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Ahmarani G, El Khoury P, Aoun M, Ahmarani MC, Rassi S. Recurrence of sleep apnea in children after intracapsular coblation tonsillectomy: A comprehensive exploration of tonsil regrowth. Int J Pediatr Otorhinolaryngol 2024; 181:111992. [PMID: 38805935 DOI: 10.1016/j.ijporl.2024.111992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/18/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVES Sleep apnea is a prevalent issue in children, associated with significant morbidities such as cardiovascular and neurocognitive disorders. There is increasing interest in intra-capsular tonsillectomy by coblation (ICTC) as a method to address obstructive sleep apnea (OSA) in children. However, the literature remains controversial regarding the most effective intra-capsular tonsillectomy (ICT) technique with the least morbidity. Our current research extends a previous study that established the effectiveness and safety of ICTC, demonstrating rapid post-surgical recovery with minimal analgesic needs. This new investigation specifically focuses on long-term follow-up. Our aim is to assess tonsil regrowth and the risk of recurrence of OSA symptoms at a mean follow-up of 6.1 years post-surgery. By presenting the results of this extended study, our goal is to gain a better understanding of the long-term effectiveness of this surgical intervention in treating OSA in children. Thus, considering the initial benefits, we will also explore potential long-term implications. MATERIALS AND METHODS This research follows up on children from our previous study who underwent ICTC, with or without adenoidectomy, for OSA resulting from tonsillar hypertrophy at a tertiary-level university hospital between March 2016 and March 2018. They were followed up for an average of 6.1 years postoperatively. Symptom recurrence is assessed by comparing preoperative OSA-18 questionnaire results with those obtained at the 6.1-year mark. Tonsil regrowth is evaluated by comparing preoperative Brodsky scores with those obtained at 6.1 years. RESULTS The mean total score of OSA-18 significantly decreased from 79.41 (SD = 14.95) before ICTC to 25.47 (SD = 8.92) at 6.1 years postoperatively (p < 0.001, mean difference = 53.94, 95 % CI [50.32, 57.56]). Similarly, the mean Brodsky score dropped from 2.95 (SD = 0.51) before ICTC to 1.04 (SD = 0.24) 6.1 years postoperatively (p < 0.001, mean difference = 1.92, 95 % CI [1.80, 2.04]). The overall regrowth rate was 2.35 % (n = 2), with a revision surgery rate of 1.18 % (n = 1). CONCLUSION ICTC exhibits minimal risk of tonsil regrowth and maintains long-term efficacy in preventing the recurrence of OSA symptoms. Therefore, it justifies broader utilization in addressing OSA symptoms arising from tonsillar hypertrophy in children.
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Affiliation(s)
- Georgina Ahmarani
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Alfred Naccache Boulevard, PO Box: 166830 Ashrafieh, Beirut, Lebanon
| | - Patrick El Khoury
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Alfred Naccache Boulevard, PO Box: 166830 Ashrafieh, Beirut, Lebanon
| | - Maroun Aoun
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Alfred Naccache Boulevard, PO Box: 166830 Ashrafieh, Beirut, Lebanon
| | - Maria Clara Ahmarani
- Centre de Recherche Azrieli Du CHU Sainte-Justine, QC, H3T 1C5, Montréal, Canada
| | - Simon Rassi
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Alfred Naccache Boulevard, PO Box: 166830 Ashrafieh, Beirut, Lebanon
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Chaudhary K, Singh V, Yadav R, Chaudhary AK, Kumar R, Gupta DK, Verma JK. Comparative Study of Complications Associated with Coblation Versus Conventional Tonsillectomy. Indian J Otolaryngol Head Neck Surg 2023; 75:2870-2877. [PMID: 37974731 PMCID: PMC10645949 DOI: 10.1007/s12070-023-03872-5] [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: 04/12/2023] [Accepted: 05/06/2023] [Indexed: 11/19/2023] Open
Abstract
Tonsillectomy is one of the most common ear, nose and throat surgical procedure, carried out worldwide1. Amongst the various method of tonsillectomy (diathermy, laser, harmonic scalpel, radiofrequency cautery cryosurgery and coblation), dissection and snare method is commonest procedure done by otorhinolaryngologist. To compare the post operative complications associated with coblation versus conventional cold-dissection steel tonsillectomy. We carried out the prospective study of complications associated with coblation versus conventional cold steel tonsillectomy in postoperative pain, anesthesia, hemorrhage, fever, pharyngitis, injury of adjacent structure & cautery burn. Average blood loss on Coblation side was 18.74 ml while on conventional side it was 44.2 ml. Post operative pain score, injury to adjacent structure and cautery burn were found to be significantly decreased in coblation. No such difference was observed in pharyngitis and fever in both methods. The use of coblator reduces the post-operative pain, peri or post-operative blood loss, injury to adjacent structure & cautery burn too.
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Affiliation(s)
- Kanchan Chaudhary
- Department of Otorhinolaryngology, Government Medical College & Super Facility Hospital, Azamgarh, India
| | - Vishwambhar Singh
- Department of Otorhinolaryngology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh India
| | - Ramraj Yadav
- Department of Otorhinolaryngology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh India
| | | | - Rajesh Kumar
- Department of Otorhinolaryngology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh India
| | - Deepak Kumar Gupta
- Department of Otorhinolaryngology, Narayan Medical College and Hospital, Sasaram, Rohtas, Bihar India
| | - Jyoti Kumar Verma
- Department of Otorhinolaryngology, Narayan Medical College and Hospital, Sasaram, Rohtas, Bihar India
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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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Vadivel S, Murugesan GS, Ravisankar M. Comparative Study of Pain Scale Assessment Between Cold Verses Hot Tonsillectomy Method. Indian J Otolaryngol Head Neck Surg 2022; 74:5258-5261. [PMID: 36742478 PMCID: PMC9895344 DOI: 10.1007/s12070-020-01942-6] [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: 05/19/2020] [Accepted: 06/28/2020] [Indexed: 02/07/2023] Open
Abstract
Tonsillectomy is an age old surgery especially in pediatric population. Over the last few years, various techniques have been proposed in performing tonsillectomy in an attempt to lower the morbidity and mortality. This study compares the post-operative pain scale of cold dissection method and newer methods like coblation, radiofrequency and bipolar cautery assisted tonsillectomy. In our prospective study, we selected 30 patients and randomly divided them into three groups. We had performed right side tonsillectomy in each divided group of ten with coblation, radiofrequency and bipolar cautery assisted and on left side tonsillectomy dissection and snare method to all subjects. We compared post-operative pain scale on the right and left side in next consecutive 3 post-operative days by using VAS of Wong-Baker. Of these 30 patients mean age is 10 ± 3 years and there is no significant sex distribution. In group 1 right side bipolar cautery (hot) method, pain scale was on 3 consecutive post-operative days (6.1 ± 1.5), (6.0 ± 1.5), (5.2 ± 0.9) when compared to left side cold method (p value 0.06). In group 2 right side coblation (hot) method, post-operative pain scale was (2.9 ± 1.6), (2.4 ± 1.6), (1.2 ± 1.4) which when compared to left side cold method showed that pain was significantly reduced (p value 0.03). In group 3 right side radiofrequency (hot) method post-operative pain scale was (4.6 ± 1.0), (2.5 ± 1.2), (1.5 ± 1.4) when compared to left side cold method pain (p value 0.08). This study revealed that coblation assisted hot tonsillectomy has less pain when compared to other techniques with normal cold method. It also has early recovery.
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Affiliation(s)
- Suresh Vadivel
- Department of ENT and Head and Neck Surgery, Govt. Stanley Medical College Hospital, Chennai, Tamil Nadu India
| | - Gowri Shankar Murugesan
- Department of ENT and Head and Neck Surgery, Govt. Stanley Medical College Hospital, Chennai, Tamil Nadu India
| | - Malarvizhi Ravisankar
- Department of ENT and Head and Neck Surgery, Govt. Stanley Medical College Hospital, Chennai, Tamil Nadu India
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Khoueir N, Rassi J, Richa T, Helou D, Khalaf MG, Rassi S. Coblation intra-capsular tonsillectomy: A prospective tertiary center trial. Int J Pediatr Otorhinolaryngol 2021; 150:110890. [PMID: 34411867 DOI: 10.1016/j.ijporl.2021.110890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There is a growing interest in intra-capsular coblation tonsillectomy (ICT) for the treatment of obstructive sleep apnea (OSA) in children. Literature remains controversial regarding which intra-capsular tonsillectomy (IT) technique is most effective and with least morbidity. Therefore, the aims of this study are to objectively measure the post-operative morbidity and the effectiveness of the ICT technique. MATERIALS AND METHODS 107 children undergoing ICT (with or without adenoidectomy) for upper airway obstruction due to tonsillar hypertrophy at a tertiary center university hospital were prospectively enrolled from March 2016 to March 2018. Efficacy of the surgery was assessed by a pre-and post-operative Obstructive Sleep Apnea score (OSA-18). Post-operative morbidity was measured based on the Parent's Post-operative Pain Measure questionnaire (PPPM), type and duration of administered pain medication, time before resuming a full diet and a normal activity, readmission for dehydration and post-operative bleeding incidence. RESULTS After a mean follow-up of 21.6 months, OSA-18 mean total score was 78.77 (SD = 15.74) before ICT and 23.7 (SD = 9.25) after surgery, with a significant difference between pre-operative and post-operative scores (p < 0.001). Mean PPPM scores were low at all evaluation points (5.89, 2.42 and 0.83 at days 2, 5 and 10 respectively). Analgesic use was restricted to acetaminophen in nearly all children for a mean duration of 1.93 days. They resumed a normal diet after 2.42 days and a normal activity (including return to school) after 2.7 days. No hospital readmission nor post-operative hemorrhage were reported. CONCLUSION Intra-capsular tonsillectomy by coblation is an effective and safe procedure that provides rapid post-operative recovery with minimal analgesic requirements, thus deserving a wider application in treating upper airway obstruction due to tonsillar hypertrophy in children.
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Affiliation(s)
- Nadim Khoueir
- Department of Otolaryngology - Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, P.O. Box 166830, Ashrafieh, Beirut, Lebanon
| | - Joe Rassi
- Department of Otolaryngology - Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, P.O. Box 166830, Ashrafieh, Beirut, Lebanon
| | - Tony Richa
- Department of Otolaryngology - Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, P.O. Box 166830, Ashrafieh, Beirut, Lebanon
| | - Diane Helou
- Department of Otolaryngology - Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, P.O. Box 166830, Ashrafieh, Beirut, Lebanon
| | - Michel G Khalaf
- Department of Otolaryngology - Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, P.O. Box 166830, Ashrafieh, Beirut, Lebanon.
| | - Simon Rassi
- Department of Otolaryngology - Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, P.O. Box 166830, Ashrafieh, Beirut, Lebanon
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Nemati S, Mohammadghasemi F, Mojtahedi A, Habibi AF, Rouhi S, Leili EKN, Moroosi M. The effects of radiofrequency on the bacteriological and histological characteristics of tonsils in patients with chronic and persistent tonsillitis. Am J Otolaryngol 2020; 41:102657. [PMID: 32829058 DOI: 10.1016/j.amjoto.2020.102657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Tonsillotomy with radiofrequency (RF) is one of the newest treatments for chronic tonsillitis, but the mechanism of RF effects and complications are still pending. The aim of this study was to evaluate the effects of RF on the histological and bacteriological characteristics of the tonsils (Case-control study). MATERIALS AND METHODS In fifty-two patients with chronic tonsillitis in 2017-2018, immediately after tonsillectomy, the tonsils were divided into 2sections; one sample treated with RF, and the other one considered as control, without intervention. All tonsil samples sent for histological and bacteriological study: morphometric assays made by Digitizer software, and type of bacterial colonies identified by microbiological and biochemical tests. Willcoxon and McNemar tests were used for statistical analysis and level of significance was p ≤ .05. RESULTS Tonsil mucosal thickness (2202.98 ± 323.09 vs. 2463.94 ± 357.61 μm) and size of the tonsil nodule (28,000.42 ± 9608.75 vs. 36,692.81 ± 7040.74 μm2) were significantly lower in the RF+ group than other group (p = .001 and p = .01, respectively). There was no significant differences in thickness of the tonsil epithelium (p = .075), number of lymphoid nodules (p = .860), and the number of reticular tonsil epithelium (p = .813) between the two groups. Bacterial growth in RF- and RF+ groups had no statistically significant difference (p = .06), however, the average colony count of S. aureus in RF+ tonsils were significantly lower, and total number of bacterial colonies were significantly lower in RF+ group(1405 ± 156 vs. 2471 ± 156), (p = .001). CONCLUSION RF surgery has significant effects on size of the nodules, thickness of the mucous layer and bacteriological characteristics of tonsil tissue. Especially S. aureus seems to be more sensitive to RF effects.
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Al-Shehri AMS, Alenzi HLS, Ali Mohammed YM, Musleh A, Bharti RK, Saeed Munshet AM. Cauterization tonsillectomy as compared to traditional tonsillectomy technique. J Family Med Prim Care 2020; 9:3981-3985. [PMID: 33110797 PMCID: PMC7586625 DOI: 10.4103/jfmpc.jfmpc_84_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/12/2020] [Accepted: 05/18/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Tonsillectomy is one of the most frequently applied and oldest surgical procedures in otorhinolaryngology. Various surgical techniques are used to perform this operation including traditional and cauterization techniques. Objectives: To assess morbidity and efficacy and compare objectively the techniques in tonsillectomy, i.e., traditional technique and cauterization technique. This study compares the traditional and cauterization tonsillectomy techniques in view of their advantages and complications. Methods: This is a retrospective study and comparative study, conducted during the period from January 2017 to March 2018 from the patients attending to Alnamas General Hospital, Aseer Region, Saudi Arabia. The questionnaire was designed to compare the traditional and cauterization tonsillectomy. Fifty patients underwent traditional technique and fifty patients underwent cauterization method. The data analyzed using SPSS V.16.0 (SPSS Inc; Chicago, IL, USA). Results: A total of 100 patients, 62 males and 38 females, aged 8 to 16 years were included in the study. A total of 100 patients were enrolled in the study. Traditional and cauterization tonsillectomy were performed. 50 (27 male and 23 female) patients, whose ages ranged from 9 to 16 years old underwent the traditional tonsillectomy, 50 (35 male and 15 female) patients whose ages ranged from 8 to 16 years underwent cauterization. The two groups were similar for demographic parameters. The difference between mean operative times of the two methods was statistically significant. Postoperative bleeding is significantly higher in the traditional technique compared to cauterization method. Postoperative pain is significantly less in cauterization method. Only a few patients experienced fever, bleeding, and other complications related to anesthesia. The bleeding severity is significantly lower in the cauterization technique. Postoperative pain was less in cauterization technique on day 1 and day 5. Postoperative pain was from mild to severe. Conclusion: This study revealed significantly less postoperative complications in traditional tonsillectomy in comparison with the cauterization method. Healing time was significantly faster in cauterization technique than in traditional method.
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Affiliation(s)
- Ali Maeed S Al-Shehri
- Ear, Nose and Throat Division, Surgery Department, College of Medicine, King Khalid University, Abha, KSA
| | | | | | - Abdullah Musleh
- Ear, Nose and Throat Division, Surgery Department, College of Medicine, King Khalid University, Abha, KSA
| | - Rishi Kumar Bharti
- Family & Community Medicine Department, College of Medicine, King Khalid University, Abha, KSA
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Oghan F, Guvey A, Aydemir O, Erdogan O, Topuz MF, Celiker M, Terzi S, Akbal S. Comparison of post-tonsillectomy morbidity operated with Cold Knife and Coblation in patients with Sleep Apnea. ENT UPDATES 2018. [DOI: 10.32448/entupdates.499040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Lin C, Thung AK, Jatana KR, Cooper JN, Barron LC, Elmaraghy CA. Impact of coblation versus electrocautery on acute post-operative outcomes in pediatric tonsillectomy. Laryngoscope Investig Otolaryngol 2018; 4:154-159. [PMID: 30828633 PMCID: PMC6383316 DOI: 10.1002/lio2.212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 07/14/2018] [Accepted: 08/22/2018] [Indexed: 12/27/2022] Open
Abstract
Objective Based on previous studies in the pediatric population, it remains unclear whether there is a difference in postoperative pain between two widely used tonsillectomy techniques: coblation and bovie electrocautery. This large prospective study investigates whether postoperative pain scores differ between these two surgical techniques for tonsillectomy. Methods Prospective, non‐randomized study of children aged 2–8 enrolled in a randomized controlled trial of single‐dose intravenous acetaminophen for pain associated with adenotonsillectomy. Included procedures occurred between October 2012 and June 2015 at a tertiary referral center. Only patients whose operations exclusively used coblation or electrocautery and who required postoperative admission for extended observation were included. Follow‐up period was the length of inpatient stay. Patients and nurses who recorded the pain scores were blinded to the tonsillectomy technique. Results A total of 183 patients were included: 117 coblation cases and 66 electrocautery cases. Pain scores in the surgical recovery unit and pain scores after admission to the floor unit were not significantly different between coblation and electrocautery, either before or after adjustment for patient age, body mass index, intravenous acetaminophen use, and surgeon. There was also no difference in length of stay, readmission rate, or post‐tonsillectomy hemorrhage. Conclusions Coblation and electrocautery tonsillectomy are associated with similar post‐operative pain scores in the recovery and inpatient units in the pediatric population. As coblation is costlier, the results of this study may affect which tool is used by otolaryngologists from a cost–benefit perspective. Level of evidence III
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Affiliation(s)
- Chen Lin
- Department of Otolaryngology-Head and Neck Surgery Nationwide Children's Hospital and The Ohio State University Wexner Medical Center Columbus Ohio
| | - Arlyne K Thung
- Department of Anesthesiology and Pain Medicine Nationwide Children's Hospital Columbus Ohio
| | - Kris R Jatana
- Department of Otolaryngology-Head and Neck Surgery Nationwide Children's Hospital and The Ohio State University Wexner Medical Center Columbus Ohio
| | - Jennifer N Cooper
- Center for Surgical Outcomes Research The Research Institute at Nationwide Children's Hospital Columbus Ohio
| | | | - Charles A Elmaraghy
- Department of Otolaryngology-Head and Neck Surgery Nationwide Children's Hospital and The Ohio State University Wexner Medical Center Columbus Ohio
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Kumar S, Padiyar B, Rai A. Cold Dissection Tonsillectomy and Radiofrequency Tonsil Ablation: A Prospective Comparative Study. DUBAI MEDICAL JOURNAL 2018. [DOI: 10.1159/000493513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Over the last few years, various techniques have been proposed for performing tonsillectomy in an attempt to lower the morbidity of this surgery. However, controversy still exists regarding the optimal technique involving the least postoperative morbidity. More recently, temperature-controlled radiofrequency has been introduced as a much more effective and safe device for tonsil reduction. <b><i>Objective:</i></b> To compare the effectiveness of conventional tonsillectomy versus radiofrequency tonsil ablation with respect to duration of surgery, amount of intraoperative bleeding, recovery time, and postsurgical pain. <b><i>Materials and Methods:</i></b> 60 patients were randomly divided into two groups. One group underwent conventional cold ablation tonsillectomy while radiofrequency tonsillectomy was performed in the second group. Duration of surgery, amount of intraoperative bleeding, recovery time, and postsurgical pain (using the Wong-Baker FACES Pain Rating Scale®) were measured. All patients were followed for 24 months. <b><i>Results:</i></b> Comparing the radiofrequency tonsillectomy group to the cold dissection tonsillectomy group, the mean duration of surgery was 6.92 versus 18 min, the amount of intraoperative bleeding was 2.75 versus 39.88 mL, and the difference on the postoperative pain scale between the two groups was statistically significant (<i>p</i> < 0.005). There was no recurrence of tonsillitis episodes in either of the 2 groups during the 2-year follow-up period. <b><i>Conclusion:</i></b> After adequate training, the radiofrequency technique is beneficial to both the surgeon and the patient, including the possibility to excise tissue and coagulate bleeding vessels with the same device. Postoperative morbidity and complications are lower as compared to the conventional cold dissection technique.
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Muthubabu K, Rekha A, Thejas SR, Vinayak R, Srinivasan MK, Alagammai S, Thushita Nivasini S, Gayathri S. Tonsillectomy by Cold Dissection and Coblation Techniques: A Prospective Comparative Study. Indian J Otolaryngol Head Neck Surg 2018; 71:665-670. [PMID: 31742039 DOI: 10.1007/s12070-018-1472-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/17/2018] [Indexed: 12/27/2022] Open
Abstract
Inflammatory and infectious diseases of tonsils are common in paediatric and adult otolaryngological practice and ensue in tonsillectomy which is a common surgical procedure. Dissection and snare method is being performed for ages and has evolved over a period of time while coblation is a newer technique started in 1997. It combines radiofrequency energy and normal saline, resulting in a plasma field of highly ionized particles which dissociates intercellular bonds and thus melts tissue at low temperatures (40-70 °C) thereby reducing tissue damage. To compare the intraoperative time, intraoperative blood loss, post operative pain and post operative blood loss between dissection tonsillectomy and coblation tonsillectomy. This study was carried out at the outpatient Department of Otorhinolaryngology and Head and Neck Surgery in Meenakshi Medical College, Hospital and Research Institute, Tamil Nadu. Patients with chronic and recurrent tonsillitis who were planned electively for tonsillectomy were included in this study. Study was based on the analysis of 60 patients aged between 5 and 40 years. All these 60 patients were thoroughly investigated by doing a complete surgical workup. They all were subjected to 2 different tonsillectomy procedures-dissection and snare method and coblation technique. Patients were assigned into two groups of 30 each by simple random sampling. Among these 60 patients, blood loss and post operative pain was less in Group 2 (coblation) and the duration of surgery was less in Group 1 (dissection and snare). In this study, patients who underwent surgery in Group 2 (coblation) showed better outcome when compared to Group 1 (dissection and snare method).
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Affiliation(s)
- K Muthubabu
- Department of Otorhinolaryngology and Head and Neck Surgery, Meenakshi Medical College Hospital and Research Institute, Karaipettai Post, Enathur, Kanchipuram, Tamil Nadu 631552 India
| | - Assadi Rekha
- Department of Otorhinolaryngology and Head and Neck Surgery, Meenakshi Medical College Hospital and Research Institute, Karaipettai Post, Enathur, Kanchipuram, Tamil Nadu 631552 India
| | - Saai Ram Thejas
- Department of Otorhinolaryngology and Head and Neck Surgery, Meenakshi Medical College Hospital and Research Institute, Karaipettai Post, Enathur, Kanchipuram, Tamil Nadu 631552 India
| | - R Vinayak
- Department of Otorhinolaryngology and Head and Neck Surgery, Meenakshi Medical College Hospital and Research Institute, Karaipettai Post, Enathur, Kanchipuram, Tamil Nadu 631552 India
| | - M K Srinivasan
- Department of Otorhinolaryngology and Head and Neck Surgery, Meenakshi Medical College Hospital and Research Institute, Karaipettai Post, Enathur, Kanchipuram, Tamil Nadu 631552 India
| | - S Alagammai
- Department of Otorhinolaryngology and Head and Neck Surgery, Meenakshi Medical College Hospital and Research Institute, Karaipettai Post, Enathur, Kanchipuram, Tamil Nadu 631552 India
| | - S Thushita Nivasini
- Department of Otorhinolaryngology and Head and Neck Surgery, Meenakshi Medical College Hospital and Research Institute, Karaipettai Post, Enathur, Kanchipuram, Tamil Nadu 631552 India
| | - S Gayathri
- Department of Otorhinolaryngology and Head and Neck Surgery, Meenakshi Medical College Hospital and Research Institute, Karaipettai Post, Enathur, Kanchipuram, Tamil Nadu 631552 India
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Topcu-Yilmaz P, Kutluk S, Onder F. Horner Syndrome as a Rare Complication of Radiofrequency Tonsil Ablation. J Pediatr Ophthalmol Strabismus 2018; 55:e14-e15. [PMID: 30074605 DOI: 10.3928/01913913-20180608-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/20/2018] [Indexed: 11/20/2022]
Abstract
Horner syndrome is a rare but likely underdiagnosed complication of tonsillary surgery. The authors report the case of a 2.5-year-old boy who developed miosis and mild ptosis after radiofrequency tonsil ablation surgery. Pharmacologic testing with apraclonidine 0.5% eye drops confirmed left Horner syndrome. This case highlights the close anatomical relationship between the tonsils and cervical sympathetic trunk and draws attention to the occurrence of Horner syndrome after tonsillectomy. [J Pediatr Ophthalmol Strabismus. 2018;55:e14-e15.].
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Chao MC, Kim HK, Crumley RL, Wong BJ. Bipolar Radiofrequency Plasma-Mediated Ablation of Porcine Nasal Septal Cartilage: A Pilot Investigation. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240501900512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The objectives of this pilot study were to (1) determine whether bipolar radiofrequency plasma-mediated ablation (PMA) can efficiently remove nasal septal cartilage and (2) calculate the ablation rate as a function of device power, probe force, and translation velocity using ex vivo porcine tissue. Methods Specimens were secured to a linear translation stage and were subjected to varying translation velocities (4, 7, and 12 cm/s), probe forces (140, 200, and 225 g), and bipolar radiofrequency generator (Coblator ENTec power settings, 38–58, 77–115, and 129–193 Watts root mean squared. Specimen mass loss and depth of ablation were measured using an analytic balance and dissection microscope, respectively. Results Visual and microscopic inspection revealed little char. Mass loss increased with decreasing translation velocity and increasing generator setting. Increasing probe force also influenced mass loss and increased crater depth. Depth of ablation did not correlate with translation velocity or generator setting. Conclusion PMA effectively ablates nasal septal cartilage and may be able to reduce or contour cartilaginous deformities and framework structures in the head and neck.
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Affiliation(s)
| | - Hong K. Kim
- Division of Facial Plastic Surgery, Department of Otolaryngology–Head and Neck Surgery, University of California Irvine Medical Center, Orange, California
- Beckman Laser Institute, University of California Irvine, Irvine, California
| | - Roger L. Crumley
- Division of Facial Plastic Surgery, Department of Otolaryngology–Head and Neck Surgery, University of California Irvine Medical Center, Orange, California
| | - Brian J.F. Wong
- Division of Facial Plastic Surgery, Department of Otolaryngology–Head and Neck Surgery, University of California Irvine Medical Center, Orange, California
- Beckman Laser Institute, University of California Irvine, Irvine, California
- Department of Biomedical Engineering, Henry Samuel School of Engineering, University of California Irvine, Irvine, California
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Verma R, Verma RR, Verma RR. Tonsillectomy-Comparative Study of Various Techniques and Changing Trend. Indian J Otolaryngol Head Neck Surg 2017; 69:549-558. [PMID: 29238690 PMCID: PMC5714902 DOI: 10.1007/s12070-017-1190-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 08/23/2017] [Indexed: 12/23/2022] Open
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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Affiliation(s)
- Ravinder Verma
- Verma Hospital and Research Centre, Gujral Nagar, Jalandhar, 144001 India
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Esteller E, Villatoro JC, Pedemonte G, Agüero A, Ademà JM, Girabent-Farrés M. Surgical Treatment for Childhood Obstructive Sleep Apnoea: Cold-Knife Tonsillar Dissection Versus Bipolar Radiofrequency Thermal Ablation. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016. [DOI: 10.1016/j.otoeng.2015.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Singal A, Ballard JR, Rudie EN, Cressman ENK, Iaizzo PA. A Review of Therapeutic Ablation Modalities. J Med Device 2016. [DOI: 10.1115/1.4033876] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Understanding basic science and technical aspects is essential for scientists and engineers to develop and enhance ablative modalities, and for clinicians to effectively apply therapeutic ablative techniques. An overview of ablative modalities, anatomical locations, and indications for which ablations are performed is presented. Specifically, basic concepts, parameter selection, and underlying biophysics of tissue injury of five currently used therapeutic ablative modalities are reviewed: radiofrequency ablation (RFA), cryoablation (CRA), microwave ablation (MWA), high-intensity focused ultrasound (HIFU), and chemical ablation (CHA) (ablative agents: acetic acid, ethanol, hypertonic sodium chloride, and urea). Each ablative modality could be refined for expanding applications, either independently or in combination, for future therapeutic use.
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Affiliation(s)
- Ashish Singal
- Department of Biomedical Engineering, University of Minnesota, 420 Delaware Street SE, B172 Mayo Building, MMC 195, Minneapolis, MN 55455 e-mail:
| | - John R. Ballard
- Medical Devices Center, University of Minnesota, 420 Delaware Street SE, G217 Mayo Building, MMC 95, Minneapolis, MN 55455 e-mail:
| | - Eric N. Rudie
- Rudie Consulting LLC, 18466 Gladstone Boulevard, Maple Grove, MN 55311 e-mail:
| | - Erik N. K. Cressman
- Department of Interventional Radiology, MD Anderson Cancer Center, FCT 14.6012 Unit 1471, 1400 Pressler Street, Houston, TX 77030 e-mail:
| | - Paul A. Iaizzo
- Mem. ASME Department of Surgery, University of Minnesota, 420 Delaware Street SE, B172 Mayo, MMC 195, Minneapolis, MN 55455 e-mail:
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Abstract
Objectives: We performed a prospective study to evaluate the incidence of post-tonsillectomy hemorrhage (PTH) in adults and children who underwent Coblation tonsillectomy (CTE) under general anesthesia. Methods: The data of 63 adults and children (mean age, 21.8 years) were analyzed. Results: There were 7 episodes of considerable bleeding (11.1%) that required surgical treatment under general anesthesia in 6 patients, of whom 5 experienced secondary bleeding (>24 hours). Moreover, bleeding and massive swelling of the pharynx required surgical treatment and prolonged intubation (35 hours) in 1 patient. None of the patients received blood transfusions. There was no case with a lethal outcome. Less intense bleeding (clots; blood-tinged sputum) was observed in 17 patients (27%) who required readmission or prolonged inpatient observation, 1 of whom had previously undergone surgical treatment of PTH. However, these 17 patients had an uneventful clinical course. In total, 22 patients experienced minor or major forms of PTH (34.9%). Conclusions: At least in our hands, CTE dramatically increased the frequency of PTH. The high rate of secondary bleeding contrasts with our documented experience using conventional methods, ie, cold dissection and suture ligation, to achieve hemostasis (7.9% with CTE versus <0.8% with conventional methods). Therefore, at our institution, tonsillectomy with conventional instruments remains the method of choice.
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Affiliation(s)
- Jochen P Windfuhr
- Department of Otorhinolaryngology-Plastic Head and Neck Surgery, St Anna Hospital, Duisburg, Germany
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Friedman M, Vidyasagar R, Bliznikas D, Joseph NJ. Patient Selection and Efficacy of Pillar Implant Technique for Treatment of Snoring and Obstructive Sleep Apnea/Hypopnea Syndrome. Otolaryngol Head Neck Surg 2016; 134:187-96. [PMID: 16455363 DOI: 10.1016/j.otohns.2005.10.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2004] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: Pillar implant (PIT) is a simple, office-based procedure with minimal morbidity that was introduced in 2003 to treat snoring and mild/moderate obstructive sleep apnea/hypopnea syndrome (OSAHS). We studied the: (1) success rate using subjective symptoms and objective polysomnographic improvement; (2) success rate based on BMI, OSAHS severity and Friedman tongue position (FTP); and (3) its value as an adjunctive or revision procedure. STUDY DESIGN AND SETTING: Retrospective review of 125 patients who underwent the PIT for snoring and OSAHS. Patients were grouped: Group I had PIT only ( n = 29); Group II received adjunctive nasal procedures ( n = 37), Group III received adjunctive oropharyngeal procedures ( n = 55); and Group IV had failed previous UPPP ( n = 4). RESULTS: Overall subjective and objective “cure” rates were 88.0% and 34.4%, respectively. Group IIb had the best objective cure rate of 46.7%. Neither AHI nor BMI correlated with outcome measures, whereas FTP did correlate. (FTP I and II had improved success vs FTP III and IV). Ten patients had partial extrusion of the PIT. These were removed and new PIT were carried out at a later date. CONCLUSIONS: Based on a short-term study, the Pillar implant is an effective treatment for snoring and OSAHS in selected patients and can be combined with adjunctive procedures to treat OSAHS.
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Affiliation(s)
- Michael Friedman
- Department of Otolaryngology and Bronchoesophagology, Rush-Presbyterian St. Luke's Medical Center, Chicago, IL, USA
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20
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Esteller E, Villatoro JC, Pedemonte G, Agüero A, Ademà JM, Girabent-Farrés M. Surgical treatment for childhood obstructive sleep apnoea: Cold-knife tonsillar dissection versus bipolar radiofrequency thermal ablation. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016; 67:261-7. [PMID: 26992775 DOI: 10.1016/j.otorri.2015.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 10/28/2015] [Accepted: 11/02/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVE Adenotonsillectomy for treatment of childhood obstructive sleep apnoea is effective. The uncomfortable postoperative period and possible complications have significantly increased the use of partial techniques, seeking to improve these aspects while achieving the same results in resolving sleep apnoea. The aim was to present the experience with 2 consecutive groups of patients, comparing total tonsillectomy to bipolar radiofrequency ablation (RFA). METHOD A group of 96 children that underwent total tonsilloadenoidectomy using cold dissection were compared to another group of 101 children that underwent RFA. In all cases, polysomnography was performed before and 1 year after surgery. The percentage of cases with persistent disease (apnea-hypopnea index ≥ 3) and the improvement of clinical symptoms at one year were evaluated. The percentages of surgical and anaesthetic complications in both groups were also compared. RESULT The persistence of the syndrome was comparable in both groups: 25% in the cold dissection and 22.77% in the radiofrequency ablation group. Anaesthetic complications (5% in the group where cold dissection was used and 4.2% in the radiofrequency ablation group) and postoperative bleeding rates were very low and statistically comparable with both techniques. CONCLUSION In the treatment of childhood obstructive sleep apnoea syndrome, both extracapsular surgery using cold scalpel and bipolar radiofrequency tunnelling techniques are safe. Likewise, results as to resolution of the syndrome show no statistically significant differences.
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Affiliation(s)
- Eduard Esteller
- Servicio de Otorrinolaringología, Hospital General de Catalunya, Sant Cugat del Vallès (Barcelona), España; Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), España.
| | - Juan Carlos Villatoro
- Servicio de Otorrinolaringología, Hospital General de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Gabriel Pedemonte
- Servicio de Otorrinolaringología, Hospital General de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Adriana Agüero
- Servicio de Otorrinolaringología, Hospital General de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Joan Manel Ademà
- Servicio de Otorrinolaringología, Hospital General de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Montserrat Girabent-Farrés
- Unidad de Bioestadística, Departamento de Fisioterapia, Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), España
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Clinical practice guideline: tonsillitis II. Surgical management. Eur Arch Otorhinolaryngol 2016; 273:989-1009. [DOI: 10.1007/s00405-016-3904-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 01/13/2016] [Indexed: 12/25/2022]
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Certal V, Silva H, Carvalho C, Costa-Pereira A, Azevedo I, Winck J, Capasso R, Camacho M. Model for prediction of pediatric OSA: Proposal for a clinical decision rule. Laryngoscope 2015; 125:2823-7. [DOI: 10.1002/lary.25438] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Victor Certal
- Department of Otorhinolarygology/Sleep Medicine Centre-Hospital CUF; Porto
- Department of Otorhinolarygology; Hospital São Sebastião; Sta Maria da Feira Portugal
| | - Hélder Silva
- Department of Otorhinolarygology; Hospital São Sebastião; Sta Maria da Feira Portugal
| | - Carlos Carvalho
- Department of Otorhinolarygology; Hospital São Sebastião; Sta Maria da Feira Portugal
| | | | | | - João Winck
- Department of Pulmonology; Faculty of Medicine, University of Porto
| | - Robson Capasso
- Department of Otolaryngology-Head and Neck Surgery; Division of Sleep Surgery; Stanford Hospital and Clinics; Stanford California
| | - Macario Camacho
- Department of Otolaryngology; Division of Sleep Surgery and Medicine; Tripler Army Medical Center; Honolulu Hawaii U.S.A
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Kucur C, Ozbay I, Oghan F, Yildirim N, Zeybek Sivas Z, Canbaz Kabay S. A Rare Complication of Radiofrequency Tonsil Ablation: Horner Syndrome. Case Rep Otolaryngol 2015; 2015:570520. [PMID: 26064747 PMCID: PMC4439494 DOI: 10.1155/2015/570520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/04/2015] [Accepted: 04/09/2015] [Indexed: 11/29/2022] Open
Abstract
Chronic tonsillitis is a common disease, and several different surgical techniques are used to treat this condition. In recent years, techniques such as radiofrequency ablation and coblation have been commonly used for tonsil surgery. In this report, we present the cases of two pediatric patients who developed ptosis, miosis, and enophthalmos (Horner syndrome) after radiofrequency ablation for tonsil reduction and discuss the technique of radiofrequency ablation of the tonsils. In the early postoperative period, miosis and ptosis were observed on the right side in one patient and on the left side in the other patient. Both patients were treated with 1 mg/kg/day methylprednisolone, which were tapered by halving the dose every 3 days. Miosis and ptosis improved after treatment in both patients. Along with the case presentation, we discuss the effectiveness and complications of radiofrequency ablation of the tonsils. These unusual complications of tonsil ablation may help ENT physicians who do not yet have a preferred surgical technique for tonsillectomy to make an informed decision. Limited data are available about the possible complications of radiofrequency ablation of the tonsils. The present report contributes to the literature on this topic.
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Affiliation(s)
- Cuneyt Kucur
- Department of Otorhinolaryngology, Dumlupinar University, 43235 Kutahya, Turkey
| | - Isa Ozbay
- Department of Otorhinolaryngology, Dumlupinar University, 43235 Kutahya, Turkey
| | - Fatih Oghan
- Department of Otorhinolaryngology, Dumlupinar University, 43235 Kutahya, Turkey
| | - Nadir Yildirim
- Department of Otorhinolaryngology, Dumlupinar University, 43235 Kutahya, Turkey
| | - Zuhal Zeybek Sivas
- Department of Otorhinolaryngology, Dumlupinar University, 43235 Kutahya, Turkey
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Deak L, Saxton D, Johnston K, Benedek P, Katona G. Comparison of Postoperative Pain in Children with Two Intracapsular Tonsillotomy Techniques and a Standard Tonsillectomy: Microdebrider and radiofrequency tonsillotomies versus standard tonsillectomies. Sultan Qaboos Univ Med J 2014; 14:e500-e505. [PMID: 25364553 PMCID: PMC4205062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/07/2014] [Accepted: 05/28/2014] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES The aim of this study was to compare the duration and severity of postoperative pain for two different tonsillotomy techniques (radiofrequency [RF] and microdebrider [MD]) with the standard tonsillectomy. METHODS This non-randomised retrospective study, carried out from February 2011 to September 2012, investigated 128 children in two independent centres: Heim Pál Children's Hospital in Budapest, Hungary, and Muscat Private Hospital in Muscat, Oman. Those undergoing conventional tonsillectomies acted as the control group. One centre tested the MD technique (n = 28) while the other centre tested the RF technique (n = 31). RESULTS The pain-free period after the tonsillotomies was similar between the two techniques and ranged up to three days. Other indicators of pain resolution, like the use of a single analgesic, reduced night-time waking and the time taken to resume a normal diet, were also similar for the two groups. However, patients benefited significantly from having a tonsillotomy rather than a tonsillectomy. CONCLUSION The partial resectioning of tonsillar tissue using the MD and RF techniques showed promising outcomes for a better postoperative quality of life when compared to a traditional tonsillectomy. In this study, the results of both the MD and RF tonsillotomy methods were almost identical in terms of the duration of postoperative pain and recovery time.
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Affiliation(s)
- Levente Deak
- Department of Ear, Nose & Throat, Al Zahra Hospital, Dubai, United Arab Emirates
| | - David Saxton
- Department of Ear, Nose & Throat, Al Zahra Hospital, Dubai, United Arab Emirates
| | - Keith Johnston
- Department of Anaesthesia & Critical Care, Muscat Private Hospital, Muscat, Oman
| | - Palma Benedek
- Department of Oto-Rhino-Laryngology & Bronchology, Heim Pál Children’s Hospital, Budapest, Hungary
| | - Gábor Katona
- Department of Oto-Rhino-Laryngology & Bronchology, Heim Pál Children’s Hospital, Budapest, Hungary
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Shin JM, Byun JY, Baek BJ, Lee JY. Effect of cold-water cooling of tonsillar fossa and pharyngeal mucosa on post-tonsillectomy pain. Am J Otolaryngol 2014; 35:353-6. [PMID: 24508083 DOI: 10.1016/j.amjoto.2014.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 01/01/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Post-tonsillectomy pain is a notable concern and thermal injury produced by electric surgical devices is considered a main cause. Intraoperative cooling of the tonsillar fossa and pharyngeal mucosa with cold water has effectively reduced postoperative pain, but no studies have fully evaluated the effects of this technique with a proper study design. We assessed mucosal cooling in two groups of patients undergoing the same surgical technique by a single surgeon, with one group receiving cold-water cooling and the other group as a control. METHODS Forty patients who underwent monopolar electrocautery tonsillectomy were randomly assigned to two groups (n = 20 for each group). Group 1 received cooling of the tonsillar fossa and pharyngeal mucosa with 4 °C saline just after removal of each tonsil whereas Group 2 did not receive cooling. Postoperative pain was recorded on operation day and 1, 2, 4, 7, and 10 days postoperatively. Post-tonsillectomy pain, return to normal diet, and incidence of postoperative bleeding were compared between the groups. RESULTS Post-tonsillectomy pain on 6 selected days and overall pain during the 10-day follow-up period were significantly lower in Group 1. However, return to normal diet and incidence of postoperative bleeding did not differ significantly between the groups. CONCLUSIONS Intraoperative application of cold water after tonsillectomy significantly reduced postoperative pain. We recommend cooling the tonsillar fossa and pharyngeal mucosa with cold water during tonsillectomy to easily and effectively reduce post-tonsillectomy pain.
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Affiliation(s)
- Jae Min Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Seoul Hospital, Seoul, South Korea
| | - Jang Yul Byun
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, South Korea
| | - Byoung Joon Baek
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, South Korea
| | - Jae Yong Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, South Korea.
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Windfuhr JP, Savva K, Dahm JD, Werner JA. Tonsillotomy: facts and fiction. Eur Arch Otorhinolaryngol 2014; 272:949-969. [DOI: 10.1007/s00405-014-3010-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 03/13/2014] [Indexed: 11/30/2022]
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Larrosa F, Dura MJ, Jeremias J, Guirao M, Alberti A, Romero E. The cost associated with interstitial thermotherapy for tonsil reduction vs. standard tonsillectomy. Eur Arch Otorhinolaryngol 2013; 271:1271-6. [DOI: 10.1007/s00405-013-2705-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 09/13/2013] [Indexed: 12/01/2022]
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Coblation vs. Electrocautery Tonsillectomy: A Prospective Randomized Study Comparing Clinical Outcomes in Adolescents and Adults. Clin Exp Otorhinolaryngol 2013; 6:90-3. [PMID: 23799166 PMCID: PMC3687068 DOI: 10.3342/ceo.2013.6.2.90] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 06/15/2012] [Accepted: 07/02/2012] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Coblation is operated in low temperature, so it is proposed that tonsillectomy with coblation involves less postoperative pain and allows accelerated healing of the tonsillar fossae compared with other methods involving heat driven processes. However, the results of the previous studies showed that the effect of coblation tonsillectomy has been equivocal in terms of postoperative pain and hemorrhage. Though, most of the previous studies which evaluated coblation tonsillectomy were performed in children. Recently, electrocautery tonsillectomy has been used most widely because of the reduced intraoperative blood loss and shorter operative time compared to other techniques. This prospective study compared intraoperative records and postoperative clinical outcomes in adolescents and adults following coblation and electrocautery tonsillectomies. METHODS Eighty patients over 16 years of age with histories of recurrent tonsillitis were enrolled. The patients were randomly allocated into coblation (n=40) and electrocautery tonsillectomy groups (n=40). All operations were performed by one surgeon who was skilled in both surgical techniques. Intraoperative parameters and postoperative outcomes were checked. RESULTS Postoperative pain and otalgia were not significantly different between the two groups; however, there was a tendency towards reduced pain and otalgia in the coblation group. More cotton balls for swabbing the operative field were used introoperatively in the electrocautery group (P=0.00). There was no significant difference in postoperative hemorrhage, wound healing, commencement of a regular diet, and foreign body sensation between the groups. CONCLUSION Only cotton use, which represented the amount of blood loss, was less in the coblation tonsillectomy group. Coblation tonsillectomy warrants further study with respect to the decreased postoperative pain and otalgia.
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Blumen M, Coquille F, Chabolle F. Lingual tonsil reduction in OSA: Transcervical radiofrequency ablation. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129:339-42. [DOI: 10.1016/j.anorl.2012.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 02/22/2012] [Accepted: 03/05/2012] [Indexed: 11/29/2022]
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Karadağ S, Özkiriş M, Kubilay U, Söyletir G. The effect of radiofrequency ablation on microbiology of the tonsils. Int J Pediatr Otorhinolaryngol 2012; 76:1654-7. [PMID: 22939330 DOI: 10.1016/j.ijporl.2012.07.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 07/24/2012] [Accepted: 07/27/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the effect of tonsil size reduction using temperature controlled radiofrequency on the number of pathogenic bacteria in the tonsil tissue. MATERIALS AND METHODS This study was performed on 25 patients who had undergone tonsillectomy under general anesthesia at our clinic. Immediately after the cold knife tonsillectomy both tonsils were removed, one was included in the control and the other one was included in the study group. In vitro radiofrequency was applied to the tonsil in the study group at eight distinct points, each lasting 15s. Biopsy materials were taken under sterile conditions from the center of each tonsil for further culturing. RESULTS The difference in bacterial number was investigated between the two groups. The bacterial number following radiofrequency administration was found to be significantly very lower compared to the control group (p<0.01). Radiofrequency administration significantly reduced growth of all types of bacteria. CONCLUSION The radiofrequency tonsil ablation technique, which is used safely and effectively in the management of obstructive tonsil hypertrophy, currently has no indication for the treatment of patients with chronic and recurrent tonsillitis. However, when the right conditions are provided, the radiofrequency tonsil ablation technique may be applied to patients with chronic and recurrent tonsillitis and further studies investigating the differences in the frequency of patients' tonsillitis episodes should be undertaken.
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Affiliation(s)
- Serkan Karadağ
- Department of Otolaryngology, Head and Neck Surgery, Sinop State Hospital, Sinop, Turkey
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Jafari B, Roux F. Non-positive airway pressure therapy for obstructive sleep apnea. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s13665-012-0016-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rakesh S, Anand TS, Payal G, Pranjal K. A Prospective, Randomized, Double-Blind Study of Coblation versus Dissection Tonsillectomy in Adult Patients. Indian J Otolaryngol Head Neck Surg 2011; 64:290-4. [PMID: 23998038 DOI: 10.1007/s12070-011-0355-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 11/10/2011] [Indexed: 11/26/2022] Open
Abstract
This randomized double blind study was conducted prospectively to determine whether coblation tonsillectomy fared better than the conventional dissection method in terms of postoperative pain, bleeding, and rapidity of healing in adult Indian patients undergoing tonsillectomy. Sixty adult patients undergoing tonsillectomy for benign indications were randomized to have one tonsil removed by subcapsular radiofrequency ablation method and the other by conventional dissection method. The operative time and blood loss was noted for each side. Patients were evaluated at 6, 12, 24, 48, 72 h and then on 7th and 20th postoperative day for postoperative pain (by visual analog scale), bleeding, and tonsillar fossa healing. Statistical comparison was done using appropriate tests. The two groups were demographically matched. It took longer to perform the coblation procedure (15 vs 11 min) (P > 0.05). The operative blood loss on the radiofrequency side was 11 ml, vs 34 ml on the conventional side (P = 0.009). 77% patients said that the coblation side was less painful for the overall 20-day recovery period. There were significant differences seen at 6, 12, 24, 48, and 72 h in terms of postoperative pain scores. Beyond that, the pain was consistently less on the coblation side, but the difference was not significant. There was no case of reactionary or secondary hemorrhage in either arm. The healing took longer on the radiofrequency side. Coblation tonsillectomy is an easy to learn technique with significantly reduced operative blood loss and postoperative pain. Longer operative times maybe further reduced with experience.
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Affiliation(s)
- Singh Rakesh
- Department of Otorhinolaryngology, LHMC & Associated Hospitals, New Delhi, India
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Joshi H, Carney AS. Use of coblation in otolaryngology, head and neck surgery. Br J Hosp Med (Lond) 2011; 72:565-9. [DOI: 10.12968/hmed.2011.72.10.565] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Himani Joshi
- Royal Australasian College of Surgeons Surgical Education and Training 1 in Otolaryngology
| | - A Simon Carney
- Consultant and Professor in Otorhinolaryngology Surgery, Flinders Medical Centre, Flagstaff Hill, South Australia, 5159, Australia
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Babademez MA, Yurekli MF, Acar B, Günbey E. Comparison of radiofrequency ablation, laser and coblator techniques in reduction of tonsil size. Acta Otolaryngol 2011; 131:750-6. [PMID: 21521008 DOI: 10.3109/00016489.2011.553244] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Coblation was seen to be a much safer method for tonsil reduction surgery with less morbidity and with a higher efficacy in early and long-term follow-up. OBJECTIVE The objective was to compare the efficacy, morbidity and safety of three techniques for reduction of tonsil size in tonsillar hypertrophy in children. METHODS This was a prospective, randomized clinical study. Seventy-nine children aged 4-13 years with symptoms of tonsillar hypertrophy were included in the study. They were randomized to the coblator (group A), laser tonsillotomy (group B) or radiofrequency (group C) technique for tonsil reduction. The efficacy was evaluated by assessing tonsillar size after surgery. Morbidity was evauated by assessing by postoperative pain and return to normal diet and activity. RESULTS Pain on the first day was significantly higher for children in group B (p = 0.0001). The mean values for analgesic usage and number of days until return to normal diet and normal activity were lower in group A. At 1-year postoperative follow-up, the mean tonsil size was higher in group C (p < 0.05). None of the children in group A, two of the children (8.3%) in group B and six of the children (21.4%) in group C need reoperation for tonsillary hypertrophy.
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Affiliation(s)
- Mehmet Ali Babademez
- Department of Otorhinolaryngology, Kecioren Training and Research Hospital, Ankara, Turkey
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Horii A, Hirose M, Mochizuki R, Yamamoto K, Kawamoto M, Kitahara T, Yamamoto Y, Kawashima T, Uno A, Imai T, Nishiike S, Inohara H. Effects of cooling the pharyngeal mucosa after bipolar scissors tonsillectomy on postoperative pain. Acta Otolaryngol 2011; 131:764-8. [PMID: 21504273 DOI: 10.3109/00016489.2011.566580] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Bipolar scissors tonsillectomy followed by cooling down the pharyngeal mucosa has advantages in terms of postoperative pain and intraoperative blood loss compared with cold dissection. OBJECTIVES The purpose of this study was to compare the postoperative pain between bipolar scissors tonsillectomy followed by cooling the pharyngeal mucosa and a traditional cold dissection. METHODS A total of 189 patients aged more than 16 years were operated due to habitual tonsillitis, obstructive sleep apnea syndrome, and IgA nephropathy. Of these, 79 patients were operated using bipolar scissors followed by cooling the pharyngeal mucosa with 4°C saline for 10 min just after the removal of tonsils. The other 110 patients underwent cold dissection tonsillectomy. Outcome measures were intraoperative blood loss, operative time, postoperative pain evaluated on a visual analog scale, and postoperative secondary hemorrhage. RESULTS Significantly lower levels of intraoperative blood loss and less postoperative pain were obtained in bipolar scissors tonsillectomy followed by cooling the pharyngeal mucosa compared with cold dissection. Postoperative hemorrhage needing hemostatic surgery occurred in 2 of 79 patients who underwent bipolar scissors tonsillectomy with cooling, while it occurred in 1 of 110 patients after cold dissection. However, the difference was not statistically significant.
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Affiliation(s)
- Arata Horii
- Department of Otolaryngology, Suita Municipal Hospital, Japan.
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Stimpson P, Kotecha B. Histopathological and ultrastructural effects of cutting radiofrequency energy on palatal soft tissues: a prospective study. Eur Arch Otorhinolaryngol 2011; 268:1829-36. [PMID: 21594723 DOI: 10.1007/s00405-011-1634-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 05/09/2011] [Indexed: 12/01/2022]
Abstract
Radiofrequency (RF) surgery has gained popularity as a safe and effective method for treating patients with snoring and mild obstructive sleep apnoea (OSA). Both interstitial and cutting radiofrequency energy may be used for multi-segmental management of the upper airway. Little is known about the effect of cutting radiofrequency energy on human soft palate. Excessive collateral injury may have an impact on tissue healing and functional outcomes. A histological analysis of specimens of human soft palate and uvula following resection with cutting RF energy was performed. In addition, ultrastructural analysis using scanning electron microscopy of excision margins was performed and compared with CO(2) LASER. Twelve patients were included. In ten patients, specimens of redundant uvula and faucial pillars were collected and underwent formal histological analysis. The maximum depth of tissue injury was 1 mm in two specimens and overall average depth of injury was 0.15 mm. Injury depth was independent of tissue subtype at the resection margin. Ultrastructural analysis demonstrated accurate incision when compared to CO(2) LASER. Cutting RF energy causes minimal collateral injury to the soft palate during resection for the treatment of snoring and mild OSA. A detailed knowledge of local effects on resection specimens allows accurate inference of in vivo tissue injury at the resection margin and may enable more precise prediction of healing patterns and repair.
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Affiliation(s)
- Paul Stimpson
- Royal National Throat, Nose and Ear Hospital, 330 Gray's Inn Road, London, UK.
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Hirunwiwatkul P, Kanjanaumporn J. Vessel sealing system uvulopalatoplasty versus uvulopalatal flap: a randomized, controlled study of efficacy and adverse effects. Eur Arch Otorhinolaryngol 2011; 268:1383-90. [PMID: 21400127 DOI: 10.1007/s00405-011-1553-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 02/14/2011] [Indexed: 11/25/2022]
Abstract
The objective of this randomized, controlled study is to compare intraoperative blood loss, operative time, postoperative pain and postoperative adverse effects (bleeding, velopharyngeal insufficiency and others) between vessel sealing system uvulopalatoplasty (VSSU) and uvulopalatal flap (UPF). The study was conducted at the Department of Otolaryngology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. 31 subjects with sleep-disordered breathing and obstruction at the retropalatal level were enrolled consecutively. Intervention was randomized by mixed block randomization into 2 groups (UPF, VSSU). Stratification was also done by the presence or absence of concomitant tonsillectomy. Measured outcomes, which were blinded to patients and outcome assessor, were intraoperative blood loss, operative time, postoperative pain, postoperative bleeding, postoperative velopharyngeal insufficiency and other adverse effects. Median (IQR) of intraoperative blood loss from VSSU and UPF was 0.00 (0.00-1.00) and 6.00 (1.25-12.75) ml (p < 0.001). Median (IQR) of operative time from VSSU and UPF was 3.50 (3.00-5.00) and 15.00 (12.25-18.00) min (p < 0.001). There was significantly less pain in VSSU group on operative day (p = 0.001) and postoperative day 1 (p = 0.009). However, no significant difference of pain on postoperative day 2 to day 14 (p = 0.055-0.983) between both groups. Regarding postoperative bleeding, 1 case of immediate bleeding in UPF group and 1 case of delayed bleeding in VSSU group were found in this study. Postoperative velopharyngeal insufficiency and other adverse effects were not found in both groups. In conclusion, VSSU was better than UPF in terms of less intraoperative blood loss, less operative time and less pain in early postoperative period. Postoperative velopharyngeal insufficiency and other adverse effects were not found in both groups.
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[Current techniques in tonsil surgery]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011; 61 Suppl 1:60-8. [PMID: 21354496 DOI: 10.1016/s0001-6519(10)71248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In recent years, consolidation of tonsillar hypertrophy as the principal surgical procedure has led to the emergence of new techniques. Most aim to reduce volume (tonsillectomy or tonsil reduction). These techniques have considerably decreased intra- and postoperative hemorrhages and pain intensity. The present article describes the mechanisms and the advantages and disadvantages of the various techniques, including electro-dissection using electrical scalpels, reduction using a microdebrider, ultrasonic scalpel, radiofrequency (with its different variations) and CO(2) laser. When techniques that reduce tonsil volume are used, the possibility of recurrence of the tonsillar hypertrophy is high if less than 85% of the tonsil is removed. There is also a considerable possibility of infection of the remaining tonsils, whichever technique is used, and therefore these techniques are not valid in the case of repetitive tonsillitis. Recently, alternatives to classical adenoidectomy using adenoid curette have also appeared. Bleeding can be minimized by using a microdebrider, radiofrequency or a blood coagulator. We also discuss the concept of partial adenoidectomy, which is preferred in patients at risk of velopharyngeal insufficiency.
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Tanyeri HM, Polat S. Temperature-controlled radiofrequency tonsil ablation for the treatment of halitosis. Eur Arch Otorhinolaryngol 2010; 268:267-72. [DOI: 10.1007/s00405-010-1356-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Accepted: 07/25/2010] [Indexed: 10/19/2022]
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Nemati S, Banan R, Kousha A. Bipolar radiofrequency tonsillotomy compared with traditional cold dissection tonsillectomy in adults with recurrent tonsillitis. Otolaryngol Head Neck Surg 2010; 143:42-7. [DOI: 10.1016/j.otohns.2010.03.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 03/14/2010] [Accepted: 03/25/2010] [Indexed: 10/19/2022]
Abstract
Objective: To compare short- and long-term results of radiofrequency tonsillotomy and traditional cold dissection tonsillectomy in adult patients with recurrent tonsillitis. Study Design: A randomized clinical trial. Setting: A tertiary referral university hospital. Subjects and Methods: Of 62 adults with recurrent tonsillitis, 24 patients were treated with cold dissection tonsillectomy, while radiofrequency tonsillotomy (RF) by use of radiofrequency induced thermotherapy probes was performed in the remaining 38 patients. Duration of surgery, amount of intraoperative bleeding, recovery time, postsurgical pain (measured by use of visual analogue scale on days 1, 3, 5, and 10 after surgery), dysphagia, weight loss, and time of return to normal diet and activity were measured. All the patients were followed for 12 to 24 months for recurrence of tonsillitis episodes. Results: Comparing the radiofrequency tonsillotomy group to the cold dissection tonsillectomy group, mean duration of surgery was 16.89 versus 45.04 minutes, recovery time was 14.32 minutes versus 17.08 minutes, and amount of intraoperative bleeding was 15 to 20 cc versus 250 to 300 cc, respectively ( P < 0.005). There was no difference between the two groups in the recurrence of tonsillitis episodes after 24 months. Conclusion: Tonsillotomy with radiofrequency is a simple, rapid, and effective method in adult patients with recurrent tonsillitis.
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Affiliation(s)
- Shadman Nemati
- Otolaryngology–Head and Neck Surgery Department and Research Center, Guilan University of Medical Sciences, Amiralmomenin Hospital, Rasht, Guilan, Iran
| | - Rahmatollah Banan
- Otolaryngology–Head and Neck Surgery Department and Research Center, Guilan University of Medical Sciences, Amiralmomenin Hospital, Rasht, Guilan, Iran
| | - Abdorrahim Kousha
- Otolaryngology–Head and Neck Surgery Department and Research Center, Guilan University of Medical Sciences, Amiralmomenin Hospital, Rasht, Guilan, Iran
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Abstract
The current guideline discusses conservative and surgical therapy of obstructive sleep apnea (OSA) in adults from the perspective of the ear, nose and throat specialist. The revised guideline was commissioned by the German Society of Ear-Nose-Throat, Head-Neck Surgery (DG HNO KHC) and compiled by the DG HNO KHC's Working Group on Sleep Medicine. The guideline was based on a formal consensus procedure according to the guidelines set out by the German Association of Scientific Medical Societies (AWMF) in the form of a"S2e guideline". Research of the literature available on the subject up to and including December 2008 forms the basis for the recommendations. Evaluation of the publications found was made according to the recommendations of the Oxford Centre for Evidence-Based Medicine (OCEBM). This yielded a recommendation grade, whereby grade A represents highly evidence-based studies and grade D those with a low evidence base.
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Comparison of radiofrequency and monopolar electrocautery tonsillectomy. The Journal of Laryngology & Otology 2009; 124:180-4. [PMID: 19943988 DOI: 10.1017/s0022215109991642] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To compare the efficacy and safety of radiofrequency and monopolar electrocautery tonsillectomy, regarding operation duration and tonsillectomy morbidity, including post-operative pain and haemorrhage and tonsillar fossa healing, in patients with recurrent chronic tonsillitis. STUDY DESIGN A prospective, randomised, double-blind, controlled clinical study. METHODS Fifty patients aged over 10 years who required tonsillectomy were randomly assigned to have one tonsil removed by radiofrequency and the other by monopolar electrocautery. Operation duration, post-operative haemorrhage, post-operative pain and tonsillar fossa wound healing were compared. RESULTS The mean +/- standard deviation of the operation duration required for the radiofrequency method was significantly longer than that for monopolar electrocautery: 8.1 +/- 1.6 minutes vs 7.3 +/- 1.5 minutes, respectively (p = 0.034). Post-operative haemorrhage was observed in only three patients (13.6 per cent). Inter-group analysis showed no significant differences in post-operative pain scores for the radiofrequency vs monopolar electrocautery methods (3.7 +/- 1.6 vs 3.3 +/- 1.4, respectively; p < 0.126). Inter-group analysis showed that tonsillar fossa wound healing scores evaluated on the fifth, 10th and 14th post-operative days were significantly higher in the radiofrequency group compared with the monopolar electrocautery group (p < 0.001). CONCLUSION The present study results indicated that monopolar electrocautery tonsillectomy was superior to radiofrequency tonsillectomy in terms of post-operative tonsillar fossa wound healing; however, both techniques were comparable in terms of post-operative pain.
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Making sense out of the tonsillectomy literature. Int J Pediatr Otorhinolaryngol 2009; 73:1499-506. [PMID: 19346010 DOI: 10.1016/j.ijporl.2009.02.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 02/10/2009] [Accepted: 02/12/2009] [Indexed: 11/21/2022]
Abstract
BACKGROUND With the increase in new technology and changing indications for tonsillectomy, the literature has exploded during the last 20 years with scores of publications reporting the relative effectiveness of many different techniques. Despite this "wealth of information," no single technique has been adopted by most surgeons. OBJECTIVES To systematically analyze the usefulness of this literature of the past 20 years concerning tonsillectomy technique in children. To propose the use of specific study parameters that could optimize clinical decision-making and future research. METHODS Detailed review of the methodologies and findings in articles which compared one or more tonsillectomy techniques in clinical trials of children, ages 1-23 years from 1987 through 2007. RESULTS The Medline search revealed 255 papers of which 89 studies were suitable for inclusion in our review. In these 89 studies (found in 87 papers), 9 dissection techniques, 3 planes of dissection, 8 methods of hemostasis, and 41 different outcome measures were reported. Forty-four (49%) were described as randomized, 63 (71%) prospective, 25 retrospective (28%), 1 case report, 1 matched pair, and 9 case series papers. Sixteen (18%) trials were non-blind, 23 (26%) were single blind, 17 (19%) were double blind, and 7 (8%) were not stated. Seventy-five (84%) were comparative and 14 (16%) non-comparative. Eight (9%) studies reported power analyses. Twelve (13%) had no follow-up; 67 (75%) of the studies performed had short-term follow-up in the peri-operative period; 10 (11%) had follow-up for greater than 1 year. Eleven (12%) mentioned outcomes related to the effectiveness of the procedure itself in relieving symptoms for which the surgery was done. CONCLUSIONS Tonsillectomy technique research is of obvious interest to the otolaryngologist. We found deficits in: the precise reporting of surgical techniques, adequate study design and useful outcome measures, all of which make the literature less useful than it could be. Guidelines for study design parameters which could lead to more valuable information for the clinician are suggested.
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Friedman M, Wilson MN, Friedman J, Joseph NJ, Lin HC, Chang HW. Intracapsular coblation tonsillectomy and adenoidectomy for the treatment of pediatric obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg 2009; 140:358-62. [DOI: 10.1016/j.otohns.2008.11.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 10/30/2008] [Accepted: 11/18/2008] [Indexed: 10/21/2022]
Abstract
Objective: To report the findings of five years' experience using standardized coblation intracapsular tonsillectomy with adenoidectomy for treatment of pediatric sleep apnea. Study Design: Case series. Methods: A five-year retrospective analysis of coblation tonsillectomy performed by a single department for sleep apnea was completed. Results: A total of 159 tonsillectomy and adenoidectomy (T&A) cases performed with coblation technique were reviewed. The mean preoperative apnea-hypopnea index (AHI) was 17.8 and mean postoperative AHI was 3.3. Polysomnogram (PSG) normalization (AHI < 1), was achieved in 54.7% patients. Normalization of PSG data was achieved in only 42.2% of overweight patients (body mass index [BMI] ≥ 85th percentile). Based on regression analysis, Friedman tongue position (III and IV) and elevated AHI were determined to be independent predictors of poor response to T&A. Conclusions: Contrary to popular belief, a review of 159 cases demonstrates that T&A does not always result in normalization of polysomnographic data. Although complete resolution is not achieved in most cases, T&A offers significant improvements in AHI. Predictive variables such as BMI, FTP, and AHI should be taken into account when designing a treatment plan. It is important to recognize the need for close follow-up and early detection of residual disease in the pediatric population.
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Affiliation(s)
- Michael Friedman
- Department of Otolaryngology–Head and Neck Surgery, Rush University Medical Center, Chicago, IL
- Department of Otolaryngology, Advanced Center for Specialty Care, Advocate, Illinois Masonic Medical Center, Chicago, IL
| | - Meghan N. Wilson
- Department of Otolaryngology, Advanced Center for Specialty Care, Advocate, Illinois Masonic Medical Center, Chicago, IL
| | - Jacob Friedman
- Department of Otolaryngology, Advanced Center for Specialty Care, Advocate, Illinois Masonic Medical Center, Chicago, IL
| | - Ninos J. Joseph
- Department of Otolaryngology, Advanced Center for Specialty Care, Advocate, Illinois Masonic Medical Center, Chicago, IL
| | - Hsin-Ching Lin
- Department of Otolaryngology, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsueh-Wen Chang
- Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
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Abstract
Several indications for surgery for obstructive sleep apnea (OSA) have been clarified within the past 3 years. In pediatric OSA, adenotonsillectomy and tonsillotomy are the most common treatments and are highly effective. In adults, nasal surgery facilitates--and sometimes enables--nasally applied continuous positive airway pressure (CPAP) treatment. Today, minimally invasive treatment options for mild OSA are established. Furthermore, several invasive surgical techniques have proven to be efficient in the treatment of mild to moderate OSA. Above an apnea-hypopnea index of 30, surgery should be done only as secondary treatment in cases of CPAP failure or noncompliance. Special forms of OSA, such as laryngeal OSA and supine OSA, must be kept in mind.
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Affiliation(s)
- T Verse
- HNO-Abteilung, Asklepios-Klinik Harburg, Eissendorfer Pferdeweg 52, 21075 Hamburg, Deutschland.
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Heidemann CH, Wallén M, Aakesson M, Skov P, Kjeldsen AD, Godballe C. Post-tonsillectomy hemorrhage: assessment of risk factors with special attention to introduction of coblation technique. Eur Arch Otorhinolaryngol 2008; 266:1011-5. [DOI: 10.1007/s00405-008-0834-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2008] [Accepted: 09/26/2008] [Indexed: 11/28/2022]
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Intracapsular versus subcapsular coblation tonsillectomy. Otolaryngol Head Neck Surg 2008; 138:153-157. [PMID: 18241707 DOI: 10.1016/j.otohns.2007.11.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 09/27/2007] [Accepted: 11/06/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare the postoperative recovery of patients who undergo intracapsular to subcapsular Coblation tonsillectomy. STUDY DESIGN AND SETTING This was a prospective, randomized, double-blinded study. A total of 69 children, aged 2 to 16 years, were randomized to intracapsular (n = 34) or subcapsular (n = 35) tonsillectomy. The Coblation technique was used with both groups. Outcomes measures were assessed on postoperative day 1 or 2 and 5 or 6. These included child and parental rating of pain with the Wong Faces pain scale, analgesic use, oral intake, and activity level. RESULTS Intracapsular tonsillectomy patients had similar levels of pain to subcapsular tonsillectomy patients on day 1 or 2. However, at day 5 or 6, intracapsular tonsillectomy patients had significantly less pain than the subcapsular tonsillectomy patients. Intracapsular patients ate more and were more active at both time points. CONCLUSION AND SIGNIFICANCE Children with obstructive sleep apnea who undergo tonsillectomy demonstrate better postoperative recovery after intracapsular tonsillectomy. The intracapsular versus subcapsular difference may be best appreciated at a delayed time point (day 5 or 6) rather than early (day 1 or 2).
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Michel RG, Weinstock BI, Tsau K. Safety and Efficacy of Pressure-assisted Tissue-welding Tonsillectomy: A Preliminary Evaluation. EAR, NOSE & THROAT JOURNAL 2008. [DOI: 10.1177/014556130808700213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We conducted a retrospective study of the safety and efficacy of a new pressure-assisted tissue-welding technology (ENTceps; Starion Instruments Corp.; Sunnyvale, Calif.) for total tonsillectomy, either alone or with adenoidectomy. The use of this instrument was compared in two groups of patients categorized by age. The younger group was made up of 50 patients aged 2 to 12 years who had undergone total tonsillectomy and adenoidectomy (T&A), and the older group was made up of 50 patients aged 13 to 47 years who had undergone either T&A or isolated total tonsillectomy. The primary safety endpoint was the presence or absence of intra- or postoperative complications—particularly the amount of intraoperative blood loss and the incidence of delayed postoperative bleeding. In each group, the mean amount of intraoperative blood loss was no more than 30 ml, and only 2 of the 100 patients experienced postoperative hemorrhage. Among the efficacy parameters were the amount of operating and recovery time and the postoperative appearance of the tonsillar fossae. The mean operating time was 13.0 minutes in the younger group and 19.5 minutes in the older group, and the mean total recovery times were 120.0 and 130.4 minutes, respectively; all tonsillar fossae were well epithelialized by 2 weeks after surgery. Finally, surgical morbidity was determined on the basis of the amount of perioperative pain medication administered, the number of unscheduled patient telephone contacts and clinic visits, and the amount of time needed to return to a normal diet and activities. Nine patients in the younger group and 6 in the older group required no pain medications during recovery; overall, pain was not a significant issue for most patients. Sixteen patients made a total of 20 telephone calls and 8 clinic visits prior to their scheduled postoperative appointment; almost all of these encounters dealt with postoperative pain. Only 1 patient, who had previously undiagnosed von Willebrand disease, had not returned to a normal diet and activities by the end of 1 week. Based on our preliminary findings—and a comparison of our results with those of other studies published in the literature relative to the amount of intraoperative bleeding, the incidence of postoperative bleeding, and operating times—we conclude that pressure-assisted tissue-welding technology is safe and compares favorably with other tonsillectomy techniques. This method of electrocautery is straightforward and relatively easy to learn.
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Affiliation(s)
- Randall G. Michel
- From the Department of Surgery (Otolaryngology), Lompoc (Calif.) District Hospital
| | - Bernard I. Weinstock
- From the Department of Surgery (Otolaryngology), Lompoc (Calif.) District Hospital
| | - Kang Tsau
- Department of Anesthesiology, Lompoc (Calif.) District Hospital
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Mitic S, Tvinnereim M, Lie E, Saltyte BJ. A pilot randomized controlled trial of coblation tonsillectomy versus dissection tonsillectomy with bipolar diathermy haemostasis. Clin Otolaryngol 2007; 32:261-7. [PMID: 17651267 DOI: 10.1111/j.1365-2273.2007.01468.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To compare postoperative recovery in children between 4 and 12 years undergoing tonsillectomy, using either coblation tonsillectomy or dissection tonsillectomy with bipolar diathermy haemostasis. DESIGN A prospective, single blind, randomised controlled trial. SETTING ENT clinic, University Teaching Hospital. PARTICIPANTS Forty paediatric patients, aged between 4 and 12 years and between 16 and 60 kg in weight with standard indication for tonsillectomy. METHODS Patients were randomly allocated to either coblation tonsillectomy or dissection tonsillectomy groups. Patients, parents, and nurses were blinded for operation method. Parents were asked to fill out a postoperative diary from 1 to 10 days. MAIN OUTCOME MEASURES Primary outcomes were scored for postoperative pain, nutrition, activity, and use of analgetics for each of the 10 postoperative days. Secondary outcomes were estimated from the nurses' postoperative data and 10-day follow-up statistics regarding crossing of the two-score limit. RESULTS The groups were statistically comparable by age, weight and operation type. There was no significant difference in operation time in two groups. Intra-operative bleeding was significantly less in the coblation group. Statistically significant differences between dissection tonsillectomy and coblation tonsillectomy were found in the day when a score of two of five was passed in pain scores (9.6 versus 6.2), nutrition scores (8.9 versus 6.6), activity score (8.4 versus 6.6) and medicine intake (9.4 versus 6.4), We found parallelism, between regression lines, that indicates better postoperative life quality for the coblation tonsillectomy group and approximately 2 days' shorter recovery time. CONCLUSION In our pilot study, patients undergoing coblation tonsillectomy reported less pain, quicker return to normal diet, quicker return to normal activity, and less use of analgetics over a 10-day period than patients undergoing dissection tonsillectomy. Our results indicate that the recovery period for coblation tonsillectomy was approximately 2 days shorter and demonstrated less morbidity.
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Affiliation(s)
- S Mitic
- ENT Department, Akershus University Hospital, Oslo, Norway.
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