Table 2.
Comparative effectiveness outcomes in studies addressing partial vs. total tonsillectomy
| Author, Year Study Design Risk of Bias |
Comparison Groups (n) | OSDB persistence | Tonsillar Regrowth | Return to Normal Diet or Activity | Throat Infections | Quality of Life | Behavioral |
|---|---|---|---|---|---|---|---|
| Chaidas 201318 RCT Low ROB |
G1: Partial cold tonsillectomy (50) G2: Total cold tonsillectomy (51) |
Snoring (6-years post-tonsillectomy) G1: 13/43 (30.2) G2: 12/48 (25) G1 vs. G2: p=NS Episodes of apnea (6-years post-tonsillectomy) G1: 2/43 (4.7) G2: 0 (0) G1 vs. G2: p=NS |
Tonsillar regrowth, 6 years post-surgery, n (%) G1: 6/13 (46.2) G2: NA Tonsillar regrowth requiring revision surgery, n (%) G1: 2/13 (5) G2: 0 |
Time to return to normal diet, mean days ± SD G1: 3.8 ± 0.2 G2: 7.1 ± 0.3 G1 vs.G2: P < 0.001 |
At least 1 episode of tonsillitis/year, 1–6 years post-tonsillectomy, n (%) G1: 5 (11.6) G2: 0 G1 vs. G2: p= NR Number throat infections/year, 1–6 years post-tonsillectomy, median (IQR) G1: 0 (0–1) G2: 0 (0–1) G1 vs. G2: p=NS |
NR | NR |
| Korkmaz 200820 RCT Moderate ROB |
G1: Partial cold tonsillectomy (40) G2: Total cold tonsillectomy (41) |
NR | Tonsillar regrowth within 2-years post-tonsillectomy, n G1+G2: 0/68 |
NR | NR | NR | NR |
| Skoulakis 200722 RCT Moderate ROB |
G1: Partial cold tonsillectomy (15) G2: Total cold tonsillectomy (15) |
NR | NR | Time to return to normal diet G1: 4 days earlier than G2 G1 < G2: p < 0.001 |
NR | NR | NR |
| Chang 200821 RCT Moderate ROB |
G1: Partial coblation tonsillectomy (34) G2: Total coblation tonsillectomy (35) |
NR | NR | Mean % of normal diet resumed (POD1–2) G1: 56 G2: 42 G1 vs.G2: p = 0.05 Mean % of normal diet resumed (POD5–6) G1: 73 G2: 48 G1 vs.G2: p < 0.05 Mean % of normal activity resumed (POD1–2) G1: 65 G2: 49 G1 vs.G2: p = 0.031 Mean % of normal activity resumed NR NR (POD5–6) G1: 84 G2: 64 G1 vs.G2: p = 0.002 |
NR | NR | NR |
| Park 200723 RCT Low ROB |
G1: Partial electrocautery tonsillectomy (19) G2: Total electrocautery tonsillectomy (21) |
NR | NR | Time to return to normal activity G1 vs.G2: p = NS |
NR | NR | NR |
| Chan 200428 RCT Moderate ROB |
G1: Partial tonsillectomy-coblation (27) G2: Total tonsillectomy-electrocautery (28) |
Worsening of obstructive symptoms (3-months post-tonsillectomy), n (%) G1: 10/21 (48) G2: 6/19 (25) p=NR Improvement in obstructive symptoms (12 months post-tonsillectomy) G1 vs. G2: p=NS |
NR | Time to return to normal diet, median days G1: 4.4 G2: 7.5 G1 vs.G2: p = NR Time to return to normal activity, median days G1: 4.1 G2: 8 G1 vs.G2: p = NR |
Incidence of sore throat or antibiotic use (3 and 12 months post-tonsillectomy) G1 vs. G2: p=NS |
NR | NR |
| Ericsson 200926,27 RCT Moderate ROB |
G1: Partial tonsillectomy-coblation (35) G2: Total tonsillectomy-cold dissection (32) |
Persistence of snoring 6-months post-tonsillectomy Greater number of children in G1 vs. G2 had snoring, p < 0.05 24-months post-tonsillectomy G1 vs. G2; p=NS Total tonsillectomy for OSDB-symptom persistence, n (%) G1: 2/35 (5.7) G2: NA |
NR | Time to return to normal diet G1: 4 days earlier than G2 G1 vs. G2: p=NS Time to return to normal activity G1: 3 days earlier than G2 G1 vs. G2: p=NS |
Sore throats requiring antibiotics, 6-months post-tonsillectomy, n G1: 4 G2: 2 G1 vs. G2: p=NS Sore throats requiring antibiotics, 24-months post-tonsillectomy, n G1: 8 G2: 1 G1 vs. G2: p= NR |
OSA-18 (Total) Change score 6-months post-tonsillectomy G1: 1.8±1.2 G2: 1.8±1.0 G1 vs. G2: p=NS Change score 24-months post-tonsillectomy G1: 1.8±1.2 G2: 1.9±1.4 G1 vs. G2: p=NS Disease-specific quality of life data in figures only |
Child Behavior Checklist, Total Score 6-months post-tonsillectomy G1: 19.5 ±18.4 G2: 13.5 ±9.8 G1 vs. G2: p=NS 24-months post-tonsillectomy G1: 13.9±12.9 G2: 13.6±21.7 G1 vs. G2: p=NS |
| Hultcrantz 200429–31 RCT Moderate ROB |
G1: Partial tonsillectomy-coblation (49) G2: Total tonsillectomy-cold dissection (43) |
Persistence of snoring 12-months and 3-years post-tonsillectomy No difference in frequency or loudness of snoring between groups Presence of apnea, 1–3 years post-tonsillectomy G1: 0 G2: 0 |
Total tonsillectomy for OSDB-symptom persistence, n G1: 1 (denominator not clear, 91 children in both groups assessed at 1 year) G2: NA |
NR | Sore throats requiring antibiotics, 12-months post-tonsillectomy, n G1: 6 G2: 4 G1 vs. G2: p=NS Sore throats requiring antibiotics, 1–3 years post-tonsillectomy, n G1: 6 G2: 5 G1 vs. G2: p=NS |
Glasgow Children’s Benefit Inventory, % 33 months post-tonsillectomy Overall QoL-Much better G1: 61 G2: 79 Overall QoL-A little better G1: 35 G2: 18 Overall QoL-No change G1: 5 G2: 3 G1 vs. G2: all p=NS |
Child Behavior Checklist, Total Score 12-months post-tonsillectomy No differences in degree of improvement between groups Glasgow Children’s Benefit Inventory, % 33 months post-tonsillectomy Behavior-Much better G1: 19 G2: 10 Behavior-A little better G1: 19 G2: 15 Behavior-No change G1: 62 G2: 74 G1 vs. G2: all p=NS |
| Chang 200524 RCT Moderate ROB |
G1: Partial tonsillectomy-coblation (52) G2: Total tonsillectomy- electrocautery (49) |
NR | NR | Mean % of normal diet resumed (POD1–2) G1: 49 G2: 30 G1 vs.G2: p < 0.005 Mean % of normal diet resumed (POD5–6) G1: 74 G2: 42 G1 vs.G2: p < 0.005 Mean % of normal activity resumed (POD1–2) G1: 53 G2: 42 G1 vs.G2: p = NS Mean % of normal activity resumed (POD5–6) G1: 82 G2: 56 G1 vs.G2: p < 0.005 |
NR | NR | NR |
| Coticchia 200634 RCT Moderate ROB |
G1: Partial tonsillectomy-coblation (13) G2: Total tonsillectomy-cold (10) |
NR | NR | N children resuming normal diet by POD7, (%) G1: 11 (85) G2: 0 (0) G1 vs.G2: p = NR |
NR | NR | NR |
| Derkay 200632 RCT Low ROB |
G1: Partial tonsillectomy-microdebrider (150) G2: Total tonsillectomy-electrocautery (150) |
NR | NR | Time to return to normal diet, median days (Q1 – Q3) G1: 3 (1.5–6) G2: 3.5 (1.5–6.5) G1 vs.G2: p = NS Time to return to normal activity, median days(Q1 – Q3) G1: 2.5 (1–5) G2: 4 (2.5–6.5) G1 vs.G2: p < 0.01 |
NR | Baseline to postoperative changes, 1 month post-tonsillectomy G1 vs. G2: p=NS Decrease in emotional distress G1>G2: p < 0.01 Decrease in activity limitation G1>G2: p < 0.01 |
NR |
| Beriat 201333 RCT Moderate ROB |
G1: Partial tonsillectomy- microdebrider (37) G2: Total tonsillectomy- cold dissection (45) |
NR | NR | NR | Recurrent throat infection (within 12-months post-tonsillectomy), n G1: 2 G2: 0 G1 vs. G2: p= NR |
NR | NR |
Abbreviations: G = Group; N = Number; NA = Not Applicable; NR = Not Reported; NS = Not Significant; OSDB = Obstructive Sleep Disordered Breathing; RCT = Randomized Controlled Trial; ROB = Risk of Bias; SD = Standard Deviation