Our Summary

This research paper is about a survey conducted on pediatric ear, nose, and throat doctors (otolaryngologists) from around the world to understand how they handle tonsil removal surgeries (tonsillectomies) in children. The survey, which ran for a little over a month in 2024, reached out to nearly 300 doctors through a WhatsApp group, and nearly half of them responded. The doctors hailed from 22 different countries.

The survey found that the most common type of tonsillectomy is the extracapsular method, where the whole tonsil is removed. This is followed by a combined approach of extracapsular and intracapsular (where only part of the tonsil is removed) tonsillectomy. The least common was the exclusive use of the intracapsular method.

When deciding on the type of surgery, the doctors preferred the extracapsular method for children with frequent tonsil infections or abscesses, and for those with sleep apnea (a disorder that disrupts breathing during sleep). Those with sleep apnea and bleeding disorders were seen as ideal candidates for intracapsular tonsillectomy. Interestingly, more than two-thirds of doctors in Europe preferred the intracapsular method.

The survey also looked at how doctors manage pain after the surgery. Most of them prescribe acetaminophen or ibuprofen, while some prescribe opioid drugs, mainly oxycodone. The doctors also reported on whether they had access to polysomnography, a type of sleep study.

The study concludes that more doctors are starting to use the intracapsular method of tonsillectomy and that there is a need for clear guidelines to address the different practices observed around the world.

FAQs

  1. What was the most common type of tonsillectomy performed by the pediatric otolaryngologists surveyed in the study?
  2. How do doctors typically manage pain after a tonsillectomy according to the survey?
  3. What types of patients are seen as ideal candidates for an intracapsular tonsillectomy, according to the doctors in the survey?

Doctor’s Tip

A helpful tip a doctor might tell a patient about tonsillectomy is to expect some pain and discomfort after the surgery, but to follow the prescribed pain management plan provided by the doctor. It’s important to stay hydrated, rest, and follow any dietary restrictions given by the doctor to aid in a smooth recovery. Additionally, be sure to attend any follow-up appointments scheduled by the doctor to monitor progress and address any concerns.

Suitable For

In summary, patients who are typically recommended tonsillectomy include:

  1. Children with frequent tonsil infections or abscesses.
  2. Children with sleep apnea.
  3. Children with bleeding disorders.
  4. Patients who have not responded to other treatments for their tonsil-related issues.
  5. Patients with enlarged tonsils causing difficulty in breathing or swallowing.

Overall, the decision to recommend tonsillectomy is based on the individual patient’s medical history, symptoms, and the severity of their condition. It is important for doctors to carefully assess each case and determine the most appropriate treatment plan for the patient.

Timeline

Before tonsillectomy:

  1. Patient experiences frequent tonsil infections, abscesses, or sleep apnea.
  2. Consultation with an otolaryngologist to discuss the need for tonsillectomy.
  3. Decision made on the type of tonsillectomy method to be used.

After tonsillectomy:

  1. Patient undergoes tonsillectomy surgery, either extracapsular, intracapsular, or a combination of both methods.
  2. Pain management prescribed, typically acetaminophen or ibuprofen, with some patients receiving opioid drugs.
  3. Recovery period at home with follow-up appointments with the otolaryngologist.
  4. Monitoring of symptoms and potential complications, such as bleeding or infection.
  5. Depending on the reason for the surgery, improvement in symptoms such as reduced infections or better quality of sleep for those with sleep apnea.

What to Ask Your Doctor

Some questions a patient should ask their doctor about tonsillectomy include:

  1. What type of tonsillectomy do you recommend for my child and why?
  2. What are the risks and potential complications associated with the surgery?
  3. How long is the recovery period expected to be, and what can we do to help manage pain during this time?
  4. Will my child need a sleep study before or after the surgery, and if so, why?
  5. Are there any specific dietary or activity restrictions that my child should follow post-surgery?
  6. How often will we need to follow up with you after the surgery for monitoring and care?
  7. What signs or symptoms should we watch for that may indicate a complication or infection after the surgery?
  8. Are there any alternative treatments or therapies that we should consider before proceeding with a tonsillectomy?
  9. How experienced are you in performing tonsillectomies, and what is your success rate with this procedure?
  10. Can you provide us with any additional resources or information to help us better understand the surgery and recovery process?

Reference

Authors: Spencer GM, Wilson CA, Davidson J, Strychowsky JE, Lawlor CM, Burns H, Bhargava EK, Fowler J, Graham ME. Journal: Int J Pediatr Otorhinolaryngol. 2025 Apr;191:112276. doi: 10.1016/j.ijporl.2025.112276. Epub 2025 Feb 19. PMID: 39985850