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PubMedDate not supplied

Postoperative pain in tonsillectomy: comparison of ultrasonic tonsillectomy versus blunt dissection tonsillectomy.

Intraoperative blood loss, postoperative pain, and postoperative appetite were compared between 15 adult patients who underwent tonsillectomy using an ultrasonically activated scalpel (UT) and 15 adult patients who underwent blunt dissection tonsillectomy with cold steel instruments (BT). The average intraoperative blood loss of the UT group was 4.6 +/- 1.9 ml (mean +/- standard deviation), while that of BT group was 41.9 +/- 12.9 ml. This difference was highly statistically significant (p < 0.0001). In contrast, there were no significant differences in the VAS pain and appetite scores between patients who underwent UT and those who underwent BT on any day in the 6-day postoperative period. Our current results show that UT is a safe technique, and we believe that it should be considered a useful alternative for tonsil surgery.

Adult↗
PubMed2000

Postoperative tonsillectomy pain in pediatric patients: electrocautery (hot) vs cold dissection and snare tonsillectomy--a randomized trial.

OBJECTIVE: To determine the effect of the method of tonsillectomy on postoperative pain in pediatric patients. DESIGN: Prospective, randomized, single-blind, controlled clinical trial. SETTING: A university pediatric hospital in Aberdeen, Scotland. PATIENTS: A volunteer sample of 54 children, aged 3 to 12 years, with recurrent tonsillitis or symptomatic adenotonsillar hypertrophy. Two patients withdrew consent. INTERVENTIONS: Twenty-six children underwent a nonelectrical (ie, cold) dissection tonsillectomy with cold steel instruments, 5 of whom also had adenoidectomy by curettage. Monopolar diathermy forceps were used for tonsillar bed hemostasis. Twenty-four children had electrocautery (ie, hot) dissection tonsillectomy, 7 of whom underwent adenoidectomy by curettage without a suction coagulator. MAIN OUTCOME MEASURES: Postoperative analgesic consumption, time to regain normal diet and activity levels, and complications. RESULTS: Patients who underwent hot dissection tonsillectomy showed no difference in time to first drink or analgesic use within the first 24 postoperative hours compared with children undergoing cold nonelectrical dissection tonsillectomy. The hot dissection tonsillectomy group took 7.5 (95% confidence interval [CI], 1-14.1) more doses of analgesics than the cold dissection group over the next 12 days (P<.05). The hot dissection tonsillectomy group took 2.5 more days than the cold dissection tonsillectomy group to regain normal diet (P<.05). Thirteen children (54%; 95% CI, 34-74) in the hot dissection tonsillectomy group and 6 (23%; 95% CI, 7-39) in the cold dissection tonsillectomy group sought outpatient care for throat pain, otalgia, poor diet, pyrexia, and/or bleeding (P<.05). Throat pain delayed in onset or of prolonged duration affected 9 children (38%; 95% CI, 19-57) in the hot dissection tonsillectomy group as opposed to 3 children (12%; 95% CI, 0-24) in the cold dissection tonsillectomy group (P<.05). CONCLUSION: Hot dissection tonsillectomy increases morbidity in pediatric patients in the recovery period following hospital discharge.

Adenoidectomy↗
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↗
PubMed2001

Traditional tonsillectomy compared with bipolar radiofrequency thermal ablation tonsillectomy in adults: a pilot study.

OBJECTIVES: To assess the morbidity and efficacy of bipolar radiofrequency thermal ablation tonsillectomy and compare it with traditional cold dissection tonsillectomy with diathermy hemostasis. DESIGN: Prospective, randomized, single-blinded, controlled clinical study. SETTING: Helsinki University Central Hospital, Department of Otorhinolaryngology-Head & Neck Surgery, Helsinki, Finland. PATIENTS: Forty healthy volunteer patients aged 18 to 65 years admitted for elective tonsillectomy with recurrent or chronic tonsillitis, obstructive tonsillar hypertrophy, or history of quinsy. Two patients were excluded from the study and 1 patient cancelled the operation. INTERVENTIONS: Nineteen patients underwent a traditional cold dissection tonsillectomy with diathermy hemostasis, and 18 patients underwent a bipolar radiofrequency thermal ablation tonsillectomy. There was no intergroup difference in age, sex, weight, and indications for tonsillectomy. The subjects were not informed of the type of procedure until the telephone interview 3 weeks after the operation. MAIN OUTCOME MEASURES: Operating time and intraoperative blood loss; need for anesthetics during the operation; different recovery indicators in the recovery room (ie, duration and medications administered), surgical ward (ie, medications administered, use of corticosteroids, general condition, and status of the uvula on the first postoperative day), and in the 2 weeks following surgery (ie, visual analog scale scores on 6 symptoms, medications needed, the day patients returned to work, use of antibiotics, and retreatment acceptance); and complications and certain laboratory parameters. RESULTS: There was a statistically significant but clinically insignificant difference in operating time and intraoperative blood loss in favor of the traditional tonsillectomy group. The other outcome measures showed no statistically significant differences. CONCLUSION: Bipolar radiofrequency thermal ablation and traditional tonsillectomy were associated with similar postoperative morbidity.

Adolescent↗
PubMed2002

A prospective double-blind randomized controlled trial comparing the suitability of KTP laser tonsillectomy with conventional dissection tonsillectomy for day case surgery.

Tonsillectomy using a KTP laser has been performed increasingly but is not a routinely practised technique in the UK. In the USA, tonsillectomy is often performed as a day case procedure but, here in the UK, it is still standard practice to admit patients for overnight stay. We present the largest prospective double-blind randomized controlled trial to date (151 patients) comparing KTP laser with standard dissection tonsillectomy and assess the suitability of both procedures for day case surgery. We found that there was significantly less peroperative haemorrhage if tonsillectomy was performed using the KTP laser, but it did cause more postoperative pain, more depression in mood and a higher rate of both reactionary and secondary haemorrhage, which was not significant when compared with conventional dissection. There was no difference in operating time, and over 40% of patients in each group needed overnight admission. We conclude that KTP laser tonsillectomy offers no benefit apart from less intraoperative bleeding over standard dissection tonsillectomy. Discharge from hospital after tonsillectomy was found to be unpredictable. Tonsillectomy is therefore an unsuitable procedure for planned surgery through a day unit, but approximately 58% of patients could be discharged on the same day from an extended day surgery unit, and the rest have one night in hospital.

Adolescent↗
PubMed1993

[A clinicopathological study of IgA nephropathy after tonsillectomy--with emphasis on renal histology and the timing of tonsillectomy].

We studied the effects and the timing of tonsillectomy on IgA nephropathy by urinalysis, serum Cr, IgA, ASLO and renal histology. The renal histology was classified into three groups according to its progression. Tonsillectomy was carried out in 31 patients (12 males and 19 females) with IgA nephropathies diagnosed by renal biopsy. The average age at tonsillectomy was 30.4 years old. The effects of tonsillectomy were followed up from more than 1 year (average 36.9 months) after operation. An improvement in urinary findings was observed in 77% and in 22 cases (71%) the tonsillectomy was evaluated as having been effective based on urinary findings and renal function. The difference between the effective group and the ineffective group, in terms of the tonsillectomy, was significant for serum Cr but not for urinary findings, serum IgA or ASLO. The effective rate in groups I and II, based on renal histological classification, was 96%. In group III (advanced stage), no case was considered to show an effective response. We conclude that tonsillectomy in IgA nephropathies should be carried out at an early stage, while renal function is normal and before renal histology has progressed to that of group III.

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↗
PubMed2002

["Ultrasound tonsillectomy" in comparison with conventional tonsillectomy].

BACKGROUND AND OBJECTIVE: The postoperative convalescence after tonsillectomy is difficult because of a high rate of secondary hemorrhages and severe pain. The Ultracision Harmonic Scalpel cuts in the longitudinal direction and coagulates simultaneously by means of a 55.500 Hz vibrating blade. A randomized prospective simple blind study was conceived to compare the advantages and disadvantages of the "Ultrasound Tonsillectomy" with the conventional method. PATIENTS: Between 8/1999 and 3/2000 25 tonsillectomies were performed with the Ultracision (TEuc-group) and 25 with conventional methods (TEkonv-group). The age of the patients was between 18 and 65 years. RESULTS: The median intraoperative blood loss in the TEuc-group was significantly lower than the TEkonv-group (19.0 g/176.0 g), the pain symptoms were comparatively less. On the other hand postoperative blood losses of the TEuc-group were clearly higher (7/25 vs. 3/25), wounds healed more slowly, the development of the wound covering and the swelling of the uvula were significantly larger. CONCLUSIONS: Based on the results of the study the ultrasound technique is not superior to the conventional tonsillectomy.

Adolescent↗
PubMed2001

Harmonic scalpel tonsillectomy versus electrocautery tonsillectomy: a comparative pilot study.

OBJECTIVE: Using quality of life criteria, this pilot study prospectively evaluates if the ultrasonic dissector coagulator's (Harmonic Scalpel [HS], Ethicon Endo-Surgery, Inc, Cincinnati, OH) unique properties offer advantages over traditional electrocautery (EC) tonsillectomies with respect to return to regular diet, activity, and complications such as bleeding and dehydration. METHODS: Over a 13-month period, 316 tonsillectomies (161 EC and 155 HS) were evaluated. Return to regular diet, regular activity, and the use of postoperative pain medications were monitored via a brief questionnaire. Complications, such as increased perioperative and postoperative bleeding, were monitored by chart review. Statistical analysis of the questionnaire data was performed. RESULTS: Seventy-five (46.6%) of the patients in the EC group responded versus 97 (62.6%) in the HS group. The ages ranged from 1 to 19 years old. Return to regular diet in 24 hours was statistically significant when comparing HS and EC questionnaire responders, 44.3% versus 22.7%, respectively; as was 72 hours, HS (74.2%) and EC (46.7%). Twenty-eight percent of the HS questionnaire responders versus 12% of EC resumed normal activity within 24 hours. The perioperative blood loss was equal in the 2 groups. There were 14 late bleeds; 9 were EC patients and 5 HS patients. Two HS patients and 4 EC patients had readmissions for dehydration. CONCLUSIONS: It appears from this early pilot study that the Harmonic Scalpel tonsillectomy offers advantages of early return to diet and activity over standard electrocautery tonsillectomies. We report no difference in perioperative or postoperative bleeding.

Adolescent↗
PubMed1994

Quinsy tonsillectomy or interval tonsillectomy--a prospective randomised trial.

Fifty-one patients with peritonsillar abscesses were randomised to undergo either quinsy tonsillectomy (QT) or interval tonsillectomy (IT), and the two groups were compared. The QT group lost fewer (10.3 v. 17.9) working days and less blood during the operation (158.6 ml v. 205.7 ml); haemostasis was easier and the operation was technically simpler in this group. There was no significant difference in length of hospital stay and neither group had intra- or postoperative complications. Only 64% of the IT group returned for tonsillectomy. In this study QT had distinct advantages over drainage and IT in the management of peritonsillar abscesses.

Absenteeism↗
PubMed2000

Methods of haemostasis in tonsillectomy assessed by pain scores and consultation rates. The Roskilde County Tonsillectomy Study.

OBJECTIVES: To compare four methods of haemostasis after tonsillectomy assessed by pain scores and consultation rates. STUDY DESIGN AND METHODS: A prospective study. The method of sole compression of the tonsillar fossae with gauze tampons was compared to ligation, bipolar diathermy and ligation/diathermy in combination. RESULTS: Highly significantly lower pain scores after discharge were found in the compression group compared to the other three groups (p < 0.025). The consultation rate in person after discharge of the compression group was significantly lower than in the diathermy group (p < 0.01) and the ligation/diathermy group (p < 0.05). CONCLUSION: Sole compression was associated with considerably less morbidity and no higher risk of postoperative haemorrhage. Sole compression should therefore be preferred in tonsillectomy whenever the surgeon considers it to be justified.

Adolescent↗