The document summarizes modern techniques for tonsillectomy, including indications, history, and innovative methods. It discusses intracapsular tonsillectomy using instruments like a microdebrider or coblation, which may reduce postoperative pain compared to traditional subcapsular removal. Studies on harmonic scalpel, laser, and coblation tonsillectomy aim to lower blood loss, pain, and recovery time versus electrocautery. However, long-term outcomes like tonsil regrowth require further evaluation.
This document discusses adenoid and tonsil procedures. Adenoidectomy is performed to treat conditions like sleep apnea and ear infections caused by adenoid hypertrophy. Risks include bleeding and injury to nearby structures. Tonsillectomy is indicated for recurrent tonsillitis or sleep apnea. The dissection and snare method involves separating the tonsil from its bed and removing it with a snare. Postoperative risks include primary and reactionary bleeding in the first 24 hours, and secondary bleeding up to 2 weeks later caused by infection. Other risks include injury to nearby structures like the tongue or uvula.
1. A deviated nasal septum is caused by trauma, developmental issues, masses in the nasal cavity, and racial or hereditary factors.
2. Types of deviations include anterior/caudal dislocation, C-shaped, S-shaped, spurs, and thickening. Clinical features include nasal blockage, recurrent colds, headaches, and epistaxis.
3. Surgical techniques to correct deviations include septoplasty, which involves scoring and removing portions of cartilage, and submucosal resection, which removes larger sections of cartilage. Complications can include hematomas, abscesses, perforations, and synechiae.
This document discusses rigid endoscopic evaluation of conventional curettage adenoidectomy. It begins with an introduction stating that adenoidectomy is a common procedure in children and conventional curettage is commonly used. It then provides details on the anatomy and physiology of the adenoids, clinical presentation of adenoid hypertrophy, diagnosis, grading systems used, different surgical techniques including conventional curettage and various types of endoscopic adenoidectomy, post-operative care, and potential complications.
1) Tonsillectomy and adenoidectomy are common ENT procedures used to treat recurrent tonsillitis, sleep apnea, and other conditions. The history of these procedures dates back to ancient times, but modern techniques use electrocautery, lasers, or other methods.
2) Complications can include bleeding, infection, and in rare cases injury to nearby structures like the uvula. Proper postoperative care and monitoring for bleeding is important.
3) A peritonsillar abscess (quinsy) occurs when a tonsillar infection spreads, causing a pocket of pus. Treatment involves antibiotics, needle drainage if large enough, or incision and drainage surgery. Recurrent or
This document describes the indications, techniques, and postoperative care for septoplasty surgery. It indicates that septoplasty is performed to correct a deviated nasal septum causing obstruction or other issues. The key steps described are making an incision, raising mucoperichondrial flaps, removing deviated cartilage and bone, and re-approximating the flaps. Potential complications are also outlined.
This document provides an overview of the steps involved in primary sinus surgery via an endoscopic approach. It begins with a brief history of sinus surgery and then discusses preoperative assessment, including CT scans to evaluate sinus anatomy and disease patterns. The basic techniques of Messerklinger and Wigand are described. The key steps of the surgery are then outlined in detail, including uncinectomy, antrostomy of the maxillary sinus, anterior and posterior ethmoidectomy, sphenoid sinusotomy, and frontal sinusotomy when necessary. Throughout, anatomical landmarks and variations are discussed to guide safe dissection and avoid complications.
This document discusses diseases of the external ear. It begins by describing the anatomy of the external ear canal. It then categorizes conditions affecting the external ear into congenital, inflammatory, reactive, traumatic, and tumors. Under congenital conditions it discusses preauricular sinus, congenital ear swellings, fistulas and anomalies. It provides details on preauricular sinus including embryology, clinical features, management and associated syndromes. It also discusses other congenital conditions such as ear swellings, fistulas and atresia. The document further describes inflammatory conditions including erysipelas, perichondritis and malignant otitis externa. It also covers reactive, traumatic, and neoplastic conditions of the external
This document provides guidance on clinically evaluating the nose. It outlines the key steps including taking a thorough patient history, performing a general examination, and conducting a local examination of the nose. The local examination involves anterior and posterior rhinoscopy to inspect the nasal cavities and paranasal sinuses. Potential abnormalities are described. Recommended blood investigations and radiological imaging include a CBC, sinus CT, and tests for underlying conditions. The goal is to arrive at an accurate diagnosis by combining the clinical findings with investigation results.
This document discusses adenoid and tonsil procedures. Adenoidectomy is performed to treat conditions like sleep apnea and ear infections caused by adenoid hypertrophy. Risks include bleeding and injury to nearby structures. Tonsillectomy is indicated for recurrent tonsillitis or sleep apnea. The dissection and snare method involves separating the tonsil from its bed and removing it with a snare. Postoperative risks include primary and reactionary bleeding in the first 24 hours, and secondary bleeding up to 2 weeks later caused by infection. Other risks include injury to nearby structures like the tongue or uvula.
1. A deviated nasal septum is caused by trauma, developmental issues, masses in the nasal cavity, and racial or hereditary factors.
2. Types of deviations include anterior/caudal dislocation, C-shaped, S-shaped, spurs, and thickening. Clinical features include nasal blockage, recurrent colds, headaches, and epistaxis.
3. Surgical techniques to correct deviations include septoplasty, which involves scoring and removing portions of cartilage, and submucosal resection, which removes larger sections of cartilage. Complications can include hematomas, abscesses, perforations, and synechiae.
This document discusses rigid endoscopic evaluation of conventional curettage adenoidectomy. It begins with an introduction stating that adenoidectomy is a common procedure in children and conventional curettage is commonly used. It then provides details on the anatomy and physiology of the adenoids, clinical presentation of adenoid hypertrophy, diagnosis, grading systems used, different surgical techniques including conventional curettage and various types of endoscopic adenoidectomy, post-operative care, and potential complications.
1) Tonsillectomy and adenoidectomy are common ENT procedures used to treat recurrent tonsillitis, sleep apnea, and other conditions. The history of these procedures dates back to ancient times, but modern techniques use electrocautery, lasers, or other methods.
2) Complications can include bleeding, infection, and in rare cases injury to nearby structures like the uvula. Proper postoperative care and monitoring for bleeding is important.
3) A peritonsillar abscess (quinsy) occurs when a tonsillar infection spreads, causing a pocket of pus. Treatment involves antibiotics, needle drainage if large enough, or incision and drainage surgery. Recurrent or
This document describes the indications, techniques, and postoperative care for septoplasty surgery. It indicates that septoplasty is performed to correct a deviated nasal septum causing obstruction or other issues. The key steps described are making an incision, raising mucoperichondrial flaps, removing deviated cartilage and bone, and re-approximating the flaps. Potential complications are also outlined.
This document provides an overview of the steps involved in primary sinus surgery via an endoscopic approach. It begins with a brief history of sinus surgery and then discusses preoperative assessment, including CT scans to evaluate sinus anatomy and disease patterns. The basic techniques of Messerklinger and Wigand are described. The key steps of the surgery are then outlined in detail, including uncinectomy, antrostomy of the maxillary sinus, anterior and posterior ethmoidectomy, sphenoid sinusotomy, and frontal sinusotomy when necessary. Throughout, anatomical landmarks and variations are discussed to guide safe dissection and avoid complications.
This document discusses diseases of the external ear. It begins by describing the anatomy of the external ear canal. It then categorizes conditions affecting the external ear into congenital, inflammatory, reactive, traumatic, and tumors. Under congenital conditions it discusses preauricular sinus, congenital ear swellings, fistulas and anomalies. It provides details on preauricular sinus including embryology, clinical features, management and associated syndromes. It also discusses other congenital conditions such as ear swellings, fistulas and atresia. The document further describes inflammatory conditions including erysipelas, perichondritis and malignant otitis externa. It also covers reactive, traumatic, and neoplastic conditions of the external
This document provides guidance on clinically evaluating the nose. It outlines the key steps including taking a thorough patient history, performing a general examination, and conducting a local examination of the nose. The local examination involves anterior and posterior rhinoscopy to inspect the nasal cavities and paranasal sinuses. Potential abnormalities are described. Recommended blood investigations and radiological imaging include a CBC, sinus CT, and tests for underlying conditions. The goal is to arrive at an accurate diagnosis by combining the clinical findings with investigation results.
This document discusses chronic rhinosinusitis (CRS). It defines CRS and outlines its main subtypes and symptoms. It describes the histopathology and pathomechanisms involved, as well as common comorbidities. Diagnosis involves nasal endoscopy, CT scans, and allergy testing. Treatment includes topical corticosteroids, antibiotics, antifungals, and surgery for refractory cases.
This document discusses differential diagnoses of nasal obstruction and neoplasms of the nose and paranasal sinuses. It provides a list of structural, infectious, allergic and other causes of unilateral and bilateral nasal obstruction. It also classifies benign and malignant nasal tumors and describes the presentation, diagnosis and treatment of inverted papilloma and sinonasal carcinomas such as maxillary sinus carcinoma. The treatment of maxillary sinus carcinoma includes surgery such as total maxillectomy with options like orbital exenteration or anterior cranio-facial resection depending on tumor extent.
1) The document discusses the surgical approach and procedure for cortical mastoidectomy. Key steps include raising skin and periosteal flaps, drilling along anatomical landmarks like the sigmoid sinus and facial nerve to identify structures, and widening the aditus and performing a posterior tympanotomy to access the mesotympanum.
2) Post-operative care involves drain removal within 48 hours and dry dressing of the ear. Potential complications discussed are persistent deafness, facial nerve injury, CSF leak, hemorrhage and infection.
3) The patient is advised restricted activity for 3 weeks followed by a gradual return to normal activity over 4 weeks, and to keep the operation site dry.
This patient presented with conductive hearing loss and tinnitus in the left ear. Examination showed normal appearing ear drums with normal mobility. The audiogram showed a characteristic Carhart's notch, indicating the probable diagnosis of otosclerosis. Otosclerosis causes stapes fixation leading to conductive hearing loss and is identified by the notch on bone conduction testing.
This document discusses the management of a 19-year-old patient with recurrent laryngotracheal stenosis following emergency intubation for acute organophosphate poisoning 2 months prior. It establishes the diagnosis of laryngotracheal stenosis through history and examination. It then discusses evaluating the severity and progression, as well as investigations including direct laryngoscopy. Finally, it outlines management approaches such as endolaryngeal procedures like dilation and LASER, open procedures like tracheal resection and anastomosis, as well as adjunct treatments and follow up.
This document discusses various types of noisy breathing and causes of hoarseness and stridor. It describes laryngomalacia as the most common congenital laryngeal anomaly manifesting as inspiratory stridor that is often relieved by prone positioning. For management of obstructed airways, it recommends techniques such as Heimlich maneuver, oropharyngeal/nasal airways, intubation, cricothyroidotomy, tracheostomy based on the level and severity of obstruction. Intubation is preferred over tracheostomy for short term airway issues in children due to easier decannulation and lower risk of subglottic stenosis.
The document discusses Functional Endoscopic Sinus Surgery (FESS). FESS is a minimally invasive procedure that uses an endoscope to access and treat the paranasal sinuses. It aims to restore sinus function by re-establishing ventilation and mucociliary clearance. Key steps in FESS include uncinectomy to remove the uncinate process, maxillary antrostomy to access the maxillary sinus, and ethmoidectomy to access the ethmoid sinuses. Proper identification of anatomical landmarks like the middle turbinate, uncinate process, and bulla ethmoidalis is important for successful FESS.
This document provides an overview of diagnostic nasal endoscopy. It discusses that nasal endoscopy allows direct visualization of the nasal and sinus passages using an endoscope. It can be performed with flexible or rigid endoscopes. The document outlines the indications, contraindications, technical considerations, equipment, patient preparation, technique, and potential complications of nasal endoscopy. Nasal endoscopy is a commonly used diagnostic tool by otolaryngologists to evaluate nasal pathology.
Tympanoplasty is a surgical procedure to reconstruct the tympanic membrane and/or ossicles that have been damaged. It is classified based on the status of the ossicles and middle ear, such as the Wullstein and Austin-Kartush classifications, which help determine the surgical approach and predict success rates. Factors like the presence of otorrhea, perforation, cholesteatoma, and ossicular chain status are used to calculate a Middle Ear Risk Index that provides a prognosis for tympanoplasty outcomes.
The nasal septum has 3 parts - the columellar septum, membranous septum, and septum proper. The septum proper contains cartilage and provides structural support to the nose. Deviations or fractures of the septum can cause nasal obstruction. Common causes of septal deviations include trauma and abnormal intrauterine positions. Symptoms include nasal obstruction and crusting. Septoplasty and submucous resection (SMR) are surgical procedures used to correct deviations. Indications for surgery include significant obstruction while risks include bleeding, perforation and infection.
This document discusses earwax, also known as cerumen, and methods for removing impacted earwax. It describes the structure and composition of earwax, noting that it helps clean and lubricate the ear canal while also playing an antibacterial and antifungal role. When earwax becomes impacted, it can cause symptoms like a blocked ear sensation, discomfort, pain, tinnitus, and hearing impairment. The document outlines common techniques for removing impacted earwax, including using cerumenolytic drops to soften the wax, syringing the ear canal with water, and instrumental removal with tools like a cerumen hook. Complications from improper removal are also discussed.
Cholesteatoma is defined as a cystic bag-like structure filled with desquamated squamous debris lying on a fibrous matrix, also known as "skin in the wrong place." It can be congenital or acquired. Acquired cholesteatomas are either primary, with unknown etiology, or secondary caused by acute necrotizing otitis media. Evaluation involves history, examination, audiometry and CT scan to determine extent. Surgical treatment aims to eradicate the cholesteatoma while preserving hearing, with options like canal wall up or down mastoidectomy depending on the case. Complications can include infection, bone destruction, hearing loss and facial nerve paralysis if
This document provides information about different types of mastoidectomy procedures. It begins with a brief history of mastoidectomy surgery dating back to 1873. It then discusses indications for various procedures like cortical mastoidectomy, canal wall up (CWU) mastoidectomy, modified radical mastoidectomy, and radical mastoidectomy. Key anatomical structures are defined. Surgical techniques for CWU mastoidectomy are outlined, including incision, periosteal elevation, and middle ear dissection steps. Contraindications and debates around CWU versus canal wall down approaches are also summarized.
A tonsillectomy is a surgical procedure to remove the tonsils. It is usually performed under general anesthesia with the patient in the Rose's position. The surgery involves using a mouth gag, grasping the tonsil with forceps, and dissecting it from the surrounding tissue using scissors or a dissector. A wire snare is then used to ligate and remove the tonsil. Post-operative care includes monitoring for bleeding, a soft diet, oral hygiene, analgesics and antibiotics. Complications can include bleeding, injury to nearby structures, infection, or scarring.
Mastoidectomy is a surgical procedure to access and treat infections of the mastoid air cells behind the ear. Over time, the procedure has evolved from simple cortical mastoidectomies described in the 17th century to more advanced techniques using an operating microscope and drill. Modern mastoidectomies are typically classified as canal wall up or canal wall down depending on whether the bony ear canal wall is preserved. Indications include treatment of cholesteatoma, refractory ear infections, and approaches for other inner ear procedures. The surgery involves an incision behind the ear to access and clean out the infected mastoid air cells.
This document contains 11 multiple choice questions regarding the OSCE examination for Ear, Nose and Throat. Each question provides images, descriptions of patient presentations, and asks for diagnoses, management plans, or other clinical information. The answers to each question are also provided.
Tonsillectomy is commonly performed to treat recurrent throat infections. Absolute indications for tonsillectomy include recurrent infections, peritonsillar abscesses, tonsillitis causing seizures, tonsil hypertrophy causing obstruction, and suspicion of malignancy. Relative indications include being a carrier of diphtheria or streptococcus. The operation is usually done under general anesthesia with the patient in Rose's position. The tonsils are grasped, dissected from surrounding tissue, and removed using a wire snare. Post-operative care involves pain management, oral hygiene, diet progression, and antibiotics to prevent infection. Potential complications include bleeding, infection, and scarring.
1. Adenoidectomy is a surgical procedure to remove enlarged adenoids from the nasopharynx. It is often performed to treat conditions like snoring, sleep apnea, and recurrent ear infections.
2. The procedure is done under general anesthesia with the patient in the Rose's position. The adenoids are removed using curettes and forceps either through the mouth or using an endoscope. Hemostasis is achieved before closing.
3. Potential complications include bleeding, injury to nearby structures like the eustachian tube, and nasopharyngeal stenosis. The patient is monitored post-operatively for bleeding and discomfort before being discharged after 24 hours typically.
Tonsillectomy is the surgical removal of the palatine tonsils. It is indicated for recurrent throat infections, peritonsillar abscesses, tonsillitis causing seizures, or tonsil hypertrophy causing airway obstruction or difficulty swallowing. The procedure involves positioning the patient with a mouth gag and dissecting the tonsils from the surrounding tissue using scissors or other tools before removing them. Post-operative care includes pain medication, antibiotics to prevent infection, soft foods and fluids, and mouthwashes or gargles to ease soreness. Complications can include bleeding, injury to nearby structures, infection, or scarring.
This document discusses the anatomy, causes, symptoms, diagnosis and treatment of tonsillitis. It describes the anatomy of the palatine tonsils and their location in the oropharynx. It explains that tonsillitis is commonly caused by bacterial or viral infections, and presents as sore throat, difficulty swallowing and fever. The types of acute tonsillitis - catarrhal, follicular and membranous - are outlined. Treatment involves rest, fluids, analgesics and antibiotics. Complications and differential diagnoses are also summarized.
This document discusses chronic rhinosinusitis (CRS). It defines CRS and outlines its main subtypes and symptoms. It describes the histopathology and pathomechanisms involved, as well as common comorbidities. Diagnosis involves nasal endoscopy, CT scans, and allergy testing. Treatment includes topical corticosteroids, antibiotics, antifungals, and surgery for refractory cases.
This document discusses differential diagnoses of nasal obstruction and neoplasms of the nose and paranasal sinuses. It provides a list of structural, infectious, allergic and other causes of unilateral and bilateral nasal obstruction. It also classifies benign and malignant nasal tumors and describes the presentation, diagnosis and treatment of inverted papilloma and sinonasal carcinomas such as maxillary sinus carcinoma. The treatment of maxillary sinus carcinoma includes surgery such as total maxillectomy with options like orbital exenteration or anterior cranio-facial resection depending on tumor extent.
1) The document discusses the surgical approach and procedure for cortical mastoidectomy. Key steps include raising skin and periosteal flaps, drilling along anatomical landmarks like the sigmoid sinus and facial nerve to identify structures, and widening the aditus and performing a posterior tympanotomy to access the mesotympanum.
2) Post-operative care involves drain removal within 48 hours and dry dressing of the ear. Potential complications discussed are persistent deafness, facial nerve injury, CSF leak, hemorrhage and infection.
3) The patient is advised restricted activity for 3 weeks followed by a gradual return to normal activity over 4 weeks, and to keep the operation site dry.
This patient presented with conductive hearing loss and tinnitus in the left ear. Examination showed normal appearing ear drums with normal mobility. The audiogram showed a characteristic Carhart's notch, indicating the probable diagnosis of otosclerosis. Otosclerosis causes stapes fixation leading to conductive hearing loss and is identified by the notch on bone conduction testing.
This document discusses the management of a 19-year-old patient with recurrent laryngotracheal stenosis following emergency intubation for acute organophosphate poisoning 2 months prior. It establishes the diagnosis of laryngotracheal stenosis through history and examination. It then discusses evaluating the severity and progression, as well as investigations including direct laryngoscopy. Finally, it outlines management approaches such as endolaryngeal procedures like dilation and LASER, open procedures like tracheal resection and anastomosis, as well as adjunct treatments and follow up.
This document discusses various types of noisy breathing and causes of hoarseness and stridor. It describes laryngomalacia as the most common congenital laryngeal anomaly manifesting as inspiratory stridor that is often relieved by prone positioning. For management of obstructed airways, it recommends techniques such as Heimlich maneuver, oropharyngeal/nasal airways, intubation, cricothyroidotomy, tracheostomy based on the level and severity of obstruction. Intubation is preferred over tracheostomy for short term airway issues in children due to easier decannulation and lower risk of subglottic stenosis.
The document discusses Functional Endoscopic Sinus Surgery (FESS). FESS is a minimally invasive procedure that uses an endoscope to access and treat the paranasal sinuses. It aims to restore sinus function by re-establishing ventilation and mucociliary clearance. Key steps in FESS include uncinectomy to remove the uncinate process, maxillary antrostomy to access the maxillary sinus, and ethmoidectomy to access the ethmoid sinuses. Proper identification of anatomical landmarks like the middle turbinate, uncinate process, and bulla ethmoidalis is important for successful FESS.
This document provides an overview of diagnostic nasal endoscopy. It discusses that nasal endoscopy allows direct visualization of the nasal and sinus passages using an endoscope. It can be performed with flexible or rigid endoscopes. The document outlines the indications, contraindications, technical considerations, equipment, patient preparation, technique, and potential complications of nasal endoscopy. Nasal endoscopy is a commonly used diagnostic tool by otolaryngologists to evaluate nasal pathology.
Tympanoplasty is a surgical procedure to reconstruct the tympanic membrane and/or ossicles that have been damaged. It is classified based on the status of the ossicles and middle ear, such as the Wullstein and Austin-Kartush classifications, which help determine the surgical approach and predict success rates. Factors like the presence of otorrhea, perforation, cholesteatoma, and ossicular chain status are used to calculate a Middle Ear Risk Index that provides a prognosis for tympanoplasty outcomes.
The nasal septum has 3 parts - the columellar septum, membranous septum, and septum proper. The septum proper contains cartilage and provides structural support to the nose. Deviations or fractures of the septum can cause nasal obstruction. Common causes of septal deviations include trauma and abnormal intrauterine positions. Symptoms include nasal obstruction and crusting. Septoplasty and submucous resection (SMR) are surgical procedures used to correct deviations. Indications for surgery include significant obstruction while risks include bleeding, perforation and infection.
This document discusses earwax, also known as cerumen, and methods for removing impacted earwax. It describes the structure and composition of earwax, noting that it helps clean and lubricate the ear canal while also playing an antibacterial and antifungal role. When earwax becomes impacted, it can cause symptoms like a blocked ear sensation, discomfort, pain, tinnitus, and hearing impairment. The document outlines common techniques for removing impacted earwax, including using cerumenolytic drops to soften the wax, syringing the ear canal with water, and instrumental removal with tools like a cerumen hook. Complications from improper removal are also discussed.
Cholesteatoma is defined as a cystic bag-like structure filled with desquamated squamous debris lying on a fibrous matrix, also known as "skin in the wrong place." It can be congenital or acquired. Acquired cholesteatomas are either primary, with unknown etiology, or secondary caused by acute necrotizing otitis media. Evaluation involves history, examination, audiometry and CT scan to determine extent. Surgical treatment aims to eradicate the cholesteatoma while preserving hearing, with options like canal wall up or down mastoidectomy depending on the case. Complications can include infection, bone destruction, hearing loss and facial nerve paralysis if
This document provides information about different types of mastoidectomy procedures. It begins with a brief history of mastoidectomy surgery dating back to 1873. It then discusses indications for various procedures like cortical mastoidectomy, canal wall up (CWU) mastoidectomy, modified radical mastoidectomy, and radical mastoidectomy. Key anatomical structures are defined. Surgical techniques for CWU mastoidectomy are outlined, including incision, periosteal elevation, and middle ear dissection steps. Contraindications and debates around CWU versus canal wall down approaches are also summarized.
A tonsillectomy is a surgical procedure to remove the tonsils. It is usually performed under general anesthesia with the patient in the Rose's position. The surgery involves using a mouth gag, grasping the tonsil with forceps, and dissecting it from the surrounding tissue using scissors or a dissector. A wire snare is then used to ligate and remove the tonsil. Post-operative care includes monitoring for bleeding, a soft diet, oral hygiene, analgesics and antibiotics. Complications can include bleeding, injury to nearby structures, infection, or scarring.
Mastoidectomy is a surgical procedure to access and treat infections of the mastoid air cells behind the ear. Over time, the procedure has evolved from simple cortical mastoidectomies described in the 17th century to more advanced techniques using an operating microscope and drill. Modern mastoidectomies are typically classified as canal wall up or canal wall down depending on whether the bony ear canal wall is preserved. Indications include treatment of cholesteatoma, refractory ear infections, and approaches for other inner ear procedures. The surgery involves an incision behind the ear to access and clean out the infected mastoid air cells.
This document contains 11 multiple choice questions regarding the OSCE examination for Ear, Nose and Throat. Each question provides images, descriptions of patient presentations, and asks for diagnoses, management plans, or other clinical information. The answers to each question are also provided.
Tonsillectomy is commonly performed to treat recurrent throat infections. Absolute indications for tonsillectomy include recurrent infections, peritonsillar abscesses, tonsillitis causing seizures, tonsil hypertrophy causing obstruction, and suspicion of malignancy. Relative indications include being a carrier of diphtheria or streptococcus. The operation is usually done under general anesthesia with the patient in Rose's position. The tonsils are grasped, dissected from surrounding tissue, and removed using a wire snare. Post-operative care involves pain management, oral hygiene, diet progression, and antibiotics to prevent infection. Potential complications include bleeding, infection, and scarring.
1. Adenoidectomy is a surgical procedure to remove enlarged adenoids from the nasopharynx. It is often performed to treat conditions like snoring, sleep apnea, and recurrent ear infections.
2. The procedure is done under general anesthesia with the patient in the Rose's position. The adenoids are removed using curettes and forceps either through the mouth or using an endoscope. Hemostasis is achieved before closing.
3. Potential complications include bleeding, injury to nearby structures like the eustachian tube, and nasopharyngeal stenosis. The patient is monitored post-operatively for bleeding and discomfort before being discharged after 24 hours typically.
Tonsillectomy is the surgical removal of the palatine tonsils. It is indicated for recurrent throat infections, peritonsillar abscesses, tonsillitis causing seizures, or tonsil hypertrophy causing airway obstruction or difficulty swallowing. The procedure involves positioning the patient with a mouth gag and dissecting the tonsils from the surrounding tissue using scissors or other tools before removing them. Post-operative care includes pain medication, antibiotics to prevent infection, soft foods and fluids, and mouthwashes or gargles to ease soreness. Complications can include bleeding, injury to nearby structures, infection, or scarring.
This document discusses the anatomy, causes, symptoms, diagnosis and treatment of tonsillitis. It describes the anatomy of the palatine tonsils and their location in the oropharynx. It explains that tonsillitis is commonly caused by bacterial or viral infections, and presents as sore throat, difficulty swallowing and fever. The types of acute tonsillitis - catarrhal, follicular and membranous - are outlined. Treatment involves rest, fluids, analgesics and antibiotics. Complications and differential diagnoses are also summarized.
Tonsillectomy should not be performed if the patient has a hemoglobin level under 10g%, an acute upper respiratory tract infection including acute tonsillitis due to increased bleeding risk, or is under 3 years old due to higher surgical risk. Tonsillectomy is also contraindicated for patients with bleeding disorders, cleft palate, uncontrolled systemic diseases, during an epidemic like polio, or during menstruation.
The document discusses adenoiditis, an infection of the adenoids. The adenoids are located behind the nose and help fight infection by trapping germs. When infected, the adenoids can become swollen and sore, making breathing difficult and causing ear problems. Symptoms include sore throat, difficulty swallowing, ear pain, and fever. Diagnosis involves examination of the throat and testing of throat swabs. Treatment consists of antibiotics if tests indicate strep infection. For recurrent infections, adenoidectomy surgery may be required to remove the adenoids.
Las amígdalas son dos masas de tejido linfoide situadas en la nasofaringe que funcionan filtrando bacterias y virus y produciendo anticuerpos. Se desarrollan durante la vida intrauterina y continúan creciendo hasta los 6 años de edad cuando comienzan a atrofiarse. Pueden infectarse causando adenoiditis aguda o crónica obstructiva si se hipertrofian, lo cual requiere tratamiento con antibióticos o cirugía adenoamigdalectomía.
The document discusses several upper respiratory tract infections including tonsillitis, pharyngitis, pharyngotonsillitis, and laryngitis. It describes the causes, signs and symptoms, diagnostic procedures, treatment, and potential complications of each condition. The infections can be acute, sub-acute, or chronic and are generally caused by bacterial or viral infections entering through the nose and mouth and causing inflammation in the tonsils, pharynx, or larynx. Common treatments include saline gargles, analgesics, antibiotics, rest, and humidified air. Complications can include conditions like tuberculosis, rheumatic heart disease, or permanent voice loss.
Acute tonsillitis is caused by bacterial or viral infections, causing sore throat, fever, and difficulty swallowing. It commonly affects children ages 5-15 but can also affect adults. The tonsils may appear swollen and congested with exudates. Treatment involves rest, fluids, analgesics, and a 7-10 day course of antibiotics like penicillin. Complications can include chronic tonsillitis, peritonsillar abscess, or spread of infection to other areas.
Adenoids are masses of lymphatic tissue located in the nasopharynx that can become enlarged. Symptoms of enlarged adenoids include nasal obstruction, mouth breathing, and ear infections. Adenoidectomy is the surgical removal of the adenoids and indications include recurrent infections and airway obstruction. The procedure involves using curettes or microdebriders to gently remove the adenoids under anesthesia. Post-operative care focuses on pain management, antibiotics, and monitoring for potential complications like bleeding or injury.
This document reviews various methods of tonsillectomy and adjunctive therapies. It examines cold knife dissection, electrocautery, coblation, harmonic scalpel, thermal welding, and intracapsular techniques. It assesses the role of perioperative steroids, hemostatic agents, antibiotics, and pain control methods. While methods vary in outcomes like pain and bleeding risks, the document concludes cold knife has the lowest pain but bipolar scissors among intracapsular methods may be best when considering time and cost. Steroids, antibiotics, and NSAIDs are generally supported for adjunctive use.
This document discusses tonsillitis, tonsillectomy, and adenoidectomy. It provides details on:
- The history and anatomy of these procedures
- Clinical evaluation and differential diagnosis of tonsillitis
- Surgical indications and techniques for tonsillectomy and adenoidectomy
- Preoperative evaluation and management of bleeding disorders
- Adjuvant therapies like antibiotics, steroids, and local anesthetics to improve postoperative outcomes
The adenoid is a mass of lymphoid tissue located in the posterior nasopharynx. It develops beginning in the third month of fetal development and is fully formed by the seventh month. The adenoid is composed of lymphoid follicles separated by ridges and clefts. It drains into local lymph nodes and veins. Enlargement of the adenoid is common in children under age 6 and can cause nasal obstruction, mouth breathing, and ear infections. Symptoms decrease as the adenoid undergoes natural atrophy after puberty.
The document discusses adenoid enlargement, including its embryology, anatomy, blood supply, histology, function, clinical features, diagnosis and management. It begins by describing the development of the adenoids from the 3rd month of fetal development. Diagnosis involves endoscopy, posterior rhinoscopy and CT scans. Management options include watchful waiting if symptoms are mild, or surgical removal (adenoidectomy) if symptoms are severe and persistent. Adenoidectomy aims to relieve nasal obstruction but risks include hemorrhage, infection and airway complications.
Special situations in tonsil and Adenoid disorder Special situations in ton...MedicineAndHealthResearch
The document discusses special considerations for managing tonsil and adenoid disorders. It covers anatomy, grading tonsil size, positions, overview of conditions like peritonsillar abscess, unilateral enlargement, hemorrhagic tonsils, lingual tonsils, and Down's syndrome. It provides details on evaluating and treating these conditions, including potential complications for cleft palate and Down's syndrome patients undergoing adenotonsillectomy.
Adenoids are lymphoid tissue located in the nasopharynx that are typically not visible through the mouth. Adenoid hypertrophy can be caused by chronic inflammation and causes nasal obstruction, mouth breathing, ear infections, and sinus infections. Indications for surgery include recurrent ear or sinus infections, obstructive sleep apnea, or cardiopulmonary complications. Treatment involves antibiotics initially and adenoidectomy or tonsilloadenoidectomy for persistent or severe cases.
Este documento describe la adenoiditis aguda, una inflamación de los tejidos adenoides ubicados en la rinofaringe. Es más común en niños en edad preescolar y escolar y suele estar acompañada de amigdalitis aguda. Los síntomas incluyen obstrucción nasal, fiebre, voz nasal y tos. El diagnóstico es clínico y se confirma con radiografías laterales de cuello. El tratamiento consiste en analgésicos y antibióticos como amoxicilina.
Anatomy and physiology of the palatine tonsilSalman Syed
This document discusses the anatomy and physiology of the palatine tonsils. It describes the tonsils as lymphoid tissue located in the lateral walls of the oropharynx that are part of Waldeyer's ring. The tonsils develop from the pharyngeal pouches during embryology and have crypts containing lymphocytes on their medial surfaces. The tonsils function as secondary lymphoid organs that sample antigens and activate B and T cells to produce antibodies for immune responses.
Tonsillitis is an inflammation or infection of the tonsils, which are lymph glands located in the throat that help fight bacteria and viruses. Common causes are streptococcus bacteria and various viruses. Symptoms include sore throat, difficulty swallowing, and fever. Diagnosis involves examination of swollen tonsils and testing of throat secretions. Complications can include abscesses, but tonsillitis is usually treated with antibiotics, acetaminophen, and ibuprofen. Repeated cases may require tonsil removal. Prevention involves avoiding sick people and practicing good hand hygiene.
Lymphoid tissue in the body includes primary, secondary, and tertiary tissues. Secondary lymphoid organs like lymph nodes initiate immune responses when lymphocytes are activated by antigens. Mature lymphocytes recirculate between blood and lymphoid organs until encountering specific antigens. The tonsils are oval masses of lymphoid tissue in the throat that help prevent pathogens from entering through the mouth and nose. They have crypts that increase surface area for protection. Infected tonsils can act as sites of infection.
The document discusses the anatomy of the tonsils and oropharynx. It describes the location and structures of the oropharynx, including the soft palate, palatoglossal arch, and palatopharyngeal arch. It then discusses the four main tonsil groups - the palatine, adenoid, tubal, and lingual tonsils - which make up Waldeyer's ring. Specifically, it describes the location of the palatine tonsils between the palatoglossal and palatopharyngeal arches, and their blood supply, nerve innervation, and histological structure.
This document provides product descriptions and specifications for various medical devices used in laparoscopic surgery, including:
1. Trocars which provide safe entry into the abdominal cavity and come in various styles such as bladed, bladeless, and Hasson.
2. Endo bags which aid in the safe capture and removal of surgical specimens.
3. Clamp forceps, unipolar scissors, and laparoscopic electrodes which are used to grasp, cut, and coagulate tissue during surgery.
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The document summarizes various aspects of modern tonsillectomy procedures including:
1) The history of tonsillectomy techniques from ancient times to the present.
2) Common indications for tonsillectomy such as recurrent infections, airway obstruction, and sleep disorders.
3) Innovative techniques used in recent decades like intracapsular tonsillectomy and the use of harmonic scalpels, lasers, and coblation.
4) Adjuvant therapies used like local anesthetics, steroids, and antibiotics to reduce postoperative pain and recovery time.
This document summarizes the history, indications, techniques, and adjuvant therapies for tonsillectomy. It discusses the evolution of tonsillectomy from ancient techniques using fingers and knives to modern methods utilizing instruments like the tonsillotome. Key indications for tonsillectomy outlined include recurrent infection, sleep disorders, and airway obstruction. Innovative techniques described are intracapsular tonsillectomy using microdebriders or lasers, as well as coblation and harmonic scalpel methods. Studies show these new techniques reduce postoperative pain and recovery time compared to electrocautery. Adjuvant therapies explored are local anesthetics like bupivacaine and perioperative steroids like dexamethas
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Tonsillectomy is the surgical removal of the palatine tonsils. It is indicated for recurrent throat infections, tonsillitis causing medical issues, or enlarged tonsils obstructing breathing.
Pre-operative assessment involves evaluating the patient's medical history, examining the throat, and in some cases checking coagulation or doing a sleep study. Certain conditions like bleeding disorders or Down syndrome require special pre-operative management.
The surgery involves using various techniques like dissection and snare to separate the tonsils from surrounding tissue and remove them. Post-operative care focuses on pain management, diet, hygiene and watching for potential complications like bleeding or infection. Newer techniques aim to reduce morbidity through less invasive procedures
This document discusses airway management in anesthesia. It provides statistics on the use of different airway devices in the UK. It then discusses predictors of difficult intubation and grades of laryngeal views. Alternative airway devices that can be used for difficult intubation are presented such as the Airtraq, LMAs, and intubating LMA. Failure rates for different airway procedures in routine and emergency cases are summarized. It emphasizes that in difficult cases, changing the approach rather than repeated attempts at the same technique is important. The document stresses having an explicit strategy rather than just a plan for managing difficult airways and airway emergencies. It concludes by noting the importance of airway management training to reduce complications.
This study aims to systematically compare and
contrast the two most commonly used techniques of
tonsillectomy- Cold tonsillectomy and cobilation tonsillectomy.
Three different age group of patients were examined and
operated. The total number of patients was 104. There were 52
patients each of cobilation and cold tonsillectomy. The
specifications being following: 35 patients of age between 3 to 7
years, 6 patients of age 7-12 years and 11 patients of age greater
than 12 years.
The result of this study showed that there is no significant and
noticeable difference between the two procedures of operating
tonsils. However slight differences in the post operative pain and
primary and secondary bleeding was seen. The operation time
was considerably lower in patients of younger age.
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coblation tonsillectomy. is it superior to cold steel method?ahmedmhoder
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This document discusses the anesthetic challenges of performing thyroidectomy for a patient with a large retrosternal goiter. It outlines the preoperative evaluation and planning required, including airway assessment, optimization of thyroid function, and involvement of a multidisciplinary team. Specific challenges addressed are potential for difficult intubation, intraoperative blood loss and cardiovascular compromise, postoperative tracheomalacia, and recurrent laryngeal nerve injury. Careful preparation and perioperative management are needed for a successful outcome in these high-risk cases.
Laparoscopic colectomy was slow to gain acceptance compared to laparoscopic cholecystectomy due to concerns over its steep learning curve, costs, operating time, and whether it could achieve the same oncological outcomes as open surgery. While short-term benefits like less blood loss, faster recovery, and lower morbidity have been shown, long-term oncological data is still lacking and conversion rates are high, particularly for rectal resections. Randomized trials show no differences in short-term outcomes or quality of life, but higher positive circumferential resection margin rates for laparoscopic anterior resection.
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This document summarizes the structure and leadership of the Council of Graduate Students (COGS) at the University of Minnesota. It provides an overview of COGS executive committee members and council chairs. It also lists open positions, upcoming elections, and topics to be discussed in reports at the COGS General Assembly meeting on September 20, 2006.
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2. History
Indications
Innovative Techniques and Comorbidites
Intracapsular tonsillectomy
Harmonic scalpel
Laser
Coblation
Adjuvant Therapy
Local Anesthesia: Bupivacaine
Perioperative Dexamethasone
Postoperative Antibiotics
Current Practice Patterns
3. History
Aulus Cornelius Celsus
1st
Century AD
“the tonsils are loosened by scraping around them and
then torn out” with a finger
Used vinegar and medication for postoperative hemostasis
Aetius of Amida
6th
Century AD
Hook and knife method
Philip Syng Physick (“Father of American surgery”)
First to develop the tonsillotome
Mackenzie
Late 1800s
Made tonsillotome use common
4. Partial versus complete tonsil removal
1906 William Lincoln Ballenger recommended
complete removal of tonsil with the capsule intact
1909 George Ernest Waugh credited as first to
describe complete tonsillectomy
1911-1917 Crowe reviewed 1000 tonsillectomies
Use of Crowe-Davis mouth gag
Sharp dissection
History
5. In U.S.
1959: 1.4 million tonsillectomies performed
1979: 500,000
1985: 340,000
1996: 287,000
In 1950s and 1960s chronic infection primary
surgical indication
Now, airway obstruction and obstructive sleep
apnea more common indications
Improvement in medical management with Abx
History
6. Indications
AAO-HNS
published
guidelines in 1995
Clinical Indicators
Compendium
Tonsillar disease
refractory to
medical therapy
3/+ infections/year
Hypertrophy
Dental malocclusion
Orofacial growth affected
Upper airway obstruction
Dysphagia
Sleep disorders
Cardiopulmonary complications
Peritonsillar abscess
Halitosis due to chronic tonsillitis
Chronic/recurrent tonsillitis with Strep
carrier state
Unilateral hypertrophy, presumed
neoplasm
American Academy of Otolaryngology-Head and Neck Surgery: 1995 Clinical indicators
compendium, Alexandria, Virginia, 1995, American Academy of Otolaryngology-Head and Neck
Surgery
7. Indications
Paradise et al, 1984
Parallel randomized and
non-randomized clinical
trials to evaluate the
efficacy of tonsillectomy in
the pediatric population
with recurrent pharyngitis
8. Criteria
7/+ episodes in last 1 year
5/+ episodes in last 2 years
3/+ episodes in last 3 years
Clinical features of each episode
Fever
Lymphadenopathy
Tonsillar/pharyngeal exudate
Positive ß-hemolytic streptococcus test
Medically treated
Paradise et al
9. Paradise conclusions
Tonsillectomy was efficacious for 2 years and
possibly a third in reducing frequency and
severity of subsequent episodes
Paradise criteria adopted by many
otolaryngologists
Paradise et al
10. Paradise et al, 2002
2 parallel randomized controlled trials to evaluate
efficacy of tonsillectomy in moderately affected
children
Surgical criteria not as stringent as those in previous
study
Results
Incidence of subsequent pharyngitis in surgical groups
significantly lower than control group for 3 years
postoperatively
However, overall incidence of recurrence was low
Concluded that surgical criteria must remain stringent
14. Statistically significant results
Intracapsular group had lower pain scores at each postoperative
time interval: POD 1-3, 4-6,7-9, after 9
Intracapsular group had earlier return to normal activity
Intracapsular group had less analgesic use
Conclusions
Tonsil capsule is not violated thereby avoiding pharyngeal muscle
exposure to secretions, injury, and inflammation
As a result, postoperative pain and recovery time reduced
Weaknesses
Retrospective study: Recall bias
Tonsillar regrowth
Surgical experience
Koltai et al.
15. Sorin et al., 2004
Retrospective review with follow up (278)
11 Complications (3.9%)
9 with tonsillar regrowth with snoring
2 required completion tonsillectomy
1 with immediate self-limited bleeding
1 with delayed bleeding
Complications of Intracapsular
Tonsillectomy
16. Sorin A et al: Complications of microdebrider-assisted powered intracapsular tonsillectomy
and adenoidectomy. Laryngoscope 114:297-300, 2004.
Sorin et al.
17. Intracapsular Tonsillectomy in
Children Under 3 Years
Bent et al., 2004
Retrospective cohort
study (226)
36 patients < 36 mo
186 patients > 36
mo
Bent et al: Ambulatory powered intracapsular tonsillectomy and adenoidectomy in children
younger than 3 years. Arch Otolaryngol Head Neck Surg 130:1197-1200, 2004.
18. Conclusions
Intracapsular tonsillectomy is safe and
efficacious in children under 3 years for
tonsillar hypertrophy and sleep disordered
breathing without need for admission
Limitations
Retrospective study
Uneven distribution
Long term results of tonsillar regrowth
unknown
Bent et al.
19. Harmonic Scalpel Tonsillectomy
Ultrasonic dissector and coagulator
Vibratory energy
Cutting: sharp blade with frequency of 55.5
kHz over distance of 80 μm
Coagulating: vibration breaks H-bonds,
thermal energy
50° – 100° C
Electrocautery 150° – 400° C
20. Willging et al., 2003
Single-blind, randomized prospective study (117)
Harmonic scalpel versus electrocautery
Indications: recurrent infection and hypertrophy with
airway obstruction
Outcomes measured: intraoperative bleeding,
operative time, postoperative hemorrhage
Questionnaire used for assessment of postop pain,
ability to eat and drink, and level of activity
Harmonic Scalpel Tonsillectomy
21. Operative time statistically significant
Harmonic scalpel 8 min 42 sec
Electrocautery 4 min 33 sec
No significant difference in intraoperative blood
loss and postoperative ability to eat and drink
Level of activity for the first postop day
significantly lower in harmonic scalpel group
Postoperative pain scores tended to be lower in
harmonic scalpel group
Postoperative bleeding
Harmonic scalpel: 6
Electrocautery: 3
Not statistically significant
Willging et al
22. Laser Tonsillectomy
Kothari et al, 2002
Prospective double-blind randomized controlled trial
(151)
Compare the use of KTP laser tonsillectomy versus cold
dissection and snare
KTP 532 laser at 10W, continuous beam
Outcomes measured
Operative time
Operative bleeding
Postoperative pain
Postoperative advancement to diet
23. Results
Operative time:
Laser 12 min
Dissection 10 min
Not statistically significant
Intraoperative blood loss
Laser 20 mL
Dissection 95 mL
Statistically significant
Laser group with higher postop pain scores
Laser group with greater difficulty resuming postoperative diet
Readmission for delayed hemorrhage was 8% in the laser group
and 4% in the dissection group
Not statistically significant
Kothari et al
24. Kothari et al
Kolthari P et al: A prospective double-blind randomized controlled trial comparing the
suitability of KTP laser tonsillectomy with conventional dissection tonsillectomy for day
case surgery. Clin. Otolaryngol. 27:369–373, 2002.
25. Conclusion
KTP laser provides little benefit over
dissection tonsillectomy except to minimize
intraoperative bleeding
Limitations
Technical expertise
Electrocautery not included
Kothari et al
26. Coblation Tonsillectomy
Bipolar radiofrequency energy transferred to
sodium molecules to create an ion or plasma
field
This thin layer of plasma is utilized to ablate
tissues at molecular level
No need for electrocautery for hemostasis
Temperature from 40° to 85° C
Electrocautery at 20W: above 400° C
27. Chang et al, 2005
Prospective randomized double-blinded
controlled study (101)
Compared intracapsular tonsillectomy using
coblation versus traditional subcapsular
tonsillectomy in children
OSA
Sleep disordered breathing
Coblation Tonsillectomy
28. Coblation
From surface out laterally
Coblate 9 setting to ablate tissues
Coblate 5 setting to coagulate
Capsule not penetrated
Electrocautery
Bovie set to 20 W
Outcomes measured
Questionnaire
Pain
Analgesics
Nausea/vomiting
Diet
Activity
Complications
Chang et al
29. Chang et al
Chang KW: Randomized controlled trial of coblation versus electrocautery tonsillectomy.
Otolaryngol Head Neck Surg 132:273-280, 2005.
30. Chang et al
Chang KW: Randomized controlled trial of coblation versus electrocautery tonsillectomy.
Otolaryngol Head Neck Surg 132:273-280, 2005.
31. Chang et al
Chang KW: Randomized controlled trial of coblation versus electrocautery tonsillectomy.
Otolaryngol Head Neck Surg 132:273-280, 2005.
32. Chang et al
Chang KW: Randomized controlled trial of coblation versus electrocautery tonsillectomy.
Otolaryngol Head Neck Surg 132:273-280, 2005.
33. Weaknesses
Study compares intracapsular technique with
subcapsular technique
Capsule and therefore underlying pharyngeal tissues not
violated
Does not account for possible long term possibility of
tonsillar regrowth
Similar study performed by Chan et al, 2004
Stoker et al, 2004 performed similar study but
used coblation for blunt dissection to perform
total tonsillectomy
Chan and Stoker had similar results in reduction
of postoperative morbidity
Chang et al
34. Coblation Tonsillectomy
Future considerations
To evaluate coblation for
intracapsular tonsillectomy,
a fair study would use
another intracapsular
technique such as power-
assisted tonsillectomy with
a microdebrider
35. Adjuvant Therapies
Aims are to reduce comorbidities of
tonsillectomy
Reduce pain
Reduce nausea
Resume diet
Resume activity
Reduce overall postoperative cost
Local Anesthetic: Bupivacaine
Steroids: Dexamethasone
Postoperative Antibiotics
36. Local Anesthetic
Tonsils innervated by:
Tonsillar branches of glossopharyngeal nerve
Palatine nerves of V2
Lingual branches of V3
Bupivacaine: amide anesthetic
High lipid solubility and protein binding
Rapid onset with effect lasting 6-9 hours
37. Violaris and Tuffin, 1989
Prospective double-blind controlled trial to
evaluate the application of topical bupivacaine
versus saline following tonsillectomy in the
same patient
The side treated with bupivacaine had higher
pain scores than saline
Local Anesthetic
38. Nordahl et al, 1999
Prospective double-blind randomized trial with three
treatment arms, intraoperative injections
42 with saline (9mg/ml)
41 with saline (9mg/ml) and epinephrine (5μg/ml)
43 with bupivacaine (2.5mg/ml) and epinephrine (5μg/ml)
Injections in tonsillar pillars and uvula
Postoperative pain scores recorded at varying
intervals
Varying experience of otolaryngologist performing
injection and tonsillectomy
Local Anesthetic
39. Nordahl et al
Nordahl SHG, Albrektsen G, Guttormsen AB, Pedersen IL, Breidablikk H-J. Effect of bupivacaine on
pain after tonsillectomy: a randomized clinical trial. Acta Otolaryngol (Stockh) 119:369–376, 1999.
40. Results
Only statistically significant pain score was with
swallowing (without food) in the bupivacaine and epi
group
Patients treated by experienced otolaryngologist in
the bupivacaine and epi group had lowest pain scores
Patients treated by less experienced otolaryngologists
in the bupivacaine and epi group had highest pain
scores
No difference in analgesic consumption among
groups
Limitations
Technique not specified for tonsillectomy
Number of patients treated by experienced or less
experienced otolaryngologists not specified
Nordahl et al
41. Kountakis et al, 2002
Prospective randomized blinded and
controlled study in adults (34)
10 mL 0.5% bupivacaine vs 10 mL NS
Electrocautery tonsillectomy
Daily questionnaires for 10 days
Pain score
Analgesic required
Oral intake
Local Anesthetic
42. Kountakis SE: Effectiveness of Perioperative Bupivacaine
Infiltration in Tonsillectomy Patients. Am J Otolaryngol 23:76-80,
2002.
Kountakis et al
43. No significant difference in pain, analgesic
use and oral intake among groups
Bupivacaine group more comfortable in
initial period following tonsillectomy
Significant variation in pain score when
bupivacaine wore off
Kountakis et al
44. Intraoperative Steroids
Systemic corticosteroids known
for mood elevation, appetite
stimulation, anti-inflammatory and
antiemetic effect
Used during chemotherapy to treat
nausea
Exact antiemetic mechanism
unknown
Dexamethasone
Half-Life 36 – 72 hours
Low cost $0.25/4mg
45. Steward et al, 2001
Meta-analysis of 8 double-blinded randomized
controlled trials using dexamethasone for
children undergoing tonsillectomy
Outcomes measured
Postoperative emesis
Return to soft or solid diet
Postoperative pain
Single dose 0.15 – 1.0 mg/kg
Sensitivity analyses performed
Intraoperative Dexamethasone
46. Steward et al
Steward et al: Do steroids reduce morbidity of tonsillectomy? Meta-analysis of randomized
trials. Laryngoscope 111:1712-1718, 2001.
47. Postoperative pain was not analyzed
Missing data and different measurements
No adverse events from Dexamethasone
Strength
Sensitivity analyses
Dose recommended 1 mg/kg
Weakness
Cannot be generalized to adult population
Steward et al
48. Carr et al, 1999
Double-blind randomized controlled trial (34)
Adults undergoing electrocautery
tonsillectomy
Dexamethasone (20mg) vs. saline
Outcomes measured
Postoperative pain
Analgesic use
Intraoperative Dexamethasone
49. Carr et al
Carr MM et al: Effect of steroids on posttonsillectomy pain in adults. Arch
Otolaryngol Head Neck Surg 125:1361-1364, 1999.
A
M
P
M
C
o
d
e
i
n
e
A
c
e
t
a
m
50. Although the dexamethasone group had
lower pain scores this was not statistically
significant
No difference in groups for number of
days off of work or to return to normal diet
Dexamethasone group tended to require
less analgesia but not statistically
significant for 10 days postoperatively
Carr et al
52. Telian et al, 1986
Randomized controlled trial to evaluate the
effect of ampicillin on recovery from
tonsillectomy in children
Ampicillin group had significantly fewer fevers,
improved oral intake, and had fewer days to
return to normal activity
Postoperative Antibiotics
53. Colreavy et al, 1999
Randomized controlled trial in children(78)
Amoxicillin/clavunanic acid
Outcomes measured:
Bacterial profiles
Postoperative pain scores
Days to normal diet
Analgesic use
Postoperative Antibiotics
54. Colreavy et al
Colreavy MP et al: Antibiotic prophylaxis post-tonsillectomy: is it of benefit? Int J Ped Otorhino
50:15-22, 1999.
55. O’Reilly et al, 2003
Randomized double-blinded controlled trial of the
effect of antibiotics in adults following tonsillectomy
Study group given intraoperative and postoperative
antibiotics while control group did not receive any
Outcomes measured
Postoperative bleeding
Postoperative pain
If PCP was contacted following surgery for pain/antibiotics
Postoperative Antibiotics
56. Results
Antibiotic administration had no influence on
postoperative pain and bleeding in adults
Weaknesses
Tonsillectomy technique not standardized
Recall bias
Patients questioned at follow-up or by mailed questionnaire
High drop out rate
High delayed hemorrhage in both groups (24%)
O’Reilly et al
57. Current Practice Patterns
In 2004, Krishna et al. conducted a 13
question survey of AAO-HNS members
regarding tonsillectomy (418)
Experience
Technique, and why
Local anesthetic
Perioperative steroids, and why
Postoperative antibiotics, and why
58. Krishna P et al: Current practice patterns in tonsillectomy and perioperative care. Int J of Ped
Otorhinolaryngology 68:779-784, 2004.
Krishna et al.
59. Technique
Monopolar electrocautery used most often
Greatest for otolaryngologists in practice < 20 years
Hemostasis
Sharp dissection most common for group in
practice > 20 years
Decreased pain
Method of hemostasis not mentioned
Local Anesthetic evenly distributed
Krishna et al.
60. Steroids
Most respondents used steroids
Decreased pain
Decreased nausea
Decreased swelling
Those in practice > 20 years less likely
Postoperative Antibiotics
Decreased pain
Decreased infection/inflammation
Faster Healing
Krishna et al.
61. Conclusions
Tonsillectomy is a surgical procedure that
carries significant postoperative morbidity
To minimize postoperative morbidity
various techniques and adjuvant therapies
have been studied
There are many options available and it
behooves an otolaryngologist to stay as
up to date as possible
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