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Tonsil surgery in children under two years of age

Published online by Cambridge University Press:  16 September 2021

O Madej  and
H Kubba
O Madej
Affiliation:
Department of Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, Scotland, UK
H Kubba*
Affiliation:
Department of Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, Scotland, UK
*
Author for correspondence: Mr H Kubba, Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Road, GlasgowG51 4TF, Scotland, UK E-mail: [email protected]
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Abstract

Background

More young children are undergoing tonsillectomy, driven by sleep-disordered breathing concerns. Their specific risks are not well described.

Method

A retrospective review was conducted of children aged 1–23 months undergoing tonsillectomy at one institution between 2014 and 2018.

Results

A total of 157 children were identified (3.9 per cent of all tonsillectomies in those aged 0–16 years). Sixty-seven per cent were male. The youngest child was six months old; the smallest weighed 6.9 kg. Sixty-eight (43.3 per cent) had co-morbidities. The indication for tonsillectomy was sleep-disordered breathing in 94 per cent; 29.9 per cent had co-existing airway lesions, mostly laryngomalacia and tracheobronchomalacia. Of the children, 83.4 per cent were managed post-operatively on the surgical ward, and 63.7 per cent stayed 1 night. Emergency paediatric intensive care unit admission occurred in 3.8 per cent. Early respiratory complications and emergency paediatric intensive care unit admission were more common if the patient was medically complex, aged less than 18 months or weighed less than 12 kg. Re-operation for bleeding occurred in 1.9 per cent.

Conclusion

Most children stay 1 night on a general ward, with an uneventful course. Complications are occasionally severe, mostly in the very young and medically complex.

Keywords

TonsillectomyEpidemiologyObstructive Sleep ApneaTonsillitisChildren
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 11 , November 2021 , pp. 1019 - 1024
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Mr H Kubba takes responsibility for the integrity of the content of the paper

References

Royal College of Surgeons of England. National Prospective Tonsillectomy Audit. London: Royal College of Surgeons of England, 2005Google Scholar
Powell, S, Kubba, H, O'Brien, C, Tremlett, M. Paediatric obstructive sleep apnoea. BMJ 2010;340:c191810.1136/bmj.c1918CrossRefGoogle ScholarPubMed
Lawlor, CM, Riley, CA, Carter, JM, Rodriguez, KH. Association between age and weight as risk factors for complication after tonsillectomy in healthy children. JAMA Otolaryngol Head Neck Surg 2018;144:399–40510.1001/jamaoto.2017.3431CrossRefGoogle ScholarPubMed
Statham, MM, Elluru, RG, Buncher, R, Kalra, M. Adenotonsillectomy for obstructive sleep apnea syndrome in young children: prevalence of pulmonary complications. Arch Otolaryngol Head Neck Surg 2006;132:476–80CrossRefGoogle ScholarPubMed
McCormick, ME, Sheyn, A, Haupert, M, Thomas, R, Folbe, AJ. Predicting complications after adenotonsillectomy in children 3 years old and younger. Int J Pediatr Otorhinolaryngol 2011;75:1391–410.1016/j.ijporl.2011.07.035CrossRefGoogle ScholarPubMed
Spencer, DJ, Jones, JE. Complications of adenotonsillectomy in patients younger than 3 years. Arch Otolaryngol Head Neck Surg 2012;138:335–9Google ScholarPubMed
Belyea, J, Chang, Y, Rigby, MH, Corsten, G, Hong, P. Post-tonsillectomy complications in children less than three years of age: a case-control study. Int J Pediatr Otorhinolaryngol 2014;78:871–410.1016/j.ijporl.2014.02.029CrossRefGoogle ScholarPubMed
ENT UK. Safe Delivery of Paediatric ENT Surgery in the UK: A National Strategy. In: https://www.entuk.org/safe-delivery-paediatric-ent-surgery-uk-national-strategy [9 September 2021]Google Scholar
Robb, PJ, Bew, S, Kubba, H, Murphy, N, Primhak, R, Rollin, AM et al. Tonsillectomy and adenoidectomy in children with sleep-related breathing disorders: consensus statement of a UK multidisciplinary working party. Clin Otolaryngol 2009;34:61–3CrossRefGoogle ScholarPubMed
Oomen, KP, Modi, VK. Occult laryngomalacia resulting in obstructive sleep apnea in an infant. Int J Pediatr Otorhinolaryngol 2013;77:1617–1910.1016/j.ijporl.2013.07.006CrossRefGoogle ScholarPubMed
Walton, J, Ebner, Y, Stewart, MG, April, MM. Systematic review of randomized controlled trials comparing intracapsular tonsillectomy with total tonsillectomy in a pediatric population. Arch Otolaryngol Head Neck Surg 2012;138:243–910.1001/archoto.2012.16CrossRefGoogle Scholar
Marcus, CL, Moore, RH, Rosen, CL, Giordani, B, Garetz, SL, Taylor, HG et al. ; Childhood Adenotonsillectomy Trial (CHAT). A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med 2013;368:2366–76CrossRefGoogle ScholarPubMed
Waters, KA, Chawla, J, Harris, MA, Heussler, H, Black, RJ, Cheng, AT et al. Cognition after early tonsillectomy for mild OSA. Pediatrics 2020;145:e20191450CrossRefGoogle ScholarPubMed