Tonsil-related procedures are considered fundamental and effective in the surgical treatment of obstructive sleep apnea (OSA). The range of techniques includes intratonsillar approaches, such as tonsillotomy (TT), as well as extracapsular procedures, such as tonsillectomy (TE) and uvulopalatopharyngoplasty (UPPP). Patients undergoing these procedures span all age groups, from children to seniors. This multicentric retrospective study, conducted between 2014 and 2018, analysed data from 3,498 patients who underwent bilateral TT, TE, or UPPP for OSA or ronchopathy. The cohort included 2,221 men (63.49%) and 1,277 women (36.51%). Of these, 2,808 patients (80.27%) underwent TT, 226 (6.46%) underwent TE, and 464 (13.26%) underwent UPPP. Late postoperative haemorrhage (LPOH) occurrence was significantly associated with the type of surgery (p < 0.0001) and the hospital where the procedure was performed (p < 0.0001). The incidence of LPOH in the TT group ranged from 0% to 5.88% across hospitals (p = 0.0068); whereas in the TE and UPPP groups, rates ranged from 0% to 33.33% (p = 0.0413 and p = 0.0409, respectively). The occurrence of repetitive bleeding was not influenced by treatment choice (readmission vs. outpatient care, observation vs. surgical revision, general vs. local anaesthesia). The severity of bleeding in all three groups was not affected by age and gender. The use of anticoagulants negatively impacted LPOH severity (p = 0.0166) in the UPPP group. No deaths occurred in our sample; however, three cases of severe postoperative bleeding (grade "D") were observed. Late postoperative haemorrhage remains a serious complication of tonsil-related surgery with the potential for life-threatening outcomes. The marked variability in bleeding incidence between surgical techniques and departments highlights the need for standardised perioperative protocols. Although no fatalities occurred, the occurrence of severe cases underlines the importance of vigilant postoperative monitoring. In our OSA cohort, tonsillotomy showed favourable safety, and recent evidence suggests it may represent a valuable alternative also in recurrent tonsillitis, warranting further research.

Background Postoperative bleeding after tonsillectomy is a potentially serious complication. Cold techniques reduce bleeding risks, but hot techniques remain widely used, reflecting national variations in clinical practice. Aims/objectives This study aimed to investigate postoperative bleeding rates after tonsillectomy and their correlation with demographic factors and surgical and haemostatic techniques, using data from national tonsil surgery registries in Norway and Sweden. Materials and methods A prospective cohort study included 28,254 tonsillectomies (2017–2022), with patients completing a 30-day postoperative questionnaire. Data on indication for surgery, surgical and haemostatic technique and postoperative bleeding were analyzed using multivariate logistic regression. Results Postoperative bleeding was reported in 7.2% of the patients, with higher rates in Norway (8.1%) compared to Sweden (6.3%). A hot + hot technique significantly increased the bleeding risk (OR 3.64), while the cold + cold technique had the lowest rate. Patients aged 19–24 years and males had higher bleeding risks. Conclusions and significance The cold + cold technique significantly reduces postoperative bleeding, but the cold + hot technique remains the most utilized approach. Norway performed more surgeries in high-risk age groups and had less frequent use of the cold + cold technique compared to Sweden. Increased adoption of the cold + cold technique may improve outcome in tonsil surgery.

This study aims to observe the changes in macular microcirculation before and after tonsil and/or adenoid surgery in children diagnosed with obstructive sleep apnea (OSA). Pediatric patients with OSA who underwent tonsillectomy and/or adenoidectomy at the Department of Otorhinolaryngology, the Affiliated Jiangning Hospital with Nanjing Medical University, from July 2019 to December 2023, were included in the OSA group (n = 100). A control group consisting of normal children who underwent physical examinations at the ophthalmology clinic was also selected (n = 50). OSA-18 scale, and optical coherence tomography angiography (OCTA) were conducted. The study focused on the changes in the superficial capillary plexus (SCP), including vascular length density (VLD), vascular perfusion density (VPD), and the foveal avascular zone (FAZ) within the central concave region of the macula. (1) VLD1, VLD2, VPD1, and VPD2 exhibited significantly lower values in the macular area of children in the OSA group compared to the control group (P < 0.05). In contrast, VLD3, VLD4, VPD3, VPD4, and FAZ did not show statistically significant differences between the two groups (P > 0.05). (2) Postoperative OSA-18 scores in children with OSA were significantly lower than preoperative scores (P < 0.05). Additionally, postoperative VLD1, VLD2, VPD1, and VPD2 were significantly elevated in children with OSA (P < 0.05), while no statistically significant differences were observed for the remaining indices before and after surgery (P > 0.05). (3) There were no statistically significant differences across all indices between the OSA group at 6 months postoperatively and the control group (P > 0.05). Tonsillectomy and/or adenoidectomy may enhance macular microcirculation, potentially aiding in the prevention of fundus complications. OCTA could serve as a supplementary tool for the early assessment of surgical indications in pediatric cases of OSA.

Introduction: Identifying perioperative bleeding risk in a pediatric population undergoing surgery is quite complex, as clinical history is often not particularly informative and laboratory tests can be influenced by multiple pre-analytical variables. The aim of the study was to evaluate the perioperative bleeding risk in a cohort of children with a borderline Factor VII deficiency (ranging from 20% to 40%) and to assess the potential need for preoperative prophylaxis. Methods: In this retrospective observational study, we evaluated consecutive pediatric patients undergoing surgery between January 2017 and February 2020 at the “Regina Margherita Hospital, Città della Salute e della Scienza”, Turin, Italy. A multivariate statistical analysis was conducted to assess whether there were variables capable of influencing the clinician’s choice about the preference of a preoperative prophylaxis strategy used only in case of abnormal perioperative bleeding versus a wait-and-see approach with Factor VII available in the operating room. Data were considered statistically significant when they had a p-value &lt;0.05. The analysis was conducted starting from a cohort of 64 children undergoing surgery (adenoid and tonsil surgery 59.3%; urological surgery for 21.9%; general surgery 4.7%; neurosurgery 4.7%; heart surgery 1.6%; high airway surgery 3.2%; toracic surgery 1.6%; ortopedic surgery 3.2%), divided into two groups based on preoperative treatment: 41 children were not subjected to prophylaxis, with rVIIa factor available in the operating room to be used in case of abnormal bleeding, while 23 children underwent preventive treatment with rVIIa factor before surgery. All patients underwent the ISTH-BAT score evaluation (ISTH-BAT 0: 85.9%; 1: 7.8%; 2: 4.7%; 3: 1.6%). Results: The group of patients who did not receive a prophylaxis, showed a higher tendency of bleeding (3/41: 7.3%), whereas in the groups of patients who received anti-haemorrhagic prophylaxis with rVIIa factor there were no bleeding episodes. Even if the bleeding is present only in the not-treated group, the difference between the two groups was not statistically significant (p=0.29). Multivariate analysis revealed that preoperative dosages of Factor VII and hemoglobin (Hb) are two independent variables: patients subjected to preoperative treatment had a more significant Factor VII deficiency (30.9%±6.4) compared to patients not subjected to a prophylactic treatment (40.5%±6.5); this difference between the groups resulted to be statistically significant (p&lt;0.0001). Moreover, patients subjected to prophylaxis had a lower Hb value than untreated patients, with a value of 12.1 +/- 1.3 gr/dl, which also resulted to be statistically significant (p&lt;0.03). Table 1. Conclusions: Our study showed a high prevalence of perioperative bleeding (3/64: 4.7%), confirming the insidiousness of Factor VII deficiency. Both the approaches of keeping Factor VII available in the operating room in case of bleeding and the preventive treatment with rVIIa factor before surgery are effective and safe in children with mild Factor VII deficiency between 20% and 40%. Even if both the approaches can be considered valid, it is noteworthy that bleeding was observed only in the group of untreated patients. Our results, although not statistically significant due to the limited number of patients, seem to indicate that a prophylactic approach in patients with Factor VII value &lt;31% is preferable to a watchful waiting approach.

Quality of life after combined adenoidectomy and laser tonsillotomy for pediatric sleep-disordered breathing: A prospective observational cohort trial.

ABSTRACTObjectivesTo study the changes in tonsil surgery practice over a 10‐year period and to survey opinions about its current use and future practice among Finnish otorhinolaryngologists.MethodsAn online survey was distributed between January and March of 2021 to otorhinolaryngologists in Finland.ResultsAltogether, 203 surveys were available for the analysis. Partial tonsil surgery has become the main surgical method, based on 75% of responders, for tonsillar hypertrophy in children over a 10‐year period. A similar change did not exist in adults and for infectious indications, but the attitudes support change. The most common surgical technique was monopolar electrocautery and cold‐steel dissection for extracapsular tonsillectomy and monopolar electrocautery and coblation for tonsillotomy. In choosing the method for tonsil surgery, the most important factors were the efficiency of symptom relief, familiarity, and avoidance of complications. In surgical practice, influencing a surgeon's choice the most was their residency experience, colleagues, and personal experience. A rather high percentage of opioid prescription (23%) after partial tonsil surgery was noted.ConclusionHere, in children, we report a paradigm shift toward partial tonsil surgery occurring within 10 years in the treatment of tonsillar hypertrophy. We also show that opinions support that this change may be used for adults and for infectious indications. A wide variety in tonsil surgery instruments ranging from newer techniques (e.g., coblation) to cold steel existed. Local practice strongly influenced the surgeon's choice.Level of EvidenceN/A.

When surgery on the palatine tonsils is indicated in children and adults with recurrent acute tonsillitis (RAT) is still the subject of debate. The aim of this article on specialist knowledge is to provide an overview of evidence-based decision-making for optimal diagnosis and treatment of RAT based on current studies and the new S3 guideline on tonsillitis. The diagnosis of a new episode of acute tonsillitis / sore throat should always include a classification with a scoring system (Centor, McIssac, FeverPain score) to assess the likelihood of bacterial tonsillitis, mainly due to group A streptococci (GAS). In unclear cases, a point-of-care test (POCT) for a GAS smear is helpful. Accurate counting of episodes is important in patients with RAT, as the cumulative frequency is the most important marker for or against tonsil surgery to date. In addition, a specific quality of life questionnaire should be used for each episode. Conservative symptomatic treatment of an episode includes a combination of paracetamol and/or non-steroidal anti-inflammatory drugs. If there is a high probability of bacterial tonsillitis, especially in high-risk patients, antibiotic treatment is initiated directly or by delayed prescription. Tonsillectomy is indicated and highly effective if the patient had ≥7 adequately treated episodes of RAT in the previous year or ≥5 such episodes in each of the previous two years or ≥3 such episodes in each of the previous three years. Whether a tonsillotomy is equivalent to a tonsillectomy in these cases will only be answered once the TOTO study has been completed. Standardized pain management is an essential part of the operation, as most patients are likely to experience severe postoperative pain. Nowadays, evidence-based treatment of patients with RAT is readily available.

The patient, a 10-year-old and 4-month-old boy, was admitted to the hospital "with a history of 19 days since tonsil surgery and 11 days of recurrent hematemesis". 19 days ago, bilateral endoscopic tonsil + adenoid plasma melting and bilateral tonsil fossa inferior pole suture were performed in the outer hospital, and recurrent hematemesis occurred 11 days ago, accompanied by transient fatigue and abdominal pain, diagnosis: ①Hematemesis to be investigated: postoperative tonsil bleeding? Upper gastrointestinal bleeding?②Acute moderate hemorrhagic anemia. On the first and third days of admission, the child had two sudden episodes of massive hematemesis, both of which were more than 1 000 mL, with pale lips, fatigue, and hemorrhagic shock. Bleeding was rapid and can terminate spontaneously, and emergency physical examination does not reveal a clear point of bleeding. Bilateral inferior pole sutures in the tonsillar fossa are in place. There were no obvious abnormalities in the emergency digestive endoscopy, no obvious bleeding points were detected in the tonsils and adenoids surgical area, and no obvious abnormalities were found in the neck CT angiography（CTA）. Emergency DSA-guided percutaneous selective external carotid artery intervention was performed, during which about 5 mm contrast agent overflowed at the origin of the facial artery, and a coil was implanted. The child had no active bleeding after the operation, and his life was as usual at 2 months of follow-up.

ABSTRACTObjectiveCoblation technology is gaining wide acceptance and use as a contemporary surgical technique for tonsil surgeries due to less post‐operative morbidity compared to the more traditional total tonsillectomy. Previous articles examined the role of post‐operative antibiotics for traditional total tonsillectomy; however, this is the first study which explores the role of post‐operative prophylactic antibiotic treatment among children undergoing coblation intracapsular tonsillectomy.MethodsA prospective randomised study included 100 children (aged 1–16) who were divided into two subgroups: with and without post‐operative antibiotics. Post‐operative follow‐up of patients included assessment for 7 days of pain levels, fever, return to diet, bleeding and halitosis. In addition, the children's caregivers completed the Parents'‐Postoperative‐Pain‐Measure (PPP‐M) questionnaire on Days 1 and 7.ResultsThe (+) antibiotic subgroup had substantially less halitosis on Days 2–6 after surgery. Prophylactic antibiotic treatment did not yield any differences between the two subgroups in the incidence of fever, return to regular diet or drinking, pain as measured by the Wong Baker Faces Pain scale, or pain as reported by the parents on the PPP‐M questionnaire.ConclusionsThis prospective study highlights that routine prophylactic post‐operative antibiotic use has a limited clinical benefit in paediatric intracapsular tonsillectomy. Improvement in halitosis was significant with antibiotic treatment; however, various other clinical parameters did not differ between the two subgroups, so the routine use of post‐operative antibiotics in the above setting is discouraged.

Background Large palatine tonsils cause a variety of symptoms including obstructive sleep apnea and snoring. In adults, the prevalence of tonsillar hypertrophy remains uncertain. Aims We estimated the incidence of tonsillectomy for adult palatine tonsillar hypertrophy using population data and retrospective patient charts. Material and Methods Patient data were retrospectively collected between 2004 and 2018 in the Hospital District of Southwest Finland. Adult patients with tonsil hypertrophy, obstructive sleep apnea or mouth breathing/snoring as an indication for surgery were included. Data were verified from patient charts. To determine in adults the incidence of tonsillectomy for tonsillar hypertrophy, the number of surgeries was compared to population data. Results The incidence of tonsillectomy for adult tonsillar hypertrophy was 8.49 per 100000 person-years. In our hospital district, 9.5% of adults who underwent tonsil surgery had tonsillar hypertrophy. The incidence rate reduced with age. The most common indication for surgery of hypertrophic tonsils was snoring (30.8%). In this study, 12.7% of patients with asymmetric tonsils had malignancy with the most common being lymphoma. Conclusions and Significance Symptomatic adult tonsil hypertrophy remains rare. In adults, tonsil asymmetry should invoke a suspicion of lymphoma. Even during adulthood, as age increases, tonsillar hypertrophy becomes less common.

This meta-analysis sought to compare knot tying against other methods of haemostasis in terms of post-operative haemorrhage, intraoperative blood loss and tonsillectomy time. Two independent reviewers performed a literature search according to PRISMA guidelines. Three databases were consulted, Pubmed, Google Scholar and Embase. Studies comparing knot tying with any other form of tonsillectomy haemostasis were included. Six studies met inclusion criteria for meta-analysis, comprising 1764 patients. When comparing knot tying with other forms of haemostasis there was no significant difference in terms of post-operative haemorrhage rates (odds ratio) (OR: 2.31, 95% CI 0.37to14.28, P = 0.37, I2 = 81%). There was significantly less intraoperative blood loss when haemostasis methods other than knot tying were used for tonsillectomy (OR: - 1.66, 95% CI: - 2.64 to - 0.69, P < 0.0008, I2=97%). haemostasis time was significantly shorter without knot tying (OR: - 1.49, 95% CI: - 2.61 to - 0.36, P < 0.01, I2 = 97%) as was total operation time (OR: - 1.93, 95% CI: - 3.61 to - 0.23, P < 0.03, I2 = 97%). Tonsillectomy is one of the oldest operations and traditional tonsil surgery has preceded the advent of evidence-based practice. Tie ligation of bleeding vessels is an effective method of securing intraoperative haemostasis and a skill all surgeons should be competent in. Our systematic review and meta-analysis found no evidence to support knot tying of tonsils to prevent post tonsillectomy bleeding compared to any haemostatic intervention during any method of tonsillectomy.

Tonsil-surgery is a common treatment for tonsillitis and upper-airway obstruction. Health benefits are a key point of clinical concern. Aim: To evaluate health benefits 6-months after pediatric tonsil-surgery and to examine the influence of the perioperative period on health-related quality of life (HRQoL). Participants, 198 children (4-17 years) who underwent tonsillectomy ± adenoidectomy on infection-related indications (TE ± A infec , n = 46), tonsillectomy ± adenoidectomy due to upper-airway-obstruction (TE ± A obstr , n = 44), or tonsillotomy ± adenoidectomy due to upper-airway-obstruction (TT ± A obstr , n = 108). Data were collected via a postoperative pain-diary, and 6-month-questionnaires. The Glasgow Children's Benefit Inventory (GCBI) evaluated HRQoL. An additional questionnaire assessed disease-specific benefits, including open-ended-questions to capture what the children wanted to convey to other children scheduled for surgery. QoL-score after surgery was positive in all indication/surgical-method groups. The highest GCBI-scores were seen in the subscale-scores for physical health and vitality. Comparing TE ± A obstr and TT ± A obstr , no significant differences were noted in the total-score or in the subscores. No differences in GCBI-scores were seen between subgroups of patients divided by postoperative pain intensity and duration. No differences in frequency or loudness of snoring or ENT-infections were seen between the groups, and satisfaction rates were high. The information that the children considered essential to share with others covered details of the day of surgery, including the anesthesia, nutrition, pain and pain relief, and well-being after surgery. All indication/surgical-method groups reported improvements regarding the health benefits of surgery, with the most pronounced effect being seen for physical health and vitality. TE ± A and TT ± A showed similar benefits in cases of obstructive and infection problems. Postoperative pain had no impact on QoL at the 6-month follow-up. Children's memories of the surgery can provide direction for management and improvements in children's care. Pain management needs to be optimized to improve recovery.

Tonsil Surgery in the Management of Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) in Children at the ENT Department of Ignace Deen National Hospital

Intracapsular versus extracapsular tonsil surgery: Comparison of postoperative haemorrhage outcomes in the Australasian setting

Objective:Hemorrhage after tonsil surgery in children is a serious and potentially life-threatening complication. The purpose of this study was to establish a risk warning model for hemorrhage after tonsil surgery in children through a national multi-center retrospective study, providing a basis for hierarchical management after tonsil surgery in children. Methods:Stratified sampling was performed on 8 854 children who underwent tonsillectomy under general anesthesia from 15 research centers in different provinces from January 15, 2022 to May 15, 2023. The sample size of this study was 2 724 cases, including 1 096 males and 1 628 females. Children were divided into bleeding and non-bleeding groups according to whether or not they had bleeding after surgery. The random forest algorithm was used to build a risk warning model. By continuously exploring the optimized model, the accuracy of predicting the postoperative bleeding rate of tonsils in children was improved, and the prediction effectiveness of the model was verified by ten-fold cross-validation. Results:Among 2 724 children, 117 had postoperative bleeding after tonsillectomy, with a bleeding rate of 4.30%. The model constructed by the random forest algorithm for the training set was verified in the test set, and the obtained prediction accuracy was 98.72%, the recall rate was 78.95%, and the area under the ROC curve AUC was 0.96. Conclusion:Although the recall rate of the random forest model needs to be improved, the overall accuracy is quite excellent. It can effectively avoid misjudging positive cases as negative cases. It is a useful tool that can be used to predict the postoperative bleeding rate of tonsils and clinical medical decision-making, laying a good foundation for subsequent optimization and improvement.

PurposeTo evaluate the long-term effectiveness of tonsillotomy (TT) compared to tonsillectomy (TE) with respect to disease-specific quality of life (QOL), sleep-disordered breathing symptoms, throat infections, and rate of reoperations over a median follow-up period of 12 years.MethodsAll patients < 16 years of age who underwent tonsil surgery between 2010 and 2011 at Helsinki University Hospital, Finland, were included in the study. In 2023, the patients answered a questionnaire concerning tonsil-related issues and a modified Tonsil and Adenoid Health Status Instrument (disease-specific QOL). Information about possible revisits and reoperations was gathered.ResultsThe study population consisted of 189 respondents, of which 87 had undergone TT and 102 TE. The median follow-up was 11.8 years in the TT group and 12.4 years in the TE group. The disease-specific QOL was equally good in both groups. Throat infections had not been an issue for the vast majority of patients and occurred to the same extent after TT and TE. The majority of participants (79.0% TT, 86.9% TE) were satisfied with the surgery, with no significant differences between the groups. After TT and TE, there were only a few revisits due to tonsil-related problems, and the reoperation rate was 6.9% and 1.0%, respectively.ConclusionLong-term clinical effectiveness of TT seems excellent. Compared to TE, with TT, equal disease-specific QOL can be achieved with a less invasive surgical method. Over a median follow-up period of 12-years, TT was not shown to be associated with an increased risk of tonsil infection problems.

Background: Even though children after tonsil surgery experience pain and other limitations in their daily lives, nursing care is transferred to parents after tonsil surgery, and they might need some kind of support. The aim of the study was to test the design of a randomized controlled trial intended to evaluate a nurse-led telephone follow-up after tonsil surgery on postoperative symptoms and quality of life. Methods: Of the seventeen children aged 3–17 years scheduled to tonsil surgery, nine were randomized to the intervention group and eight to the control group using a randomization list. The parents in the intervention group were contacted by telephone on days 1, 3, 5, and 10 postoperatively for counseling by a nurse. The instruments Postoperative Recovery in Children (PRiC) and the health-related quality of life instrument (EQ-5 D-Y) were used to evaluate postoperative symptoms and quality of life, respectively. Results: Eight participants in the intervention group reported throat pain compared to five participants in the control group on the operation day and four days after, possibly due to an uneven distribution of the type of surgery between the study groups. The parents appreciated the telephone counseling, and there were no unplanned revisits in the intervention group. However, it was difficult to recruit participants and the assessment tools were not always fully completed. Conclusions: No explicit conclusions can be drawn from this feasibility study due to the low number of participants and the study design needs adjustments.

This study aims to determine the regulations related to the protection of the professional rights of a doctor who is often suspected of committing medical malpractice in carrying out health services. In this study, the author analyzes the rules of malpractice based on positive law in Indonesia, then the author analyzes the liability carried out by the doctor’s profession in suspected malpractice in this study the author takes a case study related to tonsil surgery which caused BA’s child patient to experience brain death at the Kartika Husada, Bekasi Hospital. The method used by the author in this research uses normative or dogmatic research methods, which use documents laws, and regulations related to the issues studied and secondary data sources in the form of books and related journals. The results of the research in this case study conclude that there is no single rule that protects the rights of a doctor who is accused of committing malpractice, neglecting these rules only protects the interests of the patient, then the responsibility for the accusation of malpractice must go through the process of proof first, by the provisions of the elements of malpractice both in terms of criminal and civil law, and based on the case study that has been researched by the author, it is concluded that the efforts in dispute resolution made by the family of BA’s child patient who has died, are appropriate with the family by withdrawing the police report and carrying out peaceful efforts in the form of mediation with the hospital.

To describe postoperative analgesic regimens and patient-reported pain-related outcomes after tonsil surgery. Cohort study including perioperative data (n = 9274) and patient-reported outcome measures (n = 5080) registered in the Swedish Quality Register for Tonsil Surgery during 2023. After tonsil surgery, 92.7% received at least paracetamol and a NSAID/COX inhibitor, while 6.8% received no NSAID/COX inhibitor. Opioids were prescribed after tonsillectomy to 62.9% of adults and less often to adolescents and children (13-17-year-olds: 48.2%, 6-12-year-olds: 8.8%, 0-5-year-olds: 4.0%). Clonidine was frequently prescribed to 0-5-year-olds after tonsillectomy (54.4%). Overall, 11.7% reported dissatisfaction with the pain treatment, with the highest dissatisfaction rate after tonsillectomy in adolescents (20.6%) and adults (20.0%), and the lowest after tonsillotomy in children (4.9-6.8%). The most common complaint among dissatisfied patients was analgesics not being sufficiently helpful. Adult patients who received addition of opioids were less dissatisfied with the pain treatment (15.9% vs. 25.9%, p < 0.001), but also reported more side effects (5.7% vs. 2.7%, p = 0.039), compared with patients who received only paracetamol and NSAID/COX inhibitors. Tonsil surgery patients in Sweden receive various analgesic regimens. Although most are satisfied with pain treatment, there is room for improvement, particularly among adolescents and adults undergoing tonsillectomy. Paracetamol and a NSAID/COX inhibitor seem advisable as basic treatment. However, many patients need more effective treatment. The addition of opioids in adults results in greater satisfaction with pain treatment, but safety issues with opioid prescriptions must be taken into consideration. 4 Laryngoscope, 135:140-147, 2025.

Tonsil and Adenoid Surgery