title: Improvement in symptoms of obstructive sleep apnoea in children following tonsillectomy versus tonsillotomy: a systematic review and meta-analysis.
abstract: BACKGROUND
  Tonsillotomy (or intracapsular tonsillectomy) is a modern technique which is seen by some as potentially superior to traditional (extracapsular) tonsillectomy for the removal of tonsillar tissue to treat obstructive sleep apnoea in children. It has been suggested that peri-operative pain and haemorrhage and postoperative haemorrhage are reduced with the tonsillotomy technique. However, no systematic reviews have been carried out to assess its efficacy in treating obstructive sleep apnoea compared to tonsillectomy.
  
  
  OBJECTIVE
  To assess whether subjective improvement in symptoms of obstructive sleep apnoea following tonsillotomy is comparable to that following tonsillectomy, measured using a standardised questionnaire, the Obstructive sleep apnoea-18 (OSA-18) tool.
  
  
  METHODS
  Systematic review of the literature and meta-analysis.
  
  
  METHODS
  PubMed (MEDLINE), followed by Ovid (MEDLINE), Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, and the British Medical Journal were searched for articles published in English between 1995 and 2015 inclusive.
  
  
  METHODS
  Literature search, systematic review and meta-analysis. Studies examining improvement in mean OSA-18 score following tonsillotomy, improvement in mean OSA-18 score following tonsillectomy, and examining both were selected, examined and used for meta-analysis. Studies with and without concurrent adenoidectomy were included.
  
  
  RESULTS
  Four studies examining tonsillotomy and 16 studies examining tonsillectomy were included in the analysis. Using a random effects model, the pooled improvement in OSA-18 score for tonsillotomy was 2.46 (95% CI 1.92-2.99), and for tonsillectomy, it was 2.10 (95% CI 1.91-2.30). There was no significant difference between the methods.
  
  
  CONCLUSIONS
  That there is no significant difference in subjective outcome between tonsillotomy and tonsillectomy may support wider use of tonsillotomy over tonsillectomy for the treatment of obstructive sleep apnoea in children.
authors: School of Medicine, University of Dundee & Ninewells Hospital, Dundee, UK.
authors: D
authors: D
authors: Gorman
authors: School of Medicine, University of Dundee & Ninewells Hospital, Dundee, UK.|Departments of Medical Statistics, University of Dundee & Ninewells Hospital, Dundee, UK.
authors: S
authors: S
authors: Ogston
authors: School of Medicine, University of Dundee & Ninewells Hospital, Dundee, UK.|Otolaryngology, University of Dundee & Ninewells Hospital, Dundee, UK.
authors: S S M
authors: SS
authors: Hussain
mesh_terms: D002648:Child; D006801:Humans; D010149:Postoperative Pain / Q000473:pathology; D014066:Palatine Tonsil / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000473:pathology; D011788:Quality of Life; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014068:Tonsillectomy / Q000379:methods*