TikTok Influence on Rates of Tonsillectomies for Tonsil Stones

INTRODUCTION

Tonsillectomy is one of the most common otolaryngologic surgeries and is increasingly being performed for the management of tonsil stones or tonsilloliths. Incidentally, over the years, tonsilloliths have become a popular topic on the social media platform TikTok (ByteDance, Beijing, China) and we propose that this may be influencing the trends of tonsillectomies for tonsil stones.  Objectives: We aim to assess rates of outpatient visits and tonsillectomies for tonsil stones at our institution as well as analyze videos on TikTok regarding tonsil stones.

METHODS

A retrospective chart query was performed. Data including the number of patient encounters per month with a diagnosis code of tonsilloliths were collected from July 2016 to December 2021. The number of TikTok videos under the search result "tonsil stones" and the content of these videos were reviewed.

RESULTS

There were 126 patients seeking evaluation for tonsil stones with an average age of 33.4 years, and 76% were females. The number of patients who underwent a tonsillectomy for tonsil stones increased from two in the first full year of collection in 2017 to 13 in 2021. Similarly, the average number of patients presenting for tonsil stone evaluation per month increased steadily from 1.0 in 2017 to 3.3 in 2021. TikTok video content under the search result "tonsil stones" varied and the number of videos on this topic has increased in recent years.

CONCLUSION

Rates of patients seeking tonsillectomy for tonsil stones increased from 2016 to 2021 in conjunction with the rising popularity of TikTok. Given the numerous TikTok videos featuring tonsil stones, we believe that this social media platform may be influencing the number of patients seeking evaluation for tonsil stones. This data may be used to understand future influence patterns of social media posts on healthcare consumer behavior and patient care practices.

Analysis of Palatine and Adenoid Calcification in a Sample of the Lebanese Population Using Cone‑Beam Computed Tomography Technology

Objectives

Tonsilloliths and adenoid calcifications are usually an incidental finding in radiologic studies. Several studies were done to evaluate the presence of tonsillar calcifications using different radiological techniques that include panoramic radiographs, computed tomography (CT), and cone-beam computed tomography (CBCT). These percentages varied in different populations and changed with the technique used. A CBCT is used to allow the visualization of the calcifications to make a better diagnosis. To the best of our knowledge, this is the first study conducted in Lebanon to study tonsillar and adenoid calcifications using CBCT. This study aims to assess the epidemiology and the demographic criteria of tonsilloliths and adenoid calcifications in a sample of the Lebanese population using the CBCT.

Methods

In this retrospective study, CBCT images of 125 patients attending a private clinic in Jbeil, Lebanon from May 2016 to July 2019 were selected. Images were evaluated by a maxillofacial radiologist. Adenoid and palatine calcifications were recorded. Statistical analysis was conducted using the Statistical Package for Social Sciences (SPSS) software, version 21 (IBM SPSS Statistics, Armonk, NY, USA). The level of statistical significance was established at a p-value < 0.05.

Results

A total of 21 patients (17.35%) had palatine calcifications and two patients (1.65%) had adenoid calcifications. From those with tonsilloliths, 12 female patients (16.43%) and nine male patients (18.75%) had palatine calcifications. Moreover, one male (2.08%) and one female (1.36%) had adenoid calcifications. There was no statistically significant difference in the distribution of calcifications with respect to gender. There was a non-statistically significant difference in the mean age of the patients with respect to the distribution of palatine and adenoid calcifications. The pattern of palatine calcifications showed a statistically significant difference in various age groups. Palatine calcifications distribution, with respect to the side, were statistically significant.

Conclusion

The prevalence of tonsilloliths in our sample was found to be 17.35%. The high prevalence detected was due to the technique used, the CBCT, which ensured a more detailed examination. The distribution was not affected by gender and age. However, multiple patterns of calcification were identified in younger age groups as opposed to other studies. Moreover, adenoid calcifications were present in 1.65% of the sample.

Palatine Tonsilloliths and Actinomyces: A Multi-institutional Study of Adult Patients Undergoing Tonsillectomy

OBJECTIVE

To better characterize associations between Actinomyces and tonsillolith versus nontonsillolith tonsillectomy specimens.

STUDY DESIGN

Bi-institutional retrospective case-case study.

SETTING

University and county hospital.

SUBJECTS AND METHODS

Adult patients with a clinical history of tonsilloliths who underwent tonsillectomy from January 2006 to December 2018 were included. Patients undergoing tonsillectomy for tonsillar hypertrophy and chronic tonsillitis were identified as comparative cases. Similarly, patients with ipsilateral oropharyngeal cancer (OPC) who underwent contralateral tonsillectomy of a normal-appearing tonsil for prophylaxis against a second primary cancer were also included as comparative cases.

RESULTS

The study population comprised 134 patients who underwent tonsillectomy: 62 tonsillolith and 72 nontonsillolith (tonsillar hypertrophy, n = 30; chronic tonsillitis, n = 30; normal-appearing contralateral tonsil in patients with ipsilateral OPC, n = 12). Actinomyces was reported in 11% of the patients with tonsilloliths on initial pathology reports but in 95% after re-evaluation (n = 54 of 57). Actinomyces prevalence was significantly higher in patients with tonsilloliths as compared with patients with recurrent tonsillitis (73%, n = 22 of 30, P < .001) and normal-appearing contralateral tonsils in patients with ipsilateral OPC (58%, n = 7 of 12, P < .001). Actinomyces prevalence was not significantly different between patients with tonsilloliths and tonsillar hypertrophy (83%, n = 25 of 30, P = .11).

CONCLUSION

The prevalence of Actinomyces in tonsillolith tonsil specimens is high; however, Actinomyces routinely colonizes nontonsillolith tonsil specimens. Therefore, Actinomyces is unlikely to be the primary driver of tonsillolith pathogenesis, and Actinomyces-targeted treatment of tonsilloliths may not be effective. Treatment strategies addressing tonsilloliths should be further investigated.

Post-operative morbidity and 1-year outcomes in CO2-laser tonsillotomy versus dissection tonsillectomy

OBJECTIVE

In this study a type of partial tonsil surgery, CO2-laser tonsillotomy, was compared to regular tonsillectomy. The effectiveness and post-operative recovery rate of both interventions in adult patients was assessed by using a questionnaire.

STUDY DESIGN

Prospective follow-up non-randomized cohort study.

METHOD

One hundred and seven adults were included; 46 tonsillectomies and 61 tonsillotomies were performed. Patients in the tonsillectomy group underwent general anaesthesia, while tonsillotomy was performed in an ambulatory setting with local anaesthesia. Post-operative questionnaires were administered by mail after 2 weeks, 6 months, and 1 year to assess recovery rate and symptom recurrence.

RESULTS

In total, 72.5% of patients were cured from their initial symptoms after tonsillotomy. Three patients (7.5%) required re-surgery for their initial complaints. After tonsillectomy, 97.2% of patients were cured. Both groups showed equally high satisfaction scores after treatment. Post-operative evaluation after 2 weeks showed a mean pain-intensity score of 5.4 (Visual Analogue Scale 0-10) after tonsillotomy and a mean pain-intensity score of 7.7 after tonsillectomy. The post-operative use of analgesics was twice as long in the tonsillectomy group compared to the tonsillotomy group and the tonsillectomy group required twice as many days for full recovery. After tonsillectomy a higher rate of major post-operative haemorrhage was seen.

CONCLUSION

CO2-laser tonsillotomy is associated with a shorter and less painful recovery period. Both surgical methods are equal in terms of long-term satisfaction, although tonsillotomy comes with a higher recurrence rate of mild symptoms. A strict pre-operative patient selection for CO2-laser tonsillotomy is necessary.