Thermal injury in tonsils and its relation to postoperative pain—a histopathological and clinical study

Objectives The aim of this study was to compare thermal injury and depth of necrosis of using different monopolar power settings in partial tonsillectomy and correlate the results with the postoperative pain score. Results The study included a total of 15 patients with mean of age of 5.7 ± 2.57 years. The mean depth of injury was significantly higher for the 25 W side (0.973 ± 0.613) versus the 15 W side (0.553 ± 0.218) (p = 0.023). The postoperative pain score showed no significant differences between both sides. Conclusion The histopathologic depth of thermal injury is significantly higher with the 25 W monopolar microdissection in comparison to the 15 W; however, it does not seem to correlate with the postoperative pain level. Apparently, power settings of 25 W can be safely used for pediatric intracapsular tonsillectomies, without added postoperative morbidity despite the deeper tissue injury observed in the tonsil.

Children who underwent tonsillectomy due to OSAS have significantly bigger tonsils than those with hypertrophic tonsils without OSAS

Introduction. Tonsillectomy is one of the most commonly performed procedures in otolaryngology departments. Main indications include tonsil hypertrophy with or without obstructive sleep apnea and recurrent throat infections. The size of tonsils in the group of children qualified for tonsillectomy with obstructive sleep apnea may differ from the size of tonsils in the group without obstructive sleep apnea. Aim. Comparison of morphological features of tonsils in children with and without OSAS undergoing tonsillectomy. Material and methods. Retrospective study conducted from 2011 until 2020, including patients under 18 years old who underwent a total or partial tonsillectomy at the Department of Otorhinolaryngology at the University Medical Center in Ljubljana. Results. Among 824 patients included in the analysis, 96 underwent tonsillectomy due to OSAS and 728 due to tonsil hypertrophy without OSAS. Both groups were comparable in terms of mean age and sex distribution. Tonsil size statistically differed in both groups (p = 0.01), with the prevalence of big tonsils (grade 3 of 4) in the non-OSAS group (in 47% of patients) and large tonsils (grade 4 of 4) in the OSAS group (in 53% of patients). Conclusions. In age and sex-matched groups of children who underwent total or partial tonsillectomy, patients who underwent the procedure due to OSAS had bigger tonsils than those with hypertrophy without OSAS.

Comparison of Postoperative Pain and Appetite in Pediatric Patients Undergoing Monopolar Tonsillotomy and Cold Steel Tonsillectomy

Objectives. Adenotonsillectomy (AT) is amongst the most widely performed pediatric surgeries in the United States (US) and the whole world. AT includes two major surgical techniques: total tonsillectomy (TT) and partial tonsillectomy (PT). Several studies have been conducted to evaluate the difference between TT and PT and assess the comparative effectiveness, benefits, and sequelae between both. In Lebanon, very few studies were done tackling this issue and assessing its sequelae on the pediatric population. Methods. A prospective study was conducted including pediatric patients aged between 2 and 9 years, who were admitted for partial tonsillectomy (PT) or total tonsillectomy (TT) in 2018. An estimated number of children included were 50: 25 patients underwent PT and 25 patients underwent TT. Patients were sent home on day 1 post-op with a questionnaire that evaluates the following over the first 10 days post-op: pain using the Wong–Baker Faces Pain Rating Scale and the “Parents Postoperative Pain Measure” (PPPM) questionnaire, and appetite using the visual analogue scale (VAS). Results. Patients in the PT group and in the TT group had no demographical differences in terms of age, BMI, exposure to smoking, area of living, and attending a day care center. Comparison between PT and TT revealed a significant difference in both pain and appetite scales. Patients who underwent PT had significantly lower PPPM scores on the 1st, 2nd, 4th, 5th, 6th, and 10th day after surgery compared to the TT patients. Further validation was revealed by the Wong–Baker Faces Pain Rating Scale, showing that the PT surgery group experienced significantly less postoperative pain compared to the TT surgery group. Assessing the appetite using the visual analogue scale favored PT over TT. Comparisons revealed that most PT patients returned to their normal eating habits starting at day 4 while this was applicable in the TT group at day 10. Postoperative pain improved from day 1 to day 10 in both surgical groups. Conclusion. In conclusion, the recovery process after the PT surgery causes less postoperative morbidity, thus an earlier return to normal activity compared to the TT. The patients of the latter group are affected by more pain and less appetite over the first 10 days after the surgery.

Comparative Effectiveness of Partial versus Total Tonsillectomy in Children: A Systematic Review

Objective To assess the effectiveness of partial versus total tonsillectomy in children. Data Sources MEDLINE, EMBASE, and Cochrane Library from January 1980 to June 2016. Review Methods Two investigators independently screened studies and extracted data. Investigators independently assessed risk of bias and strength of evidence of the literature. Heterogeneity precluded quantitative analysis. Results In 16 eligible randomized controlled trials (RCTs), definitions of “partial” tonsillectomy varied. In addition to comparing partial with total tonsil removal, 11 studies compared surgical techniques (eg, coblation). In studies comparing the same technique, return to normal diet or activity was faster with partial removal (more favorable outcomes in 4 of 4 RCTs). In studies with differing surgical techniques, return to normal diet and activity was faster with partial versus total tonsillectomy (more favorable outcomes in 5 of 6 studies). In 3 of 4 RCTs, partial tonsillectomy was associated with more throat infections than total tonsillectomy. Differences between groups were generally not statistically significant for obstructive symptom persistence, quality of life, or behavioral outcomes. Across all studies, 10 (6%) of roughly 166 children had tonsillar regrowth after partial tonsillectomy. Conclusions Data do not allow firm conclusions regarding the comparative benefit of partial versus total removal; however, neither surgical technique nor extent of surgery appears to affect outcomes markedly. Partial tonsillectomy conferred moderate advantages in return to normal diet/activity but was also associated with tonsillar regrowth and symptom recurrence. Effects may be due to confounding given differences in populations and surgical approaches/techniques. Heterogeneity and differences in the operationalization of “partial” tonsillectomy limited comparative analyses.

Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children: A Systematic Review and Meta-analysis

Objective To assess posttonsillectomy hemorrhage (PTH), associated nonoperative readmissions/revisits, and reoperations in children. Data Sources MEDLINE, EMBASE, and the Cochrane Library. Review Methods Two investigators independently screened studies against predetermined criteria and extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. We calculated unadjusted pooled estimates of PTH frequency and conducted a Bayesian meta-analysis to estimate frequency of primary and secondary PTH and PTH-associated reoperation and revisits/readmissions by partial and total tonsillectomy and surgical approach. Results In meta-analysis, the frequency of primary and secondary PTH associated with total and partial tonsillectomy was <4% for any technique and with overlapping confidence bounds. Pooled frequencies of PTH were also <5% overall (4.2% for total tonsillectomy, 1.5% for partial tonsillectomy) in comparative studies. Fewer PTH episodes occurred with tonsillectomy for obstructive sleep-disordered breathing than for throat infection. In meta-analysis, frequency of PTH-associated nonoperative revisits/readmission or reoperation ranged from 0.2% to 5.7% for total tonsillectomy and from 0.1% to 3.7% for partial tonsillectomy. At least 4 deaths were reported in case series including 1,778,342 children. Conclusions PTH occurred in roughly 4% of tonsillectomies in studies included in this review. Although studies typically did not report bleeding severity or amount, relatively few episodes of PTH necessitated reoperation for hemostasis. Nonetheless, tonsillectomy is not without risk of harm. Frequency of PTH across techniques was similar; thus, we cannot conclude that a given technique is superior.

Partial Tonsillectomy

Objectives: Evaluate the content and readability of health information regarding partial tonsillectomy. Methods: A web search was performed using the term partial tonsillectomy in Google, Yahoo!, and Bing. The first 50 websites from each search were evaluated using HONcode standards for quality and content. Readability was assessed using the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease, Gunning-Fog Index, Coleman-Liau Index, Automated Readability Index, and SMOG score. The Freeman-Halton extension of Fisher’s exact test was used to compare categorical differences between engines. Results: Less than half of the websites mentioned patient eligibility criteria (43.3%), referenced peer-reviewed literature (43.3%), or provided a procedure description (46.7%). Twenty-two websites (14.7%) were unrelated to partial tonsillectomy, and over half contained advertisements (52%). These finding were consistent across search engines and search terms. The mean FKGL was 11.6 ± 0.11, Gunning-Fog Index was 15.1 ± 0.13, Coleman-Liau Index was 14.6 ± 0.11, ARI was 12.9 ± 0.13, and SMOG grade was 14.0 ± 0.1. All readability levels exceeded the abilities of the average American adult. Conclusions: Current online information regarding partial tonsillectomy may not provide adequate information and may be written at a level too difficult for the average adult reader.