Effects of Tonsil size on Pulmonary Function test Results after Tonsillectomy in Children

Document Type : Original


1 Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran.

2 Department of Otorhinolaryngology Head and Neck Surgery, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran.

3 Department of Epidemiology and Biostatistics, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran.


Adenotonsillar hypertrophy is a typical cause of surgery in children. Evaluation and identification of patients as potential candidates tonsillectomy is a primary concern for otolaryngologists. This study focuses on the results of pulmonary function tests (PFTs) after tonsillectomy in children.
Materials and Methods:
This cross-sectional study examined 50 patients suffering from tonsillar hypertrophy in 2013. Full details and results of otolaryngology examinations were recorded. Moreover, patients were examined with respect to forced inspiratory flow at 50% of vital capacity (FIF50%), forced expiratory flow at 50% of vital capacity (FEF50%), forced expiratory volume in 1 second (FEV1)/peak expiratory flow rate (PEFR), and FEV1/forced expired volume in 0.5 seconds (FEV0.5) before and after surgery using spirometry. All data were analyzed using SPSS Software (version 19), and central descriptive measures, and data were compared by performing T-test and Chi-square tests.
According to tonsil size, patients were distributed as follows: 18 patients (36%) with +1 tonsil size, 18 patients (36%) with +2 tonsil size, and seven patients (14%) with +3 tonsil size, and seven patients (14%) with +4 tonsil size. Thirty-three (66%) and 17 patients (34%) were female and male, respectively, with a mean of age of 9.7 2.97 years (range, 7–18 years). Seventy-eight percent of patients were aged 10 years or less. Moreover, 25 patients (50%), 17 patients (34%), and eight patients (16%), respectively, reported obstructive symptoms, recurrent tonsillitis, and both symptoms. In patients with +3 and +4 tonsil size, spirometric parameters indicated relief of symptoms of obstruction. Only in patients with +4 tonsil size were the changes statistically significant.
Tonsillectomy can relieve obstructive symptoms in patients with tonsils larger than +3 to a great extent. Additionally, spirometry can identify patients with +3 and +4 tonsils who do not have clinical signs of an obstructive upper airway.


Main Subjects

1. Baugh RF, Archer SM, Mitchell RB, Rosenfeld RM, Amin R, Burns JJ, et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 2011; 144(1) Suppl S1–S30.
2. Lescanne E, Chiron B, Constant I, Couloigner V, Fauroux B, Hassani Y, et al. Pediatric tonsillectomy: clinical practice guidelines. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129(5):264–71.
3. Bellussi LM, Marchisio P, Materia E, Passali FM. Clinical guideline on adenotonsillectomy: the Italian experience. Adv Otorhinolaryngol 72:142–5.
4. American Academy of Otolaryngology-Head and Neck Surgery; Clinical Indicators: Adenoidetomy http:// www.entnet. org/ Practice/ upload/ Adenoidectomy- CI_Final- May- 2012. pdf (Accessed on August 14, 2013).
5. Leach J, Olson J, Hermann J, Manning S. Polysomnographic and clinical findings in children with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 1992; 118(7):741-4.
6. Brouillete RT, Fernbach SK, Hunt CE. Obstructive sleep Apnea in infants and children. J Pediatr 1982; 100(1): 31-40.
7. Abdu MH, Feghali JG. Uvulopalatopharyngoplasty in a child with obstructive sleep apnea. J Laryngoloto 1988; 102(06):546–8.
8. Ali NJ, Pitson D, Stradling JR. Effects of adenotonsillectomy on behavior and psychological functioning. Eur J Pediatr 1996;155: 56–62.
9. Anuntaseree W, Rookkapan K, Kuasirikul S, Thongsuksai P. Snoring and obstructive sleep apnea in Thai school-age children: Prevalence and predisposing factors. Pediatr. Pulmonol 2001; 32(3): 222–7.
10. Farber J. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome Pediatrics 2002; 109:704–12.
11. Helmus, C. Tonsillectomy and adenoidectomy in the one and two-year-old child. The Laryngoscope. 1979; 89(11):1764–71.
12. Kavukcu S, Coskun S, Cevik N, Kuscu B, Akkoclu A. The importance of pulmonary function tests in adenotonsillectomy indications. Indian J Pediatr 1993; 60:249–55.
13. Yadav SPS, Dodeja OP, Gupta KB, Chanda R. Pulmonary function tests in children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2003; 67(2):121–5.
14. Kornblot A. A Traditional approach to surgery of the tonsils and adenoids. Otolaryngol Clin North Am 1987; 20(2):349–63.
15. Van Den Akker EH, Hoes AW, Burton MJ, Schilder AG. Large international differences in (adeno) tonsillectomy rates. Clin Otolaryngol Allied Sci 2004; 29:161–4.
16. Blair RL, McKerrow WS, Carter NW, Fenton A. The Scottish tonsillectomy audit. Audit Sub-Committee of the Scottish Otolaryngological Society. J Laryngol Otol 1996; 110 Suppl 20:1–25.
17. Boss EF, Marsteller JA, Simon AE. Outpatient tonsillectomy in children: demographic and geographic variation in the United States, 2006. J Pediatr 2012;160:814–9.
18. Capper R, Canter RJ. Is there agreement among general practitioners, paediatricians and otolaryngologists about the management of children with recurrent tonsillitis? Clin Otolaryngol Allied Sci 2001; 26(5):371–8.
19. Lock C, Wilson J, Steen N, Eccles M, Brittain K, Carrie S, et al. Childhood tonsillectomy: who is referred and what treatment choices are made? Baseline findings from the North of England and Scotland Study of Tonsillectomy and Adenotonsillectomy in Children (NESSTAC). Arch Dis Child 2010;95:203–8.
20. Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. Natl Health Stat Report 2009;(11):1–25.
21. Baugh RF, Archer SM, Mitchell RB, Rosenfeld RM, Amin R, Burns JJ, et al. Am Acad Otolaryngol Head Neck Surg Found. Clinical Practice Guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 2011;144(1 Suppl):S1–30.
22. Ramos SD, Mukerji S, Pine HS. Tonsillectomy and adenoidectomy. Pediatr Clin North Am  2013; 60(4):793–807.
23. Clayburgh D, Milczuk H, Gorsek S, Sinden N, Bowman K, MacArthur C. Efficacy of tonsillectomy for pediatric patients with dysphagia and tonsillar hypertrophy. Arch Otolaryngol Head Neck Surg 2011;137(12):1197–202.
24. Belyea J, Chang Y, Rigby MH, Corsten G, Hong P. Post-tonsillectomy complications in children less than three years of age: A case-control study. Int J Pediatr Otorhinolaryngol 2014;78(5):871–4.
25. Ruppel GL, Enright PL. Pulmonary function testing. Respir Care 2012;57(1):165–75.
26. Roland PS, Rosenfeld RM, Mitchell RB, Friedman NR, Jones J, Kim TW, et al. American Academy of Otolaryngology-Head  and  Neck  Surgery Foundation. Practice Guideline: Polysomnography Before Tonsillectomy in Children. Otolaryngol Head Neck Surg 2011;145(2 Suppl):   S1–15.
27. J.Epstein L, Kristo D, J.Strollo P, Friedman N, Malhotra A, Patil SP, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009; (5)3:263–76.