TABLE 3.
Summary of Evidence in Studies Addressing Effectiveness of Tonsillectomy in Children With OSDB
| Intervention and Comparator | No./Type of Studies (Total Participants, N) | Key Outcome(s) | SOE Grade | Findings |
|---|---|---|---|---|
| Tonsillectomy versus no surgery in children with OSDB | Meta-analysis | AHI | Low SOE for greater improvement of AHI with tonsillectomy compared with no surgery | Significant improvement in tonsillectomy versus no surgery groups in 1 RCT and 2 retrospective cohort studies; no significant group differences in 1 RCT and 1 prospective cohort. In 3 studies, children in control arms improved from baseline. |
| 2 RCT (456)15,17 | 4.8-point improvement in AHI in tonsillectomy arms in meta-analysis. | |||
| 1 Prospective cohort (38)28 | ||||
| 2 Retrospective cohort (94)25,32 | ||||
| 2 RCT (456)15,17 | Sleep-related quality of life | Moderate SOE for modest improvement in sleep-related quality of life after tonsillectomy versus no surgery | Significant improvements in tonsillectomy versus no tonsillectomy groups on measures of sleep-related quality of life in 2 RCTs and 1 cohort study in the short term. | |
| 1 Retrospective cohort (32)25 | ||||
| 1 RCT (397)17 | Behavioral outcomes | Low SOE for improvements in negative behaviors after tonsillectomy versus no surgery | Significant improvements in tonsillectomy versus no surgery in 1 RCT and 1 retrospective cohort; no significant differences in 1 prospective cohort; differences in measurement time frames across studies (7 mo–4 y) and unclear clinical significance of changes. | |
| 1 Prospective cohort (38)28 | ||||
| 1 Retrospective cohort (32)25 | ||||
| 1 Prospective cohort (38)28 | Cognitive changes (IQ) | Insufficient SOE | Insufficient evidence in 1 small study. | |
| 1 RCT (397)17 | Executive function | Insufficient SOE | Differences in follow-up time and medium study limitations preclude conclusions. | |
| 1 Prospective cohort (38)28 | ||||
| 1 RCT (397)17 | Cardiometabolic outcomes | Insufficient SOE | Insufficient evidence in only 1 RCT. | |
| 1 Prospective cohort (220)24 | Health care utilization | Insufficient SOE | Insufficient evidence in only 1 RCT. |
Non-RCT, nonrandomized trial; SOE, strength of evidence.