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PubMed2000

Tonsillectomy and tonsillitis in Cape Town--age and sex of patients.

OBJECTIVES: To assess the sex and age of patients undergoing tonsillectomy in the Cape Town metropolitan area. METHODOLOGY: A retrospective audit was conducted from 1991 to 1995 comparing the sex and age of patients undergoing tonsillectomy with patients admitted to hospital for acute tonsillitis and the general population. RESULTS: A total of 7,250 tonsillectomies were performed for recurrent tonsillitis, and 111 adult patients were admitted with acute tonsillitis. When the data for the adult tonsillectomy patients were isolated, the female/male ratio was 3.22:1, which is highly significant when compared with the data for the general population (Cornfield's 95% confidence limit: 2.82, 3.68) and for patients with acute tonsillitis (Cornfield's 95% confidence limit: 1.14, 2.65). CONCLUSION: Recurrent tonsillitis requiring tonsillectomy occurs more commonly in female than male patients.

Adolescent↗

PubMed2001

[Risk of hemorrhage after outpatient versus inpatient tonsillectomy].

INTRODUCTION: This study evaluates the risk of post-tonsillectomy haemorrhage in outpatient surgery compared to conventional inpatient management. MATERIAL AND METHODS: We reviewed 528 tonsillectomies performed at the ENT Department, Rigshospitalet, University of Copenhagen, in the period 1.6.1997 to 31.5.1998. The 264 outpatient tonsillectomies were compared with 264 inpatient procedures. The number of post-operative haemorrhages and the time interval from operation to post-operative bleeding were registered, along with the need for re-operation. Outpatients were discharged 8 hours after surgery, inpatients after 24 hours. RESULTS: Forty-five (8.5%) of 528 tonsillectomies had post-operative haemorrhage complications, 15 (2.8%) patients needed a re-operation. Twenty-five (55%) cases of reactionary haemorrhage occurred < 8 hours after surgery and nine needed a re-operation. Two of three cases of post-operative haemorrhage 8-24 hours after primary surgery were re-operated, whereas four of 17 patients with haemorrhage > 24 hours post-operatively needed another surgery. There were no differences between inpatient and outpatient management. Eighty-nine per cent of all early (0-24 h) post-operative haemorrhages occurred < 8 hours post-operatively. In the time period from 8-24 hours post-operatively there were only three cases of reactionary haemorrhage. The risk of post-operative haemorrhage after discharge was 4.2% and 3.4% after outpatient and inpatient management respectively, a difference of only 0.8%. This makes outpatient tonsillectomy an acceptable alternative to inpatient management.

Adolescent↗

PubMed2002

Comparison of bipolar scissors and bipolar forceps in tonsillectomy.

Bipolar diathermy scissors tonsillectomy is a relatively new surgical technique. We conducted a prospective study of 90 patients to compare this technique with bipolar forceps tonsillectomy. We found that the use of the bipolar scissors required significantly less operating time (mean: 3.03 min less) and allowed patients to resume eating solid food more rapidly (mean: 40.35 min earlier). Bipolar scissors tonsillectomy was safe, and there were no intraoperative complications or primary hemorrhages. A postoperative follow-up telephone survey revealed that patients who underwent scissors tonsillectomy experienced no more morbidity than did the forceps group during the first 2 weeks after surgery. We conclude that bipolar scissors tonsillectomy is a safe and rapid technique that can be used successfully as an outpatient procedure.

Adolescent↗

PubMed1952

Incidence of poliomyelitis; the effect of tonsillectomy and other operations on the nose and throat.

A statistical survey was made of all the cases of poliomyelitis occurring in all of Los Angeles County during the three years of 1949, 1950 and 1951 in an attempt to determine the effect of operations on the nose and throat on the incidence of poliomyelitis. Tonsillectomy and adenoidectomy were the only operations noted with any degree of frequency. Yet, in the total of 3,601 cases of poliomyelitis that occurred in this three-year period there were only 20 (0.55 per cent) in which the patient had had recent tonsillectomy and adenoidectomy. The incidence of this disease in patients who had had tonsillectomy and adenoidectomy was compared with the "expected" incidence as determined from the incidence in other patients, in the same age group. There was no significant difference between actual and expected incidence even during the summer months when most cases of poliomyelitis occurred. The same was true with regard to recently tonsillectomized patients in the epidemic months of July through October. In a separate survey of 675 patients with poliomyelitis, it was noted that only 30 per cent ever had had tonsillectomy or adenoidectomy. Inasmuch as it is estimated that one of every three persons in the general young population nowadays has had tonsillectomy and adenoidectomy, this figure is no more or less than could be expected.

Adenoidectomy↗

PubMed2004

Socio-economic status and surgery in children: myringotomies and tonsillectomies in Ontario, Canada, 1996-2000.

AIM: To examine the relation between socio-economic status and (1) receipt of paediatric otolaryngological surgery, and (2) inclusion of adjuvant procedures. METHODS: Using data on myringotomies with insertion of tympanostomy tube and tonsillectomies for all children in Ontario, Canada, from 1996 to 2000, and census data on socio-economic status, we examined the association between socio-economic status and (1) the probability of surgery (myringotomy or tonsillectomy), and (2) the probability that surgery was accompanied by an adjuvant procedure. RESULTS: Lower socio-economic status was associated with increased likelihood that a child's initial surgery was a tonsillectomy rather than a myringotomy (odds ratio per unit increase in the deprivation index = 1.09, p = 0.01, confidence interval 1.06-1.11), and with increased likelihood that those children having a myringotomy would undergo a tonsillectomy during the same hospitalization (odds ratio 1.14, p < 0.0001, confidence interval 1.11-1.16). Children from neighbourhoods with larger immigrant populations were less likely to receive either procedure (odds ratios per 1% increase in the proportion of immigrants = 0.97 (p < 0.0001, confidence interval 0.96-0.97) for myringotomies and 0.97 (p < 0.0001, confidence interval 0.97-0.98) for tonsillectomies). CONCLUSIONS: Socio-economic status was associated with treatment selection for the two most common paediatric surgical procedures. Further research should examine whether differences in treatment arise at the level of the primary care physician, the specialist, and/or are due to parental preference.

Adenoidectomy↗

PubMed2004

Harmonic scalpel tonsillectomy versus hot electrocautery and cold dissection: an objective comparison.

We conducted a large-scale retrospective study to compare the surgical efficacy, practical utility, safety, and costeffectiveness of ultrasonic harmonic scalpel tonsillectomy, hot electrocautery, and cold surgical dissection. We based our findings on the length of operating time, complication rates, the length of hospital stay for patients with complications, and relative costs. We then compared our findings with those published in earlier reports, none of which were based on a three-way comparison. Our study population was made up of 316 patients--175 males and 141 females aged 1 to 23 years (mean: 7.3)--who had undergone adenotonsillectomy or tonsillectomy alone at our tertiary care children's hospital between Sept. 1, 2000, and Aug. 31, 2001. The harmonic scalpel was used on 75 patients (23.7%), electrocautery on 109 patients (34.5%), and cold surgical dissection on 132 (41.8%). The mean length of operating time for adenotonsillectomy was 42.4 (n = 70), 43.0 (n = 103), and 49.2 (n = 95) minutes, respectively; the corresponding times for tonsillectomy alone were 23.6 (n = 5), 30.2 (n = 6), and 35.3 (n = 37) minutes. Overall complication rates were 2.7, 5.5, and 6.1%, respectively. Hospital stays for immediate (<24 hr) postoperative bleeding averaged 2.0, 1.0, and 0.7 days, respectively, and stays for dehydration averaged 1.0, 1.3, and 1.5 days. Mean per-patient institutional costs were 460.00 dollars, 310.75 dollars, and 300.00 dollars, respectively. We conclude that harmonic scalpel tonsillectomy is efficacious, practical, safe, and cost-effective, and we recommend that any institution involved with a significant number of pediatric tonsillectomies consider using it.

Adenoidectomy↗

PubMed2004

The relationship between preoperative serum immunoglobulin levels and the development of bacteremia after tonsillectomy.

OBJECTIVES: We examined the risk for the development of bacteremia during tonsillectomy and evaluated the presence of an association between bacteremia and preoperative serum immunoglobulin levels. PATIENTS AND METHODS: The study included 40 patients (16 males, 24 females; mean age 16.8 years; range 5 to 35 years) who underwent tonsillectomy with the use of the dissection-snear technique. Preoperatively, venous blood samples were collected from all the patients to determine serum immunoglobulin levels and the presence or absence of bacteremia. Bacteremia was also investigated in blood samples postoperatively. RESULTS: There was no growth in the preoperative blood cultures, but bacteremia was documented in 10 patients (25%) after tonsillectomy. Increased serum IgG levels were determined in 15 patients before operation, seven of whom developed bacteremia after tonsillectomy (p<0.05). There was no correlation between postoperative bacteremia and preoperative serum IgM or IgA levels (p>0.05). CONCLUSION: Although our current knowledge does not allow to predict bacteremia following tonsillectomy in advance, the finding that seven of 10 patients who developed bacteremia had increased preoperative IgG levels draws attention to serum IgG, especially in patents in whom bacteremia may present additional risks.

Adolescent↗

PubMed2005

[Indications for tonsillectomy in 2005].

Tonsillectomy is one of the most frequent ENT operations but yet a very disputed one. The majority of children and adults are treated for recurrent angina, which is validated by several clinical trials. For an adult a peritonsillar abscess is best treated by immediate tonsillectomy. Incision and drainage is a validated method as well, as long as there is no indication to a delayed tonsillectomy. The tonsillectomy alone is not a validated treatment for adult upper airway obstruction. On the other hand it is a recommended procedure for children upper airway obstruction. Partial tonsillectomy (tonsillotomy) is also a validated procedure for this indication. Finally the peritonsillar abscess in a child should first be treated by one or two days of intravenous antibiotics.

Abscess↗

PubMedDate not supplied

Intracapsular versus standard tonsillectomy: review of literature.

For the past century, standard (total) tonsillectomy has been the preferred method for treating illness resulting from tonsillar infection and hypertrophy. With the advent of antibiotics, however, more cases of tonsillitis are treated medically. As a result, tonsillectomies are being performed less frequently for infection than for obstructive symptoms associated with tonsillar hypertrophy and sleep-disordered breathing. This shift has led to the re-emergence of the tonsillotomy, and more specifically the partial or intracapsular tonsillectomy, as an option for treating tonsillar hypertrophy, mainly in an effort to reduce the post-operative complications of pain, subsequent dehydration from lack of oral intake, and, potentially, delayed postoperative bleeding. The following is a review of the literature comparing intracapsular tonsillectomy to standard tonsillectomy for tonsillar hypertrophy associated with sleep-disordered breathing.

Humans↗

PubMedDate not supplied

Tonsillectomy--cold dissection vs. hot dissection: a prospective study.

Throughout the years, investigators and surgeons have developed new techniques for tonsillectomy aiming to lessen the postoperative morbidity and complications of tonsillectomy. It is generally accepted that the ideal method should decrease operative time, blood loss, postoperative haemorrhage and morbidity. To compare the technique and post-operative morbidity of two different tonsillectomy methods: cold dissection and bipolar electrodissection. A prospective study including a total of 545 children (Age: 3-16 yrs) undergoing tonsillectomy at The Children's University Hospital in Dublin, Ireland, from January 2003 to December 2003. The incidence of primary, secondary haemorrhage and postoperative pain was compared between both techniques. The overall rate of haemorrhage was 3.6% (20 patients) this included primary haemorrhage in 0.3% (2 patients) and secondary haemorrhage in 3.3% (18 patents). Primary haemorrhage occurred only in the electrodissection technique. As regards to secondary haemorrhage it was higher in the electrodissection technique 2.3% (12 patients) compared to 1% (6 patients) of the cold dissection technique. Patients rated pain to be more severe in the electrodissection technique compared to the cold dissection technique. Cold dissection tonsillectomy technique is still considered to be a safe and effective method with less posoperative morbidity complications as evidenced from our study.

Adolescent↗

PubMed2006

Adult tonsillectomy--are long waiting lists putting patients at risk?

There is a paucity of data on morbidity associated with long waiting lists for adult tonsillectomy. The aim of this study was to assess the morbidity associated with long waiting lists for adult tonsillectomy in a developing world setting. Of 350 patients on the waiting list at Groote Schuur Hospital for 18 months or more, only 55 were contactable. This low yield (15.7%) from the telephonic survey highlighted the difficulty of managing long waiting lists efficiently in a developing world setting. As only 1/55 patients on the waiting list had a complication (quinsy), it appears to be safe to delay tonsillectomy in adult patients. Only half of patients ultimately required tonsillectomy because of a natural reduction in the number of episodes of tonsillitis with time. In order to avoid unnecessary tonsillectomy we need to find better prognosticators to identify the subgroup of adult patients likely to have continued recurrent tonsillitis.

Adolescent↗

PubMed2006

Preincisional infiltration of tonsils with ropivacaine in post-tonsillectomy pain relief: double-blind, randomized, placebo-controlled intraindividual study.

OBJECTIVE: To determine whether pre-emptive ropivacaine has an influence on postoperative pain in adult patients undergoing tonsillectomy. DESIGN: A prospective, randomized, double-blind, placebo-controlled clinical trial. SETTING: University hospital. PATIENTS: The study included 20 adult patients undergoing elective tonsillectomy. Anesthetic induction and maintenance, dissection tonsillectomy, hemostasis techniques, and postoperative analgesic treatment were standardized for all patients. Before the onset of incision, one tonsillar fossa was administered 5 mL of 2% ropivacaine hydrochloride with epinephrine, whereas the other side received 5 mL of 0.9% saline with epinephrine and was designated as the control side. MAIN OUTCOMES MEASURES: For each side, postoperative pain, otalgia, operating time, amount of intraoperative blood loss, and postoperative hemorrhage were assessed. The intensity of postoperative pain was measured at rest and when the patient was drinking and was scored on a visual analogue scale. The patients were followed up for 10 days after surgery. RESULTS: There was no statistically significant difference in the amount of intraoperative hemorrhage and operation time between sides (p > .05). The constant postoperative pain in the ropivacaine side at rest was significantly less than in the placebo side on days 1, 2, 5, and 6 (p < .05). The post-tonsillectomy pain experienced in the ropivacaine side when swallowing was significantly less than that in the placebo side throughout the study period except on day 10 (p < .05). CONCLUSION: Based on the present findings, preincisional infiltration of ropivacaine 2% appears to be effective against both early and late postoperative pain, especially on swallowing, following tonsillectomy in adults.

Adolescent↗

PubMed1991

[Peritonsillar abscess. Occurrence of disease requiring surgery in the remaining tonsil after unilateral tonsillectomy à chaud].

The occurrence of disease requiring surgery of the remaining tonsil after unilateral tonsillectomy à chaud in the treatment of peritonsillar abscess was studied in 536 patients. None of the patients histories of previous severe tonsillitis at the time of the unilateral had tonsillectomy. 9.3% of the patients under 30 years of age were readmitted for surgery on the remaining tonsil during the follow up period. Only 0.5% of the patients over 30 years were readmitted. Previous investigations have shown increasing frequency of pharyngitis after bilateral tonsillectomy. The present authors suggest bilateral tonsillectomy in all patients under 30 years of age who suffer from peritonsillar abscess irrespectively of previous tonsillar disease. In patients over 30 years, unilateral ablation is recommended unless clear indication for bilateral tonsillectomy are present.

Adolescent↗

PubMed1991

Daycare tonsillectomy and/or adenoidectomy at the British Columbia Children's Hospital.

The fact that tonsillectomy (T), or tonsillectomy with adenoidectomy (T & A) or adenoidectomy (A) can be performed safely in selected children on a daycare or outpatient basis is well proven. This article illustrates the approach that the British Columbia Children's Hospital (B.C.C.H.) took to confirm that the procedures were safe locally. A pilot project was started in June of 1984 to perform daycare adenoidectomies only, using two full-time pediatric otolaryngologists. When this proved successful, other otolaryngologists were encouraged to use the program. In June of 1988, a second pilot project was started for daycare tonsillectomies (or tonsillectomy and adenoidectomy). Criteria were established for patient selection, preparation, anesthesia, post-anesthetic recovery (PAR), Daycare Unit (DCU) nursing, and discharge. Follow-up information was obtained. Daycare tonsillectomy with or without adenoidectomy and daycare adenoidectomy are now routine procedures at B.C.C.H.

Adenoidectomy↗

PubMed1979

Immunological evaluation of children undergoing tonsillectomy.

This study was carried out on 80 patients undergoing tonsillectomy for chronic tonsillitis. Twenty healthy school children in the same age group were investigated for control values. Ten children were also available for evaluation of any immunological change after tonsillectomy. No significant variation was seen in the serum IgG, IgA, and IgM levels before and after tonsillectomy. Peripheral absolute lymphocyte count was higher in the pre-operative cases as compared to the control group, and this count became near normal following tonsillectomy. Skin tests with recall antigens PPD and Candida and contact sensitizing agent 2:4 DNCB showed an improved cell mediated immune response following tonsillectomy.

Adolescent↗

PubMed1984

[Indications for tonsillectomy in childhood from the current viewpoint].

Any discussion of tonsillectomy must necessarily be based on the function and pathophysiology of the palatine tonsils. Their unique anatomic structure illustrates their main immunological function: to recognize and process the transgressors from the environment, to transfer the resulting immunological information to the entire lymphatic system and, therefore, to contribute to the immuno-defensive mechanism of the infant organism. In spite of the abundance of lymphocytes of the T- and B-type in the reticular zone of their epithelium, the tonsils seem to be dispensable because the lympho-epithelial tissue of the pharyngeal mucosa has the same immunological function and, moreover, tonsillectomy does not result in any persistent immunologic defect. However, tonsillectomy in infants up to an age of 4 years should be recommended with great reluctance if at all, since up to this age the tonsils play an important part in the immunological "learning process". Some bacterio-virological aspects are equally important for the indication of tonsillectomy in individual cases as the differentiation between chronic and recurrent tonsillitis. In the treatment of the secondary cervical lymphadenitis, too, such differentiation is mandatory. Chronic tonsillitis in terms of a "focal disease" is a rare event in infants, and tonsillectomy is recommended only in such exceptional cases where recurrent streptococcal infections resulted in rheumatism or glomerulonephritis.

Age Factors↗

PubMedDate not supplied

[The randomized double-blind study of postoperative tonsillectomy pain control by muscle relaxants].

Tonsillectomy is accompanied by 7 to 14 days of pain. We entered 36 patients into a double blind placebo controlled study with dantrolene sodium, lioresal to evaluate modification of tonsillectomy pain and analgesic requirements after tonsillectomy. Patients were randomly assigned either dantrolene or lioresal or placebo orally four times a day for 5 days postoperatively. On a standardized questionnaire the patients recorded pain, activity level, analgesic requirements and side effects. We conclude that there is no significant differences in subjective pain or analgesic requirements between 3 groups. The muscle spasm is not the only factor of tonsillectomy pain. There is the association of other factors: nerve endings, individual sensitivity, local products of inflammation. In conclusion to control tonsillectomy pain we must use drugs with different action.

Adolescent↗

PubMed1993

Electrocautery versus epinephrine-injection tonsillectomy.

This prospective, single-blinded study on tonsillectomy was done to compare the Bovie electrocautery dissection technique with the epinephrine-and-lidocaine injection technique and to document which technique is safer, faster, and less morbid. Twenty-nine patients who were scheduled for tonsillectomy at two Northern California Region Kaiser Permanente Medical Centers were enrolled in the study. Each patient served as his or her own control, and tonsillectomy technique was randomized on the basis of even or odd numbers of the last digit of the medical record number. The time of injection of epinephrine and time of dissection for each tonsil was recorded. Blood loss was quantified for each dissection, and pain was assessed by asking the patient which side hurt more. I found no statistically significant difference in operating time, intraoperative blood loss, or postoperative hemorrhage between these two methods. The electrocautery, or Bovie, technique produced more clinically significant eschar and delayed healing than the epinephrine-injection technique did. The Bovie technique produced more inadvertent burns to surrounding tissue than the epinephrine-injection technique did, but the epinephrine caused transient tachycardia in 14% of the study participants. The present study showed no difference between the two techniques in postoperative pain experienced by study participants, but other recent studies have shown that patients experience more pain when the Bovie technique is used. Study data do not support the superiority of Bovie tonsillectomy. I recommend epinephrine-injection tonsillectomy as a safe and expedient operation.

Adolescent↗