Resolving of Tonsillectomy Dilemma Among Children Under Age of Three Years

Abstract

Backgrund and objectives: Tonsillectomy is the most common surgical procedure in specialty of otorhinolaryngology. Therefore there are frequent premises regarding this procedure to be improved from different aspects, indications, time of surgery, techniques, safety measures, and postoperative care. One of big issues regarding this procedure is the most suitable age for the surgery. This point is creating a lot of controversies particularly at extreme age groups i.e. less than three years and more than sixty years. Although the extreme old age groups are considered as risky for any surgical procedures specially for tonsillectomy due to lack of proper body tissues tolerance and response to post-tonsillectomy bleeding as well as upper air way edema and obstruction but those age groups are still at lesser incidence of morbidity and mortality as compared to infantile age groups who take the wider spectrum of ENT surgeons’ concentration, discussions, and researches regarding this issue. Therefore this study was conducted prospectively to confirm whether the tonsillectomy can be performed safely before age of three years with non-significant difference regarding post-operative morbidity and mortality as compared to the other age group of three years or more. Patients and methods: 648 children aged from 8 months through 8 years presented at ENT department - Althowra central teaching hospital and Altarahom private center – Elbyda city – Libya at period in between September 2005 to October 2012 with different indications for tonsillectomy. 241 patients were under age of three years who represent group-A while remaining 407 at age from three years and above and constitute group-B. As prospective analytic study, both groups compared in relation to intra-operative time consumption and whether there is any significant difference between two groups regarding the incidence of serious postoperative complications occurrence. In addition both groups compared for any significant difference regarding the period of postoperative hospitalization which can be used as objective indicator to measure the postoperative morbidity rate. Results: This presenting study confirmed that the tonsillectomy procedure is an easy procedure among children younger than three years of age as in older children; this can be indicated by the appearance of non-significant difference between both groups regarding the intra-operative time consumption. On the other hand this procedure approved to be a safe procedure among children with age below three years as in older children; this was illustrated by the presence of non-significant difference between group-A and group-B regarding the serious suspected post-tonsillectomy complications namely post-tonsillectomy hemorrhage, aspiration, air way obstruction, negative pressure pulmonary edema, dehydration, and metabolic as well as nutritional deficiencies. Conclusion: Generally speaking the tonsillectomy is a safe procedure which can be performed successfully among children at different age groups with low incidence of post-tonsillectomy complications as compared to adults.