Tonsillectomy in children under 4 years of age: Safety and indications

Abstract

Background: Tonsillectomy with or without adenoidectomy is a worldwide famous pediatric surgery performed by otorhinolaryngologists. This study was designed to review the records of carefully selected children under 4 years of age who underwent tonsillectomy with or without adenoidectomy over a period of 5 years. We studied the safety and indications for tonsillectomy.Design and Setting: A retrospective study was conducted in King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia.Subjects & Methods: The study included 51 children (29 male & 22 female), under 4 years of age (ranged from 12 to 48 months) who underwent tonsillectomy with or without adenoidectomy in between 1989 and 1993 in the Otorhinolaryngology Department, King Abdulaziz University Hospital. Safety and indications for tonsillectomy were also recorded. Myringotomy with or without ventilation tube insertion was performed in cases of otitis media with hearing loss and tonsillitis.Results: Through 1989-1993, the overall number of tonsillectomy with or without adenoidectomy, performed in the Otorhinolaryngology Department, King Abdulaziz Uuniversity Hospital, was 1159. Of the 1159, only 51 (4.4%) were under 4 years of age, ranged from 12 to 48 months. 1108 (95.6%) of total were over 4 years of age. Indications for tonsillectomy under 4 years of age were recorded and were as the following: Recurrent tonsillitis in 24 children (47.05%). Upper airway obstruction due to adenotonsillar hyperplasia causing nasal obstruction and mouth breathing in 16 children (31.37%), Recuurrent otitis media with hearing loss and tonsillitis in 6 children (11.76%), Tonsillar mass in 4 children (7.84%) and Ventricular septal defect in 1 child only (1.6%). The postoperative follow up of these 51 children was uneventful and all children were discharged in the next day of surgery.Conclusion: The results of this study show that tonsillectomy under the age of four is a safe procedure, provided that the patient is carefully selected, using expert anaesthesia on an in-patient basis with close post-operative monitoring. We recommend conducting a recent similar retrospective study to see if there is epidemiologic change in trend of indications for tonsillectomy in our saudi pediatric community.