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Tonsillectomy has benefits in kids with dysphagia and enlarged tonsils

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Tonsillectomy is an effective treatment for children with dysphagia related to enlarged tonsils, according to results of a prospective cohort study.

Removing the tonsils also eases swallowing difficulties in children whose primary indication for the surgery is obstructive sleep apnea (OSA) or chronic tonsillitis, not dysphagia.

Following surgery, both groups experienced “significant improvement” in swallowing-related quality of life and were better able to tolerate a normal diet, Dr. Daniel Clayburgh and colleagues from Oregon Health and Science University in Portland report in the December Archives of Otolaryngology Head and Neck Surgery.

In the United States, tonsillectomy is the second most commonly performed procedure among children, with more than a half million done each year, although the number of procedures is on the decline.

“This study,” Dr. Clayburgh told Reuters Health, “is really one of the first to examine the role that tonsillectomy may play in addressing pediatric dysphagia.”

“While we have good evidence that tonsillectomy is beneficial in treating other problems such as obstructive sleep apnea and recurrent tonsillitis in children, until now there has been little evidence to support the use of tonsillectomy in children with enlarged tonsils and swallowing difficulty,” he said.

The study included 18 children referred for tonsillectomy due to dysphagia-related tonsillar hypertrophy as the primary complaint (the dysphagia cohort) and 39 children with other indications for tonsillectomy, primarily OSA and recurrent tonsillitis (the control cohort).

One month after surgery, the dysphagia cohort demonstrated significant improvement (P < 0.001) in all domains of the Swallowing Quality of Life (SWAL-QOL) and these improvements persisted at six months.

The control cohort also demonstrated significant gains (P < 0.001) across almost all domains of the SWAL-QOL at one month, which persisted at six months. Children in this cohort had higher SWAL-QOL scores at baseline than the dysphagia cohort.

“Although the primary indication for tonsillectomy in the control cohort was not dysphagia, it was striking that many control patients had significantly abnormal SWAL-QOL scores before surgery, suggesting that many of these patients had dysphagia in addition to their primary problem,” the authors note.

“Perhaps one of the most interesting results from our study was the high incidence of swallowing complaints in our control group,” Dr. Clayburgh added in comments to Reuters Health. “Many of these patients also had swallowing problems that were significantly improved after tonsillectomy.”

Compared with before surgery, one month after surgery, more patients were tolerating a regular diet (as opposed to a liquid or pureed diet) in the dysphagia cohort (60% after surgery vs 33% before surgery; P = 0.01) and in the control cohort (94% vs 81%; P = 0.04).

Both groups achieved a significant increase in weight percentile for age after surgery, which indicates, the investigators say, that the subjective changes in symptoms measured on the SWAL-QOL translated into measurable gains in patient health.

“Although further research is warranted to define the subset of patients most likely to benefit from tonsillectomy to treat dysphagia, these results may help the clinician counsel patients and families about the effects of tonsillectomy on dysphagia,” Dr. Clayburgh and colleagues say.

Dr. Clayburgh noted that, “While most practicing clinicians that see children with tonsillar hypertrophy ask about sleep symptoms and infections as possible indications for tonsillectomy, this study suggests that clinicians should also inquire about swallowing problems, as most children with dysphagia related to tonsillar hypertrophy will see improvements in swallowing after tonsillectomy.”


Efficacy of Tonsillectomy for Pediatric Patients With Dysphagia and Tonsillar Hypertrophy

Arch Otolaryngol Head Neck Surg. 2011;137:1197-1202.