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PubMed1992

[Prevention and control of pain in (adeno)tonsillectomy].

Pain prevention and analgesia in (adeno)tonsillectomy OBJECTIVE. To study the efficacy of three analgesia protocols in children subjected to (adeno)tonsillectomy. SETTING. Twenteborg District Hospital, Almelo, the Netherlands. PATIENTS AND METHODS. In 64 children with body weights ranging from 15 to 25 kg (mean 20.4 kg) subjected to (adeno) tonsillectomy according to the procedure most current in the Netherlands (according to Sluder with administration of a volatile anaesthetic without intubation in day treatment), three protocols for preventing and treating postoperative pain were applied, with the analgetics most current in the Netherlands. Permission from the Medical Ethical Committee and written informed consent from the parents were obtained. According to protocol I 240 mg paracetamol was given, according to protocol II, 500 mg paracetamol and according to protocol III, 500 mg paracetamol plus 10 mg codeine, in suppository form, every 4 hours always starting 60 minutes before operation. Initially, protocol I was carried out, subsequently randomization of protocols II and III. After a pilot study use of a control group was omitted for ethical reasons because of the severe pain in a placebo group. MEASUREMENTS. The efficacy of the analgesia was evaluated by means of pain assessments by the children themselves using the Oucher test, 1, 3 and 6 hours after operation. The statistical processing of the children's pain scores was performed primarily in a descriptive sense, with simultaneous comparison of the three groups using a single variance analysis for comparison of several groups. Multiple comparisons were carried out according to Ducans' multiple range test. The level of significance was put at p less than or equal to 0.05. RESULTS. One hour postoperatively there was no significant difference among the mean pain scores (0: no pain and 10: very bad pain) of the three groups, viz. 5.2 (SD 3.0), 4.7 (SD 2.9) and 4.7 (SD 2.3), respectively; three hours postoperatively there was a significant difference between the mean pain scores of group I (4.5; SD 2.4) and group II (2.7; SD 2.4) but not between group I and group III (3.3; SD 1.5); six hours postoperatively there was a significant difference between the mean pain scores of group I (4.1; SD 2.1) on the one hand and of groups II (2.1; SD 1.5) and III (2.6; SD 1.6) on the other. CONCLUSION. The findings indicate existence of violent pain immediately after recovery from anaesthesia after (adeno)tonsillectomy as shown by the pain assessments by the children themselves one hour postoperatively, in spite of preventive administration of a high dose of a 'minor' analgetic according to each of the three protocols. Modification of the anaesthetic technique should be considered to effect adequate prevention or suppression of pain.

Acetaminophen↗
PubMed2006

[Study the safety and effectively of human thrombin after tonsillectomy].

OBJECTIVE: To evaluate the safety and effectively of human thrombin after tonsillectomy. METHOD: This was a prospective, randomized and controlled clinical trial. 80 cases of both tonsillectomies were divided into study group and control group. We evaluated the hemostatic role in study group: human thrombin has been insufflated locally in right side; physiological saline was in lift side. Observed the effects on the hemostatic time, hemorrhagic volume and hemorrhagic volume per square unit. RESULT: After two sides received different drugs in both tonsillectomies, in study group and control group, the average hemostatic time was (62.8 +/- 24.6) S and (94.7 +/- 36.9) S, the hemorrhagic volume was (4.9 +/- 6.7) g and (7.3 +/- 13.4) g, the hemorrhagic volume per square unit was (0.79 +/- 0.98) g/cm and (1.14 +/- 1.95) g x cm(-2), respectively. Two sides had the significant difference (P < 0.05). During the study, no adverse event was reported in two groups. The index of HBsAg, HIV, HCV and Syphilis in study group (10 cases) were not abnormalities after the thrombin had been insufflated 3 months. CONCLUSION: Human thrombin had the better hemostatic role and security on the hemorrhage of capillary of tonsillectomy wound.

Adolescent↗
PubMed2005

[Postoperative hemorrhage after tonsillectomy in Denmark].

Removal of the tonsils, or tonsillectomy, is a very frequent surgical procedure in Denmark (5 million inhabitants). Nowadays, about 7-8,000 patients are operated on each year. The indications for surgery and the surgical principles have largely remained the same for a century, but different techniques have been employed. As in all surgical procedures, there are complications to tonsillectomy, first and foremost postoperative bleeding which occurs in 4-8% of all operated patients. In the last 100 years many studies have been undertaken to shed light on the frequency of postoperative bleeding following tonsillectomy. It is noteworthy that the studies have been carried out at times where there was a certain interest in the subject whereas in other periods of time, the subject has been of little interest to researchers. The definition of postoperative hemorrhage is not unambiguous. Despite the fact that various surgical techniques have been applied, no significant change in the incidence of postoperative hemorrhage after tonsillectomy has been shown over the past 100 years. The study calls for caution when evaluating new surgical techniques since the incidences of postoperative hemorrhage have been shown to change between high and low percentages through the entire 100 year period.

Denmark↗
PubMed1978

Tonsillectomy and adenoidectomy.

Tonsillectomy and adenoidectomy is the definitive treatment for chronic tonsillitis and adenoid hypertrophy. It is most important to determine if the patient has chronic tonsillitis--a diagnosis that can only be made between acute attacks when the patient is clinically well. Decisions regarding the need for a tonsillectomy and adenoidectomy should be made only at this time and never during an episode of acute tonsillitis. Frequency of acute attacks should not by itself be the indication for surgery. The family physician who performs tonsillectomy and adenoidectomies has an opportunity to correlate the preoperative and postoperative clinical course of the patient with the findings at the time of surgery. In my experience, patients carefully selected for tonsillectomy and adenoidectomy on the basis of these criteria do benefit from the surgery, and the clinical improvement is sustained in the long-term follow up of these patients.

Adenoidectomy↗
PubMed1988

Post-tonsillectomy and adenoidectomy hemorrhage.

This is a retrospective review of 6842 tonsillectomies and adenoidectomies performed over a seven-year period at the Montreal Children's Hospital. The total incidence of postoperative bleeding was 2.5%. The incidence of primary post-tonsillectomy hemorrhage was 1.0%, with 78% of these children having developed bleeding within 12 hours of surgery. The overall incidence of secondary post-tonsillectomy hemorrhage was 1.2%. Twenty-nine percent of children with primary hemorrhage required a second general anesthetic, and 40% required blood component transfusion. Eight percent of children with secondary hemorrhage required a second general anesthetic and 24% received transfusions. Based on these findings, primary and secondary hemorrhage can be classified further into major and minor. The criteria for a major post-tonsillectomy hemorrhage are: requirements of a general anesthetic to control and repair the bleeding, or blood loss that is sufficient to require blood component transfusion therapy. The relevance of these findings with regard to outpatient adenotonsillectomies is discussed.

Adenoidectomy↗
PubMed1983

[Antibody formation against specific Epstein-Barr virus antigens in infectious mononucleosis with tonsillectomy in the acute phase of the disease].

In the present study, the clinical course and the specific humoral immunological response to Epstein-Barr virus antigens have been investigated in patients affected with infectious mononucleosis after tonsillectomy in the acute phase of the disease, compared against conservatively treated patients. Clinical results confirm that tonsillectomy in the acute phase of infectious mononucleosis has a favourable effect on the course of the disease, and reduces the duration of the disease by about half of the usual time. Statistically significant differences - indicating a confined, delayed humoral immunological response or unresponsiveness to some extent - regarding the examined antigens after tonsillectomy in the acute phase of infectious mononucleosis, could be observed between the two groups of patients in respect of the production of antibodies against viral capsid and nuclear antigens of the Epstein-Barr virus and heterophilic antibodies. For this reason, tonsillectomy should be suggested only as therapy of infectious mononucleosis in anginous courses of the disease which appear life-threatening.

Acute Disease↗
PubMedDate not supplied

[Tonsillectomy and adenoidectomy in children of 1 and 2 years].

The aim of this paper is evaluate the risk and the benefit to tonsillectomy and adenoidectomy in very young children. Between January 1989 and May 1993 we have operated on 166 children less than 3 years old (98 adenoidectomies and 68 adenotonsillectomies). 19 one year old children were submitted to adenoidectomy and 7 to tonsillectomy, the youngest was 7 months old. The indication for adenoidectomy were prevalent mouth breathing, snoring and recurrent otitis media; the criteria for tonsillectomy have been obstructive sleep problems, history of snoring, eating and swallowing disorders (97% of cases) and recurrent viral tonsillitis (3% of cases). All operation were performed under general anesthesia with children in Rose position. Postoperatively no antibiotics were given and only one dose of analgesic drug. We have never used aspirin either before or after surgery. No child had postoperative bleeding. No child has been readmitted for dehydration. We conclude after this study that tonsillectomy and adenoidectomy can be a safe procedure also in very young children.

Adenoidectomy↗
PubMed1996

Day-stay tonsillectomy: is hospital stay reduced at the expense of increased community care?

There is concern about the burden day-stay surgery created upon community services. We have followed 128 children and 38 adults undergoing day-stay tonsillectomy and a similar cohort of adults and children undergoing tonsillectomy as inpatients and looked at the demands made on general practice and casualty services over the 2 weeks after discharge. Twelve adults (18%) and four children (3%) required overnight admission after day-stay surgery. Within the first 2 weeks, 27 adults (48.2%) and 62 children (50%) visited their GP and 13 adults (23.2%) and six children (4.8%) visited the casualty department. There was no statistically significant difference for either adults or children when comparing the day-stay and inpatient cohorts. Adult day-stay tonsillectomy is associated with a high admission rate. Both adult and paediatric tonsillectomy lead to considerable demand for general practice and casualty services, but this demand is high regardless of whether the day-stay or inpatient route is chosen.

Adolescent↗
PubMed1998

[Is postoperative hemorrhage a risk in ambulatory tonsillectomy?].

Day-case surgery is being used increasingly to improve health care efficiency. In Denmark, tonsillectomy is performed on an in-patient basis because of safety concerns regarding primary haemorrhage. This study aims at investigating the likely safety of day-case tonsillectomy by defining the incidence and timing of primary haemorrhage and thereby to establish a safe time period for a possible same day discharge. Retrospectively recorded data on 2,888 tonsillectomies were reviewed. Serious primary posttonsillectomy haemorrhage arose in 34 patients (2.7 percent), of which 65 percent presented within eight hours and 95 percent within 23 hours postoperatively. In view of the fact that one quarter of the patients with a primary posttonsillectomy haemorrhage experience it more than 12 hours postoperatively, tonsillectomy cannot be recommended as a safe routine day-case procedure.

Ambulatory Surgical Procedures↗
PubMed2005

The effect of preoperative dexamethasone on early oral intake, vomiting and pain after tonsillectomy.

OBJECTIVE: Postoperative morbidity in patients undergoing tonsillectomy with or without adenoidectomy includes inadequate oral intake, pain, nausea, vomiting and bleeding. The purpose of this study is to evaluate the effect of preoperative 0.5 mg/kg i.v. dexamethasone on postoperative early oral intake, pain, vomiting in patients undergoing adenotonsillectomy while performing standard anesthesia technique and sharp dissection tonsillectomy. METHODS: In this prospective, double-blinded, placebo-controlled study 62 children, aged 4-12 years, who underwent tonsillectomy with or without adenoidectomy were randomly assigned to receive single dose of 0.5 mg/kg i.v. dexamethasone preoperatively. Patients started to receive 100 ml of clear fluids 2 h postoperatively, then were offered every hour. When pain score was 3 or above, paracetamol was given for pain control. Tolerating 400 ml of clear fluids, no bleeding and no vomiting were accepted as discharge criteria. The discharge time was also recorded. The incidence of early vomiting, pain scores, amount of oral intake were recorded until the discharge time. RESULTS: Compared with placebo, the patients who received preoperative dexamethasone had significantly less pain score during the first 6 h postoperatively (p<0.05), adequate amount of oral intake time was shorter (p<0.05) and the discharge time was earlier (p<0.05). No difference was found in vomiting incidence in both groups. CONCLUSION: Preoperative dexamethasone use significantly reduces early posttonsillectomy pain, improves oral intake and facilitates meeting the discharge criteria while using standard anesthesia technique and sharp dissection tonsillectomy without any significant side effects.

Anti-Inflammatory Agents↗
PubMed1999

Safety of pediatric short-stay tonsillectomy.

OBJECTIVE: To determine the safety of a relatively brief (<3-hour) period of postoperative observation prior to discharge in children undergoing outpatient tonsillectomy. DESIGN: Retrospective chart review. SETTING: Tertiary care children's hospital and public teaching hospital. PATIENTS: The records of all patients (12 years of age who underwent tonsillectomy or adenotonsillectomy from November 1995 through July 1997 were reviewed. A total of 143 patients scheduled for ambulatory treatment were identified; 9 were excluded owing to insufficient follow-up. The remaining 134 patients made up the study group. MAIN OUTCOME MEASURES: (1) Duration of observation prior to discharge; (2) complication rates. RESULTS: The mean age of the study population was 6.1+/-2.6 (mean+/-SD) years. Obstructive sleep apnea was an indication for surgery in 86.5%. Eleven (8.2%) of 134 planned outpatients were electively admitted from the recovery room for inpatient observation, most often because of respiratory compromise. Patients admitted from the recovery room were significantly younger (mean age, 4.0 years) than those who were discharged as planned (6.3 years, P<.001). One hundred twenty-three patients were discharged from the recovery room as anticipated, following a mean+/-SD duration of postoperative observation of 144+/-48 minutes. Overall, 5 (4.1%) of these 123 outpatients suffered complications after discharge. Two patients (1.6%) experienced primary bleeding, both at 8 hours after surgery. Four patients (3.2%) were readmitted. The complication rate did not vary significantly with the duration of postoperative observation (P= .71). CONCLUSION: A short postoperative observation period is safe, with a low rate of complications, in appropriately selected children scheduled for ambulatory tonsillectomy.

Adenoidectomy↗
PubMed2000

The effectiveness of tonsillectomy in diagnosing lymphoproliferative disease in pediatric patients after liver transplantation.

OBJECTIVE: To determine the effectiveness of diagnosing forms of lymphoproliferative disease by performing tonsillectomy in pediatric patients who develop symptomatic or asymptomatic tonsillar hypertrophy during immunosuppressive therapy after liver transplantation. DESIGN: Retrospective chart and pathological review. SETTING: Urban tertiary referral children's hospital. MAIN OUTCOME MEASURES: The presence of a pathological stage of lymphoproliferative disease or Epstein-Barr virus (EBV) diagnosed using tonsillar specimens, resulting in a change in therapy. RESULTS: Of 275 pediatric patients who underwent liver transplantation, 13 had tonsillectomy performed with histopathological review of the tonsillar specimens. The specimens from 5 patients (39%) demonstrated pathological changes thought to be consistent with EBV-related changes or a form of lymphoproliferative disease. Histological changes ranged from tonsillar hyperplasia associated with EBV infection to large cell lymphoma. Immunosuppressive therapy was reduced or discontinued, and antiviral therapy was initiated. CONCLUSION: Children who have undergone liver transplantation and develop tonsillar hypertrophy should undergo a diagnostic tonsillectomy, regardless of the clinical presentation, to rule out a form of posttransplant lymphoproliferative disease. Arch Otolaryngol Head Neck Surg. 2000;126:1444-1447

Antiviral Agents↗
PubMed2001

Ropivacaine with or without clonidine improves pediatric tonsillectomy pain.

OBJECTIVE: To determine if preemptive analgesia with ropivacaine hydrochloride with or without clonidine hydrochloride decreases pain and hastens recovery after tonsillectomy. DESIGN: Prospective, randomized, triple-blinded trial. SETTING: University referral center; pediatric ambulatory practice. PARTICIPANTS: Sixty-four children, aged 3 to 15 years, undergoing tonsillectomy. INTERVENTIONS: Patients received injections in the tonsillar fossae of isotonic sodium chloride, ropivacaine, or ropivacaine plus clonidine prior to tonsil excision. MAIN OUTCOME MEASURES: Visual analogue (pain) scale scores at rest and when drinking, opioid use, recovery time to normal activity, and incidence of symptoms such as otalgia. RESULTS: Pain was reduced on postoperative day 0 in the ropivacaine-treated and ropivacaine plus clonidine-treated groups as compared with the isotonic sodium chloride-treated group (P<.05). Pain was also decreased in the ropivacaine plus clonidine-treated group on postoperative days 3 and 5 (P<.05). Intravenous narcotic use was decreased on day 0 in the ropivacaine-treated and ropivacaine plus clonidine-treated groups (P<.05). Cumulative codeine use was similar at day 3 for all patients, but was decreased at day 5 in the ropivacaine plus clonidine-treated group (P<.05). The incidence of otalgia decreased from 89% (16/18) in the isotonic sodium chloride-treated group to 63% (12/19) in the ropivacaine-treated and 61%(11/18) in the ropivacaine plus clonidine-treated groups (P<.01). Recovery to normal activity was shortened from 8.1 +/- 1.6 days to 5.8 +/- 2.9 days (mean +/- SD) in the isotonic sodium chloride-treated and ropivacaine plus clonidine-treated groups, respectively (P =.03). CONCLUSION: Preincisional injection of ropivacaine with clonidine prior to tonsillectomy has a preemptive analgesic effect that outlasts the local anesthetic and decreases pain, opioid use, and the time to return to normal activity.

Adolescent↗
PubMed2003

Postoperative hemorrhage with nonsteroidal anti-inflammatory drug use after tonsillectomy: a meta-analysis.

OBJECTIVE: To use standard meta-analysis techniques to determine the risk of postoperative hemorrhage associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) after tonsillectomy. DATA SOURCES: The MEDLINE database (1966-2001) restricted to the English language was searched using the keywords tonsillectomy, hemorrhage, analgesics, and NSAID in various combinations. Additionally, published articles were cross-referenced. To ensure completeness, the search was rerun using the Science Citation Index database. STUDY SELECTION: Of the 110 articles identified, 7 were selected. Selected studies were prospective trials comparing the effects of an NSAID and a control drug on posttonsillectomy pain and hemorrhage in pediatric and/or adult patients. In all cases, the NSAID or control was administered through an enteric route in the postoperative period. Patients were monitored for early and delayed hemorrhage. DATA EXTRACTION: Data were extracted independently by 2 investigators. DATA SYNTHESIS: A random effects model was used to compute a pooled odds ratio. For the 1368 patients included in analysis, the pooled odds ratio of posttonsillectomy hemorrhage with NSAIDs compared with controls was 1.29 and was not statistically significant (95% confidence interval, 0.85-1.73; P>/=.05). A subgroup analysis revealed an odds ratio of 0.93 (95% confidence interval, 0.44 -1.95; P>/=.05) for the nonaspirin NSAID group, while the aspirin group had a statistically significant odds ratio of 1.94 (95% confidence interval, 1.09-3.42; P =.02). CONCLUSIONS: There is an increased risk of posttonsillectomy hemorrhage with the use of aspirin after tonsillectomy; however, there appears to be no significant increased risk of bleeding for nonaspirin NSAIDs in this meta-analysis.

Adolescent↗
PubMed2003

Microdissection needle tonsillectomy and postoperative pain: a pilot study.

OBJECTIVE: To determine whether microdissection needle cautery for tonsillectomy results in decreased postoperative pain when compared with standard electrocautery. DESIGN AND SETTING: A randomized prospective study of 2 groups of young children in an academic pediatric otolaryngology practice. SUBJECTS: Forty-two healthy children between the ages of 4 and 12 years. INTERVENTION: The 42 children were randomly assigned to 2 groups: in group A, the tonsillectomy was performed with standard monopolar electrocautery tip at 20 W; in group B, the microdissection needle was used at 8 W. The same surgeon performed each tonsillectomy. Other aspects of the procedure were constant, including patient positioning, intraoperative injection of 0.25% bupivacaine hydrochoride (Marcaine), a weight-appropriate dose of steroids, and the use of postoperative antibiotics. OUTCOME MEASURES: The subjective measure of postoperative pain was a questionnaire based on a standard visual analog scale ranging from 0 to 10. More objective measures included the doses of pain medications consumed and the tolerance of oral intake. RESULTS: There was no statistical significant difference in the amount of intraoperative hemorrhage between groups (P>. 01). Operative time was on average 3.2 minutes longer in group B (11 minutes vs 7.8 minutes). The postoperative pain as measured by the visual analog scale was significantly different on days 3, 4, and 5 in group B (P<.05). This difference in pain correlated to differences in the number of doses of pain medications used on the same days. There was no statistically significant difference between the 2 groups concerning the amount of fluids tolerated (P>.01). CONCLUSIONS: Without any increase in complications, subjective and objective measurement showed that the use of the microdissection needle resulted in significantly less postoperative pain by day 3.

Anesthetics, Local↗
PubMed2004

Ambulatory powered intracapsular tonsillectomy and adenoidectomy in children younger than 3 years.

OBJECTIVES: (1) To assess the safety and efficacy of outpatient intracapsular tonsillectomy, which has been recently described as a less invasive means of treating obstructive tonsillar hypertrophy, in children younger than 3 years; and (2) to challenge the standard dictum that children younger than 3 years should be admitted to the hospital after tonsil and adenoid surgery. DESIGN: Retrospective cohort study via medical chart review and telephone interview. SETTING: Pediatric otolaryngology group practice with academic affiliation. Patients Children with symptomatic tonsillar and adenoid hypertrophy (n = 226) who underwent microdebrider-assisted intracapsular tonsillectomy between September 1, 2000, and October 1, 2002. METHODS: Comparison of study group (children <3 years old, n = 38; mean age, 30.3 months; 20 boys and 18 girls) with control group (children > or =3 years, n = 188), measuring pain, oral intake, analgesic requirements, complications, need for readmission, and relief of symptoms. RESULTS: There were no statistically significant differences in pain, oral intake, or analgesic requirements. All children, regardless of age, were discharged home within 4 hours of surgery. No child in either group required readmission, and there were no complications related to the time of discharge. Younger children experience equivalent symptomatic improvement. CONCLUSION: Children younger than 3 years may undergo intracapsular tonsillectomy as outpatients without sacrificing safety or efficacy.

Adenoidectomy↗
PubMed2006

Postoperative recovery after microdebrider intracapsular or monopolar electrocautery tonsillectomy: a prospective, randomized, single-blinded study.

OBJECTIVE: To prospectively assess the postoperative recovery in patients randomly selected to receive either microdebrider intracapsular tonsillectomy (MT) or monopolar electrocautery tonsillectomy (ET). DESIGN: A prospective, randomized, single-blinded study. SETTING: Tertiary care children's hospital. PATIENTS: A total of 74 patients between the ages of 3 and 7 years undergoing adenotonsillectomy for obstruction were randomly assigned to the MT and ET groups. MAIN OUTCOME MEASURES: Families were blinded to the technique used and given a checklist to fill out daily quantifying pain, activity, diet, and the number of doses of pain medication given over a 10-day period. Other variables assessed included the time of surgery and intraoperative blood loss. RESULTS: The average time of surgery was 16.9 minutes for ET compared with 20.9 minutes for MT (P<.001). The average blood loss was 30 mL for ET compared with 45 mL for MT (P = .01). Resumption of near-normal dietary intake was achieved 1.7 days earlier in patients receiving MT compared with ET (P = .04). There was no significant difference in the number of days taken for the resolution of pain or resumption of normal activity between the 2 groups. CONCLUSIONS: Microdebrider tonsillectomy takes over 4 minutes longer to perform compared with ET and has slightly higher intraoperative blood loss. There appears to be a slight advantage in the resumption of normal dietary intake with MT but no significant difference in the number of days taken for the resolution of pain or resumption of normal activity.

Adenoidectomy↗
PubMed2006

Microdebrider tonsillotomy vs electrosurgical tonsillectomy: a randomized, double-blind, paired control study of postoperative pain.

OBJECTIVE: To examine whether microdebrider intracapsular tonsillotomy (MT) results in less postoperative pain compared with electrosurgical extracapsular tonsillectomy (ET). DESIGN: Prospective, randomized, double-blind, matched pair, clinical trial. SETTING: Specialty care hospital. Patients Twelve male (48%) and 13 female (52%) children aged 5 to 15 years, with obstructive tonsillar hyperplasia were randomized to have one tonsil removed by MT and the other by ET. INTERVENTIONS: An angled endoscopic microdebrider was used to perform MT, and ET was performed by standard monopolar cautery technique. Parents and children were blinded to the side of MT and ET. Children rated the pain 0 to 5 by side using the Faces Pain Scale-Revised. Blinded data collection was via telephone daily for 2 weeks by a study nurse. MAIN OUTCOME MEASURES: Primary: postoperative pain as recorded by Faces Pain Scale-Revised; secondary, presence or absence of otalgia and postoperative bleeding. RESULTS: Twenty-two children (88%) had tonsillectomy and adenoidectomy, while 3 children (12%) had tonsillectomy alone. On postoperative days 1 to 9, children reported significantly less pain on the MT side compared with the ET side (paired t test; P<.01). By postoperative days 10 to 14, the difference between sides disappeared. Twenty children (80%) reported otalgia, and it was always unilateral. For those children reporting otalgia, there was a 100% correlation between the side of otalgia and the side of ET. There was no posttonsillectomy bleeding among the 25 children. CONCLUSION: Microdebrider intracapsular tonsillotomy is significantly less painful compared with electrosurgical ET in children undergoing surgical intervention for obstructive tonsillar hypertrophy.

Adenoidectomy↗