Tonsillectomy versus Tonsillotomy for Sleep-Disordered Breathing in Children: A Meta Analysis

Abstract

ObjectivesTonsillotomy has gained popular acceptance as an alternative to the traditional tonsillectomy in the management of sleep-disordered breathing in children. Many studies have evaluated the outcomes of the two techniques, but uncertainty remains with regard to the efficacy and complications of tonsillotomy versus a traditional tonsillectomy. This study was designed to investigate the efficacy and complications of tonsillotomy versus tonsillectomy, in terms of the short- and long-term results.MethodsWe collected data from electronic databases including MEDLINE, EMBASE, and the Cochrane Library. The following inclusion criteria were applied: English language, children, and prospective studies that directly compared tonsillotomy and tonsillectomy in the management of sleep disordered breathing. Subgroup analysis was then performed.ResultsIn total, 10 eligible studies with 1029 participants were included. Tonsillotomy was shown to be advantageous over tonsillectomy in short-term measures, such as a lower hemorrhage rate, shorter operation time, and faster pain relief. In long-term follow-up, there was no significant difference in resolution of upper-airway obstructive symptoms, the quality of life, or postoperative immune function between the tonsillotomy and tonsillectomy groups. The risk ratio of SDB recurrence was 3.33 (95% confidence interval = 1.62 6.82, P = 0.001), favoring tonsillectomy at an average follow-up of 31 months.ConclusionsTonsillotomy may be advantageous over tonsillectomy in the short term measures and there are no significant difference of resolving obstructive symptoms, quality of life and postoperative immune function. For the long run, the dominance of tonsillotomy may be less than tonsillectomy with regard to the rate of sleep-disordered breathing recurrence.

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

“…We should also point out that more recent trends have revealed a progressive shift towards tonsillotomy by ENT surgeons with a corresponding decline in tonsillectomies, as there is some evidence indicating reduced post-surgical complication rates in tonsillotomy, such as bleeding, pain scores and related interventions, and briefer recovery period. A meta-analysis that evaluated tonsillectomy and tonsillotomy for OSA in children examined the findings of 10 studies, and showed that there appeared to be no significant differences in the rates of OSA symptomatic relief, quality of life, or in the changes in immune function after surgery [47]. However, tonsillotomy exhibited a much higher risk (more than 3-fold) of OSA recurrence compared to tonsillectomy.…”

Intracapsular versus extracapsular dissection tonsillectomy for adults: A systematic review

“…10 Studies, mainly in the pediatric population, have shown a comparable positive effect on improving symptoms with ICDT while reducing postoperative morbidity and complications compared to ECDT. 12,13 Finding and preserving the fibrous capsule while removing all lymphoid tissue can be time consuming especially while training in the technique and operative efficiency must be considered. 14 Residual tonsillar tissue left adherent to the capsule theoretically may regrow leading to recurrent obstructive symptoms or infections.…”

Indications for tonsillectomy stratified by the level of evidence

“…This meta-analysis [107] was limited to the English literature and compared the outcome of TE vs. TOTO for OSAS in pediatric patients (≤18 years). Exclusively prospective studies with at least 10 patients were included and a last update was carried out in 2014.…”

“…It should be noted that even today, the resulting trials are still cited in the contemporary scientific literature in national guidelines and publications [403]. Despite the extraordinary high frequency of the interventions [566], [567] plus the increasingly performed TOTO [107], [568] only few trials analyzed the clinical value of the interventions. This deserves a comment: …”