Acute pharyngitis, tonsillitis and tonsillectomy

Respiratory infections are the most common group of diseases experienced in the community and treated by doctors. Tonsillitis and pharyngitis, sometimes referred to together as acute sore throat, are among the most common of the individual respiratory infections.     

Subcutaneous emphysema as a complication of tonsillectomy

Subcutaneous emphysema occurs when air is introduced into the tissues. This can happen as a complication during, or immediately after surgery. It has rarely been described after tonsillectomy. Definitive treatment will depend on the cause. We report two cases of subcutaneous emphysema following tonsillectomy.     

Long-term prognosis for tonsillectomy patients with IgA nephropathy

A retrospective study of 85 patients with IgA nephropathy was undertaken to determine the long-term effect of tonsillectomy. Forty-three patients (24 males and 19 females) had received tonsillectomies (Group A) and 42 patients (17 males and 25 females) had not (Group B). These patients had been followed up for more than 5 years after renal biopsy. The average age at the initial renal biopsy was 25.72 years in Group A, and 33.16 years old in Group B. The average period of renal biopsy to tonsillectomy in Group A was 10.47 months. The average follow-up period was 8 years and 9 months in both groups. At the beginning of treatment, the two groups were well matched in terms of creatinine clearance, urinalysis, and blood pressure. Six patients in Group A and eight patients in Group B were treated with steroids. The glomerular injury detected at the renal biopsy was more extensive in Group A than in Group B. Renal function in the two groups was compared. The clinical remission rate in Group A was significantly higher than in group B (P<0.05). The stable renal function rate in Group A was significantly higher than in Group B (P<0.05). The renal survival rate was 97.7% in Group A and 83.3% in Group B, but there was no significant difference between the two groups. Histologically, the rate of remission of the minor lesion in Group A was significantly higher than in Group B (P < 0.05). Our results showed that tonsillectomy for IgA nephropathy was clinically of great value.     

The effect of tonsillectomy on eustachian tube function

A two-part study was designed to investigate the effect of tonsillectomy on eustachian tube function and to identify if any change is related to postoperative pain. Middle ear pressure was measured by tympanometry and results were classified as type A (+50 daPa to -99 daPa), type B (flat) or type C (-100 daPa to -350 daPa). Thirty-one patients with type A tympanograms, undergoing tonsillectomy enrolled in study A. Patients had tympanometry the next day and filled in a questionnaire incorporating visual analogue pain scores. In study B, 30 patients underwent a similar protocol and were followed up at 1 week tympanometry and a questionnaire. A control group of 26 patients undergoing appendicectomy was recruited. Follow-up was available on 23 patients from study B. Combining A and B, on the first postoperative day 39% of patients developed type C tympanograms. No member of the control group developed any change in middle ear pressure. There was no significant relationship between pain scores for throat pain or otalgia and the development of negative middle ear pressure. By day 7 all patients had type A tympanograms. Otalgia was a delayed symptom significantly associated with increased throat pain. Transient negative middle ear pressure commonly occurs following tonsillectomy.     

A review of tonsillectomy for recurrent throat infection

Tonsillectomy is most frequently carried out for recurrent throat infection, but there is uncertainty about its effectiveness. This paper reviews the evidence of its effectiveness obtained from a search of the Cochrane database and MEDLINE for randomized controlled trials comparing tonsillectomy with non-surgical management of recurrent throat infection. The results show that the effectiveness of a procedure such as tonsillectomy, needs to be considered in the light of its adverse effects. Attempts should be made to inform patients about the uncertainty surrounding the procedure.     

Local infiltration of epinephrine and bupivacaine before tonsillectomy

The effects of peritonsillar injections of epinephrine and local anesthetics before tonsillectomy on blood loss and postoperative pain were evaluated in a prospective, randomized double-blind trial on 103 children. Patients were randomly assigned into one of three groups: controls given injections of 0.9% NaCl (n = 34), patients injected with 0.4 ml/kg (1:200,000) epinephrine combined with 0.25% bupivacaine (n = 33) and patients given only 1:200,000 epinephrine (n = 36). All injections and operations were performed by the same surgeon (KS). Blood loss was calculated by weighing all blood aspirated perioperatively and swabs used during surgery. Postoperative pain was assessed at regular intervals by using three methods: (1) use of a visual analogue scale by parents and nurses to estimate pain; (2) postoperative need for nalbuphine as analgesic; (3) the Hannallah-Broadman semi-objective pain score (including crying, anxiety, restlessness, and changes in blood pressure). The mean blood loss in the control group (given NaCl) was 132 g, which was significantly increased when compared with the epinephrine/bupivacaine group (85 g) and the group treated with only epinephrine (90 g). However, analysis of the postoperative pain scores did not reveal any significant differences among groups. These findings indicate that the peritonsillar injection of bupivacaine does not decrease postoperative pain, but peritonsillar injections of epinephrine will significantly reduce blood loss during tonsillectomy.     

The effect of tonsillectomy and adenoidectomy on neutrophil chemotaxis

Although tonsillectomy and adenoidectomy are common surgical procedures, the effects of these operations on the immune system have not been thoroughly determined. Our data on neutrophil chemotaxic functions in a group of 17 patients with chronic tonsillitis and adenoid hypertrophy show that chronic tonsillitis and adenoid hypertrophy impair neutrophil chemotaxic functions and that there is a subsequent normalization of these values following tonsillectomy and adenoidectomy.     

Premedication with oral dextromethorphan reduces postoperative pain after tonsillectomy

The aim of the present study was to examine whether premedication with dextromethorphan, a clinically available N-methyl-D-aspartic acid (NMDA) receptor antagonist, could reduce postoperative pain after tonsillectomy. Thirty-six patients scheduled for elective bilateral tonsillectomy were investigated in a double-blinded, randomized study. The patients were randomly assigned to one of three groups: control, dextromethorphan 30 mg (Dex 30), and dextromethorphan 45 mg (Dex 45) groups. In the control group, premedication was with oral placebo and intramuscular (i.m.) midazolam and atropine. In the Dex 30 and Dex 45 groups, patients were premedicated with i.m. midazolam and atropine and oral dextromethorphan 30 mg and 45 mg, respectively. Pain was evaluated repeatedly throughout 7 postoperative days, at rest and on swallowing, using a self-rating visual analog scale (VAS). The total doses of analgesics administered postoperatively were also recorded. The Dex 45 group showed significantly lower VAS scores than the control group both at rest and on swallowing throughout the 7 days. The total doses of postoperative analgesics in the Dex 45 group were significantly less than those in the control group. The Dex 30 group showed significantly lower VAS scores than the control group at rest, but not on swallowing. These results indicate that premedication with Dex 45 reduces postoperative pain after tonsillectomy, not only at rest but on swallowing. IMPLICATIONS: Recently, it has been suggested that central sensitization caused by the activation of N-methyl-D-aspartic acid receptors may contribute to the postoperative pain. We found that premedication with 45 mg of dextromethorphan, a clinically available N-methyl-D-aspartic acid receptor antagonist, reduced postoperative pain after tonsillectomy.     

Ambulatory tonsillectomy. Is postoperative hemorrhage a risk factor?

The aim of this study was to investigate the usefulness of chemosensory event-related potentials (CSERPs) in response to both olfactory and intranasal trigeminal stimulation in the diagnosis of anosmia. Forty-four patients participated. Gaseous CO2 was used for trigeminal stimulation, vanillin and H2S were used as olfactory stimulants. Event-related potentials to olfactory stimuli could not be obtained in any of the anosmic patients, indicating the complete loss of the sense of smell. However, all patients responded to stimulation of the trigeminal nerve with CO2. These data clearly demonstrate the clinical significance of CSERPs in the assessment of anosmia.     

The effect of post-operative instructions on recovery after tonsillectomy and adenoidectomy

The effect of postoperative diet and activity instructions on the recovery rate after tonsillectomy and adenoidectomy (T & A) was assessed in 92 children ages 3 to 14 years. Two types of postoperative instruction were randomly assigned: 'Restricted', which advised limited, stay at home activities and a soft food liquid diet for 7-10 days, and 'nonrestricted', which advised return to activity and diet as tolerated by the child. Parental evaluation of the levels of pain, activity, and diet using an equal intervals scale was obtained. The number of doses of pain medication, the types of food eaten and postoperative complications were also recorded. No significant differences were found between the two groups in pain level, activity tolerance, return to normal diet, and numbers of doses of pain medication at day 3 and day 7 after surgery. More 'junk' food and spicy foods were eaten in the 'nonrestricted' group. Postoperative hemorrhage requiring intervention occurred in one child in each group. Implications for the children and their families undergoing T & A are discussed with attention to a review of the literature.