Redefining indications and evaluation of dissection versus diathermy method of tonsillectomy

Fozia Wani, Mohd. Latif Chisti, Ayaz Rehman, Sajad Hamid, Mushtaq Sangoo, Shahnawaz Hamid, Mohd. Arif

Abstract


The current availability of randomized clinical trials have assessed the efficacy of the most common presumed indications for tonsillectomy, but the controversery still exists So, the present study was conducted to assess (1) Whether tonsillectomy leads to any significant benefits as compared to watchful waiting (2) evaluating the two most commonly used techniques for tonsillectomy i.e; cold dissection & diathermy. 170 patients were included,104 were assigned to the surgical group (Group A) & 66 patients acted as control (Group B).The surgical group underwent tonsillectomy.The efficacy of tonsillectomy viz-a-viz chronic tonsillitis related morbidity, school absenteeism, & work absenteeism, Group A beta hemolytic streptococcal pharyngitis, otitis media, Rhinosinusitis, obstructive sleep apnea & psoriasis was studied.The results of our study were as; Majority among children (7-15 years)& the mean age of adult population was 23.02 years.Tonsillectomy definitely provided benefit in case of chronic tonsillitis, mild to moderate obstructive sleep apnea on polysomnographic findings where as the Patients who had been included in this study to redefine otitis media & rhinosinusitis as an indication for tonsillectomy did not benefit much when compared to the watchful waiting groupThe three most commonly used techniques of tonsillectomy i.e; cold steel using ties & packs, cold steel using monopolar diathermy for hemostasis & using monopolar diathermy exclusively were evaluated.The operating time was least for the diathermy alone method. The intraoperative blood loss was minimal for the monopolar diathermy method. The primary hemorrhage rate was maximum in technique of cold steel with ties & packs as hemostasis.The secondary hemorrhage rate was maximum in monopolar diathermy method. The postoperative pain measured by using the verbal rating scale was considerable after using monopolar diathermy alone with 33% complaining of severe pain & 67% complaining of moderate pain.


Keywords


Tonsil, Hypertrophy, Tonsillectomy, Diathermy, Dissection

Full Text:

PDF

References


Alan D. Kornbult. The tonsils and adenoids. The Otolaryngologic Clinics of North America Vol. 20, No. 2: May 1987.

AJCC Cancer staging manual. 6th edition, 2002 pp 17-19.

Birgit K Van staaij, Emma H Vander Akker, Maroeska KR, et al. Effectiveness of adenotonsillectomy in children with mild symptoms of throat infection or adenotonsilla hypertrophy. BMJ; September 2004:329:17-22.

Birgit K Van Staaiij, Emma H Vander Akker, GJMG Vander Heijden, AG Schilder, AW Hoes. Adenotonsillectomy for upper respiratory infections: evidence based. Arch Dis Child 2005; 90:19-25.

Byron J Bailey. Head and Neck Surgery Otolaryngology- 3rd edition; 986. Lippincott Williams and Wilkins.

Comway WA, Fujita S,Zorick F et al. UPPP-one year follow-up. Chest: 1985:88:385-387.

David H. Darrow, Christopher Siemens. Indications for tonsillectomy and adenoidectomy. Layngoscope: A2002;112:6-10.

EA Magdy, S. Elwany, AS El-daly, M. Abdel-Haidi, M.A. Morshedy. Coblation tonsillectomy: A prospective, double blind, randomized clinical and histopathological comparison with dissection ligation, monopolar cautery and laser tonsillectomy. JLO 2008; 122:282-290.

Ellen S. Deutsch. Tonsillectomy and adenoidectomy, changing indications. Pediatrics Clinics of North America 1996; 43:1319-1338.

George A. Gates, Thomas W. Folbre, San Autoni O. Indications for tonsillectomy. Arch Otolaryngol Head Neck Surg May 1986;112:501-503.

Gray’s Anatomy 38 th ed. Pages 1444-1480.

Hone SW, Donelly MJ, Powell F et al. Clearance of recalcitrant psoriasis of the tonsillectomy. Clinical Otol Layngol and Allied Sciences 1996; 21:547-7.

H.L.Tay. Postoperative morbidity in electrodissection tonsillectomy. JLO 1995;109:209-211.

H.L.Tay. Post-tonsillectomy pain with selective diathermy hemostasis. JLO 1996;110:446-448.

Interim results from National Prospective Tonsillectomy Audit Final Report 2003.

Jack L. Paradise, Charles D. Bluestone, Ruth Z Bachman,D Colborn, Beverly S. Bernard, Floyd h Taylor, Kenneth d Rogers. Et al. Efficacy of tonsillectomy for recurrent throat infection in severely affected children. The New England Journal of Medicine March 1984 ; 310:674-683

Jefferey A. Koempel. On the origin of tonsillectomy and the dissection method. Laryngoscope Sept. 2002; 112: 1583-1585.

Karim P.Q.Oomen, Maroeska M. Rover’s. Emma H.Vander Akker, Birgit K. Van Staaij, Arno W Hoes, Anne G M Schilder. Effect of adenotonsillectomy on middle ear status in children. Laryngoscope 2005; 115:731-734.

Keith L. Moore, Athur F. Dalley. Anatomy 4th ed. P. No. 1052-1053.

Kidera Kazuki, Takagi Seizi, Uchida Masabumi. Efficacy of tonsillectomy for improving skin lesions of pustulosis Palmaris et plantaris. Nippon Jibinkoka Gukkai Kaiho 1994; 97(9).

Kujawski O,Dulgerov P,Gysin C.Lehmann W. Microscopic tonsillectomy –a double-blind randomized trial. Otolaryngol Head and Neck Surgery. 1997; 117;641-647.

Laing MR, Mckerrow WS. Adult Tonsillectomy. Clinical Otolaryngology 16: 21-24.

Laura J. Orvidas, Jennifer L, Amy L Weaver. Efficacy of tonsillectomy in treatment of recurrent GABHS Pharyngitis. Laryngoscope 2006; 116:1946-1950.

Lily HP, Ngyyen, John J. Manoukean, Ade Joskoviteh et al. Adenoidectomy: Selection Criteria for surgical cases of otitis media. Laryngoscope May 2004;114:863-866.

Mckee WJE. Acontrolled study of the effects of tonsillectomy and adenoidectomy in children. British Journal of Preventive and Social Medicine 1963;17:49.

McMillan BD, Madderm BK, Graham WR. A role of tonsillectomy in treatment of psoriasis. Ear, Nose and Throat Journal 1999; 78(3):155-8

MG Watson, PJD Dawes, PR Sameul, HF. Marshall, C. Rayappa, J. Hill, D Meikle. Etal Study of hemostasis foolowing tonsillectomy comparing ligatures with diathermy. The JLO August 1993; Vol.109:pp 711-715.

Mui S. Rasgon, Hilsmger RL. Efficacy of tonsillectomy for recurrent throat infections in adults. Laryngoscope 1998; 108:1325-1328.

Neil Bhattacharya, Lym J. Kepnes, Jo Shapiro. Efficacy of tonsillectomy and quality of life impact of adult tonsillectomy. Arch Otolaryngol Head Neck Surg 2001 Vol. 127, 1347-1350.

Neil Bhattacharya. When does an adult need a tonsillectomy. Cleveland Clinical Journal of Medicine Vol. 70, No.8, Aug. 2003 ;689-701.

Neils Rasmussen.Complications of tonsillectomy and adenoidectomy. Otolaryngologic clinics of North America. Vol.20,No.2,May 1987; 383-390.

Nunez BA, Provan J, Crawford M. Electrocautery versus cold dissection and snare tonsillectomy- a randomized trial. Archives of Otolaryngol Head and Neck Surgary. 2000; 126(7):837-841.

Nyfors A. Improvement of recalcitrant psoriasis vulgaris after tonsillectomy. JLO 1976; 90(8):789-94.

Olli-pekka Alho, Petri Koivunen,Toni penna, Heikki Teppo, Markku Koskela,Jukka Luotonen. Tonsillectomy versus watchful waiting in recurrent streptococcal pharyngitis in adults, randomized controlled trials. BMJ 2007; 334:939-41.

Phillipps JJ, Thoruton ARD. Tonsillectomy hemostasis: diathermy or ligation. Clinical Otolaryngology 1989; 14:419-423.

P. Koivunen, T. Penna, H. Teppo, OP Alho. Factors affecting quality of life impact of adult tonsillectomy. The JLO 2009;123:1010-1014.

Ramzi T. Younis, Rande H. Lazar. History and current practice of tonsillectomy. Laryngoscope. 2002; 112:3-5.

R.Fox, M.Temple, D.Owens, A Short, A Tomkinson. Does tonsillectomy lead to improved outcomes over above and the effect of time. A longitudinal study. JLO 2008:112:1197-1200.

Rosenberg RW,Dubenstein LE, Dubersten AJ et al. Effects of tonsillectomy and other otorhinolaryngologic surgery on psoriasis society of investigative dermatology. Annual Meeting April 1994 Baltimore.

Scott –Browns. Otorhinolaryngology Acute and chronic pharyngeal infection Vol. 2, 1988-1994;7th ed.

Steven J. Van den dev, Diane G. Heatley. Efficacy of adenoidectomy in relieving symptoms of chronic sinusitis in children. Ach Otolaryngol Head & Neck Surg. July 1997; 123:675-678.

Thomas Verse, Beatrice A Kroker, Wolfgang Pirsig. Tonsillectomy as a treatment of OSA in adults with tonsillar hypertrophy. Laryngoscope 2000; 110:1556-1559.

TS Anand, MS Arun, Ekta Chabra TB.Shashidhar, Saumitra. Ligation vs. bipolar diathermy coagulation for hemostasis in tonsillectomy. A comparative study. Orrisa Journal of ORL and HNS jan-jun 2009; Vol. 3, No.1.

V. Raut, N. Bhat, J. Kinsella, J G. Toner, AR. Sinnathuray, M. Stevenson. Bipolar scissors versus cold dissection tonsillectomy: a prospective randomized multi-unit study. Layngoscope 2001; 111: 2178-2182.