Indications For Tonsillectomy Research Articles

Indications for tonsillectomy: A 10 year retrospective review

ObjectiveRecurrent tonsillitis and obstructive sleep apnea (OSA) are the most common indications for tonsillectomy. This study was undertaken to determine if recurrent tonsillitis is increasing as an indication for tonsillectomy by reviewing the recent trend at a single institution. MethodsA retrospective chart review of patients undergoing tonsillectomy from 2003 to 2012 was performed. Data was gathered from pre-operative symptoms and sleep study results. Patients were categorized by the following indications: (1) obstructive sleep apnea, (2) recurrent tonsillitis and OSA, (3) recurrent tonsillitis alone and (4) other. Literature review was conducted to find similar studies; the results of the literature review were compared to our results. ResultsA total of 2369 patients were included, 52% were boys. Over the study period OSA was the indication for surgery for 67% of patients. There was an increasing trend in OSA as the indication for tonsillectomy (p<0.0001). Girls were more likely to have tonsillitis as an indication for tonsillectomy (21% vs. 17%, OR: 1.32, p<0.0001). Children younger than 2 or 2–5 are less likely than those older than 5 to have tonsillitis as an indication for surgery (2.30% and 6.26% vs. 27.46%, OR=0.06 and 0.18, p<0.0001). 987 of 2370 (42%) patients undergoing tonsillectomy had a pre-operative sleep study. Younger children were more likely to have had a sleep study. ConclusionThere were mild variations from year to year; however, obstructive sleep apnea is the most common reason for tonsillectomy.

Tonsillectomy under the age of 3 years: is it recommended or not?

Abstract Tonsillectomy is the most common surgical procedure in specialty of otorhinolaryngology. Therefore, there are frequent premises regarding this procedure to be improved from different aspects, indications, time of surgery, techniques, safety measures, and postoperative care. One of the major issues regarding this procedure is the most suitable age for the surgery. This point is creating a lot of controversies particularly at extreme age groups — that is, less than 3 years and more than 60 years. Although the extreme old age groups are considered as risky for any surgical procedures specially for tonsillectomy due to lack of proper body tissues tolerance and response to post-tonsillectomy bleeding as well as upper airway edema and obstruction, those age groups are still at lesser incidence of morbidity and mortality as compared to the infantile age groups who take the wider spectrum of ENT surgeons’ concentration, discussions, and studies regarding this issue. Therefore, this study was conducted prospectively to confirm whether tonsillectomy can be performed safely before 3 years of age with nonsignificant difference regarding postoperative morbidity and mortality as compared to the other age group of 3 years or above. A total of 648 children aged from 8 months to 8 years presented at ENT department, Al-Thowra central teaching hospital and Altarahom private center, Elbyda city, Libya during the period between September 2005 and October 2012 as cases of chronic adenotonsillitis with variable patterns of indications for tonsillectomy, namely 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. In all, 241 patients were under age of 3 years who represented group A, whereas remaining 407 patients at age of 3 years and above constituted group B. As prospective analytic study, both groups were compared with respect to intraoperative time consumption and whether there is any significant difference between the two groups regarding the incidence of serious postoperative complications occurrence, namely post-tonsillectomy bleeding, aspiration, airway obstruction, dehydration, postadenotonsillectomy negative pressure pulmonary edema, and metabolic as well as nutritional deficiencies. In addition, both groups were compared for any significant difference regarding the period of postoperative hospitalization, which can be used as objective indicator to measure the postoperative morbidity rate. This presenting study confirmed that the tonsillectomy procedure is an easy procedure among children younger than 3 years of age as in older children; this can be indicated by the appearance of nonsignificant difference between both groups regarding the intraoperative time consumption. In contrast, this procedure approved to be a safe procedure among children with age below 3 years as in older children; this was illustrated by the presence of nonsignificant difference between group A and group B regarding the serious suspected post-tonsillectomy complications, namely post-tonsillectomy hemorrhage, aspiration, airway obstruction, negative pressure pulmonary edema, dehydration, and metabolic as well as nutritional deficiencies. In general, tonsillectomy is a safe procedure that can be performed successfully among children at different age groups with low incidence of post-tonsillectomy complications as compared with adults.

Incidence and Potential Risk Factors of Post - Tonsillectomy Hemorrhage

Objective: To evaluate the incidence of postoperative tonsillectomy hemorrhage (PTH) and to identify the possible risk factors associated with its occurrence. Design: A Retrospective Study. Setting: Two private hospitals: Mahayel Hospital and Saudi German Hospital. Method: Four hundred seventy-seven patients had tonsillectomy or adenotonsillectomy from January 2008 to December 2013. All PTH incidents were identified. A data collection sheet was constructed by the author, which included patient’s age, sex, and day of postoperative bleeding evaluation. Result: Two hundred eighty-eight (60.4%) were children and 189 (39.6%) were adults. Two hundred forty-two (50.7%) were males. The indication for tonsillectomy in 394 (82.6%) was recurrent tonsillitis and in 83 (17.4%) was obstructive sleep apnea. Twenty-nine (6.1%) patients had PTH, 8 (27.6%) had primary PTH and 21 (72.4%) had secondary. The incidence of PTH was significantly higher among adult patients than children (9%, 4.2%, respectively, p=0.031) and among patients with recurrent tonsillitis than those with obstructive sleep apnea (7.1%, 1.2%, respectively, p=0.041). There were no statistically significant differences in timing of PTH (primary or secondary) according to patients’ characteristics. Conclusion: The incidence of PTH in our study is not high. Risk factors include older age and preoperative recurrent tonsillitis. PTH occurs mainly 24 hours postoperatively. Awareness of these risk factors should help improve patient care and outcomes. _________________________________________________________________________ *Associate Professor and Consultant of Ear, Nose and Throat Division Department of Surgery College of Medicine King Khalid University Abha, Kingdom of Saudi Arabia Email: alimaeedalshehri@yahoo.com; namas3@hotmail.com

Erkrankungen der Gaumenmandeln im Kindesalter

Die Operation an den Gaumenmandeln ist im Kindesalter eine der haufigsten, und oftmals ist es der erste chirurgische Eingriff bei einem kleinen Patienten. Seit der medienwirksamen Haufung an Todesfallen von Kindern nach Tonsillektomie in Osterreich 2006 kommt es langsam zu einem Paradigmenwechsel in Deutschland. Da jedoch klare Leitlinien fehlen, werden Eingriffe an den Tonsillen je nach Landkreis und Vorlieben sehr inhomogen gehandhabt. In einigen Kreisen werden 8-mal so vielen Kindern die Gaumenmandeln entfernt wie in anderen. Kinder unter 6 Jahren sollten nur noch bei andauernden bakteriellen Mandelentzundungen komplett tonsillektomiert werden. Die Teilentfernung der hyperplastischen Mandeln, die Tonsillotomie, ist wesentlich risikoarmer und der Tonsillektomie vorzuziehen. Die Blutungsgefahr und die postoperativen Schmerzen sind bei der Tonsillotomie deutlich geringer als bei der Tonsillektomie. Die Tonsillotomie kann mit dem Laser, Radiofrequenzgerat, Shaver, Coblation, bipolarer Schere oder monopolarer Nadel durchgefuhrt werden. Entscheidend ist, dass die Krypten offen bleiben und lymphatisch aktives Gewebe in der Fossa tonsillaris zuruck bleibt. Die Indikation zur Tonsillektomie besteht weiterhin bei rezidivierenden bakteriellen Infekten, Antibiotikaallergie, PFAPA Syndrom (periodisches Fieber, Apthen, Pharyngitis, Adenitis) und Peritonsillarabszess (einseitig). Bei den rezidivierenden Tonsillitiden kommt es auf die Schwere und die Haufigkeit an. Bei Kindern bis zum Alter von 16 Jahren sollte man sich an die Paradise Kriterien halten: Eine Indikation zur klassischen, kompletten Tonsillektomie besteht bei 5 oder mehr Tonsillitiden in mindestens 2 aufeinander folgenden Jahren oder bei 7 oder mehr Tonsillitiden innerhalb eines Jahres. Die Diagnose Tonsillitis kann klinisch gestellt werden. Sie besteht bei Schmerzen, tonsillarem Exsudat und Fieber>38,3°C. Wandernder Schmerz, niedrigeres Fieber und Husten lassen eher an eine Viruspharyngitis denken. Im Zweifel sollte ein Abstrich oder Antigentest angelegt werden. Beim Abstrich oder Antigen-Schnelltest muss aber berucksichtigt werden, dass Viren, Bakterien und Pilze zur transienten Mundflora gehoren und 10% aller Kinder klinisch inapparente, nicht behandlungsbedurftige Dauerausscheider von Streptokokken sind. Screeningtests mittels Antistreptolysintiter, Abstrichen oder Schnelltests (wie von manchen Kindertagesstatten gefordert) sind daher sinnlos und rechtfertigen keine Antibiotikatherapie. Die akute, bakterielle Tonsillitis sollte mit nicht steroidalen Antirheumatika (z. B. Ibuprofensaft), Betalactamantibiotika (z. b. Penicillin oder Cefuroxim) und bei Kindern und Jugendlichen auch oralem Steroid (z. B. Dexamethason) behandelt werden. Hinsichtlich der Verkurzung des Krankheitsverlaufes und der Reduktion der Symptome ist die Kurzzeittherapie mit Azithromycin (20mg/kg KG) fur 3 Tage oder Clarithromycin und einem Cephalosporin fur 5 Tage der Langzeit Penicillintherapie ebenburtig. Auch das fruhzeitige Absetzen der Penicilline nach 5 Tagen zeigte keine Nachteile im Krankheitsverlauf, der Rezidivrate oder der Resistenzbildung. Aber nur die empfohlene 10 Tage Antibiotikatherapie senkt die Inzidenz des rheumatischen Fiebers (derzeit 0,5 Falle pro 100 000 Kinder in Europa) und der Glomerulonephritis signifikant. Hauptproblem bei der Tonsillektomie ist, neben dem Schmerz, die gefurchtete Spatnachblutung. Diese kann bis zum kompletten Abheilen der Wunde (i. d. R. nach drei Wochen) auftreten und lebensbedrohlich sein. Grosere Massenblutungen kundigen sich oft durch kleinere, spontan sistierende Blutungen an. Daher muss jede Nachblutung ernst genommen und der betroffene Patient stationar aufgenommen werden. Die Patienten und die Eltern sind uber das korrekte Vorgehen bei Nachblutung idealerweise vor der Operation, aber spatestens bei Entlassung, schriftlich zu informieren. Das Informationsblatt sollte Adressen, Notruftelefonnummern und Ansprechpartner enthalten. Schwere oder letale Verlaufe entstehen meist durch falsches Management der Nachblutung. Eine besondere Lebensgefahrdung besteht bei Kleinkindern, die ein geringes Blutvolumen haben und relativ viel Blut unbemerkt schlucken konnen, bzw. aspirieren. Fur den Notarzt stellt die Intubation einer massiven Nachblutung nach Tonsillektomie eine extreme Herausforderung dar, welche oft nur mit einem geeigneten starren Tonsillensauger bewerkstelligt werden kann. Alle Operationstechniken haben ein Risiko der Nachblutung und selbst der erfahrenste Operateur ist nicht davor gefeit. Jedoch zeigte die „Kalte Dissektion“ mit Ligatur oder Umstechungen die geringsten Nachblutungsraten. Nach Laser-, Coblations-, mono- oder bipolaren Techniken kommt es signifikant haufiger zu schweren Nachblutungen. Kinder mit Gerinnungsstorungen bluten haufiger nach und konnen praoperativ unentdeckt bleiben. Eine standardisierte Blutungsanamnese (17 Punkte Checkliste), wie von den Fachgesellschaften fur Padiatrie, Anasthesie und HNO empfohlen, ist sensitiver und einfacher als das Screening mittels Gerinnungsparametern. In der Realitat zeigt sich jedoch, dass in Deutschland sehr viele der operativ-tatigen HNO Arzte weiterhin harte Laborwerte wie INR und PTT bevorzugen, obwohl diese den haufigen Von-Willebrand-Faktormangel nicht detektieren ­konnen.

Indications for tonsillectomy and adenoidectomy: Our experience

Infection and obstruction are the most common indications for performing tonsillectomy and adenoidectomy. In the past, infection was the main indication for these procedures; however, in the last few decades obstruction is said to be more prominent as an indication when compared to infection. The objective of this study was to report our observations of indications for tonsillectomy and adenoidectomy. This is a 2 year retrospective analysis of case records of patients aged 0-18 years who have had tonsillectomy, adenoidectomy and adenotonsillectomy performed in a tertiary hospital. IBM SPSS (for windows, version 19) software was used to analyze this data. A total of 115 patient's records were reviewed. Moreover, 33.9% were children under 3 years, 60.0% were between 4 years and 10 years and 6.1% were between the ages of 11 years and 18 years. Obstruction accounted for a total of 68.7% while infection accounted for only 31.3% of the indication for these procedures. Obstruction as an indication is proportionally higher in younger children while infection is proportionally higher in older children.

Coblation tonsilloadenoidectomy - treatment of choice for very small children

Tonsillectomy is one of the most common operative procedures in childhood. According to the Croatian national guidelines for the treatment of sore throat (ISKRA guidelines), apsolute indications for tonsillectomy are recurrent tonsillitis (>4 per year) and sleep disordered breathing (including snoring and obstructive sleep apnea). Most children in Croatia undergo conventional cold steel tonsillectomy with bipolar diathermy coagulation using reusable surgical accessories. Estimated blood loss during this type of surgery is about 10% of complete blood volume. That is why, tonsillectomy is performed mostly in children 3 years of age and above because their weight and blood volume. Coblation tonsillectomy results in less postoperative blood loss and less postoperative morbidity and is therefore the method of choice for operating on very small children.We present the case of a 3-year-old girl with somatic retardation (height 92 cm, weight 9,280 kg) who underwent coblation tonsilloadenoidectomy. As far as we now, this procedure has never been performed in a child of lower weight.

Effect of Thermal Welding Tonsillectomy on Emergence Agitation

: This study sought to examine the effect of thermal welding tonsillectomy that reduces pain and length of anesthesia on emergence agitation. A total of 60 patients (age range, 3–6 years) with chronic recurrent tonsillitis with an indication for tonsillectomy were included. Patients were randomly assigned to 2 groups. The control group (the CD group) was composed of patients undergoing cold dissection (CD) tonsillectomy. The study group (TW group) included patients undergoing thermal welding (TW) tonsillectomy. All patients were given sevoflurane as an anesthetic agent. For all patients, anesthesia time, operation time, extubation time, Pediatric Anesthesia Emergence Delirium scale, pain scale, nausea/vomiting score, and delivery time were recorded. The duration of anesthesia, operation, and delivery was significantly lower in the TW group as compared with the CD group (P = 0.000 < 0001). The pain and agitation scores were significantly lower in the TW group as compared with the CD group (P = 0.000 < 0001). We assume that, besides reducing pain and allowing surgery without bleeding, the TW tonsillectomy method diminishes emergence agitation induced by anesthetic agents, such as sevoflurane.

Tonsillar hyperplasia and recurrent tonsillitis: clinical-histological correlation

Hypertrophy and recurrent tonsillitis are common indications of tonsillectomy. However, the pathological reports are similar, regardless of clinical aspects. ObjectiveSearch for histopathological changes that differentiate palatine tonsils operated because of hypertrophy vis-à-vis those operated because of recurrent tonsillitis. MethodA prospective cross-sectional descriptive study involving 46 children divided into group I - 22 with hypertrophy; and group II - 24 with recurrent tonsillitis, in the period between 2010 and 2012, in a public hospital. We evaluated clinical and histopathological features (lymph follicles, germinal centers, fibrosis, necrosis, reticulation, infiltration by plasma cells and neutrophils). ResultsThe patients' ages ranged between 2 and 11 years (5.17 ± 2.28). In group I, half of the patients had had the latest infection at seven months or more, and all with obstruction degree greater than 3 (≥ 50%). In group II, all had had the latest infection at less than seven months, and most with obstruction degree below 4 (≤ 75%). There was a statistically significant difference in the degree of obstruction (p = 0.0021) and number of germinal centers (p = 0.002) was higher in group I. ConclusionThis study suggests that the number of germinal centers is the only histopathological criterion that can be used to differentiate the two groups.

Evolving Indications for Tonsillectomy

Objectives: Determine if there is a change in the trend of indication for tonsillectomy in a pediatric population over the last 9 years. Recurrent tonsillitis and obstructive sleep apnea are the two most common indications for tonsillectomy. Recurrent tonsillitis was the most common indication for tonsillectomy from the 1950s to 1980s. With the advent and effectiveness of antibiotic therapy for treatment of tonsillitis, however, recurrent tonsillitis has become a less prevalent indication. Methods: A retrospective chart review of patients undergoing tonsillectomy from 2003 to 2012 at a tertiary care children’s hospital was performed. Patients were categorized by indication with the following group classifications: 1) Obstructive sleep apnea/sleep disordered breathing (OSA/SDB), 2) Recurrent tonsillitis and SDB/OSA, and 3) Recurrent tonsillitis alone. The data were analyzed using SPSS software. Results: A total of 2367 patients undergoing tonsillectomy were identified, 52% male, with mean age of 6.4 years. The frequency of OSA as an indication for tonsillectomy increased from 37% in 2003 to an average of 71% over the last 3 years. In 2003, 33% of children underwent tonsillectomy for recurrent tonsillitis alone. This dropped to a low of 10.5% in subsequent years. In the last half of 2011 and throughout 2012, the incidence increased to about 19%. Children with OSA and sore throats together as an indication for surgery has run about 12% over the last 5 years. Conclusions: Recurrent tonsillitis dropped in frequency around 2005, but more recently there has been a trend toward an increase in its frequency.

Is the Trend in Indications for Tonsillectomy and Adenotonsillectomy Really Changing?

Objectives: Infection and obstruction are the most common indications for performing tonsillectomy and adenotonsillectomy. In the past, infection was the main indication for these procedures; however, in the last few decades, obstruction is said to be more prominent as an indication when compared to infection. This study evaluates the changing trend in indications for tonsillectomy and adenotonsillectomies. Methods: This is a 2 year retrospective analysis of case records of patients aged 0-18 years who have had tonsillectomy or adenoidectomy and tonsillectomy performed in Aminu Kano Teaching Hospital. IBM SPSS (for Windows, version 19) software was used to analyze these data. Results: A total of 115 patient case records were reviewed. 33.9% were children under 3 years old, 60.0% were between 4-10 years, and 6.1% were between 11-18 years. Obstruction accounted for a total of 68.7% while infection accounted for only 31.3% of the indications for these procedures. There was a significant association between age groups and indications for adenotonsillectomies ( P = 0001, Phi and Cramer’s V = 0.363, respectively). Conclusions: Obstruction as an indication is proportionally higher in younger children, while infection is proportionally higher in older children.

Indications of Pediatric Tonsillectomy

Possible indications for tonsillectomy include sleep apnea and other obstructive sleep-related breathing disorders, recurrent tonsillitis, peritonsillar abscess, periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA), and other miscellaneous rare conditions. Over the last century indications have changed, with a decrease in infectious causes and an increase in sleep apnea disorders. Sleep apnea in children is difficult to diagnose short of polysomnography (PSG) which is expensive and disturbing, especially in young children. In sleep apnea confirmed by PSG, tonsillectomy relieves the trouble in close to 80% of patients. What remains unclear is how to diagnose sleep-related breathing disorders without PSG and the efficacy of tonsillectomy in this population. Recurrent tonsillitis is generally poorly documented and randomized studies assessing the efficacy of tonsillectomy are sparse. When frequent infections are present for several years (>7 episodes/1 year, >5/2, >3/3) some benefit from tonsillectomy could be found. If fewer infectious episodes are present, the benefit of tonsillectomy is low. Peritonsillar abscess tends to be treated with quinsy tonsillectomy. Some PFAPA and psoriasis children might benefit from tonsillectomy. Tonsillectomy for other conditions is not warranted.

Tonsillectomy at age below 3 years: is it recommended?

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.

Sore throat consultations in general practice prior to tonsillectomy among eight hundred and sixty‐three children in England: is this in accordance with the SIGN guidelines?

The Scottish Intercollegiate Guidelines Network first published guidelines on the indications for tonsillectomy for sore throats in adults and children in 1999. These guidelines highlighted the importance of reserving the operation for those who are severely affected by recurrent sore throats and by applying the Paradise criteria. This study aimed to determine if the guidelines have been adopted by general practitioners.

The preoperative and postoperative oxidative status of children with chronic adenotonsillar hypertrophy.

This study aimed to evaluate the preoperative and postoperative oxidative status of children with chronic adenotonsillar hypertrophy. The study comprised 25 patients with indications for tonsillectomy and/or adenoidectomy following a diagnosis of chronic adenotonsillar hypertrophy and 25 age-gender matched control patients were included to the study. Blood samples were taken from the patients preoperatively and at four weeks postoperatively. Preoperative and postoperative serum total oxidant (TOS) and total antioxidant (TAS) levels were measured and the oxidative stress index (OSI) was calculated. The serum total oxidant level and oxidant stress index values in the preoperative and postoperative periods of the patients were found to be significantly high compared to those of the control group. While the preoperative serum total oxidant level values were found to be significantly high compared to the postoperative values, no statistical significance was found between the total antioxidant and oxidative stress index values. The development of chronic adenotonsillar hypertrophy plays a role in oxidative status and therefore, to neutralize high levels of oxidants in patients, the use of antioxidants for a period preoperatively and postoperatively is thought to be necessary.

Health costs and consequences: have UK national guidelines had any effect on tonsillectomy rates and hospital admissions for tonsillitis?

Tonsillectomy is a common therapeutic option in the management of recurrent tonsillitis. In 1999, the Scottish Intercollegiate Guidelines Network (SIGN) introduced SIGN 34 outlining appropriate indications for tonsillectomy. Following concerns of increasing hospital admissions for tonsillitis, in 2009 ENT UK suggested that too few tonsillectomies were being undertaken. This study analyses the effect the SIGN guidelines have had on trends in population rates of tonsillectomy and hospital admissions for tonsillitis and peritonsillar abscess in England, Scotland and Wales. A retrospective study was undertaken using the health databases of England, Scotland and Wales between 1999 and 2010. Tonsillectomy, acute tonsillitis and peritonsillar abscess were identified using national classification codes. Changes in rate of tonsillectomy and hospital admissions for tonsillitis and peritonsillar abscess were assessed using a linear regression model. 699,898 tonsillectomies were undertaken in the three national cohorts over the study period. Linear regression analysis suggested that implementation of SIGN 34 significantly reduced the population rate of tonsillectomy in England (p = 0.005) and Wales (p = 0.003) but not in Scotland (p = 0.24), and indicated there had been an increase in hospital admissions for acute tonsillitis in all cohorts (England p = 0.000008, Scotland p = 0.03, Wales p = 0.000005) and peritonsillar abscess in England (p < 0.05) and Wales (p = 0.03). SIGN 34 has reduced tonsillectomy rates in England and Wales but not in Scotland. This finding is associated with increasing hospital admissions for acute tonsillitis in all national cohorts, which may suggest that the current stipulated guidelines miss patients who would benefit from surgical intervention.

The immune status in situ of recurrent tonsillitis and idiopathic tonsillar hypertrophy

To analyze the immune status in situ of tonsils of patients with recurrent tonsillitis (RT) and idiopathic tonsillar hypertrophy (ITH) with the aim to discuss the indications of tonsillectomy (TE) and tonsillotomy (TT) in young children. The histological and immunohistological study of tonsillar tissue of RT and ITH in correlation with immunological parameters in peripheral blood in 13 patients with RT and 16 patients with ITH. In the RT group, we found a higher degree of fibrosis with a higher density of memory lymphocytes (CD45R0+), B-lymphocytes (CD20+) and cytotoxic T-lymphocytes (CD8+) in surface epithelium of tonsils compared to the ITH group (NS). The density of immunoglobulin IgG in the crypt epithelium in RT was significantly higher than in the ITH group (p = 0.041). We also measured a higher sera concentration of immunoglobulines (IgG, IgM, IgA) and TNF-α in RT compared to the ITH group (NS) and TH-1 immune response in tonsillar tissue based on differences between local cytokine concentration TNF-α and IL-4. RT has a higher inflammatory reaction in tonsillar tissue as a result of persistent bacterial antigenic stimulation. In patients with RT, the tonsillectomy might be the only option for surgical treatment. In patients with ITH with mild symptoms, the tonsillotomy should be preferred (Tab. 3, Ref. 24).

Gabapentin and Post Tonsillectomy Pain-The Next Best Thing?

Gabapentin and Post Tonsillectomy Pain-The Next Best Thing?

Evaluation of the validity of high serum antistreptolysin o titre only, as an indication for tonsillectomy.

Serum Antistreptolysin O (ASO) titre is raised when there is infection of any organ of the body, by Group A beta haemolytic streptococci (GABHS), Group C or Group G streptococci [1]. Increased serum ASO titre should not be the only deciding criterion for tonsillectomy if GABHS is not present in the palatine tonsils. In this study, we evaluate the rationality of performing tonsillectomy in raised serum ASO titre only, in absence of GABHS in palatine tonsil. The study was designed as a prospective cohort study in which the main out come measure is to find out: The main outcome measure is to find out whether only the raised serum ASO titre is to be considered to perform tonsillectomy or not. Fifty consecutive patients (both children and adults) clinically diagnosed to have chronic tonsillitis were included in this prospective cohort study. Throat swab culture, tonsilar core tissue culture and Serum ASO titre tests were performed in all the patients. The results showed that out of the 50 patients 45 had raised ASO titre and 5 patients had normal ASO titre. GABHS was found in 5 cases (10%) in throat swab culture and 8 cases (16%) in FNA of tonsil core culture. The sensitivity of throat swab culture as compared to FNA Tonsil core culture was 62.5% and positive predictive value was 100%. The sensitivity of ASO titre as compared to core culture was 100% and positive predictive value was 17.8%. Specificity was only 12%. From the results of this study, it is evident that FNA culture of the tonsil core is a valid and a reliable test for the diagnosis of bacterial micro flora in recurrent tonsillitis. One should perform throat swab culture and FNA culture from tonsil core along with ASO titre before doing tonsillectomy in absence of any other indications. Identifying GABHS in the tonsil by FNA test and/or in the throat swab culture along with high serum ASO titre may be one of the ideal indications for tonsillectomy.

Pediatric tonsillectomy: Clinical practice guidelines

This article presents the Clinical Practice Guidelines for Pediatric Tonsillectomy of the French Society of ENT and Head and Neck Surgery (SFORL), entitled "Amygdalectomie de l'enfant: Recommandation pour la pratique clinique" (SFORL, 2009). The French Society of ENT (SFORL), in partnership with the French Association for Ambulatory Surgery (AFCA) and French Society for Anaesthesia and Intensive Care (SFAR), set up a representative panel in the fields of anesthesiology, ENT and head-and-neck surgery, pediatrics, sleep medicine and general medicine. Following the literature analysis reported in the Presentation of the Guidelines, recommendations were drawn up taking account of risk/benefit ratios, levels of evidence, feasibility in pediatric tonsillectomy and baseline risk assessment in the relevant population. Around 50,000 pediatric tonsillectomies, with or without associated adenoidectomy, are performed in France each year. Postoperative morbidity and mortality are non-negligible, despite progress in peri-operative management. The present guidelines address the following questions: 1) What are the indications for tonsillectomy, notably in case of obstructive sleep disorder; 2) What pre-operative assessment is required? 3) What are the technical principles involved? 4) What are the selection criteria for ambulatory tonsillectomy? 5) How should postoperative follow-up be organized? 6) How should complications be managed? The present Clinical Practice Guidelines for pediatric tonsillectomy in France should improve clinical and organizational practices to enhance patient safety. They seek to ensure optimal conditions of care for all children undergoing tonsillectomy.

Predictive factors for prolonged hospital stay in pediatric tonsillectomy patients

To determine factors that may potentially predict a prolonged hospital stay after scheduled tonsillectomy in the pediatric population. Retrospective chart review. A review of pediatric patients who had undergone a tonsillectomy at a tertiary medical center from July 2007 to November 2010 was made. Preoperative variables were analyzed to determine predictors of prolonged hospital stay (defined as >24 h) that may have influenced their length of stay. Tertiary care medical center. 827 patient charts were reviewed. One hundred and one patients (12.2 %) had hospital stays >24 h. Indications for tonsillectomy included obstructive sleep apnea (69.2 %), tonsillitis (13.8 %), and tonsillar asymmetry (0.9 %). Seventy-seven (76.2 %) patients of the extended stay group had a delayed discharge because of poor oral intake. Fever and respiratory complications accounted for 0.5 and 1.8 % respectively of those patients who had extended stays. Patients with extended stays were younger (p < 0.001) and weighed less (p < 0.001). Patients with a history of sickle cell crises, reactive airway disease, bronchodilator use, and anti-reflux medication use (p < 0.05) were more likely to have a prolonged hospital stay. Factors from the history and physical of pediatric patients may predict which children are at higher risk for extended hospital stays after routine tonsillectomy. Predictors of extended stays include those under the age of four and children weighing <20 kg, those with a history of sickle cell crises or reactive airway disease, and those using bronchodilators or anti-reflux medication.