Outcomes of tonsillectomy in neurologically impaired children.
OBJECTIVE
Children with neurologically impaired (NI) swallow can undergo tonsillectomy safely and effectively.


METHODS
Retrospective review.


METHODS
Forty-five children with documented dysphagia were compared to age- and procedure-matched normal children for operating room and clinical experience. Three further studies were limited to the NI children only: preoperative and postoperative video swallow studies (VSS), and polysomnography (PSG) for sleep-disordered breathing history. Long-term telephone follow-up of clinical outcomes was performed.


RESULTS
There were no differences between the two groups measured by tonsil size or intraoperative or late post-tonsillectomy hemorrhage, but lowest measured oxygen levels were statistically different. No intraoperative complications, early post-tonsillectomy hemorrhage, hospital readmission, or mortality occurred in either group. Three NI children each had an episode of aspiration pneumonia (early or late) without sequelae. Of the 32 VSS available for review, postoperative aspiration incidence was significantly improved, but with new-onset aspiration occurring in five children. Of available matched pre- and postoperative PSG, 91% confirmed resolution of identified preoperative obstructive sleep apnea. Long-term telephone follow-up of 20 NI children revealed improved breathing (95%), communication (90%), and feeding efficiency (55%).


CONCLUSIONS
This study suggests tonsillectomy in NI children can be performed safely with appropriate monitoring and precautions with a 48-hour hospital postoperative stay recommended. Swallowing safety appears to improve both objectively and subjectively in most NI children following tonsillectomy. Both preoperative and postoperative VSS are recommended for any NI child undergoing tonsillectomy. Long-term follow-up identified improved quality of life measures for the majority of the NI children queried.
Conley
Stephen F
SF
Division of Pediatric Otolaryngology, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.. sfconley@mcw.edu
Beecher
Robert B
RB
Delaney
Amy L
AL
Norins
Nan A
NA
Simpson
Pippa M
PM
Li
Shun-Hwa
SH
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009422:Nervous System Diseases / Q000150:complications; D012189:Retrospective Studies; D014068:Tonsillectomy; D016896:Treatment Outcome