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Tonsillectomy-Comparative Study of Various Techniques and Changing Trend

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Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

Tonsillectomy is a major surgical procedure in terms of volume in the general otolaryngological practice. It is a 3000-year-old surgical operation, referred in Hindu medicine. There has been a conceptual change in the indications and surgical technique in the last 40 years. A comparative study between the various methods of tonsillectomy was done. The study was carried out in the single institutional set up by the same surgeon but using different techniques. The study aimed at comparing the intra-operative factors (blood loss, time taken for surgery), postoperative results (pain, bleeding, dehydration, time taken for complete healing), and other complications like vomiting and hospitalization time between different groups of surgical methods. This study was done in 2500 patients undergoing tonsillectomy with or without adenoid removal in a period of 35 years (1979–2013). The majority of the patients (approximately 41%) in the first half of this period underwent cold steel tonsillectomy whereas 39% underwent microdebrider assisted tonsillectomy. Microdebrider assisted tonsil surgery was done as day care procedure in 90%. In 21% of the patients, other methods viz coblation, radio frequency and laser were used. Microdebrider intracapsular tonsillectomy is associated with lower mortality and morbidity as compared to cold steel, coblation, electrodissection, laser and radio frequency.

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Abbreviations

LAST:

Laser assisted serial tonsillectomy

LAUP:

Laser assisted uvulopalatopharygoplasty

PIT:

Powered partial intracapsular tonsillectomy

OSA:

Obstructive sleep apnea

SDB:

Sleep-disordered breathing

References

  1. Andrea M (1993) Microsurgical bipolar cautery tonsillectomy. Laryngoscope 103(10):1177–1178

    Article  CAS  PubMed  Google Scholar 

  2. Aremu SK (2012) A review of tonsillectomy techniques and technologies. In: Gendeh BS (Ed) Otolaryngol, InTech, ISBN: 978-953-51-0624-1 pp 161–170. www.intechopen.com/books.otolaryngology/a-review-oftonsillectomy-techniques-and-technologies

  3. Babademez MA, Yurekli MF, Acar B, Gunbey E (2011) Comparison of radiofrequency ablation, laser and coblator techniques in reduction of tonsil size. Acta Otolarygol 131(7):750–756. doi:10.3109/00016489.2011.553244

    Article  Google Scholar 

  4. Baugh RF, Archer SM, Mitchell RB, Rosenfeld RM, Amin R, Burns JJ, Darrow DH, Giordano T, Litman RS, Li KK, Mannix ME, Schwartz RH, Setzen G, Wald ER, Wall E, Sandberg G, Patel MM (2011) Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 144(1S):S1–S30

    Article  PubMed  Google Scholar 

  5. Bluestone CD (1992) Current indications for tonsillectomy and adenoidectomy. Ann Otol Rhinol Laryngol Suppl 155:58–64

    Article  CAS  PubMed  Google Scholar 

  6. Darrow DH, Siemens C (2002) Indications for tonsillectomy and adenoidectomy. Laryngoscope 112(suppl 100):6–10

    Article  PubMed  Google Scholar 

  7. Densert O, Desai H, Eliasson A, Frederiksen L, Anderson D, Olaison J, Widmark C (2001) Tonsillotomy in children with tonsillar hypertrophy. Acta Otolaryngol 121(7):854–858

    Article  CAS  PubMed  Google Scholar 

  8. Don Setliff- discussion on net OTO-HNS group, Medispeciality.com 27 Dec 2013

  9. Deutsch ES (1996) Tonsillectomy and adenoidectomy Changing indications. Pediatr Otolaryngol Pediatr Clin North Am 43(6). http://www.pediatric.theclinics.com/article/S0031-3955(05)70521-6/fulltext

  10. Erez Bendet in a personal communication (Discussion) at otohns group dt 27 Dec 2013

  11. Friedman M, LoSavio P, Ibrahim H, Ramakrishanan V (2003) Radiofrequency tonsil reduction: safety, morbidity and efficacy. Laryngoscope 113(5):882–887

    Article  PubMed  Google Scholar 

  12. Gallagher TQ, Wilcox L, McGuire E, Derkay CS (2010) Analysing factors associated with major complications after adenotonsillectomy in 4776 patients: comparing three tonsillectomy techniques. Otolaryngol Head Neck 142(6):886–892. doi:10.1016/j.otohns.2010.02.019

    Article  Google Scholar 

  13. Glover EEV (1918) Historical account of tonsillectomy. Br Med J 2(3025):685

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Goycoolea MV, Cubillos PM, Martinez GC (1982) Tonsillectomy with suction coagulator. Laryngoscope 92(7):818–819

    Article  CAS  PubMed  Google Scholar 

  15. Haase FR, Noguera JT (1962) Hemostasis in tonsillectomy by electrocautery. Arch Otolaryngol 75(2):25–26

    Article  Google Scholar 

  16. Hesham A (2009) Bipolar diathermy versus cold dissection in paediatric tonsillectomy. Int J Pediatr Otorhinolaryngol 73(6):793–795

    Article  PubMed  Google Scholar 

  17. Johnson LB, Elluru RG, Myer CM (2002) Complications of adenotonsillectomy. Laryngoscope 112:35–36

    Article  PubMed  Google Scholar 

  18. Johnston DR, Gaslin M, Boon M, Pribitkin E, Rosen D (2010) Postoperative complications of powered intracapsular tonsillectomy and monopolar electrocautery tonsillectomy in teen versus adults. Ann Otol Rhinol Laryngol 119(7):485–489

    Article  PubMed  Google Scholar 

  19. Kaluskar SK, Krespi J, Remacle M, Kacker A (2014) Laser tonsil surgery section VI. In: Oswal VS et al (eds) Laser tonsil surgery in principles and practice of lasers in otolaryngology and head and neck surgery, 2nd edn, Vol I. Kugler Publications, Amsterdam, pp 651–655

  20. Koltai PJ, Solares CA, Mascha EJ, Xu M (2002) Intracapsular partial tonsillectomy for tonsil hypertrophy in children. Laryngoscope 112:17–19

    Article  PubMed  Google Scholar 

  21. Krespi YP, Ling EH (1994) Laser-assisted serial tonsillectomy. J Otolaryngol 23:325–327

    CAS  PubMed  Google Scholar 

  22. Leong SC, Karkos PD, Papouliakos SM et al (2007) Unusual complications of tonsillectomy: a systemic review. Am J Otolarygol 28:419–422

    Article  Google Scholar 

  23. Linder A, Markstrom A, Hultcrantz E (1999) Using the carbon dioxide laser for tonsillotomy in children. Int J Peditr Otolaryngol 50(1):31–36

    Article  CAS  Google Scholar 

  24. Martinez SA, Akin DP (1987) Laser tonsillectomy and adenoidectomy. Otolaryngol Clin North Am 20(2):371–376

    CAS  PubMed  Google Scholar 

  25. Mcneill RA (1960) A history of tonsillectomy: two Millenia of trauma, haemorrhage and controversy. Ulster Med J 29(1):59–63

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Noah PP, David LW (2011) Trends in the indications for pediatric tonsillectomy or adenoidectomy. Int J Ped Otolarygol 75(2):282–285

    Article  Google Scholar 

  27. Nishimura T, Yagisawa M, Suzuki A, Okada T (2009) Laser tonsillectomy. Acta Otolaryngolica (Stockh). 105(suppl 454):313–15. http://www.tandfonline.com/doi/abs/10.3109/00016488809125046?journalCode=ioto20#.VoN0nxHUb2Q

  28. Pang YT (1995) Paediatric tonsillectomy: bipolar electrodissection and dissection/snare compared. J Laryngol Otology 109(8):733–736

    Article  CAS  Google Scholar 

  29. Paradise JL, Bluestone CD, Colborn DK, Bernard BS, Rockette HE, Kurs-Lasky M (2002) Tonsillectomy and adenoidectomy for recurrent throat infection in moderately affected children. Pediatrics 110:7–15

    Article  PubMed  Google Scholar 

  30. Pratt LW, Gallagher RA (1979) Tonsillectomy and adenoidectomy: incidence and mortality 1968–1972. Otolarygol Head Neck Surg 87:159–166

    Article  CAS  Google Scholar 

  31. Randel A (2011) Paradise criteria for tonsillectomy in children and adolescents; Practice guidelines: AAO–HNS guidelines for tonsillectomy in children and adolescents. Am Fam Physician 84(5):566–573

    PubMed  Google Scholar 

  32. Randall DA, Hoffer ME (1998) Complications of tonsillectomy and adenoidectomy. Otolaryngol Head Neck Surg 118(1):61–68

    Article  CAS  PubMed  Google Scholar 

  33. Refik Caylon, Personal communication, Discussion group,OTOHNS(Medispeciality.com) 26 Dec 2013

  34. Rosenfeld RM, Green RP (1990) Tonsillectomy and adenoidectomy: changing trends. Ann Otol Rhinol Laryngol 99:187–191

    CAS  PubMed  Google Scholar 

  35. Royal College of Surgeons of England. National prospective tonsillectomy audit: final report of an audit carried out in England and Northern Ireland between July 2003 and September 2004. May 2005. www.entuk.org/members/audit/tonsil/tonsillectomyauditreport_pdf. Accessed February 3, 2010

  36. Schmidt R, Herzog A, Cook S, O’Reilly R, Deutsch E, Reilly J (2007) Complications of tonsillectomy: a comparison of techniques. Arch Otolaryngol Head Neck Surg 133(9):925–928

    Article  PubMed  Google Scholar 

  37. Solares CA, Koempal JA, Hirose K, Abelson TI, Reilly JS, Cook SP, April MM, Ward RF, Bent JP 3rd, Xu M, Koltai PJ (2005) Safety and efficacy of powered intracapsular tonsillectomy in children: a multi- center retrospective case series. Int J Pediatr Otorhinolaryngol 69(1):21–26

    Article  PubMed  Google Scholar 

  38. Stuck BA, Windfuhr JP, Genzwurker H, Schroten H, Tenenbaum T, Gotte K (2008) Tonsillectomy in children. Dtsch Arztebl Int 105(49):852–861

    PubMed  PubMed Central  Google Scholar 

  39. Stucken EZ, Grunstein E, Haddad J Jr, Modi VK, Waldman EH, Ward RF, Stewart MG, April MM (2013) Factors contributing to cost in partial versus total tonsillectomy. Laryngoscope 123(11):2868–2872. doi:10.1002/lary.24025

    Article  PubMed  Google Scholar 

  40. Vaughan AH, Derkey CS (2007) Microdebrider intracapsular tonsillectomy. ORL J Otolaryngol Relat Spec 69(6):358–363

    Article  Google Scholar 

  41. Verma R (2005) Soft tissue shavers in Adenotonsillectomy. Ind J Otol H N Surg spl issue-II:452–54

  42. Windfuhr JP, Chen YS, Remmert S (2006) Hemorrhage following tonsillectomy and adenoidectomy in 15218 patients. Otolaryngol Head Neck Surg 132:281–286. doi:10.1016/j.otohns.2004.09.007

    Article  Google Scholar 

  43. Windfuhr JP, Schloendoff G, Andreas MS, Andreas P, Kremer B (2009) A devastating outcome after adenoidectomy and tonsillectomy: ideas for improved prevention and management. Otolaryngol Head Neck Surg 140:191–196

    Article  PubMed  Google Scholar 

  44. Windfuhr JP, Schloendorff G, Baburi D, Kremer B (2008) Serious post-tonsillectomy hemorrhage with and without lethal outcome in children and adolescents. Int J Ped Otorhinolaryngol 72(7):1029–1040

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Verma Hospital and Research Centre, Gujral Nagar, Jalandhar, 144001, India

    Ravinder Verma, Ravneet Ravinder Verma & Rohan Ravinder Verma

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  1. Ravinder Verma
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Verma, R., Verma, R.R. & Verma, R.R. Tonsillectomy-Comparative Study of Various Techniques and Changing Trend. Indian J Otolaryngol Head Neck Surg 69, 549–558 (2017). https://doi.org/10.1007/s12070-017-1190-6

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