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Efficacy of Powered Intracapsular Tonsillectomy and Adenoidectomy

Authors

  • David E. Tunkel MD,

    Corresponding author
    1. From the Departments of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
    2. From the Pediatrics Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
    • Send correspondence to David E. Tunkel, MD, Johns Hopkins Outpatient Center, 6161B, 601 North Caroline Street, Baltimore, MD 21287-0910
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  • Karin S. Hotchkiss MD,

    1. From the Departments of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
    2. Tampa Bay Pediatric ENT Tampa, Florida, U.S.A.
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  • Kathryn A. Carson ScM,

    1. From the Departments of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
    2. The Department of Epidemiology Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, U.S.A.
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  • Laura M. Sterni MD

    1. From the Departments of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
    2. From the Pediatrics Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
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  • Editor's Note: This Manuscript was accepted for publication March 3, 2008. Supported by a grant from the General Clinical Research Center at Johns Hopkins Hospital.

Abstract

Objectives/Hypothesis: We sought to determine the effectiveness of powered intracapsular tonsillectomy and adenoidectomy (PITA) in the treatment of children with moderately severe obstructive sleep apnea and to measure changes in quality of life that occur with such treatment.

Study Design: Prospective, nonrandomized clinical trial in an academic pediatric otolaryngology practice.

Methods: Convenience sample of children ages 3 to 12 years diagnosed with obstructive sleep apnea of moderate severity, defined as an apnea-hypopnea index (AHI) between 5 and 20 on polysomnography. Children with recurrent streptococcal pharyngitis, chromosomal abnormalities, craniofacial abnormalities, neuromotor disease, sickle cell disease, obesity, or coagulopathy were excluded. PITA was performed by using the microdebrider. Polysomnography was performed before surgery and repeated 4 to 8 weeks after surgery. The Obstructive Sleep Apnea (OSA)-18 questionnaire was completed at surgery and at the time of postoperative polysomnography to assess quality of life changes. The main outcome measure was cure of obstructive sleep apnea, as defined by a postoperative AHI of 1 or less for complete cure and less than 5 for partial cure. Improvements in quality of life were assessed by changes in the OSA-18 questionnaire.

Results: Nineteen children underwent PITA for moderate obstructive sleep apnea syndrome (OSAS), and 14 completed postoperative polysomnography. All 14 subjects who completed the study achieved at least partial cure. Thirteen of 14 (93%) subjects had a complete cure of OSAS after PITA. The median preoperative AHI was 7.9, and the median AHI after surgery was 0.1. The mean number of arousals per hour before surgery was 9.5, and this was reduced to a mean of 5.6 after surgery. Quality of life measures on OSA-18 also improved, with large improvements in total quality of life scores and in all five domains seen after surgery.

Conclusions: PITA cures otherwise healthy children with obstructive sleep apnea of moderate severity, at least in the short-term, as documented by postoperative polysomnography. Improvements in quality of life measures, as documented by changes in OSA-18, were seen in all children as well.

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