After a tonsillectomy, the OSA symptoms recede fully for some patients and, at least, partially for most of the patients.
Will tissue-saving tonsil surgery also be an option for adults in the future?Tonsillectomy, or the removal of the tonsils, is one of the most common surgical procedures in both children and adults. In children, it is increasingly usual to remove the tonsils only partially. The method is known as tonsillotomy and it accelerates the healing process after surgery. A current research project aims to clarify if this tissue-saving surgical technique would be a valid option for the treatment of tonsil-related issues in adults as well.
Writer: Jaakko Piitulainen
Tonsillectomy, or the removal of the tonsils, is one of the most common surgical procedures. The recovery after surgery takes, on average, 12 days for adults and 10 days for children. It is possible to remove the tonsils completely or partially. Recovery from a partial removal of the tonsils – also known as tonsillotomy or intracapsular tonsillectomy – is significantly faster and less painful. Research-based knowledge concerning tonsillotomy has accumulated especially for children with symptoms caused by the excess growth of tonsils. In this patient group, a partial removal of the tonsils has become increasingly popular also in Finland.
In adult patients, tonsils are, in most cases, still entirely removed. The most frequent indications for surgery in adults include recurrent or chronic tonsillitis. In addition, tonsillectomy is used as a method to treat obstructive sleep apnoea in patients with enlarged tonsils that narrow the mouth and throat.
In summer 2018, I had the opportunity to take part in the ESPO Congress, Working together for the Child, in Stockholm. Various tonsillectomy methods were one of the congress topics. On the basis of the presentations and discussions at the congress, I began to ponder if a tissue-saving surgery would be a feasible method for the treatment of tonsil-related issues in adults as well. Could a partial removal of the tonsils yield the benefits of a tonsillectomy, but with fewer complications, lower costs and a shorter recovery period?
Within the current research project, with funding granted by the Sakari Alhopuro Foundation, my research group aims to produce additional information about the safety, efficiency and cost-effectiveness of various tonsillectomy methods in the adult population. Our hypothesis is that by using a tissue-saving method, that is, intracapsular tonsillectomy, it is possible to shorten the average recovery time for patients. We also assume that the method will reduce post-operative pain and bleeding. Our initial research project focuses on patients aged 16–65 years with recurrent tonsillitis. The subjects will evaluate their recovery from the surgery on a daily basis over a period of three weeks. The efficiency of the treatment will be further assessed over a period of five years by means of symptom and quality of life questionnaires as well as a follow-up visit.
For the cost-effectiveness analysis, the direct and indirect costs related to the treatment will be investigated. The research will provide us with new information about the post-operative recovery period, which varies individually both in terms of duration and intensity of pain. The prospective, randomised and blinded study design is the strength of our study, which is aimed to compare the treatment outcomes of tonsillectomy, with the complete removal of the tonsils, versus intracapsular tonsillectomy as a tissue-saving method. Also, the follow-up period of five years enables us to evaluate the efficiency of the treatment in the longer term.
Our second project involves patients with obstructive sleep apnoea (OSA) and enlarged tonsils. Although OSA is one of our public diseases, the excess growth of tonsils (tonsillar hypertrophy) is not very common in adulthood. In my work as an ear-nose-throat specialist, however, I meet patients whose symptoms are compatible with those caused by large tonsils that narrow their mouth and throat. After a tonsillectomy, the OSA symptoms recede fully for some patients and, at least, partially for most of the patients. The treatment is considered successful if the interruptions of breathing during sleep decrease by 50 per cent. For some patients, the symptoms may recur in time. The strength of our study is the assessment of the severity of OSA by means of sleep recordings conducted at home before the operation and twice post-operatively, at six moths and two years after the surgery. The research will provide new information about the long-term outcomes of a tissue-saving tonsil surgery as a form of treatment for obstructive sleep apnoea.
Jaakko Piitulainen, MD, PhD, is currently working as a Specialist, Researcher and Clinical Lecturer at the Department of Ear, Nose and Throat Diseases of Turku University Hospital (Tyks) and the Department of Otorhinolaryngology of the University of Turku. In 2015, he earned his PhD from the University of Turku, with his thesis concerning the reconstruction of cranial bone defects with fibre-reinforced composite-bioactive glass implants. Within the research project funded by the Sakari Alhopuro Foundation, Piitulainen is leading a research team that investigates the safety, efficiency and cost-effectiveness of different tonsillectomy methods.