Traditional Tonsillectomy Research Articles

Intrapersonal Randomized Controlled Trial Comparing Bipolar Scissors and Conventional Cold Tonsillectomy

ABSTRACTObjectiveTo evaluate bipolar scissors tonsillectomy by comparing it with traditional cold dissection tonsillectomy in the same patients, utilizing one technique on either side.Study designRandomized controlled trial.SettingsThe ENT day care unit of the Karolinska University Hospital at Danderyd Hospital, Stockholm.PatientsA total of 50 patients of which 49 were eligible (M/F 20/29), mean age 14.3 (4-41) years and included in the study. Thirty-one patients were operated due to upper airway obstruction and 18 for chronic tonsillitis. Outcome measures: (1) Intraoperative bleeding, (2) operative time, (3) postoperative pain and (4) complication rates, including postoperative primary and secondary hemorrhage.MethodsModern cold technique; cold scissors, Henke tonsil elevator, bipolar diathermia. Hot technique; bipolar scissors (Ethicon, set on 20 W), bipolar diathermia if needed. Each side was completed separately. Blood loss and total operative time on each side were registered. Pain was evaluated daily on a visual analog scale, VAS (0-100 mm) in patients from 10 years of age.ResultsMean operative time for the conventional cold technique was 11.6 SD ± 8.5 (range 1.0-55 mins) and for the hot technique 3.1 SD ± 3.1 min (range 0.5-8.5 mins) (Wilcoxon-test, p < 0.001). The corresponding median values were 3 and 1.9 mins, respectively. The mean blood loss was 43.2 SD ± 41.7 ml (range 7-225 ml)vs3.0 SD ± 4.7 ml (range 0-25 ml) (Wilcoxon-test p < 0.001). The corresponding median values were 30 and 1 ml respectively. No primary or secondary postoperative hemorrhages requiring surgical intervention occurred. There was no difference in pain.ConclusionTonsillectomy with bipolar scissors was almost four times faster and the blood loss significantly less than on the side operated with the conventional cold technique, whereas no difference in morbidity was found.

Postoperative Morbidity in Traditional versus Coblation Tonsillectomy

The aim of this study was to compare levels of postoperative pain after traditional (cold steel with bipolar cautery) and Coblation tonsillectomies. Patients with recurrent or chronic tonsillitis, including tonsillar hyperplasia, were randomized to undergo tonsillectomies using either a traditional cutting technique or the Coblation technique. Patients and staff on the relevant wards were blinded regarding patient allocation. Pain, odynophagia, and activity limitations were recorded on a visual analog scale. Analgesics were self-administered, and daily analgesic consumption by patients was reported. All complications were also registered. Fifty-seven patients (between 6 and 57 years of age) completed the study. No significant difference was found between the two techniques with regard to reported pain, odynophagia, activity limitations, or use of analgesics. A slight tendency toward decreased pain and decreased use of analgesics in the Coblation group reached statistical significance only when the adult patients were analyzed separately. Two cases of hospital readmission occurred because of postoperative bleeding following Coblation tonsillectomies. Overall,the two methods are equivalent in terms of postoperative pain,including the use of analgesics. The risk of postoperative bleeding after the Coblation method requires further evaluation with specifically designed studies.

Bipolar radiofrequency tonsillotomy compared with traditional cold dissection tonsillectomy in adults with recurrent tonsillitis

Objective To compare short- and long-term results of radiofrequency tonsillotomy and traditional cold dissection tonsillectomy in adult patients with recurrent tonsillitis. Study Design A randomized clinical trial. Setting A tertiary referral university hospital. Subjects and Methods Of 62 adults with recurrent tonsillitis, 24 patients were treated with cold dissection tonsillectomy, while radiofrequency tonsillotomy (RF) by use of radiofrequency induced thermotherapy probes was performed in the remaining 38 patients. Duration of surgery, amount of intraoperative bleeding, recovery time, postsurgical pain (measured by use of visual analogue scale on days 1, 3, 5, and 10 after surgery), dysphagia, weight loss, and time of return to normal diet and activity were measured. All the patients were followed for 12 to 24 months for recurrence of tonsillitis episodes. Results Comparing the radiofrequency tonsillotomy group to the cold dissection tonsillectomy group, mean duration of surgery was 16.89 versus 45.04 minutes, recovery time was 14.32 minutes versus 17.08 minutes, and amount of intraoperative bleeding was 15 to 20 cc versus 250 to 300 cc, respectively ( P < 0.005). There was no difference between the two groups in the recurrence of tonsillitis episodes after 24 months. Conclusion Tonsillotomy with radiofrequency is a simple, rapid, and effective method in adult patients with recurrent tonsillitis.

Comparison of three common tonsillectomy techniques: A prospective randomized, double‐blinded clinical study

To evaluate three current tonsillectomy techniques--intracapsular microdebridement, intracapsular coblation, and traditional extracapsular electrocautery dissection--comparing surgical parameters, efficacy, and morbidity in the treatment for obstructive sleep disordered breathing in children. Prospective, double-blinded study with follow-up by telephone interview. From February 2004 to July 2006, a total of 156 patients between the ages of 6 months and 22 years scheduled for adenotonsillectomy were randomly assigned to electrocautery, coblator, and microdebrider groups. 1) Patient demographics; 2) Intraoperative time; 3) Surgeon's perception of difficulty; 4) Indicators of postoperative morbidity: pain, use of pain medication, return to diet, and activity level; 5) Complications; 6) Cost. Microdebrider technique produced the shortest total surgical time, averaging 16 minutes. Use of coblation resulted in 2 less days of pain medication compared to electrocautery. Patients in the coblator and microdebrider groups returned to a normal diet 1.51 days and 1.77 days earlier, respectively, than in the electrocautery group. They also returned to preoperative activity levels 1.85 days and 2.06 days earlier than in the electrocautery group. Of all three methods, the microdebrider was the most cost effective. The coblator and microdebrider did not differ significantly from each other in all other parameters. The three techniques showed no statistically significant difference in assessment of difficulty, average pain scores, or postoperative complications. Postoperative recovery following intracapsular adenotonsillectomy in children with obstructive sleep apnea is significantly earlier with use of either the coblator or microdebrider versus traditional extracapsular tonsillectomy with electrocautery. Microdebrider and coblator were comparable in all other areas except for shorter operative time and less cost for the microdebrider.

Complications of Tonsillectomy

To compare the postoperative complications of intracapsular tonsillectomy using a microdebrider with traditional electrodissection tonsillectomy. Retrospective chart review. Tertiary care pediatric referral center. The medical records of 2944 patients undergoing tonsillectomy with or without adenoidectomy at our institution between January 1, 2002, and May 31, 2005, were reviewed. Incidence of delayed postoperative hemorrhage, return to the hospital or emergency department for pain or dehydration, and the need for revision surgery. There were 1731 patients in the intracapsular tonsillectomy group and 1212 in the traditional electrodissection tonsillectomy group. The incidence of delayed hemorrhage was 1.1% in the intracapsular tonsillectomy group and 3.4% in the traditional electrodissection tonsillectomy group (P < .001). For delayed hemorrhage requiring treatment in the operating room for control, the incidence was 0.5% in the intracapsular tonsillectomy group and 2.1% in the traditional electrodissection tonsillectomy group (P < .001). Treatment in the emergency department or hospital for pain or dehydration was necessary in 3.0% of the intracapsular tonsillectomy group and in 5.4% of the traditional electrodissection tonsillectomy group (P = .002). Eleven patients (0.64%) in the intracapsular tonsillectomy group required revision tonsillectomy. Intracapsular tonsillectomy has a lower incidence of postoperative hemorrhage and pain leading to hospital-based evaluation compared with traditional electrodissection tonsillectomy.

Powered intracapsular tonsillectomy in the management of recurrent tonsillitis

To compare intracapsular tonsillectomy (IT) and traditional tonsillectomy (TT) in treating recurrent adenotonsillitis or streptococcal pharyngitis. Retrospective chart review. Tertiary care pediatric referral center. Of 166 patients who met all inclusion criteria, 117 received TT and 49 received IT. Seventeen TT patients and 8 IT patients were treated at least once postoperatively for streptococcal pharyngitis or tonsillitis. The mean number of infections after surgery in each group did not reach statistical significance (P = 0.295). There was no difference between the IT and TT groups in postoperative infection rates.

Tonsillotomy or tonsillectomy?—a prospective study comparing histological and immunological findings in recurrent tonsillitis and tonsillar hyperplasia

We evaluated the differences in histological and immunological findings in children with recurrent tonsillitis and tonsillar hyperplasia and assessed the risk for relapsing tonsillar hyperplasia or recurrent tonsillitis after tonsillotomy in a prospective clinical study. Sixty-four children with recurrent tonsillitis underwent traditional (total) blunt dissection tonsillectomy between October 2003 and July 2004. Partial tonsillectomy (tonsillotomy) using CO(2)-laser technique was performed on 49 children with tonsillar hyperplasia and no history of recurrent tonsillitis between August 2003 and March 2005. The present study compares preoperative serum anti-streptolysin-O antibody and immunoglobulin levels (IgG, IgA and IgM), C-reactive protein levels (CRP) and blood leukocyte counts of the two study groups. Additionally the tonsillar tissue removed by tonsillotomy or tonsillectomy was histologically examined in order to determine the grade of hyperplasia, chronic inflammation and fibrosis. Furthermore, the grade of fresh inflammation within the tonsillar crypts of the specimens was analysed. The parents of 40 patients treated by laser tonsillotomy were surveyed in average 16 months. There was no statistically significant difference in preoperative serum anti-streptolysin-O antibody and immunoglobulin levels, C-reactive protein levels and blood leukocyte counts between the two study groups. All specimens showed the histological picture of hyperplasia. There was no statistically significant difference in the grades of hyperplasia between the two study groups. Signs of fresh but mild inflammation within the tonsillar crypts could be found in over 70% of both study groups. Fibrosis only occurred in children with recurrent tonsillitis (9%). In all specimens signs of chronic inflammation could be detected. The histological examinations of specimens from children with repeated throat infections more frequently showed a moderate chronic inflammation of the tonsillar tissue. Two of forty patients treated by tonsillotomy required a subsequent tonsillectomy due to a recurrence of tonsillar hyperplasia but no recurrent tonsillitis occurred. Tonsillotomy with CO(2)-laser technique is an effective surgical procedure with a long-lasting effect in patients with tonsillar hyperplasia. The benefits over conventional tonsillectomy are a lower risk for postoperative haemorrhage, reduced postoperative morbidity and accelerated recovery. Even in children with no history of recurrent tonsillitis signs of chronic inflammation histologically can be found in specimens after tonsillotomy. The occurrence of recurrent tonsillitis after tonsillotomy is rare, however. A low incidence of relapsing tonsillar hyperplasia after tonsillotomy should be expected. Preoperative laboratory investigations show few differences in patients with tonsillar hyperplasia and recurrent tonsillitis. Components of the antimicrobial defense system are also produced by chronically infected tonsils. Therefore tonsillotomy with CO(2)-laser could also be an option in some patients with mild symptoms of recurrent tonsillitis.

Human Immunodeficiency Virus Infection in a rural community of Plateau State: effective control measures still a nightmare?

This study was designed to find out the prevalence of human immunodeficiency virus (HIV) infection in Zawan village as well as their socio-cultural practices that promote its spread. Three hundred subjects were recruited into the study comprising 193 males and 107 females by a simple random sampling method. A structured questionnaire was administered to each respondent and 5mls of blood collected and assayed for anit-HIV antibodies. The results were analysed using statistical software Epi-Info version 6, P < 0.05 was considered significant. The prevalence of HIV in Zawan village was found to be 8.3% (25 out of 300) and the significant risk factors noted were--use of sharp objects, trading and the divorce/separated group, (P < 0.05). Other factors such as tattooing, male circumcision by traditional method and tonsillectomy were not found to be statistically associated with HIV infection in this community, (P > 0.05). HIV is still causing serious devastation in our rural communities. Hence government should supply affordable antiretroviral drugs to our rural dwellers, step up public enlightenment campaign and pursue with vigour the present micro-economic revival policies to alleviate abject poverty in our rural communities.

Bipolar electrodissection tonsillectomy in children

The purpose of this study was to compare bipolar electrodissection tonsillectomy with traditional cold dissection tonsillectomy in the pediatric population. Forty children with recurrent tonsillitis and/or obstructive symptoms were included in the study. The study population was randomly divided into two groups, and the two techniques were compared with regard to operative time, intraoperative and postoperative bleeding and postoperative pain. There were 23 children in the bipolar electrodissection tonsillectomy group (mean age, 8.1 years; range, 5-12 years), and 17 children in the cold dissection tonsillectomy group (mean age, 6.7 years; range, 5-12 years). The average operative times were 15.2+/-8.5 min for bipolar electrodissection tonsillectomy and 29.06+/-13.5 min for cold dissection tonsillectomy (P < 0.05). The blood loss in bipolar electrodissection tonsillectomy and cold dissection tonsillectomy was 5.0+/-4.2 ml and 32.1+/-11.3 ml, respectively (P < 0.05). Postoperative hemorrhage was not observed. Bipolar electrodissection tonsillectomy was less painful the first 30 min postoperatively (P < 0.05). Bipolar electrodissection tonsillectomy in children is a useful technique, with results comparable to traditional cold dissection tonsillectomy.

Pain Reduction by Fibrin Sealant in Older Children and Adult Tonsillectomy

Because tonsillectomy is a painful procedure in adults, this study was performed to see whether the addition of fibrin sealant (Tisseel) to the tonsillar fossa at the completion of tonsillectomy would reduce pain in adults and allow them to return to work sooner. Forty adult patients over the age of 12 were entered into a prospective randomized study to see whether the addition of fibrin sealant (Tisseel) to the tonsillar fossa at the completion of tonsillectomy for recurrent tonsillitis would reduce the time the patient needed to take narcotic analgesics after surgery. Fifteen adults had a traditional complete tonsillectomy by means of a needle point Bovie and served as a control group. Twenty-five (adults had the same procedure with the addition of Tisseel to see how long they required narcotic analgesics postoperatively and when they were able to resume normal activities. The control group took narcotics for an average of 10.3 days, whereas the addition of Tisseel reduced the time to 8.16 days (P = .0058). This significant reduction of time allowed adults to return to work and other activities sooner. Because the time required to return to work is often of paramount interest to patients having surgery, Tisseel should be considered a safe addition to older children and adult tonsillectomy in patients who are not allergic to bovine products because it will allow an earlier return to normal activities.

Randomized controlled trial of Coblation versus electrocautery tonsillectomy

To compare the postoperative recovery of patients receiving Coblation-assisted (Arthrocare, Sunnyvale, CA) intracapsular tonsillectomy with that of patients receiving traditional subcapsular electrocautery tonsillectomy. This was a prospective, randomized, double-blinded, controlled study. One hundred one children, aged 2 to 16 years, were randomized to Coblation or to conventional electrocautery tonsillectomy. Only patients with the operative indication of obstructive sleep apnea were entered into the study. Intracapsular tonsillectomy was performed on the Coblation group, and traditional subcapsular dissection was performed on the electrocautery group. Adenoidectomy was performed with the curette in both groups. Outcome measures were assessed on days 1, 3, and 5 after surgery. These included child and parental rating of pain by using the Wong Faces pain scale, analgesic use, oral intake, and activity level. Patients, parents, and the nurse practitioner obtaining the outcome data were blinded to treatment arm. Treatment groups were similar in age, gender, and weight. Surgical time and estimated blood loss were similar. There were no complications in either group. Coblation patients had less pain and greater oral intake at all 3 time points. Percentage of normal activity level returned to >70% earlier and more frequently in Coblation patients. There was slightly decreased analgesic use on postoperative day 5 in the Coblation group. Children with obstructive sleep apnea undergoing tonsillectomy and adenoidectomy demonstrate significantly better postoperative recovery after Coblation-assisted intracapsular tonsillectomy.

Long-term effects of intracapsular partial tonsillectomy (tonsillotomy) compared with full tonsillectomy

To compare the long-term effects (six years after surgery) of two techniques for pediatric tonsil surgery with respect to snoring, apneas, eating difficulties, infections and general health. The two methods were intracapsular partial tonsillectomy (tonsillotomy, "TT") using CO(2)-laser technique and traditional (total) blunt dissection tonsillectomy (TE). A questionnaire distributed by mail to the parents of children, who, in 1998, were included in a prospective clinical randomized study in one tertiary care ENT clinic. A 10 question survey follow-up of 41 children, between 9 and 15 years of age, who originally, six years earlier had been randomized to either TT with CO(2)-laser (n=21) or TE (n=20). The main indication for the surgery was a history of sleep related breathing distress (SRBD). Before the present study, all of the children had participated in earlier follow-ups at six months and one year after surgery. All the children in both groups answered the questionnaire. There were no significant differences between the answers from the two groups in any respects: the effect on snoring and apneas was equally stable for both groups. The number of children who remained free from snoring decreased from 40 after the first year to 25 after six years (11 TT, 14 TE). Snoring in the recurrent cases was not rated to be as frequent or as loud as before the surgery. Infections of the upper respiratory tract (URI) that had been treated with antibiotics occurred to the same extent in both groups. None had eating difficulties. The patients' satisfaction with the results of the surgery was high or very high in 18/21 TT and 20 TE cases, and the vast majority of the parents rated their children's present health status as improved compared with the preoperative condition. Tonsillotomy with CO(2)-laser seems to be a reliable method for tonsil surgery with substantially less primary morbidity than conventional tonsillectomy and with the same positive long-term effects after six years.

Randomized, Controlled, Multisite Study of Intracapsular Tonsillectomy Using Low-Temperature Plasma Excision

To determine the efficacy of intracapsular tonsillectomy using low-temperature plasma excision for improving the quality of the postoperative experience and for treating obstructive symptoms through 12 months postoperatively. Prospective, randomized, controlled, single-blind study. Multiple private or institutional otolaryngology clinics. Fifty-five children (aged 3-12 years) with obstructive tonsillar hypertrophy. Patients were randomly assigned and blinded to undergo either intracapsular tonsillectomy using low-temperature plasma excision (n = 27) or total tonsillectomy using conventional electrosurgery (n = 28). Operative data, 14-day recovery variables, and obstructive symptoms were prospectively collected through 12 months. During the first 14 days, significantly fewer children in the intracapsular group reported nausea (P = .01) or lost weight (P = .003). The intracapsular group had a significantly faster resolution of pain (P = .01), had an earlier return to a normal diet (P = .004), ceased taking pain medication sooner (P = .002), and returned to normal activity sooner (P = .04). Postoperatively, the intracapsular group had more residual tonsil tissue than the total tonsillectomy group (P = .002 for the 3- and 12-month visits). However, the incidence of recurring obstructive symptoms, pharyngitis, and antibiotic use was similar in both treatment groups during the 12 months. Postoperative morbidity normally associated with traditional (total) tonsillectomy was significantly reduced after intracapsular tonsillectomy using low-temperature plasma excision. The residual tonsillar tissue associated with this technique was of no clinical consequence.

Use of ionized field ablation for chronic tonsillar irritation.

Objectives: Chronic tonsillar irritation and its treatment have not been extensively discussed in the literature. Yet in the general otolaryngology practice patients frequently present with symptoms that include tonsillith, halitosis, and chronic pharyngeal irritation. In individuals without bacterial infections, a traditional tonsillectomy has not been a satisfactory option for these patients. Many patients are relegated to daily oral irrigation and crypt manipulation to control their symptoms. Over the last 3 years we have offered these patients a subtotal tonsillectomy using ionized field ablation (IFA). Methods: Retrospective nonrandomized study. Ten adults ranging between 24–46 years of age underwent IFA-assisted subtotal tonsillectomy for chronic tonsillar irritation without infection in 2000–2002. The medical records were reviewed and the patients were contacted to assess the morbidity in the immediate postoperative period and also to evaluate the long-term sequelae of the procedure. Main Outcome Measures: Postoperative pain and long-term resolution of symptoms on adults that underwent IFA-assisted subtotal tonsillectomy. Results: The adults included in this study underwent the operation with minimal blood loss and no significant complications. Postoperatively, the time to recovery was significantly less than that associated with traditional tonsillar surgery. All patients noted complete resolution of the majority of their symptoms at an average follow-up of a year after surgery. Conclusion: For patients with chronic tonsillar irritation, IFA-assisted subtotal tonsillectomy had a favorable postoperative course and has relieved the majority of their preoperative symptoms short term. Though further study is needed, this may offer these particular patients a more attractive surgical solution than traditional tonsillectomy.

Randomized controlled trial of coblation vs electrocautery tonsillectomy

Objectives: To compare the postoperative recovery of patients receiving coblation-assisted intracapsular tonsillectomy to traditional electrocautery tonsillectomy. Methods: This was a prospective, randomized, double-blinded, controlled study. Eighty-three children, aged 2 to 17 years, were randomized to coblation or conventional electrocautery. Only patients with the operative indication of obstructive sleep apnea were entered into the study, and all received tonsillectomy and adenoidectomy by a single surgeon. Intracapsular tonsillectomy was performed on the coblation group, and traditional subcapsular dissection was performed on the electrocautery group. Adenoidectomy was performed with the curette in both groups. Outcomes measures were assessed on days 1, 3, and 5 following surgery. These included child and parental rating of pain using the Wong Faces pain scale, analgesic use, oral intake, activity level, and presence/absence of nausea and/or vomiting. Patients, parents, and the nurse practitioner obtaining the outcomes data were blinded to treatment. Results: Treatment groups were similar in age, gender, and weight. Surgical time was similar and estimated blood loss slightly less in the coblation group. There were no complications in either group. Coblation patients had less pain and greater oral intake at all 3 time points. Percent of normal activity level returned to above 70% earlier and more frequently in coblation patients. There was decreased analgesic use in the coblation group. After controlling for codeine or hydrocodone intake, there was no difference in nausea and/or vomiting. Conclusions: Children with obstructive sleep apnea undergoing tonsillectomy and adenoidectomy demonstrate significantly better postoperative recovery following coblation intracapsular tonsillectomy.

Intracapsular tonsillectomy with RF surgery versus regular tonsillectomy: One-year results

Problem: To compare 2 techniques for pediatric tonsil surgery with respect to postoperative pain and morbidity and the long-term (that is, 1 year) effects on snoring and recurrent tonsillitis. Methods: Ninety-two children with a history of snoring and (few to several of them) tonsillitis, were randomized to either regular tonsillectomy (T)(n = 43) or intracapsular tonsillectomy (TT) using the radio-frequency (RF) surgical technique (n = 49). Surgitrone™ (Ellman int) 1.7 MHz was used with specially made sling electrodes. Results: In the TT group, the children recorded less pain from the second hour after surgery onward and were back in school and pain-free 3 days earlier than children in the T group. The TT children used fewer doses of painkillers and did not lose weight postoperatively compared to the T-group children who lost a mean of 660 g in 10 days. One year after surgery, both groups were satisfied and in good health. The T-group children remembered their pain as a trauma. The positive effect on snoring was the same in both groups and recurrence of infections had not occurred in a significant higher degree in the TT group. Conclusion: Intracapsular tonsillectomy with RF surgery is a safe method; it causes less pain and morbidity than regular tonsillectomy and has the same effect on snoring and recurrence of infections. Significance: A surgical technique that results in less suffering and a shorter length of time the child and a parent have to stay at home postoperatively is a health gain, as well as a socioeconomic one. Is it defendable to continue performing traditional tonsillectomy? Support: Financial support from the Research Council of South East Sweden (FORSS). Technical support from Ellman int.inc, NY, USA, which has provided with specially made electrodes.

Complications of microdebrider-assisted powered intracapsular tonsillectomy and adenoidectomy.

To study complications of powered intracapsular tonsillectomy and adenoidectomy (PITA) in pediatric patients with obstructive sleep apnea (OSA). Retrospective chart review and long-term follow-up in office or by telephone interview. We studied 278 patients who underwent PITA between September 2000 and October 2002. Outcome measures were postoperative bleeding, velopharyngeal insufficiency, need for hospital readmission, tonsil regrowth, and return of snoring or sleep apnea symptoms. All 278 children treated by PITA had immediate resolution of symptoms of OSA. Complications were noted in 11 patients (3.9%). Nine patients (3.2%) experienced tonsil regrowth with snoring, two of whom evolved to a return of OSA that was definitively managed by means of a complete tonsillectomy. Two patients (0.7%) had self-limited bleeding. None of the patients developed persistent velopharyngeal insufficiency or required hospital readmission. Microdebrider-assisted PITA is a safe and effective alternative for children otherwise treated with traditional tonsillectomy for symptoms of OSA due to adenotonsillar hypertrophy. This series suggests a 3.9% overall rate of complications, with the most common noted as tonsillar regrowth without recurrence of OSA. Prospective trials with longer follow-up may define higher complication rates.

Complete excision versus tonsil ablation for surgical management of tonsillar disease

The surgical approaches and techniques for tonsillar disease have evolved over the years. Complete subcapsular tonsillectomy has traditionally been the procedure of choice for all tonsillar surgery indications. Although new surgical modalities such as ultrasonic-activated scalpel and ionized field ablation appear to decrease the postoperative pain of tonsillectomy, patients continue to have a significant incidence of postoperative hemorrhage. Subsequently, supracapsular partial tonsillectomy has been used for patients with obstructive tonsillar hypertrophy with efficacy equal to that of complete subcapsular tonsillectomy. Partial tonsillectomy seems to offer a less painful postoperative course and a decrease in the complications common after complete tonsillectomy. Although originally the CO2 laser was used for surgical ablation of the tonsils, ionized field ablation and radiofrequency tissue ablation also have very promising results. The authors conclude that although traditional complete tonsillectomy continues to be the procedure of choice for recurrent infections or chronic tonsillitis, partial supracapsular tonsillectomy is a viable alternative for obstructive disease, offering lower postoperative morbidity with equal efficacy.

Bipolar scissors versus cold dissection for pediatric tonsillectomy—a prospective, randomized pilot study

Objective: To evaluate bipolar scissors tonsillectomy by comparing it with traditional cold dissection tonsillectomy. The outcome measures used were: (1) intra-operative bleeding; (2) operative time; (3) post-operative pain; and (4) complication rates including reactionary and secondary hemorrhage. Method: A prospective, randomized multiunit study involving three teaching hospitals in Belfast. Fifty consecutive children aged 10–16 years undergoing tonsillectomy for recurrent or chronic tonsillitis, between March 2000 and September 2000 were recruited as a subgroup of 200 patients selected for this study. These children were analysed separately from the adults, in a pilot study for the above parameters. Results: The mean age of the study population was 14.3 years. Sixty-eight percent of the children were girls. Median intra-operative blood loss was 6 ml for bipolar scissors tonsillectomy and 86 ml for cold dissection tonsillectomy ( P<0.001). The median operative time was 10.5 min for bipolar scissors tonsillectomy compared to 14.5 min for the cold dissection method ( P=0.001). There was no statistically significant difference in the pain scores between the two methods ( P>0.05). The overall reactionary hemorrhage rate was 4% while the overall secondary hemorrhage rate was 14%. The hospital readmission rate was 4%. The reactionary and secondary hemorrhage rates were unaffected by the surgical method. Conclusions: This pilot study has shown that bipolar scissors tonsillectomy is a relatively safe technique in children aged 10–16 years with a similar morbidity to the cold dissection method. Its use is associated with a significant decrease in surgical time and blood loss compared to the cold dissection method. These advantages make it a favourable instrument for pediatric tonsillectomy especially in this age group.

The use of coblation technology for traditional tonsillectomy

The use of coblation technology for traditional tonsillectomy