Tonsillotomy: Is Taking a Piece of Tonsil Bringing Increased Peace of Mind? :

Children with obstructive sleep apnea have long been considered prime candidates for tonsillectomy. Over the past few years however, a variation on tonsil removal—partial tonsil removal or tonsillotomy—has been increasing in popularity given its reportedly having less postoperative morbidity. So is one method truly better than the other?  Borgstrom et al (10.1542/peds.2016-3314) have attempted to answer that question in a new randomized controlled trial of non-inferiority when patients got one of the two treatments and were followed for a year.  The authors studied 79 children between 2 and 6 years with obstructive sleep apnea (OSA) with 40 randomized to adenotonsillotomy (ATT) and 39 to adenotonsillectomy (ATE).  Both groups were given polysomnography (PSG) at baseline and at one year along with a set of OSA symptom questions.  The good news is that at a year both methods showed the same level of improvement in PSG and OSA questionnaires.  The interesting news however is that 5 of the 40 who got ATT needed repeat surgery for regrowth of tonsillar tissue.  So which would you use based on this study?   You might share this study with your local pediatric otolaryngologist and then discuss what method he or she prefers and why.  This study may not guide you in making a different decision, but we hope it makes you more aware of future studies that will look at cost-effectiveness and long-term outcomes of both ATT and ATE which in turn might change the way the tonsils are handled going forward for patients with OSA.