Tonsillectomy Indications and Complications: 10 Years of Experience

Abstract

Objective: In this study, tonsillectomy indications and post-tonsillectomy complications were discussed in the light of the literature. Material and Method: A retrospective file review of 775 patients who underwent tonsillectomy was performed between January 2014 and January 2024. Demographic data, preoperative indications, perioperative and postoperative complications of the patients were accessed from hospital records. Results: Of the 775 patients who underwent tonsillectomy, 459 (59.2%) were male and 316 (40.8%) were female. Of the 630 pediatric patients, 404 (64.1%) were operated on for obstruction, 209 (33.1%) for recurrent tonsillitis, 11 (1.7%) for suspected malignancy, and 6 (0.9%) for Periodic Fever-Aphthous-Stomatitis-Pharyngitis-Adenitis (PFAPA) Syndrome. Of the 145 adult patients, 67 (46.2%) were operated on for recurrent tonsillitis, 39 (26.9%) for obstruction, 32 (22.1%) for suspected malignancy, 4 (2.7%) for peritonsillar abscess, and 3 (2.1%) for chronic caseous tonsillitis. In the postoperative period, bleeding was detected in 18 (2.8%) of 630 pediatric patients and oral intake disorder was detected in 4 (0.6%). Postoperative bleeding complications were observed in 15 (10.3%) of 145 adult patients. Conclusion: In our study, obstruction was seen as the primary indication for surgical intervention in the pediatric patient group, while infectious causes were seen in the adult patient group. The most common complication was bleeding. Tonsillectomy is an operation in which good planning of surgical indications and good postoperative follow-up are important.

Keywords

• Tonsillectomy
• indication
• complication
• bleeding.

Tonsillektomi Endikasyon ve Komplikasyonları: 10 Yıllık Deneyim

Abstract

Amaç: Tonsillektomi, Kulak Burun Boğaz hekimlerinin en sık uyguladığı ameliyatlardandır. Bu çalışmada, tonsillektomi endikasyonları, tonsillektomi sonrası görülen komplikasyonlar literatür eşliğinde tartışıldı Yöntem ve Gereç: Ocak 2014 ile Ocak 2024 arasında bademcik ameliyatı geçiren 775 hastanın retrospektif dosya incelemesi yapıldı. Hastaların demografik verilerine, ameliyat öncesi endikasyonlarına, ameliyat sırasındaki ve ameliyat sonrası komplikasyonlara hastane kayıtlarından ulaşıldı. Bulgular: Tonsillektomi yapılan 775 hastanın 459’u (%59,2) erkek, 316’sı (%40,8) kadın idi. 630 pediatrik hastanın 404’ü (%64,1) obstrüksiyon, 209’u (%33,1) rekürren tonsillit, 11’i (%1,7) malignite şüphesi ve 6’sı (%0,9) PFAPA sendromu nedeniyle opere edildiği saptanmıştır. Yetişkin 145 hastanın 67’si (%46,2) rekürren tonsillit, 39’u (%26,9) obstrüksiyon, 32’si (%22,1) malignite şüphesi, 4’ü (%2,7) peritonsiller apse ve 3’ü (%2,1) kronik kazeöz tonsillit nedeniyle opere edildiği saptanmıştır. 630 pediatrik hastanın 18’inde (%2,8) kanama ve 4’ünde (%0,6) oral alım bozukluğu saptanmıştır. Sonuç: Çalışmamızda pediatrik hasta grubunda obstrüksiyon, yetişkin hasta grubunda enfeksiyöz nedenlerin operasyon endikasyonları arasında ilk sırada olduğu görülmüştür. Komplikasyonlardan da kanama daha sık saptanmıştır. Bu ameliyatın, cerrahi endikasyonun iyi planlanmasının ve postoperatif takibin iyi yapılmasının önemli olduğu operasyonlardan biri olduğunu düşünüyoruz.

Keywords

• Tonsillektomi
• endikasyon
• komplikasyon
• kanama.

References

1. Lock C, Wilson J, Steen N, Eccles M, Brittain K, Carrie S, et al. Childhood tonsillectomy: who is referred and what treatment choices are made? Baseline findings from the North of England and Scotland Study of Tonsillectomy and Adenotonsillectomy in Children (NESSTAC). Arch Dis Child. 2010;95(3);203-208. doi: 10.1136/adc.2009.165530.
2. Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. Natl Health Stat Report. 2009;28(11):1-25.
3. Baugh RF, Archer SM, Mitchell RB, Rosenfeld RM, Amin R, Burns JJ, et al. Clinical practice guideline: tonsillectomy in children Otolaryngol Head Neck Surg. 2011;144(1):S1-S30. doi: 10.1177/0194599810389949.
4. Inuzuka Y, Mizutari K, Kamide D, Sato M, Shiotani A. Risk factors of post-tonsillectomy hemorrhage in adults Laryngoscope Investig Otolaryngol. 2020;5(6):1056-1062. DOI: 10.1002/lio2.488.
5. Darrow DH, Siemens C. Indications for tonsillectomy and adenoidectomy. Laryngoscope 2002;112(8 Pt 2 Suppl 100):6-10. doi: 10.1002/lary.5541121404.
6. Paradise JL, Bluestone CD, Bachman RZ, D K Colborn, B S Bernard, F H Taylor, et al. Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials. N Engl J Med 1984;310(11):674-83. doi: 10.1056/NEJM198403153101102.
7. Alvo A, Hall A, Johnston J, Mahadevan M. Paediatric Posttonsillectomy Haemorrhage Rates in Auckland: A Retrospective Case Series. Int J Otolaryngol. 2019;6:4101034. doi: 10.1155/2019/4101034.
8. Torres BPG, García FDM, Orozco JW. Tonsillectomy in adults: Analysis of indications and complications. Auris Nasus Larynx. 2018:45(3);517-521. doi: 10.1016/j.anl.2017.08.012.

9. Rohlfing ML, Wistermayer PR, Bungo TM, Mims JW, Kirse DJ. Investigation of Postoperative Oral Fluid Intake as a Predictor of Postoperative Emergency Department Visits After Pediatric Tonsillectomy. JAMA Otolaryngol Head Neck Surg. 2016;142(4):357-363. doi: 10.1001/jamaoto.2015.3711.
10. Chen JW, Liao PW, Hsieh CJ , Chen CC, Chiou SJ. Factors associated with changing indications for adenotonsillectomy: A population-based longitudinal study. Plos One. 2018:13(5):e0193317.
11. Derkay CS. Pediatric otolaryngology procedures in the United States: 1977–1987. Int J Pediatr Otorhinolaryngol. 1993: ;25(1-3):1-12. doi: 10.1016/0165-5876(93)90004-m.
12. Rosenfeld RM, Green RP. Tonsillectomy and adenoidectomy: changing trends. The Ann Otolaryngol. 1990:99;187–91.
13. Erickson BK, Larson DR, Sauver JLS, Meverden RA, Orvidas LJ. Changes in incidence and indications of tonsillectomy and adenotonsillectomy, 1970-2005. Otolaryngol Head Neck Surg. 2009:140(6);894-901. doi: 10.1016/j.otohns.2009.01.044.
14. Ahmed AO, Aliyu I, Kolo ES. Indications for tonsillectomy and adenoidectomy Our experience. Niger J Clin Pract. 2014;17(1):90-94. doi: 10.4103/1119-3077.122855.
15. Beaty MM, Funk GF, Karnell LH, Graham SM, McCulloch TM, Hoffman HT, et al. Risk factors for malignancy in adult tonsils. Head Neck.1998;20(5):394-403. doi: 10.1002/(sici)1097-0347(199808)20:5<399::aid-hed7>3.0.co;2-t.
16. Erdag TK, Ecevit MC, Guneri EA, Dogan E, Ikiz AO, Sutay S. Pathologic evaluation of routine tonsillectomy and adenoidectomy specimens in the pediatric population: is it really necessary? Int J Pediatr Otorhinolaryngol. 2005;69(10):1321–1325. doi: 10.1016/j.ijporl.2005.05.005.
17. Randall DA, Martin PJ, Thompson LDR. Routine Histologic Examination is Unnecessary for Tonsillectomy or Adenoidectomy. Laryngoscope. 2007;117(9):1600-1604. doi: 10.1097/MLG.0b013e318093ee4e.
18. Garavello W, Romagnoli M, Sordo L, Spreafico R, Gaini RM. Incidence of Unexpected Malignancies in Routine Tonsillectomy Specimens in Children. Laryngoscope. 2004;114(6):1103-1105. doi: 10.1097/00005537-200406000-00027.
19. Tsikopoulos A, Fountarlis A, Tsikopoulos K, Dilmperis F, Garefis K, Tsikopoulos L, et al. Immediate or interval abscess tonsillectomy? A systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2015;279(5):2245-2257. doi: 10.1007/s00405-022-07294-x.
20. Mughal Z, Gupta KK, Yeo JJY, Metcalfe C, Weller M. Blood, Sweat, and Tonsils: Bleeding After Abscess Tonsillectomy for Quinsy-A Meta-Analysis. Laryngoscope. 2024;134(10):4186-4195. doi: 10.1002/lary.31449.
21. Ferguson M, Aydin M, Mickel J. Halitosis and the Tonsils: A Review of Management. Otolaryngol Head Neck Surg. 2014;151(4):567-574. doi: 10.1177/0194599814544881.
22. Osborne MS, Clark MPA. The surgical arrest of post-tonsillectomy haemorrhage: Hospital Episode Statistics 12 years on. Ann R Coll Surg Engl. 2018;100(5):406-408. doi: 10.1308/rcsann.2018.0034.
23. Rasmussen N. Complications of tonsillectomy and adenoidectomy. Otolaryngol Clin North Am. 1987;20(2):383–390.
24. Obiako MN. Speech defects as an unusual complication of adenotonsillectomy. Ear Nose Throat J. 1988;67(10):752–754.
25. McLaughlin KE, Jacobs IN, Todd NW, Gussack GS, Carlson G. Management of nasopharyngeal and oropharyngeal stenosis in children. Laryngoscope. 1997;107(10):1322–1331. doi: 10.1097/00005537-199710000-00006.