Our Summary

This study looked at the risks of bleeding after a specific type of tonsil removal surgery, called abscess tonsillectomy, which is done during a severe tonsil infection (quinsy). Some doctors hesitate to perform this surgery because they worry it might cause excessive bleeding. To investigate this, the researchers searched through several medical databases and found 18 studies that met their criteria for review.

They found that about 6.65% of patients experienced bleeding after their surgery, and about 2.35% of patients had to return to the operating room because of this bleeding. The chance of bleeding was about the same whether one or both tonsils were removed. However, they found that the use of a technique called “bipolar dissection” was linked to a higher risk of bleeding compared to a technique called “cold steel dissection”.

Overall, the quality of the evidence they found was moderate. These results provide valuable information for doctors to consider when deciding how to treat severe tonsil infections.

FAQs

  1. What is the risk of bleeding after an abscess tonsillectomy?
  2. Does the use of “bipolar dissection” technique increase the risk of bleeding compared to “cold steel dissection” in tonsillectomy?
  3. Does the number of tonsils removed impact the likelihood of post-surgery bleeding?

Doctor’s Tip

One helpful tip a doctor might give a patient about tonsillectomy is to follow all post-operative care instructions carefully to minimize the risk of bleeding. This may include avoiding certain foods, staying hydrated, and avoiding strenuous activities. It is also important to contact your doctor immediately if you experience any signs of bleeding, such as persistent throat pain, coughing up blood, or vomiting blood. By following these guidelines, you can help ensure a smooth recovery after your tonsillectomy.

Suitable For

Patients who are typically recommended tonsillectomy include those with:

  1. Recurrent tonsillitis: Patients who have frequent episodes of tonsillitis (usually defined as at least seven episodes in one year, five episodes per year for two years, or three episodes per year for three years) may be recommended for tonsillectomy to prevent future infections.

  2. Enlarged tonsils causing breathing problems: Patients with enlarged tonsils that obstruct their airway, causing sleep apnea, difficulty breathing, or snoring, may be recommended for tonsillectomy to improve their breathing.

  3. Tonsil abscess (quinsy): Patients with a severe tonsil infection that has formed an abscess may require abscess tonsillectomy to drain the abscess and remove the infected tonsils.

  4. Tonsil stones: Patients with recurrent tonsil stones (tonsilloliths) that cause discomfort, bad breath, or difficulty swallowing may be recommended for tonsillectomy to prevent future stone formation.

  5. Cancerous or suspicious tonsil growths: Patients with cancerous or suspicious growths on their tonsils may require tonsillectomy as part of their treatment plan.

  6. Chronic tonsil infections: Patients with chronic or persistent tonsil infections that do not respond to other treatments may be recommended for tonsillectomy to resolve the infection.

It is important for patients to discuss their symptoms and medical history with their healthcare provider to determine if tonsillectomy is the appropriate treatment option for them.

Timeline

Before tonsillectomy:

  1. Patient experiences symptoms of severe tonsil infection, such as sore throat, difficulty swallowing, fever, and enlarged tonsils.
  2. Patient consults with a doctor who may prescribe antibiotics or recommend tonsillectomy if the infection is severe or recurrent.
  3. Patient undergoes pre-operative tests and evaluations to ensure they are a suitable candidate for surgery.

After tonsillectomy:

  1. Patient undergoes tonsillectomy surgery, either with cold steel dissection or bipolar dissection technique.
  2. Patient is monitored in the recovery room for any immediate post-operative complications.
  3. Patient is discharged from the hospital or surgical center and instructed on post-operative care, including pain management, diet restrictions, and activity limitations.
  4. Patient may experience pain, discomfort, and difficulty swallowing for several days after surgery.
  5. Patient follows up with their doctor for post-operative appointments to monitor healing and address any concerns.

What to Ask Your Doctor

  1. What are the potential risks and complications of having a tonsillectomy, particularly in cases of severe infection like quinsy?
  2. What is the likelihood of experiencing bleeding after the surgery, and what steps can be taken to minimize this risk?
  3. Are there any specific techniques or methods used during the surgery that could impact the risk of bleeding?
  4. How will post-operative care be managed to monitor for bleeding or other complications?
  5. What should I do if I experience excessive bleeding or other concerning symptoms after the surgery?
  6. Are there any factors in my medical history or current health that could increase my risk of complications from a tonsillectomy?
  7. What is the expected recovery time and overall outcome of the surgery in cases of severe tonsil infections?

Reference

Authors: Mughal Z, Gupta KK, Yeo JJY, Metcalfe C, Weller M. Journal: Laryngoscope. 2024 Oct;134(10):4186-4195. doi: 10.1002/lary.31449. Epub 2024 Apr 13. PMID: 38613457