Secondary Post-tonsillectomy Haemorrhage Research Articles

BiZact™ tonsillectomy: Predictive factors for post-tonsillectomy haemorrhage from a 1717 case series.

To determine primary and secondary post-tonsillectomy haemorrhage (PTH) rates and identify predictive factors in a cohort of consecutive adult and paediatric BiZact™ tonsillectomy cases. Retrospective cohort study. Patients from Flinders Medical Centre, Noarlunga Hospital and private otolaryngology practices who underwent BiZact™ tonsillectomy from 2017 to 2020. patient age, indication for tonsillectomy, surgeon experience, time and severity of PTH, including return to theatre. Each secondary PTH was graded using the Stammberger classification. Logistic regression was utilised to identify predictors of secondary PTH. One thousand seven hundred and seventeen patient medical records were assessed (658 adults and 1059 children). The primary PTH rate was 0.1%, and secondary PTH rate was 5.9%. The majority of secondary PTH cases were Stammberger grade A (80/102, 78.4%) requiring observation only. Few secondary PTH required medical intervention (grade B; 9/102, 8.8%), return to theatre (grade C; 12/102, 11.8%), or blood transfusion (grade D; 1/102, 1.0%), with no death reported (grade E; 0/102, 0.0%). Recurrent secondary PTH occurred in 8 patients (0.5%). Predictive factors of secondary PTH in children were surgeon experience with trainees having greater chance of PTH (OR 2.502, 95% CI 1.345-4.654; p = .004) and age of child (OR 1.095, 95% CI 1.025-1.170; p = .007). Surgeon experience was a predictive factor for adults (OR 3.804, 95% CI 2.139-6.674; p < .001). BiZact™ tonsillectomy has a low primary PTH rate, with a secondary PTH rate comparable to other 'hot tonsillectomy' techniques. The majority of PTH events were minor and self-reported. There appears to be a learning curve for trainee surgeons.

A Technical Approach to Anesthesia in the Case of Tonsillectomy

&lt;div class="WordSection1"&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tonsillectomy is the most common surgical procedure performed by an ENT doctor (Throat Nose Ear) in children. This surgery can cause pain, bleeding and swelling in the injured throat. Patient may complain of pain, difficulty swallowing, eating, drinking disorders, nausea and vomiting and fall into a dehydrated state. This can reduce patient satisfaction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion:&lt;/strong&gt; Postoperative pain management of tonsillectomy is a concern both by the ENT doctor and by the anesthesiologist. The high incidence of post-tonsillectomy pain or anxiety increases the risk of secondary post-tonsillectomy bleeding. It is necessary to know the mechanism of post operative pain and the negative impact of pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Doctors should give attention to reduce postoperative pain and choose a rational analgesic to overcome post operative tonsillectomy pain.&lt;/p&gt;&lt;/div&gt;

Does infection play a role in post-tonsillectomy haemorrhage? A narrative review.

Post-tonsillectomy haemorrhage is an increasingly common cause of morbidity following tonsillectomy. Secondary post-tonsillectomy haemorrhage occurring more than 24 hours after an operation has long been attributed to post-operative infection; however, there is little evidence to support this hypothesis and the associated use of antibiotics in the current literature. This study looked at the aetiology and evidence-based management of post-tonsillectomy haemorrhage, and investigated the impact of bacterial infection and antimicrobials on the pathogenesis and clinical course of this complication. A number of peri-operative risk factors for post-tonsillectomy haemorrhage exist, and infective pathologies, including recurrent or chronic tonsillitis and group A streptococcus on blood cultures, may predispose to bleeding. Very few studies have shown a link between post-tonsillectomy haemorrhage and objective markers of infection such as pyrexia, raised inflammatory markers or positive microbiology cultures. The role of antibiotics in secondary post-tonsillectomy haemorrhage remains controversial, and numerous randomised, controlled trials of peri-operative antibiotics have shown no significant difference in bleeding rates between antibiotics and controls. Further trials investigating the role of antibiotics and more robust studies investigating the presence of bacterial infection at the time of bleeding may be required to determine the true role of infection in post-tonsillectomy haemorrhage.

Secondary post-tonsillectomy haemorrhage: is there evidence of diurnal and monthly variation in haemorrhage rates?

Anecdotally, secondary post-tonsillectomy haemorrhage tends to occur out-of-hours. This study sought to establish whether there is a link between haemorrhage and time of day, and examined correlations with month and with monthly temperature. Data were obtained for patients in our hospital undergoing surgical arrest of secondary post-tonsillectomy haemorrhage between January 2002 and December 2020. Haemorrhage timing was categorised into daytime (07:00-18:00), evening (18:00-22:00) and overnight (22:00-07:00). The chi-square test was used to assess diurnal and monthly variation in haemorrhage rates (p < 0.05). Pearson's correlation test was used to analyse monthly haemorrhage rates and average monthly temperature. Fifty per cent of patients suffered post-tonsillectomy haemorrhage overnight and 28.1 per cent haemorrhaged in the evening, representing a significant difference (p = 0.018). The highest rate of haemorrhage was in July (2.96 per cent), which was statistically significant (p = 0.0024). There was a positive correlation between average monthly temperature and haemorrhage rate (Pearson's correlation = 0.478, p = 0.116004), although this was not significant. Most post-tonsillectomy haemorrhages occur out-of-hours (78.1 per cent), which could be conveyed during the consent process. The haemorrhage rate is lower in winter, which may influence planned operating theatre scheduling.

Are intravenous antibiotics routinely indicated in the management of secondary post tonsillectomy haemorrhage?

Are intravenous antibiotics routinely indicated in the management of secondary post tonsillectomy haemorrhage?

Postulation of the Effect of Unpredicted Predisposing Factors for Post-Tonsillectomy Bleeding

Back ground and objectives 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. Hence the tonsils and peritonsillar tissues are highly vascular zone that supplied by direct branches of external carotid artery thus the post-tonsillectomy bleeding remains one of significant issues in relation to this widely performed procedure. The post-tonsillectomy bleeding needs frequently to be postulated for its incidence, prevalence, etiology, predisposing factors, management and prevention. This subject constitutes one of most risky aspects that increase wariness of the surgeons regarding this commonly conducted procedure. Although there are huge numbers of presentative literatures coming from American as well as western institutes that tried to put guidelines for purpose of prevention and management of post-tonsillectomy bleeding but broadly at our middle-east region and locally at our Libyan society we found for some extent difficulties to apply all these guidelines. For this reason this issue has been take the wider spectrum of ENT surgeons’ concentration, discussions, and researches. Therefore this study was conducted prospectively and for long time to confirm the possible predisposing factors that could be responsible for increasing the risk of post-tonsillectomy bleeding at our region and in the same time to illustrate the concluded recommendations to prevent the occurrence of this important complication. Patients and methods 2880 patients aged from 8 months to 85 years presented at ENT department-AL-hawari ENT and urology teaching center- Benghazi-city – Libya as well as AL-thowra central teaching hospital and AL-tarahom private center – Elbyda city – Libya at period in between September 2003 to March 2015 as cases of chronic adeno-tonsillitis and solitary acute as well as chronic related palatine tonsillar disease with variable patterns of indications for tonsillectomy namely snoring and apnea attacks, recurrent attacks of acute tonsillitis, persistent otitis media with effusion, recurrent attacks of acute suppurative otitis media, failure to thrive, recurrent attacks of chest infection, mal-occlusive dental deformity, unilateral enlarged tonsils, post-traumatic avulsed tonsils, history of quinsy abscess and persistent halitosis. All patients were assessed intra-operatively and post-operatively too for any evidences of primary, reactionary, or secondary hemorrhage in relation to wide spectrum of factors as patient's demographic, medical, and socio-habitual factors, in addition to technical as well as post-operative care factors. Results This presenting study confirmed that the most common type of post-tonsillectomy bleeding was the secondary variety (71%) as compared to primary (22%) and reactionary (7%) among all presented post-tonsillectomy bleeding cases. Although through this presenting serial study there were multifactorial pre-dispositions elucidated for secondary post-tonsillectomy hemorrhage but as general poor post-operative care can be considered as the cornerstone for the pathogenesis of this significantly raised incidence of secondary post-tonsillectomy bleeding this may be in form of inadequate patient's hydration and nutritional supply (47%), poor patient's antibiotic compliance (23%), and child's maternal negligence (19%). The time of surgery was found to be another important pre-disposing factor for post-tonsillectomy bleeding, it was postulated that the incidence of reactionary as well as secondary post-tonsillectomy hemorrhage significantly increased at summer and autumn seasons (69%) as compared to other seasons. The place of surgery was another interesting proposed studied factor among this serial presentation it was observed that the incidence of post-tonsillectomy bleeding among patients who operated at AL-hawari ENT and urology teaching center-Benghazi-city significantly higher (63%) than that among cases who interfered at AL-thowra central teaching hospital and AL-tarahom private center – Elbyda city. Conclusion Generally speaking, post-tonsillectomy bleeding is considered as one of important issues in ENT and one of significant post-tonsillectomy complications which may create a critical morbidity that may rarely extend to post-operative mortality. Hence the most common pattern of post-tonsillectomy bleeding is the secondary type; however this type of post-tonsillectomy hemorrhage is pre-disposed and induced by many factors. Most of these factors are treatable and curable thus the prophylaxis against this significant complication can be achievable.

Evaluation of Secondary Post-Tonsillectomy Bleeding among Children in Saudi Arabia: Risk Factor Analysis.

Tonsillectomy is one of the most widely recognized surgeries for tonsillitis. It is the default surgery option for obstructive sleep apnea, recurrent tonsillitis, and recurrent peritonsillar abscess. However, there are limited risk factor analyses in Saudi Arabia related to tonsillectomy. The goal of study is to evaluate and analyze the risk factors for secondary post-tonsillectomy bleeding in Saudi Arabia. This retrospective review study was directed at King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia. Univariate and multivariate investigations were performed to decide the risk factors. A total of 713 children were included. Post-tonsillectomy bleeding occurred in only 5.3% of tonsillectomies. There was no seasonal variation impact on post-tonsillectomy bleeding rate (P = .8). The multivariate analysis showed a significant association between post-tonsillectomy bleeding and both age (odds ratio [OR] = 1.156; 95% CI: 1.007-1.326; P = .039) and sleep disorder breathing/obstructive sleep apnea (OR = 3.581; 95% CI: 1.454-8.820; P = .006). This study revealed that age, sleep disorder/obstructive sleep apnea, and longer hospital stay after tonsillectomy are significant risk factors for post-tonsillectomy bleeding. This study provides an important baseline for further local studies in the future.

The therapeutic use of tranexamic acid reduces reintervention in paediatric secondary post-tonsillectomy bleeding

The therapeutic use of tranexamic acid reduces reintervention in paediatric secondary post-tonsillectomy bleeding

Posttonsillektomi kanama: Çocuklar ve yetişkinler arasındaki farklar

Amaç: Tonsillektomi veya adenotonsillektomi yapılan erişkin ve çocuk hastalarda görülen posttonsillektomi kanamaların (PTK) özelliklerini incelemek ve karşılaştırmakMateryal ve Metod: Bu retrospektif kesitsel çalışmada 1 Ocak 2014 ile 30 Eylül 2018 arasında Tokat Devlet Hastanesinde bipolar elektrokoter ile tonsillektomi veya adenotonsillektomi yapılan 421 hastanın elektronik medikal kayıtları incelendi. Hastaların yaş, cinsiyet, uygulanan cerrahi prosedürler, PTK' nın gerçekleştiği gün, PTK için kan transfüzyonu gerekliliği, PTK da hemostazın tipi gibi özellikleri değerlendirildi.Bulgular: PTK, erişkinlerde (yaş≥16) %6,10, çocuklarda (yaş&amp;lt;16) % 2,41 oranında görüldü. Primer PTK bir erişkin hastada görülürken,çocuk hastalarda primer PTK görülmedi. Sekonder PTK erişkinlerde sekiz (%6,10) hastada görülürken, çocuklarda yedi (%2,41) hastada görüldü. PTK insidansı erişkinlerde çocuklara göre anlamlı düzeyde yüksek bulundu (p&amp;lt;0,05). Kan tranfüzyonu ihtiyacı iki erişkin PTK’lı hastada olurken, çocuk hastalardaki PTK’ ların hiçbirinde kan transfüzyonu ihtiyacı olmadı. PTK görülen yedi çocuk hastanın üçünde spontan hemostaz görülürken, dört hastada hemostaz genel anestezi altında sağlandı. PTK görülen 9 erişkin hastanın birinde spontan hemostaz görüldü. Altı hastada ise hemostaz genel anestezi altında sağlandı. Sonuç: Erişkinlerde PTK çocuklara göre daha fazla görülmektedir. Genel olarak PTK nın en sık görüldüğü günler postoperatif 6.-8. Günler arasıdır. Spontan hemostaz çocuklarda erişkinlere göre daha fazla görülürken, çocuklardaki PTK da genel anestezi altında hemostaz oranı daha yüksektir.

Surgeons' preferences and anxiety levels in paediatric adenotonsillectomy: European perspective.

This study assessed the preferences of surgeons regarding surgical modalities used for adenotonsillectomy, and determined anxiety levels related to the adenotonsillectomy procedure. A 10-question survey created by the authors was administered to 413 ENT specialists attending the 4th Congress of Otorhinolaryngology Head and Neck Surgery, held in October 2017 in Barcelona, Spain. Cold knife dissection was the preferred surgical modality for both adenoidectomy and tonsillectomy. Most participants reported encountering one to five patients with post-tonsillectomy bleeding throughout their entire career. The mean anxiety levels during surgery and the 10-day post-operative period were 3.39 ± 2.14 and 4.18 ± 2.63, respectively (p &lt; 0.05). There was a significant negative correlation between anxiety level and surgeon's experience (p &lt; 0.05). Cold dissection is still the preferred surgical modality for adenotonsillectomy, while both suture ligation and electrocautery are used for haemostasis. Paediatric adenotonsillectomy is likely to generate anxiety in ENT surgeons, and the possibility of secondary post-tonsillectomy bleeding increases the anxiety levels of surgeons in the post-operative period.

Clinical Practice Guideline: Tonsillectomy in Children (Update)-Executive Summary.

ObjectiveThis update of a 2011 guideline developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation provides evidence-based recommendations on the pre-, intra-, and postop...

Clinical Practice Guideline: Tonsillectomy in Children (Update)

ObjectiveThis update of a 2011 guideline developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation provides evidence-based recommendations on the pre-, intra-, and postop...

Day-case tonsillectomy in children: Experience from a Teaching Hospital in Jordan

ObjectivesThis study has been conducted for the first time in Jordan to investigate safety issues relating to day-case tonsillectomies in childrens and to study the post-operative complication rate compared to tonsillectomies carried out with inpatient admission to hospital. Materials and methodsRetrospective review of medical charts of 419 pediatric patients who had undergone tonsillectomies. Patients were divided into two groups, with 103 patients in the inpatient group and 316 patients in the day-case group. A comparison is made between the clinical and demographic data of the patients studied and the postoperative complication rate. ResultsThe two main indications for tonsillectomy in all patients were recurrent infection and tonsillar hypertrophy. For instances of day-case tonsillectomy, only one patient had secondary post-tonsillectomy bleeding (0.32%); likewise, there was only one case of this reported for the inpatient group (1%), and there were no cases of reactionary hemorrhage reported in either groups. Statistical analysis failed to show a significant association between the inpatient and day-case surgery groups (P > 0.05) in terms of post-tonsillectomy bleeding. ConclusionWe found day-case tonsillectomy to be a safe procedure in children if the inclusion and exclusion criteria followed properly. The observation time following tonsillectomy is crucial to avoid the postoperative complications.

Management of post tonsillectomy secondary haemorrhage: Flinders experience

Background: Secondary posttonsillectomy haemorrhage (sPTH) is a significant complication inOtolaryngology. Most studies have focussed on different risk factors associatedwith sPTH. However, few studies have reported on the outcomes of sPTH afterpresentation to a tertiary public hospital. We sought to present our experiencewith the management of sPTH. Methods: A retrospectivereview of all patients (n=145) presenting with a sPTH to Flinders MedicalCentre (FMC) was analysed over a two-year period. The Stammberger grade forsPTH was applied and recorded in the case notes at presentation of allpatients. Results: 59% of thesepatients were adults. Overall, 79% of patients were conservatively treated anddischarged safely without returning to the operating theatre. Adults weremarginally more likely to return to theatre (RTT) with a relative risk (RR) of1.07 (CI 0.5–2.3). Patients who had coblation (COB) tonsillectomy had a higherRR of RTT (RR =1.45) compared to cold steel (CS) tonsillectomy. Patients whohad a COB tonsillectomy (16.6%) were also more likely represent with a secondbleeding episode compared to CS tonsillectomy (9.8%). The length of stay (LOS)was significantly longer (13 hours) in adults with Stammberger grade C sPTH(P&lt;0.05) compared to grade A1 sPTH, with other factors having no significanteffect on LOS. Conclusions: The overall riskof a second bleeding episode is low in patients with sPTH, and conservativemanagement in the first instance is safe. Patients with a COB tonsillectomy arelikely to present with multiple episodes of sPTH if initial management wasconservative. Stammberger grade at initial sPTH presentation is not predictiveof subsequent presentations.

Peritonsillar infiltration of lidocaine with adrenaline is associated with increased risk of secondary post-tonsillectomy haemorrhage.

In order to evaluate the safety of tonsillectomy among children, we retrospectively studied the incidence of post-operative complications, adverse events and their association with peri-operative medication. Data were collected from the medical records of 691 patients aged 1-16 years, including details of post-operative complications (any unplanned contact with the hospital), analgesics, dexamethasone, 5-HT3 antagonists, local anaesthetic and haemostatic agents. Recovery was complicated in 13.6 per cent of patients, of whom 8.4 per cent were re-admitted to the ward. The most common complication was post-tonsillectomy haemorrhage, experienced by 7.1 per cent of patients. Re-operation under general anaesthesia (for grade III post-tonsillectomy haemorrhage) was required by 4.2 per cent of patients. Peritonsillar infiltration of lidocaine with adrenaline increased the risk of post-tonsillectomy haemorrhage (odds ratio = 4.1; 95 per cent confidence interval = 2.1 to 8.3). Every seventh paediatric patient experienced a complicated recovery after tonsillectomy, caused by post-tonsillectomy haemorrhage in most cases. Local peritonsillar infiltration of lidocaine with adrenaline was associated with an increased risk of post-tonsillectomy haemorrhage.

Effect of paracetamol/prednisolone versus paracetamol/ibuprofen on post-operative recovery after adult tonsillectomy

ObjectiveTo compare the effect of Paracetamol/Prednisolone versus Paracetamol/Ibuprofen on post-operative recovery after adult tonsillectomy. BackgroundVarious analgesic protocols have been proposed for the control of post-tonsillectomy morbidity with need for better control in adult population for having higher severity of post-operative pain and risk of secondary post-tonsillectomy bleeding. MethodsThis is a prospective cohort study conducted on 248 patients with age of 12 years or older distributed as two equal groups; the first one receiving Paracetamol/Prednisolone and the second one receiving Paracetamol/Ibuprofen. Both groups were compared at 7 days post-operative regarding pain at rest, tiredness of speech, dietary intake, and decrease in sleep duration. Both groups were compared regarding incidence of nausea and vomiting at 2 days post-operative. The incidence and severity of secondary post-tonsillectomy hemorrhage was compared between the two groups. ResultsPain at rest (no swallowing - no talking) was less in group I but not reaching statistical significance (p = 0.36). In addition, dietary intake was better in group I but not reaching statistical significance (P = 0.17). However, talking ability was better with statistically significant difference (P = 0.03) in group I. Impairment of sleep was less with group II but not reaching statistical significance (p = 0.31). The incidence of vomiting at second post-operative day was less in group I with statistical significance (p = 0.049). The incidence of secondary post-tonsillectomy bleeding was significantly higher in group II with statistical significance (p = 0.046). The severity of bleeding episodes was also significantly higher in group II (p = 0.045). ConclusionBoth ibuprofen and prednisolone were effective as a part of post-operative medication regimen after adult tonsillectomy. However, prednisolone was superior to ibuprofen regarding improvement of pain at rest, dietary intake, tiredness of speech and post-operative nausea and vomiting. However, ibuprofen had a better impact on sleep. The incidence and severity of secondary post-tonsillectomy hemorrhage were significantly higher with ibuprofen favoring the selection of prednisolone to be combined with paracetamol in the post-operative medication protocol following tonsillectomy.

Trends in the management of secondary post-tonsillectomy hemorrhage in children

ObjectiveTo define current practices in management of secondary post-tonsillectomy hemorrhage (PTH) in children by pediatric and general otolaryngologists. IntroductionBleeding after tonsillectomy is common. Our goal was to describe management methods across the U.S. MethodsQuestions regarding perioperative management and treatment in response to three hypothetical cases featuring secondary post-tonsillectomy bleeding were posed via REDCap survey. Comparisons were made for pediatric otolaryngology fellowship training, regions of residency training and current practice, practice type, and number of years in practice. ResultsA total of 400 surveys were distributed with 104 responses. Fellowship-trained respondents were more likely to have been in practice for less than ten years (41.5% versus 17.8%) and to practice in an academic setting (67.3% versus 13.6%). They were less likely to prescribe antibiotics after tonsillectomy and more likely to prescribe acetaminophen (98.3% versus 80.4%), ibuprofen (79.3% versus 56.5%), and narcotics (74.1% versus 50.0%) compared to general otolaryngologists. When faced with a post-tonsillectomy patient with visible clot but no active bleeding, pediatric otolaryngologists were less likely to remove the clot (31.6% versus 54.3%) and more likely to proceed to the OR (75.9% versus 56.5%) and admit the patient (87.9% versus 68.9%). Few regional differences were encountered; however, factors influencing the decision to pursue operative intervention varied by region. ConclusionPediatric otolaryngologists are more likely to follow American Academy of Otolaryngology guidelines for tonsillectomy perioperative management. They also manage patients with secondary PTH differently than general otolaryngologists. Management trends are similar by region but salient factors considered in the decision-making process vary.

Post-tonsillectomy haemorrhage in Australia—a multivariable analysis of risk factors

Background: Tonsillectomy is a common procedure in otolaryngology and currently, there are limited multivariable analyses regarding factors associated with secondary post-tonsillectomy haemorrhage (PTH) in an Australian metropolitan setting. This study aims to provide further analysis of various factors associated with secondary PTH in an Australian metropolitan health service. Methods: A retrospective review was conducted for all elective tonsillectomies performed at Western Health, Australia between December 2011 and December 2015. Multivariable logistic regression analyses were performed. Results: A total of 1,257 tonsillectomies were included. Secondary PTH was observed in 87 (6.9%) patients with 35 (2.8%) returning to theatre. No differences in PTH were found between surgical techniques, month of tonsillectomy, same day discharge and surgeon experience. Multivariable analysis showed that patients receiving ibuprofen (OR =2.07; 95% CI =1.08, 3.99), as well as a 1-year increase in age (OR =1.03; 95% CI =1.01, 1.05) were associated with significantly increased odds of PTH. Conclusions: Tonsillectomy is a common procedure in otolaryngology and this study provides updated local data for a more accurate comparison of surgical outcome.

Rate of post-tonsillectomy haemorrhage in different tonsillectomy techniques: Retrospective study, Dubai hospital experience in 16-Month period

Introduction: Tonsillectomy is one of the most common otolaryngology procedures performed. Haemorrhage has been divided into two broad categories; primary, occurring 24 h post-operation although commonly 5–10 days after the operation. Objectives: This study was conducted to determine the rate of post-tonsillectomy bleeding in our hospital, to review the rate of bleeding between different methods of tonsillectomy and to encourage surgeons with high bleeding rate to change to different techniques. Methods: It was a retrospective study conducted at the Department of Otolaryngology (ENT), Dubai Hospital, Dubai, United Arab of Emirates. It was conducted from 1st June 2014 to 30th September 2015. Study population were 554 patients who underwent tonsillectomy or adenotonsillectomy during this period. The patients were grouped into four groups according to the tonsillectomy technique. Results: Twenty-two patient presented with bleeding (3.97%). Out of these, one was primary post-tonsillectomy bleeding and 21 were secondary post-tonsillectomy bleeding. The highest rate of secondary post-tonsillectomy bleeding was in bipolar tonsillectomy group (8.98%), while the lowest rate was in radiofrequency group. The primary bleeding was encountered in one patient in cold dissection group while no primary bleeding was encountered in other groups. 40.9% of cases were managed surgically, while 59.1% were managed medically. Conclusion: Post-tonsillectomy bleeding is still a clinically significant complication despite advances in surgical techniques. Radiofrequency tonsillectomy has the lowest bleeding rate. Our hospital rate of bleeding stand in the international range and we are going to be better regarding secondary bleeding, but we are one of the best regarding primary.

Bleeding after tonsillectomy

Oropharyngeal hemorrhage after tonsillectomy is one of the most common postprocedural ENT emergencies that require immediate attention. Management choices depend on the severity of bleeding, underlying platelet or coagulation disorders, and the patient’s maturity and age. Treatment range from simple observation to an emergent need to both secure the airway and stop the hemorrhage. The workup of the hemorrhagic patient will be discussed from the preoperative to postoperative time period. Surgical techniques in response to various acuity will be discussed to fully elucidate options to control the hemorrhage.