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Original Investigation |

Effectiveness of Powered Intracapsular Tonsillectomy in Children With Severe Obstructive Sleep Apnea

Nadia Mostovych, MD1; Laurens Holmes, DrPH2; Nicole Ruszkay, BS3; Alexandra LaHurd, BS2; Robert Heinle, MD4; Heather Nardone, MD1,5
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
2Office of Health Equity and Inclusion, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
3University of Maryland, College Park
4Division of Pulmonary Pulmonology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
5Division of Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
JAMA Otolaryngol Head Neck Surg. 2016;142(2):150-156. doi:10.1001/jamaoto.2015.3126.
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Importance  Powered intracapsular tonsillectomy and adenoidectomy (PITA) is an increasingly common pediatric procedure. Few studies have examined its effectiveness in children with severe obstructive sleep apnea (OSA).

Objective  To assess the effectiveness of PITA in patients with severe OSA as evidenced by change in polysomnographic parameters.

Design, Setting, and Participants  We performed a case series study with medical record review of 70 children with severe OSA who underwent PITA at a tertiary care pediatric hospital from January 1, 2010, through December 31, 2014.

Main Outcomes and Measures  Preoperative and postoperative polysomnographic parameters.

Results  Of the 70 children with severe OSA who underwent PITA, 39 (56%) were boys, and the median age at surgery was 3.7 years. There were significant mean (SD) decreases in the postoperative apnea-hypopnea index (32.4 [28.4] vs 5.8 [9.7], P < .001), obstructive apnea index (20.4 [17.97] vs 2.55 [5.9]), obstructive apnea-hypopnea index (25.5 [22.4] vs 3.9 [7.3], P < .001), arousal index (53.7 [33.9] vs 27.4 [22.6], P < .001), percentage of total sleep time spent snoring (28.6 [30.5] vs 13.6 [20.8], P = .001), and oxygen desaturation index of 4% or more (22.9 [26.4] vs 4.5 [9.9], P < .001). Mean (SD) oxygen saturation (96.8 [2.0] vs 98.2 [1.3], P < .001) and oxygen saturation nadir (75.5 [13.1] vs 88.4 [8.1], P < .001) increased significantly. A significant decrease in time was observed with an end-tidal carbon dioxide greater than 55 mm Hg (49.67 [97.5] vs 19.1 [73.9] minutes, P = .01).

Conclusions and Relevance  Powered intracapsular tonsillectomy and adenoidectomy improved OSA in this series of pediatric patients by reducing obstructive apneas and hypopneas, oxygen desaturation, arousal index, carbon dioxide level, and snoring, as well as increasing oxygen saturation nadir. Results are comparable to those described for traditional electrocautery tonsillectomy and support the use of PITA for the treatment of severe OSA in children with adenotonsillar hypertrophy.

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