Evaluation of post‐tonsillectomy hemorrhage and risk factors

Abstract

Otolaryngology-Head and Neck Surgery August 1999 Methods: The patient sample for this study consisted of 50 consecutive patients who presented to a private otolaryngology practice who were diagnosed with chronic rhinosinusitis using standard AAO-HNS criteria. All patients were examined with nasal endoscopy in the office at one of their first two visits and were included in the sample if they met the appropriate criteria. These patients all completed the Rhinosinusitis Disability Index (RSDI) and a symptom questionnaire at their initial visit. They all had coronal CT scans of their sinuses, which were blindly staged using the Lund-Mackay system. Allergy testing was done in all patients using serial endpoint titration (SET) as the method for testing. Endpoints were assessed on each of 18 antigens and were used for data analysis. Results: The results of the study demonstrated a mean CT stage among patients with chronic rhinosinusitis of 4.0, with a range of 0 to 18. As had been previously noted, there was no significant correlation between CT stage and quality of life as assessed by the 3 subscales of the RSDI. Of these 50 patients, all had at least one significant endpoint of 2 or higher on SET testing, demonstrating some degree of allergy among all patients presenting with symptoms of chronic sinusitis. There was no significant correlation, however, between CT stage and allergy as assessed by any of the 18 antigens or the overall SET mean. A small but significant correlation was noted between SET scores and quality of life as assessed by the RSDI. Conclusion: These findings demonstrate no association between CT stage and quality of life, confirming findings of previous researchers. In addition, there was no correlation between CT stage and severity of allergic disease. There was, however, an association between SET results and quality of life. Patients with more severe allergic disease were more impaired in their specific quality of life than those with milder disease. These findings support prior research demonstrating the association between quality-of-life impairment and allergic rhinitis. The presence of allergic disease appears to be a better indicator of impaired quality of life among patients with chronic rhinosinusitis than are CT findings. These findings support the need for careful evaluation of allergic disease among patients with chronic rhinosinusitis.

Tonsilar haemorrhage and re-admission: a questionnaire based study

“…With regard to the indication of tonsil surgery recurrent/ chronic tonsillitis is the most common [5,7], whereas upper airway obstruction, or tonsil hypertrophy as stated in our study, is the most frequent indication for children [11,12]. The type of operation appeared to be less frequent for tonsillectomy with or without adenoidectomy in children younger than 6 years.…”

“…Major reasons for this tremendous disparity are varying deWnitions of "postoperative bleeding" and the way how bleeding episodes were assessed. Concerning the deWnition of postoperative bleeding rates, some authors deWne haemorrhage as any bleeding that lead to re-admission [5]; others constitute haemorrhage as bleeding requiring surgical treatment under general anaesthesia [6]; and some even do not provide any deWnition of the term "haemorrhage" [7,8]. Regarding the study design, the majority of authors have recorded hospital re-admission as a benchmark for posttonsillectomy haemorrhage rates.…”

Surgery for Cervicofacial Nontuberculous Mycobacterial Adenitis in Children<subtitle>An Update</subtitle>

“…5 The adult posttonsillectomy hemorrhage rate in the literature ranges from 1.5% to 18%, with most in agreement on a rate between 3% and 6%. [6][7][8][9][10][11][12][13] Less than half these cases require returns to the operating room, 2 and death secondary to postoperative hemorrhage is rare at 0.007%. 5 Although the percentage of posttonsillectomy hemorrhage is low, it can be traumatic for the patient who undergoes cauterization under local anesthesia or the patient who receives a subsequent general anesthetic.…”

A Comparative Study of Cold Knife Adenotonsillectomy and Coblation Adenotonsillectomy

“…In several studies upper airway obstruction and OSA have shown serious effects with disruption of school performance, and aggressive behaviour. A study by Susan L. Garetz, Ann Arbor [15] in 2008 assessed behaviour, cognition and quality of life in pediatric children with sleep disordered breathing after Adenotonsillectomy in 25 studies. Stewart et al reported [16] disease-specific Quality of Life with the Tonsil and Adenoid Health Status Instrument and global Quality of Life using the CHQPF -28 (Children's Health Questionnaire Parent Form) in 47 children with suspected Obstructive sleep disorders and showed that there was considerable improvement in behavior, polysomnography and quality of life post-surgery.…”