April 17, 2013 Jagdeep S. Thakur, MS; N.K. Mohindroo, MS, DLO; D.R. Sharma, MS; Shobha Mohindroo, MD; Anamika Thakur, MD
article
Abstract
Worldwide, tonsillitis is very common. The most common etiology is cross-infection with bacteria and viruses. These cases are managed with antibiotics and anti-inflammatory drugs without any further investigation because the diagnosis is based on simple clinical examination. Usually, leukemia presents with bleeding, weight loss, lymphadenopathy, fever, and frequent infection. Tonsillitis is a rare first presentation of leukemia. We present 3 cases in which the diagnosis of leukemia was made on routine examination, and in 1 case diagnosis was suspected during tonsillectomy.
March 24, 2013 Ozan Seymen Sezen, MD; Utku Kubilay, MD; Yusuf Erzin, MD; Murat Tuncer, MD; Seref Unver, MD
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Abstract
Eradication of Helicobacter pylori, which is associated with diverse gastroduodenal pathologies of varying severity, is sometimes challenging. We conducted a prospective study to determine the effect of tonsillectomy on the eradication of H pylori from the gastrointestinal tract. Our study population was made up of 46 patients-32 females and 14 males, aged 14 to 58 years (mean: 28.84 ± 9.65)-who had chronic tonsillitis and concomitant dyspepsia. An initial gastrointestinal endoscopy was performed to obtain specimens for histology and a rapid urease test. These gastroscopies revealed that 32 patients were H pylori-positive (69.6%) and 14 were H pylori-negative (30.4%); these groups were designated A and B, respectively. The 32 H pylori-positive patients were divided into three subgroups based on the sequence in which they underwent drug therapy and tonsillectomy. All 3 subgroups received the same 14-day combination-drug regimen for eradication of gastric H pylori. The patients in group A1 (n = 12) underwent tonsillectomy prior to receiving drug treatment; 2 months after the cessation of drug therapy, they underwent a second gastroscopy. The patients in group A2 (n = 10) received drug treatment first followed by tonsillectomy; 2 months later, they underwent their second gastroscopy. The patients in group A3 (n = 10) received drug treatment first, then they underwent a second gastroscopy, and then they were taken for tonsillectomy. The success or failure of H pylori eradication was determined by the second gastroscopy. Also, analyses were performed after tonsillectomy to look for H pylori infection in tonsillar specimens. Eradication of gastric H pylori was achieved in 9 of the 12 group A1 patients (75.0%), 8 of the 10 group A2 patients (80.0%), and 7 of the 10 group A3 patients (70.0%); there were no statistically significant differences among the three groups. Likewise, there were no significant differences between any subgroups or combination of subgroups in terms of tonsillar positivity. As far as we know, this is the first study to investigate the effect of tonsillectomy on the outcome of H pylori eradication treatment. In light of our findings, we may speculate that tonsillar tissue does not seem to be a reservoir for H pylori infection. Although tonsillectomy had no significant effect on gastric H pylori eradication in our study, our results might have been skewed by the relatively small size of our sample.
March 24, 2013 Paul Lennon, MB BCh BAO, MRCS; Mohamed Amin, FRCSI; Michael P. Colreavy, FRCS(ORL)
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Abstract
We conducted a prospective study to assess how well parents ensured that their children received their prescribed analgesia following tonsillectomy. Our study was based on 69 cases of tonsillectomy that were carried out at our tertiary pediatric care center. Postoperatively, all patients were prescribed paracetamol (acetaminophen) on the basis of their weight; the standard pediatric dosage of this agent at the time of our study was 60 mg/kg/day. The parents were telephoned 2 weeks postoperatively to assess their compliance with this regimen. Of the original 69 patients who had been recruited, 66 completed the study-35 girls and 31 boys, aged 2 to 15 years (mean: 7.0; median 5.5). According to the parents, only 15 children (22.7%) received our recommended 60-mg/kg/day dosage and were thus determined to be fully compliant. Overall, parents reported a wide variation in the amount of drug administered, ranging from 12.5 to 111.0 mg/kg/day (mean: 44.8), indicating that parents often underdose their children. We recommend that more emphasis be placed on weight-directed, parent-provided analgesia during the post-tonsillectomy period.
October 31, 2012 Umit Taskin, MD; Omer Binay, MD; Cigdem Binay, MD; Ozgur Yigit, MD
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Abstract
Hyponatremia develops as a result of the inappropriate secretion of antidiuretic hormone. In rare cases, it develops as an iatrogenic complication. For example, acute iatrogenic post-tonsillectomy hyponatremia has been described in children following the infusion of hypo- or isotonic fluid. We report a case of rapidly developing post-tonsillectomy iatrogenic hyponatremia in a 5-year-old girl following an excessive infusion of hypotonic fluid. Her signs and symptoms began with nausea and vomiting and progressed to seizures and coma. We corrected the electrolyte disturbance by infusing a 3% sodium chloride solution until her neurologic manifestations disappeared, at which time her serum sodium concentration had risen back to 135 mEq/L. Otolaryngologists are not generally exposed to much information about hyponatremia, so we must be aware of its associated neurologic signs and symptoms.
August 10, 2012 Joshua I. Warrick, MD; David S. Brink, MD; Ronald B. Mitchell, MD
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Abstract
Paragangliomas of the head and neck are rare. We describe the case of an 11-year-old girl who presented with an enlarged right palatine tonsil (grade 4). After a bilateral tonsillectomy, microscopic examination of the right tonsillar tissue revealed well-formed nests of polygonal epithelial cells separated by a collagenous stroma. The tumor cell nuclei were centrally placed and featured finely clumped chromatin and moderate anisonucleosis. Occasional mitotic figures were present. No necrosis was seen. An immunohistochemical staining panel showed no label for keratin, epithelial membrane antigen, HMB-45, or Melan-A; there was a strong label of tumor cells with chromogranin A, synaptophysin, and neuron-specific enolase. The S-100 protein label was strongly positive in the surrounding stromal cells and weakly positive in the polygonal tumor cells. Given the classic histology and the immunohistochemical staining profile, the diagnosis of paraganglioma was made. At 7 months postoperatively, the patient exhibited no evidence of recurrence or metastasis. To the best of our knowledge, no case of a paraganglioma of the palatine tonsil has been previously described in the literature.
August 10, 2012 Yekaterina A. Koshkareva, MD; Michael Cohen, MD; John P. Gaughan, PhD; Vincent Callanan, MD; Wasyl Szeremeta, MD
article
Abstract
We conducted a 3-year retrospective study to examine the results of preoperative
hematologic screening, the incidence of postoperative bleeding, and the possible
relationship between the two factors in patients who had undergone tonsillectomy
with or without adenoidectomy. Our study population was made up of 875 patients—441
boys and 434 girls, aged 2 to 18 years (mean: 7.52 ± 4.25)—who had been treated at
our institution from January 2004 through December 2006. In addition to demographic
data, we compiled information on each patient’s medical and surgical history, personal
and family history of abnormal bleeding, indication for tonsillectomy, and preoperative
hematologic screening results. The latter included determinations of the prothrombin
time, activated partial thromboplastin time, international normalized ratio (INR), and
platelet count. A total of 748 patients (85.5%) had normal findings on preoperative
hematologic screening, and 127 (14.5%) had at least one abnormality. Postoperatively,
hemorrhagic complications occurred in 31 children (3.5%)—in 22 of the 748 patients
with normal screening results (2.9%) and in 9 of the 127 with a screening abnormality
(7.1%); the difference between the two groups was statistically significant (p = 0.041).
The abnormalities in the latter group consisted of an elevated INR but no otherwise
identifiable coagulopathy. Another 14 patients with an abnormal screening result
(11.0%) were found to have at least one coagulopathy that was newly diagnosed during
our preoperative evaluation; they were treated perioperatively, and none bled
postoperatively. Of 21 patients who had a personal or family history of abnormal
bleeding, 5 (23.8%) were found to have a coagulopathy, but none bled following surgery.
In conclusion, we found that preoperative hematologic screening identified patients
with undiagnosed coagulopathies, and with appropriate treatment our surgeons were able
to prevent some bleeding events in these patients. Our finding that patients with a
mildly elevated INR had a higher incidence of postoperative hemorrhage warrants
further study.
June 4, 2012 Christopher Y. Chang, MD; Richard Thrasher, MD
article
Abstract
We introduce a novel and potentially effective approach in the treatment of tonsil stones using Coblation technology. A retrospective pilot case series was performed demonstrating the effectiveness of a technique that we call Coblation tonsil cryptolysis. This technique is unique in that it can be performed in adult patients without sedation using only local anesthesia, much like laser tonsil cryptolysis. As with laser cryptolysis, pain is significant for only a few days and most adults can resume normal diet and activity within 1 week. In contrast, tonsillectomy entails significant morbidity for several weeks. However, Coblation avoids the significant disadvantages of laser use, including the potential for airway fire, retinal damage from reflected scatter, dealing with plume from vaporized tissues, oral/facial burns, and the high cost of purchasing and maintaining laser equipment. After a single session of Coblation tonsil cryptolysis, a significant decrease and even elimination of tonsil stones can potentially be achieved.
April 30, 2012 Marc C. Thorne, MD, MPH, Assistant Professor, Associate Program Director
article
Although gross pathologic analysis may seem like a good alternative to examining every specimen microscopically, from the point of view of cost-effectiveness, it is the worst option and is quite unlikely to identify significant pathology.
March 31, 2012 Parker A. Velargo, MD and Jerome W. Thompson, MD
article
Although herniation of parapharyngeal fat into the tonsillar fossa during a tonsillectomy is uncommon, such deftects need to be closed when they occur. One approach is to use a local flap for repair.
October 31, 2009 Cem Ozbek, MD, Safak Dagli, MD, E. Evrim Unsal Tuna, MD, Onur Ciftci, MD, and Cafer Ozdem, MD
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Abstract
Retropharyngeal abscess is an uncommon entity that can have severe and even fatal complications if it is not identified and treated early. Clinical and radiologic findings must be considered together prior to surgical drainage of a suspected retropharyngeal abscess. Airway obstruction may require emergent surgical management with tracheotomy. We describe the case of a 22-year-old man with a massive retropharyngeal abscess that was caused by inadequate treatment of acute tonsillitis. He responded well to surgical drainage and empiric antibiotic therapy.
August 31, 2009 Tammara L. Watts, MD, PhD and Stilianos E. Kountakis, MD, PhD
article
Abstract
We conducted a randomized, controlled, double-blind, prospective study to evaluate the effect of intraoperative bupivacaine injection on postoperative pain control following Bovie cautery-assisted tonsillectomy in 26 adults. Sixteen patients were injected with 10 ml of 0.5% bupivacaine with 1:200,000 epinephrine, and 10 were injected with 10 ml of normal saline solution. For 10 days after surgery, patients completed a questionnaire to rate their overall pain and to record their narcotic consumption and oral intake. At study's end, there was no statistically significant difference in pain scores, narcotic use, and oral intake between the bupivacaine group and the controls (p = 0.13, 0.37, and 0.35, respectively). We conclude that the effects of perioperative bupivacaine on postoperative pain control in tonsillectomy patients are similar to those of placebo.
May 31, 2009 Ryan F. Osborne, MD, FACS, Jason S. Hamilton, MD, FACS, and Sofia Avitiaz, MD
