Changes in incidence and indications of tonsillectomy and adenotonsillectomy, 1970‐2005

Erickson, Britt; Larson, Dirk R.; Sauver, Jennifer L. St.; Meverden, Ryan A.; Orvidas, Laura J.

doi:10.1016/j.otohns.2009.01.044

Cited by 194 publications

(189 citation statements)

References 14 publications

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“…In the United States alone, approximately one in every 154 children undergoes the procedure each year. [1][2][3][4] The procedure can be associated with significant postoperative pain, and opioids are used commonly to treat posttonsillectomy pain. As opioids can be associated with respiratory depression, otolaryngologists and anesthesiologists alike must reconcile adequacy of pain control with the risk of respiratory complications after tonsillectomy.…”

Section: Résumémentioning

confidence: 99%

High-dose dexmedetomidine increases the opioid-free interval and decreases opioid requirement after tonsillectomy in children

Pestieau

Quezado

Johnson

et al. 2011

Can J Anesth/J Can Anesth

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Section: Résumémentioning

confidence: 99%

High-dose dexmedetomidine increases the opioid-free interval and decreases opioid requirement after tonsillectomy in children

Pestieau

Quezado

Johnson

et al. 2011

Can J Anesth/J Can Anesth

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“…While the rate of prophylactic tonsillectomy decreased in Denmark, as described by Fakhry and colleagues, in the United States, tonsillectomy is still among the most common surgical procedures performed in children, now being done mainly for obstructive indications. In 1959, 1.4 million tonsillectomies were performed in the United States, and although a drop in frequency to 380,000 procedures was observed by 1996, 130,000 out of 380,000 procedures (34%) were done in patients over 15 years of age (8). The immediate impact on health and healthcare expenditure from complications of tonsillectomy is considerable and was reported by Seshamani and colleagues (9) in a cohort study of 36,210 adult patients who underwent tonsillectomy.…”

mentioning

confidence: 99%

“…Some of the currently reported strategies using biomarkers obtained from body fluid, such as serum and saliva, show promise and can be considered in future trials in healthy populations (5,6,(16)(17)(18). In the Denmark Registry Study by Fakhry and colleagues, the majority of tonsillectomies were done in persons under the age of 20, and in the United States a large number of tonsillectomies were done in children over 15 years of age (8). Gardasil, a vaccine for use in the prevention of certain strains of HPV, was approved in the United States on June 8, 2006, by the FDA for girls and in October 2009 for males ages 9 to 26 (19).…”

mentioning

confidence: 99%

Role of Prophylactic Bilateral Tonsillectomy as a Cancer Preventive Strategy

Misiukiewicz

Posner

2015

Cancer Prevention Research

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The rate of vaccination against human papillomavirus (HPV) among adolescent girls and boys over the past few years has been stagnant in spite of the increase in incidence of HPVpositive oropharyngeal (OPX) squamous cell carcinoma (SCC). The indirect relationship between HPV cancer incidence and preventive vaccination poses a public health concern and has caused clinicians to search for other methods toward eradicating the ongoing oropharyngeal carcinoma epidemic. This alarming increase in OPX is motivating a search for therapeutic prevention strategies, including biomarker discovery, risk assessment, therapeutic vaccines, immunotherapy, and surgery. The current Danish Cancer Registry study by Fakhry and colleagues (in this issue) is the first to investigate the impact of prior tonsillectomy on the development of HPV OPX. They report that remote tonsillectomy resulted in a decreased incidence of tonsillar SCC. While thought-provoking, this study has a small sample size. Also, tonsillectomy does not address all anatomic sites at risk; there is lack of well-defined precancerous lesions or biomarkers to identify high-risk patients, and cost and morbidity make it impractical to justify prophylactic tonsillectomy as a cancer preventive strategy at present. The provocative clinical signal reported in this study supports further research and strategies that employ surgery when the technology and epidemiology can reliably be used to identify high-risk subjects. Cancer Prev Res; 8(7); 580-2. Ó2015 AACR.See related article by Fakhry et al., p. 583The high prevalence of human papillomavirus (HPV)-related oral infection and the increase in incidence of HPV16-caused oropharyngeal (OPX) cancers calls for surveillance and/or pharmacologic or surgical preventive measures for these malignancies (1). Currently, the rate of HPV OPX squamous cell carcinoma (SCC) is about 10,000 cases per year and rising yearly (2). The goal of vaccination, immunotherapy, chemotherapy, or surgical-based prophylaxis is to decrease the number of cancers that develop in all anatomic areas at risk. It is understood, however, that in order to show a decreased incidence of cancer in a prospective manner, a large sample size of patients with an extensive follow-up period is needed. The challenges faced by prevention trials in OPX include the inability to clearly define high-risk patients through precancerous lesions or biomarkers that would reliably identify the subjects who might benefit (3-6). The current retrospective study of the Danish Cancer Registry by Fakhry and colleagues is the first report to investigate the impact of prior tonsillectomy on the development of HPV OPX (7). The authors suggest that this study may provide evidence to support the development of clinical trials that prospectively investigate the role of prophylactic tonsillectomy in high-risk patients. In the Fakhry report, a reduction in the risk of tonsillar carcinoma after a remote history of tonsillectomy was observed in patients, especially in individuals younger than 60 ...

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“…It is intuitive to offer tonsillectomy, with or without adenoidectomy, to these children and is now the mainstay of treatment for SDB. In 1970 the percentage of children who underwent adenotonsillectomy for SDB was 12% compared to 77% in 2005 [3]. Moreover, since the first publication of Scottish Intercollegiate Guidelines Network (SIGN) guidelines for tonsillectomy in 1999, the trend in indication for tonsillectomy has gradually shifted from 'recurrent tonsillitis' to 'Sleep Disordered Breathing (SDB)'.…”

Section: What Is Osa?mentioning

confidence: 99%

Risk Stratification of Paediatric Obstructive Sleep Apnoea (OSA) for Adenotonsillectomy: How we do it at a UK District General Hospital

HM¹

2017

JOENTR

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Obstructive Sleep Apnoea (OSA) in children is a common condition, diagnosed and managed by various medical professionals including general practitioners, paediatricians and general and paediatric otolaryngologists. If not investigated and treated early, it carries significant long-term consequences such as poor growth, failure to thrive, attention-deficit disorder, behavioural problems, poor academic performance and cardiopulmonary disease. The most common etiology is adenotonsillar hypertrophy, for which adenotonsillectomy is currently the mainstay of treatment. This article aims to raise awareness of the definition of OSA, presentation and methods of investigation of children with OSA and risk stratification in such children owing to high risk of perioperative and postoperative complications following adenotonsillectomy. We discuss current clinical guidelines including our own departmental guidelines, at a United Kingdom (UK) District General Hospital (DGH), as an example in risk stratification of children with OSA in view of adenotonsillectomy in order to improve service and optimise patient safety.

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Changes in incidence and indications of tonsillectomy and adenotonsillectomy, 1970‐2005

Abstract: Epidemiological trends in tonsillectomy and adenotonsillectomy have shifted substantially. Overall numbers have increased, and surgical indications have shifted from infection to upper airway obstruction.

Cited by 194 publications

References 14 publications

High-dose dexmedetomidine increases the opioid-free interval and decreases opioid requirement after tonsillectomy in children

High-dose dexmedetomidine increases the opioid-free interval and decreases opioid requirement after tonsillectomy in children

Role of Prophylactic Bilateral Tonsillectomy as a Cancer Preventive Strategy

Risk Stratification of Paediatric Obstructive Sleep Apnoea (OSA) for Adenotonsillectomy: How we do it at a UK District General Hospital

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