Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0037315 (sleep apnea)
 8,000 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Tonsillectomy (TE) is one of the most frequent as well as one of the most controversial surgical interventions. The objective of this paper was to assess the evidence of the most common indications for TE. For this purpose the literature of the past 25 years was analysed using the criteria of evidence based medicine. In children seventy-five percent of TEs are performed because of recurrent tonsillitis. Several randomised clinical trials (RCTs) have demonstrated the efficacy of TE in this disease. This indication is based on evidence grade I-II. No consensus has yet been reached, however, about the number of annual episodes that justify TE. The remaining paediatric TEs are performed to relieve symptoms of airway obstruction. TE has been shown to improve obstructive symptoms in up to 100% of patients. It is the accepted treatment of paediatric obstructive sleep apnoea, although the evidence is not based on major RCTs. In adults, too, the majority of TEs are performed for recurrent or chronic tonsillitis. There are no good RCTs, but the indication can be based on a series of well controlled studies (evidence grade III). Obviously, TE is indicated if there is suspicion of neoplasm. Peritonsillar abscess per se is no indication for TE, unless the abscess cannot be drained otherwise. TE plays no role in the standard management of OSAS and mononucleosis.
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PMID:[Evidence based indications for tonsillectomy]. 1519 18

Possible indications for tonsillectomy include sleep apnea and other obstructive sleep-related breathing disorders, recurrent tonsillitis, peritonsillar abscess, periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA), and other miscellaneous rare conditions. Over the last century indications have changed, with a decrease in infectious causes and an increase in sleep apnea disorders. Sleep apnea in children is difficult to diagnose short of polysomnography (PSG) which is expensive and disturbing, especially in young children. In sleep apnea confirmed by PSG, tonsillectomy relieves the trouble in close to 80% of patients. What remains unclear is how to diagnose sleep-related breathing disorders without PSG and the efficacy of tonsillectomy in this population. Recurrent tonsillitis is generally poorly documented and randomized studies assessing the efficacy of tonsillectomy are sparse. When frequent infections are present for several years (>7 episodes/1 year, >5/2, >3/3) some benefit from tonsillectomy could be found. If fewer infectious episodes are present, the benefit of tonsillectomy is low. Peritonsillar abscess tends to be treated with quinsy tonsillectomy. Some PFAPA and psoriasis children might benefit from tonsillectomy. Tonsillectomy for other conditions is not warranted.
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PMID:Indications of pediatric tonsillectomy. 2397 10