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Masoudifar M, Rezaeian A, Mosharaf S. The Effect of Half Percent Oxymetazoline Nasal Drops on Post-Tonsillectomy Cough, Sore Throat and Bleeding in Children; A Double-Blind Randomized Clinical Trial. Adv Biomed Res 2023; 12:193. [PMID: 37694249 PMCID: PMC10492611 DOI: 10.4103/abr.abr_247_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 09/12/2023] Open
Abstract
Background Considering the high prevalence of tonsillectomy in children and concerns of postoperative management, this study was conducted with the aim of evaluating the effects of oxymetazoline on bleeding, cough, and sore throat in children undergoing tonsillectomy. Materials and Methods The current double-blind clinical trial study was conducted on 88 tonsillectomy candidate patients. These patients were randomly divided into two groups. In the first group, oxymetazoline 0.05% nasal spray (OXY group) and in the second group, distilled water spray (Control group) was prescribed as one puff in each nostril immediately after anesthesia induction., the nasal spray was prescribed again in both nostrils at 12 h after tonsillectomy. Then the hemodynamic parameters, post-tonsillectomy hemorrhage (PTH) and sore throat were evaluated. Results The mean of the sore throat of children was not significantly different between the two groups in any of the follow-up times (P value >0.05). PTH in recovery and in the ward in the OXY group with the mean of 57.60 ± 71.82 ml and 22.11 ± 22.50 ml, respectively, was significantly lower than the control group (83.50 ± 113.64 ml and 27.52 ± 35.11 ml) (P value < 0.05). Also, the frequency of cough in the ward in the OXY group with 27.3% was significantly lower than the control group with 56.8% (P value = 0.005). Conclusion Regarding the results of the present study, sore throat and hemodynamic parameters did not change significantly with the administration of oxymetazoline. But this drug has played a significant role in reducing PTH and cough in children.
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Affiliation(s)
- Mehrdad Masoudifar
- Department of Anesthesiology, School of Medicine, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Rezaeian
- Department of Otolaryngology, School of Medicine, Isfahan University of Medical Sciences Isfahan, Iran
| | - Sheida Mosharaf
- Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Sedgwick MJ, Saunders C, Bateman N. Intracapsular Tonsillectomy Using Plasma Ablation Versus Total Tonsillectomy: A Systematic Literature Review and Meta-Analysis. OTO Open 2023; 7:e22. [PMID: 36998549 PMCID: PMC10046729 DOI: 10.1002/oto2.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 02/19/2023] Open
Abstract
Objective To determine whether intracapsular tonsillectomy, using plasma ablation, results in differences in postoperative patient outcomes to total tonsillectomy. Data Sources A systematic review of two databases (Embase and PubMed) was conducted in March 2022 to identify published English-language randomized controlled trials and observational studies which provided a comparison between intracapsular tonsillectomy, using plasma ablation, and total tonsillectomy. Review Methods Qualitative synthesis and meta-analysis were used to compare outcomes between techniques. Results Seventeen studies were identified for inclusion. Across these, 1996 and 4565 patients underwent intracapsular and total tonsillectomy, respectively. Studies included 8 randomized controlled trials, 1 prospective cohort study, and 8 retrospective cohort studies. Time to pain free, time on analgesia, time to normal diet, and time to normal activity were significantly shorter with intracapsular tonsillectomy by on average 4.2 (95% confidence interval [CI] 1.5-5.9; p < .0001), 4.1 (95% CI 2.7-5.4; p < .0001), 3.5 (95% CI 1.7-5.4; p = .0002) and 2.8 (95% CI 1.6-4; p < .0001) days, respectively. Risk of posttonsillectomy hemorrhage was significantly lower following intracapsular tonsillectomy (relative risk [RR] 0.36; 95% CI 0.16-0.81; p = .0131); risk of posttonsillectomy hemorrhage requiring surgical management was lower but failed to reach significance (RR 0.52; 95% CI 0.19-1.39; p = .19). Conclusion Intracapsular tonsillectomy using plasma ablation has similar efficacy in managing indications for tonsil surgery to total tonsillectomy while significantly reducing the postoperative morbidity and likelihood of posttonsillectomy hemorrhage experienced by patients, allowing them to return to their normal life faster.
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Affiliation(s)
| | | | - Neil Bateman
- Paediatric Otolaryngology Department, Manchester Academic Health Science Centre, Royal Manchester Children's HospitalManchester University Hospitals NHS Foundation TrustManchesterUK
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Bipolar loop device versus bipolar diathermy for tonsillectomy: A pilot randomized controlled trial. Int J Pediatr Otorhinolaryngol 2021; 141:110505. [PMID: 33239197 DOI: 10.1016/j.ijporl.2020.110505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Tonsillectomy is one of the most common surgeries performed in the pediatric population. Although different forms of instruments and various methods are used to perform tonsillectomy, none of them is still recognized as the best global technique. This study aimed to compare the outcomes of the new Bipolar Loop tonsillectomy versus bipolar diathermy technique. METHODS This study is a pilot randomized clinical trial and was conducted on 40 pediatric patients who were the candidate of tonsillectomy. Patients were divided into two groups of Bipolar Loop or bipolar diathermy. Operation time, intraoperative bleeding, tonsillar fossa wound, postoperative complications, and duration of return to normal diet were evaluated in the current study. RESULTS In both of the Bipolar Loop and bipolar diathermy groups, no significant difference was found in terms of sex, age, and weight. The average amount of the operative time, intra-operative blood loss, and postoperative pain loss were significantly less in the Bipolar Loop group (P < .001). In addition, the tonsillar fossa wound healing scores were significantly better (on the 14th day, P = 0.009). However, there was no significant difference between the two groups in terms of postoperative bleeding, duration of return to a normal diet, and postoperative symptoms of fever, otalgia, or voice change between the groups. CONCLUSION The study showed that blood loss and postoperative pain through day 7 were significantly less in the Bipolar Loop group. Tonsillectomy with Bipolar Loop can be recommended as one of the methods for tonsillectomy, especially in pediatric patients.
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Keltie K, Donne A, Daniel M, Stephenson K, Wyatt M, Kuo M, Saunders M, Kumar NB, Philpott CM, Bruce I, Smith ME, Hardman JC, Cognigni P, Richardson H, Gross S, Sims AJ, Powell S. Paediatric tonsillectomy in England: A cohort study of clinical practice and outcomes using Hospital Episode Statistics data (2008-2019). Clin Otolaryngol 2021; 46:552-561. [PMID: 33377276 PMCID: PMC8048929 DOI: 10.1111/coa.13707] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 02/06/2023]
Abstract
Objectives To assess the safety of paediatric tonsillectomy procedures conducted in NHS hospitals in England between 2008 and 2019. Design Retrospective observational cohort study using Hospital Episode Statistics (HES) data. Setting Acute NHS trusts in England conducting paediatric tonsillectomy procedures. Participants Children (≤16 years old) undergoing bilateral tonsillectomy. Main outcome measures Number of tonsillectomies performed per year by procedural method. In‐hospital complications including return to theatre for arrest of haemorrhage. Readmission within 28 days, including those for pain, haemorrhage and surgical arrest of haemorrhage. Long‐term outcomes: all‐cause mortality, revision tonsillectomy. Results A total of 318 453 paediatric tonsillectomies were performed from 2008 to 2019:278,772 dissection (87.5%) and 39 681 coblation (12.5%). The proportion of tonsillectomy performed using coblation increased from 7% in 2008/9 to 27% in 2018/9. Five patients died in hospital (including 4 due to respiratory complications). In‐hospital complications occurred in 4202 children (1.3%), with the most frequent being haemorrhage. Within 28 days of tonsillectomy, 28 170 patients (8.8%) were readmitted and 7 deaths occurred. Readmission rates for haemorrhage and pain have increased since 2008. The proportion of children undergoing revision tonsillectomy procedures within 5 years following coblation tonsillectomy (1.4%) was approximately double that of dissection (0.6%). Conclusions Clinical practice of paediatric tonsillectomy has changed in England over the past 11 years. The overall mortality rate associated with the procedure is 0.0037%. Differences in outcomes have been identified for different procedural methods. However, routine administrative data are limited in differentiating procedural detail (eg we are unable to differentiate intra or extra‐capsular techniques from current clinical coding of tonsillectomy procedures). Therefore, prospective national data collection or more granular clinical coding is essential to capture relative outcomes of the different tonsillectomy methods and techniques being used in the NHS.
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Affiliation(s)
- Kim Keltie
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Faculty of Medical Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Adam Donne
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Mat Daniel
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kate Stephenson
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Michelle Wyatt
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Michael Kuo
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Michael Saunders
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Nirmal B Kumar
- Wrightington, Wigan and Leigh Teaching NHS Foundation Trust, Wigan, UK
| | - Carl M Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK.,Norfolk & Waveney ENT Service, Norfolk, UK
| | - Iain Bruce
- Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Matthew E Smith
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Paola Cognigni
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Hayley Richardson
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Andrew J Sims
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Faculty of Medical Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Steven Powell
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Faculty of Medical Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
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