Outcomes of tonsillectomy in neurologically impaired children. Laryngoscope 2009 Nov;119(11):2231-41
Date
08/04/2009Pubmed ID
19650126DOI
10.1002/lary.20600Scopus ID
2-s2.0-73449103925 (requires institutional sign-in at Scopus site) 16 CitationsAbstract
OBJECTIVES/HYPOTHESIS: Children with neurologically impaired (NI) swallow can undergo tonsillectomy safely and effectively.
STUDY DESIGN: Retrospective review.
METHODS: Forty-five children with documented dysphagia were compared to age- and procedure-matched normal children for operating room and clinical experience. Three further studies were limited to the NI children only: preoperative and postoperative video swallow studies (VSS), and polysomnography (PSG) for sleep-disordered breathing history. Long-term telephone follow-up of clinical outcomes was performed.
RESULTS: There were no differences between the two groups measured by tonsil size or intraoperative or late post-tonsillectomy hemorrhage, but lowest measured oxygen levels were statistically different. No intraoperative complications, early post-tonsillectomy hemorrhage, hospital readmission, or mortality occurred in either group. Three NI children each had an episode of aspiration pneumonia (early or late) without sequelae. Of the 32 VSS available for review, postoperative aspiration incidence was significantly improved, but with new-onset aspiration occurring in five children. Of available matched pre- and postoperative PSG, 91% confirmed resolution of identified preoperative obstructive sleep apnea. Long-term telephone follow-up of 20 NI children revealed improved breathing (95%), communication (90%), and feeding efficiency (55%).
CONCLUSIONS: This study suggests tonsillectomy in NI children can be performed safely with appropriate monitoring and precautions with a 48-hour hospital postoperative stay recommended. Swallowing safety appears to improve both objectively and subjectively in most NI children following tonsillectomy. Both preoperative and postoperative VSS are recommended for any NI child undergoing tonsillectomy. Long-term follow-up identified improved quality of life measures for the majority of the NI children queried.
Author List
Conley SF, Beecher RB, Delaney AL, Norins NA, Simpson PM, Li SHAuthors
Stephen Conley MS, MD Emeritus Professor in the Otolaryngology and Communication Sciences department at Medical College of WisconsinPippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentChild
Child, Preschool
Deglutition Disorders
Female
Humans
Infant
Male
Nervous System Diseases
Retrospective Studies
Tonsillectomy
Treatment Outcome
