Tonsillectomy or tonsillotomy?--A randomized study comparing postoperative pain and long-term effects.
BACKGROUND
tonsillectomy (TE) is currently the most common treatment for children with snoring and sleep apnea. Many of these children have not had any severe throat infections. To cure such children from their obstructive problems, without influencing the immunological function of the tonsils, tonsillotomy (TT) with CO2-laser was performed in a randomized study comparing it to regular tonsillectomy, with special attention to postoperative pain and symptom recurrence.


METHODS
41 children 3.5-8 years-old were included--21 'TT's' and 20 'TE's'. They were all operated under the same anesthesia and followed the same postoperative scheme for analgesia. A visual analogue scale for pain measurements with faces was used for the first 24 h. After that, each day until pain-free, the parents registered the child's pain on a three graded scale, what the child was able to eat, and the amount of analgesic drugs used.


RESULTS
all the children were cured from their breathing obstruction. The mean time used for the surgery was the same and no postoperative bleeding was seen in either group. 'TT children' were pain-free after 5 days and 'TE children' after 8 days. Eight to ten days after surgery, the TT-children had gained weight and the TE children lost weight significantly. The TE group used twice as much analgesic drugs as the TT group during the first postoperative week. The TT group was healed with normal-looking, but small tonsils after 8-10 days; the TE group often still showed edema and crusts. At the one-year follow-up 2/21 among the 'TT-children' snored, but did not require re-surgery.


CONCLUSIONS
tonsillotomy is much less painful than TE and children recover more quickly. Results with respect to breathing obstruction are almost the same for both methods at 1-year follow-up.
Hultcrantz
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Department of Otorhinolaryngology, ENT Clinic, University Hospital, Uppsala, Sweden. elisabeth.hultcrantz@orl.uu.se
Linder
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Markström
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D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D014066:Palatine Tonsil / Q000601:surgery*; D012008:Recurrence; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014068:Tonsillectomy