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Denise Mann contributed to this report.
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Kids Recover Quicker from Partial Tonsillectomies An old procedure for removing tonsils is gaining new popularity. If your little one snores because his tonsils obstruct his airway, partial tonsillectomy might be just the ticket, according to the American Academy of Otolaryngology Head and Neck Surgery. Researchers at The Children's Hospital at the Cleveland Clinic Foundation studied over 550 children who needed a tonsillectomy because of enlarged tonsils. Half the group had a standard tonsillectomy that consists of removing all of the tonsillar tissue and the tonsillar capsule. The other half had a partial tonsillectomy, which included shaving away a portion of the tonsillar tissue and leaving the capsule, which encases the tonsils, in place. Afterwards, they interviewed the parents. They found that, compared to the standard operation, children who had partial tonsillectomies had less pain, fewer days of pain medication, and fewer days needed to return to normal activities and normal diet. The surgery was a success at relieving sleep apnea — a condition in which patients stop breathing for short periods repeatedly throughout the night — and for children with tonsil infections. Investigators said the two surgeries were similar when comparing blood loss and post-operative complications. They did not study the likelihood of possible tonsil re-growth after partial tonsillectomy. Dale Mazer, M.D., M.P.H.
—————————————————————— Local doc tries “cool burn” method
By Kristen J. Gough
Susan Friedlaender recalls June 19, 2002 as one of the longest days of her life. The New Rochelle mother waited and worried as both of her children, Jason, age five, and Greg, age eight, had their tonsils removed. While she didn’t relish the idea of surgery for her children, it was better than the alternative — countless visits to the doctor’s office and throat infections so frequent that her boys had a tough time making it to birthday parties, soccer practices and even school. Friedlaender’s doctor, Stephen Jablon, M.D., of ENT and Allergy Associates in Rye Brook, suggested a new procedure for Jason and Greg — a coblation tonsillectomy. After surgery, both boys were sore but within a couple of days they had returned to their normal diets and by the end of the week they were back at summer camp. When asked if she would have the surgery for her children again, Friedlaender responded enthusiastically. “Yes, we’ve had no sick days this year,” she said, “but I might not do them both on the same day.” Friedlaender’s sons were two of nearly 700,000 children in the U.S. to undergo tonsillectomies last year. As previously stated, while tonsillectomies are common, the method of performing the surgery is not uniform. And method of tonsillectomy is an ongoing debate within the medical community, specifically among Ear, Nose and Throat (ENT) specialists, or otolaryngologists. Although coblation tonsillectomy holds promise for easing the pain of the procedure, many doctors question its effectiveness. “I understand doctors’ concerns about the technique,” explains Dr. Kelvin Lee of Rye, associate professor of clinical otolaryngology at New York University Medical Center and associate director of otolaryngology at Bellevue Hospital Center. Dr. Lee developed the coblation procedure because, he says, “The traditional approach to tonsillectomy, using a scalpel to cut or an electrocautery to burn the tissue and then remove the tonsil, continues to be associated with a high level of postoperative pain and significant incidence of postoperative bleeding.” To address both of these concerns, Dr. Lee used coblation technology, which had previously been effective in orthopedic surgery. Coblation tonsillectomy is often described as a “cool burn”. By passing a wand-like instrument over the infected tonsil, low-temperature radio frequency energy breaks down the tissue, essentially dissolving it. The doctor is then able to take out the tonsil with minimal damage to the surrounding tissue. A study of pediatric coblation tonsillectomy, appearing in the International Journal of Pediatric Otorhinolayrngology, concluded, “This new technique using tissue coblation for tonsil removal offers significant advantages in the post-operative period, with rapid return to a normal diet and a drastic reduction in analgesic requirements (pain medication) following the surgery.” “These studies have been limited,” says Dr. R.J. Ruben, distinguished university professor at the Albert Einstein College of Medicine and the Montefiore Medical Center. Dr. Ruben has performed coblation tonsillectomies, but prefers more traditional techniques. “It’s very simple,” he explains. “There’s a very small incidence of complication with tonsillectomy but there are risks. You are working in the middle of a child’s airway. Tonsillectomies are performed on relatively healthy children. And I would rather use a traditional approach, which I have found effective, rather than risk the patient’s health for the possibility of less post-operative morbidity (pain).” Along with lack of significant studies, Dr. Stephen Salzer, an instructor in surgery at the Yale University School of Medicine, points out that the coblation procedure is a slower technique than a traditional tonsillectomy. The time of surgery is significant because the longer the procedure takes, the greater likelihood that the tongue will be more swollen and the pain after surgery more severe. “No one wants to inflict more pain in a patient, especially a child,” says Dr. Sylvan Stool, former chief of pediatric otolaryngology at Philadelphia Children’s Hospital. “Every [new tonsillectomy] procedure has come out and said that it causes less pain than another. The bottom line is that you can’t do surgery in the mouth in an area that is involved with activities such as swallowing and eating without pain until healing occurs. It just doesn’t make sense.” Dr. Stool suggests a more old-fashioned approach to easing children’s post-surgery pain. “There is a great individual variation among children concerning their perception of pain and how they handle it,” he says. “Some of that perception is in reaction to their parent’s anxiety. If parents continually ask the child, ‘Are you hurting?’, they’ll be hurting.” While the debate continues over how to improve tonsillectomies, experts point out that parents need to discuss with their doctor the most effective surgery for their child. “With each patient,” Dr. Lee says, “you have to evaluate their circumstances and present parents with their options so that they can make an informed decision.” For more information on tonsillectomy, visit www.snoreinfo.com, www.kids-ent.com, and www.entandallergy.com.
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