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The Egyptian Journal of Otolaryngology
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Tonsillectomy under the age of 3 years: is it recommended or not?

The Egyptian Journal of Otolaryngology volume 30, pages 337–342 (2014)Cite this article

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Abstract

Background and objectives

Tonsillectomy is the most common surgical procedure in specialty of otorhinolaryngology. Therefore, there are frequent premises regarding this procedure to be improved from different aspects, indications, time of surgery, techniques, safety measures, and postoperative care. One of the major issues regarding this procedure is the most suitable age for the surgery. This point is creating a lot of controversies particularly at extreme age groups — that is, less than 3 years and more than 60 years. Although the extreme old age groups are considered as risky for any surgical procedures specially for tonsillectomy due to lack of proper body tissues tolerance and response to post-tonsillectomy bleeding as well as upper airway edema and obstruction, those age groups are still at lesser incidence of morbidity and mortality as compared to the infantile age groups who take the wider spectrum of ENT surgeons’ concentration, discussions, and studies regarding this issue.

Therefore, this study was conducted prospectively to confirm whether tonsillectomy can be performed safely before 3 years of age with nonsignificant difference regarding postoperative morbidity and mortality as compared to the other age group of 3 years or above.

Patients and methods

A total of 648 children aged from 8 months to 8 years presented at ENT department, Al-Thowra central teaching hospital and Altarahom private center, Elbyda city, Libya during the period between September 2005 and October 2012 as cases of chronic adenotonsillitis with variable patterns of indications for tonsillectomy, namely snoring and apnea attacks, persistent otitis media with effusion, recurrent attacks of acute suppurative otitis media, failure to thrive, recurrent attacks of chest infection, and malocclusive dental deformity. In all, 241 patients were under age of 3 years who represented group A, whereas remaining 407 patients at age of 3 years and above constituted group B. As prospective analytic study, both groups were compared with respect to intraoperative time consumption and whether there is any significant difference between the two groups regarding the incidence of serious postoperative complications occurrence, namely post-tonsillectomy bleeding, aspiration, airway obstruction, dehydration, postadenotonsillectomy negative pressure pulmonary edema, and metabolic as well as nutritional deficiencies. In addition, both groups were compared for any significant difference regarding the period of postoperative hospitalization, which can be used as objective indicator to measure the postoperative morbidity rate.

Results

This presenting study confirmed that the tonsillectomy procedure is an easy procedure among children younger than 3 years of age as in older children; this can be indicated by the appearance of nonsignificant difference between both groups regarding the intraoperative time consumption. In contrast, this procedure approved to be a safe procedure among children with age below 3 years as in older children; this was illustrated by the presence of nonsignificant difference between group A and group B regarding the serious suspected post-tonsillectomy complications, namely post-tonsillectomy hemorrhage, aspiration, airway obstruction, negative pressure pulmonary edema, dehydration, and metabolic as well as nutritional deficiencies.

Conclusion

In general, tonsillectomy is a safe procedure that can be performed successfully among children at different age groups with low incidence of post-tonsillectomy complications as compared with adults.

References

  1. Bofares KM, Salem AM. Comparative study of indomethacin and paracetamol for treatment of pain after adeno-tonsillectomy in children. GMJ 2006; 23: 41–47

    Google Scholar 

  2. Windfuhr JP, Ulbrich T. Post tonsillectomy bleeding: result of 3 months follow up. Ear Nose Throat J 2001; 80: 790.

    Article  CAS  Google Scholar 

  3. Fujihara K, Koltai PJ, Hayashi M, Tamura S, Yamanaka N. Tonsillectomy in children. Ann Otol Rhinol Laryngol 2006; 115: 365–369.

    Article  Google Scholar 

  4. Sanders JC, King MA, Mitchell RB, Kelly JP. Perioperative complications of adenotonsillectomy in children with obstructive sleep apnea syndrome. Anesth Analg 2006; 103: 1115–1121.

    Article  Google Scholar 

  5. Paradise JL, Bluestone CD, Colborn DK, Bernard BS, Rockette HE. Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children. Pediatrics 2002; 110: 7–15.

    Article  Google Scholar 

  6. Fedeli U, Marchesan M, Avossa F, Zambon F, Andretta M, Baussano I, Spolaore P. Variability of adenoidectomy/tonsillectomy rates among children of the Veneto Region, Italy. BMC Health Serv Res 2009; 9: 25

    Article  Google Scholar 

  7. Roy A, Deal Rosa C Veechio TA. Bleeding following tonsillectomy, a study of electro — coagulation and ligation techniques. Arch otolaryngol 1996; 102: 9–10.

    Article  Google Scholar 

  8. Bear GA, Roaius HG, Kolehmainen S Selin S. The effect of paracetamol or diclofenac administered before operation on postoperative pain behavior after adenoidectomy in small children. Anaesthesia 1997; 47: 1078–1080.

    Article  Google Scholar 

  9. Randall DA, Hoffer MF. Complications of tonsillectomy and adenoidectomy. Otolaryngol Head Neck Surg 1998; 118: 61–68.

    Article  CAS  Google Scholar 

  10. Thomas CL Plamer TJ Shipley P. Pediatric pulmonary edema, post tonsillectomy and adenoidectomy. AANA J 1999; 67:425.

    PubMed  CAS  Google Scholar 

  11. Johnston DR, Gaslin M, Boon M, Pribitkin E, Rosen D. Postoperative complications of powered intracapsular tonsillectomy and monopolar electrocautery tonsillectomy in teens versus adults. Ann Otol Rhinol Laryngol 2010; 119: 485–489.

    Article  Google Scholar 

  12. Gustavii N, Bove M, Dahlin C. Postoperative morbidity in traditional versus coblation tonsillectomy. Ann Otol Rhinol Laryngol 2010; 119: 755–760.

    Article  Google Scholar 

  13. Walker P, Gillies D. Post-tonsillectomy haemorrhage rates: are they technique dependent? Otolaryngol Head Neck Surg. 2007; 136: S27–S31.

    Article  Google Scholar 

  14. Sutters KA, Savedra MC, Miaskowski C, Holdridge-Zeuner D, et al. Children’s expectations of pain, perceptions of analgesic efficacy, and experiences with nonpharmacologic pain management strategies at home following tonsillectomy. J Spec Pediatr Nurs 2007; 12: 139–148.

    Article  Google Scholar 

  15. Nunes DA, Provan J, Crawford M. Postoperative tonsillectomy pain in pediatric patients. Arch Otolaryngol Head Neck Surg 2000; 126: 837–841.

    Article  Google Scholar 

  16. Arthur CG, John EH. Somatic sensation: II. Pain, headache. 10th ed. Harcourt Health Sciences; 2000. 554–556.

  17. Gary AT, Kevin TP. Central nervous system. In: Anatomy and physiology. 4th ed. Gary AT, by Mosby and Imprint of Elsevier Sciences; 1999, p. 384.

  18. Colbert SA, McCrory C, O’Hanlon DM, Scully M, Tanner A, Doyle MA. Prospective study comparing intravenous tenoxicam with rectal diclofenac for pain relief in day case surgery. Eur J Anasthesiol 1998; 15: 544–548.

    Article  CAS  Google Scholar 

  19. Shinhar S, Scotch BM, Belenky W, Madgy D, Haupert M. Harmonic scalpel tonsillectomy versus hot electrocautery and cold dissection: an objective comparison. Ear Nose Throat J 2004; 83: 712–715.

    Article  Google Scholar 

  20. Tawalbeh MI. Comparative study of diclofenac sodium and paracetamol for treatment of pain after adeno-tonsillectomy in children. Saudi Med J 2001; 22: 121–123

    PubMed  CAS  Google Scholar 

  21. Bofares KM. Laser oropharyngeal surgeries versus non-laser oropharyngeal surgical procedures. JMJ 2009; 9: 327–333

    Google Scholar 

  22. Clark MP, Waddell A. The surgical arrest of post-tonsillectomy haemorrhage: hospital episode statistics. Ann R Coll Surg Engl 2004; 86: 411–412.

    Article  CAS  Google Scholar 

  23. Krishna P, Lee D. Post-tonsillectomy bleeding: a meta-analysis. Laryngoscope 2001; 111: 1358–1361.

    Article  CAS  Google Scholar 

  24. Bhattacharyya N. Evaluation of post-tonsillectomy bleeding in the adult population. Ear Nose Throat J 2001; 80: 544.

    Article  CAS  Google Scholar 

  25. Elhakim M, et al. Dexamethasone reduces postoperative vomiting and pain after pediatric tonsillectomy. Can J Anesth 2003; 50: 392–397.

    Article  Google Scholar 

  26. Stewart R, et al. Dexamethason reduces pain after tonsillectomy in adults. Clin Otolaryngol 2002; 7: 321–327.

    Article  Google Scholar 

  27. K Liu, et al. Effect of dexamethasone on postoperative emesis and pain. B J Anaesth 1998; 80:85–86.

    Article  CAS  Google Scholar 

  28. I Kaygusuz, et al. The effects of Dexamethasone, bupivacain and topical lidocain spray on pain After tonsillectomy. Int J Pediatr Ontolaryngol 2003; 67:737–742.

    Article  Google Scholar 

  29. Tewary AK, Cable HR, Barr GS. Steroids and control of post-tonsillectomy pain. J Laryngol Otol 1993; 107: 605–606.

    Article  CAS  Google Scholar 

  30. Catlin FI, Grimes WJ. The effect of steroid therapy on recovery from tonsillectomy in children. Arch Otolaryngol Head Neck Surg 1991; 117: 649–652.

    Article  CAS  Google Scholar 

  31. Furst SR, Rodarte A. Prophylactic antiemetic treatment with ondansetron in children undergoing tonsillectomy. Anesthesiology 1994; 81: 799–803.

    Article  CAS  Google Scholar 

  32. Wei JL, Beatty CW, Gustafson RO. Evaluation of post-tonsillectomy hemorrhage and risk factors. Otolaryngol Head Neck Surg 2000; 123: 229–235.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Omar Almoukhtar University, Elbyda, Libya

    Khalid M. Bofares MD

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  1. Khalid M. Bofares MD
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Correspondence to Khalid M. Bofares MD.

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Bofares, K.M. Tonsillectomy under the age of 3 years: is it recommended or not?. Egypt J Otolaryngol 30, 337–342 (2014). https://doi.org/10.4103/1012-5574.144967

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