Efficacy of tonsillectomy for pediatric patients with dysphagia and tonsillar hypertrophy

Objective: To determine the effectiveness of tonsillectomy for the treatment of dysphagia related to tonsillar hypertrophy. Design: Prospective cohort study. Setting: Tertiary care pediatric otolaryngology practice. Participants: Eighty-five children aged 2 to 14 years referred for tonsillectomy owing to dysphagia related to tonsillar hypertrophy (dysphagia cohort) or for other indications (control cohort). Interventions: Swallowing Quality of Life (SWALQOL) dysphagia questionnaires were administered at the initial clinic visit, on the day of surgery, and at 1 month and 6 months after surgery. Patients were weighed on the day of surgery and at 1 month after surgery. Main Outcome Measures: The primary outcome measure was the SWAL-QOL score. Secondary outcome measures were the type of diet consistency patients tolerated at home and the weight percentile for age. Results: Of 85 patients enrolled, 57 went on to have surgery, completed at least 1 postoperative questionnaire, and were included in the data analysis. At 1 month after tonsillectomy, the dysphagia cohort (n=18) demonstrated improved SWAL-QOL scores (mean [SD], 58.4 [4.8] before surgery vs 82.4 [5.3] after surgery; P<.001), more patients tolerating a regular diet (12 of 37 patients [33.3%] before surgery vs 22 of 36 [60.0%] after surgery, P=.01), and increased weight percentile for age (mean [SD], 36.5 [10.7] before surgery vs 50.0 [10.6] after surgery; P=.01). Similarly, at 1 month after tonsillectomy, the control cohort (n=39) demonstrated improved SWAL-QOL scores (mean [SD], 80.8 [2.6] before surgery vs 91.7 [1.8] after surgery; P<.001), more patients tolerating a regular diet (30 of 37 patients [81.1%] before surgery vs 34 of 36 patients [94.4%] after surgery, P=.04), and increased weight percentile for age (mean [SD], 62.8 [5.4] before surgery vs 70.4 [5.1] after surgery; P=.003). Conclusions: Dysphagia related to tonsillar hypertrophy is a significant problem not only among children with dysphagia with a primary complaint but also among a large subset of patients referred for tonsillectomy for other indications. Following tonsillectomy, both groups experience significant improvement in swallowingrelated quality of life, ability to tolerate a regular diet, and weight percentile for age. Tonsillectomy is an effective treatment for the management of dysphagia related to tonsillar hypertrophy in children.