Research Gaps - Tonsillectomy in Children
While there is a body of literature from which the guidelines were drawn, significant gaps remain in knowledge about preoperative, intraoperative, and postoperative care in children who undergo tonsillectomy. As determined by the guideline panel's review of the literature, assessment of current clinical practices, and determination of evidence gaps, research needs were determined as follows:
- Investigate the treatment of recurrent throat infections by tonsillectomy versus antibiotics/watchful waiting (less than and greater than 12 months) using a multicenter, randomized controlled trial design and including the following endpoints: QoL, health care utilization, missed school days, parental satisfaction, and recurrence of throat infections.
- Conduct prospective cohort studies on indications for PSG in children with SDB and other comorbidities.
- Measure QoL/school performance (not just missed school days) following tonsillectomy in mild SDB patients and those with recurrent infections whose history does not meet Paradise criteria.
- Determine if the 12-month watchful-waiting period causes unnecessary morbidity based on QoL/school performance measures.
- Determine the optimal follow-up schedule for SDB following tonsillectomy.
- Determine when postoperative polysomnogram is indicated after tonsillectomy for SDB.
- Determine when preoperative polysomnogram is indicated.
- Determine the percentage of patients who have full resolution/partial resolution/no resolution of SDB in the short-term and long-term postoperative period.
- Assess how future weight gain/obesity would play a role in failure to respond following tonsillectomy for SDB.
- Assess the immunological role of the tonsils and, specifically, at what point the benefits of tonsillectomy exceed the harm using a biomarker approach.
- Determine the cost-effectiveness (direct and indirect) of different tonsillectomy techniques.
- Evaluate and compare oral postoperative pain medications.
- Conduct studies that incorporate hydration as an outcome measure.
- Determine the optimal regimen for treating PONV in children who have received dexamethasone.
- Investigate microbiologic and immunologic changes associated with tonsillectomy to provide a reasonable pathophysiologic explanation for perceived improvement with surgical intervention through a change in oropharyngeal and/or nasopharyngeal biofilms or flora.
- Assess for areas of improvement in the postoperative coordination between the primary care clinician and specialist.
- Evaluate the impact and use of the guideline by determining how the guideline translates to performance measurement and performance improvement.
- Evaluate shared decision making in tonsillectomy, specifically how to present risks and benefits in a quantitative or qualitative way to nonmedical individuals.