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Letters to the Editor
March 2005

Tonsillectomy Techniques—Reply

Arch Otolaryngol Head Neck Surg. 2005;131(3):279-280. doi:10.1001/archotol.131.3.279-b

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.

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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
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Mann  DSt George  CSchiener  E  et al.  Tonsillectomy: some like it hot.  Laryngoscope 1984;94677- 679PubMedGoogle ScholarCrossref
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Weimert  TBabyak  J Electrodissection tonsillectomy.  Arch Otolaryngol Head Neck Surg 1990;116186- 188PubMedGoogle ScholarCrossref
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Nunez  DAProvan  JCrawford  M Postoperative tonsillectomy pain in pediatric patients.  Arch Otolaryngol Head Neck Surg 2000;126837- 841PubMedGoogle ScholarCrossref
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