Post-tonsillectomy outcomes: a prospective analysis of morbidities in 70 patients

Farzana Hoque; Mohammad Kamran Akhtar

doi:10.18203/2320-6012.ijrms20263089

Authors

Farzana Hoque Department of ENT-Head and Neck Surgery, Medical College for Women and Hospital, Dhaka, Bangladesh
Mohammad Kamran Akhtar Medical Officer National Institute of Cancer Research and Hospital (NICRH), Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20263089

Keywords:

Dysphagia, Hemorrhage, Pain measurement, Postoperative period, Tonsillectomy

Abstract

Background: Tonsillectomy is one of the most commonly performed surgical procedures in otolaryngology. Despite its routine nature, postoperative morbidities remain a significant concern for both surgeons and patients. Objective was to prospectively analyze the outcomes of tonsillectomy with a specific focus on the spectrum and frequency of early postoperative morbidities following cold dissection tonsillectomy.

Methods: This prospective study was conducted at the department of otolaryngology-head and neck surgery, Medical College for Women and Hospital, Dhaka, from July to December 2010. A total of 70 patients undergoing tonsillectomy for recurrent tonsillitis were enrolled using purposive sampling. Pain was assessed using a 0-10 numeric rating scale. Data were analyzed by SPSS version 23.0.

Results: Among 70 patients, females predominated (61.43%), with the highest proportion aged 21-30 years (38.57%). Most operations (50%) lasted 20-30 minutes. Senior surgeons performed 42.86% of procedures. On postoperative day 1, dysphagia was the most frequent morbidity (68.57%), followed by otalgia (12.86%) and nausea or vomiting (2.86%). Instrumental injuries occurred in 14.29% of patients. Secondary hemorrhage occurred in one patient (1.43%) on day 6. On postoperative day 7, throat pain persisted in 28.57%, dysphagia in 22.86%, and otalgia in 20%. Pain scores showed 17 patients scoring 5/10 on day 1, reducing to 30 patients scoring 1/10 by day 7.

Conclusions: Dysphagia and pain are the predominant early morbidities following cold dissection tonsillectomy. Instrumental injuries remain notable, particularly with less experienced surgeons. Secondary hemorrhage is rare but requires vigilance.

Metrics

Metrics Loading ...

References

Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, et al. Clinical practice guideline: tonsillectomy in children (update). Otolaryngol Head Neck Surg. 2019;160: S1-42. DOI: https://doi.org/10.1177/0194599818801757

Šumilo D, Nichols L, Ryan R, Marshall T. Incidence of indications for tonsillectomy and frequency of evidence-based surgery: a 12-year retrospective cohort study of primary care electronic records. Br J Gen Pract. 2018. DOI: https://doi.org/10.3399/bjgp18X699833

Pankhania M, Rees J, Thompson A, Richards S. Tonsillitis, tonsillectomy, and deep neck space infections in England: the case for a new guideline for surgical and non-surgical management. Ann Royal Coll Surg Engl. 2021;103(3):208-17. DOI: https://doi.org/10.1308/rcsann.2020.7030

Manimaran V, Mohanty S, Jayagandhi SK, Umamaheshwaran P, Jeyabalakrishnan S. A retrospective analysis of peroperative risk factors associated with posttonsillectomy reactionary hemorrhage in a teaching hospital. Int Arch Otorhinolaryngol. 2019;23(04):e403-7. DOI: https://doi.org/10.1055/s-0039-1696702

Ordemann AG, Hartzog AJ, Seals SR, Spankovich C, Stringer SP. Is weight a predictive risk factor of postoperative tonsillectomy bleed? Laryngoscope Investig Otolaryngol. 2018;3(3):238-43. DOI: https://doi.org/10.1002/lio2.155

Hong SA, LaGorio L, Husain I. Post-tonsillectomy dysphagia secondary to glossopharyngeal nerve injury. BMJ Case Reports CP. 2020;13(1):e232657. DOI: https://doi.org/10.1136/bcr-2019-232657

Say MA, Bilgin E, Baklacı D. Evaluation of anterior and posterior pillar suturing following adult tonsillectomy in terms of hemorrhage, pain, and dysphagia complications. Indian J Otolaryngol Head Neck Surg. 2022;74(Suppl 3):5624-9. DOI: https://doi.org/10.1007/s12070-021-02965-3

Østvoll E, Sunnergren O, Ericsson E, Hemlin C, Hultcrantz E, Odhagen E, et al. Mortality after tonsil surgery, a population study, covering eight years and 82,527 operations in Sweden. Eur Arch Oto-Rhino-Laryngol. 2015;272(3):737-43. DOI: https://doi.org/10.1007/s00405-014-3312-z

Kumar A, Kumar S, Krishnan A, Verma M, Garg U, Sharma N. A comparative analysis of outcomes of conventional cold dissection versus laser tonsillectomy in pediatric cases in a tertiary care hospital in Haryana. Indian J Otolaryngol Head Neck Surg. 2022;74(3):5311-8. DOI: https://doi.org/10.1007/s12070-020-02301-1

Dhakal A, Shrestha BL, Pokharel M, Shrestha KS, Khadka L. Microscopic assistance in cold dissection tonsillectomy- does it improve surgical outcome? J Coll Med Sci Nepal. 2022;18(3):185-93. DOI: https://doi.org/10.3126/jcmsn.v18i3.42487

Locatello LG, Pietragalla M, Taverna C, Bonasera L, Massi D, Mannelli G. A critical reappraisal of primary and recurrent advanced laryngeal cancer staging. Ann Otol Rhinol Laryngol. 2019;128(1):36-43. DOI: https://doi.org/10.1177/0003489418806915

Guntinas-Lichius O, Geissler K, Mäkitie AA, Ronen O, Bradley PJ, Rinaldo A, et al. Treatment of recurrent acute tonsillitis- a systematic review and clinical practice recommendations. Front Surg. 2023;10:1221932.

Lawlor CM, Riley CA, Carter JM, Rodriguez KH. Association between age and weight as risk factors for complications after tonsillectomy in healthy children. JAMA Otolaryngol Head Neck Surg. 2018;144(5):399-405. DOI: https://doi.org/10.1001/jamaoto.2017.3431

Guntinas-Lichius O, Geissler K, Mäkitie AA, Ronen O, Bradley PJ, Rinaldo A, et al. Treatment of recurrent acute tonsillitis- a systematic review and clinical practice recommendations. Front Surg. 2023;10:1221932. DOI: https://doi.org/10.3389/fsurg.2023.1221932

Hoque F, Chowdhury MA, Shumon AM, Yasmeen N, Jamil AN, Barua R. Complications of tonsillectomy in adults: tonsillectomy complications. J Med Coll Women Hosp. 2024;20(2):64-71. DOI: https://doi.org/10.3329/jmcwh.v20i2.77478

Ali MA, Alam MM, Biswas AC, Islam MZ, Ali MT. Comparison of postoperative complications of tosillectomy, adenoidectomy and adenotonsillectomy. Bangladesh J Otorhinolaryngol. 2016;22(1):40-7. DOI: https://doi.org/10.3329/bjo.v22i1.45083

Walker P, Gillies D. Post-tonsillectomy hemorrhage rates: are they technique-dependent? Otolaryngolog Head Neck Surg. 2007;136(4_suppl):s27-31. DOI: https://doi.org/10.1016/j.otohns.2006.10.022

Chowdhury MA, Yasmeen N, Rabbani SG, Malakar M, Hoque F, Lisa TF. Advantages of ultrasonic tonsillectomy by harmonic scalpel. Bangladesh J Otorhinolaryngol. 2010;16(2):91-5. DOI: https://doi.org/10.3329/bjo.v16i2.6843

Fortier MA, Chorney JM, Rony RY, Perret-Karimi D, Rinehart JB, Camilon FS, et al. Children’s desire for perioperative information. Anesth Analg. 2009;109(4):1085-90. DOI: https://doi.org/10.1213/ane.0b013e3181b1dd48

Cai FG, Hong W, Ye Y, Liu YS. Comparative systematic review and meta-analysis of the therapeutic effects of coblation tonsillectomy versus electrocautery tonsillectomy. Gland Surg. 2022;11(1):175. DOI: https://doi.org/10.21037/gs-21-832