SEARCH · PubMed Health

Results for “Tonsillectomy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 289 records · Page 16Linked to original sources

PubMed2004

Current practice patterns in tonsillectomy and perioperative care.

OBJECTIVES: Tonsillectomy is one of the most commonly performed otolaryngologic procedures in the United States. Many options and controversies exist regarding techniques and peri-operative management. The purpose of the study was to examine current practice patterns among otolaryngologists regarding tonsillectomy. METHODS: A 13 question survey regarding tonsillectomy techniques and peri-operative management was mailed to 10% of randomly selected board certified otolaryngologists of the AAO-HNS in the spring of 2002. Four hundred and eighteen anonymously completed questionnaires were returned, for a response rate of 58.5%. Statistical analysis of survey data was performed by means of cross tabulation and Pearson Chi-Square Calculation. RESULTS: Monopolar electrocautery was the most common technique used among those surveyed (53.5%). There was a significant correlation between choice of monopolar electrocautery and the cited reason for choice of technique being decreased blood loss (P < 0.001). There was no relationship between pediatric fellowship training and choice of technique. 97.7% routinely admitted sleep apnea patients for post-operative observation. There was no significant correlation between practice setting (tertiary versus community) and type of post-operative monitoring for sleep apnea patients, with patients most commonly admitted to an intermediate care setting. CONCLUSION: In our survey, the most common surgical technique for tonsillectomy was monopolar electrocautery, chosen for the reason of decreased blood loss.

Anesthesia, Local↗

PubMed2005

Pre-incisional infiltration for pediatric tonsillectomy: a randomized double-blind clinical trial.

OBJECTIVE: Tonsillectomy is frequently associated with post-operative pain of considerable duration. The aim of the current study is to corroborate our previous observational data by conducting a prospective double-blind placebo-controlled randomized clinical trial to determine the potential effect of pre-incision infiltration of local anesthesia on post-operative pain after tonsillectomy. DESIGN: Randomized double-blind controlled clinical trial. SETTING: Tertiary care facility in Beirut, Lebanon. PATIENTS: Ninety patients who underwent tonsillectomy allocated evenly in three groups. INTERVENTIONS: Pre-incision infiltration of 1.5 local anesthetic mixture in each tonsil was performed in conjunction with general anesthesia (infiltration, n=30). Pre-incision infiltration of 1.5 ml of 0.9% of normal saline was applied with general anesthesia (placebo, n=30). GA received only general anesthesia. OUTCOME MEASURES: Post-operative pain at rest, eating soft diet, jaw opening at 0, 6, 12, and once daily for the 10-day follow-up period, hemodynamic stability, hospital stay, parent and surgeon satisfaction, ear pain and analgesics consumption were assessed. RESULTS: Hemodynamic stability was maintained during pre, per and post-operation. 93.1% of infiltration group left the hospital the same day compared to 60% in placebo groups and 41.4% in general anesthesia group (p=0.001). Surgeon's satisfaction was significantly higher in infiltration group compared to placebo and general anesthesia groups (p=0.001). Parent's satisfaction was significantly higher in infiltration group (89.65%) compared to general anesthesia group (13.8%) and placebo group (36.7%) (p=0.001). The average pain scores at rest, on jaw opening and when eating soft diet were significantly lower in infiltration group compared to placebo group and general anesthesia group (p<0.05). Analgesic consumption in placebo and general anesthesia groups were significantly higher compared to infiltration group (p<0.05). CONCLUSION: This modified pre-incision infiltration of anesthetic mixture combined with general anesthesia reduces significantly post-tonsillectomy pain in children and provides a more rapid return to normal activity compared to general anesthesia alone or in combination with a placebo infiltration.

Anesthetics, Local↗

PubMed2005

Tonsillectomy using the Ligasure vessel sealing system. A preliminary report.

OBJECTIVE: To evaluate and introduce a new method of tonsillectomy with the use of Ligasure vessel sealing system (LVSS) in pediatric population. METHOD: A prospective study was conducted on children undergoing tonsillectomy with the use of LVSS. Indications included chronic tonsillitis, peritonsilar abscess history, and obstructive sleep apnea syndrome. Patients undergoing adenoidectomy, or any procedure together with tonsillectomy, and patients with bleeding disorders were excluded. Among the available head-pieces, the 'Precise' instrument was used, both as haemostatic and dissection tool. Intraoperative bleeding, operative time, and complication rates, were evaluated. RESULTS: Our series consisted of 83 children among 103 patients undergone LVSS tonsillectomy. There was no measurable bleeding during surgery in any of the cases. In 18 children limited peritonsilar edema was noticed. No postoperative hemorrhage or other complication occurred. Mean operative time was 16 min. CONCLUSIONS: LVSS was found quite effective and safe, providing sufficient haemostasis, minimal intraoperative blood loss, and safety against the variant Creutzfeld-Jakob disease transmission.

Adolescent↗

PubMed2005

Tonsillitis index: an objective tool for quantifying the indications for tonsillectomy for recurrent acute tonsillitis.

This report is a preliminary exploration of the concept of a "Tonsillectomy Index" (TI) as an objective tool for quantifying the indications for tonsillectomy for recurrent acute tonsillitis (AT). The TI is derived by multiplying the number of episodes of AT by the number of years during which the episodes of AT occurred. Our objective in this study was to investigate whether there is a relationship between the natural history of AT, the immunological functions of tonsils and our proposed TI. For the natural history of AT, we medically followed 11 children with a history of AT for 5 years. When TI was equal to or greater than 8 (TI> or =8), the children suffered a significantly greater number of episodes of AT. For the immunological portion of our study, we enrolled 36 children and 46 adults undergoing tonsillectomy for either AT (study group) or tonsillar hypertrophy (control group, CG). We analyzed the co-stimulatory signals, CD80 and CD86 on tonsillar B-lymphocytes. The expression rates of CD80 and CD86 in the AT group with TI> or =8 were significantly decreased compared to those with TI was less than 8 (TI<8), as well as with those in control (tonsillar hypertrophy) group. Our preliminary findings suggest that when the TI> or =8, the tonsils have deteriorated immunologically and spontaneous resolution of recurrent AT is less likely to occur, hence tonsillectomy is appropriate. TI may be a useful tool for surgical decision making.

Acute Disease↗

PubMed2006

Prolonged hospitalization following tonsillectomy in healthy children.

OBJECTIVE: To determine the incidence and factors that influence prolonged hospitalization in healthy children following tonsillectomy. METHOD: A retrospective analysis was performed of all the children who underwent tonsillectomy with or without other otolaryngological procedures in a tertiary care center. Analysis were carried out on otherwise healthy children who were unexpectedly hospitalized for two nights or more to identify factors that influenced their length of stay as well as readmission to hospital. RESULTS: Out of a total of 1229 children who underwent tonsillectomy within the study period, there were 1129 children who had no significant co-morbidities. Within this group a total of 73 (6.5%) children were unexpectedly hospitalized for two nights or more. There were 45 (62%) males and 28 (38%) females with a mean age of 5.3 yr and mean length of stay of 2.7 days. The most common reasons for prolonged hospitalization were poor oral intake and fever. While gender was not a risk factor, these children were younger compared with those discharged within 24h (5.3 yr versus 6.2 yr, p-value of 0.046). Nine of the children (12%) who required prolonged hospitalization were readmitted, which is significantly higher compared with the readmission rate of 3.9% in children who were discharged within 24h (p-value<0.001). Delayed hemorrhage was the principle cause of readmission. CONCLUSION: A significant proportion of otherwise healthy children require prolonged hospitalization following overnight-stay tonsillectomy. It is unclear whether planned discharge on day of surgery would be beneficial in lowering this rate.

Adolescent↗

PubMed2004

Contact diode laser tonsillectomy in children.

OBJECTIVE: To compare contact diode laser (CDL) tonsillectomy to monopolar cautery (MPC) with regard to pain and other morbidity during recovery. STUDY DESIGN AND SETTING: Single-blind, randomized trial in a tertiary-care pediatric hospital. Tonsillectomy was performed by CDL in 30 children and by MPC in 28. Parents completed a daily questionnaire for 10 days after surgery. RESULTS: There was significantly less pain in the CDL group than in the MPC group. The CDL group also required much less medication, and was much less likely to experience multiple awakenings (P < 0.001 for all comparisons). CONCLUSION: Recovery after CDL tonsillectomy was associated with much less pain and discomfort than after MPC surgery. SIGNIFICANCE: Postoperative pain is a major concern for surgeons, patients, and their parents. The long recovery period also has costs in school days missed for the child and work missed for the parents. CDL tonsillectomy may greatly mitigate these burdens.

Airway Obstruction↗

PubMed2004

Post-tonsillectomy hemorrhage: cold versus hot dissection.

OBJECTIVE: The aim of our study was to assess the rate of reactionary and secondary posttonsillectomy hemorrhage using "cold" dissection and bipolar diathermy and to determine whether there was any difference in the postoperative hemorrhage rate between the 2 methods. METHODS: This was a prospective study of all patients undergoing tonsillectomy between November 8, 1999 and November 7, 2000 in a tertiary medical centre. The data collected included patient identity, age, gender, date of surgery, method of operation, and complications (if any). The timing of reactionary or secondary posttonsillectomy hemorrhage and the treatment were recorded. We hypothesized no difference in posttonsillectomy hemorrhage rates using the 2 methods. Chi2 test was used for statistical analysis. RESULTS: A total of 349 patients underwent tonsillectomy in the period (134 males, 215 females, mean age was 16.7 years). Of these, 337 were bilateral procedures, 145 patients had tonsillectomy using cold dissection, and 192 patients had bipolar diathermy. Reactionary hemorrhage occurred in 1 patient (0.3%) and 31 patients (9.2%) developed secondary hemorrhage. The hemorrhage rates using cold dissection (n = 8) and bipolar diathermy (n = 24) were 5.5% and 12.5%, respectively ( P < 0.05). CONCLUSIONS: The primary and secondary posttonsillectomy hemorrhage rates were 0.3 and 9.2%, respectively. Tonsillectomy using bipolar diathermy has a statistically significant higher secondary hemorrhage rate than using cold dissection (12.5% vs. 5.5%, P < 0.05).

Adolescent↗

PubMed2005

Does hydrogen peroxide mouthwash improve the outcome of secondary post-tonsillectomy bleed? A 10-year review.

OBJECTIVE: To determine whether hydrogen peroxide (H(2)O(2)) mouthwash influences the outcome of secondary post-tonsillectomy hemorrhage in children. STUDY DESIGN: Ten-year retrospective study of all children with secondary post-tonsillectomy hemorrhage. SETTING: Tertiary otolaryngology center. RESULTS: Of the 156 patients, 59 received H(2)O(2) and 97 did not. All patients received broad-spectrum intravenous antibiotics. The average rehospitalization duration due to hemorrhage was 1.7 days (H(2)O(2) group) and 1.6 days (control group). In the H(2)O(2) group, 8.5% required surgery, compared with 10.3% in the control group. Further hemorrhage episodes requiring readmission occurred in 3.4% of the H(2)O(2) group and 3.1% of controls. There was no difference between the 2 groups in rehospitalization duration (P = 0.49), rate of surgical intervention (P = 0.85), and rate of readmission with further hemorrhage (P = 0.92). CONCLUSION: Hydrogen peroxide mouthwash does not improve the outcome of secondary post-tonsillectomy hemorrhage in pediatric patients. SIGNIFICANCE: This study does not support the common practice of treating post-tonsillectomy hemorrhage with H(2)O(2).

Case-Control Studies↗

PubMed2006

Steroids for post-tonsillectomy pain reduction: meta-analysis of randomized controlled trials.

OBJECTIVES: To determine whether meta-analysis supports the use of corticosteroids to reduce post-tonsillectomy pain for pediatric patients. METHODS: A systematic review of currently available randomized controlled trials using a single-dose, intravenous corticosteroid during pediatric tonsillectomy was performed. Visual analog pain scale (VAS) data was extracted with reviewers blinded to results. Meta-analysis was performed with weighted mean difference and random-effects model using Revman 4.2 software. RESULTS: Eight randomized trials were included in analysis of post-tonsillectomy pain. A statistically significant reduction in pain as measured by VAS on postoperative day 1 was noted (mean VAS difference = -0.97; CI 95 % = -1.74,-0.19; P = 0.01). CONCLUSIONS: A single, intraoperative dose of dexamethasone may reduce post-tonsillectomy pain on postoperative day 1, by a factor of 1 on a 10-point pain scale. As the side effects and cost of dexamethasone dose appear negligible, consideration of routine use seems reasonable.

Anti-Inflammatory Agents↗

PubMed2006

Antibiotics to improve recovery following tonsillectomy: a systematic review.

OBJECTIVE: To determine if antibiotics improve recovery following tonsillectomy. STUDY DESIGN DATA SOURCES: Electronic databases Medline, Embase, and Cochrane Controlled Trials Register were searched using relevant search terms. Additional trials, if any, were retrieved by searching the references from all identified trials, reviews, correspondences, editorials, and conference proceedings. No language restriction was applied. STUDY SELECTION: Systematic review of trials in which antibiotic was administered as a study medication intraoperatively and/or postoperatively, in children or adults undergoing tonsillectomy or adenotonsillectomy. Only randomized, placebo-controlled, double-blind trials attaining preset quality scores were included. Outcomes analyzed: 1) pain, need for analgesia, fever, halitosis, and return to normal diet and activities; 2) secondary hemorrhage using 2 parameters-significant hemorrhage (ie, warranting readmission, blood transfusion, or return to theatre for hemostasis) and total hemorrhage; and 3) adverse events. RESULTS: Five trials met the eligibility criteria. Antibiotics significantly reduced the number of subjects manifesting fever (relative risk [RR]: 0.62, 95% confidence interval [CI]: 0.45, 0.85) and duration of halitosis (-1.94 [-3.57, -0.30] days), and marginally reduced the time taken to resume normal activity (-0.63 [-1.12, -0.14] days), but had no significant effect in reducing pain scores (-0.01 [-0.60, 0.57]) or need for analgesia. Similarly, there was no significant difference in the time taken to resume normal diet or incidence of significant and total hemorrhage, although data was underpowered to detect differences for these outcomes. In the antibiotic group 4 patients developed an adverse reaction (3 cases of rash and 1 case of oropharyngeal candidiasis), while in the control group 1 patient had an adverse reaction (rash). The RR of antibiotic-related adverse events was 2.45 (0.45, 13.31). CONCLUSION: Antibiotics appear to be effective in reducing some, but not all, morbid outcomes following tonsillectomy, and may increase the risk of adverse events. Further trials are needed to better define the role of antibiotics in facilitating post-tonsillectomy recovery. EBM RATING: A-1a.

Adenoidectomy↗

PubMedDate not supplied

[Analysis of the relationship between chronic pharyngitis and tonsillectomy with the microbiologic study of the cavum].

Chronic pharyngitis is an usual process with difficult treatment. It has been related to tonsillectomy. This study collected 224 patients suffering from chronic pharyngitis, 55 tonsillectomies and 169 without operation. Bacteriological culture was done from nasopharynx in the different seasons. Microorganisms more frequent were Staphylococcus aureus, Corynebacterium sp and Aspergillus. The time between the tonsillectomy and this study has been of more than 17 years. No relationship has been found between chronic pharyngitis and tonsillectomy, considering types of microorganisms, seasons, numbers of microorganisms isolated per culture, Gram stain, and age of the patients.

Adult↗

PubMed2003

Depressive symptoms in children after tonsillectomy.

OBJECTIVE: Several cases of severe depression after tonsillectomy have been described in children, indicating psychological trauma after surgery and hospitalization. The actual prevalence of depressive symptoms after tonsillectomy is unknown and possibly underestimated. This study aims to quantify this problem by employing current diagnostic methods. METHODS: This is a prospective study of 159 children who underwent tonsillectomy in a major Pediatric University Hospital. All patients stayed in the hospital overnight. Parents were sent questionnaires based on diagnostic criteria for depression (ICD-10) 3 weeks postoperatively. Whenever the criteria for a depressive episode were met, a telephone interview with the parents followed 3 months after the operation. RESULTS: Some 89 questionnaires were returned (56%), revealing that 15 patients (17%), 4-16 years old, developed depressive symptomatology compared with a 4% prevalence of depression in the general child population and 10-20% in the pediatric hospital populations. No children had persisting symptoms 3 months later. CONCLUSIONS: These results suggest that post-tonsillectomy morbidity can occasionally manifest with depressive symptoms, usually resolving spontaneously. A high index of suspicion is required by the otolaryngologist, nurses and primary care physician for early diagnosis and referral of persisting cases to a specialist. Emphasis is given to a structured preoperative psychological preparation of pediatric patients.

Adolescent↗

PubMed2003

The effects of dexamethasone, bupivacaine and topical lidocaine spray on pain after tonsillectomy.

OBJECTIVE: To compare the administration of bupivacaine hydrochloride, dexamethasone and lidocaine hydrochloride in decreasing post-tonsillectomy pain. METHODS: Eighty patients were enrolled in the study in ENT Clinic, Firat University, and in ENT Clinic Elaziğ SSK Hospital, Elaziğ (Turkey). Children between 6 and 14 years of age referred to our department for bilateral tonsillectomy for either recurrent tonsillitis or tonsillar hypertrophy. Data from 80 patients were analyzed. The first group had bupivacaine hydrochloride. The second group had dexamethasone infiltrated around each tonsil. The third group was given equal doses of 10% lidocain hydrochloride sprayed on the tonsillectomy fossa four times a day, and a placebo group received 9% NaCl applied to the tonsillar fossa four times a day. Pain scores, determined by visual analog scale, were obtained in the first, third and seventh postoperative days. RESULTS: Pain scores in the postoperative period were identical in the first, third and seventh postoperative days. According to VAS results the groups were compared on the basis of postoperative pain. In the first postoperative day, the difference between bupivacaine-placebo, dexamethasone-placebo and lidocaine-placebo groups was found to be statistically significant (P<0.05). Nevertheless the difference between bupivacaine-dexamethasone, bupivacaine-lidocaine and dexamethasone-lidocaine were not significant (P>0.05). In the third postoperative day, the difference between bupivacaine and lidocaine group found to be statistically significant (P<0.05). In the seventh post-operative day the results of bupivacaine, dexamethasone, lidocaine and placebo groups were similar (P>0.05). CONCLUSION: Bupivacaine, Dexamethasone and Lidocaine nasal aerosol decreased the pain significantly in the first postoperative day when it was compared with the placebo group. These three medicines can be used to reduce pain for children during the postoperative period applied tonsillectomy during the post-operative period. But lidocaine was more preferable, reducing pain in the third postop day better than bupivacaine.

Administration, Topical↗

PubMed2003

The perceived risk of variant Creutzfeld-Jakob disease and the effect of additional delay in tonsillectomy: a questionnaire based parents perspective.

OBJECTIVES: In February 2001 the United Kingdom Department of Health in conjunction with the British Association of Otolaryngology, Head and Neck Surgeons decreed that all non-emergency tonsillectomies should be performed using disposable instruments because of the theoretical risk of transmission of variant Creutzfeld-Jakob disease (vCJD). There was an understandable delay in the provision of these instruments by the various manufacturers, leading to an increase in waiting time for surgery. It was decided to assess parental attitudes to the risk of vCJD, and assess the effect the additional delay had on their child. METHOD: A questionnaire was sent to the parents of all 249 children on the waiting list for tonsillectomy. RESULTS: Seventy percent replied, and of these, 37% felt there was a risk of reusing instruments, only 10% felt there was no risk, and the remaining 53% did not know if there was any risk. Nevertheless 41% of parents would have gone ahead using old instruments if allowed. All parents of the 73 children waiting greater than 6 months were questioned on the effect of the additional delay. Only 7% reported improvement in symptoms, and 68% felt the additional delay had badly affected their child's health and wellbeing. Ninety percent of parents felt their child's symptoms still warranted tonsillectomy. CONCLUSION: There is an awareness of risk of vCJD among parents whose children await tonsillectomy, although understandably the level of risk they feel is hard to quantify. The rate of symptom resolution whilst on the waiting list was very low.

Adult↗

PubMed1997

The risk of postoperative haemorrhage in tonsillectomy as an outpatient procedure in children.

The safety of performing tonsillectomy as an outpatient procedure is still questionable. This study determined whether there was an increased risk of postoperative bleeding by performing tonsillectomy as an outpatient procedure. A six years' retrospective chart review was made of 363 children who underwent tonsillectomy. Out of 363 children, 43 had been selected as an inpatient group before the operation, 264 patients were discharged home 6 h after the operation and were the outpatient group, and 56 children had to be kept overnight because of complications that had occurred. We compared the haemorrhage rate in the outpatient and the inpatient groups. We found no increase in the postoperative haemorrhage rate in the outpatient group. No statistically significant correlations were found between the children's ages, indication for surgery, type of operation or intra-operative complications and the risk of postoperative haemorrhage. Only children who had haemorrhage in the recovery room were identified as a high risk subgroup for recurrent bleeding. On the basis of our findings we believe that tonsillectomy can be performed as an outpatient procedure regardless of age, indication for surgery, or type of procedure, as long as good recovery room supervision exists for 4 to 6 h.

Adolescent↗

PubMed1998

The development of a paediatric quality of life questionnaire to measure post-operative pain following tonsillectomy.

In this paper we describe the process through which a Paediatric Quality of Life Questionnaire was developed to assess the pain experienced by children following tonsillectomy. The impetus behind the questionnaire development was the clinical observation that the pain experienced by children undergoing tonsillectomy was not being detected and analgesia was not being prescribed in adequate amounts. The eight-item questionnaire provides the independent observer with an objective measure of the physical and emotional distress a child experiences post-tonsillectomy to which analgesic requirements can be titrated. The questionnaire was tested on a sample of 48 children aged between 2 and 13 years (average age 7.1 years) who underwent elective dissection tonsillectomy by the same surgeon using a standardised operative technique. The conclusions substantiate the hypothesis that there is the need for an assessment tool based on non-verbal behaviour to measure post-operative pain in children. In the discussion we summarise the increasing role of quality of life assessments in surgical practice.

Adolescent↗

PubMed1997

Ultrasonic tonsillectomy: rationale and technique.

Dissection using ultrasonic aspiration is characterized by its unique tendency to spare fibrous and vascular structures during removal of parenchymal lesions. This preliminary study was undertaken to evaluate the feasibility and efficiency of tonsillectomy using the ultrasonic aspirator. Tonsillectomy was performed on 23 patients using the ultrasonic aspirator. Pericapsular removal of the tonsil was easily accomplished with complete preservation of the tonsillar pillars and minimal peritonsillar trauma. The ability to identify significant vasculature before transection, and the constant aspiration integrated into the ultrasonic aspirator allowed excellent visualization of the operative field at all times. No postoperative complications were noted and recovery was typical for tonsillectomy patients. The ultrasonic aspirator may increase the efficiency and margin of safety of tonsillectomy.

Adolescent↗

PubMedDate not supplied

Peritonsillar abscess: recurrence rate and the indication for tonsillectomy.

Two hundred ninety patients treated for peritonsillar abscess (PTA) between 1970 and 1982 were reviewed. The patients were divided into those with a history of recurrent tonsillitis prior to developing PTA (72 patients, 25%), and those without (218 patients, 75%). The patients in the first group had four times more recurrences than those in the second group (40% versus 9.6%). Patients older than 40 years were found to have a lower incidence of throat infections than younger patients, and no PTA recurrences were observed. Neither subsequent tonsillitis nor recurrent PTA was observed among 72 patients (25%) who underwent tonsillectomy 6 to 12 weeks after PTA. The pre-PTA history was found to be a dominant factor in determining the need for tonsillectomy. In patients who suffered from recurrent tonsillitis prior to PTA, tonsillectomy is recommended. In those with a single episode of PTA and no history of tonsillitis, tonsillectomy is not indicated.

Female↗