This document summarizes a comparative study on different techniques for tonsillectomy conducted over 35 years from 1979 to 2013 with 2500 patients. The study compared cold steel tonsillectomy, microdebrider assisted tonsillectomy, and other methods like coblation and laser on factors like blood loss, surgery time, postoperative pain, bleeding, healing time and complications. The results found that microdebrider and coblation techniques had less blood loss and fewer complications like hemorrhage compared to cold steel. Pain and readmission rates were also lowest with partial tonsillectomy using microdebrider or coblation. The study concluded that powered intracapsular partial tonsillectomy using microdebrid

1. ENT-HNS JOURNAL CLUB
DR ANAND JHA
2ND YEAR RESIDENT, ENT-HNS
KISTMCTH, LALITPUR.

2. TONSILLECTOMY-COMPARATIVE STUDY OF
VARIOUS TECHNIQUES AND CHANGING TREND
 Ravinder Verma
 Ravneet Ravinder Verma
 Rohan Ravinder Verma
 Received: 23 September 2015
 Accepted: 23 August 2017
 Published online: 18 September 2017
 Indian J Otolaryngol Head Neck Surg.

3. INTRODUCTION
 Tonsillectomy is a 3000-year-old operation
 In 1959 1.4 million tonsillectomies were performed in the United States.
 The number had dropped to 260,000 by 1987
 24th most common indication for hospital admission

4. INTRODUCTION
 A comparative study between the various methods of tonsillectomy was done
to compare the rates of major complications.
 The study aim:
 Comparing the intra-operative factors (blood loss, time taken for surgery)
 Postoperative results (pain, bleeding, dehydration, time taken for complete
healing)
 Other complications like hemorrhage, vomiting and hospitalization time
between all groups of surgical methods

5. INTRODUCTION
 2500 patients undergoing tonsillectomy with or without adenoid removal in a
period of 35 years (1979–2013)
 41% of the patients underwent cold steel tonsillectomy.
 39% underwent microdebrider assisted tonsillectomy
 21% of the patients, other methods like coblation, radio frequency and laser
were used.

6. METHODOLOGY:
 Study design: comparative study on following parameter
 Comparing the intra-operative factors (blood loss, time taken for surgery)
 Postoperative results (pain, bleeding, dehydration, time taken for complete
healing)
 Other complications like hemorrhage, vomiting and hospitalization time
between all groups of surgical methods

7. METHODOLOGY:
 Study duration : 1979–2013
 Sample size: 2500
 Study population: patients with recurrent throat infection, sleep disordered
breathing causing daytime sleepiness, inattention and poor concentration.
 Inclusion criteria:
 Chronic recurrent tonsillitis
 Chronic hypertropic tonsillitis with OSA
 Hypertropic tonsillitis with snoring and dental malocclusion
 Quinsy tonsillectomy
 Unilateral hypertropic tonsil
 Patient with age > 2 years

8. METHODOLOGY:
 Exclusion criteria:
 Bleeding diathesis
 Poor anesthetic risk or uncontrolled medical illness
 Anemia
 Acute infection

9. METHODOLOGY:
 Sampling technique:

10. METHODOLOGY
 Examination of study subjects:
 Laboratory investigations: CBC, BT, CT, ASO titre.
 Throat swab from the surface of tonsils for culture and sensitivty was done in
120 patients whenever felt necessary especially with chronic tonsillitis not
responding to medical treatment.

11. RESULTS:
 The blood loss during surgery was the least with microdebrider and more with
cold steel

12. RESULTS
 The rate of primary, secondary and tertiary hemorrhage was 5, 6 and 1%
respectively with cold steel method.
 The rate of hemorrhage with microdebrider and coblation were minimum of
all methods.

13. RESULTS
 Pain was found to be minimum in the patients undergoing partial
tonsillectomy with coblation and microdebrider

14. RESULTS
 The readmission rate was found to be higher in cases done with cold steel
(4%) due to vomiting, bleeding and dehydration

15. RESULTS
 The patients were back to normal activity within 3 days with partial
tonsillectomy but within 10–20 days with total tonsillectomy.

16. RESULTS
 The real operative time was comparable across all methods

17. CONCLUSION
 Intracapsular partial technique is better in terms of pain, hemorrhage and
healing.
 The author of this study found that the Powered intracapsular partial
tonsillectomy using microdebrider is the best method followed by coblation as
far as per-operative and post operative complications are concerned.

18. CRITICAL COMMENTS:
TITLE:
 self explanatory
 abbreviations
 3 authors
 Author’s name: stated
 Academic degree: not stated

19. CRITICAL COMMENTS:
 ABSTRACT:
 143 words( 150-250 words)
 No concrete information about study
 Introduction/objective/methods/results: mentioned
 Keywords mentioned: 4 in number (3-6)

20. CRITICAL COMMENTS
 INTRODUCTION:
 Objective: included
 Rationale: briefly stated
 Justification of current study: explained

21. CRITICAL COMMENTS:
MATERIALS AND METHODS:
 Not Listed in separate headings
 Study design: comparative
 Study place: not mentioned
 Duration of study: mentioned (2079-2013)
 Ethical clearance and consent from study subject: not mentioned
 Inclusion and exclusion criteria: mentioned
 Statistical methods : not mentioned

22. Critical comments
 Sample size and technique: mentioned.

23. CRITICAL COMMENTS:
RESULTS:
 Author’s main finding:
 clearly presented
 The author states first half and second half of study, the date of first half and
second half not mentioned.
 Met the objective mentioned.

24. CRITICAL COMMENTS
DISCUSSIONS:
 Explanation of individual research finding: not elaborated
 Comparision with other studies: done adequately
 Different technique of tonsillectomy: briefly mentioned.
 Limitation of the study : not mentioned
CONCLUSION:
 As per objective
REFERENCES:
 Vancouver system
 44 journal article.

25. THANK YOU.