Table 3.

Summary of evidence in studies addressing effectiveness and harms of tonsillectomy techniques

Intervention and comparator	Number/Type of Studies (Total N Participants)	Key Outcome(s)	Strength of Evidence (SOE) Grade	Findings
Total vs. partial cold dissection tonsillectomy	2 RCT18,22 (131)	Return to normal diet	Low SOE for faster return to normal diet after partial vs. total tonsillectomy	Children undergoing partial tonsillectomy returned to normal diet approximately 4 days sooner than children undergoing total tonsillectomy according to parent report
	1 RCT18 (101)	Throat infection, OSDB persistence	Insufficient SOE	Insufficient data to assess effects on throat infections given single, small study
Partial vs. total coblation tonsillectomy	1 RCT21 (69)	Return to normal diet or activity	Insufficient SOE	Insufficient data to assess effects on return to normal diet or activity given single, small study
Partial vs. total electrocautery tonsillectomy	1 RCT23 (40)	Return to normal activity	Insufficient SOE	Insufficient data to assess effects on return to normal diet or activity given single, small study
Total vs. partial tonsillectomy (mixed techniques)	6 RCT24,26–28,32,34,35 (620)	Return to normal diet or activity	Low SOE for more favorable return to normal diet and activity in children undergoing partial vs. total tonsillectomy	Children undergoing partial vs. total tonsillectomy had consistently more favorable outcomes but unit of measure varied across studies (e.g., mean days, N children)
	3 RCT26–31 (214)	OSDB persistence	Low SOE for no difference in effects on long-term persistence of OSDB symptoms between partial and total tonsillectomy	More children undergoing partial vs. total tonsillectomy had short-term snoring or obstructive symptoms in 2 studies but no group differences in longer term in any study
	2 RCT26,27,29–31 (159)	Quality of Life (≥12 months post-tonsillectomy)	Low SOE for no long-term differences in quality of life after partial vs. total tonsillectomy	Improvements from baseline in both groups in 2 small studies, but no significant group differences in quality of life in either study
	2 RCT26,27,29–31 (159)	Behavioral Outcomes (≥12 months post-tonsillectomy)	Low SOE for no long-term differences in behavioral outcomes after partial vs. total tonsillectomy	Improvements from baseline in both groups on the Child Behavior Checklist in 2 small studies, but no significant group differences in either study
	4 RCT26–31,33 (296)	Throat Infections (≥12 months post-tonsillectomy)	Low SOE for no effect on throat infections following partial vs. total tonsillectomy	More throat infections or sore throats following partial vs. total tonsillectomy in 3 of 4 RCTs but no significant group differences

Abbreviations: N=number; OSDB=obstructive sleep disordered breathing; RCT= randomized controlled trial; SOE=strength of evidence