Elective Tonsillectomy Research Articles

The efficacy of a subhypnotic dose of propofol in preventing laryngospasm following tonsillectomy and adenoidectomy in children

Laryngospasm is a well-known problem typically occurring immediately following tracheal extubation. Propofol is known to inhibit airway reflexes. In this study, we sought to assess whether the empiric use of a subhypnotic dose of propofol prior to emergence will decrease the occurrence of laryngospasm following extubation in children. After approval from the Institutional Ethics Committee and informed parental consent, we enrolled 120 children ASA physical status I and II, aged 3-14 years who were scheduled to undergo elective tonsillectomy with or without adenoidectomy under standard general anesthesia. Before extubation, the patients were randomized and received in a blinded fashion either propofol 0.5 mg.kg(-1) or saline (control) intravenously. Tracheal extubation was performed 60 s after administration of study drug, when the child was breathing regularly and reacting to the tracheal tube. Laryngospasm was seen in 20% (n = 12) of the 60 children in the control group and in only 6.6% (n = 4) of 60 children in the propofol group (P < 0.05). During emergence from inhalational anesthesia, propofol in a subhypnotic dose (0.5 mg.kg(-1)) decreases the likelihood of laryngospasm upon tracheal extubation in children undergoing tonsillectomy with or without adenoidectomy.

An evaluation of pain and postoperative nausea and vomiting following the introduction of guidelines for tonsillectomy

Tonsillectomy and adenotonsillectomy have a high incidence of postoperative pain, and postoperative nausea and vomiting (PONV). Pain is traditionally controlled with morphine but this increases the risk of PONV and may cause respiratory depression. Antiemetics reduce PONV but their routine use has been questioned on safety grounds. After determining the current anesthetic management of elective tonsillectomy and adenotonsillectomy patients in our hospital, guidelines were developed to avoid the routine use of morphine and antiemetics. The effect on pain and PONV was then evaluated over a 3 month period. Postoperative pain was scored using the Oucher visual analog scale and nausea scored using a five point scale. We analysed 34 cases to determine our current practice and 37 cases to evaluate the effect of introducing guidelines. Postguidelines, the median Oucher pain score at 4 h was 10, and at 8, 12, 16 h was zero. Despite receiving no antiemetics, only two children vomited (5%) after introduction of guidelines. Guidelines which use a combination of paracetamol, nonsteroidal anti-inflammatory drugs and fentanyl, provide excellent analgesia with minimal PONV after elective tonsillectomy and adenotonsillectomy. As a result the routine use of morphine and antiemetics can be avoided.

Patients’ preferences for length of stay: valuable in day-case tonsillectomy planning

Day-case tonsillectomy is becoming more common, but patient satisfaction varies. Before beginning day-case tonsillectomies, we evaluated patients' wishes as to optimal discharge timing. We conducted a prospective study of all 294 patients undergoing elective tonsillectomy or adenotonsillectomy at a tertiary care clinic for 1 year. At discharge, patients received a questionnaire on their preferred length of stay. Of the 236 (80.3%) patients returning the questionnaire, 94 (39.8%) preferred discharge on the 1st, 141 (59.7%) on the 2nd postoperative day or later, and only one patient (0.4%) would have wished day-case tonsillectomy. Patients with postoperative fever, older patients and those discharged on the 2nd postoperative day or later were more likely to prefer a longer postoperative stay. Patients rejected the idea of day-case tonsillectomy after in-patient operation. Day-case tonsillectomies should be begun only after careful preparation of the staff, in children, and preferably in a day-surgery unit.

Post-tonsillectomy haemorrhage: A retrospective comparison of abscess- and elective tonsillectomy

Conclusion. There is no increased risk of postoperative haemorrhage for abscess tonsillectomies in comparison to elective tonsillectomies. Objective. There is still controversy as regards the optimal management of peritonsillar abscess. Opponents of tonsillectomy à chaud cite an increased postoperative bleeding risk. Most authors who compared the risks of postoperative haemorrhage after tonsillectomy à chaud and tonsillectomy à froid did not take into consideration criteria such as the age and gender of the patients or the experience of the surgeon. We aimed to eliminate this bias by performing a retrospective study in which a large series of abscess tonsillectomies were compared with an age- and gender-matched group of elective tonsillectomies. Material and methods. All patients had been operated on at the Department of Otorhinolaryngology, University of Duisburg-Essen between March 1994 and August 2000. There were 350 patients in the abscess tonsillectomy group (61% male, 39% female; mean age 31.8 years; range 3–88 years) and 311 in the elective tonsillectomy comparison group (61% male, 39% female; mean age 30.0 years; range 2–83 years). Results. In the abscess tonsillectomy group, 9 patients (2.6%; confidence level 1.1–4.8%) had postoperative haemorrhages which required treatment under general anaesthesia, compared to 17 (5.5%; confidence level 3.2–8.6%) in the age- and gender-matched group of “selected” elective tonsillectomies. The difference between these two rates was not significant (p=0.056). The fairly high rate of haemorrhages in the elective tonsillectomy group was mainly due to the effect of the age-matching procedure, which excluded a considerable number of usually unproblematic tonsillectomies for tonsillar hyperplasia in young children. Moreover, our results show that there is a learning curve for surgeons performing tonsillectomies with regard to postoperative haemorrhages.

Nurse-led ‘one stop’ clinic for elective tonsillectomy referrals

Nurse-led ‘one stop’ clinic for elective tonsillectomy referrals

Patient Contact with Healthcare Professionals after Elective Tonsillectomy

Objective—To assess the amount and causes of patient contact with healthcare professionals after elective tonsillectomy.Material and Methods—This was a prospective study. All consecutive patients undergoing elective tonsillectomy or adenotonsillectomy in 1997 received a questionnaire concerning the post-discharge period.Results—A total of 276 patients (93.6%) answered questions regarding post-discharge contact. After their discharge, 43.8% of patients contacted healthcare professionals. Pain was the leading indication for telephone contact, and hemorrhage for visits in person. Information given over the telephone was sufficient in 49.5% of cases. Telephone contact was followed by a visit in person in the case of hemorrhage in 88.9% of patients and in the case of pain in 34.1%. Contact was made most frequently in the older age groups.Conclusions—Although the patients repeatedly received both written and oral information, nearly half of them still contacted healthcare professionals during the recovery period. Frequent post-tonsillectomy contact should be taken into account when the financial and personnel resources of day surgery units are evaluated. In order to reduce the amount of post-tonsillectomy contact with healthcare professionals, careful attention must be paid to the quality of patient counseling prior to discharge.

Hemorrhage in abscess tonsillectomy

Objectives: The goal of this study was to evaluate the incidence, side, and possible predictive factors of posttonsillectomy hemorrhage in abscess tonsillectomy. Methods: A retrospective study was performed on 150 patients who underwent abscess tonsillectomy under general anesthesia between 1995 and 2002. Nine patients were excluded from the study because only unilateral tonsillectomy was performed. Age, sex, recurrent tonsillitis, prior peritonsillar abscess history, bleeding disorders, current treatments (NSAID, aspirin, antibiotics), side of peritonsillar abscess, initial treatment (observation, needle drainage, surgical incision, tonsillectomy), surgeon’s experience, operative time, anti-inflammatory treatment peri- and postoperatively, bacteriology, systolic and diastolic blood pressure, side and postoperative day of hemorrhage, and management strategy were reviewed. Results: A total of 103 patients (73%) underwent abscess tonsillectomy within the first 24 hours. In the other 38 patients (27%), observation, needle aspiration or surgical drainage did not show any improvement of symptoms, and tonsillectomy was performed on days 2 to 5. Bleeding occurred in 18 patients (12.8%). Ipsilateral hemorrhage was observed in 5 patients (3.5%), and contralateral hemorrhage in 13 patients (9.3%). This is a nonsignificant trend for bleeding on the contralateral side( P = 0.08). Posttonsillectomy hemorrhage occurred after the fourth day in all these cases. Only aspirin intake was associated with increased posttonsillectomy hemorrhage ( P = 0.015). Conclusions: The risk of postoperative hemorrhage (12.8%) in abscess tonsillectomy seems higher than reported in elective tonsillectomy. The posttonsillectomy hemorrhage incidence could be reduced by excluding patients taking aspirin and by performing only ipsilateral abscess tonsillectomy.

Inpatient treatment of tonsillectomy from the patient's point of view

Hospitalization after tonsillectomy for more than 24 h is still controversial. In order to obtain the patient's point of view, we designed a questionnaire for all patients undergoing tonsillectomy. From January 2002, we asked all patients admitted for elective tonsillectomy to fill out an anonymous questionnaire on their preferences for the duration of hospitalization after surgery. The majority of patients (79.6%) returning the questionnaire supported a hospital stay of at least 4 days after surgery. Options for a shorter stay of only 24 h or tonsillectomy in day-surgery without overnight stay were declined by all patients. We found that most patients preferred to remain in hospital for about 4 days postoperatively because they felt that they would have better access to effective analgesia. Another reason involved the increased risk for haemorrhage during the first few days after tonsillectomy.

The Effect of Ketorolac and Fentanyl on the Emergence Characteristics after Sevoflurane Anesthesia in Children Undergoing Tonsillectomy and Adenoidectomy

Background: The rapid emergence and recovery from general anesthesia provided by sevoflurane is associated with a frequent incidence of emergence agitation in children. In this study, we compared the emergence and recovery profiles of patients who received sevoflurane with or without intravenous ketorolac or/and fentanyl. Methods: By using a prospective, double blinded design, 60 children of 3 to 10 year of age, scheduled for elective tonsillectomy and adenoidectomy, were anesthetized with sevoflurane (1-3 vol%) in a 50% gas mixture. Patients were randomized to one of four groups (group 1: sevoflurane only, group 2: sevoflurane + ketorolac 0.5 mg/kg, group 3: sevoflurane + fentanyl 1, group 4: sevoflurane + ketorolac 0.5 mg/kg + fentanyl 1). A blinded observer evaluated each patient using an agitation scale, Faces scale and an Objective pain/discomfort scale. Results: No significant differences were observed among the four groups regarding age, sex, weight or duration of anesthesia. Recovery and discharge times were not statistically different. The incidence of severe agitation and the scores of Faces scale in the post anesthesia care unit, were significantly lower in groups 2, 3 and 4 than in group 1 (P of fentanyl or both were sufficient to prevent severe emergence agitation and pain in children undergoing tonsillectomy and adenoidectomy with sevoflurane anesthesia.

Comparison of Emergence Agitation from Sevoflurane Anesthesia in Propofol or Thiopental Sodium Induction

Background: Sevoflurane, with its low pungency, rapid emergence and recovery, is an attractive anesthetic in paediatric anesthesia, but the high incidence of postoperative agitation represents a problem. Propofol-anesthesia is recognised for its rapid and clear-headed emergence. We tested the hypothesis that the maintenance of anesthesia with sevoflurane after propofol induction reduces the incidence of excitatory behavior compared with thiopental sodium induction. Methods: Children aged 4-10 years, undergoing elective tonsillectomy, were randomly assigned to receive propofol 2.5 mg/kg (Group P) or thiopental sodium 5 mg/kg (Group T) for induction. After loss of consciousness, tracheal intubation was performed with rocuronium 0.6 mg/kg and all patients received sevoflurane (2-3 vol.%)- (2 L/min)- (2 L/min) for anesthesia maintenance. Ventilation was controlled to maintain normocarpnia. At the end of surgery, sevoflurane and were discontinued and muscle relaxant was reversed. Extubation time, agitation grade in recovery room, postoperative side effects and time in the recovery room were checked and compared between the two groups. Results: Time to extubation (6.84 J 1.57 vs 8.48 1.05 min), discharge from the recovery room(33.7 3.9 vs 55.0 7.9 min) and emergence agitation incidence (8% vs 92%) were significantly different in Group P and Group T, respectively (P

Immediate tonsillectomy for peritonsillar abscess

Immediate tonsillectomy is the management strategy used in our hospital for peritonsillar abscess (PTA). To determine the effectiveness and safety of immediate tonsillectomy for PTA, we reviewed the cases of PTA treated in our clinic in comparison to cases of tonsillitis treated by elective tonsillectomy. During the past 20 years, a total of 238 patients were treated in our clinic for PTA. Immediate tonsillectomy was performed in 222 of these patients under general anesthesia. Elective tonsillectomy was performed in 423 patients. Blood loss was greater and hospital stay was shorter in patients who underwent immediate tonsillectomy than in those who underwent elective tonsillectomy. Tonsil remnants were found in five PTA patients, and postoperative bleeding occurred in four PTA patients. Airway obstruction, deep neck infection, MRSA enterocolitis, and pulmonary edema occurred in one PTA patient each. Although bacteremia occurred in 12 PTA patients, none of the 12 showed clinical symptoms of sepsis. Immediate tonsillectomy under general anesthesia was carried out safely in this patient series. We recommend immediate tonsillectomy under general anesthesia performed by a well-trained anesthesiologist for the treatment of PTA.

The Effect of Lesser Palatine Nerve Block on Pain after Elective Pediatric Tonsillectomy

Background: This prospective double-blind randomized study was performed to evaluate the an- algesic effect of lesser palatine nerve block for postoperative pain control after a pediatric tonsillectomy and to compare the analgesic effects of pre-emptive versus postoperative blocks. Methods: Forty-eight ASA class 1 children scheduled for an elective tonsillectomy were randomized into three groups. Patients received lesser palatine nerve blocks using divided doses of 0.05 ml/kg of 0.2% ropivacaine 5 min prior to the beginning of tonsillectomy (Pre-block group or immediately after surgery (Post-block group. Patients allocated into the Control group did not receive any nerve block. Postoperative pain was measured immediately after surgery 3 6 12 and 24 hours following operation using a 0 to 4 points pain scale based on a facial expression of pain scale ruler. Side effects and the number of analgesic injections were observed for 24 hours postoperatively. Results: No significant differences in the pain scores were observed immediately after surgery and at 3 6 12 and 24 hours after operation in the three groups (P > 0.05. The number of analgesic injections was similar in the groups. Conclusions: T he results of this study reveal that the lesser palatine ner ve block was not effective for postoperative pain control following pediatric tonsillectomy and that the pre-emptive block offered no pain control benefit over the postoperative block. Therefore we do not recommend lesser palatine nerve blocks for the management of postoperative pain after pediatric tonsillectomy. (Korean J An- esthesiol 2003; 44: 820~827

Tramadol for pain relief in children undergoing tonsillectomy. A comparison with morphine

Introduction Pain control for paediatric patients undergoing tonsillectomy remains problematic. The combination of intra‐operative morphine and rectal diclofenac results in a high incidence of post‐operative nausea and vomiting as well further analgesic requirements. Tramadol is reported to be an effective analgesic and have a side effect profile similar to morphine. It is not classed as a controlled drug and is available in tablet, suppository and injection form. It is currently not licensed for paediatric use in the UK.Methods We conducted a prospective, double blind, randomised controlled trial in children scheduled for elective tonsillectomy or adenotonsillectomy at the Royal Aberdeen Children Hospital. Following local ethics committee approval and obtaining a drug exemption certificate from the Medicines Licensing Agency for an unlicensed drug in paediatrics we recruited 60 patients into three groups: morphine (0.1 mg·kg−1), tramadol (1 mg·kg−1) and tramadol (2 mg·kg−1). These drugs were given as a single injection following induction of anaesthesia. In addition, all patients received diclofenac (1 mg·kg−1) rectally. The post‐operative analgesic requirements, sedation scores, signs of respiratory depression and nausea and vomiting as well as antiemetic requirements were noted at 4 hourly intervals until discharge. Statistical analysis was performed using chi‐square, Kruskal–Wallis and one‐way anova tests as appropriate. P &lt; 0.05 was considered statistically significant.Results There were no statistical significant differences in age, weight, type of operation or induction of anaesthesia, 4 hourly sedation and pain scores and further analgesic requirements. There were no incidences of respiratory depression. Morphine was associated with a significantly higher incidence of vomiting following discharge to the wards (75% vs 40%, P = 0.03) when compared to both tramadol groups. The differences in anti‐emetic requirements did not reach statistically significant difference (P = 0.078).Conclusions We conclude that tramadol has similar analgesic properties and side effects when compared with morphine. The pharmaceutical presentation and the availability as a non‐controlled substance may make it a useful addition to paediatric anaesthesia if it becomes licensed for paediatric anaesthesia in the UK.

Pre-Operative Versus Post-Operative Peritonsillar Infiltration with Local Anesthetic on Post-Tonsillectomy Pain

To compare the efficacy of either preoperative or postoperative peritonsillar infiltration of local anesthetic upon posttonsillectomy pain, 70patients aged 15/40 years scheduled for elective tonsillectomy under general anesthesia were divided into three groups. Six patients were excluded for failure to complete the postoperative data, two patients had post-operative bleeding and two patients developed otitis media on the second day postoperatively. Twenty patients received peritonsillar infiltration with 0.25% bupivacaine, twenty received 0.9% saline and a third group of twenty had peritonsillar infiltration with 0.25% bupivacaine after completion of surgery but before being awakened from anesthesia. Significant changes occurred with bupivacaine infiltration in reducing pain during the first 24 hours after surgery. It is concluded that preoperative and postoperative blocking of nociceptive impulses reduces postoperative pain but causes no reduction in the intake of analgesics. It is further suggested that the timing of peritonsillar infiltration with bupivacaine is not of clinical importance and does not affect the quality of postoperative analgesia in a patient undergoing tonsillectomy.

Increased post-tonsillectomy secondary haemorrhage with disposable instruments: an audit cycle.

The objective of the audit was to examine the increased morbidity associated with elective tonsillectomy with single-use instruments in a district general hospital in England. Retrospective audit of consecutive case notes of 145 patients who underwent tonsillectomy in a 6-week period after the introduction of single-use instruments was carried out. The main outcome measure was incidence of secondary haemorrhage. In total, 9.5% of patients required re-admission indicated by secondary haemorrhage, 4% required emergency surgery and 43% of the total group had haemostasis achieved with ties. None of these was re-admitted. Out of the total group, 57% had haemostasis achieved with single-use bipolar forceps; 16.8% of these patients were re-admitted, with 7% of this group requiring emergency surgery to control the haemorrhage. Animal tissue experiments and design analysis of the single-use bipolar diathermy highlighted the deficiencies of the initial single-use bipolar diathermy. This was replaced by a new design of single-use diathermy forceps. A second audit was performed which revealed a significant reduction in postoperative morbidity. Complications associated with the introduction of new instruments can be identified by repeated audit cycles.

Spontaneous resolution of recurrent tonsillitis in pediatric patients on the surgical waiting list

Objective: To assess the impact of the waiting list on the spontaneous resolution of recurrent acute tonsillitis in children. Methods: We have evaluated 623 cases placed on the waiting list for elective tonsillectomy (with or without adenoidectomy) between February 1994 and May 1999 at our institution. In each child, age, time on the waiting list, type of procedure and outcome were registered. There were two possible outcomes after the preoperative evaluation: tonsillectomy was still indicated or tonsillectomy was not necessary. Results: Mean length of time on the waiting list was 10.8 months (range: 3.0–35.6 months; median: 8.2 months). In 507 of the 623 children (81.4%), the operation was still indicated. However, 116 patients (18.6%) did not need surgery because of spontaneous resolution of the clinical picture. No relation was found between outcome and age, time on the waiting list or type of procedure ( P>0.05). Conclusion: There was no clinical evidence for claiming that resolution of recurrent acute tonsillitis in children is spontaneous with time.

The association between periodontal disease and peritonsillar infection: A prospective study

Objective: To study the relationship between periodontal status and peritonsillar disease/recurrent tonsillitis. Study Design and Setting: A total of 158 patients presenting over a 3-year period with peritonsillar abscess (PTA) confirmed by needle aspiration and a control group of 112 patients booked for elective tonsillectomy for recurrent tonsillitis (RT) were examined in terms of their periodontal status using the WHO Community Periodontal Index of Treatment Needs (CPITN). Results: The mean CPITN index was 2.81 (Standard Deviation [SD], 1.10) in patients with PTA and 1.41 (SD, 0.92) in patients with RT. One hundred seven of 158 patients with PTA had significant periodontal pathology (CPITN, 3 or 4) compared with 12 of 112 patients with RT. These differences were statistically significant. Conclusion: Patients with peritonsillar abscess had an increased prevalence of periodontal disease as compared with patients with recurrent tonsillitis. Significance: There is a need to further explore this correlation and determine its nature, although it could be the result of common pathogenic factors, a causal relation cannot be excluded. (Otolaryngol Head Neck Surg 2002;126:91-4.)

The management of severe infectious mononucleosis tonsillitis and upper airway obstruction.

Acute tonsillectomy has been advocated for severe infectious mononucleosis (IM) pharyngotonsillitis with upper airway obstruction (UAO) and not responding to corticosteroids. This paper reviews and rationalizes our management. A five-year chart review was carried out with a follow-up telephone survey. There were 36 admissions. Nine had UAO of whom 89 per cent (eight of nine patients) had a tonsillectomy. The diagnosis of UAO was not standardized. Twenty-seven patients did not have UAO and only a small proportion of these patients, 16 per cent (four of 25) went on to have an elective tonsillectomy. Corticosteroids made no significant difference to the tonsillectomy rate. UAO appears to identify patients with more severe disease who are likely to suffer recurrent tonsillitis. Acute tonsillectomy is an appropriate treatment option for this subgroup. The diagnosis of significant IM UAO is not defined and a schema is proposed. Recurrent tonsillitis is an uncommon sequela of severe IM pharyngotonsillitis without UAO.

The need for routine pre-operative coagulation screening tests (prothrombin time PT/partial thromboplastin time PTT) for healthy children undergoing elective tonsillectomy and/or adenoidectomy

In some medical centers, the routine pre-operative evaluation of healthy children undergoing elective tonsillectomy and/or adenoidectomy (T and A) includes coagulation screening tests (PT, prothrombin Time; PTT, partial thromboplastin time; and INR, international normalized ratio). In this retrospective study, we determined whether there is a positive correlation between prolonged PT/PTT/INR tests in healthy children, with no prior medical history of coagulation problems, and bleeding during surgery and/or bleeding in the month following surgery. We reviewed the records of 416 elective T and A surgeries performed at the Soroka University Medical Center in Beer-Sheva, Israel, over the course of 1999. One hundred and twenty-one (29.1%) patients had preoperative prolonged PT values but only four (3.3%) of these patients experienced light bleeding during surgery. Seven (5.8%) of the 121 patients with prolonged PT tests experienced bleeding episodes during the 1st month subsequent to the surgery. Of the 65 (15.6%) patients who had prolonged pre-operative INR values, only three (4.6%) experienced light bleeding during surgery. Two (3.1%) patients with prolonged INR values experienced light bleeding during the 1st month subsequent to surgery. Sixty-one (14.7%) patients had prolonged first preoperative PTT values, only five of whom (8.2%) experienced light bleeding during surgery. Two (3.3%) of the 61 with prolonged PTT values experienced light bleeding during the 1st month subsequent to surgery. We therefore concluded that pre-operative coagulation screening tests provide low sensitivity and low bleeding predictive value. As such, routine coagulation tests before T &A are not indicated unless a medical history of bleeding tendency is suspected.

Immediate abscess tonsillectomy — a safe procedure?

Objective: Peritonsillar abscess is the most common infection involving deep neck planes to be treated by otolaryngologists with varying management strategies. In some countries, like Japan, immediate tonsillectomy is considered only for selected cases due to the risk of post-operative complications. Post-tonsillectomy bleeding is considered as the major complication following surgery and serves as a landmark for the safety of the operation. The purpose of this study was to evaluate if there is an increased risk of post-tonsillectomy haemorrhage following immediate tonsillectomy in non-selected patients. Methods: A retrospective study was performed on 6329 patients who underwent tonsillectomy, with or without adenoidectomy, in St. Anna Hospital, Duisburg, between January 1988 and August 2000 to evaluate the complication rate following 1481 immediate tonsillectomies (group A) compared to 4848 patients who underwent elective tonsillectomy (group B). 56.9% (group A) were male, the youngest patient was 18 months, the oldest 87 years old. Patients of group B were younger in general (mean age: 18.7 vs. 32.9 years), 49.9% were male, between 5 months and 93 years of age. Patients of both groups underwent surgery under general anaesthesia and were observed for 6 days. The incidence of post-tonsillectomy haemorrhage in both groups was compared using χ 2-test, the age distribution was compared by Mann-Whitney U-test. Results: Bleeding occurred in 43 patients of group A (2.9%) and 138 patients (2.8%) of group B. Excessive bleeding requiring ligature of the external carotid artery became necessary in one patient of group A (0.13%) and four patients of group B (0.08%). A 42-month-old patient (group B) died due massive haemorrhage at home 6 days after surgery. The latest bleeding occurred 12 (group B) and 13 days (group A) after surgery. Statistical evaluation (Pearson χ 2-test P=0.908) shows no significant difference of post-operative bleeding between the compared groups. Post-tonsillectomy haemorrhage occurred with statistical significance ( P<0.001) in elder patients after immediate tonsillectomy. Conclusions: We conclude, that immediate tonsillectomy can be recommended as a safe surgical procedure in non-selected patients to evacuate quinsy without an additional risk of bleeding thus making a second hospital stay unnecessary.