Secondary Post-tonsillectomy Hemorrhage Research Articles

A comparison of coblation and modified monopolar tonsillectomy in adults

ObjectiveTo compare the intraoperative records and postoperative clinical outcomes of adults who underwent coblation and modified monopolar tonsillectomy tonsillectomies.Materials and methodsAdult patients with tonsillectomy were randomly divided into the coblation and modified monopolar tonsillectomy groups. The estimated blood loss, postoperative pain score, operation time, post-tonsillectomy hemorrhage (PTH), and cost of disposable equipment were compared.ResultsPain intensity in the coblation and monopolar groups was similar on postoperative days 3 and 7. However, the mean maximum pain score in the monopolar group was significantly higher compared to the coblation group on postoperative days 1 (P < 0.01) and 2 (P < 0.05).Secondary PTH occurred in 7.1% (23/326) of patients in the coblation group and 2.8% (9/327) of patients in the monopolar group (P < 0.05).ConclusionAlthough pain was significantly increased on postoperative days 1 and 2 in the modified monopolar tonsillectomy group, the operation time, secondary PTH, and medical costs were significantly decreased compared to the coblation technique group.

Assessing the Relationship Between Infection Frequency and Risk of Post-Tonsillectomy Hemorrhage.

To determine the relationship between frequency of tonsillitis and the risk of post-tonsillectomy hemorrhage (PTH) in pediatric patients undergoing tonsillectomy for recurrent tonsillitis. After obtaining IRB approval from Nationwide Children's Hospital, charts for all patients who underwent a total tonsillectomy in 2017 for recurrent or chronic tonsillitis were retrospectively reviewed (n = 424). Patients were divided into 2 cohorts based on the frequency of tonsillitis prior to surgery: those meeting the 1-year criteria with 7 or more infections in the past year (n = 100), and those who did not meet criteria defined as those with fewer than 7 infections in the past year (n = 324). The primary outcome of interest was PTH. Comparison of cohorts and frequency of PTH were assessed using bivariate analyses. Kaplan-Meier curves were used to compare time to onset of hemorrhage between primary vs. secondary PTH. Generalized mixed and logistic regression models were used to evaluate risk of hemorrhage following tonsillectomy. Among a total cohort of 424 patients undergoing tonsillectomy, 23.58% (n = 100) met criteria while 76.42% (n = 324) did not. A total of 8.73% (n = 37) patients experienced PTH. Compared to those who did not meet criteria, those who met criteria had a higher odds of developing PTH; however, this was not significant (OR: 1.42 [95% CI: 0.67, 2.98], P = .3582). Estimated probability of developing PTH for those who met criteria was 11% [95% CI: 6.19, 18.81] compared to 8.03% [95% CI: 5.52, 11.54] for those who did not meet criteria. Among all PTH cases, 5.41% (n = 2) were primary hemorrhage while 94.59% (n = 35) were secondary hemorrhage with 50% of those with secondary PTH having experienced hemorrhage within 6 days [95% CI: 5, 7] of tonsillectomy. Patients with neuromuscular conditions had significantly higher odds of PTH (OR: 4.75 [95% CI: 1.19, 18.97], P = .0276). Patients who met the 1-year criteria for tonsillectomy did not have a significantly higher odds of PTH. Further research is needed to better evaluate the relationship between infection frequency and risk of PTH.

Development and validation of a machine learning-based predictive model for secondary post-tonsillectomy hemorrhage.

The main obstacle to a patient's recovery following a tonsillectomy is complications, and bleeding is the most frequent culprit. Predicting post-tonsillectomy hemorrhage (PTH) allows for accurate identification of high-risk populations and the implementation of protective measures. Our study aimed to investigate how well machine learning models predict the risk of PTH. Data were obtained from 520 patients who underwent a tonsillectomy at The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army. The age range of the patients was 2-57 years, and 364 (70%) were male. The prediction models were developed using five machine learning models: decision tree, support vector machine (SVM), extreme gradient boosting (XGBoost), random forest, and logistic regression. The performance of the models was evaluated using the area under the receiver operating characteristic curve (AUC). Shapley additive explanation (SHAP) was used to interpret the results of the best-performing model. The frequency of PTH was 11.54% among the 520 patients, with 10.71% in the training group and 13.46% in the validation set. Age, BMI, season, smoking, blood type, INR, combined secretory otitis media, combined adenoidectomy, surgical wound, and use of glucocorticoids were selected by mutual information (MI) method. The XGBoost model had best AUC (0.812) and Brier score (0.152). Decision curve analysis (DCA) showed that the model had a high clinical utility. The SHAP method revealed the top 10 variables of MI according to the importance ranking, and the average of the age was recognized as the most important predictor variable. This study built a PTH risk prediction model using machine learning. The XGBoost model is a tool with potential to facilitate population management strategies for PTH.

Assessment of risk factors for secondary post-tonsillectomy hemorrhage in children

Assessment of risk factors for secondary post-tonsillectomy hemorrhage in children

Risk factors for secondary post tonsillectomy hemorrhage

Introduction: Tonsillectomy is one of the most common worldwide surgical procedures performed by Otolaryngologists which is usually uncomplicated. The most common complication seen after tonsillectomy is hemorrhage. This can be primary or secondary. Primary hemorrhage occurs within twenty four hours after surgery and secondary hemorrhage occurs any time following the initial 24 hours. Although the exact mechanism behind post-tonsillectomy hemorrhage remains unclear. Risk factors can be helpful in pointing toward an etiology. Methods: We performed a retrospective review of 200 patients (above 3 years and of both gender), who were subjected for tonsillectomy with or without adenoidectomy at the ENT Department, Aswan University hospital, and then 50 of them presented with secondary post tonsillectomy hemorrhage (&gt; 24 hours) post-operative, after hospital discharge, between February 2020 and February 2021. Results: Considering risk factors, the patient ages ranged from 4-40 years with a mean of 15.42 years. Most of patients 37 (74%) were male. O positive blood group were predominant in 26 (52%) of patients. Repeated tonsillitis was the most common indication 35 (70%) of patients. bipolar technique was done in most of patients 36 (72%). The majority of patients 31 (62%) were subjected for tonsillectomy without adenoidectomy.

A single center retrospective comparison of post-tonsillectomy hemorrhage between BiZact and Coblator

IntroductionOver 550,000 tonsillectomies are performed every year. While post-tonsillectomy hemorrhage (PTH) has been studied in the coblator, bovie, and cold steel technique, there is a dearth of studies examining the post-tonsillectomy outcome using BiZact. This study examines the rate of BiZact PTH requiring control of hemorrhage in the OR and assess resident comfort using the device. MethodsRetrospective chart review for all tonsillectomies performed between January 2018 and December 2020 were performed. Rates of PTH were analyzed. In addition, a 7-question BiZact resident experience survey was administered to 25 otolaryngology residents. Results1384 patients were included in this study; 444 (32%) Bizact and 940 (68%) Coblation. 11 (2.48%) BiZact patients had PTH requiring OR for control of hemorrhage, compared to 44 (4.68%) Coblation patients. There were no patient deaths because of PTH. The mean age of patients with PTH was 7.44 (SD 4.07) years old. 22 (88%) residents responded to the survey. 17 (77.27%) felt more confident with Coblator while performing tonsillectomy most commonly reported for ease of use, followed by BiZact 4 (18.18%), most commonly reported for improved surgical plane. ConclusionBiZact is a safe and effective addition. At our institution, the rate of secondary PTH requiring OR intervention for BiZact is comparable to the national average for other tonsillectomy devices. The rate of BiZact PTH requiring OR intervention in our experience was nearly half of those done with Coblator. Overall residents at SCHC preferred Coblator over BiZact mainly attributed to Coblator’s versatility and ability to control intraoperative tonsil bleeding without additional instruments despite BiZact’s shorter operative time.

A prospective, randomized, single-blind study comparing coblation and monopolar extracapsular tonsillectomy.

ObjectiveThe aim of this study was to compare intraoperative blood loss, postoperative pain, post‐tonsillectomy hemorrhage (PTH), and medical costs associated with extracapsular tonsillectomy between coblation and monopolar electrocautery in children.Materials and methodsThis study included 293 patients aged 6–15 years planned to undergo extracapsular tonsillectomy. Data on estimated blood loss, postoperative pain score, operation time, PTH, and the cost of disposable equipment were collected.ResultsCoblation extracapsular tonsillectomy was associated with significantly lower mean pain scores than monopolar technique on postoperative days 1 (p <.001) and 2 (p = 0.02). However, the pain score was similar between the groups at all other time points. The monopolar group had a significantly shorter operation time compared to the coblation group (11.09 ± 7.53 vs. 17.12 ± 4.29 min, p <.001). Intraoperative estimated blood loss was not significantly different between the groups (p = .43).The cost of extracapsular tonsillectomy was significantly lower in the monopolar compared to the coblation group (US$ 28.18 vs. US$ 430.48, p <.001). PTH occurred in 17 patients (5.80%) and required a second surgery. Secondary PTH occurred in 6.16% (9/146) and 0.68% (1/147) of patients in the coblation and monopolar groups, respectively (p <.001). The PTH was significantly higher in the tonsillitis compared to in the tonsillar hypertrophy (12.37% vs. 2.55%, p = .002), However, the difference of PTH was not significant among mean pain scores subgroups. Of the 17 patients with PTH, the lower pole, middle portion, and upper pole were involved in 15 (88.24%), 2 (11.76%), and 0 cases, respectively.ConclusionsCoblation and novel monopolar electrocautery extracapsular tonsillectomy are associated with similar postoperative pain scores except on postoperative days 1 and 2. However, monopolar technique offers significant advantages over coblation method with less operative time, decreased secondary PTH, and cost.Level of Evidence: NA.

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.

Nebulized Tranexamic Acid in Secondary Post-Tonsillectomy Hemorrhage: Case Series and Review of the Literature.

IntroductionPost-tonsillectomy hemorrhage is a serious postoperative complication, and its acute management can present a challenge for the emergency provider. Although various strategies have been proposed, guidance on the best approach for management of this condition in the emergency department (ED) setting remains limited. Anecdotal reports of the use of nebulized tranexamic acid (TXA) for management of tonsillar bleeding have emerged over the past two years. Two recently published case reports describe the successful use of nebulized TXA for stabilization of post-tonsillectomy hemorrhage in an adult and a pediatric patient.Case SeriesEight patients who presented to our ED with secondary post-tonsillectomy hemorrhage received nebulized TXA for hemostatic management. The most common TXA dose used was 500 milligrams, and all but one patient received a single dose of the medication in the ED. Hemostatic benefit was observed in six patients, with complete bleeding cessation observed in five cases. Interventions prior to nebulized TXA administration were attempted in three of the six patients and included ice water gargle, direct pressure with TXA-soaked gauze, and nebulized racemic epinephrine. All but one of the patients were taken to the operating room for definitive management after initial stabilization in the ED.ConclusionNebulized TXA may offer a hemostatic benefit and aid in stabilization of tonsillectomy hemorrhage in the acute care setting, prior to definitive surgical intervention. Consideration of general principles of nebulization and aerosol particle size may be an important factor for drug delivery to the target tissue site.

Transarterial embolization with N-butyl 2-cyanoacrylate for the treatment of recurrent secondary post-tonsillectomy hemorrhage

BackgroundPostoperative hemorrhage is a potential complication of tonsillectomy, and early diagnosis and adequate management are mandatory to prevent hemorrhagic shock. The aim of this study was to assess the safety and efficacy of transcatheter embolization of recurrent post-tonsillectomy hemorrhage by using N-butyl 2-cyanoacrylate.ResultsWe performed a retrospective analysis of the medical records, imaging findings, technical details, and clinical outcome of eight patients with delayed post-tonsillectomy hemorrhage who underwent endovascular embolization. All patients were followed up; technical and clinical successes of treatment were evaluated. All patients had arterial pseudoaneurysm as a source of bleeding. The injured artery was facial artery in four patients, lingual artery in three patients, and linguofacial trunk in one patient. All lesions were treated by endovascular embolization using NBCA glue. All patients were successfully embolized with no clinical complications. In one patient with pseudoaneurysm at the ostium of the facial artery, after filling the pseudoaneurysm with glue, inadvertently proximal reflux into the adjacent part of the external carotid artery (ECA) occurred leading to its occlusion with no related immediate or delayed complication.ConclusionEndovascular embolization is an effective and almost safe procedure in the management of recurrent post-tonsillectomy bleeding. In such cases, we can use NBCA glue with certain precautions as an effective appropriate embolizing agent.

Predictive clinical exam findings in post-tonsillectomy hemorrhage

ObjectivesPost tonsillectomy hemorrhage (PTH) is a common complication of tonsillectomy. Our objectives were to: 1) Examine the postoperative course of patients presenting to St. Christopher's Hospital for Children (SCHC) with PTH; 2) Compare patients with and without a blood clot visualized in the tonsillar fossa at time of presentation to determine if outcomes regarding return to the operating room (OR) differ. MethodsThis was a retrospective chart review conducted at an academic, tertiary, pediatric hospital in an urban setting. Pediatric patients who underwent a tonsillectomy with concurrent adenoidectomy and were admitted for observation following secondary post tonsillectomy hemorrhage were reviewed. The effects of age, gender, indication, and clinical exam findings on admission on the rate of eventual return to the OR for control of hemorrhage were also analyzed. Chi-square analysis and Fisher's exact test were used to compare the significance of categorical frequencies. ResultsThe rate of blood clot presence in our cohort was 50.9% (28/55). Return to OR rates were defined as patients who began actively hemorrhaging following admission for observation, further stratified by presence or absence of clot on admission physical exam. There was a statistically significant higher rate of return to OR in patients who presented with a clot (46.6%) on clinical exam versus no clot (18.5%) after resolved post tonsillectomy hemorrhage (p < .027). Furthermore, patients with a blood clot present were significantly more likely to require OR sooner (21.31 h from admission) than those without a clot (100.75 h from admission) (p < .012). There was no statistically significant higher rate of blood clot presence or rate of return to OR in groups based on age, gender, or indication. DiscussionPediatric patients presenting after resolved secondary PTH with a blood clot visualized in the tonsillar fossa are more likely to require return to the OR for hemostasis and cautery than are those without a blood clot, and this is more likely to occur within 24 h of admission. Thus, patients with a blood clot on initial presentation may benefit from admission for a 24-h observation period, while a similar observation period may be unproductive for patients without a blood clot. ConclusionsPatients who present with a resolved secondary PTH and a blood clot present on clinical exam require return to the OR more often than patients presenting without a blood clot. While previously controversial, we feel that this demonstrates that a 24-h observation of a patient with a clot on exam is reasonable.

Incidence of Hemorrhage after ENT Procedures and Seasonal Variation: A Retrospective Study and Literature Review

Background: Ear, nose, throat procedures are the most performed procedures for adults and children per year. Doctors might have noticed that at certain times of the year, there would be an increase in admissions of post tonsillectomy bleeding or epistaxis after nasal surgeries. Objectives: To determine whether a correlation exists between season and the rate of hemorrhage presentation after ear, nose, throat procedures. Methods: A 12-year retrospective review from January of 2003 to June of 2015, involving 1032 patients who developed secondary hemorrhage following ear, nose, throat related surgeries. We analyzed the presentation of hemorrhage in relation to the month of admission. Meteorological data were obtained from the Meteorological directorate of Bahrain. Results: Post-Operative Hemorrhage occurred in (1032) patients. The season and air temperature had a significant influence on secondary post-tonsillectomy hemorrhage and post-septoplasty epistaxis according to the age with a significant increase in their rate during the summer months (p < 0.05). Conclusion: The incidence of hemorrhage showed monthly and seasonal variations. This is clearly a multi-factorial problem. However, in patients at high risk of bleeding, consideration should be given to performing surgeries at a time of year of lower rates.

Postoperative hemorrhage following coblation tonsillectomy with and without suture: A randomized study in Chinese adults.

Coblation tonsillectomy (TE) increases gradually in China. Hemorrhage is the main complication after tonsillectomy. The conclusions of the studies about suture after tonsillectomy are conflicting. To compare the post-tonsillectomy hemorrhage (PTH) rates in patients who underwent coblation with vs. without suture. This was a randomized controlled study of adult patients who underwent coblation TE at our hospital between 01/2017 and 08/2019. The patients were randomized to TE with or without suture. The primary endpoint was the secondary PTH. The secondary endpoints included the primary PTH, grade of PTH, and incidence of PTH within 4weeks post-TE. There were no differences between the two groups regarding sex, age, disease course, and BMI (all P>0.05). The occurrence of secondary PTH was lower in the suture group compared with the non-suture group (2.8% vs. 7.7%, P=0.016). Compared with non-suture group, the incidence of PTH within 4weeks (2.8% vs. 10.6%, P=0.009) and the PTH degree (P=0.02) were all significantly lower in the suture group. Intraoperative suture reduces the secondary PTH in adult patients who underwent coblation tonsillectomy. The incidence of PTH within 4weeks, PTH degree and pain might all improved for intraoperative suture.

Risk factors for secondary post-tonsillectomy hemorrhage in children

Risk factors for secondary post-tonsillectomy hemorrhage in children

Prevalence of Post-Tonsillectomy Hemorrhage in Adults and Children

Background and objectivesHemorrhage is the most common complication of tonsillectomy. However, the incidence of post-tonsillectomy hemorrhage may be affected by various factors including weight, age, medications, surgical technique, etc. This study was carried out to determine prevalence of post-tonsillectomy hemorrhage in patients undergoing tonsillectomy in a teaching hospital in Gorgan, Iran.MethodsThis descriptive study was conducted on 1,043 cases of tonsillectomy who were admitted to a referral teaching hospital in Gorgan (Iran) between 2016 and 2017. Data were collected from medical records. Demographics characteristics, the applied surgical technique (e.g., tonsillectomy, adenoidectomy and adenotonsillectomy), the time of bleeding onset, the results of coagulation tests and the method of post-tonsillectomy hemorrhage management were recorded.ResultsThe frequency of tonsillectomy was 19.2, 50.8, 18.6, 4, 2.1 and 5.3% in subjects aged 0-5, 5-10, 10-15, 15-20, 20-25 and more than 25 year old, respectively. The overall prevalence of post-tonsillectomy hemorrhage was 2.1%. The frequency of post-tonsillectomy hemorrhage was highest (13.6%) in patients aged 20-25 years. The incidence of post-tonsillectomy hemorrhage was zero in those aged ≤5 years. The rate of post-tonsillectomy hemorrhage was 54.5, 31.8 and 13.6% for those undergoing tonsillectomy, adenoidectomy and adenotonsillectomy, respectively. Secondary post-tonsillectomy hemorrhage (after 24 hours) was more common (81.8%). Moreover, the rate of re-admission for controlling the bleeding was 63.4% (14 cases).ConclusionThe incidence of post-tonsillectomy hemorrhage, the methods for its management and the need for re-admission are quite different in different age groups.

Risk factor analysis of secondary post-tonsillectomy hemorrhage in children

Objective: To analyze the risk factors of secondary post-tonsillectomy hemorrhage (PTH) in children, and to provide a theoretical basis for reducing complications after tonsillectomy. Method: A retrospective analysis of 354 children underwent tonsillectomy was performed, among which 42 secondary hemorrhage cases were divided into bleeding group, and other 312 cases were divided into non-bleeding group. To analyze the risk factors of secondary PTH and to discusses the pathogenesis of the hemorrhage, statistical analysis was conducted among eight clinical data including gender, age, reason of surgery, degree of tonsil embedding, surgery approach, surgeon' s skill level, intra-operative hemorrhagic volume, and postoperative absence of upper respiratory tract infection. Result: Univariant analysis showed that there was no statistical difference of gender, reason for operation, surgeon' s skill level, intra-operative hemorrhagic volume and postoperative upper respiratory tract infection different between bleeding group and non-bleeding group, while there was significant statistical difference of age, degree of tonsillar embedding, and surgery approach. Further multivariate logistic regression analysis of the three relevant factors showed that there was a significant correlation between the degree of tonsillar embedding and the surgery approach and the hemorrhage. Conclusion: Hemorrhage after tonsillectomy is a common and potentially fatal complication, with risk factors of the degree of tonsillar embedding, and the surgery approach. .

Risk Factors For Post-Tonsillectomy Hemorrhage

Objectives: This research was undertaken to determine the frequency of post-tonsillectomy hemorrhage (PTH) in one particular clinical setting and to assess which risk factors exist for PTH. Methods: Following a retrospective case review of 892 patients who had gone through either tonsillectomy or adenotonsillectomy, a subgroup of 50 records were selected for detailed study. These 50 patients were then classified as either pediatric cases (aged under 16) or adult cases (aged over 16). Their risk factors were then assessed. Risk factors included: age, sex, surgical indication; type of surgery; time hospitalized post-operatively; timing of PTH (primary and secondary); management used to staunch bleeding and time in hospital following PTH. Results: The overall rate of PTH was 5.6% (3.0% pediatric, 2.6% adult). All PTH instances were secondary and no primary type occurred. In comparing the adult and pediatric cases of PTH, there was no statistically significant difference (p>0.05) in terms of age, sex, time hospitalized post-operatively, management used to staunch bleeding or time in hospital following PTH. There was, however, a statistically significant difference (p<0.05) between groups in terms of surgical indication and timing of PTH (primary or secondary). Conclusion: There was an increased frequency of secondary PTH in both groups. PTH typically happened between day 5 and 10 post-operatively. Patients need to be advised about this risk and show caution regarding factors that increase the risk of PTH after surgery.

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.

The effect of perioperative dexamethasone dosing on post-tonsillectomy hemorrhage risk

ObjectivesDexamethasone is currently recommended for routine prophylaxis against postoperative nausea and vomiting after tonsillectomy procedures. However, some studies have raised concern that dexamethasone use may lead to higher rates of post-tonsillectomy hemorrhage. Our objective was to determine whether higher doses of dexamethasone administered perioperatively during tonsillectomy procedures are associated with an increased risk of secondary post-tonsillectomy hemorrhage. MethodsWe conducted a retrospective review of 9843 patients who underwent tonsillectomy and received dexamethasone at our institution from January 2010 to October 2014. We compared the dose of dexamethasone administered to patients who did and did not develop secondary post-tonsillectomy hemorrhage using Mann Whitney U tests. Multivariable logistic regression models were used to evaluate the association between dexamethasone dose and post-tonsillectomy hemorrhage after adjustment for demographic and clinical characteristics. ResultsA total of 280 (2.8%) patients developed secondary post-tonsillectomy hemorrhage. Patients who developed hemorrhage tended to be older (median (interquartile range) 7 (4–11) vs. 5 (3–8) years), p < 0.001) and had undergone tonsillectomy more often for chronic tonsillitis but less often for tonsillar or adenotonsillar hypertrophy or sleep disturbances. Dexamethasone dose was significantly lower on average in patients who experienced secondary post-tonsillectomy hemorrhage (median (interquartile range) 0.19 (0.14, 0.23) mg/kg vs. 0.21 (0.17, 0.30), p < 0.001). Multivariable modeling demonstrated that the dose of dexamethasone was not significantly associated with post-tonsillectomy hemorrhage after adjustment for age. ConclusionsThere does not appear to be a dose-related increase in the risk of post-tonsillectomy hemorrhage for patients receiving dexamethasone during tonsillectomy procedures.