Tonsillectomy Surgery Research Articles

Randomized Controlled Study of Ultrasonic Scalpel Tonsillectomy Versus Cold Dissection Tonsillectomy

Background The purpose of this study is to compare two different techniques of tonsillectomy, the ultrasonic scalpel, and the cold dissection tonsillectomy. In this study, the duration of the surgery, intraoperative blood loss, post-operative pain and post-operative hemorrhage rate will be compared. Material and Methods This is a randomized controlled study involving 72 patients within the age of 3-40 years old with history of recurrent tonsillitis or tonsillar hypertrophy with obstructive symptoms. The patients are randomized to have both tonsils removed either by cold dissection method or ultrasonic scalpel method. During the surgery, operative time and intra-operative blood loss will be documented. The post-operative pain score was documented by the patient using the visual analog pain score. Post-operative hemorrhage will also be documented if present. Results The data collected will be analysed statistically. The duration of surgery for ultrasonic scalpel tonsillectomy was significantly shorter (mean 14.11 minutes versus 29.09 minutes, p <0.001) and intra-operative bleeding was also significantly lower (mean 9.58 ml versus 87.57 ml, p <0.001). There were no significant mean differences of post-operative pain score between cold dissection and ultrasonic scalpel in first 6 hours up to day 6 of post-surgery. However, post-operative pain score for cold dissection tonsillectomy was significantly less on the 7th day of post-surgery. Conclusions There was no documented post-operative hemorrhage. Ultrasonic scalpel tonsillectomy is more superior compared to cold dissection tonsillectomy in terms of operative time and intra-operative blood loss, however there is no difference in the post-operative pain score. Bangladesh Journal of Medical Science Vol. 23 No. 04 October’24 Page : 1142-1148

Routine Histopathology of Tonsillectomy Specimens, Is It Necessary? A Prospective Observational Study

Routine histopathology of tonsillectomy specimens is not standard practice due to cost and resource constraints. This study aimed to evaluate the prevalence of abnormal histopathologies in tonsillectomy specimens to determine the necessity of routine histopathology. A prospective observational study was conducted from January 2014 to August 2016 at a general tertiary care center after approval of Institutional Ethics Committee (IEC). Patients scheduled for tonsillectomy surgery as per the AAOHNS 2011 criteria were included in the study. All tonsillectomy specimens were sent for histopathology, and abnormal findings were documented. Statistical analysis was performed. A total of 111 patients were enrolled in this study, and 222 tonsillectomy specimens were analyzed. The most common finding was chronic tonsillitis, which justified the selection criteria in 91.89% of patients. Two patients with chronic tonsillitis were also found to have actinomycosis present on the surface without parenchymal tissue reaction. Abnormal histopathological findings were observed in 9 (8.10%) of patients, leading to further investigations or treatment in 8 cases. These abnormalities included chronic granuloma, non-Hodgkin's lymphoma, early squamous cell carcinoma, and one choristoma. Tonsillar asymmetry, recent onset of symptoms and older age were found to be significantly correlated with abnormal histopathology and malignancy. Routine histopathology in tonsillectomy specimens helps to identify important findings that may require additional treatment. Based on the study we strongly recommend routine histopathology of tonsillectomy specimen. When significant cost constraints exist, risk-based approach can be adopted. Factors such as older age, asymmetry of tonsils, referred otalgia, duration of symptoms (recent onset) and a history of addiction should be considered for proceeding with histopathology.

Opioid Free Ptyregopalatine Ganglion Block Based Multimodal Anesthesia Versus Conventional Opioid Based Multimodal Anesthesia for Tonsillectomy Operations: A Randomized Controlled Trial.

Otolaryngology often involves adenotonsillectomies, surgical procedures aimed at addressing obstructive sleep-disordered breathing and underlying apnea in children. Pediatric anesthesiologists and otolaryngologists encounter challenges in managing pain post-adenotonsillectomy, especially due to the use of opioid medications in children who have an elevated baseline risk of airway obstruction and associated morbidity and mortality. This prospective, randomized, double-blinded study was conducted at Eldemerdash Hospital, Ain Shams University, Egypt, from September 2022 to August 2023. A total of 90 patients aged 5 - 13 years who underwent elective tonsillectomy surgery were randomly assigned to two groups, with 45 patients in each group. The first group, referred to as group A, received intravenous 1.0 μg/kg fentanyl, dexamethasone 150 μg/kg, and paracetamol 15 mg/kg. The second group, referred to as group B, received dexamethasone 150 μg/kg and paracetamol 15 mg/kg, with an opioid-free pterygopalatine ganglion block for multimodal anesthesia. The primary outcome measure of this study was the postoperative Wong-Baker scale at 1st, 3rd, and 24th hours. This study included 90 individuals with similar demographic profiles and comparable initial characteristics and surgical techniques in both groups (P > 0.05). Intraoperative heart rate, mean blood pressure, additional analgesia, postoperative Wong-Baker scale, postoperative rescue analgesia, and laryngospasm did not show significant differences between the two groups (P > 0.05). However, there were statistically significant differences between the groups in terms of nausea, vomiting, hypoxia, and post-anesthesia care unit stay, with group B experiencing fewer of these issues (P < 0.05). Both conventional opioid-based multimodal anesthesia and opioid-free pterygopalatine ganglion block-based multimodal anesthesia are effective methods for providing analgesia during and after tonsillectomy surgery. The pterygopalatine ganglion block, the latter option, has been found to result in fewer postoperative complications such as nausea, vomiting, and hypoxia. Additionally, patients who receive this type of anesthesia typically require less time in the post-anesthesia care unit.

Coblation Reduced Post-operative Pain Over Bipolar Diathermy in Tonsillectomy Operation

Background: Tonsillectomy is a common surgical procedure performed for conditions like chronic tonsillitis and obstructive sleep apnea. Coblation and Bipolar Diathermy are advanced techniques that offer potential benefits over traditional methods; however, comparative studies evaluating these techniques in Bangladesh are scarce. Methods: A prospective analysis of 750 tonsillectomy cases (420 Coblation, 330 Bipolar Diathermy) was conducted at the Department of ENT, Rajshahi Medical College Hospital and Metropolitan Hospital, Rajshahi, Bangladesh, from January 2021 to June 2024. Data were collected on primary outcomes (pain duration, post-operative bleeding rates, healing time) and secondary outcomes (operation time, analgesic use, intra-operative bleeding, diet, and healing degree). Statistical analysis included chi-square and t-tests. Results: Coblation tonsillectomy significantly reduced post-operative pain duration compared to Bipolar Diathermy. In the pediatric group (ages 3-15 years), 85% of Coblation patients reported pain resolution within 5-7 days, while only 60% in the Bipolar group achieved resolution within 8-12 days. In adults (&gt;15 years), 70% experienced pain resolution within 8-10 days with Coblation versus 55% with Bipolar Diathermy. Coblation was associated with lower reactionary hemorrhage rates (pediatric: 0.24% vs. 1.21%; adult: 0.1% vs. 0.61%) and secondary hemorrhage rates (pediatric: 1.67% vs. 3.33%; adult: 2.17% vs. 3.57%). Healing times were shorter with Coblation, with reduced analgesic use, lower intra-operative bleeding (average 1.5 ml vs. 3.5 ml), earlier return to a normal diet, and faster healing in the tonsillar fossa. Conclusion: Coblation tonsillectomy provides superior outcomes in terms of pain management, bleeding complications, and healing time compared to Bipolar Diathermy. These findings support Coblation as a preferred tonsillectomy technique for both pediatric and adult patients in a tertiary care setting in Bangladesh.

The Effect of Different Propofol-Ketamine Combinations on Emergence Delirium in Children Undergoing Adenoidectomy and Tonsillectomy Surgery

PurposeEmergence delirium (ED) after sevoflurane anesthesia remains a serious issue in children. We aimed to compare different ratios of propofol-ketamine combinations to determine a better option for preventing ED. DesignA prospective, randomized clinical trial. MethodsIn this study, 112 children aged between 3 and 12 years who underwent adenoidectomy and tonsillectomy were recruited. Propofol 1 mg kg−1 + ketamine 1 mg kg−1 (1:1 ratio), propofol 1.5 mg kg−1 + ketamine 0.75 mg kg−1 (2:1 ratio), propofol 2 mg kg−1 + ketamine 0.66 mg kg−1 (3:1 ratio), and propofol 3 mg kg−1 were applied at induction of anesthesia for Groups I, II, III, and IV, respectively. Fentanyl 1 mcg kg−1 and rocuronium 0.6 mg kg−1 were applied at induction, and anesthesia was maintained with sevoflurane and O2/N2O mixture for all participants. Intravenous morphine 0.1 mg kg−1 was applied for postoperative analgesia in the last 10 minutes of surgery. ED was defined as a Watcha score of ≥3. Demographics, hemodynamics, extubation time, Watcha scores, the Face, Legs, Activity, Cry, and Consolability scores, length of stay in the postanesthesia care unit (PACU), rescue analgesic requirement, and postoperative complications were recorded. FindingsED was significantly higher at 10 and 20 minutes in Group IV. Eighteen children experienced ED in PACU, (3, 2, 2, and 11 children in Groups I, II, III, and IV, respectively). Face, Legs, Activity, Cry, and Consolability scores were significantly different at all times. Rescue analgesics were required by 3 children (10.7%) in Group I, 2 (7.1%) in Group II, 2 (7.1%) in Group III, and 10 (35.7%) in Group IV (P = .012). The PACU stay was 21.9 ± 6.4 in Group I, 18.7 ± 6.3 in Group II, 16.7 ± 5.8 in Group III, and 17.4 ± 5.8 in Group IV. Nystagmus was observed in three children in Group I. ConclusionsTo addition of ketamine to propofol during the induction of sevoflurane anesthesia can reduce the ED and analgesic requirements in children. A propofol-to-ketamine ratio of 3:1 provided better postoperative recovery with less pain and ED, without prolonging the PACU length of stay.

Characteristics of Tonsillectomy Surgery Patients at Prof. Dr. R. D. Kandou Manado General Hospital

Characteristics of Tonsillectomy Surgery Patients at Prof. Dr. R. D. Kandou Manado General Hospital

Body Mass Index Greater Than 46 Associated With Increased Risk of 30 Day Complications Following Adult Tonsillectomy: A Retrospective Cohort Study.

Background: The study aimed to identify data-driven body mass index (BMI) thresholds that are associated with varying risk of 30 day complications following adult tonsillectomy. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was utilized to conduct a retrospective cohort analysis of patients undergoing adult tonsillectomy from 2005 to 2019. Stratum-specific likelihood ratio (SSLR) analysis was conducted to determine data-driven BMI strata that maximized the likelihood of 30 day complications following adult tonsillectomy. Patient demographics and clinical comorbidities were compared using chi-squared analysis and student t tests, where appropriate, for each stratum. Multivariable regression analysis was conducted to confirm association between identified data-driven strata with 30 day complication rates. Results: In total, 44,161 patients undergoing adult tonsillectomy were included in this study. SSLR analysis identified 2 BMI categories: 18 to 45 and 46+. Relative to the 18 to 45 BMI cohort, the 46+ BMI cohort was more likely to have 30 day all-cause complications after surgery [odds ratio (OR): 1.62, P = .007]. Specifically, the 46+ BMI cohort had significantly higher odds for 30 day major medical complications (OR: 2.86, P = .001), pulmonary domain complications (OR: 1.86, P = .041), unplanned reintubation (OR: 2.65, P = .033), and deep vein thrombosis (OR: 6.54, P = .026). Conclusions: We identified a BMI threshold of 46+ that was associated with a significantly increased risk of 30 day all-cause complications following adult tonsillectomy. These BMI strata can guide preoperative planning and risk-stratifying models for predicting 30 day complications in tonsillectomy surgery.

Pain control is comparable between opioid versus non-opioid management after otolaryngology procedures.

The current study aims to measure patient-reported satisfaction with pain control using opioid and non-opioid medications after undergoing the following otolaryngology procedures: parathyroidectomy, thyroid lobectomy, total thyroidectomy, and bilateral tonsillectomy. A prospective cohort study was performed at an academic medical center that included a telephone questionnaire and chart review. Opioid prescriptions, usage, and patient-reported pain outcomes were recorded. Bivariate analyses were used to compare opioid and non-opioid users. Of the 107 total patients undergoing otolaryngology procedures included in the study, 49 (45.8%) used an opioid for pain management postoperatively and 58 (54.2%) did not. Among the 81 patients who underwent endocrine procedures (parathyroidectomy, total thyroidectomy/lobectomy), most patients reported being "very satisfied" or "satisfied" with pain control whether they used opioids (n = 27/30, 90%) or not (n = 50/51, 98%). Of the 26 patients who underwent bilateral tonsillectomy, 19 (73%) were prescribed opioids and among these, most (n = 17/19, 89%) reported they were "very satisfied" or "satisfied" with pain control. In the non-opioid usage group, all patients (n = 7/7, 100%) reported they were "satisfied" with pain control. There was no statistically significant difference in patient-reported satisfaction with pain control between opioid and non-opioid users for any of the procedures listed. The results of our study suggest that patients who did not use opioids have a similar level of satisfaction with pain control compared to those using opioids after thyroid, parathyroid and tonsillectomy surgeries. Considering the magnitude of the opioid crisis, providers should reassess the need for opioid prescriptions following certain ENT procedures. IV.

The relationship between posttonsillectomy bleeding to hemogram and coagulation parameters.

Tonsillectomy is a common surgery performed for indications such as chronic tonsilitis, tonsil hypertrophy and obsructive sleep apnea. Although posttonsillectomy bleeding (PTB) is rare and can be controlled with simple interventions in many patients, it is one of the most feared complications of tonsillectomy surgery. In our study, we investigated the effects of changes in hemogram and coagulation values and seasonal effects on PTB. Pediatric and adult patients who underwent tonsillectomy with cold knife method between August 2020 and August 2023 in our clinic were retrospectively reviewed. Demographic data, hemogram and coagulation values of the patients in the control and study groups were recorded and the differences between the two groups in terms of these parameters were evaluated. Our study included 991 patients aged 1-51years. The rate of PTB was calculated as 2.82%. No patient with primary PTB was found. The duration of bleeding development was 7.03days. Age, WBC and neutrophil values were statistically significantly higher in the study group. There were no significant differences between two groups in terms of gender, season and other hemogram and coagulation parameters. Age, high WBC and neutrophil levels were determined as possible risk factors for PTB. Seasonal and gender distribution, aPTT and INR values were similar in the two groups. In order to prevent and predict bleeding, detailed infection investigation should be performed and the risk of bleeding should be considered to increase with increasing age.

Effect of Hydrogen Peroxide on Hemostasis during Tonsillectomy Operations

Effect of Hydrogen Peroxide on Hemostasis during Tonsillectomy Operations

Clinical case of laser ablation of lingual amygdala

Hypertrophy of the lingual tonsil is a condition in which the lingual tonsil, located at the base of the tongue, enlarges. This tonsil consists of clusters of follicles separated by a central groove. In children under 5 years old, the number of follicles usually ranges from 10 to 12, while in adults up to 40 years old, it can reach 35 to 40. This structure plays an important role in the immune system, helping the body fight infections and microbes. Like other tonsils in the throat, the lingual tonsil can sometimes cause problems, such as hypertrophy (enlargement) or chronic infections. The causes of lingual tonsil hypertrophy can be diverse. In some cases, it develops as a compensatory process after the removal of the palatine tonsils. The primary cause in adults may be chronic inflammation of the pharynx. Severe degrees of lingual tonsil hypertrophy are very rare but can lead to various symptoms, such as coughing, difficulty swallowing and breathing, a feeling of pressure in the area beneath the tongue, and other nonspecific complaints. These symptoms are not pathognomonic for lingual tonsil hypertrophy. The challenges in diagnosis and the lack of a standardized approach to surgical treatment require detailed consideration and description in each individual case. Sometimes, patients with lingual tonsil hypertrophy complain of coughing paroxysms. In such cases, mechanical irritation of the lingual tonsil with a probe can provide some assistance in diagnosis. In the context of this study, lingual tonsillectomy surgery was performed on a patient using a diode laser. The results obtained confirmed the high level of technological feasibility and appropriateness of using laser ablation for the treatment of lingual tonsil hypertrophy. Laser ablation is one of the possible surgical procedures for treating lingual tonsil hypertrophy. It can be an effective and technologically advanced method, although it requires experience and qualification of specialists.

Clinical case of laser ablation of lingual amygdala

Hypertrophy of the lingual tonsil is a condition in which the lingual tonsil, located at the base of the tongue, enlarges. This tonsil consists of clusters of follicles separated by a central groove. In children under 5 years old, the number of follicles usually ranges from 10 to 12, while in adults up to 40 years old, it can reach 35 to 40. This structure plays an important role in the immune system, helping the body fight infections and microbes. Like other tonsils in the throat, the lingual tonsil can sometimes cause problems, such as hypertrophy (enlargement) or chronic infections. The causes of lingual tonsil hypertrophy can be diverse. In some cases, it develops as a compensatory process after the removal of the palatine tonsils. The primary cause in adults may be chronic inflammation of the pharynx. Severe degrees of lingual tonsil hypertrophy are very rare but can lead to various symptoms, such as coughing, difficulty swallowing and breathing, a feeling of pressure in the area beneath the tongue, and other nonspecific complaints. These symptoms are not pathognomonic for lingual tonsil hypertrophy. The challenges in diagnosis and the lack of a standardized approach to surgical treatment require detailed consideration and description in each individual case. Sometimes, patients with lingual tonsil hypertrophy complain of coughing paroxysms. In such cases, mechanical irritation of the lingual tonsil with a probe can provide some assistance in diagnosis. In the context of this study, lingual tonsillectomy surgery was performed on a patient using a diode laser. The results obtained confirmed the high level of technological feasibility and appropriateness of using laser ablation for the treatment of lingual tonsil hypertrophy. Laser ablation is one of the possible surgical procedures for treating lingual tonsil hypertrophy. It can be an effective and technologically advanced method, although it requires experience and qualification of specialists.

Does parental stress improve after pediatric tonsillectomy?

ObjetiveParental stress is defined as a subjective perception that parenting demands are higher than their resources and is reportedly higher in parents who have children with both chronic and acute illnesses. Ear-nose-throat (ENT) disorders, such as recurrent infections and obstruction sleep disorders, are one of the most prevalent comorbidities in pediatric age. Worldwide, tonsillectomy stands as the surgical treatment for these conditions, associated with a significant burden on both the children and their parents.The purpose of this study is to determine parental stress levels before and after tonsillectomy and to ascertain whether these levels improve after the children's surgery. MethodsThis is a prospective cohort study enrolling 48 parents accompanying their children aged 3–10 for outpatient tonsillectomy surgery in a tertiary portuguese hospital.Consent for participation in this study was obtained and parental stress was determined using the portuguese version of Parental Stress Scale (PSS). All parents completed PSS before surgery and at the 6-month follow-up evaluation. ResultsOf the 48 surveys obtained, 38 were mothers aged from 24 to 45 years. The median age of children was 3 (3–9) years and half were girls. Surgery was performed due to obstruction sleep disorders in about 71 % of children.The overall average stress level was 29,19 (standard deviation 7,5), with higher scores being associated with male children. At the 6-month reevaluation PSS was significantly lower (26,98), with a prominent reduction in the parental stress subscale in mothers comparing to fathers. ConclusionsThese results highlight the importance of prompt diagnosis and treatment of children requiring tonsillectomy, as this condition may affect not only their physical health, but also parental relations, reflecting on their upbringing.

Clinical efficacy of local infiltration of lidocaine and tranexamic acid application in tonsillar region on postoperative pain and bleeding during tonsillectomy: prospective, randomized, double-blind controlled study

BackgroundAnesthetic techniques are designed to minimize intraoperative surgical bed bleeding which is a major problem that may interfere with precision, surgery duration, or postoperative wound healing. The main reason for reoperation and/or mortality in children who have had tonsillectomies is post-tonsillectomy hemorrhage. We evaluate the local application effect of tranexamic acid and lidocaine local infiltration in the tonsillar bed during tonsillectomy surgery on postoperative analgesia and bleeding.ResultsFLACC scores showed a statistically significant reduction in the first 24 h in group T (P < 0.05). Post-tonsillectomy hemorrhage was significantly minimized in group T. No complications were recorded following the local application of tranexamic acid and local lidocaine infiltration inside the tonsil bed.ConclusionsLocal infiltration of lidocaine provides adequate postoperative analgesia, and tranexamic acid application during tonsillectomy surgery minimizes postoperative bleeding and shortens surgery duration.Trial registrationThis study was preregistered with the Clinical Trials Registry (NCT05817474).

Medical Inventions in the Abbasid Caliphate and their Development in the Present Era

Aim: This research aimed at collecting information relating to the attention of the rulers in the Abbasid Caliphate on medical inventions and the innovative forms of the achievements in medicine in the current era. &#x0D; Methods: The doctrinal research methodology and descriptive, explanatory, analytical, and comparative research approaches were used in this study. It is worth mentioning that this research study is entirely based on library sources.&#x0D; Results: The study found that medical inventions such as construction and development of hospitals, the production and use of surgical wound sutures, the appointment of medical professionals and scholars from the various parts of the globe, first time eye, nose, and tonsillectomy surgeries happened during Abbasid Caliphate. Also, the training of some famous medical professionals and doctors like Abu Bakr al-Razi, Abul Qasim al-Zahrawi, Ibn al-Nafis, Ibn Sina, Ibn al-Haytham, and Mahzab al-Din al-Baghdadi were the developments and inventions during the era of Abbasid Caliphate.&#x0D; Conclusion: Special attention was paid to the profession of medicine in the Abbasid Caliphate and many inventions and developments in the field of medicine took place.&#x0D; Recommendation: The study recommended Ministry of Public Health to organize scientific and research seminars on the personalities and achievements of famous Muslim doctors of the Abbasid Caliphate. This will assist medical doctors and other professionals of the modern era to get more reliable information about the developments, progress, and inventions of the Abbasid Caliphate era and use and take advantage of the inventions, experiences, and instructions in their professional careers.

The impact of different types of anaesthesia on the course of tonsillectomy surgery

Recurrent tonsillitis is considered to be one of the most common ENT diseases. Tonsillectomy as a method of recurrent tonsillitis' treatment is being performed as usual as 20% of all surgeries in ENT departments. The critical criteria for the success of tonsillectomy for the surgeon are the frequency of perioperative complications, long-term results of treatment, and the patient's recovery time. For the patient, those criteria are the severity of pain, psychoemotional stress, the time spent in the hospital, and how quickly he can return to his daily life routine. The factors that significantly affect the outcome of tonsillectomy are the choice of anaesthetic management.&#x0D; Our study aimed to optimise the approach to choosing between endotracheal anaesthesia and local anaesthesia. Clinical studies were made among 158 patients with recurrent tonsillitis who underwent a bilateral tonsillectomy. The patients were divided into two groups.&#x0D; The first group consisted of 97 patients undergoing tonsillectomy using local anaesthesia. The control group included 61 patients undergoing tonsillectomy using endotracheal anaesthesia. We considered the factors such as duration of surgery, the amount of blood loss, intraoperative events, number of incidents of primary and secondary bleeding, assessment of pain syndrome, necessity of analgesics administration, length of hospital stay, and recovery period.&#x0D; Conclusions: tonsillectomy surgery using local anaesthesia requires less time to perform, has less blood loss, fewer intraoperative events, and fewer incidents of primary and secondary bleeding. The average level of pain is higher in patients using endotracheal anaesthesia.

Distribution of serum uric acid concentration and its association with lipid profiles: a single-center retrospective study in children aged 3 to 12 years with adenoid and tonsillar hypertrophy

BackgroundPresently, there is no consensus regarding the optimal serum uric acid (SUA) concentration for pediatric patients. Adenoid and tonsillar hypertrophy is considered to be closely associated with pediatric metabolic syndrome and cardiovascular risk and is a common condition in children admitted to the hospital. Therefore, we aimed to evaluate the relationship between SUA and dyslipidemia and propose a reference range for SUA concentration that is associated with a healthy lipid profile in hospitalized children with adenoid and tonsillar hypertrophy.MethodsPreoperative data from 4922 children admitted for elective adenoidectomy and/or tonsillectomy surgery due to adenoid and tonsillar hypertrophy were collected. SUA concentrations were scaled to standard deviation (SD), and SUA deviations were expressed as SD from the mean SUA of children without dyslipidemia.ResultsThe mean SUA concentration of the participants was 4.27 ± 1.01 mg/dL, and the prevalence of hyperuricemia was 1.6% when it was defined using an SUA of ≥ 7.0 mg/dL. Participants with dyslipidemia (856, 17.4%) had a higher prevalence of hyperuricemia (3.4% vs. 1.2%, P < 0.001) and higher SUA concentrations (4.51 ± 1.15 vs. 4.22 ± 0.97 mg/dL, P < 0.001) than those with ortholiposis. The circulating lipid status of participants with SUAs < 1 SD below the mean value for the participants with ortholiposis (range 1.80–3.28 mg/dL) was more normal. Each 1-SD increase in SUA was associated with a 27% increase in the risk of dyslipidemia (OR = 1.270, 95% CI, 1.185–1.361). Adjustment for a number of potential confounders reduced the strength of the relationship, but this remained significant (OR = 1.125, 95% CI, 1.042–1.215). The higher risk of dyslipidemia was maintained for participants with SUAs > 1 SD above the mean value of the participants with ortholiposis.ConclusionsSUA was independently associated with dyslipidemia in children with adenoid and tonsillar hypertrophy, and an SUA < 1 SD below the mean value for patients with ortholiposis was associated with a healthy lipid profile.

Is daycare tonsillectomy a safe outpatient surgery at Pokhara ENT Center, Nepal

Introduction: Tonsillectomy is one of the most common surgical procedure in the world performed by Ear, Nose and Throat surgeon. Over the past decade, there has been progress in surgical techniques for tonsillectomy, yet pain and bleeding after tonsillectomy remain important surgical complications. With the increasing need to reduce healthcare costs in developing countries, there is currently a trend towards performing tonsillectomy on a daycare basis and this study aims at evaluating how efficacious it may be in our setting. Methods: A retrospective review of all the daycare tonsillectomy surgeries performed at the Pokhara ENT Center, Pokhara, Nepal from February 2018 to January 2019. Patients aged 15 years and up of either sex who met the paradise criteria were included while patients who met the same but had a contraindication for tonsillectomy surgery were excluded. Demographic information as well as complications within six hours of surgery before discharge and on follow-up on the seventh post-operative day were evaluated, as were any emergency room visits in the first 24 hours and any complications requiring a visit to a healthcare facility. Results: On day of surgery 17% had worst pain and on seventh post-operative day 75% had no pain, only 2% presented with primary hemorrhage and 3% presented with secondary hemorrhage. None of them required revision surgery. Conclusions: Daycare tonsillectomy is being done in only some of the centers owing to the risk of postoperative complications in our country. In our study, the number of complications was lower and not life-threatening. It can be considered a safe and cost-effective method, though patient selection is crucial.

Comparison between landmark and ultrasound-guided percutaneous peristyloid glossopharyngeal nerve block for post-tonsillectomy pain relief in children: a randomized controlled clinical trial

ABSTRACT Background Glossopharyngeal nerve (GPN) block is a useful treatment option for acute post-tonsillectomy pain. This study aimed to assess safety and efficacy of the landmark (LM) technique versus the ultrasound (US)-guided technique for GPN block in children undergoing tonsillectomy. Methods This double-blinded, parallel-group, randomized trial enrolled 54 children of both genders who were American Society of Anesthesiologists physical status grade I–II and were scheduled for tonsillectomy under general anesthesia. All patients underwent percutaneous peristyloid GPN block. In the LM group, 27 patients were managed by insertion of the needle at midpoint of the line between the mastoid process and angle of the mandible. In the US group, 27 patients were managed with the US-guided technique to locate the styloid process. The outcomes were time to first analgesic requirement, pain in rest and during swallowing, easiness of the technique, time required for the technique performance, recovery time from anesthesia, and anesthetist, surgeon, parent, and staff satisfaction. Results The post-tonsillectomy pain score during rest and swallowing, rescue analgesic request, recovery time from general anesthesia, anesthetist’, surgeon’, staff nurses’, and parents’ satisfactions were comparable between the LM technique and US-guided percutaneous peristyloid GPN block (all p ˃ 0.05). However, the LM technique was significantly easier and required shorter duration than the US-guided technique (p ˂ 0.05). Conclusion In tonsillectomy surgery, both the LM technique and the percutaneous peristyloid US-guided GPN block were safe and effective in reducing postoperative pain. Furthermore, the LM technique was easier and had shorter duration to perform than the US-guided technique.

Opioid and non-opioid analgesic prescribing practices for pediatric adenotonsillectomy in a tertiary care center.

The U.S. is in an opioid epidemic with greater than 40,000 deaths annually. Pediatric adenotonsillectomy is one of the most common and painful otolaryngology surgeries performed, often associated with opioid prescriptions. To understand postoperative prescribing practices of adenotonsillectomy in a tertiary care institution and associated postoperative emergency department (ED) visits. Descriptive analysis of retrospective cohort data. Tertiary academic healthcare institution. Pediatric patients <18yo undergoing adenotonsillectomy between 2013 and 2016. Postoperative analgesic regimens assessed including opioid and non-opioid analgesic prescriptions upon discharge from tonsillectomy surgery. Main outcomes included ED presentation within 30-days of surgery and reoperation. Secondary outcomes included reason for ED presentation and relation to prescribed analgesics. Data was analyzed between November 2021-February 2022. 200 patients were included in the study with 69% prescribed opioids, and 51% prescribed non-opioid analgesics. Number of opioid doses ranged widely with a median of 37 (Q1, Q3: 0, 62). There were no demographic differences in patients prescribed opioids from those who were not. Of those patients who presented to the ED, 81% were not specifically prescribed acetaminophen (p<0.001). Regression analysis models were not predictive of postoperative analgesic regimen or 30-day ED presentation (p>0.05) CONCLUSIONS: Wide ranges of post tonsillectomy prescribing practices currently exist in our institution. Prescribing acetaminophen may help to reduce 30-day ED presentation rate. Larger prospective studies are needed to optimize pain control regimens and reduce variability of opioid prescribing practices. Standardization of postoperative pain medication doses may also reduce postoperative ED presentations.