Tonsillectomy is one of the most common surgical procedures performed in children anywhere in the world and has a  3000-year-old history as a medical treatment. During the past four decades there has been a noticeable shift not only in the indications for tonsillectomy, but also in the surgical technique. A recent study examines the difference in intra-operative factors, postoperative results and other complications between all possible and commonly practiced surgical methods.

Tonsillectomy continues to evolve as a surgical procedure, with new research on techniques and indications being published regularly. Recurrent tonsillar infection has traditionally been the most common indication for tonsillectomy – 30 years ago, approximately 90% of pediatric tonsillectomies were conducted on basis of recurrent infection. As the awareness of the incidence of obstructive adenotonsillar hypertrophy with associated obstructive sleep apnea has increased in recent years, so have also the indications for tonsillectomy – nowadays 20% of procedures are conducted for infection and 80% for obstructive sleep-disordered breathing.

Tonsillitis (a type of pharyngitis) an inflammation, caused by Streptococcus or viral agents. Symptoms include inflammation and swelling of the tonsils, sometimes severe enough to cause respiratory obstruction, as well as throat pain, redness or yellow coating on the tonsils, vomiting, nausea and abdominal pain in children.

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Post operative pain

  • 2-5 years old
  • 6-12 years old

Complications of tonsillectomy

  • Primary Hemorrhage
  • Secondary Hemorrhage
  • Tertiary Hemorrhage
  • Vomiting

Return to normal activity (days)

  • 2-5 years old
  • 6-12 years old
  • Plasma Ablation
  • Microdebrier

METHODS:

Patients <18 years old undergoing adenoidectomy without tonsillectomy were selected for this prospective, single-blinded, randomized controlled trial. Participants were enrolled into one of two groups based on birth date: coblation or ME. The surgeons completed a standard survey about intraoperative factors for each method. Recovery nurses filled out a standardized survey postoperatively. A third standardized survey was completed via a phone interview with the parent or patient caregiver on postoperative day 3 to assess procedure outcomes. The survey results were then compared using ANOVA statistical analysis.

RESULTS:

50 patients were enrolled in the coblation group and 51 were enrolled in the ME group. There was no significant difference in mean age between the coblation (4.96 years) and ME groups (4.58 years) (p = 0.525). The mean time (in minutes) for coblation (5.50) was significantly lower than ME (9.47) when controlling for the confounder: surgical site exposure (p < 0.001). The surgical time was significantly influenced by the quality of exposure/visualization (p = 0.037). The coblator method had significantly less intraoperative blood loss compared to ME (p < 0.001). There was a statistically significant difference between coblation (1.53) and ME (2.05) for days of pain (p = 0.045) when controlling for the confounder adenoid size.

CONCLUSION:

In our study we found that coblation demonstrated significantly less intraoperative time and less blood loss, as well as a shorter duration of postoperative pain, when compared to ME for adenoidectomy.

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Praesent vitae nulla pellentesque, efficitur augue vitae, egestas magna. Sed vitae condimentum lorem, sed commodo augue. Nulla in ante non metus ultrices maximus. Maecenas interdum sollicitudin suscipit.

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