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Tonsillectomy Techniques—Reply

Tonsillectomy Techniques—Reply In reply We thank Lipman for his interest in our article and for his comments. We chose to perform “cold tonsillectomy” with directed electrocautery for hemostasis in our series as we feel that this is the most common method of cold tonsillectomy performed in the United States today, as Lipman alludes to in his letter. This would make our results applicable to the greatest number of practicing otolaryngologists. Even with directed electrocautery, which Lipman writes results in more pain compared with suture ligation of bleeding points, our results demonstrate significantly reduced pain in patients who receive a single perioperative intravenous dose of 1 mg/kg dexamethasone. A review of the literature was recently performed by Leinbach et al1 addressing the results of hot vs cold tonsillectomy. Six prospective studies1-6 have been performed between 1984 and 2001. Of these, 4 of the studies1,3,4,6 included cold tonsillectomies performed with directed electrocautery for hemostasis, and 2 of the studies2,5 included cold tonsillectomies performed with suture ligation of bleeders. Regardless of the technique used for hemostasis (and regardless of the technique used for dissection, hot or cold), there was no meaningful difference in the rate of primary or secondary postoperative bleeding. Intraoperative blood loss and operative time have been shown to be decreased in patients who undergo tonsillectomy with monopolar electrocautery dissection, and pain is decreased in patients who undergo sharp dissection, regardless of whether bleeding is controlled with suture ligation or directed electrocautery. Back to top Article Information Correspondence: Dr Messner, Department of Otolaryngology/Head & Neck Surgery, Stanford School of Medicine, 801 Welch Rd, Palo Alto, CA 94305 (amessner@stanfordmed.org). References 1. Leinbach RFMarkwell SJColliver JALin SY Hot versus cold tonsillectomy: a systematic review of the literature. Otolaryngol Head Neck Surg 2003;129360- 364PubMedGoogle ScholarCrossref 2. Mann DSt George CSchiener E et al. Tonsillectomy: some like it hot. Laryngoscope 1984;94677- 679PubMedGoogle ScholarCrossref 3. Weimert TBabyak J Electrodissection tonsillectomy. Arch Otolaryngol Head Neck Surg 1990;116186- 188PubMedGoogle ScholarCrossref 4. Tay H Post-operative morbidity in electrodissection tonsillectomy. J Laryngol Otol 1995;109209- 211PubMedGoogle Scholar 5. Wexler DB Recovery after tonsillectomy: electrodissection versus sharp dissection techniques. Otolaryngol Head Neck Surg 1996;114576- 581PubMedGoogle ScholarCrossref 6. Nunez DAProvan JCrawford M Postoperative tonsillectomy pain in pediatric patients. Arch Otolaryngol Head Neck Surg 2000;126837- 841PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 2005 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.131.3.279-b
Publisher site
See Article on Publisher Site

Abstract

In reply We thank Lipman for his interest in our article and for his comments. We chose to perform “cold tonsillectomy” with directed electrocautery for hemostasis in our series as we feel that this is the most common method of cold tonsillectomy performed in the United States today, as Lipman alludes to in his letter. This would make our results applicable to the greatest number of practicing otolaryngologists. Even with directed electrocautery, which Lipman writes results in more pain compared with suture ligation of bleeding points, our results demonstrate significantly reduced pain in patients who receive a single perioperative intravenous dose of 1 mg/kg dexamethasone. A review of the literature was recently performed by Leinbach et al1 addressing the results of hot vs cold tonsillectomy. Six prospective studies1-6 have been performed between 1984 and 2001. Of these, 4 of the studies1,3,4,6 included cold tonsillectomies performed with directed electrocautery for hemostasis, and 2 of the studies2,5 included cold tonsillectomies performed with suture ligation of bleeders. Regardless of the technique used for hemostasis (and regardless of the technique used for dissection, hot or cold), there was no meaningful difference in the rate of primary or secondary postoperative bleeding. Intraoperative blood loss and operative time have been shown to be decreased in patients who undergo tonsillectomy with monopolar electrocautery dissection, and pain is decreased in patients who undergo sharp dissection, regardless of whether bleeding is controlled with suture ligation or directed electrocautery. Back to top Article Information Correspondence: Dr Messner, Department of Otolaryngology/Head & Neck Surgery, Stanford School of Medicine, 801 Welch Rd, Palo Alto, CA 94305 (amessner@stanfordmed.org). References 1. Leinbach RFMarkwell SJColliver JALin SY Hot versus cold tonsillectomy: a systematic review of the literature. Otolaryngol Head Neck Surg 2003;129360- 364PubMedGoogle ScholarCrossref 2. Mann DSt George CSchiener E et al. Tonsillectomy: some like it hot. Laryngoscope 1984;94677- 679PubMedGoogle ScholarCrossref 3. Weimert TBabyak J Electrodissection tonsillectomy. Arch Otolaryngol Head Neck Surg 1990;116186- 188PubMedGoogle ScholarCrossref 4. Tay H Post-operative morbidity in electrodissection tonsillectomy. J Laryngol Otol 1995;109209- 211PubMedGoogle Scholar 5. Wexler DB Recovery after tonsillectomy: electrodissection versus sharp dissection techniques. Otolaryngol Head Neck Surg 1996;114576- 581PubMedGoogle ScholarCrossref 6. Nunez DAProvan JCrawford M Postoperative tonsillectomy pain in pediatric patients. Arch Otolaryngol Head Neck Surg 2000;126837- 841PubMedGoogle ScholarCrossref

Journal

Archives of Otolaryngology - Head & Neck SurgeryAmerican Medical Association

Published: Mar 1, 2005

References