Long term outcome of tonsillar regrowth after partial tonsillectomy in children with obstructive sleep apnea

Abstract

We investigated the long-term effects of partial tonsillectomy, and potential risk factors for tonsillar regrowth in children with obstructive sleep apnea hypopnea syndrome (OSAHS). Children affected by OSAHS with obstructive hypertrophic tonsils underwent partial tonsillectomy or total tonsillectomy with radiofrequency coblation. Polysomnography was performed prior to and 5 years following surgery. Blood samples from all participants were taken prior to and 1 month following surgery to assess immune function. All participants were interviewed 5 years following surgery to ascertain effects of the surgery, rate of tonsillar regrowth, and potential risk factors. All parents reported alleviation of breathing obstruction. Postoperative hemorrhage did not occur in the partial tonsillectomy group compared to 3.76% in the total tonsillectomy group. Tonsillar regrowth occurred in 6.1% (5/82) in children following partial tonsillectomy. Palatine tonsil regrowth occurred a mean of 30.2 months following surgery, and 80% of children with tonsillar regrowth were younger than 5 years of age. All five patients had a recurrence of acute tonsillitis prior to enlargement of the tonsils. Four of the five had an upper respiratory tract allergy prior to regrowth of palatine tonsils. There were no differences in IgG, IgM, IgA, C3, or C4 levels following partial tonsillectomy or total tonsillectomy. Partial tonsillectomy is sufficient to relieve obstruction while maintaining immunological function. This procedure has several post-operative advantages. Palatine tonsils infrequently regrow. Risk factors include young age, upper respiratory tract infections, history of allergy, and history of acute tonsillitis prior to regrowth.