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Health and well-being of children and young adults in relation to surgery of the tonsils
Linköpings universitet, Hälsouniversitetet, Sverige.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Tonsillectomy is one of the most frequently performed surgical procedures in children and youths. The aim of this thesis was to study children and youths in relation to tonsil surgery with the goal of improving the care, and to describe partial tonsillectomy/tonsillotomy (TT) using radiofrequency technique (RF) (Ellman International) in comparison with the more commonly used total tonsillectomy (TE).

The thesis covers studies of wo age-groups with obstructive problems, with or without recurrent tonsillitis. Randomization to surgery was done from the existing waiting list; 92 children, 5-15 years old to 49/TT and 43/TE, (I-III) and 76 youths, 16-25 years old to 32/TT and 44/TE (IV-V).

The first purpose (I, IV) was to compare the two surgical techniques with respect to pain and postoperative morbidity. Pain measures were for the children the Face Pain Scale and for the youths and parents and staff a verbal-pain-rating-scale. From the first day, the TT-groups scored significantly less pain than the TE-groups. The doses of pain-killing drugs (paracetamol and diclofenac) taken were significantly less for the children and youths receiving the TT-surgery, they could stop taking pain-killers sooner, and were back to normal activity three (5-15yrs) or four (16-25yrs) days earlier compared with TE-groups.

Paper II focused on the child’s behavior (Child Behavior Checklist/CBCL), experience of pain, anxiety (State-Trait-Anxiety Inventory for Children /STAIC), previous experiences of surgery/tonsillitis, and the management of pain. The children scored higher on CBCL than a normative group before surgery, but no connection was observed between CBCL rating and experience of pain reported post surgically. There was no relation between preoperative anxiety and reported pain, but the postoperative anxiety level correlated with pain. The Egroup scored higher anxiety after surgery. Previous experience of surgery or tonsillitis did not influence the postoperative pain. The nurses scored pain lower than the parents/children and under-medicated.

The second purpose was to compare the long-term effects of TT and TE-surgery after one and three years (5-15yrs) and one year (16-25yrs) (III, IV). The effect on snoring was the same for both TT and TE-groups and the rate of recurrence of throat infections was low after both surgical techniques.

After one year, all children (TT/TE) showed improvements on CBCL to the same degree and there was no longer a difference between total behavior and normative values. They also scored improvements in health-related quality of life (HRQL) with Glasgow-Children-Benefit-Inventory.

For both TT and TE, the older group reported lower HRQL preoperatively on all dimensions of Study-Short-Form (SF-36) compared with a normal population. After one year, a large improvement was found in HRQL in both groups and there were no differences compared with a normal population.

Conclusion: Preoperative obstructive problems, in combination with recurrent tonsillitis have a negative impact on HRQL. Both after TE and TT there are large improvements in HRQL, infections, obstructive, and behavior problems one to three years after surgery, indicating that both surgical methods are equally effective. With fewer postoperative complications, less pain, shorter recovery time, and lower cost, TT with RF should be considered as method of choice.

Place, publisher, year, edition, pages
Linköping: Linköping University , 2007. , 103 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 992
Keyword [en]
Pain, Pain - postoperative, Quality of life, Tonsil - surgery, Tonsillectomy, Tonsillitis - surgery
National Category
Otorhinolaryngology
Identifiers
URN: urn:nbn:se:hj:diva-9733ISBN: 978-91-85715-38-1 (print)OAI: oai:DiVA.org:hj-9733DiVA: diva2:228462
Public defence
Berzeliussalen, Hälsouniversitetet (ingång 65), Linköping (Swedish)
Opponent
Supervisors
Note
Medicine doktorsexamenAvailable from: 2009-08-17 Created: 2009-08-02 Last updated: 2009-08-17Bibliographically approved
List of papers
1. Pediatric Tonsillotomy with Radiofrequency Technique: Less Morbidity and Pain
Open this publication in new window or tab >>Pediatric Tonsillotomy with Radiofrequency Technique: Less Morbidity and Pain
2004 (English)In: The Laryngoscope, ISSN 0023-852X, Vol. 114, no 5, 869-875 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:hj:diva-6707 (URN)
Available from: 2008-11-05 Created: 2008-11-05 Last updated: 2009-03-03Bibliographically approved
2. Pre-surgical Child Behavior Ratings and Pain Management after Two Different Techniques of Tonsil Surgery
Open this publication in new window or tab >>Pre-surgical Child Behavior Ratings and Pain Management after Two Different Techniques of Tonsil Surgery
2006 (English)In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, Vol. 70, no 10, 1749-1758 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:hj:diva-6705 (URN)
Available from: 2008-11-05 Created: 2008-11-05 Last updated: 2009-02-26Bibliographically approved
3. Pediatric Tonsillotomy with Radiofrequency Technique: Long-Term Follow-Up
Open this publication in new window or tab >>Pediatric Tonsillotomy with Radiofrequency Technique: Long-Term Follow-Up
2006 (English)In: The Laryngoscope, ISSN 0023-852X, Vol. 116, no 10, 1851-1857 p.Article in journal (Refereed) Published
National Category
Otorhinolaryngology Nursing
Identifiers
urn:nbn:se:hj:diva-9731 (URN)10.1097/01.mlg.0000234941.95636.e6 (DOI)
Available from: 2009-08-02 Created: 2009-08-02 Last updated: 2010-02-23Bibliographically approved
4. Tonsil Surgery in Youths: Good Results with Less Invasive Method
Open this publication in new window or tab >>Tonsil Surgery in Youths: Good Results with Less Invasive Method
2007 (English)In: The Laryngoscope, ISSN 0023-852X, Vol. 117, no 4, 654-661 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:hj:diva-6704 (URN)
Available from: 2008-11-05 Created: 2008-11-05 Last updated: 2009-02-26Bibliographically approved
5. Long-term improvement of quality of life as a result of tonsillotomy (with radiofrequency technique) and tonsillectomy in youths
Open this publication in new window or tab >>Long-term improvement of quality of life as a result of tonsillotomy (with radiofrequency technique) and tonsillectomy in youths
2007 (English)In: The Laryngoscope, ISSN 0023-852X, Vol. 117, no 7, 1272-1279 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:hj:diva-6703 (URN)
Available from: 2008-11-05 Created: 2008-11-05 Last updated: 2009-03-11Bibliographically approved

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