OBJECTIVES

To compare two methods of tonsil surgery with respect to long term effect in a group of pre-school children

METHODS

67 pre-school children, age 4-5 with symptoms of tonsillar hyperplasia were randomized to conventional tonsillectomy,TE,(n: 32) or tonsillotomy using radio frequency technique,TT(n:35).

28 TT patients and 25 TE patients underwent adenoidectomy at the same occasion. 5 TT and 1 TE had

already undergone an adenoidectomy. Six months and two years after surgery all children were evaluated through questionnaires including the

OSA-18 quality of life survey and two years after surgery they were again evaluated by an ENT-specialist, speech therapist and dentist.

RESULTS

The TT-children experienced less pain from the first day after surgery and were free from pain three days earlier than the TE-children. Six months after surgery there was no difference between the groups

concerning snoring and frequency and severity of upper airway infections. After two years, three of the 35 TT-children and one of the TE children had been reoperated due to recurring obstructive problems, the TEchild and one of the TT-children with adenoidectomy, two TT-children with tonsillectomy. The otherchildren did not snore and no increased tendency towards infections was noted in any child. Evaluation with VAS before/two years after surgery was 8,4/1,3 for TE and 8,5/1,6 for TT.(Median). The total OSA-18 score and the scores for all domains within OSA 18 showed significant improvement after surgery for both groups of children(p<.0001) in short- and long term scores. Three of the TT-children had some tonsillar tissue protruding from the tonsillar cleft and half of the TEchildren had small tonsillar remains in the tonsillar clefts.

CONCLUSIONS

Young children in an age with rapid immunological development have a six percent risk of recurrence of tonsil hyperplasia-related obstructive symptoms within two years after tonsillectomy, and may need to be reoperated. This risk should be weighed against the much lower postoperative morbidity of tonsillotomy as compared to tonsillectomy.ral