Post Tonsillectomy Research Articles

Evaluation of Erythrocyte Sedimentation Rate, C Reactive Protein and Ante-Streptolysin O Titer Regarding Tonsillectomy Indication and their Postoperative Changes

Objective: To evaluate the serum erythrocyte sedimentation rate, C reactive protein and antistreptolysin O titer as indicators for tonsillectomy with assessment of their postoperative changes.Patients and Methods: Our prospective comparative study was carried out on 150 patients divided into two groups. Group I included 75 patients clinically diagnosed as chronic tonsillitis by symptoms and signs and group II included 75 patients with previous tonsillectomy as a control group. Both groups were compared regarding the levels of the three laboratory markers. Also, the preoperative values of these markers were compared with postoperative values at 1, 3 and 6 months.Results: The values of the three markers in group I were higher than values in group II but statistically insignificant (p = 0.13, 0.11 and 0.78 respectively). There was a highly significant decrease in postoperative results of erythrocyte sedimentation rate, C reactive protein in group I at 1, 3 and 6 months after tonsillectomy (p value < 0.0001 for all). There was a significant decrease in postoperative results of antistreptolysin O titer in group I at 1, 3 and 6 months after tonsillectomy (p= 0.008, 0.019, 0.001 respectively).Conclusion: Erythrocyte Sedimentation Rate, C Reactive Protein and antistreptolysin O Titer should not be considered as indicators for tonsillectomy in chronic tonsillitis patients by having a non-significant difference when compared with post tonsillectomy patients. Being inflammatory markers, the values of these markers showed a significant decrease after tonsillectomy due to removal of the septic focus of chronic tonsillitis

The potentially therapeutic role of tonsillectomy in the alleviation of several renal diseases apart from IgA nephropathy

Tonsils are located mainly at the gateway of the respiratory tract, and are reportedly one of the secondary lymphatic organs of the immune system. The development of several diseases including IgA nephropathy (IgAN) is associated with inflammatory stimulation and an aberrant immune response of the tonsils. Several studies have reported an improvement in and/or an increase in the stability of the clinicopathological findings of patients with IgAN post tonsillectomy. However, the efficacy in and precise mechanism of the alleviation of symptoms of other renal diseases by tonsillectomy remain unknown. We hypothesize that tonsillectomy may play a potentially therapeutic role in renal diseases apart from IgAN, which are thought to be caused by an impaired regulation of the immune system.

Role of Pre-incisional Bupivacaine Infiltration in Post-tonsillectomy Analgesia.

Tonsillectomy is one of the common surgeries performed by Otorhinolaryngologists and is associated with several morbidities with pain being the commonest, which can cause considerable delay in oral intake and discharge from the hospital. As a commonly performed day care procedure nowadays, pain control is much better than what it used to be previously observed. Therefore newer drugs are being constantly studied inorder to give better analgesia and post operative comfort to the patient with minimal side effects. The main obstacle being finding the best medical method to control pain with minimum side effects, but at the same time making sure that the patient is adequately hydrated and they resume regular eating as soon as possible. Our aim is to study the role of pre-incisional 0.5% bupivacaine versus normal saline infiltration in post-tonsillectomy analgesia. Over a period of 1year, 30 patients with each group of 15 were compared for the efficacy of 0.5% bupivacaine and 0.9% normal saline in post-operative tonsillectomy pain management. After thorough clinical examination and investigations, all patients underwent tonsillectomy by dissection and snare method. After intubation, 0.5% bupivacaine or normal saline was infiltrated in the tonsillar fossa and pain scores was obtained using Visual Analogue Scale (V.A.S) at 6, 12 and 24h post operatively. Using Mann-Whitney non-parametric statistical test, inter-group analysis was done which showed highly significant p-value (<0.0001) indicating that the pre-incisional bupivacaine infiltration is highly effective in reducing the post-tonsillectomy pain. Hence, we recommend the routine use of pre-incisional peritonsillar infiltration of 0.5% bupivacaine in all tonsillectomy/adenotonsillectomy cases, irrespective of the age of the patient to reduce the post tonsillectomy pain and other discomfort associated with it.

Secondary Heamorrhage After Cold Steel Tonsillectomy: An Audit Performed in Shalamar Hospital

Introduction: Tonsillectomy is a common surgical procedure in which post tonsillectomy heamorrhage remains the most serious complication. The cold steel dissection method is the oldest and safest method used to perform tonsillectomies. Aims &amp; Objectives: This study was done to see the frequency of posttonsillectomy heamorrhage with cold steel dissection method. It was a clinical audit performed retrospectively to compare our results with International standards. Place and duration of study: Our clinical audit was conducted at Otolaryngology department in Shalamar Hospital, Lahore, Pakistan. This study was conducted in a period of 6 months. Material &amp; Methods: The charts of patients (n=344) that underwent tonsillectomy at Shalamar Hospital from January 2016 till December 2019 were retrospectively viewed, in a cross-sectional, pilot study, using convenience sampling technique. All the tonsillectomy procedures were performed using the cold steel dissection method. Frequencies were recorded and chi-square test was applied. Results: The complication of secondary heamorrhage occurred in 7 patients and the frequency was calculated as 2%. A significant difference (P=0.01) of age was found in patients suffering from secondary heamorrhage. The incidence was lower in patients below 18 years of age (0.7%) as compared to patients above 18 years of age (7.14%). The rate of heamorrhage was found to be slightly higher in males than in females (2.6% and 1.31% respectively). Conclusion: We conclude that the rate of secondary heamorrhage in our institution is up to the rate reported in literature. Different hot techniques for tonsillectomy should also be performed in clinical settings and compared with the standard cold steel dissection tonsillectomy.

A Comparative study of intraoperative peritonsillar infiltration versus intravenous dexemedetomidine for perioperative analgesia in tonsillectomy

Background: Tonsillectomy is one of the most common surgical procedures in population and post tonsillectomy pain affects analgesic consumption, hospital stay, oral intake and return to regular activity.&#x0D; Aims and Objectives: The purpose of the study was to compare peritonsillar infiltration and intravenous administration of dexmedetomidine for perioperative analgesia in tonsillectomy.&#x0D; Materials and Methods: This was a placebo-controlled study to compare peritonsillar infiltration and intravenous administration of dexmedetomidine in patients undergoing tonsillectomy. Ninety patients were included in this study on the basis of a predefined inclusion and exclusion criteria. These patients were divided in 3 groups on the basis of whether they received Peritonsillar dexmedetomidine, intravenous dexmedetomidine or intravenous normal saline. The groups were compared for post-operative pain, time to first request of rescue analgesia (duration of analgesia), post-operative sedation, analgesic requirement during first 24 hours and side effects. SSPS 21.0 was used for statistical analysis and p value less than 0.05 was taken as statistically significant.&#x0D; Results: Out of total 90 patients included in this study there was a female preponderance with a M: F ratio of 1:1.5. The mean age and ASA grades and mean duration of surgery of patients in all 3 groups were found to be comparable with no statistically significant difference in any of the groups (P&gt;0.05). Preoperative mean systolic and diastolic blood pressures as well as mean arterial pressure and SPO2 was found to be comparable in all 3 groups. However intraoperative blood pressures (systolic, diastolic as well as mean arterial pressures) and SPO2 showed significant difference amongst the groups (P&lt;0.05). Time to first request of rescue analgesia was found to be more in group - Dpt than group – Div and group – Pb which was highly statistically significant (p &lt;0.0001).There was statistical significant difference in number of diclofenac injections consumed during first 24 hours between group – Dpt &amp; group – Div and highly significant difference between group – Dpt &amp; group – Pb, group – Div &amp; group – Pb.&#x0D; Conclusion: Peritonsillar infiltration of dexmedetomidine is better alternative to intravenous dexmedetomidine in tonsillar surgeries.

The Role of Oxidants and Antioxidants in Chronic Tonsillitis.

The aim of the study was to determine the possible role of oxidants and antioxidants in chronic tonsillitis in paediatric age group and also to know the outcome of tonsillectomy on the oxidative stress 60 patients (30 tests, 30 controls) in the age group 3-14years were recruited in the study. Total antioxidant capacity, superoxide dismutase (antioxidants), Malondialdehyde (oxidant) was measured from the venous blood sample. In the study group, i.e. group with chronic tonsillitis who were to undergo tonsillectomy, these levels were measured twice, preoperatively and 1month after surgery. In the control group the parameters were measured only once. The results were compared statistically. Malondialdehyde levels (oxidant) levels in blood were siginificantly high in patients with chronic tonsillitis which reduced post tonsillectomy but did not normalise in 1month after tonsillectomy. Total antioxidant capacity and superoxide dismutase levels (antioxidants) in blood were significantly low in patients with chronic tonsillitis which improved post tonsillectomy but did not normalize 1month post-surgery. The study showed that oxidants and antioxidants have a role in chronic tonsillitis.Children with chronic tonsillitis are under significant oxidative stress. Reduction in oxidative stress post tonsillectomy suggested that the surgery was helpful in this respect.

Peritonsillar Ropivacaine Infiltration in Paediatric Tonsillectomy: A Randomised Control Trial.

Introduction:Various efforts have been made to reduce post tonsillectomy pain in children. The present study was undertaken to evaluate the efficacy and safety of Ropivacaine in post-operative pain management in these children.Materials and Methods:This study is a Randomized control study on 140 patients between 4 - 12 years of age, in whom tonsillectomy was performed in a tertiary care centre between January 2017 to November 2018 using standard dissection and snare surgical technique. Postoperatively, patients were randomized into 2 groups of 70 patients each, receiving tonsillar fossa infiltration with 0.2% Ropivacaine or 0.9% normal saline respectively. Patients were assessed as per Wong Baker’s Faces Scoring System at 2 hours, 4 hours, 8 hours, 18 hours, 24 hours, and 48 hours postoperatively. All the results were analyzed by SPSS software. Chi- square test and Mann-Whitney test were used for assessment of level of significance, with P- value of less than 0.05 taken as significant. Results:Both the groups were comparable with respect to age and sex. At 48 hours, in study group, maximum number of patients 35 (50%) had Wong Baker score 0, while in control group, maximum number of patients 52 (74.3%) had Wong Baker score 4 (P< 0.01). The difference in the mean Deglutition time between both groups was significant (P< 0.01).Conclusion:Ropivacaine infiltration is a effective modality for post-tonsillectomy pain management in children, with minimal side-effects.

Comparative study of 0.5% bupivacaine infiltration versus sterile water infiltration in tonsillar fossa during tonsillectomy performed under general anaesthesia

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tonsillectomy is a treatment of choice when medical line treatment is failed in chronic tonsillitis. Post tonsillectomy pain is the most common problem of this surgery which may persists for weeks and affect normal daily activities. Use of opiods and non-steroidal anti-inflammatory drugs for relieving pain may leads to nausea, vomiting and post tonsillectomy haemorrhages. We renewed interest in infiltration of local anaesthetic drug in the tonsillar fossa during tonsillectomy. To evaluate the efficacy of 0.5% bupivacaine infiltration in tonsillar fossa during tonsillectomy under general anaesthesia in terms of post-operative pain relief.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; It is double blinded prospective comparative study was carried out on 100 patients of either sex and age 5-40 years who diagnosed with chronic tonsillitis undergoing tonsillectomy and willing to participate in study were included.50 patients were infiltrated with sterile water and other 50 patients were infiltrated with 0.5% bupivacaine in the tonsillar fossa during tonsillectomy performed under general anaesthesia. Postoperatively at 2nd, 6th, 24th hours and 7th day all patients were evaluated for pain score by using visual analogue scale. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study, post-operative pain mean score 2nd, 6th, 24th hour and 7th day post-operative period for test and control group was “3.3 and 7.1”, “3.2 and 5.2”, “1.7 and 4.8” and “0.6 and 2.2” respectively which was found to be statistically significant (p&amp;lt;0.001).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; 0.5% bupivacaine infiltration in the tonsillar fossa during tonsillectomy had lower pain score in post-operative period compare to sterile water infiltration.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Correlation between clinical grading of adenoid or tonsil hypertrophy and adenoid or tonsil volume post adenotonsillectomy: a prospective cohort study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Measuring adenoid or tonsil volume in surgically removed specimens is likely the most accurate method for quantifying adenotonsillar hypertrophy severity which may predict the extent of surgery to curtail post tonsillectomy haemorrhage a potential lethal complication.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; All patients with adenoid or tonsil hypertrophy were graded clinically while the objective grading by volumetric saline displacement in accordance with Archimedes’ principle; between August 1, 2017 to July 31, 2019 at the Jos University Teaching Hospital, Plateau State, Nigeria. Data analysis was by the SPSS version 21.0 Chicago IL, USA. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The study had 96 participants with a M:F=1.7:1. Age range was 9 months to 51 years, median was 3 yrs, mean was 9.5 yrs±15.5 yrs with 83 (86.5%) who were ≤18 yrs. Main features of this study, no. of patients in snoring was 83 (86.5%), nasal obstruction 71 (74.0%), rhinorrhoea 32 (33.3%), noisy breathing 23 (24.0%), dysphagia- 18 (18.8%), mouth breathing 18 (18.8%). Grading of this study was 78 (81.2%) were Brodsky grade III &amp;amp; IV while 72 (75.0%) had ANR of ≥0.5. Blood loss was range 10 ml to 250 ml, median 35 ml, mean 52.7±46.9 ml while 51 (63.0%) had blood loss of ≤50 ml. Volume of surgical specimen of adenoid; range 0.20-4.50 ml, mean 1.56±0.83 ml while tonsil; (Rt)-range 1.00-12.50 ml, mean 3.18±1.97 ml. There was a positive correlation between adenoid or tonsil grade and volume at 99% CI; (r)=0.409, (p=0.000) and grade (mean) 3.11±0.78, volume (mean) 3.18±1.96.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study establishes a positive correlation between clinical grading of adenoid or tonsil and volume with a certain level of accuracy which may predict extent of surgery to avoid post tonsillectomy hemorrhage, a life-threatening/lethal complication from excessive, partial or suboptimal surgery commonly.&lt;/p&gt;

Comparison of Early versus Interval Tonsillectomy in Cases of Peritonsillar Abscess

Objective: To compare early versus interval tonsillectomy in cases of peritonsillar abscess.Study Design: Comparative study.Place and Duration of Study: The study was carried out at ENT Department of Combined Military Hospital, Mardan from January 2017 to January 2018.Materials and Methods: A total 50 patients were selected from ENT outpatient department. All the cases were randomly divided into two groups of 25 each. Group A underwent early tonsillectomy after initial incision and drainage, Group B underwent interval tonsillectomy after 6 weeks. Both the groups were compared in terms of perioperative blood loss, operation time, ease of dissection and postoperative complications including pain and hemorrhage. Tonsillectomy was done with bipolar cautery in all the cases.Results: The mean age was 30.22 + 8.25. Out of 50 patients, 42 (84%) were males and 8 (16%) were females. The mean operative time of surgery in group A (early tonsillectomy) was 45.04+5.78 minutes compared to 32.72+4.37 minutes for group B (interval tonsillectomy (p=0.00). Mean post-operative pain in group A was 3.68+2.12 compared to group B where mean score was 3.36+1.93 (p=0.579). There were 3 cases of mild perioperative blood loss, 19 cases of moderate and 3 of severe perioperative blood loss in group A. There were 18 cases of mild perioperative blood loss, 7 cases of moderate and no case of severe perioperative blood loss in group B (p=0.00). Dissection was found to be significantly easier in group B (interval tonsillectomy). There were 7 cases of post-op secondary hemorrhage in group A compared to 3 in group B (p=0.289). All these cases of secondary hemorrhage were managed conservatively.Conclusion: Interval tonsillectomy is a safer procedure as compared to early tonsillectomy in terms of perioperative blood loss, operative time, dissection with almost similar post-op pain and similar risk of post tonsillectomy hemorrhage.&#x0D; How to cite this: Khan MA, Ahmed A, Khan M. Comparison of Early versus Interval Tonsillectomy in Cases of Peritonsillar Abscess. Life and Science. 2020; 1(1): 24-28. doi: https://doi.org/10.37185/L&amp;S.1.1.13

Advantage of Application of Topical Hyaluronic Acid in Reducing Post Tonsillectomy Pain; Cross Sectional Comparative Study

Introduction: Tonsillectomy is common surgical operation performed in otolaryngology department. Various techniques could be used that include traditional cold dissection, powered instrumentation like electro cautery, harmonic scalpel, laser, and radiofrequency technique. As with any surgery, there are some risks can occur with tonsillectomy, these includes bleeding, pain at the site of surgery and/or referred otalgia, and infection. The aim of our study was to assess the postoperative use of topical hyaluronic acid with regards to safety, pain relief. Method: The research was considered a cross-sectional research made on 60 patients needing tonsillectomy from a period began from January to September 2018. The patients had been separated into two groups both from 30 patients, one group (group A) treated by using high molecular weight(HMW) Hyaluronic acid spray on tonsillar beds after operations , and the second group(group B) dealt as control. Early complications were registered in questionnaires and then the data were evaluated for each group. Results: The use of high molecular weight (HMW) Hyaluronic acid spray on tonsillar beds after surgery has reduces the pain significantly after 3 – 7 days (p-value = 0.0001) while has no implication on pain reduction within12 - 24 hours p-value (0.17 and 0.3) respectively . Conclusion: The use of (HMW) hyaluronic acid spray can be used safely in post tonsillectomy patients. Hyaluronic acid spray can minimize post tonsillectomy pain.

Role of bupivacaine in reducing post tonsillectomy pain

Role of bupivacaine in reducing post tonsillectomy pain

Post Tonsillectomy Bleeding among Children in a Tertiary Hospital in the Kingdom of Bahrain: Two Years Experience

Background: Palatine tonsils are part of the immune system located within the Waldeyer’s ring, they are prone to infections, hypertrophy or both. These conditions are known as tonsil diseases that usually require surgical removal through tonsillectomy. Tonsillectomy is one of the most common procedures done for children but it is challenged by the occurrence of complications, especially post tonsillectomy bleeding (PTB). In the current study, the incidence of post tonsillectomy bleeding in children younger than 14 years undergoing tonsillectomy in Salmaniya Medical Complex is evaluated and their demographic data and risk factors are assessed. Method: Pediatric patients who are younger than 14 years with postoperative tonsillectomy bleeding that were treated in Salmaniya Medical Complex between the period of January 2018 and December 2019 were retrospectively studied for risk factors. Results: A total of 1161 patients within the age range of 2 - 13 years old underwent tonsillectomy in Salmaniya Medical Complex from the period of January 2018 to December 2019. Twenty-eight pediatric patients had post-tonsillectomy bleeding (PTB) during the study period with an incidence of 2.4% of the total number of pediatric tonsillectomies done in our institute. The majority were male patients and the mean age was 6.2 years. The main indication of tonsillectomy for those with bleeding was recurrent tonsillitis. A second surgery was needed in 64.5% to control the bleeding. The size of the tonsil, the level of the surgeon and the season at which the tonsillectomy was done did not seem to have any effect on the incidence of post-tonsillectomy bleeding (PTB). Conclusion: The incidence of post tonsillectomy bleeding (PTB) in Salmaniya Medical Complex is 2.4%, which makes it a common complication for a common surgery irrelevant to any patient, surgeon or climate related factors.

Impact of cold dissection tonsillectomy method combined with selective low voltage bipolar diathermy cauterization on the post tonsillectomy pain in the pediatric age group

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Pediatric tonsillectomies are commonly performed by cold&lt;strong&gt; &lt;/strong&gt;dissection or electro cautery dissection. Both the techniques have been compared in many articles for their role in controlling the post-operative pain and bleeding. With the electro cautery dissection the blood loss is comparatively less, but the post-operative pain is reported as more. Several expensive new techniques are available to address the problems. A simple technique of cold dissection tonsillectomy combined with selective low voltage bipolar diathermy cauterization performed in the pediatric age group is being studied retrospectively for its impact in managing the post-operative pain.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The case records of 73 patients aged 4-15 years who were operated for tonsillectomy from January 2018 to July 2019 are retrospectively studied. 33 patients underwent cold dissection and ligature tonsillectomy and 40 patients underwent tonsillectomy by cold dissection combined with selective low voltage bipolar diathermy cauterization. The postoperative pain incidence in these two groups is studied. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The cold dissection tonsillectomy combined with selective low voltage bipolar diathermy cauterization technique was found to be useful in managing the postoperative pain in pediatric tonsillectomies.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Performing&lt;strong&gt; &lt;/strong&gt;cold dissection tonsillectomy with precise mucosal incision, gentle&lt;strong&gt; &lt;/strong&gt;dissection and combining it with selective low voltage bipolar diathermy cauterization of the bleeding points was found to be helpful in controlling the postoperative pain in pediatric tonsillectomies. Prescribing a syrup form of NSAID from the second post-operative day was found to be of additional help.&lt;/p&gt;

Comparative analysis of local infiltration of tonsillar fossa with bupivacaine versus dexamethasone on post tonsillectomy morbidity

Background: Tonsillectomy is one of the most common surgery performed in pediatric otorhinolaryngology. Pain and vomiting being the usual morbidity following this surgery. Aim &amp; Objective: To compare the efficacy of infiltration of Bupivacaine versus dexamethasone into the tonsillar fossa in postoperative pain and vomiting. Methods: A total of 100 patients, aged 10-30 years of both sexes with chronic tonsillitis accrued into the study. They were divided in to two groups A and B. Group A was infiltrated with 0.5% bupivacaine (1mg/kg body weight) locally and Group B with dexamethasone (0.15mg/kg bodyweight) locally into the tonsillar bed. All patients underwent tonsillectomy by dissection/snare technique, bleeding was controlled by applying local pressure, and by ligatures, thereby avoiding cauterization. Post tonsillectomy pain assessed by visual analog scale (VAS), nausea and vomiting by absence/presence was compared between both groups. Results: In Bupivacaine group (A), 86% patients observed analgesic effect by the 1st postoperative hour and by 6th hour all had complete analgesia. In dexamethasone group (B) the analgesic effect started by 12thhour and by 48th hour in all patients (p&lt;0.001). Post-operative occurrence of nausea and vomiting in bupivacaine group (A) was 76% and 30% respectively. However, in dexamethasone group (B), the nausea and vomiting was observed in 10% respectively. Conclusion: Our study showed that 0.5% bupivacaine reduces immediate post-operative pain significantly as compared to dexamethasone and dexamethasone reduces postoperative nausea and vomiting significantly as compared to 0.5% bupivacaine. There were no adverse reactions or complications due to the additional surgical intervention in both the groups.

Tonsillectomy in Adults: Analysis of Indications and Outcome in Sokoto, North Western Nigeria

Background: Tonsillectomy is a well-established surgical procedure practiced commonly by otolaryngologist for removal of tonsils. Although being a relatively simple and common procedure, it is not without considerable complications. This study aimed to profile the indication and outcome of adult tonsillectomy in our region.&#x0D; Method: This was a retrospective study of all adults who had tonsillectomy in the department of Otorhinolaryngology, Usman Danfodiyo Teaching Hospital, (UDUTH) Sokoto, over a seven-year period from 1st January 2011 to 31st December 2017. All information was carefully retrieved from each patient’s case file and from the operation register. The data retrieved was subsequently analysed.&#x0D; Results: A total of 55 adults patients had tonsillectomy over the period of study. Age range was 18 to 45 years with a mean age of 26.3 years. There were 16 males (29.1%) and 39 females (70.9%) with a male to female ratio of 1:2.4. Recurrent tonsillitis 28(50.9%) was the commonest indication; others include: post quinsy 13(23.6%), tonsillomegally 6(10.9%); suspected neoplasm 6(10.9%); recurrent otalgia secondary to tonsillomegally 2(3.6%) Five patients had unilateral tonsillectomy for suspected neoplasm while others had bilateral tonsillectomy. Cold dissection was used in 37 (67.2%) of the patients, while 18(32.7%)were by electro cautery (Bipolar diathermy).&#x0D; The commonest post-operative complication was pain in all patients, followed by otalgia (29.1%) and secondary post tonsillectomy bleed in two patients. No patient had blood transfusion. Hospital average stay was 3 days.&#x0D; Follow up was uneventful in 16 (29.1%) of patients while 4(7.3%) patients had squamous cell carcinoma and were refered to Oncologist. The remaining 35 patients were lost to follow up.&#x0D; Conclusion: The commonest indication for Adult tonsillectomy is chronic recurrent tonsillitis. Histopathological analysis of every tonsil specimen is advocated.

Pain on the first postoperative day after tonsillectomy in adults: A comparison of metamizole versus etoricoxib as baseline analgesic

ObjectiveTo compare the effect of metamizole versus etoricoxib as baseline analgesic for treating postoperative pain after tonsillectomy.DesignSingle centre prospective cohort study.SettingTwo consecutive cohorts of tonsillectomy patients.Participants124 patients (n = 55 treated with etoricoxib, n = 69 with metamizole); median age 30.5 years; 50% women.Main outcome measuresPatients rated their pain on first postoperative day using the questionnaires of the German-wide project Quality Improvement in Postoperative Pain Treatment (QUIPS) including numeric rating scales (NRS, 0–10) for pain determination. The influence of preoperative and postoperative parameters on patients' pain was estimated by univariate and multivariate statistical analysis.ResultsThe demographic parameters showed no differences between the patients in the metamizole group and the etoricoxib group (all p>0.05) with one exception: Patients in the metamizole group had significantly more preoperative pain than patients in the etoricoxib group (p = 0.001). The metamizole group had a mean postoperative pain in activity of 4.4 ± 2.1 and the etoricoxib group of 4.5 ± 2.2. Maximal pain for the metamizole group and the etoricoxib group were 5.6 ± 2.2 and 6.1 ± 1.9, respectively. Pain in activity, maximal pain and minimal pain were not different between both groups (p = 0.652, p = 0.113, p = 0.276, respectively). Patients of the etoricoxib group received more frequently piritramide in recovery room as demand medication (p = 0.046). In the whole cohort, patients with peritonsillar abscess had more preoperative pain in comparison to chronic tonsillitis (p<0.001). Patients under 30.5 years reported higher maximal pain than older patients (p = 0.049). On the other hand, a significant influence of patients’ age on the pain in activity and minimal pain could not be demonstrated (p = 0.368, p = 0.508, respectively). Men reported lower minimal pain than women (p = 0.041). Also, patients with ASA status I had lower minimal pain than patients with higher ASA status (p = 0.019). The multivariate analysis did not show an association between postoperative pain in activity and preoperative counseling on postoperative pain management (p = 0.588, p = 0.174, respectively). Special preoperative counseling on postoperative pain management resulted in lower levels of maximal pain (p = 0.024). Linear regression demonstrated an independent association of higher pain in activity with higher mobility impairment (p = 0.034) and respiratory impairment (p = 0.002). The linear regression of minimal pain identified female gender (p = 0.005) as an independent influencing factor with higher pain levels. In terms of satisfaction, no preoperative pain therapy (p = 0.016) could be found as an independently significant influencing factor with higher satisfaction.ConclusionEtoricoxib does not have an advantage as baseline analgesic for post tonsillectomy pain in comparison to metamizole.

Effect of acupressure on post tonsillectomy pain in adolescents: a randomized, single-blind, placebo-controlled trial study.

Tonsillectomy is one of the most common pediatric surgeries in the world and pain control following tonsillectomy is very important. The aim of this study is to investigate the effect of acupressure on the amount of pain following tonsillectomy in children. One hundred and forty-four children aged 5-12 years old were assigned into one of three groups: interventions, control and placebo. In the intervention group, acupressure was applied at three acupoints and in the placebo group, sham acupressure was applied. In the control group routine care only was applied. There was a significant difference between an average of changes in pain score before and after the intervention during the 3 time periods after the tonsillectomy operation in the acupressure group (p = 0.002). The results showed that acupressure had a positive effect on pain reduction after tonsillectomy in children in the intervention group.

Comparison of the efficacy of ropivacaine and ropivacaine with dexmeditomidine in post tonsilectomy pain relief after peritonsillar infiltration- A prospective randomized double blind study

Introduction: Post operative pain relief is desired goal after tonsillectomy, infiltration of local anesthetic with or without adjuvant can reduce post tonsillectomy pain. Objective: To compare the postoperative analgesic efficacy and side-effects of peritonsillar-infiltration of ropivacaine with or without dexmeditomidine. Materials and Methods: Sixty patients aged 4-14 years posted for tonsillectomy under GA were randomly assigned in two groups of 30 each. In group R: Inj. ropivacaine (0.5%) 0.2ml/kg and in group RD: Inj.ropivacaine (0.5%) 0.2 ml/kg + Inj. dexmeditomidine 1mcg/kg were infiltrated in peritonsillar fossa post tonsillectomy. Patient were monitored for post-operative pain using VAS score, CHEOPS score and Wong baker pain rating scale at 30 minute, 1hr, 2hr, 4hr, 10 hr, 16hr and 24hr, pain on deglutination, time to first analgesic requirement, total dose of analgesics requirement in 24 hr postoperatively, amount of bleeding and parent’s satisfaction score. Results: VAS score, CHEOPS and Wong baker pain rating scale were comparable in both the groups at 30 min, 1hr, 2hr (P >0.05) but it was significantly low in group RD as compared to group R at 4hr, 10hr, 16hr and 24hr (P Conclusion: We concluded, peritonsillar infiltration of ropivacaine with or without dexmeditomidine is effective method for post-tonsillectomy pain relief. Addition of dexmeditomidine was found to prolong duration, decrease analgesic requirement and improve parent’s satisfaction score. Keywords: Tonsillectomy, Visual analog score, CHEOPS, Wong baker pain rating scale, Ropivacaine and dexmeditomidine.

The effect of acupuncture on postoperative pain, nausea and vomiting after pediatric tonsillectomy: a systematic review.

Tonsillectomy is one of the most commonly performed surgical procedures among children around the world and management of post tonsillectomy complications are very important. The aim of this study was to evaluate the effects of acupuncture on the amount of pain, nausea and vomiting after tonsillectomy in children. In this study, two researchers searched individually for qualified articles on the effects of acupuncture on post-tonsillectomy pain, nausea and vomiting using PubMed, Cochrane Library, Embase, Google scholar and Ovid databases by September 2018. After critically appraising the searched studies, 12 studies were selected and entered into a systematic review. Among the studies, various acupuncture methods were used. This systematic review shows that acupuncture as a complementary method can prevent and reduce the severity of complications surrounding tonsillectomy.