title: Randomized study comparing inflammatory response after tonsillectomy versus tonsillotomy.
abstract: To determine if there was a difference in the inflammatory reaction after tonsil surgery with "traditional" techniques (tonsillectomy and adenoidectomy or TA) compared to partial intracapsular tonsillectomy and adenoidectomy (PITA).
  
  
  METHODS
  Randomized, double-blind study.
  
  
  METHODS
  tertiary care academic hospital. Children under the age of 16 years with a diagnosis of obstructive sleep disordered breathing were randomly allocated into three study groups: TA with electrocautery (n = 34), PITA with CO2laser (n = 30) and PITA with debrider (n = 28). All of the children underwent adenoidectomy with a current at the same surgical procedure.
  
  
  METHODS
  c-reactive protein level (CRP) was the primary endpoint. In addition, the following were assessed: white blood cells (WBC), neutrophils (NEU), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α). Pre- and post-procedure measurements were compared between the groups. Parents filled out a questionnaire daily during the first postoperative week assessing pain, swallowing and snoring. CRP levels ascended higher in the PITA groups after surgery (p = 0.023), WBC and NEU showed the same pattern, IL-6 levels were higher in PITA group and there was no difference in TNF-alpha levels between the two types of procedures. Postoperative pain and postoperative hemorrhage were significantly lower in the PITA groups as compared to the TA group (p = 0.01 and 0.048). PITA in comparison to TA is associated with lower morbidity; however, the inflammatory response does not differ significantly in the first 24 h after surgery. Additional long-term studies assessing efficacy of PITA are warranted.
  
  
  METHODS
  Level 1, prospective randomized controlled trial.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Box 151, 84101, Beersheva, Israel. artur33@012.net.il.
authors.forename: Sofia
authors.initials: S
authors.lastname: Kordeluk
authors.affiliation: Department of Pediatrics and Sleep-Wake Disorders Unit, Soroka University Medical Center, Beersheva, Israel.
authors.forename: Aviv
authors.initials: A
authors.lastname: Goldbart
authors.affiliation: Department of Public Health, Faculty of Medical Sciences, Ben-Gurion University in the Negev, Beersheva, Israel.
authors.forename: Lena
authors.initials: L
authors.lastname: Novack
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Box 151, 84101, Beersheva, Israel.
authors.forename: Daniel Michael
authors.initials: DM
authors.lastname: Kaplan
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Box 151, 84101, Beersheva, Israel.
authors.forename: Sabri
authors.initials: S
authors.lastname: El-Saied
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Box 151, 84101, Beersheva, Israel.
authors.forename: Musa
authors.initials: M
authors.lastname: Alwalidi
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Box 151, 84101, Beersheva, Israel.
authors.forename: Angelica
authors.initials: A
authors.lastname: Shapira-Parra
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Box 151, 84101, Beersheva, Israel.
authors.forename: Nili
authors.initials: N
authors.lastname: Segal
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Box 151, 84101, Beersheva, Israel.
authors.forename: Yuval
authors.initials: Y
authors.lastname: Slovik
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Box 151, 84101, Beersheva, Israel.
authors.forename: Puterman
authors.initials: P
authors.lastname: Max
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Box 151, 84101, Beersheva, Israel.
authors.forename: Ben-Zion
authors.initials: BZ
authors.lastname: Joshua
mesh_terms: D000233:Adenoidectomy / Q000295:instrumentation / Q000379:methods*; D000234:Adenoids; D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003646:Debridement / Q000295:instrumentation; D004311:Double-Blind Method; D004564:Electrocoagulation / Q000379:methods; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D053685:Laser Therapy / Q000379:methods; D007958:Leukocyte Count; D008297:Male; D009504:Neutrophils; D010149:Postoperative Pain; D014066:Palatine Tonsil / Q000473:pathology / Q000601:surgery*; D010290:Parents; D019106:Postoperative Hemorrhage / Q000601:surgery; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D012913:Snoring / Q000601:surgery*; D011795:Surveys and Questionnaires; D014068:Tonsillectomy / Q000295:instrumentation / Q000379:methods*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein
keywords: Inflammatory markers; Obstructive sleep disordered breathing; Pain; Polysomnography; Snoring; Tonsillectomy; Tonsillotomy