Tonsillectomy at age below 3 years: is it recommended?
Authors: Bofares Khalid M. 
Published: September 2023

EnAbstract
Back ground and objectives
Tonsillectomy is the most common surgical procedure in otorhinolaryngology and hence efforts are being constantly directed toward improving its various aspects, such as indications for the procedure, duration of surgery, techniques, safety measures, and postoperative care. One of the major concerns of this procedure is determination of the most suitable age for surgery. This issue is under a lot of controversy particularly with respect to extreme age groups of younger than 3 years and older than 60 years. Although the extremely old age groups are considered to be at risk for any surgical procedure, they are considered to be especially at risk for tonsillectomy because of lack of proper body tissue tolerance and response to post-tonsillectomy bleeding and upper airway edema and obstruction. However, individuals belonging to these age groups are still at lower risk for morbidity and mortality compared with infants, and hence a large part of ENT research is focused on this extremely young age group. Therefore, this study was conducted prospectively to confirm whether tonsillectomy can be performed safely in children younger than 3 years with nonsignificant difference with respect to postoperative morbidity and mortality as compared with the other age groups of 3 years or older.

Patients and methods
A total of 648 children aged from 8 months to 8 years presented at the ENT Department, Al-Thawra Central Teaching Hospital (Elbyda City, Libya), from 2005 to 2012 with chronic adenotonsillitis with variable patterns of indications for tonsillectomy, such as snoring and apnea attacks, persistent otitis media with effusion, recurrent attacks of acute suppurative otitis media, failure to thrive, recurrent attacks of chest infection, and malocclusive dental deformity. Of these 648 children, 241 were under the age of 3 years and represented group A, whereas the remaining 407 were aged 3 years and above and constituted group B. As a prospective analytical study, both groups were compared with respect to intraoperative time and the incidence of serious postoperative complications such as post-tonsillectomy bleeding, aspiration, airway obstruction, dehydration, postadenotonsillectomy negative-pressure pulmonary edema, metabolic changes, and nutritional deficiencies. In addition, both groups were compared with respect to the period of postoperative hospitalization, which can be used as an objective indicator of postoperative morbidity rate.

Results
This study confirmed that tonsillectomy is an easy and safe procedure among children younger than 3 years as it is in older children as indicated by the appearance of a nonsignificant difference between the two groups with respect to intraoperative time and occurrence of serious suspected post-tonsillectomy complications such as post-tonsillectomy hemorrhage, aspiration, airway obstruction, negative-pressure pulmonary edema, dehydration, metabolic changes, and nutritional deficiencies.

Conclusion
Generally speaking, tonsillectomy is a safe procedure that can be performed successfully among children belonging to different age groups with a low incidence of post-tonsillectomy complications compared with adults.