The quality of evidence is downgraded by imprecise results (wide confidence intervals).
A Cochrane review [Abstract] 1 included 22 studies with a total of 1 984 children with obstructive sleep-disordered breathing (oSDB). Three studies used polysomnography as part of their inclusion criteria. Follow-up duration ranged from 6 days to 6 years. Only results from a few studies could be pooled due both to the variety of outcomes and the measurement instruments used, and an absence of combinable data.
It was uncertain whether tonsillotomy reduced peri-operative blood loss by a clinically meaningful amount (MD 14.06 mL, 95% CI 1.91 to 26.21 mL; 8 studies, n=610) compared to tonsillectomy. The risk of postoperative complications requiring medical intervention in the first week after surgery was lower in children who underwent tonsillotomy (4.9% versus 2.6%, RR 1.75, 95% CI 1.06 to 2.91; 16 studies, n=1 416).There was little or no difference in postoperative pain between tonsillectomy and tonsillotomy at 24 hours, 2 to 3 days, or at 4 to 7 days.Children who underwent tonsillotomy were able to return to normal activity 4 days earlier (MD 3.84 days, 95% CI 0.23 to 7.44; 3 studies, n=248) comapred to tonsillectomy.
No difference in the recurrence of oSDB symptoms at 6 months (RR 0.26, 95% CI 0.03 to 2.22; 3 studies, n=186), 12 months (RR 0.35, 95% CI 0.04 to 3.23; 4 studies, n=206), or 24 months (RR 0.21 95% CI 0.01 to 4.13; 1 study, n= 65 children) were observed. Data on the effects of the 2 operations on the resolution of signs and symptoms of oSDB itself, quality of life and behaviour of the child, recurrence of oSDB, the incidence of throat infections and the need for a reoperation were limited. Although studies reporting these outcomes found no differences between the two surgical procedures, these findings should be interpreted with great caution since the evidence derived from these studies was mostly of very low certainty.
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