[Outpatient diode laser tonsillotomy in children with tonsillar hyperplasia. Clinical results].
BACKGROUND
The aim of this retrospective study was to present the postoperative development, therapy effectiveness, and parental satisfaction after an outpatient diode laser tonsillotomy in children with noninflammatory tonsillar hyperplasia.


METHODS
The study included 183 children with noninflammatory tonsillar hyperplasia who were operated on between October 2004 and October 2006 (average age: 4 years and 7 months). All children underwent diode laser tonsillotomy in contact mode (812 nm, continuous wave, 13 W) with or without additional procedures (adenotomy, paracentesis, tympanic drainage). All surgeries were carried out under endotracheal anesthesia by two ENT physicians in private practice in an outpatient surgery center. The patients (n=82) of one of the physicians were given an oral antibiotic for the 7 days following the surgery (cefuroxime syrup), and all children were given standard pain medication after the surgery (ibuprofen syrup). The postoperative development, complications, or late complications, the recurrence frequency, the effectiveness of the treatment, and the parental satisfaction were assessed using the respective results of the follow-up exams (average follow-up period: 1 year) and a standardized parent questionnaire, completed on average 1 year and 8 months after the surgery. For data digitalizing and statistical analysis with SPSS the chi(2) test and the Wilcoxon test were used (p<0.05).


RESULTS
Generally, patients experienced no or only very little pain, and there was no secondary bleeding after tonsillotomy. Occasionally, a conspicuous wound surface (2.9%), fever (2.3%), or reddened palatal arch (1.2%) were noted. There were no late complications such as scar tissue distortions on the soft palate or peritonsillar abscesses. The procedure's effectiveness with regard to snoring, obstructed respiration, apnea, lack of appetite, and susceptibility to infection was very good and the level of parental satisfaction very high. The postoperative development showed significant differences between the two groups (with and without oral antibiotic) concerning postoperative pain (point score: 0-3): in the antibiotics group there was no postsurgical pain (average point score: 0.1), and in the group without antibiotics there was slight postsurgical pain (point score: 0.5).


CONCLUSIONS
Outpatient diode laser tonsillotomy for children with symptomatic tonsillar hyperplasia is a rather painless surgery method with a low perioperative risk, very high treatment effectiveness, and parental satisfaction. For this indication tonsillotomy is the therapy of choice. There were no differences in terms of postoperative development between the diode laser tonsillotomy compared to the literature of the more common CO(2) laser tonsillotomy.
Sedlmaier
B
B
Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin. benedikt.sedlmaier@charite.de
Bohlmann
P
P
Jakob
O
O
Reinhardt
A
A
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006965:Hyperplasia / Q000453:epidemiology / Q000601:surgery; D007223:Infant; D053685:Laser Therapy / Q000706:statistics & numerical data*; D054023:Lasers, Semiconductor / Q000706:statistics & numerical data; D008297:Male; D010149:Postoperative Pain / Q000453:epidemiology* / Q000517:prevention & control*; D014066:Palatine Tonsil / Q000473:pathology* / Q000601:surgery*; D015995:Prevalence; D012189:Retrospective Studies; D014068:Tonsillectomy / Q000706:statistics & numerical data*; D016896:Treatment Outcome