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PubMed2001

[Efficacy of tonsillectomy on psoriasis and tonsil histology].

Treatment outcomes of tonsillectomy were studied in 7 Japanese patients with psoriasis--3 males and 4 females aged 9 to 46 years (median: 23 years)--followed up 2 to 9 years after tonsillectomy. All skin lesions disappeared in 3 patients, 80% of those in 2, and no change in the remaining 2 during follow-up. Of 5 in whom skin lesions improved, 4 were females and had a history of tonsillitis making skin lesions worse. In quantitative immunohistologic analysis on tonsillar tissues by CD20 and anti-ssDNA antibodies, areas of T cell-nodules were significantly expanded, but those of the B-lymphoid follicles were smaller, and the number of apoptotic cells increased in tonsils from patients with psoriasis and PPP compared to those with recurrent tonsillitis. The area of T cell-nodules and the number of apoptosis cells were significantly larger in tonsils from 4 patients with complete recovery after tonsillectomy compared to the remaining 9 without complete recovery. This suggests that histologic evaluation may be helpful in estimating the effectiveness of tonsillectomy.

Adolescent↗
PubMed2006

[Treatment of Henoch-Schönlein purpura nephritis in children with tonsillectomy].

Henoch-Schönlein purpura nephritis (HSPN) is an important complication of Henoch-Sch6nlein purpura (HSP). Pathological findings in the kidney are similar to those for IgA nephritis, which is characterized by the deposition of IgA immune complex in the glomerular mesangium. Since a tonsillectomy is useful for IgA nephritis, this procedure holds great promise for the treatment HSPN. In the present study, we assessed the effectiveness of a tonsillectomy in children with HSPN whose conditions could not be controlled by medication, including predonisone and cyclophosphamide. Seven patients (four boys and three girls) with histologically well-defined HSPN who had undergone a tonsillectomy between 1998 and 2000 and who had been followed for more than 6 postoperative months were retrospectively examined. The age of the patients ranged between 3 and 13 years (average, 7.6 +/- 3.2 years) at the time of operation. Postoperative changes in urinary data were assessed according in the severity of the pathological findings in the kidney and the patient's clinical condition. The severity of the pathological findings in the kidney was determined based on the classification of the International Study of Kidney Disease (ISKDC) and the Index of Glomeruler Lesion (IGL). All patients examined in the present study had an ISKDC classification of over grade II. One patient had a grade IV classification, 3 had a grade III classification, and 3 had a grade II classification. The patients were placed in one of five clinical groups: (1) nephritic-nephrotic syndrome, (2) acute nephritic syndrome, (3) nephritic syndrome, (4) over 1 g/day of proteinuria without hypoalbuminemia or oedema, or 5) below 1 g/day of proteinuria with or without hematuria. One patient was classified in group 1, 1 was group classified in 2, 2 were classified in group 3, 2 were classified in group 4 and 1 was classified in group 5. The mean observation period was 74 +/- 6.4 months. The hematuria and proteinuria resolved in all patients, regardless of their preoperative pathological or clinical severity, within 12 postoperative months. During the observation period, no relapse was observed. Moreover, all medication, including steroid use, was stopped within the observation period. Therefore, a tonsillectomy was considered to be effective for the treatment of children with HSPN whose conditions cannot be controlled using medication.

Adolescent↗
PubMed1996

[Tonsillectomy in a boy liver transplant].

As of 1995, organ transplantation from cadaver donors is under debate in the Japanese Diet. Depending on what the Diet decides, more organ transplantations may be performed. Since cases of orthotopic liver transplantation (OLT) may increase, the need to perform surgical operations in post-OLT patients may arise. The purpose of this report is to enlighten Japanese otorhinolaryngologists on the post-transplant state. An 8-year-old boy who underwent OLT in Australia 7 years previously underwent successful tonsillectomy, adenoidectomy and insertion of ventilation tubes into both ears under general anesthesia (GA) to treat habitual angina, hypertrophy of the nasopharyngeal and palatine tonsils, and secretory otitis media. The optimal circumstances for operation require adequate but not excessive immunosuppression and a well-functioning graft. Vascular complications (VCs) such as hepatic artery thrombosis become rare after a few years post-OLT. However, once VCs occur the mortality rate of OLT patients is high, and excessive perioperative changes in circulation must be avoided. Immunosuppressive agents should be continued throughout the perioperative period and perioperative antibiotic prophylaxis should be employed, just as in non-transplant patients. Tonsillectomy is an effective means of prophylaxis for upper respiratory infection in habitual angina patients. Infection of an OLT patient may become critical because immunosuppressive agents to prevent rejection lower immune barriers and increase the risk of infection, and dose reduction may increase the risk of rejection. Tonsillectomy may also prevent a possible lympho-proliferative disorder (LPD). Tonsillar hypertrophy in OLT patients may be due to life-threatening LPD. Thus, tonsillectomy serves both as a prophylactic and curative measure against possible complications OLT may cause later, and therefore may improve the outcome of OLT.

Anesthesia, General↗
PubMed1999

Tonsillectomy and adenotomy as a one day procedure?

With special reference to the postoperative hemorrhage rate and its subsequent course, we retrospectively evaluated the outcome of 2,363 tonsillectomies and 3,295 adenotomies performed over the last 11 years at our department. The postadenotomy major bleeding frequency was 0.2%. After tonsillectomy the immediate postoperative major bleeding frequency was 2.6% and 3.0%, respectively in children and adults. Secondary bleeding after tonsillectomy occurred in 0.3% of the children and 0.5% of the adults. In contrast to adenotomy, which can be considered as a safe one day procedure, based on our results we propose to perform tonsillectomy as a more prolonged, one night stay procedure.

Adenoids↗
PubMed2000

[Tonsillectomy as a routine treatment in cases of branchiogenic cancer].

The pathogenesis of the branchiogenic cancer is still unknown. A number of authors think that it is a metastasis in the form of a cyst from a primary focus in the pharynx most often located in the palatal tonsil. Hence a conclusion is put forward to perform a tonsillectomy even when a tonsil is not clinically changed. The author presents a medical record of a patient with plano-epithelial carcinoma of a cyst from a primary focus in the pharynx most often located in the palatal tonsil. Hence a conclusion is put forward to perform a tonsillectomy even when a tonsil is not clinically changed. The author presents a medical record of a patient with plano-epithelial carcinoma of a lateral cervical cyst. It developed in the epithelium, sub-epithelium and in the palatal tonsil. The tonsillectomy was performed in spite of the clinically unchanged. This case indicates that cancer can develop simultaneously in the cyst wall and in the tonsil. The presence of the wall architecture elements typical of a lateral cervical cyst and the duct connecting the cyst with the wall of the pharynx indicates that it wasn't a metastasis from the focus in tha tonsil. The development of both these focuses could have resulted from the spreading of a lesion through continuity in the ascending way (a cyst-a tonsil) or through the descending way (a tonsil-a cyst). The author suggests that a branchiogenic cancer is an indication for a routine prophylactic ipsilateral tonsillectomy and neck dissection together with consecutive irradiation.

Branchioma↗
PubMed2000

[Tonsillectomy as a major outpatient procedure. Prospective 8-year study: indications and complications. Comparison with inpatients].

Tonsillectomy is a classic procedure in othorinolaryngology and the most frequent performed in some industrialized countries. In the US more than 390,000 procedures were performed per year. The indications for tonsillectomy and the advisability of outpatients surgery are often debated in the current literature. A prospective 8 years study was made to collect the complications ina total of 348 inpatients and 148 outpatients tonsillectomy. The mean age of inpatients was 6.68 years and 6.14 years in the outpatients group; the 57.18% and 56.52% respectively were men. The mean duration of the surgery in all patients was 23 minutes and the mean time for discharge in the outpatients 173 minutes. The complications occurred in the 1.89% of the inpatients (3 reinterventions, 1 delayed bleeding and 3 delayed discharge) and in the 2.17% of the outpatients (2 reinterventions and 1 anaesthetic complication). Pain was present in the 30% of the patients, vomiting in the 1.57% and fever under 38 degrees C in the 5.52%. We conclude that tonsillectomy has a low rate of complications, the patients can be discharged 4 hours after the surgery, the age under 4 years and SAS were unrelated with the risk of complications, and the poor fluid intake is not a criterion for admission.

Ambulatory Care↗
PubMed2000

Factors associated with post-tonsillectomy hemorrhage.

Despite the otolaryngologist's most diligent efforts to prevent it, hemorrhage is the most common, albeit sporadic, significant complication of tonsillectomy. For this retrospective study of post-tonsillectomy hemorrhage rates, we examined the charts of 430 consecutive tonsillectomy patients who had been operated on by one of two general otolaryngologists at our institution. The two surgeons used the same removal technique (cold dissection and snare), but slightly different methods of hemostasis. We found that the overall bleeding rate was 4%; the primary (< 24 hr) hemorrhage rate was 0.23%, and the secondary rate was 3.7%. Factors that were positively correlated with postoperative bleeding were the patient's sex, the time of year the surgery was performed, the length of the procedure, the amount of blood lost during surgery, and the use of intraoperative vasoconstrictors and steroids. However, we believe the use of steroids can probably be discounted as a causative factor. The chi 2 test was used to determine statistical significance. None of the 21 patients who were operated on for peritonsillar abscess experienced any delayed postoperative bleeding. The mean decrease in hemoglobin was 2.3 grams; the lowest postoperative level was 6.6 grams. The highest incidence of delayed bleeding occurred on the eighth postoperative day. Two patients required transfusions, and both recovered without any adverse consequences. It appears that one controllable variable in preventing delayed bleeding following tonsillectomy and adenoidectomy might be related to certain details of hemostatic technique. Vasoconstrictors and "field" cauterization might be associated with an increased temporal and spatial application of coagulating current. Although this technique is very effective in preventing primary hemorrhage, it does result in a deeper and more extensive zone of necrosis and the exposure of more and larger vessels when sloughing of the eschar occurs.

Adenoidectomy↗
PubMed2000

The use of the laryngeal mask airway in post-tonsillectomy haemorrhage--a case report.

INTRODUCTION: The use of the laryngeal mask airway in elective adenotonsillectomy has been well described. However, there is no literature to support its use in post-tonsillectomy haemorrhage. CLINICAL PICTURE: We report a case of a patient who presented with primary post-tonsillectomy haemorrhage, which required general anaesthesia for haemostasis after undergoing bilateral functional endoscopic sinus surgery, uvulopalatopharyngoplasty and tonsillectomy. TREATMENT AND OUTCOME: The laryngeal mask airway was used successfully after an initial attempt at endotracheal intubation had failed. There were no complications. CONCLUSIONS: The laryngeal mask airway can be used to secure the airway for haemostasis for post-tonsillectomy haemorrhage if intubation is not possible.

Chronic Disease↗
PubMed2001

[Bacteremia in tonsillectomy: Sluder's technique versus dissection. Preliminary results].

Fifty-one patients undergoing elective tonsillectomy for recurrent acute tonsillitis, 21 by dissection tonsillectomy (41%), and 30 guillotine tonsillectomy (59%). Positive post-operative blood cultures were obtained in 22 patients (43%), but only 4 in the dissection group (19%) and in 18 of the guillotine group (60%). Streptococci (21.5%) and Staphylococci (9.8%) are the commonest organisms cultured. This data are suggestive for the necessity of an antibiotic prophylaxis before tonsillectomy.

Adolescent↗
PubMed2000

Ultrasonic tonsillectomy.

High-frequency ultrasound is an effective mechanism for cutting and coagulating tissue. It is widely used in laparoscopic surgery and may have advantages in tonsillectomy. Twenty-five consecutive cases of tonsillectomy were performed using an ultrasonic scalpel; these were compared with a similar previous consecutive group performed by conventional cold dissection and monopolar electrocautery. There was no undue primary bleeding in either group and no immediate or late postoperative bleeding. Since adenoidectomy was often performed and the total blood loss in each group was so small, no statistical difference could be determined between the groups. No complications were noted in either group. The ultrasonic scalpel has the potential to produce a bloodless tonsillectomy and less collateral tissue damage and is easy to use. There may be less postoperative pain, although this could not be shown statistically in this retrospective study. Ultrasonic tonsillectomy appears to be a safe, and possibly a superior, method of performing this common operation.

Adenoidectomy↗
PubMedDate not supplied

Post-tonsillectomy and adenotonsillectomy morbidity & complications at District Headquarter Hospital Daggar.

BACKGROUND: Tonsillectomy or adenotonsillectomy is one of the commonly performed operations in ENT practice. Morbidity & complications associated with tonsillectomy and adenotonsillectomy include severe otalgia, pyrexia, odynophagia and haemorrhage. METHODS: A prospective study was undertaken from April 1996 to April 2001 to report the experience regarding postoperative morbidity/complications in tonsillectomy and/or adenotonsillectomy. A total of 1500 patients undergoing tonsillectomy or adenotonsillectom for chronic/recurrent tonsillitis or adenotonsillar hypertrophy were included. These patients received antibiotic in the form of amoxycillin and clavulanic acid and non-salicylate analgesics for 7 days postoperatively. 100 patients were lost to follow up. RESULTS: Seventy percent of patients were female and thirty percent males with maximum number of patients between the age of 11-22 years. Postoperative complications developed in 25 out of 1400 patients, 14 of them developed post-operative bleeding and 9 developed postoperative infection. CONCLUSIONS: It was found that postoperative morbidity/complications were less in this study with regard to secondary haemorrhage, operative site infection, intensity & duration of postoperative pain, postoperative pyrexia and time for return to normal activities.

Adenoidectomy↗
PubMed2002

Do antibiotics decrease post-tonsillectomy morbidity?

OBJECTIVE: A tonsillectomy audit was carried out and compared with other studies, to emphasize the role of antibiotics. METHODS: This study was carried out at North West Armed Forces Hospital, Tabuk, Kingdom of Saudi Arabia, during the year January 1999 through to December 1999. This is a retrospective study of patients who had tonsillectomy with or with adenoidectomy, the topics audited included indication for surgery, grade of surgeon, method of surgery, length of hospital stay, complications and the use of postoperative antibiotics. RESULTS: A total of 185 patients underwent tonsillectomy with or without adenoidectomy. The patients age ranged between 2 years to 53 years and the majority were children. In our audit we found no difference with regard to grade of surgeons, method of hemostasis in the outcome of surgery. Moreover, postoperative antibiotics had no role in pain control, postoperative fever, secondary hemorrhage or reduction in hospital stay. The administration of analgesics on the basis of, as required, had poor pain control. CONCLUSION: Post tonsillectomy antibiotics did not prove to have a role in minimizing postoperative morbidity. Moreover, analgesics given on the basis of as required had a limited value.

Adolescent↗
PubMedDate not supplied

[The effect of lidocaine HCL aerosol on postoperative pain in tonsillectomy patients].

OBJECTIVES: We evaluated the efficacy of lidocaine hydrochloride aerosol on postoperative pain relief in patients undergoing tonsillectomy. PATIENTS AND METHODS: The study included 60 patients (25 females, 35 males; mean age 25.43 years; range 16 to 35 years) undergoing tonsillectomy. The procedure was performed by the same surgeons under local anesthesia. The patients were randomly divided into two groups to receive either lidocaine HCl (n = 30) or NaCl (n = 30). A total of 4 mg/kg of 10% lidocaine HCl aerosol and 2 ml of 0.9% NaCl were applied to the tonsillectomy fossa eight times daily, respectively. Evaluation of pain was made on the first, third, and seventh postoperative days using a visual analogue scale. RESULTS: Significant differences were found between the groups on the first, third, and seventh postoperative days (p < 0.05). In each group, patient's evaluation of pain differed significantly (p < 0.05). The significance levels were higher for lidocaine on the first and third days. CONCLUSION: Our results suggest that lidocaine HCl aerosol exerts a therapeutic effect on postoperative pain control in tonsillectomy patients.

Adolescent↗
PubMed2002

Abscess tonsillectomy for acute peritonsillar abscess.

Peritonsillar abscess (PTA) is a common but potentially serious complication of acute exudative tonsillitis. Several treatment guidelines have been described including needle aspiration, incision and drainage or abscess tonsillectomy. From January 1996 to September 2000 145 patients (53 female and 92 male, age range 3-95 years) were treated for PTA at the Department of Otorhinolaryngology, Head and Neck Surgery of the MLU Halle-Wittenberg, Germany. The highest incidence of PTA was observed in the second and third decades of life. Immediate abscess tonsillectomy was performed in 105 cases. This procedure, considered as safe and easy, has a lot of advantages. Compared with other treatments, it removes the abscess with amelioration of the trismus and dysphagia. Needle aspiration as the initial and only treatment was performed in 13 patients. In 20 patients without clinical improvement after aspiration, abscess tonsillectomy was undertaken. We conclude that immediately performed abscess tonsillectomy is an effective and safe treatment for peritonsillar abscess.

Abscess↗
PubMed2002

Incidence of post-tonsillectomy hemorrhage in children and adults: a study of 4,848 patients.

We conducted a retrospective study of 4,848 patients to evaluate the age-specific incidence of post-tonsillectomy hemorrhage that required surgical treatment. We reviewed the charts of 2,567 patients younger than 15 years (pediatric group) and 2,281 patients aged 15 years and older (adult group) who had undergone tonsillectomy with or without adenoidectomy. We found that post-tonsillectomy hemorrhage occurred significantly more often in the adult group (3.9 vs 1.6%; p < 0.001). Moreover, primary hemorrhage (< 24 hr postoperatively) was also significantly more common in the adult group than in the pediatric group (82.9 vs 65.9%, p = 0.023). Analysis of other parameters revealed that post-tonsillectomy hemorrhage was significantly more common in males and in patients who had a history of chronic or recurrent throat infection. Awareness of these risk factors should help improve patient care and outcomes.

Adenoidectomy↗
PubMed2003

[Influence of tonsillectomy in adults on the concentration and glycosylation profile of acute phase proteins].

Chronic tonsillitis (ch.t.) in adults can have the effect on immunological system and its function. The aims of this study were: 1. the estimation of concentration and glycosylation of acute-phase serum protein (a.ph.s.p.)--C-reactive protein (CRP), alpha 1-acid glycoprotein (AGP), alpha 1-antichymotrypsin (ACT), transferrin (Tf) and the concentration of immunoglobulins (Ig) and alpha 2-macroglobulin (alpha 2-M) in adults with ch.t. 2. the influence of tonsillectomy on the concentration and glycosylation a.ph.s.p. in I week and 6-8 months after surgery and determination of normalization estimated parameters. 116 patients with ch.t. and 15 healthy persons were evaluated. In all patients with ch.t. the concentration of acute-phase serum protein, alpha 2-M and immunoglobulins were determined before, in I-II day, VII day and 6-8 months after surgery. In patients with ch.t. were observed the significantly higher the concentration of CRP, AGP, ACT, IgG and the significantly decreased the concentration of serum transferrin before tonsillectomy, as an effects of immunological response on chronic inflammation. Tonsillectomy induced further increases the concentration of a.ph.s.p. and the highest value attained the CRP level. The change of glycosylation of AGP and ACT were results of chronic inflammatory process and analysis the glycosylation of these proteins can be useful in the estimation of activity of inflammatory process. The normalization of the concentration of acute-phase serum protein were observed in 6-8 months after tonsillectomy and confirmed the withdrawal of inflammatory process.

Acute-Phase Proteins↗
PubMed2004

Harmonic scalpel versus conventional tonsillectomy: a double-blind clinical trial.

We conducted a prospective, double-blind clinical trial to evaluate the differences in operating time, intraoperative blood loss, postoperative pain at 3 hours and 1 week, and delayed (>24 hr) bleeding associated with ultrasonic harmonic scalpel tonsillectomy and conventional tonsillectomy. The study was carried out on 28 patients with recurrent tonsillitis and/or adenotonsillar hypertrophy who underwent harmonic scalpel tonsillectomy on one side and cold dissection tonsillectomy with suction electrocautery hemostasis on the other. The harmonic scalpel was associated with significantly less intraoperative blood loss (mean: 6.2 vs. 58.8 ml; p < 0.0001) and less early (3 hr) postoperative pain as determined by scores on a 10-point visual analog scale (mean: 3.5 vs. 4.4; p = 0.0042); although the difference in early pain scores is statistically significant, it is probably not clinically significant. Pain scores at 1 week were nearly identical (mean: 2.7 vs. 2.6; p = 0.9246). The length of operating time was similar (mean: 10.9 vs. 7.7 min; p = 0.0022). An unanticipated finding was the fact that delayed bleeding, which occurred in 3 patients (10.7%), occurred only on the harmonic scalpel side. We conclude that the only clearly demonstrable advantage that the harmonic scalpel had over cold dissection was that it caused less intraoperative blood loss.

Adolescent↗
PubMed2005

[Analysis of postoperative hemorrhage after adenoidectomy and tonsillectomy in children in own material].

Hypertophy of pharyngeal tonsil and palatine tonsils is the most common cause of nasal obstruction in children. When the obstruction of the nasopharynx causes recurrent infections of upper respiratory tract, chronic otitis media secretoria or sleep apnoea, then adenoidectomy with or without tonsillectomy is indicated. The purpose of the study was analysis of postoperative hemorrhage after adenoidectomy with or without tonsillectomy. The influent of frequent infections of upper respiratory tract, disorders of blood clotting, chronic diseases, seasons of the year, operation time and general anesthesia on postoperative hemorrhage was estimated. A group of 1184 children after adenoidectomy with or without tonsillectomy was studied. Postoperative hemorrhage occurred in 59 children (4.98%). Early bleeding was frequently occurred after adenotonsillectomy and late bleeding after adenoidectomy. There was relationship between the time of general anesthesia and incidences of postoperative bleeding. Food or inhalation allergy, recurrent infections of upper respiratory tract and male sex are risk factors of postoperative hemorrhage after adenoidectomy with or without tonsillectomy.

Adenoidectomy↗