Author(s)
Bailey Pierce, Bachelor of Science
Scott Brietzke, MD, MPH2
Affiliation(s)
1Florida Atlantic Univ., Boca Raton, FL, 2Joe DiMaggio Children's Hosp., Hollywood, FL.
Abstract:
Introduction: Tonsil size assessment on physical exam is often used as a key component of clinical decision-making, specifically the prognostication of the potential success or failure of adenotonsillectomy surgery. The true reliability of this approach is not specifically known. The objective of this study is to systematically review the biomedical literature for data comparing subjective pre-operative tonsil (and adenoid) size (0-4+ scale) to adenotonsillectomy (T/A) outcomes using polysomnography (PSG) or quality of life outcomes.
Methods: A comprehensive PubMed and Embase search was conducted to identify articles comparing subjective tonsil/adenoid size to surgical outcomes. Inclusion criteria included pediatric patients only, patients who received a tonsillectomy or adenotonsillectomy, and articles that included pre- and post-surgical data. Exclusion criteria included patients who also received surgery beyond T/A and studies that did not compare distinct tonsil/adenoid size grades to surgical outcome. A customized quality assessment of each study was performed.
Results: 27 studies were included in the final data set. The mean sample size was 79.7 (range, 17-250) and grand mean age was 6.3 (range, 4.2-12.8 years). Case series was the predominant study design (20 studies). 14 studies specifically excluded obesity and craniofacial syndromes whereas two studies addressed patients with trisomy 21 only and five studies focused on obese patients. Outcome measures included PSG (19 studies), OSA-18 (four studies), OSA-6 (one study), oxygen desaturation index (one study), and overnight pulse oximetry (one study). 10 studies conducted postoperative evaluations within 90 days of the intervention and 17 studies had greater than 90 day follow-up. 23 of the 27 studies (85.2%) concluded that there was no association between pre-operative tonsil/adenoid size and successful surgical outcome, whereas four studies (14.8%) concluded that there was an association. Studies showing no association had a higher mean quality score than those showing an association (15.6 vs 14.5) but this was not statistically significant (p=0.12).
Conclusion: The large majority of the published clinical evidence suggests that subjective tonsil/adenoid size is not a reliable predictor of adenotonsillectomy success or failure.