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PubMed2006

Use of intravenous steroids at induction of anaesthesia for adult tonsillectomy to reduce post-operative nausea and vomiting and pain: a double-blind randomized controlled trial.

OBJECTIVE: To assess the effectiveness of intravenous steroids at induction of anaesthetic to reduce post-operative nausea and vomiting and pain after adult tonsillectomy. DESIGN: Prospective, double-blind, randomized, placebo controlled trial, with ethical approval, following Consolidated Standards of Reporting Trials guidelines. SETTING: District General Hospital in Scotland, UK. PARTICIPANTS: Seventy-two adults between 16 and 70 years, American Association of Anaethetists (ASA) 1, listed for elective tonsillectomy. INTERVENTION: Single dose of either 10 mg of dexamethasone or 2 mL of saline after induction with a consistent anaesthetic technique. MAIN OUTCOME MEASURES: Patients filled in a visual analogue scale relating to pain and post-operative nausea and vomiting for the day of operation and 7 days after operation. The time to first ingestion of food and drink after operation was also noted. RESULTS: Data completion rate of 64% (46 of 72 patients enrolled). Statistically significant relative decrease (62%P = 0.001) in the incidence of post-operative nausea and vomiting was seen in those treated with dexamethasone. Statistically significant relative decrease (23%P = 0.016) in post-operative pain scores for the day of operation was seen in those treated with dexamethasone. Significant decrease (17.5%, P < 0.001) in mean pain score for seven post-operative days was seen in those treated with dexamethasone. No adverse effects were seen. CONCLUSIONS: Dexamethasone given as a single dose of 10 mg at induction of anaesthesia for adult tonsillectomy is an effective, safe and inexpensive method for reducing morbidity in adult tonsillectomy.

Adolescent↗
PubMed2002

Cigarette smoking, appendectomy, and tonsillectomy as risk factors for the development of primary sclerosing cholangitis: a case control study.

BACKGROUND AND AIMS: The strong clinical association between primary sclerosing cholangitis (PSC) and ulcerative colitis (UC) suggests common factors in their pathogenesis. Smoking, previous appendectomy, and tonsillectomy have been associated with a decreased risk of developing UC. In this study, our aim was to examine these risk factors in patients with PSC with and without underlying inflammatory bowel disease (IBD). METHODS: The smoking habits and history of previous appendectomy and/or tonsillectomy of 170 patients with PSC, 41 without underlying IBD, 170 patients with UC but normal liver function tests, and 170 age and sex matched community controls were obtained by questionnaire. RESULTS: A total of 112 PSC patients (66%) had never smoked compared with 66 controls (39%). Only 12 PSC patients (7%) were current smokers versus 43 controls (25%). The resultant odds ratio of having PSC was 0.17 (95% confidence interval (CI) 0.08-0.35) among current smokers and 0.33 (95% CI 0.21-0.52) among ever (former+current) smokers. Among former smokers, the odds of having PSC were also significantly decreased (odds ratio 0.45, 95% CI 0.26-0.73; p<0.05). In the subgroup of PSC patients without IBD, only 5% were current smokers versus 26% of matched controls, and never smokers were overrepresented (68% v 37%). The rate of previous appendectomy was similar in all three study groups (14%, 12%, and 13%) but the frequency of tonsillectomy was reduced in the PSC group (21% v 31%; p=0.05). CONCLUSION: PSC, like UC, is a disease of non-smokers as the odds of having PSC was significantly decreased among current and former smokers. The association between non-smoking and PSC was independent of whether the PSC patient had underlying IBD. Previous tonsillectomy but not appendectomy may also be associated with a decreased risk of PSC but this warrants further study.

Adult↗
PubMed1975

Improvement of refractory psoriasis vulgaris after tonsillectomy.

In order to ascertain what effect tonsillectomy may have in the treatment of children and adolescents with recurring psoriasis vulgaris, refractory to topical therapy and courses of penicillin, and triggered by infection, and also to test a possible correlation between tonsillitis and exacerbations of psoriasis, a retrospective study of the course of psoriasis after tonsillectomy, using charts and questionnaires, was undertaken in 74 psoriatic patients. Each patient served as his won control. The average age of the patients at tonsillectomy and the duration of psoriasis were 14.2 years and 4.5 years, respectively, while the average follow-up period was 4.5 years. The clearing of the psoriasis was statistically significant (p less than 0.01) as it occurred throughout the entire follow-up period in one-third of the patients, while an additional third noticed considerable improvement of their psoriasis. After trying tropical therapies of various sorts as well as courses of penicillin, tonsillectomy might be considered for recurring, refractory psoriasis vulgaris in children and adolescents.

Adolescent↗
PubMed2003

Effect of modern fibrin glue on bleeding after tonsillectomy and adenoidectomy.

We performed a prospective randomized study in 179 patients to examine the second-generation surgical fibrin sealant Quixil as an effective substitute for different types of electrocautery in tonsillectomy and adenoidectomy. We compared the rates of hemorrhagic complications in a group with bipolar or needle point electrocautery and in a group in whom fibrin glue was used to stop intraoperative bleeding and to prevent postoperative bleeding. The operations were performed under general anesthesia in typical fashion with sharp dissection. For the control group, hemostasis was achieved by bipolar or needle point electrocautery. For the fibrin glue group, hemostasis was achieved by spraying Quixil fibrin glue approximately 0.5 mL to each tonsillar fossa and 0.5 mL to the nasopharynx (in adenoidectomy). The results were excellent in all the patients of the fibrin glue group, with complete hemostasis and resolution of the major symptoms. In this group, the intraoperative blood loss averaged 15 mL in tonsillectomy and 9 mL in adenoidectomy. There were no cases of postoperative hemorrhage or any other complications. The electrocautery group required a longer time for healing, and its intraoperative blood loss (tonsillectomy) averaged 29 to 33 mL. The incidence of posttonsillectomy bleeding in this group was 4.35% (4 patients). Three patients (3.26%) had primary hemorrhage (bleeding that occurs within the first 24 hours of surgery), and 1 patient (1.09%) had secondary hemorrhage (bleeding that occurs after the first 24 hours). We conclude that Quixil fibrin glue application to the operative sites in tonsillectomy and adenoidectomy provides effective hemostasis and sealing with good systemic and local compatibility. With the help of Quixil, we minimized surgical trauma and achievedabsolute hemostasis at the same time. We found this fibrin glue to be a more convenient and effective hemostatic sealant than bipolar or needle point coagulation.

Adenoidectomy↗
PubMed2004

Post-tonsillectomy hemorrhage and pediatric emergency care.

A cross-sectional, retrospective review of consecutive patients who presented to 1 of 2 pediatric emergency departments with post-tonsillectomy hemorrhage was undertaken. The study population included children who had secondary hemorrhage (bleeding at greater than 24 hours after tonsillectomy). Over a period of 2 years, 90 children received emergency care for secondary post-tonsillectomy hemorrhage. The average age was 8.5 years and there were 40 (44%) males. The average time from tonsillectomy to emergency department (ED) presentation was 7.3 days. One patient was hypotensive, and 7 had hemoglobins <10 mg/dL. Signs of bleeding on examination of the tonsillar fossa were active (4), oozing (18), clots (48), and none (14). Of the 70 children with signs of bleeding, 63 (90%) were treated surgically and 7 (10%) were observed. Four (6%) of the 63 children who had signs of bleeding and were managed surgically and 3 (43%) of the 7 children who had signs of bleeding and were managed by observation had repeat episodes of bleeding. Of the 14 patients with no signs of bleeding, all were observed and none had repeat episodes of bleeding. Signs of bleeding were not documented in 6 patients. Active hemorrhage and cardiovascular compromise were uncommon in this study population. Surgical management is recommended for children who have signs of bleeding, while observation appears to be appropriate for children who have no signs of bleeding.

Adolescent↗
PubMed1988

Oral dantrolene sodium for tonsillectomy pain: a double-blind study.

Tonsillectomy in adults and older children is typically accompanied by 7 to 14 days of pain. On the basis of clinical observations of patients treated perioperatively with dantrolene sodium for malignant hyperthermia, we hypothesized that pharyngeal muscle spasms are a major factor in tonsillectomy pain. We entered 113 patients, 11 years of age and older, into a double-blind, placebo-controlled study to evaluate the effectiveness of dantrolene sodium in reduction of tonsillectomy pain. Patients were randomly assigned either dantrolene (1.5 mg/kg per day) or placebo orally four times a day for 5 days postoperatively. On a standardized questionnaire, the patient recorded pain, diet, activity level, analgesics, and side effects, daily for 2 weeks. Also, alkaline phosphatase (alk phos) and serum aspartate aminotransferase (SGOT) levels were determined before the operation and 2 weeks after. Patients who received dantrolene had no significant differences in subjective pain, diet, or activity level scores from those of patients who received placebo. Dantrolene patients did, however, require significantly less analgesic use than placebo patients (p = 0.034, 0.015, and 0.005 for postoperative days 2, 3, and 4, respectively). There was no significant difference in side effects or changes in liver enzyme between the dantrolene and placebo groups. We conclude that dantrolene sodium, given in the dosage noted, is effective in reduction of analgesic requirements after tonsillectomy.

Administration, Oral↗
PubMed1994

Ambulatory pediatric tonsillectomy and the identification of high-risk subgroups.

Financial and utilization concerns have focused on reducing hospitalization costs for many procedures, including tonsillectomy. However, the safety of ambulatory tonsillectomy for all patients remains questionable. At our institution, tonsillectomy has essentially been an inpatient procedure by policy. We have reviewed the charts of 153 consecutive patients under 19 years of age who underwent this procedure between 1989 and 1990, in an attempt to identify "high-risk" subgroups. Variables examined were: indication for surgery, hours to adequate oral intake and to discharge, age, sex, surgeon status, underlying medical condition, complications, and concomitant procedures. Statistically significant differences (p < 0.05) were found in the time to adequate oral intake and discharge for children under 4 years of age as compared to older patients. Furthermore, 7% of patients with a preoperative diagnosis of obstructive sleep apnea showed clinical evidence of significant airway compromise postoperatively. No patient in the study group experienced postoperative bleeding before discharge. Our results have identified high-risk subgroups of children undergoing tonsillectomy who are at greater risk for these complications, and therefore may benefit from an inpatient setting.

Adolescent↗
PubMed2000

Multiple sclerosis and tonsillectomy: no evidence for an influence on the development of disease or clinical phenotype.

The notion that cervical lymphatic surgery may influence the development of multiple sclerosis has been suggested before. Recent work in experimental allergic encephalomyelitis lends further support to this idea. We, therefore conducted a case:control study of tonsillectomy in multiple sclerosis. We found no evidence to suggest that tonsillectomy affects susceptibility to multiple sclerosis. This result supports previous studies, which have largely failed to show any link between prior tonsillectomy and the subsequent development of multiple sclerosis. In addition, we failed to show any effect of tonsillectomy on the extent of cerebral demyelination as assessed clinically or with magnetic resonance imaging.

Adenoidectomy↗
PubMed2001

Role of a home care team in paediatric day-case tonsillectomy.

The feasibility of paediatric day-case tonsillectomy (PDCT) depends on its safety and acceptance by parents and patients. The purpose of our retrospective study of paediatric day-case tonsillectomy was to review the role of the home care team (HCT) in improving the safety and acceptance of the procedure. Between January 1997 and June 1999, 352 consecutive children underwent day-case tonsillectomy. The notes and HCT assessment sheets were reviewed for telephone calls made by HCT or by parents, home visit by HCT, types of complication and their outcome. The primary haemorrhage rate was 0.6 per cent. The effective day-case rate was 97 per cent. The unplanned admission rate was three per cent. The HCT visited about 25 per cent of patients at home. We conclude that paediatric day-case tonsillectomy is associated with high morbidity and considerable parental anxiety that can be dealt with by timely reassurance, support and advice by a dedicated HCT.

Adenoidectomy↗
PubMed2002

Histological features in routine tonsillectomy specimens: the presence and the proportion of mesenchymal tissues and seromucinous glands.

Tonsillectomy is a frequently performed operation but there is little information about the histological features of a tonsillectomy specimen. In this study, we re-evaluated archival materials of 1220 cases who underwent tonsillectomy because of hyperplastic tonsils. Haematoxylin and eosin sections of the cases were re-examined and the presence and the proportion of mesenchymal tissues (skeletal muscle, cartilage, fat, bone) and seromucinous glands were noted as focal, multifocal or abundant. The incidence of skeletal muscle was 89 per cent (1085 cases; 206 focal, 465 multifocal, 414 abundant), seromucinous glands 35 per cent (429 cases; 236 focal, 134 multifocal, 59 abundant), fat 21 per cent (251 cases; 208 focal, 43 multifocal), cartilage three per cent (31 cases), and bone one per cent (seven cases). Also in 165 cases (14 per cent) skeletal muscle, in 12 cases (one per cent) was seromucinous glands, in eight cases (one per cent) was cartilage, in seven cases (one per cent) fat, and in four cases (less than one per cent) bone were found between hyperplastic lymphoid tissue. It can be concluded that mesenchymal tissues (skeletal muscle, cartilage, fat, bone) and seromucinous glands may be seen in different proportions in routine tonsillectomy specimens.

Adolescent↗
PubMed2003

Randomized controlled trial comparing argon plasma coagulation tonsillectomy with conventional techniques.

Argon plasma coagulation (APC) is based on the principle of ionized argon creating a conductive plasma between an activating electrode and a tissue surface. To date, its use in tonsillectomy has not been extensively examined. The purpose of this randomized controlled trial was to assess the clinical efficacy of APC as a tool for this common surgical procedure. Forty patients were randomized into two groups--treatment A (conventional tonsillectomy, n = 20) and treatment B (APC tonsillectomy, n = 20). Trial end-points included a) operative time, b) intra-operative blood loss, and c) objective assessment of post-operative pain, by completion of a visual analogue pain score chart, over a two-week period. Thirty-one patients were available for analysis. There was a statistically significant reduction in the intra-operative blood loss with treatment B (p = 0.02). There was no statistical difference between both groups for the other outcome measures. First clinical experience with this treatment modality shows that it is an attractive alternative to conventional tonsillectomy and may offer possible benefits.

Adolescent↗
PubMed1976

Routine abscess tonsillectomy: late results.

The late results of abscess tonsillectomy as a routine treatment of peritonsillar abscess were investigated. The material comprises 113 patients. Follow-up was performed two to five years after the operation (bilateral dissection tonsillectomy under general anesthesia). Symptoms of pharyngitis, recurrent or chronic, were present in 17 percent of the patients, in most cases without major objective changes in the throat. The incidence of these symptoms was highest--70 percent--in patients past middle age without any history of trouble from the throat before the peritonsillar abscess. Tonsil remnants were seen in 28 percent, but only 6 percent of the patients had new episodes of febrile throat infections. The results are discussed. A reserved attitude to abscess tonsillectomy (and to interval tonsillectomy) is recommended for peritonsillar abscess in elderly patients without previous trouble from the throat.

Adolescent↗
PubMed1986

Tonsillectomy: a clinical study comparing the effects of local versus general anesthesia.

The purpose of tonsillectomy is the complete removal of the palatine tonsils with minimal blood loss while avoiding unnecessary trauma to adjacent tissue. Despite the fact that advances in modern general anesthetic techniques have lessened risks, it has not been clear what specific differences there are when using local versus general anesthesia for tonsillectomy. In order to provide some objective information as to the advantages or disadvantages of performing tonsillectomy using local or general anesthesia, a retrospective analysis was performed on 73 fully evaluable cases of adult tonsillectomy performed in an 8 1/2-year period. Approximately one half of these were performed using local and one half general anesthesia. Analyses of the data indicated statistically significant differences in the methods. With local anesthesia the operation required less time, produced less intraoperative hemorrhage, and was less costly. However, there was no significant difference in the incidence of postoperative complications or morbidity.

Adolescent↗
PubMed1987

Post-tonsillectomy bleeding: an evaluation of risk factors.

While tonsillectomy is usually a safe operation, it is always accompanied by the risk of immediate postoperative bleeding. Despite continued efforts to eliminate this problem, it remains a persistent risk. In reviewing 775 consecutive cases of tonsillectomy, immediate postoperative bleeding occurred in 21 (2.7%). Diagnostic, demographic, hematologic, hemodynamic and surgical management factors were evaluated. The role of local anesthesia for tonsillectomy was also examined. Postoperative bleeders were more likely to have abnormal preoperative clotting studies, greater elevations of their mean postoperative blood pressures, and unusual surgical indications. Local anesthetic cases were shorter, had less intraoperative bleeding and were not associated with greater postoperative bleeding. We conclude that local anesthesia is safe and efficient and that identifiable factors are associated with primary post-tonsillectomy bleeding. An awareness of these factors can help identify potential postoperative bleeders.

Adolescent↗
PubMed1990

Morbidity in pediatric tonsillectomy.

Tonsillectomy is one of the most common operations performed in the pediatric age group. Previous literature on morbidity in tonsillectomy has dealt predominantly with postoperative hemorrhage. Children undergoing tonsillectomy were divided in a prospective and random fashion into eight study groups to evaluate postoperative morbidity as it relates to the surgical technique used (electrocautery, dissection, KTP laser), methods of hemostasis (electrocautery, suture ligature), and the use of postoperative antibiotics. A total of 80 children were evaluated. Using the parameters of morbidity as defined in this study, blunt dissection tonsillectomy using suture ligatures for hemostasis, without postoperative antibiotics was found to result in the least morbidity in the pediatric age group.

Adolescent↗
PubMed1992

Is outpatient tonsillectomy appropriate for young children?

The current literature suggests that outpatient tonsillectomy is a safe, cost-effective procedure. These reports have based their conclusions on the low rates of postoperative bleeding and dehydration. Generally, they have not examined other factors that may influence the postoperative course or identified groups of patients in whom outpatient management may not be appropriate. The literature regarding tonsillectomy in young children is conflicting. A retrospective analysis of the records of 223 children, 36 months of age and younger who had tonsillectomies, was performed. Postoperative airway complications including oxygen desaturation and airway obstruction developed in 115 patients. Seventeen (7.6%) children required postoperative care in an intensive care unit while an additional 117 (52.5%) patients received more than standard management. Preoperative apnea, an age of less than 12 months, and the presence of accompanying medical conditions were associated with a higher incidence of postoperative airway complications. It is recommended that tonsillectomy in patients under 36 months of age be planned as an inpatient procedure.

Age Factors↗
PubMed1993

Clinicopathological study of the effectiveness of tonsillectomy in IgA nephropathy accompanied by chronic tonsillitis.

Tonsillectomy is often effective in reducing proteinuria in patients with IgA nephropathy (IgAN), which might otherwise lead to renal failure. Twenty-eight patients with IgAN accompanied by chronic tonsillitis were observed for more than 2 years after tonsillectomy and studied clinicopathologically. Tonsillectomy was effective in 17 patients (effective group), but not effective in 11 (noneffective group). Many patients in the effective group showed mild proteinuria, whereas proteinuria of 1 g/24 h or higher was found in a few cases. In comparison with the noneffective group, the levels of serum IgA, polymeric IgA and circulating immune complex (CIC) in the effective group were significantly higher prior to tonsillectomy. Histopathologically, there was only a slight increase in mesangial cells and matrixes in the effective group compared with the noneffective group, and global glomerular sclerosis, small glomerular crescents and interstitial scarring were seldom found. Rupture of the glomerular basement membrane (GBM) occurred more frequently in the noneffective than in the effective group. In a study of IgA subclasses in the mesangial area of the glomerulus, IgA1 was predominantly stained in the effective group.

Chronic Disease↗
PubMed1998

[Long-term prognosis for tonsillectomy patients with IgA nephropathy].

A retrospective study of 85 patients with IgA nephropathy was undertaken to determine the long-term effect of tonsillectomy. Forty-three patients (24 males and 19 females) had received tonsillectomies (Group A) and 42 patients (17 males and 25 females) had not (Group B). These patients had been followed up for more than 5 years after renal biopsy. The average age at the initial renal biopsy was 25.72 years in Group A, and 33.16 years old in Group B. The average period of renal biopsy to tonsillectomy in Group A was 10.47 months. The average follow-up period was 8 years and 9 months in both groups. At the beginning of treatment, the two groups were well matched in terms of creatinine clearance, urinalysis, and blood pressure. Six patients in Group A and eight patients in Group B were treated with steroids. The glomerular injury detected at the renal biopsy was more extensive in Group A than in Group B. Renal function in the two groups was compared. The clinical remission rate in Group A was significantly higher than in group B (P<0.05). The stable renal function rate in Group A was significantly higher than in Group B (P<0.05). The renal survival rate was 97.7% in Group A and 83.3% in Group B, but there was no significant difference between the two groups. Histologically, the rate of remission of the minor lesion in Group A was significantly higher than in Group B (P < 0.05). Our results showed that tonsillectomy for IgA nephropathy was clinically of great value.

Adolescent↗