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Extracapsular versus intracapsular tonsillectomy: Outcomes in children with a focus on developmental delay.

Shraddha S Mukerji¹, Smruti Rath², Wynne Q Zhang²

¹Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, USA; Division of Pediatric Otolaryngology, Texas Children's Hospital, Houston, TX, USA.

International Journal of Pediatric Otorhinolaryngology

|November 28, 2021

Summary

Intracapsular tonsillectomy (IT) in children with developmental delays (DD) shows reduced hospital stays and less need for post-operative narcotics and steroids compared to extracapsular tonsillectomy (TT). Both methods effectively treat pediatric sleep apnea symptoms.

Keywords:

Coblation Extracapsular Intracapsular Tonsillectomy

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Area of Science:

Otolaryngology
Pediatric Surgery
Developmental Pediatrics

Background:

Outcomes of intracapsular tonsillectomy (IT) in children with developmental delays (DD) are not well-established.
Comparison of IT versus extracapsular tonsillectomy (TT) outcomes in pediatric patients with DD is needed.

Purpose of the Study:

To compare outcomes and complications of IT and TT in pediatric patients with DD.
To compare outcomes and complications of IT and TT in non-developmentally delayed (NDD) children.

Main Methods:

Retrospective study of pediatric patients undergoing tonsillectomy between 2016-2019.
Included patients with Down Syndrome, Autism Spectrum Disorder, genetic syndromes, and global developmental delay.
Analyzed outcomes and complications for IT and TT in DD and NDD cohorts.

Main Results:

In the DD cohort, IT resulted in shorter hospital stays and reduced use of post-operative narcotics and steroids.
IT and TT showed comparable efficacy in improving the Apnea Hypopnea Index (AHI) for pediatric sleep apnea.
No statistically significant differences in emergency room visits or post-operative bleeding between IT and TT in the DD group.

Conclusions:

Children with DD undergoing IT experience shorter hospital stays and reduced inpatient administration of opioids and steroids.
IT demonstrates comparable efficacy to TT in treating pediatric sleep apnea with a potentially better safety profile.
Further long-term studies are required to assess tonsil regrowth, revision surgery rates, and persistent obstructive sleep apnea (OSA).