Identifying cohort differences in children undergoing partial intracapsular tonsillectomy vs traditional tonsillectomy for sleep disordered breathing.

OBJECTIVE: Partial intracapsular tonsillectomy (PIT) is a well-established technique for reducing post-operative morbidity in pediatric patients with sleep disordered breathing (SDB). Although tonsillar re-growth rates are reported as low, risks of symptom recurrence or need for completion tonsillectomy are clear disadvantages when compared to traditional tonsillectomy (TT). We aim to identify cohort differences to better guide clinical decision making and identify patient-specific factors that may influence this decision. A secondary aim was to evaluate potential risk factors for tonsillar regrowth. METHODS: Retrospective chart review of pediatric patients who underwent TT or PIT for SDB between 2015 and 2019 at a tertiary care academic medical center. Records were reviewed for age, gender, race, body mass index, comorbidities, diagnosis, apnea-hypopnea index, pre-operative Brodsky tonsil size, length of stay, post-operative hemorrhage, tonsillar regrowth, symptom recurrence, and need for completion tonsillectomy. RESULTS: 315 patients were included: 174 underwent TT and 141 underwent PIT. Patients undergoing TT were more likely to have a sleep study showing OSA (OR 3.01, p < 0.0001), asthma (OR 4.28, p = 0.000124), and other comorbidities (OR 4.06, p = 0.0258). The overall complication rate was 4.44% (14/315). Tonsillar regrowth was exclusive to the PIT group, occurring in 7/141 patients (4.96%). Age ≤4 years was significantly associated with increased risk of tonsillar regrowth (≤4 years: 7.69%, >4 years: 0%; p = 0.049). Race and pre-operative tonsil size were not associated with regrowth. CONCLUSIONS: Our study supports the low incidence of tonsillar regrowth in PIT and suggests an association with younger age. Moreover, we found that patients undergoing TT are more likely to be older, have OSA, asthma, and other comorbidities.

Methicillin-resistant Staphylococcus aureus colonization in otitis-prone children.

OBJECTIVES: To examine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization among children undergoing bilateral myringotomy and tube insertion with or without adenoidectomy for chronic otitis media with effusion or recurrent acute otitis media, as well as to examine the occurrence of postoperative otorrhea in children who have vs do not have MRSA colonization. DESIGN: Prospective cohort study. SETTING: Hospital-based pediatric otolaryngology practice in a metropolitan area. PATIENTS: Seventy-six children (51 boys and 25 girls), with a mean (SD) age of 3.6 (1.8) years. INTERVENTIONS: Cultures for S aureus from the nasopharynx, external auditory canals, middle ears, and adenoid were obtained at the time of surgery, as well as middle ear cultures for bacteriologic culture and sensitivity. Patients were followed up for the development of otorrhea. MAIN OUTCOME MEASURES: Prevalence of MRSA colonization and predictors of subsequent otorrhea. RESULTS: The prevalence of S aureus colonization at the time of bilateral myringotomy and tube insertion was 7.9% (95% CI, 3.0%-16.4%), and the prevalence of MRSA colonization was 3.9% (95% CI, 0.8%-11.1%). All MRSA-positive specimens were resistant to erythromycin, and 2 were resistant to clindamycin. The mean (SD) follow-up period was 11.6 (3.6) months. Twenty-seven patients (35.5% [95% CI, 25.1%-46.9%]) developed at least 1 episode of otorrhea. One of 3 patients with MRSA colonization had subsequent otorrhea. The only predictor of otorrhea was younger age. CONCLUSIONS: The prevalence of MRSA colonization among otitis-prone children was similar to rates reported among the general pediatric community. Methicillin-resistant S aureus colonization at the time of bilateral myringotomy and tube insertion was not predictive of subsequent otorrhea.