Tonsillotomy in the treatment of obstructive sleep apnea syndrome in children: Polysomnographic results

Chaux, R. de la; Klemens, Christine A.; Patscheider, Martin; Reichel, Oliver; Dreher, A.

doi:10.1016/j.ijporl.2008.06.008

Cited by 51 publications

(32 citation statements)

References 37 publications

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“…19 Another study evaluating ATT in 70 children, reports success rates of 30% (success = AHI <1) and 73% (success = AHI <5) after ATT. 20 Another nonrandomized study of ATE versus ATT that included 29 children showed similar improvements after 6 months in both groups, 21 with comparable mean AHI reductions: 96% in the ATT group and 95% in the ATE group.…”

Section: Discussionmentioning

confidence: 99%

Adenotonsillotomy Versus Adenotonsillectomy in Pediatric Obstructive Sleep Apnea: An RCT

2017

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BACKGROUND: Adenotonsillectomy (ATE) is a well-established and effective treatment of pediatric obstructive sleep apnea (OSA). In recent years, a more conservative method, adenotonsillotomy (ATT), has gained popularity because it is associated with less postoperative morbidity. Yet no previous randomized study has compared these 2 methods regarding their effectiveness in treating pediatric OSA in terms of polysomnographic data, which was the primary aim of this study. The hypothesis was that ATT is noninferior to ATE after 1 year. METHODS: Seventy-nine children, aged 2 to 6 years, with OSA (Apnea-Hypopnea Index [AHI] 5–30) were randomized to ATT (n = 40) or ATE (n = 39). Polysomnography (PSG) and questionnaire OSA-18 were assessed at baseline and 1 year postsurgery. RESULTS: Mean difference between groups in the primary outcome, change in AHI, was 0.83, 95% confidence interval –3.2 to 4.9, not exceeding the noninferiority margin of 5. After ATE, AHI decreased from median 12.7 (interquartile range 8.3–19.1) to 2.0 (1.2–3.1) and after ATT from 15.8 (8.5–21.2) to 4.0 (1.2–5.1). For both groups, significant improvements of PSG and OSA-18 questionnaire outcomes were observed, with no significant differences between groups. Five children (13%) in the ATT group needed repeated surgery for tonsil regrowth and recurrence of OSA. CONCLUSIONS: The results suggest that ATT is noninferior to ATE in treating pediatric OSA regarding PSG outcomes after 1 year. ATT could be considered an alternative to ATE for treatment of pediatric OSA. However, after ATT, there is a nonnegligible risk of recurrence of OSA, and this should be taken into account when selecting surgical method.

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Section: Discussionmentioning

confidence: 99%

Adenotonsillotomy Versus Adenotonsillectomy in Pediatric Obstructive Sleep Apnea: An RCT

2017

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“…Four publications did not mention as to whether adenoidectomy was performed or not [24,25,28,29]. A simultaneous adenoidectomy was an exclusion criterion for some authors [27,30], performed in every single patient [16] [17] who postulated that success is defined by an AHI \ 1. Moreover, a definition of short-term and long-term success needs to be clarified [15].…”

Section: Methodsmentioning

confidence: 99%

“…Reichel et al [23] stated, ''in Germany TT is strictly contraindicated in patients with recurrent throat infections''. A total of 14 authors (35.9 %) excluded patients with a history of tonsillitis for Class I [10,11,16,23,24,26] or Class II procedures [14,39,41,[44][45][46][47]49]. Despite these concerns, Chan et al [52] included patients if they reported two or fewer episodes of streptococcal pharyngitis per year.…”

Section: Unvalidated Exclusion Criteriamentioning

confidence: 99%

“…The results were confirmed with the first large retrospective study in 2003 by Koltai et al [14] who used a microdebrider as surgical instrument. However, in a small pediatric patient population, a significant impact of ''intracapsular tonsillectomy'' on OSA-albeit not successful in all patients-was proven by means of polysomnographic studies [15][16][17] and better OSA-18 Scores [18]. Numerous studies have proven the benefits of intracapsular procedures but failed to replace the role of TE at least in relation to SDB.…”

Section: Introductionmentioning

confidence: 99%

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Tonsillotomy: it's time to clarify the facts

Windfuhr

Werner

2013

Eur Arch Otorhinolaryngol

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“…In einer eigenen Studie (de la Chaux et al [14]) wurde bei 20 Kindern im Alter von 4,1±2,0 Jahren eine CO 2 -Laser-Tonsillotomie und Adenotomie bei kindlichem OSAS durchgeführt. Im Mittel 7,7 Monate nach der Operation konnte in der Polysomnographie ein Rückgang des AHI von 14,9 auf 1,1 pro h gesehen werden.…”

Section: Co 2 -Laser-tonsillotomie Und Adenotomie Bei Kindlichem Osasunclassified

New techniques of tonsil surgery in children with obstructive sleep apnea syndrome

et al. 2009

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Tonsillotomy in the treatment of obstructive sleep apnea syndrome in children: Polysomnographic results

Cited by 51 publications

References 37 publications

Adenotonsillotomy Versus Adenotonsillectomy in Pediatric Obstructive Sleep Apnea: An RCT

Adenotonsillotomy Versus Adenotonsillectomy in Pediatric Obstructive Sleep Apnea: An RCT

Tonsillotomy: it's time to clarify the facts

New techniques of tonsil surgery in children with obstructive sleep apnea syndrome

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