DRHC Dubai ENT Clinic
Evidence base for tonsillectomy
Adenotonsillectomy is the treatment of choice for healthy children with obstructive sleep apnea. It has shown improvement in 90% of cases including improvement in their behaviour, growth and development.
However, for recurrent infections there is a widespread perception that high-quality evidence of the efficacy of tonsillectomy is lacking. Certainly, the evidence for benefit of adenotonsillectomy for recurrent infections was sparse until quite recently studies looking at quality of life (QOL) before and after operation suggest that tonsil disease has a marked adverse effect on QOL and there is significant benefit from surgery.
The Scottish tonsillectomy audit was a large-scale audit to look at patient satisfaction after tonsillectomy in more than 5000 patients. This audit reported 97% satisfaction rate 1 year after tonsillectomy.
The traditional methods of tonsillectomy are
Cold Steel Technique uses metal instruments. Several other methods have been introduced with perceived advantages in terms of reduced bleeding, reduced pain, more rapid healing and ease of surgical technique.
Bipolar dissection tonsillectomy is an alternative method to traditional cold steel tonsillectomy. In a Cochrane review of dissection versus diathermy, it was demonstrated that diathermy reduced intra-operative bleeding but increased pain in the diathermy group with no difference in secondary haemorrhage rate.
This technique uses a specially designed probe which both coagulates and cuts the tissues. In the NPTA, postoperative bleeding rates were unacceptably high. It has been suggested that post-operative pain is less than conventional dissection but some studies have cast doubt on this and shown that morbidity was less with cold steel dissection.
The National Institute for Health and Care Excellence (NICE) advises that electrosurgery (Diathermy and Coblation) can be used for tonsillectomy but that surgeons must be appropriately trained.
Ultrasonic dissection uses an oscillating blade which acts as both a cutting and a coagulating device. Some studies claim reduced pain with this technique but evidence of benefits are lacking.
Using a laser as a tool to dissect out the tonsils has been claimed to have advantages in terms of reduced bleeding and post-operative pain. But studies have failed to confirm this. There is evidence that the rate of secondary bleeding and pain is greater with laser.
Tonsillectomy surgical package is available via the following link - Tonsillectomy package