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Long-Term Outcomes of Microdebrider-Assisted Endoscopic Powered Intracapsular Tonsillectomy and Adenoidectomy in
Ryota Koshu1, Masao Noda1,2, Haruna Nakamoto1
1Department of Otolaryngology Jichi Medical University Shimotsuke Japan.
Insights
Microdebrider-assisted powered intracapsular tonsillectomy and adenoidectomy (PITA) offers a safe and effective long-term solution for pediatric obstructive sleep apnea (OSA). Caregiver reports show sustained symptom improvement and minimal complications after PITA surgery.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Sleep Medicine
Background:
- Obstructive sleep apnea (OSA) significantly impacts children's quality of life.
- Surgical interventions are crucial for managing pediatric OSA.
- Evaluating long-term outcomes of minimally invasive techniques is essential.
Purpose of the Study:
- To assess the long-term efficacy and safety of microdebrider-assisted endoscopic powered intracapsular tonsillectomy and adenoidectomy (PITA) in pediatric OSA patients.
- To evaluate caregiver-reported symptom improvement and postoperative complications following PITA.
Main Methods:
- A single-center retrospective observational study involving 65 children under 15 years old who underwent PITA.
- Caregivers completed a validated OSA-18 questionnaire retrospectively assessing symptom severity.
- Follow-up duration was at least one year, with a median of 48 months.
Main Results:
- Significant improvements were observed in all five OSA-18 domains (sleep disturbance, physical symptoms, emotional distress, daytime functioning, caregiver concerns) (p < 0.001).
- Outcomes were consistent regardless of follow-up duration ( < 5 vs. ≥ 5 years) or age at surgery.
- Postoperative complications were minimal, with no peritonsillar abscesses reported and a low incidence of tonsillitis (4.6%).
Conclusions:
- PITA is a safe and effective long-term surgical option for pediatric OSA.
- Retrospective caregiver evaluations indicate sustained symptom improvement and high satisfaction.
- The PITA technique demonstrates durable benefits with a favorable safety profile.
Objectives:
This study aimed to evaluate the long-term efficacy and safety of microdebrider-assisted endoscopic powered intracapsular tonsillectomy and adenoidectomy (PITA) in pediatric patients with obstructive sleep apnea (OSA) using caregiver-reported retrospective assessments of pre- and post-operative symptom states.
Methods:
This single-center retrospective observational study included 65 children aged < 15 years who underwent PITA and at least 1 year of postoperative follow-up. Caregivers completed a structured postoperative questionnaire, retrospectively assessing preoperative and postoperative symptom severity using the validated Japanese version of the Obstructive Sleep Apnea Questionnaire-18 (OSA-18). The questionnaire evaluated sleep disturbance, physical symptoms, emotional distress, daytime functioning, and caregiver concerns. Postoperative complications, including tonsillitis, peritonsillar abscess, and perceived symptom recurrence, were also assessed. All surgeries were performed using an endoscopic PITA technique designed to preserve the tonsillar capsules.
Results:
Among the 65 pediatric patients (median follow-up, 48.0 months; interquartile range, 25.0-65.0), significant improvements were observed across all five OSA-18 domains. The mean preoperative scores were 5.2, 4.5, 2.3, 3.4, and 4.7 for sleep disturbance, physical symptoms, emotional distress, daytime functioning, and caregiver concerns, respectively. Postoperative scores improved to 1.7, 2.3, 1.7, 2.1, and 1.8, respectively (all, p < 0.001). Subgroup analyses showed no significant differences in outcomes based on follow-up duration (< 5 vs. ≥ 5 years) or age at surgery (≤ 4 vs. > 4 years), suggesting durable and consistent long-term benefits of PITA regardless of age or time since surgery. No peritonsillar abscesses were reported; only three patients (4.6%) experienced postoperative tonsillitis. Thirteen percent of the caregivers reported a subjective recurrence of symptoms; however, none required revision surgery.
Conclusion:
PITA is a potentially safe and effective long-term surgical option for pediatric OSA. Retrospective caregiver evaluation revealed sustained symptom improvement, minimal postoperative complications, and high satisfaction levels.
Level Of Evidence:
Level IV.
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