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PubMed1993

Parental cigarette smoking and tonsillectomy in children.

The deleterious effects of parental smoking on the upper respiratory tracts of children are becoming increasingly recognized. This study examines the effect of parental smoking on the frequency of tonsillitis and incidence of tonsillectomy in children. A group of children being admitted for tonsillectomy and a control group of children from an orthoptic clinic were studied. Details recorded about the children included a history of tonsillectomy and the number of courses of antibiotics taken for sore throats in the previous 12 months. Parents were questioned about their smoking habits. A marked and statistically significant association has been found between the incidence of tonsillectomy in children and parental smoking in the home environment. There was a higher frequency of attacks of tonsillitis requiring antibiotic treatment in those children whose parents smoked. This effect may be mediated by altered oropharyngeal flora, mucociliary dysfunction, increased cross infection or a combination of these. If parents are encouraged to stop smoking there will be a reduction in tobacco smoke levels in the home environment and this should lead to a fall in both the incidence of tonsillitis and the need for tonsillectomy in their children.

Adult↗

PubMed2005

A double-blinded randomized controlled trial of coblation versus conventional dissection tonsillectomy on post-operative symptoms.

OBJECTIVES: The aim of this study was to compare postoperative symptoms following coblation tonsillectomy with those experienced following a traditional cold dissection. DESIGN: A prospective randomized controlled trial. SETTING: Secondary otorhinolaryngology care. PARTICIPANTS: Ninety-two adult patients with recurrent tonsillitis meriting tonsillectomy were recruited and randomly allocated into either coblation or cold dissection tonsillectomy groups. MAIN OUTCOME MEASURES: Primary outcomes were post-operative pain, otalgia, swallowing and analgesia use at 6-8 hours, 1, 3, 7 and 14 days post-operative. Secondary outcomes were post-operative day returned to eating and returned to normal activities/work. RESULTS: No significant differences between the two groups (P >or= 0.1) were found in any of the above primary outcomes, apart from swallowing at 6-8 hrs post-operatively where the cold dissection group had less pain. This group also returned earlier to normal eating (P = 0.03). The power of the study was sufficient to show a difference in the visual analogue scores of 2 between groups. CONCLUSIONS: The use of coblation to perform tonsillectomy does not confer any symptomatic benefits to the patient over conventional cold dissection tonsillectomy.

Adolescent↗

PubMed2004

Relationship between tonsils and IgA nephropathy as well as indications of tonsillectomy.

Although there are many papers about IgA nephropathy (IgAN) and tonsils, respectively, reviews about the relationship between tonsils, tonsillitis, tonsillectomy, and IgAN are limited. In this review, we introduced the structure, development, and function of tonsils, difference of tonsils with and without IgAN, consistency of both tonsillar IgA and glomerular IgA, the effect of tonsil stimulation, tonsil infection, and tonsillectomy on IgAN showed some evidences in which tonsils were closely related to IgAN and polymeric IgA1 deposited in glomerular mesangium were at least in part of tonsillar origin. Tonsillectomy can improve the urinary findings, keep stable renal function, improve mesangial proliferation and IgA deposit, have a favorable effect on long-tern renal survival in some IgAN patients, and do not cause significant immune deficiency and do not increase incidence of the upper respiratory tract infections, and can be used as a potentially effective treatment. The indications of tonsillectomy in patients with IgAN include mainly the deterioration of urinary findings after tonsillar infection, mild or moderate renal damage. However, tonsillectomy may not be enough and may not change the prognosis in IgAN patients with marked renal damage.

Bacterial Infections↗

PubMedDate not supplied

Role of tonsillectomy and adenoidectomy in the management of children with middle ear effusion.

Evidence for the clinical effectiveness of adenoidectomy or tonsillectomy and adenoidectomy in the management of children with persistent middle ear effusions is incomplete and what evidence there is the literature is not convincing. In the first year after tonsillectomy and adenoidectomy there is less otitis media. The beneficial effects of tonsillectomy and adenoidectomy on the incidence of otitis media declines in the second year after the operation. The prevailing opinion is that adenoidectomy is not indicated in the vast majority of children in whom a middle ear effusion has persisted for six weeks or more in spite of antibiotic therapy. Factors favoring an adenoidectomy would be persistent nasal obstruction, persistent purulent rhinorrhea and persistent adenoiditis. The role of tonsillectomy is even less clear, but the decision regarding tonsillectomy is made by most clinicians on the basis of the amount of intercurrent or chronic tonsillitis rather than on the basis of the middle ear effusion per se.

Adenoidectomy↗

PubMed1990

A comparison of postoperative bleeding incidence between general and local anesthesia tonsillectomies.

Postoperative bleeding after tonsillectomy is a problem that has earned the respect and cautious attention of the most experienced surgeons. The incidence of postoperative hemorrhage after tonsillectomy, as well as many factors affecting this incidence, has been extensively investigated. A possible factor that has not been well studied as a possible influence in postoperative tonsillectomy bleeding is the choice of anesthetic. A study was completed comparing the incidence of postoperative tonsillectomy bleeding between patients operated on using general anesthetic and local anesthetic. One hundred ninety-two patients consecutively undergoing tonsillectomy at Naval Hospital, Oakland, California, were included in the study. Three of 150 patients (3%) having general anesthesia and 13 of 87 patients (15%) having local anesthesia experienced postoperative bleeding. Possible factors influencing this difference in postoperative bleeding incidence are discussed. The possibility is suggested that surgeons (and previous reports) may underestimate the rates of postoperative bleeding as a result of patients being treated by other than the operating physician.

Adolescent↗

PubMed1999

Social conditions and paediatric day case tonsillectomy.

OBJECTIVE: To develop a simple method for assessing the proportion of children referred to hospital for tonsillectomy in different areas likely to be suitable for day case treatment based on their medical and social characteristics. METHODS: Four patient suitability criteria were selected based on previous experience of successful day case surgery and a literature review of the prevalence of contraindications and postoperative complications, as follows: medical contraindications (at least American Society of Anesthetists grade ASA2 to be eligible); home circumstances (no telephone, no car and single parent households were ineligible); distance from the hospital (more than 10 miles resulted in ineligibility); and likelihood of postoperative complications. Data relating to the social criteria were collected prospectively from 500 children under 12 years of age reviewed in the outpatient department and under the care of one of the authors. In addition, the electoral ward UPA8 (Jarman 8) deprivation score relevant to each child was recorded and the sample was divided into quintiles according to mean UPA8 scores. In each quintile, the percentage of children with the appropriate social criteria for day case tonsillectomy was calculated. The relationship between deprivation score and social criteria for day case tonsillectomy was determined using logistic regression. RESULTS: The proportion of children deemed socially suitable for day surgery fell continuously from 95% in the least deprived quintile to 55% in the most deprived group (proportion passing the social criteria for suitability = -1.5035 + 0.0298UPA8). Using these findings and those from the literature review on the nature and prevalence of contraindications and postoperative complications, a simple formula for realistic day case tonsillectomy targets was specified as A x B x C x D x 100%, where A is the proportion of children with no additional medical problems, B is the proportion passing the social suitability criteria, C is the proportion living within 10 miles and D is the proportion with no postoperative complications. Values for A and D would be derived from local audits. CONCLUSIONS: The formula can be used by purchasers and hospital managers to set differential day case targets for hospitals related to the characteristics of their patients referred for tonsillectomy. In principle, a similar approach could be applicable to other procedures and other age groups.

Ambulatory Surgical Procedures↗

PubMed2001

Blood splash and tonsillectomy: an underestimated hazard to the otolaryngologist.

Mucocutaneous exposure is an important route of transmission of hepatitis viruses and HIV in healthcare workers. Few data exist in the literature on the risk of transconjunctival exposure during many surgical procedures. We investigated the use of eye protection during tonsillectomy and measured the incidence of potential eye splash. No otolaryngologist surveyed routinely used eye protection during tonsillectomy. Splash events occurred in 23 out of 103 tonsillectomies. In all cases the surgeon was unaware of the splash. Splash events were significantly more likely to occur during adult tonsillectomy (p < 0.05). We strongly advise the routine use of eye protection during tonsillectomy.

Adolescent↗

PubMed2003

Increased post-operative haemorrhage seen in adult coblation tonsillectomy.

Coblation is a new soft tissue surgical technique that is being used for tonsillectomy. Published results show a significant decrease in the amount of post-operative pain experienced by patients undergoing coblation tonsillectomy. There has been no published work to date on the incidence of post-operative haemorrhage. From August 2001 to November 2002 one surgeon performed 36 coblation tonsillectomies on adults. On another list he performed 29 by his standard method of dissection and bipolar coagulation. Retrospective analysis found a significant increase in the secondary haemorrhage rate in adult patients undergoing coblation tonsillectomy (22.2 vs. 3.4 per cent). At our department coblation tonsillectomy has been abandoned until further work into its safety has been published.

Adolescent↗

PubMed2005

The influence of weather on the frequency of secondary post-tonsillectomy haemorrhage.

The aim of this study was to determine whether certain weather variables influence the secondary post-tonsillectomy haemorrhage rate and to examine the influence of a change in these variables on secondary haemorrhage. This was a prospective study carried out in a tertiary referral institution. All patients undergoing bilateral tonsillectomy over a one-year period were included. Local weather data, including daily temperature (max/min), relative humidity and water vapour pressure, were acquired. All patients readmitted to our department with secondary post-tonsillectomy haemorrhage were recorded. Of 346 patients undergoing tonsillectomy, 32 developed secondary haemorrhage (9.2 per cent). A significant negative correlation was found between secondary haemorrhage rate and the average monthly temperature (max/min) and water vapour pressure (Pearson's correlation = -0.8) (p < or = 0.002). These results suggest that performing tonsillectomy in warmer weather when the water vapour pressure is higher may reduce the secondary haemorrhage rate.

Adolescent↗

PubMed2004

The surgical arrest of post-tonsillectomy haemorrhage: hospital episode statistics.

INTRODUCTION: In the consent of patients for tonsillectomy, the risk of returning to theatre for control of postoperative bleeding may be determined from data provided on Hospital Episode Statistics (HES) provided by the Department of Health website. METHODS: HES data for England from 1998-2002 were used. The numbers of tonsillectomies and of surgical arrest of post-tonsillectomy haemorrhage were considered for children and adults. RESULTS: Of 220,497 tonsillectomies performed over the 4-year period, 1804 (0.82%) returned to theatre for control of bleeding. However, this was 3.87 times more likely in adults than children (P <0.0001). CONCLUSION: Adults are nearly four times more likely than children to require surgery for the arrest of post-tonsillectomy haemorrhage.

Adolescent↗

PubMed2003

American Society of Anesthesiology classification may predict severe post-tonsillectomy haemorrhage in children.

OBJECTIVE: The purpose of this study was to identify pre- or intraoperative markers for post-tonsillectomy haemorrhage (PTH) that may help to define in-/outpatient tonsillectomy. DESIGN: A retrospective case-control study of tonsillectomized patients. SETTING: A tertiary referral university hospital. METHODS: Twenty-three children with PTH were compared with 69 tonsillectomized age- and sex-matched children without bleeding. The cohort consisted of 559 individuals under 18 years old who were scheduled for tonsillectomy or adenotonsillectomy between 1996 and 2000. MAIN OUTCOME MEASURES: Physical and analytical variables were investigated, including blood pressure, haemoglobin and haematocrit levels, coagulation profile, American Society of Anesthesiology (ASA) physical status classification, indications for surgery, obstructive sleep apnea and snoring, surgical experience, addition of adenoidectomy, method of tonsillectomy, type of anaesthesia, method of haemostasis, and total surgical time. Statistical significance was calculated by the Mann-Whitney U test and Fisher's exact test. RESULTS: The incidence of PTH was 4.11%, and all but one case were primary bleedings. Nineteen cases occurred within the first 8 hours. A possible risk marker identified was ASA class 2 (odds ratio = 5.69, p = .04). Other investigated factors were not significant. CONCLUSIONS: The ASA classification may be a predictor for PTH and could be used to select outpatients before tonsillectomy.

Adenoidectomy↗

PubMed1993

Effect of and indication for tonsillectomy in IgA nephropathy.

Although more than 20 years have passed since the initial report of IgA nephropathy, the etiology of this disease is still unclear. Some reports suggest that the tonsil is an important etiological factor. We performed tonsillectomy on 26 patients with IgA nephropathy associated with chronic tonsillitis, and followed up the patients for two years after the operation to evaluate its clinical effect on this disease. Twelve patients (efficacy rate 46%) showed distinct improvement in urinary findings after the operation, although the efficacy rate went down as renal injury advanced. Serum IgA levels decreased significantly after the operation both in patients who improved and in those who did not; the decrease was especially evident in patients who had high levels of serum IgA before tonsillectomy. In 4 patients who improved, the level of circulating immune complex (CIC) was extremely high before, and decreased significantly after, the operation. One patient suffered renal failure three years after tonsillectomy. When renal injury has advanced to the clinically apparent degree, as occurred in this patient, tonsillectomy is absolutely contraindicated. In reaching a decision as to whether tonsillectomy is indicated in mild cases, the change in the number of erythrocytes in urinary sediments may be a sensitive parameter of the tonsillar provocation test.

Adult↗

PubMed1993

[Changes in transaminase before and after tonsillectomy].

Almost all patients who undergo palatine tonsillectomy for chronic tonsillitis and/or tonsillar hypertrophy manifest postoperative changes in their condition and laboratory data. In some patients, high preoperative transaminase levels decrease postoperatively. I studied 17 patients who had abnormal serum transaminase levels 10 days before tonsillectomy. Before tonsillectomy, serum glutamate oxaloacetate transaminase (GOT) levels were abnormal in half and serum glutamate pyruvate transaminase (GPT) were abnormal in all. Before operation, laboratory values of serum GPT were higher than those of serum GOT in all 17 patients. After tonsillectomy, the abnormal GOT levels in all patients gradually improved to the normal range before the 11th postoperative day and GPT levels did so before the 25th day. Measurement of intracellular transaminase activity of the palatine tonsil suggested that the migration of intracellular transaminase from tonsillar cells to serum would not elevate the serum transaminase level. Postoperative changes in serum transaminase and serum cholinesterase were different from the recovery process observed in fatty liver. The high transaminase level observed in patients with tonsillectomy is suspected to be due to other organs, rather than continuous inflammation of the palatine tonsil.

Adult↗

PubMed2001

Tonsillectomy and adenotonsillectomy in Sudanese patients.

OBJECTIVES: To highlight the indications for and complications of tonsillectomy or adenotonsillectomy operations in Sudanese patients and to find out whether any correlation can be deduced between routinely requested pre-operative investigations and the complications which may arise. DESIGN: A prospective study. SETTING: Khartoum ENT Teaching Hospital, Khartoum, Sudan. SUBJECTS: One hundred and twenty patients, 55% females and 45% males, age range 3 to 50 years. Pre-operative investigations consisted of a complete blood count and bleeding and clotting times., ASO titres and urinalysis. INTERVENTIONS: Consisted of tonsillectomy or adenotonsillectomy performed on in-patients by one of the authors under general anaesthesia. MAIN OUTCOME MEASURES: High erythrocyte sedimentation rate (ESR) or ASO titres should not deter an indicated tonsillectomy operation which can still be carried out if meticulous haemostasis is observed. RESULTS: Three or more episodes of exudative tonsillitis per year and upper airway obstruction were the commonest indications for tonsillectomy or adenotonsillectomy accounting for 72.5% and 16.7% of the operations. Intra-operative bleeding occurred in 63 (52.5%) of the patients. Low figures of reactionary and secondary haemorrhages were seen. CONCLUSION: It is concluded that as bleeding, both intra- and post-operative is the main complication of tonsillectomy, its incidence can be reduced to minimal levels by careful selection of patients, in whom the operation is carried out under general anaesthesia with gentle handling of tissues and detention of the patients post-operatively for two to three days. We also found out that coagulation tests need not be routinely requested and reserved for patients with a history of bleeding tendencies.

Adenoidectomy↗

PubMed1999

[Tonsillectomy--day surgery or hospitalization?].

Most current studies show that adenotonsillectomies can be performed safely as day case surgery. We wanted to evaluate patient acceptability of ambulatory surgery. A prospective study was undertaken in order to compare (adeno)tonsillectomies performed on an inpatient and outpatient basis. 104 patients underwent day surgery (adeno)tonsillectomy. 88 patients were treated as inpatients, but would have met the selection criteria for ambulatory surgery if an exception had been made in relation to travel distance. Tonsillectomy is an operation with high postoperative morbidity. Our study shows that patients undergoing day case surgery had better sleep, better oral intake and had less pain during the first postoperative night. The majority of the inpatients considered tonsillectomy performed as day case surgery less tolerable. With adequate information and patient selection, our study showed that most patients prefer day surgery. Questioned two weeks postoperatively, 92% of the patients preferred tonsillectomy performed as a day case procedure. Use of day surgery may improve health care efficiency. At the same time, it may improve quality of care for the patients.

Adolescent↗

PubMed1999

The incidence and management of post-tonsillectomy haemorrhage: a Singaporean experience.

AIM OF STUDY: To audit the incidence and management of post-tonsillectomy haemorrhage in the Singaporean context. METHODS: Three hundred and sixty-six consecutive tonsillectomies done over a 2-year period were retrospectively studied. Demographic details and indication for operation were evaluated in conjunction with the incidence and management of post-operative haemorrhage. RESULTS: 84.4% of the patients were adults while 58.7% were males. Chronic tonsillitis was the most common indication for operation (84.5%). The incidence of primary and secondary haemorrhage was 0.6% and 7.1% respectively. 3.8% of the patients had to return to the operation theatre to secure haemostasis. The use of post-operative antibiotics did not significantly affect the incidence of haemorrhage. There was no mortality from this complication. The haemorrhage rate was significantly higher among the adults (p = 0.048) and males (p = 0.019) in this study. CONCLUSION: Our overall post-tonsillectomy haemorrhage rate was higher than that reported in most of the Western publications because adults rather than children predominated in our series. We report a low incidence of primary haemorrhage which is in keeping with the results of studies on electrodissection tonsillectomies. Our findings indicate that tonsillectomy is a safe procedure which can be performed on a day surgery basis if the patients are carefully selected.

Adolescent↗

PubMed2000

A comparison of dissection-method and diathermy tonsillectomies.

OBJECTIVE: To compare the dissection and diathermy methods of tonsillectomy and evaluate their advantages and disadvantages during surgery and convalescence. METHODS AND SETTING: Patients who had tonsillectomy at Aga Khan University Hospital, between January 1994-December 1997. RESULTS: Four year retrospective analysis was done of 200 patients who underwent tonsillectomy by either electrocautery or dissection method. One hundred and eleven underwent tonsillectomy by electrocautery and the other 79 had their tonsils removed by dissection-method and 2 had a combination of both. The average intra-operative blood loss was 10 ml with cautery and 65 ml with dissection method. The average operative time was 15.7 minutes with cautery and 26.9 minutes for dissection. We found higher amounts of blood loss and intra-operative time with dissection method than electrocautery. In comparing diathermy dissection method tonsillectomies, there was marked diffference between two, in peri-operative blood loss and operative time. CONCLUSION: Although post-operative bleeding, pain and infection are complications of both techniques and in our study their incidence in similar in both, but intra-operative blood loss and time are two important factors, based on which we can conclude that electrocautery technique is a more effective technique in our set up.

Adolescent↗

PubMed2000

Clinical advantage of abscess tonsillectomy in peritonsillar abscess.

At the moment, regardless of the prevalence of the peritonsillar abscess (PTA), a definite protocol concerning the treatment of PTA has not yet been established and the treatment remains controversial. In the treatment of PTA the two most used therapeutic approaches are compared in this short study carried out on 16 patients. A group of patients presenting PTA received an abscess tonsillectomy (AT) is compared with another group treated with aspiration and subsequently operated on with interval tonsillectomy (IT). The results show obviously that the abscess tonsillectomy is better than the interval tonsillectomy in every aspect of treatment. The hospitalization time and global costs are also reduced. So when a young person has PTA and once the indication of tonsillectomy is posed, the operation has to be carried out "à chaud".

Adult↗