Coblation Intracapsular Tonsillectomy and Coblation Complete Tonsillectomy for Obstructive Sleep Apnea

Itzhak Braverman,Miriam Sarid,Galit Avior,Adi Klein,Alex Nemirovsky

doi:10.4236/ijohns.2015.45059

Abstract

Objective: Total tonsillectomy and intracapsular tonsillectomy are common procedures for the treatment of obstructive sleep apnea (OSA) in children. The objective of this study was to compare the effectiveness of coblation intracapsular tonsillectomy (ICT) and coblation complete tonsillectomy (CT) as treatments for OSA. Study design: A retrospective study of all the children ages 2 - 18 years with OSA who underwent coblation intracapsular tonsillectomy (ICT) or coblation complete tonsillectomy (CT) from January 2007 to August 2010 by the same surgeons at one institution. Methods: Data were retrieved from children’s charts and from telephone interviews with children’s parents, regarding pre and postoperative OSA-18 scores, postoperative pain, postoperative complications, use of analgesic drugs, and time to return to a solid food diet. Results: All 43 children who underwent ICT and 37 children who underwent CT suffered from OSA before surgery, and none did postoperatively. There were no minor complications in the ICT group, compared to 13.5% in the CT group (p = 0.01). According to parental report, 72% and 21% suffered a low level of postoperative pain, and 9% and 33% severe pain in the ICT and CT groups, respectively. For these respective groups, 49% and 73% needed analgesic drugs (p < 0.05); and 65% and 35% ate solid food during the first 3 days post surgery. Conclusions: Both ICT and CT were safe, with few complications; however recovery was faster in the ICT group, as demonstrated by less pain, and more rapid return to a solid food diet.

Highlights

Obstructive sleep apnea (OSA) in children is characterized by a decrease or complete halt in airflow despite an ongoing effort to breath, and by upper airway collapse that disrupts normal respiratory gas exchange or causes sleep fragmentation
This is a retrospective study of children aged 2 - 18 years old who underwent coblation intracapsular adenotonsillectomy (ICT) or coblation subcapsular adenotonsillectomy (CT) for treatment of OSA at one institution, with the same surgeons, during a five year period (2007 to 2010)
All the children who underwent ICT or complete tonsillectomy (CT) with adenoidectomy were free from OSA symptoms postoperatively

Summary

Introduction

Obstructive sleep apnea (OSA) in children is characterized by a decrease or complete halt in airflow despite an ongoing effort to breath, and by upper airway collapse that disrupts normal respiratory gas exchange or causes sleep fragmentation. A systematic review concluded that 4% to 11% of children suffer from sleep-disordered breathing, ranging in severity from snoring to OSA, as assessed by parent report [1]. The most common etiology of OSA is adenotonsillar hypertrophy. Tonsillar surgery is the treatment of choice for most children with OSA. OSA, rather than chronic infection, has become the primary indication for pediatric tonsillectomy, especially in younger children [4] [5]. A large recently published randomized trial supports the beneficial effects of early adenotonsillectomy, compared with a strategy of watchful waiting, for school-age children with OSA [6]. Pain is a common postoperative morbidity of tonsillectomy; the degree is usually severe, and often leads to poor oral intake and dehydration

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