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At least 19 recordsLinked to original sources
PubMed1990

A comparison of the KTP/532-laser tonsillectomy vs. traditional dissection/snare tonsillectomy.

This study compared tonsillectomy by potassium-titanyl-phosphate (KTP/532) laser with tonsillectomy by traditional dissection and snare. Eighty-three consecutive patients who were candidates for a tonsillectomy were randomly assigned to one of four groups in a prospective study. The four treatments were bilateral traditional dissection/snare tonsillectomy, bilateral KTP/532-laser tonsillectomy, left laser tonsillectomy and right dissection/snare tonsillectomy, and left dissection/snare tonsillectomy and right laser tonsillectomy. Intraoperative comparisons were made between the two methods with regard to blood loss and operating time. Postoperatively bleeding and healing time were also recorded. A questionnaire answered on a daily basis assessed the patient's pain. Disadvantages of the KTP/532 tonsillectomy included increased cost, increased total operating time as a result of increased setup time and laser malfunctions, delayed healing, and no statistically significant improvement in level of pain. The sole advantage associated with the KTP/532 laser tonsillectomy was decreased blood loss, which may be significant for patients with a coagulopathy.

Adolescent↗
PubMed1977

Peritonsillar abscess. A comparison of treatment by immediate tonsillectomy and interval tonsillectomy.

The generally accepted therapeutic regimen for peritonsillar abscess consists of the administration of parenteral antibiotics with incision and drainage followed by interval tonsillectomy in four to six weeks. Treatment by immediate tonsillectomy, however, is practiced widely in Europe and has received recent attention in the American literature. This report compares the clinical course of patients treated by interval tonsillectomy and immediate tonsillectomy. Patient morbidity was lessened by immediate tonsillectomy, since two separate surgical procedures were avoided, and the total period of hospitalization was reduced by nearly 50%. Advantages and disadvantages of both methods of therapy are discussed.

Anti-Bacterial Agents↗
PubMed1979

Abscess tonsillectomy à tiède.

During recent years, primary tonsillectomy, tonsillectomy à chaud, has again become popular as the standard therapy for the peritonsillar abscess, whereas the traditional tonsillectomy à froid, made 4--6 weeks after the incision, has been partially eclipsed. It seems, however, that the intermediate form between these two, tonsillectomy à tiède, an abscess tonsillectomy made 3--4 days after the incision, would be highly practical in many cases, compared with the other two mentioned above. The tonsillectomy à chaud requires such a high state of readiness for anaesthesia, even during the emergency hours, that it is not practical in all otolaryngological departments. Tonsillectomy à tiède needs a longer hospitalization, yet requires fewer days off work than does the classical tonsillectomy à froid method. Furthermore, a significant proportion of the patients fail to present themselves for tonsillectomy at the agreed time and consequently get a recurrence of the disease later on. Tonsillectomy à tiède is almost as easy an operation as the normal tonsillectomy, both for the surgeon as for the patient. During the years 1976--77, 153 cases of peritonsillar abscess were seen. 105 cases were treated with the tonsillectomy à tiède method. The average duration of treatment was 6 1/2 days. The only complications were 6 cases of light secondary bleeding. A tonsillectomy à chaud was performed on 9 children in the age group 3--9 years.

Adolescent↗
PubMedDate not supplied

Tonsillectomy under local anesthesia: a safe and effective alternative.

Tonsillectomy using local anesthesia (local tonsillectomy) is a safe and effective alternative to general anesthesia in the healthy cooperative teenage or adult patient. This retrospective analysis involved 64 local tonsillectomies performed over the past 7 years in a minor operating room using only local anesthesia with intravenous sedation. Operations were performed by residents in training as well as by experienced head and neck surgeons. Blood loss, morbidity, complications, and patient satisfaction were reviewed and compared with tonsillectomies done under general anesthesia. The average blood loss was 42 mL in the local tonsillectomy group with no cases of postoperative hemorrhage, compared with 198 mL in the general anesthesia group with two cases of postoperative hemorrhage. There was one major complication related to postoperative antibiotic use in the local anesthesia group, and follow-up interviews revealed that patients were satisfied with the procedure and would recommend and choose local anesthesia again. We conclude that local tonsillectomies have high patient acceptance and are associated with minimal morbidity and complications. Furthermore, they are cost-effective.

Adolescent↗
PubMed1991

Role of quinsy tonsillectomy in the management of peritonsillar abscess.

Peritonsillar abscess (PTA) is the most frequent complication of acute tonsillitis requiring surgical intervention. Debate continues concerning optimal therapy in terms of patient morbidity and cost-effectiveness. A retrospective study was performed on 45 tonsillectomies for PTA in military personnel from December 1986 through December 1988. Twenty-three quinsy (abscess) tonsillectomies and 22 interval tonsillectomies were identified. Parameters studied were age, sex, abscess location, interval prior to operation, blood loss, operative time, operative experience, and combined hospital and convalescent days for the two groups. Significant differences were noted between the quinsy and interval tonsillectomy groups concerning the average number of days hospitalized (3.0 versus 4.5) and their respective convalescent periods (10.3 versus 17.3). We conclude that quinsy tonsillectomy is the best management for PTA in a young work force when the optimal treatment choice is between interval or acute tonsillectomy.

Adolescent↗
PubMed2026

A Triple-Blinded, Randomized, Controlled Trial Comparing Hydromorphone vs. Fentanyl for Children Undergoing Tonsillectomy.

BACKGROUND: Tonsillectomy is one of the most frequently performed pediatric surgeries; however, little evidence guides the choice of intraoperative opioids in a population at an elevated risk for perioperative respiratory complications. This study tested the hypothesis that fewer children who received hydromorphone during tonsillectomy would require postoperative "rescue" opioids compared to children who received fentanyl. METHODS: We conducted a triple-blind, randomized, controlled trial to compare intravenous hydromorphone versus fentanyl in pediatric patients undergoing tonsillectomy. Children aged 2-15 years undergoing bilateral tonsillectomy or adenotonsillectomy were assigned (1:1) to receive hydromorphone (10 mcg/kg) or fentanyl (1 mcg/kg) intraoperatively. The primary endpoint was the number of patients who required rescue intravenous opioid analgesia following endotracheal extubation. Secondary endpoints included pain scores, pulse oximetry saturations, postoperative nausea, time in the recovery room, morphine milligram equivalents in the post-anesthesia care unit, and adverse events. RESULTS: A total of 188 children underwent randomization, and 180 were analyzed (90 in each group). The median age was 5 years (interquartile range: 3-7 years). Rescue intravenous opioid was administered to 48 (53%) children who received intraoperative hydromorphone and 66 (73%) children who received intraoperative fentanyl (difference, 20.0 percentage points; 95% confidence interval, 6.2-33.8) (p = 0.005). Children who received hydromorphone also had lower mean pain scores for the first 15 min postoperatively and lower median morphine milligram equivalents. The incidence of adverse events was similar between the two groups. CONCLUSIONS: This study in children undergoing tonsillectomy found that intraoperative hydromorphone resulted in improved analgesia in the recovery room compared to fentanyl. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04230681.

Adolescent↗
PubMed1990

Hodgkin's disease in adults: association with social factors and age at tonsillectomy. A case-control study.

The relationship between socio-economic characteristics, previous tonsillectomy, family history of cancer and risk of Hodgkin's disease (HD) was investigated in a case-control study. One hundred and sixty patients, aged 15-78, with histologically confirmed HD, and 185 hospital controls were interviewed. A statistically significant decrease in risk of HD was observed among subjects with large sibship size (RR = 0.63, C.I. 0.46-0.86) and among those who underwent tonsillectomy prior to the age of 10 (RR = 0.46, C.I. 0.22-0.94). High educational level was associated with an increased risk of HD (RR = 6.68, C.I. I.94-23.08). Analysis by age-group (15-39 yrs and 40 yrs or more) confirmed the role of high educational level as a risk factor in both young and old subjects, while the protective effect of tonsillectomy at an early age seems to be confined to young subjects. Analysis by histological subtype showed a statistically significant decrease in risk of HD in large sibship size for both nodular sclerosis (NS) and mixed-cell subtypes; the role of education and tonsillectomy was observed only for NS. These data confirm the role of social factors in HD risk and suggest a protective effect of tonsillectomy performed early in life that needs to be confirmed in larger population-based studies.

Adolescent↗
PubMed1986

Post-tonsillectomy hemorrhage: incidence, prevention and management.

Tonsillectomy (with or without adenoidectomy) continues to be a commonly performed operation in the United States. Over the years, the incidence of post-tonsillectomy hemorrhage (reported between 0% and 20%) has decreased, but continues to pose serious problems. We reviewed 1,445 tonsillectomies performed over a 2-year period to study the incidence of post-tonsillectomy hemorrhage. Thirty-eight of 1,445 children (2.62%) had postoperative bleeding. The incidence of primary hemorrhage (within 24 hours) was 0.14%. Delayed hemorrhage requiring operative intervention or observation in the hospital was 1.03% and 0.76%, respectively. Ten patients (0.69%) had delayed hemorrhage of a minor nature that had stopped by the time they reached the hospital; these children were treated with observation alone and did not require hospitalization or operative intervention. The proposed reasons for this low rate of post-tonsillectomy hemorrhage include complete preoperative coagulation screening, meticulous attention to surgical technique, use of suction-cautery to obtain hemostasis and, possibly, use of postoperative antibiotics. Management of hemorrhage is discussed with respect to observation, surgical intervention, and blood transfusion.

Adolescent↗
PubMed1991

Iatrogenic influences on the heritability of childhood tonsillectomy: cohort differences in twin concordance.

In 1980-82, a mailed questionnaire was completed by 3,810 pairs of adult twins enrolled on the Australian NH&MRC Twin Register. Twins were asked whether they had had their tonsils out and, if so, at what age. The sample was divided into four birth cohorts of approximately equal size, and only childhood tonsillectomy (to the age of 18) was considered. The prevalence of tonsillectomy differed markedly between cohorts, being highest in those born in the 1940s and early 1950s. Within each cohort, the prevalence was very similar in MZ and DZ twins, yet concordance was much higher in MZ twins, indicating the importance of genetic factors in predisposition to tonsillectomy. However, the proportions of variance in liability due to genetic and shared environmental factors differed markedly between cohorts. In the 1950s, when tonsillectomy was fashionable, shared environment accounted for 60% of variance and genetic factors for only 29%. However, by the early 1960s, when tonsillectomy was going out of fashion, heritability was up to 0.82 and shared environment accounted for only 10% of variance. Our results illustrate, once again, that heritability is not a constant, but depends on the precise characteristics of the population and the time at which it is studied.

Australia↗
PubMed1988

Post-tonsillectomy analgesia: the use of benzocaine lozenges.

Tonsillectomy frequently results in a significant degree of post-operative pain. Conventional management consists of the administration of intra-muscular opiates prior to the commencement of oral analgesia and is often inadequate, producing variable levels of pain relief. One of the recommended uses of benzocaine lozenges is the relief of throat discomfort following tonsillectomy, but there are no clinical trials to support this claim. Therefore, a prospective placebo controlled trial was undertaken to compare the efficacy of benzocaine lozenges (10 mg.) with standard oral analgesia in the management of post-operative pain following tonsillectomy in an adult population. Consecutive patients undergoing elective tonsillectomy were randomised to receive either benzocaine lozenges (10 mg.) or placebo. Intake of supplementary oral analgesia was recorded, and the level of post-operative pain was assessed by use of a visual linear analogue scale. There was no significant difference in analgesic intake or pain severity as measured by linear analogue between the two groups. These results suggest that there is no benefit in administering benzocaine lozenges for the relief of post-tonsillectomy pain, and its use in this situation cannot be recommended.

Adolescent↗
PubMed1991

Combined study to assess the role of calcium alginate swabs and ligation of the inferior tonsillar pole in the control of intra-operative blood loss during tonsillectomy.

Bleeding is the major source of morbidity and mortality of tonsillectomy and most operative time is spent securing haemostasis. Calcium alginate reduces experimental wound blood loss. This study assessed the efficacy of alginate swabs during tonsillectomy and inferior tonsillar pole ligation in the control of blood loss during tonsillectomy. Ninety-nine tonsillectomy patients were randomized to gauze or alginate swab use. A haemoglobinometer measured blood losses collected by suction during dissection and by swab until haemostasis was secured. Operative time, complications and healing were also assessed. Mean total blood losses and operative times were similar for the two groups. Swab blood loss was significantly lower for surgeons who ligated the lower tonsillar pole, compared with surgeons who used a snare. This finding was independent of swab type. Independent assessment showed no difference in the healing rate. Alginate swabs offer no advantage over gauze in terms of blood loss, operative time or complications of tonsillectomy. The results show that routine lower pole ligation significantly reduces post-dissection blood loss. We suggest that this technique should be more widely adopted.

Adolescent↗
PubMed1991

Peritonsillar abscess: risk of disease in the remaining tonsil after unilateral tonsillectomy à chaud.

The occurrence of disease in the remaining tonsil after unilateral tonsillectomy à chaud in the treatment of peritonsillar abscess, was studied in 536 patients. No patient had a history of previous severe tonsillitis at the time of the unilateral tonsillectomy, 6.1 per cent of the patients were readmitted for surgery of the remaining tonsil during the follow-up period. Ninety-seven per cent of these patients were younger than 30 years of age. Previous investigations have shown increasing frequency by age of pharyngitis after bilateral tonsillectomy. We suggest bilateral tonsillectomy in all cases of patients younger than 30 years old who suffer from peritonsillar abscess irrespective of previous tonsillar disease. Patients older than 30 should be treated with unilateral ablation, unless there is a clear indication for bilateral tonsillectomy.

Adolescent↗
PubMed1992

Acute tonsillectomy in the management of infectious mononucleosis.

Life-threatening upper airway obstruction can be caused by tonsillopharyngitis secondary to infectious mononucleosis (IM). The administration of corticosteroids, emergency tracheostomy and acute tonsillectomy have been advocated as ways of managing this problem. In a series of 25 patients admitted over a five-year period with IM, 15 were judged to have symptoms severe enough to warrant the administration of corticosteroids. Six of these 15 patients had little improvement in their condition and thus underwent acute tonsillectomy. There were no significant complications of this surgery. A further three patients who received corticosteroids required tonsillectomy for recurrent tonsillitis later in the study period. By contrast, only one of the ten patients who did not receive corticosteroids subsequently required tonsillectomy. Acute tonsillectomy is of value in selected cases of IM tonsillopharyngitis. It may decrease the morbidity of recurrent tonsillitis after IM, in addition to averting the immediate risk of respiratory obstruction.

Acute Disease↗
PubMed1978

Tonsillectomy and infectious mononucleosis.

Tonsillar tissue may be the primary site of infection with Epstein-Barr virus (EBV), the etiologic agent of classical infectious mononucleosis (IM). Therefore, a retrospective study of the association between tonsillectomy and IM was performed in a college student population. In the first part of the study, tonsillectomy rates were compared between 164 IM-positive students and 164 student controls who attended UCLA in 1972-1975. Although it was determined that the development of IM during college years was statistically less commin in tonsillectomized students, the difference was not inordinately large and probably had no significant biologic meaning. The authors speculate that the difference was due to the greater likelihood, and greater yield, in considering the diagnosis of IM in young adults with enlarged, inflamed tonsils. In support of this is the fact that IM-positive students who had received a prior tonsillectomy usually had the surgical procedure performed at a younger age than the control group. Conceivably, tonsillar ablation in the very young is more liable to result in incomplete removal and eventual regrowth of this tissue. Indeed, six IM-positive students who had received a tonsillectomy at six years of age or less were found to have exudate in tonsillar fossae or pillars during their IM episode. In the second part of the study, clinical and laboratory measures were found to be similar between a larger group of IM-positive students with or without a history of prior tonsillectomy.

Adolescent↗