Tonsillectomy under the age of 3 years: is it recommended or not?

Abstract

Abstract Background 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 the major 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 — that is, less than 3 years and more than 60 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 airway edema and obstruction, those age groups are still at lesser incidence of morbidity and mortality as compared to the infantile age groups who take the wider spectrum of ENT surgeons’ concentration, discussions, and studies regarding this issue. Therefore, this study was conducted prospectively to confirm whether tonsillectomy can be performed safely before 3 years of age with nonsignificant difference regarding postoperative morbidity and mortality as compared to the other age group of 3 years or above. Patients and methods: A total of 648 children aged from 8 months to 8 years presented at ENT department, Al-Thowra central teaching hospital and Altarahom private center, Elbyda city, Libya during the period between September 2005 and October 2012 as cases of chronic adenotonsillitis with variable patterns of indications for tonsillectomy, namely snoring and apnea attacks, persistent otitis media with effusion, recurrent attacks of acute suppurative otitis media, failure to thrive, recurrent attacks of chest infection, and malocclusive dental deformity. In all, 241 patients were under age of 3 years who represented group A, whereas remaining 407 patients at age of 3 years and above constituted group B. As prospective analytic study, both groups were compared with respect to intraoperative time consumption and whether there is any significant difference between the two groups regarding the incidence of serious postoperative complications occurrence, namely post-tonsillectomy bleeding, aspiration, airway obstruction, dehydration, postadenotonsillectomy negative pressure pulmonary edema, and metabolic as well as nutritional deficiencies. In addition, both groups were 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 3 years of age as in older children; this can be indicated by the appearance of nonsignificant difference between both groups regarding the intraoperative time consumption. In contrast, this procedure approved to be a safe procedure among children with age below 3 years as in older children; this was illustrated by the presence of nonsignificant difference between group A and group B regarding the serious suspected post-tonsillectomy complications, namely post-tonsillectomy hemorrhage, aspiration, airway obstruction, negative pressure pulmonary edema, dehydration, and metabolic as well as nutritional deficiencies. Conclusion: In general, tonsillectomy is a safe procedure that can be performed successfully among children at different age groups with low incidence of post-tonsillectomy complications as compared with adults.