Tonsillectomy Techniques Research Articles

Reduction of post-operative pain after tonsillectomy by a local mucosal flap – a prospective, randomized, controlled clinical trial on 100 adult patients

Background: Tonsillectomy is one of the most frequent operations in otorhinolaryngology being associated with intense post-operative pain and an impairment of swallowing and speech.Aims: To determine whether wound sealing with a local mucosal flap can improve patient rehabilitation.Materials and methods: The study was designed as a prospective, randomized, monocentric, controlled clinical trial including 100 patients. Patients were operated on using either conventional extracapsular tonsillectomy (n = 50) or a modified technique with a local mucosal flap prepared from the posterior surface of the tonsil (n = 50). Number of requested pain medications, local oedema, patient-reported pain level, post-operative haemorrhage, impairment of speech, swallowing and general condition were assessed. The study was registered at the German Clinical Trials Register.Results: The mucosal flap technique significantly reduced post-operative pain [2.94 (intervention group) vs. 4.61 (control group) in an numerical analogue scale, p < .001] and the number of pain medications [6 (intervention group) vs. 1 (control group), p < .001].Conclusions: Wound sealing with a local mucosal flap can reduce post-operative pain in tonsillectomy patients and is recommended whenever anatomically feasible.Significance: This new tonsillectomy technique can help to reduce post-operative pain and thereby improve the patients’ post-operative rehabilitation.

Day case adenotonsillectomy for paediatric obstructive sleep apnoea: a review of the evidence.

Tonsillectomy and adenoidectomy are two of the most commonly performed procedures by otolaryngologist, especially in the paediatric population. Most common indications for adenotonsillectomy in the paediatric population include recurrent tonsillitis, otitis media (glue ear) and obstructive sleep apnoea (OSA). Whilst adenotonsillectomy is routinely performed as a day case for recurrent tonsillitis, many surgeons advocate an overnight stay for patients for OSA. The practice of keeping these patients in overnight for saturation monitoring is widely undertaken. There has been some dispute as to whether this is required. This review sets out to consider the evidence supporting the safety of day case adenotonsillectomies for paediatric obstructive sleep apnoea (OSA). The available literature between 2004 and 2017 was reviewed via searches on Pubmed, Medline, EMBASE and Google Scholar. The search terms used were: Adenotonsillectomy, day case, paediatric, obstructive sleep apnoea, and complications. A literature search identified 31 articles that were relevant to our review. After screening six articles were appropriate for inclusion in this review paper, all were retrospective reviews of case notes. 1463 children out of 1992 (including at least 207 children with comorbidities who were kept overnight) children had day case adenotonsillectomy for obstructive sleep apnoea. Tonsillectomy techniques were not discussed in any of the papers. Day case adenotonsillectomy for children between 3 and 17years who appears to be a safe option with a growing body of evidence. Large randomised control trials would likely add weight to this conclusion and help change the mind-set of clinicians.

Cost-Effectiveness Analysis of Intracapsular Tonsillectomy and Total Tonsillectomy for Pediatric Obstructive Sleep Apnea.

We performed an economic evaluation using a decision-tree model to analyze the relative cost effectiveness from the United States Centers for Medicare and Medicaid Services (CMS) perspective of two different methods of tonsillectomy (traditional total tonsillectomy and partial intracapsular) for pediatric obstructive sleep apnea (OSA). Procedural costs were drawn from published literature and Medicare values. Effectiveness and probabilities were drawn from medical literature. Primary intervention was monopolar-technique total tonsillectomy or microdebrider-assisted partial intracapsular tonsillectomy. Secondary interventions included operative control of hemorrhage, treatment of severe dehydration, or revision tonsillectomy. The decision model starts with pediatric patients with OSA, choosing between total and partial tonsillectomy. Outcomes were measured by costs (US dollars), effectiveness [quality-adjusted life year (QALY)], and a willingness-to-pay threshold of US$100,000/QALY. Base case analysis, probabilistic sensitivity analysis (PSA) and deterministic sensitivity analyses were performed. Primary outcome was incremental cost-effectiveness ratio (ICER) for each of the two tonsillectomy techniques. Base case analysis demonstrated that total tonsillectomy was more cost effective at US$12,453.40 per QALY gained. In PSA, 82.84% of the simulations show total tonsillectomy to be the more cost-effective strategy. Deterministic sensitivity analyses showed that when the rate of OSA recurrence is lower than 3.12%, partial tonsillectomy would be more cost effective. When the failure rate of partial tonsillectomy is below 1.0%, it is more cost effective even when total tonsillectomy is 100% successful. Study results suggest that overall monopolar-technique total tonsillectomy is more cost effective. However, with varying adjustments for disutility caused by procedural complications, intracapsular tonsillectomy could become a more cost-effective technique for treating pediatric OSA.

Comparative Post-operative Pain Analysis Between Coblator Assisted and Bipolar Diathermy Tonsillectomy in Paediatric Patients.

Tonsillectomy is one of the commonly performed otolaryngological operations. Despite a range of different techniques post-operative pain remains a major side-effect of this operation. Coblation assisted tonsillectomy is a latest technique of tonsillectomy. This technique is said to be associated with less intra-operative bleeding and less postoperative morbidity. We conducted a study in 100 patients to compare the pain scores between coblation assisted and bipolar diathermy tonsillectomy by FLACC score and Wong Baker scale score. The data so collected was statistically analysed using a t test and p values were calculated. The p value was highly significant (p < 0.001) for both scores in coblation assisted tonsillectomy 6h postoperatively and on 1st postoperative day (p < 0.05). On 7th post-operative day however there was no significant difference in post-operative pain score using FLACC score in both groups but Wong baker scale scores were still significant. We concluded that post-operative pain was less with coblator assisted tonsillectomy as compared to bipolar diathermy tonsillectomy at least in early post-operative period.

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

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

Comparison of Tonsillectomy Techniques and their Histopathological Healing Patterns

Comparison of Tonsillectomy Techniques and their Histopathological Healing Patterns

The debate continues: a prospective, randomised, single-blind study comparing Coblation and bipolar tonsillectomy techniques.

Tonsillectomy is a common procedure with significant post-operative pain. This study was designed to compare post-operative pain, returns to a normal diet and normal activity, and duration of regular analgesic use in Coblation and bipolar tonsillectomy patients. A total of 137 patients, aged 2-50 years, presenting to a single institution for tonsillectomy or adenotonsillectomy were recruited. Pain level, diet, analgesic use, return to normal activity and haemorrhage data were collected. Coblation tonsillectomy was associated with significantly less pain than bipolar tonsillectomy on post-operative days 1 (p = 0.005), 2 (p = 0.006) and 3 (p = 0.010). Mean pain scores were also significantly lower in the Coblation group (p = 0.039). Coblation patients had a significantly faster return to normal activity than bipolar tonsillectomy patients (p < 0.001). Coblation tonsillectomy is a less painful technique compared to bipolar tonsillectomy in the immediate post-operative period and in the overall post-operative period. This allows a faster return to normal activity and decreased analgesic requirements.

Coblation versus other surgical techniques for tonsillectomy.

Coblation versus other surgical techniques for tonsillectomy.

Coblation tonsillectomy: a systematic review and descriptive analysis.

Coblation is one of the more recent techniques for tonsillectomy; however, it remains unclear whether it exhibits any benefit or increased risk when compared to other techniques. This review provides an updated assessment of coblation tonsillectomy and how it compares to other tonsillectomy techniques. Systematic review and descriptive analysis of published literature. Electronic searches of MEDLINE, EMBASE, Web of Science and the Cochrane Database were performed. We included all randomized control trials comparing coblation tonsillectomy (not 'tonsillotomy') with any other tonsillectomy technique. Studies were excluded if tonsils, rather than individuals, were randomized. 16 eligible studies were identified, including a total of 567 patients, both adults and children. Coblation was compared with a variety of other tonsillectomy techniques. Outcomes included pain, primary and secondary haemorrhage, intraoperative bleeding and operation time. Postoperative pain was the primary outcome in most studies. There was a trend towards less pain in the coblation group in seven of the included studies. More recent studies appeared to fare more favourably in terms of pain outcomes and operating time. The coblation technique appears to be comparable with other commonly employed techniques for tonsillectomy; however, there is still no strong evidence to suggest that it possesses any definitive benefits. Findings would advocate further work being done through carefully designed randomised control trials, which compare coblation with cold dissection as the 'gold standard' and place an emphasis on reducing the amount of adjuvant electrocautery used so as to maximise the benefits of coblation and the lower temperature it generates.

Comparison Between Coblation Assisted Tonsillectomy Versus Conventional Tonsillectomy Regarding the Postoperative Pain and Bleeding

Background: The tonsillectomy is one of the most common surgical procedure in the world. Common complications are postoperative pain and bleeding. Coblation tonsillectomy is recent method of these surgical procedure and there are few publications in the literature and published information which are focused on the specific aspects of this surgical techniques or early postoperative complications. This study compare coblation and traditional tonsillectomy techniques in view of their advantages and complications. methods: In our prospective study type we include 60 children and adolescents, divided equally:30 conventional tonsillectomy versus 30 surgically treated with Coblation II system Arthrocare (Smith and Nephew). We compared the postoperative pain and intraoperative bleeding in the patients underwent surgery within conventional method versus coblation assisted tonsillectomy. To measure the pain we used visual-analogue scale of Wong-Baker with face expressions (0 no hurt; 10-hurts worst). We follow-up the level of pain in the day 1,2 and 7 after the surgery Estimated blood loss for coblation tonsillectomy was calculated by deducting the total amount of blood in suction jar with estimate saline used for the surgery. Results: Average age of participants surgically treated with conventional method group are 6,87±3,01. In the group where we used coblation method the average age of participant were 8.16±4,74. We found statistically significant differences (p-value<0.0001) in these parameters in both surgical techniques: the pain is less weak in intensity in the patients treated with the Coblation method in all the three days. In regard of intraoperative bleeding we found statistically significant difference between both methods (p-value -9.3132*10-10). The average bleeding in the conventional method is 97,5 ml ±12,12 ml, comparing with the coblastion-assisted tonsillectomy the average intraoperative bleeding is 27,1 ml ±14,28 ml. Conclusions: This study revealed a significantly less intraoperative or postoperative complications and morbidity in coblation tonsillectomy in comparison with traditional method. Coblation was associated with less pain and quick return to normal diet and daily activity. These findings addressed coblation tonsillectomy as an advanced method.

Comparison of the use of LigaSure versus a standard technique for tonsillectomy in dogs

The principal aim of this study was to document the effectiveness of tonsillectomy in dogs using a vessel-sealing device compared with a standard technique with tonsillectomy forceps. A secondary aim...

Assessment of secondary hemorrhage following tonsillectomy

We determined the rate of secondary haemorrhage following tonsillectomy by performing a telephone interview with 60 consecutive patients from ages 12+ years and above undergoing tonsillectomy alone. We were able to contact all Patients in our study group and found that 40% of patients reported a significant episode of bleeding postoperatively following discharge. Many previous studies only considered readmission rates for secondary haemorrhage that are clearly much lower than this and highly variable. We would suggest that although secondary hemorrhage can occasionally be very serious, the majority is minor. It therefore would be more useful to consider numbers of patients returning to theatre than readmission rates when comparing different techniques for tonsillectomy.

Innovative Intracapsular Tonsillectomy: How we do it.

OBJECTIVE: To present a new technique of intracapsular tonsillectomy using carbondioxide CO2 lasers, aiming to increase visibility by providing a better view of the tonsil and related structures in the obscure area by using the technique of rotating the operating table, 20°-30° instead of using a 30° endoscope. MATERIALS AND METHODS: From October 23, 2014 to October 23, 2015, 124 patients underwent an intracapsular tonsillectomy using a CO2 laser with the technique of rotating the operating table 20°-30° to have a clearer view of the tonsil tissue and the related structure. Absorbable suture material (3-0 vicryl) is also used to tie 6-8 areas of each side of the tonsillar capsule to prevent post-tonsillectomy bleeding. RESULTS: Rotating the operating table 20°-30° to the left and to the right while operating the intracapsular tonsillectomy using a CO2 laser helps the surgeons see the tonsillar tissue and the related structures in the obscure part clearer. That makes the intracapsular tonsillectomy using a CO2 laser safer and more precise due to improved ability to preserve healthy tonsillar tissue and vaporize the infected tonsillar tissue. Moreover, surgeons can also see the bleeding area (if any) and can precisely control the bleeding by using the electric cautery or suture ligation. CONCLUSION: Rotating the operating table 20°-30° in intracapsular tonsillectomy using a CO2 laser helps the surgeon not only to identify the upper, lower, and the side edges of the tonsillar capsule clearer but also makes the surgery safer and easier. Suture ligation of tonsillar capsule using 3-0 vicryl helps reduce the chance of post-tonsillectomy bleeding effectively.

Patterns of Hospital Use and Regionalization of Inpatient Pediatric Adenotonsillectomy.

Pediatric adenotonsillectomy is one of the most frequently performed procedures in the United States. Whereas several studies have focused on tonsillectomy techniques and outcomes, little is known about the overall changes in the distribution of care. Variations in care patterns between academic and nonacademic settings may have important financial and educational effects. To determine whether regionalization of inpatient pediatric adenotonsillectomy has occurred over the past decade with respect to hospital teaching status and primary expected payer. Secondary analysis of all inpatient admissions following pediatric adenotonsillectomy (age <18 years) in the Nationwide Inpatient Sample during the calendar years 2000, 2005, and 2010. Inpatient pediatric tonsillectomy. The percentage distributions of pediatric adenotonsillectomies with respect to hospital teaching status and primary payer were compared according to calendar year to determine temporal changes. Multivariate analysis was conducted with logistic regression to determine year-to-year changes in the proportion of pediatric adenotonsillectomy admissions, controlling for hospital teaching status and expected source of payment. The estimated numbers of inpatient hospital pediatric adenotonsillectomy stays in the United States in 2000, 2005, and 2010 were 12 879 (SE, 1695), 17 245 (SE, 2276), and 13 732 (SE, 2082), respectively. There was a significant increase in the proportion of children admitted to academic hospitals from 60.1% to 69.8% to 78.6%, respectively (P = .045). With respect to teaching hospitals, the primary expected payer distribution shifted significantly, with an increase in Medicaid recipients from 38.4% to 38.9% to 50.5%, and a decline in private insurance from 57.7% to 51.5% to 43.9% (P = .02). Inpatient pediatric adenotonsillectomies are increasingly being regionalized to academic/teaching hospitals. Concurrently, the proportion of patients using Medicaid as the primary payer has increased for inpatient tonsillectomies in teaching hospitals. Such regionalization has important implications for health care reimbursement and distribution of care.

Rethinking Surgical Technique and Priorities for Pediatric Tonsillectomy

The past 100years have witnessed dramatic shifts in the concept of ideal surgical goals and operative technique in tonsil surgery. Surgeons are reviving a technique of intracapsular tonsillectomy with increasing precision thanks to modern technology. With intracapsular tonsillectomy, pediatric patients recover faster, use less pain medication, and have a lower risk of dehydration and hemorrhage. Various considerations will dictate the adoption of this technology in the coming years. This current review explores concepts and controversies surrounding tonsillectomy with a focus on quality improvement.

Safety of Cold Tonsillectomy Techniques: Comparison between Wired Snare and Inferior Tonsillar Pole Ligation Methods

Safety of Cold Tonsillectomy Techniques: Comparison between Wired Snare and Inferior Tonsillar Pole Ligation Methods

Erişkinde soğuk bıçak tonsillektomi ve termal welding tonsillektominin karşılaştırılması: prospektif çalışma

Objective: The aim of this prospective study was to compare the duration and the postoperative complaints of the patients who had tonsillectomies with cold knife vs thermal welding. Methods: Thirty-one adults undergoing tonsillectomy were included. Traditional tonsillectomy was implemented in one tonsil, and thermal welding tonsillectomy (TWT) was implemented in other tonsil of the same patient. Duration of the operation, amounts of blood loss and morbidity (postoperative pain) were recorded. Results: Degree of pain, as assessed by Visual Analogue Scale, within the 1st postoperative day was not different between the two groups. Sensation of pain in 2nd–14th days were significantly lower in TWT group than in traditional tonsillectomy group. Although sensation of throat swelling and difficulty in eating tended to be lower in TWT group than in traditional tonsillectomy group, difference was not statistically significant. Although degree of ear ache on TWT side tended to be lower than traditional tonsillectomy side, difference was not statistically significant. In terms of postoperative hemorrhage, there was no difference between two tonsillectomy techniques. Duration of operation was significantly lower in TWT group than in traditional tonsillectomy group. Conclusion: TWT results in decreased postoperative pain and significantly shortened operation time compared to the traditional tonsillectomy. Therefore, we suggest that TWT is a quite effective in tonsillectomy procedure.

What Are the Trends in Tonsillectomy Techniques in Wales? A Prospective Observational Study of 19,195 Tonsillectomies over a 10-Year Period

There are a multitude of techniques to undertake tonsillectomy, with hot techniques such as diathermy and coblation being associated with a higher risk of secondary haemorrhage. The UK National Prospective Tonsillectomy Audit (2004) advocated cold steel dissection and ties to be the gold standard. This prospective observational study investigates the trends in tonsillectomy techniques across Wales in the last decade to establish if surgeons have adhered to this national guidance. Data relating to tonsillectomy were extracted over a 10-year period from 1 January 2003 to 31 December 2012 from the Wales Surgical Instrument Surveillance Programme database. A total of 19,195 patients were included. Time-series analysis using linear regression showed there was an increase in the number of bipolar diathermy tonsillectomies by 84% (Pearson's r = 0.762, p = 0.010) and coblation tonsillectomies by 120% (r = 0.825, p = 0.003). In contrast, there was a fall in the number of cold steel dissection tonsillectomies with ties by 60% (r = −0.939, p < 0.001). This observational study suggests that the use of bipolar and coblation techniques for tonsillectomy has increased. This deviation from national guidance may be due to these techniques being faster with less intraoperative bleeding. Further study for the underlying reasons for the increase in these techniques is warranted.

Childhood snoring: ENT approach and examination

Childhood snoring is caused the narrowness of the upper airway, mainly due to an adenotonsillar hypertrophy. It may impact the quality of life, neurocognitive development and growth. ENT clinical examination is one of the essential components of therapeutic decision-making, taking account of the severity and duration of obstructive signs, presence of complications and, in some cases, sleep recording data, weighed against operative risk. The new technique of radiosurgical partial tonsillectomy has modified this trade-off by considerably decreasing the surgical risk of bleeding and pain.

A Rare Complication of Radiofrequency Tonsil Ablation: Horner Syndrome.

Chronic tonsillitis is a common disease, and several different surgical techniques are used to treat this condition. In recent years, techniques such as radiofrequency ablation and coblation have been commonly used for tonsil surgery. In this report, we present the cases of two pediatric patients who developed ptosis, miosis, and enophthalmos (Horner syndrome) after radiofrequency ablation for tonsil reduction and discuss the technique of radiofrequency ablation of the tonsils. In the early postoperative period, miosis and ptosis were observed on the right side in one patient and on the left side in the other patient. Both patients were treated with 1 mg/kg/day methylprednisolone, which were tapered by halving the dose every 3 days. Miosis and ptosis improved after treatment in both patients. Along with the case presentation, we discuss the effectiveness and complications of radiofrequency ablation of the tonsils. These unusual complications of tonsil ablation may help ENT physicians who do not yet have a preferred surgical technique for tonsillectomy to make an informed decision. Limited data are available about the possible complications of radiofrequency ablation of the tonsils. The present report contributes to the literature on this topic.