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Assessing outcomes after partial and total tonsillectomy for sleep-disordered breathing in children using Clinical

Jacob G Mabey1, Candice Kremer1, Sarah E Maurrasse1

  • 1Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, CT, United States of America.

American Journal of Otolaryngology
|August 11, 2022
PubMed

Insights

The Clinical Assessment Score-15 (CAS-15) significantly improved sleep disordered breathing (SDB) symptoms after both partial intracapsular tonsillectomy (PIT) and total tonsillectomy (TT). The CAS-15 change was similar between PIT and TT, suggesting PIT may be a preferred surgical option.

Area of Science:

  • Otolaryngology
  • Pediatric Surgery
  • Sleep Medicine

Background:

  • Sleep disordered breathing (SDB) is common in children.
  • The Clinical Assessment Score-15 (CAS-15) assesses SDB risk in outpatient settings.
  • Previous studies show significant CAS-15 change after total tonsillectomy (TT), but not partial intracapsular tonsillectomy (PIT).

Purpose of the Study:

  • To evaluate the CAS-15's utility in assessing PIT effectiveness for SDB.
  • To compare CAS-15 changes after PIT versus TT.

Main Methods:

  • Children aged 2-18 with SDB underwent either PIT (N=16) or TT (N=8).
  • The CAS-15 was administered pre- and post-operatively.
  • Paired t-tests assessed within-group CAS-15 changes; unpaired t-tests compared between-group differences.

Main Results:

  • No significant differences in age, BMI, pre-op CAS-15, or tonsil size between PIT and TT groups.
  • Both PIT and TT showed significant CAS-15 score reductions (p < 0.0001 and p < 0.0002, respectively).
  • The magnitude of CAS-15 decrease was comparable between PIT and TT (p > 0.49).

Conclusions:

  • CAS-15 scores significantly decrease after both PIT and TT, indicating SDB symptom improvement.
  • Similar CAS-15 changes suggest PIT is a viable alternative to TT with potentially lower morbidity.
  • CAS-15 may serve as a valuable tool for SDB assessment post-tonsillectomy, potentially complementing or replacing polysomnography (PSG).
Abstract

Keywords:
Clinical Assessment Score-15Obstructive sleep apneaPartial intracapsular tonsillectomySleep disordered breathing

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