Re: “Systematic Review of Complications of Tonsillotomy versus Tonsillectomy”

We are writing in response to the recent publication by Acevedo and colleagues: “Systematic Review of Complications of Tonsillotomy versus Tonsillectomy.” ¹ The renewed interest in partial tonsillectomy as a treatment for tonsillar hypertrophy in sleep-disordered breathing has provoked rigorous debate within the otolaryngologic community. In 2003, Koltai ² published the first large retrospective series of 243 children undergoing partial tonsillectomy for sleep-disordered breathing, and since that time, there has been a plethora of studies comparing total and partial tonsillectomy in this population.

Most otolaryngologists would agree that if the partial tonsillectomy technique is used, it should be confined to a population with sleep-disordered breathing, and certainly most of the published evidence examines the pediatric cohort alone. For these reasons, it was disappointing that the authors included in their systematic review and meta-analysis studies comparing partial and total tonsillectomy in patients for whom tonsillitis was the indication for surgery. ³ In addition, conclusions were drawn for adults and children.

A previous systematic review of the level 1 evidence in the pediatric cohort comparing partial tonsillectomy to total tonsillectomy where the indication for surgery was sleep-disordered breathing has shown different conclusions to those you have published. ⁴ Superior outcomes were reported for partial tonsillectomy compared with total tonsillectomy for secondary hemorrhage rate and the number of days until pain free with no difference in other recovery-related outcomes.

Given that the otolaryngologic community is currently trying to determine best practice in this area, we feel this is an important distinction that should be drawn.