Global tonsillectomy practice patterns - A survey study of pediatric otolaryngologists

Abstract

OBJECTIVE: There is variation in surgical techniques and postoperative management of tonsillectomy globally. Our objective was to consolidate international similarities and differences in tonsillectomy management by pediatric otolaryngologists. METHODS: This cross-sectional survey study was conducted from April 4 to May 16, 2024. It involved a 55-item questionnaire distributed online to an international sample of pediatric otolaryngologists via an international WhatsApp group comprising pediatric otolaryngologists from various countries. The study achieved responses from 132 out of 293 invited pediatric otolaryngologists (45.1 % response rate). Participants were from 22 countries. Eligibility included proficiency in English and currently practicing pediatric otolaryngology. RESULTS: Among respondents, the majority primarily performed extracapsular tonsillectomy (44.7 %), followed by those who used both intracapsular and extracapsular tonsillectomy equally (34.8 %), and those who predominantly performed intracapsular tonsillectomy (20.5 %). Ideal patient candidates for extracapsular tonsillectomy included those with recurrent tonsillitis (70.5 %), recurrent peritonsillar abscesses (67.4 %), and obstructive sleep apnea (46.2 %). Ideal candidates for intracapsular tonsillectomy were those with obstructive sleep apnea (50.0 %) and bleeding disorders (38.6 %). Intracapsular tonsillectomy adoption was notably high in this cohort, with 68.8 % of European respondents favoring intracapsular tonsillectomy. Postoperative pain management varied, with 76.5 % of respondents using acetaminophen, 77.3 % using ibuprofen, and 28.8 % prescribing opioids, primarily oxycodone (48.6 %). Access to polysomnography was reported by 84.0 % of respondents. Common indications for inpatient admission included age under three (75.8 %), medical comorbidity (71.2 %), and severe sleep apnea (59.1 %). CONCLUSION: This study highlights the increasing adoption of intracapsular tonsillectomy and the need for comprehensive guidelines addressing the observed global variability in practices.