after surgery.
Main Outcome Measures:
The primary outcome measure was the SWAL-QOL score. Secondary outcome measures were the type of diet consistency patients tolerated at home and the weight percentile for age.
Results:
Of 85 patients enrolled, 57 went on to have surgery, completed at least 1 postoperative questionnaire, and were included in the data analysis. At 1 month after tonsillectomy, the dysphagia cohort (n = 18) demonstrated improved SWAL-QOL scores (mean [SD], 58.4 [4.8] before surgery vs 82.4 [5.3] after surgery; P < .001), more patients tolerating a regular diet (12 of 37 patients [33.3%] before surgery vs 22 of 36 [60.0%] after surgery, P = .01), and increased weight percentile for age (mean [SD], 36.5 [10.7] before surgery vs 50.0 [10.6] after surgery; P = .01). Similarly, at 1 month after tonsillectomy, the control cohort (n = 39) demonstrated improved SWAL-QOL scores (mean [SD], 80.8 [2.6] before surgery vs 91.7 [1.8] after surgery; P < .001), more patients tolerating a regular diet (30 of 37 patients [81.1%] before surgery vs 34 of 36 patients [94.4%] after surgery, P = .04), and increased weight percentile for age (mean [SD], 62.8 [5.4] before surgery vs 70.4 [5.1] after surgery; P = .003).
Conclusions:
Dysphagia related to tonsillar hypertrophy is a significant problem not only among children with dysphagia with a primary complaint but also among a large subset of patients referred for tonsillectomy for other indications. Following tonsillectomy, both groups experience significant improvement in swallowing-related quality of life, ability to tolerate a regular diet, and weight percentile for age. Tonsillectomy is an effective treatment for the management of dysphagia related to tonsillar hypertrophy in children.
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