New Data on Tonsillectomy: Behavior Advantages and Best Technique

She added, though, that the lack of agreement between polysomnography parameters and clinical diagnosis makes diagnosing all children with SDB a continual challenge

“Quality of life instruments are very different in nature compared with polysomnography, so they may in fact represent a different aspect of the SDB spectrum,” she said. “Our data demonstrates an association between adenotonsillectomy and improvement in sleep and behavior as measured by the PSQ and the Connor’s instrument. Treatment of children with clinically diagnosed SDB, even if not confirmed with polysomnography, can still result in improvement of behavior and sleep and the PSQ may be used as a screening tool and as an adjunct to clinical history and exam when determining candidacy for surgery, especially when polysomnography is not feasible.”

Tonsillectomy Complications

Tonsillectomy has been around for more than 2,000 years and has been performed countless times, yet it is not without certain morbidities, the most prevalent of which are postoperative pain or bleeding.

“If one could design the ideal surgery, it would be painless with no risk of bleeding and would lead to the immediate resumption of a normal diet and activity,” said Richard Schmidt, MD, a pediatric otolaryngologist at the A.I. DuPont Hospital for Children in Wilmington, Del. “Over the last couple of decades, new technologies have come to the forefront and have held promise, but with widespread use, have frequently not lived up to that promise.”

A previously published study of patients treated with intracapsular tonsillectomy, compared to a similarly sized group of patients treated with standard tonsillectomy, found that fewer patients in the intracapsular group experienced delayed bleeding or required re-admission for dehydration.

A previously published study of patients treated with intracapsular or standard tonsillectomy found that fewer patients in the intracapsular group experienced delayed bleeding or required re-admission for dehydration.

“It is believed that pain is lessened after this procedure because the capsule is left behind. We believe that inflammation of the pharyngeal constrictor muscles after tonsillectomy is the cause of most of the postoperative pain that patients experience and, by leaving the tonsillar capsule behind, the muscles are protected from inflammation and they act like sort of a biological dressing.”

Likewise, bleeding may be lessened after the procedure because the larger primary tonsillar vessels are not exposed due to the small amount of tonsillar tissue and capsule left behind, he added.

Comparing Techniques

“Our hypothesis was that children undergoing intracapsular tonsillectomy (IT) have less pain and lower incidence of secondary hemorrhage than those receiving traditional tonsillectomy (TT),” he said. “We did a retrospective chart review; we looked at the technique used, the indications for surgery, patient age, gender and length of follow-up.”