ORLANDO — Both the indications for, and the incidence of, adenotonsillar procedures in children have changed, according to Dr. Laura Orvidas.
“We seem to do more adenotonsillectomies for sleep-disordered breathing than we have in the past,” she said at the combined sections meeting of the Triological Society.
To evaluate changes in the incidence and indications for tonsillectomy and adenotonsillectomy, Dr. Orvidas of the Mayo Clinic in Rochester, Minn., reviewed data from the Mayo Clinic's database for a 35-year period between 1970 and 2005. The study population included 8,106 tonsillectomy and/or adenotonsillectomy patients aged 6 months to 29 years (mean age, 10.5 years).
The most interesting finding was the change in surgical indications for all procedures, said Dr. Orvidas: “Early on we were treating mostly for infection, and now it seems to be mostly for upper airway obstruction.” In 1970, treatment of infection accounted for approximately 90% of either adenotonsillectomies or tonsillectomies, while upper airway obstruction accounted for about 10%. In 2005, upper airway obstruction accounted for more than half of the indications for both procedures, while infection accounted for about 25% and a combination of both upper airway obstruction and infection accounted for approximately 20%.
The incidence of tonsillectomy or adenotonsillectomy was 369/100,000 person-years during the period from 1970 to 1974, compared with 642/100,000 person-years from 2001 to 2005, Dr. Orvidas said.
Sixty-five percent of the tonsillectomy patients, 48% of the adenotonsillectomy patients, and 55% of the patients for both conditions were female.
“Neither the indication nor the incidence for adenotonsillar surgery has been static,” Dr. Orvidas noted at the meeting, jointly sponsored by the Triological Society and the American College of Surgeons.
Adenotonsillectomy incidence increased more than tonsillectomy incidence overall, although there was a high density of tonsillectomies in adolescent females, she said. For tonsillectomy alone, the mean age across the entire study period was 16 years vs. a mean of 7 years for adenotonsillectomy.
Dr. Orvidas also noted an increase in both adenotonsillectomy and tonsillectomy procedures for younger males. The possible reasons for these two trends were not addressed in the Mayo Clinic study.
Disclosures: None was reported.