Sleep-disordered breathing (SDB) constitutes the most common indication for tonsil surgery. For a long time, the only performed tonsil procedure was tonsillectomy (TE) which reserves relatively high morbidity, and many patients suffer from complications, most often postoperative haemorrhage. Hence, tonsillotomy (TT), the less invasive method of tonsil surgery, has gained popularity in recent years. However, Finnish studies on TT are still lacking. This thesis aimed to examine TT – its utility in children – and to discuss the potential benefits and disadvantages of TT compared to TE. The first study analysed the trends in tonsil surgery over a 10-year period and evaluated the effects of these changes on the incidence of tonsil surgery complications and specialist service costs. TTs were started at the Department of Otorhinolaryngology, Helsinki University Hospital, in 2009, and since 2011, TT has become a more common method in the treatment of SDB in children than TE. Consequently, the incidence of complications has decreased, thereby lowering hospital costs. In the second study, the postoperative recovery after TT and TE was evaluated and compared in a prospective cohort of children. All the recovery-related outcomes showed a tendency towards faster recovery after monopolar TT than TE; for children who had undergone TT, the need for analgesics was shorter, and they were able to return to normal activities earlier than children who had undergone TE. The third study examined the health-related quality of life (HRQoL) and the costs of use of health care in children operated with TT. The results of this study were compared to those of an earlier cohort of children operated on with TE. Both TT and TE improved HRQoL in children with SDB and reduced health care service needs and sick leave days. There was no difference in the mean total hospital costs between TT and TE in the one-year follow-up. The fourth study histologically evaluated the differences in tissue from children with re-hypertrophy of tonsils after TT and those with tonsillar hyperplasia without a history of earlier surgery. Also, the incidence of reoperations and potential predictive factors for tonsillar regrowth were assessed retrospectively. There was no evidence of severe chronic inflammation or scarring in the regrown tonsils. The incidence for resurgery was low (1.9%), and young age seemed to be a predictive factor for tonsillar regrowth. This study confirmed the superiority of TT over TE in several aspects: the recovery from surgery was faster and less painful after TT than after TE, and the rate of complication was lower. TT improved HRQoL and reduced visits of health care. The incidence of resurgery because of tonsillar regrowth was low.
|Status||Publicerad - 2022|
|MoE-publikationstyp||G5 Doktorsavhandling (artikel)|
Bibliografisk informationM1 - 93 s. + liitteet
- 3125 Öron-, näs- och halssjukdomar, ögonsjukdomar