Tonsillectomy Instrument Trends of Today Versus 15 Years Ago

Newswise — Pediatric adenotonsillectomies have been performed for years. However, as new methods have emerged, so have certain trends. A recent survey sent to 300 members of the American Society of Pediatric Otolaryngology (ASPO) that assessed instruments currently used in tonsillectomy and adenoidectomy five, ten, and 15 years ago, finds that while the use of coblation has increased, monopolar electrocautery has remained the most preferred method.

The research efforts to examine changing trends in instrument usage for pediatric adenotonsillectomy can be found in the study entitled, "A Survey Assessing Past and Present Instrument Use in Pediatric Adenotonsillectomy." The research team consists of David L. Walner, MD, Noah P. Parker, BA, and Robert P. Miller, MD, from the Department of Otolaryngology and Bronchoesophagology, Rush University Medical Center, Chicago, Illinois, U.S.A. (D.L.W. and N.P.P.) and the Department of Pediatric Otolaryngology, Advocate Lutheran General Children's Hospital, Park Ridge, Illinois, U.S.A. (D.L.W. and R.P.M.) The researchers are presenting their findings at the 110th Annual Meeting & OTO EXPO of the American Academy of Otolaryngology—Head and Neck Surgery Foundation, being held September 17-20, 2006, at the Metro Toronto Convention Centre, Toronto, Canada.

MethodologySurveys were completed by 120 of the 300 members of the American Society of Pediatric Otolaryngology (ASPO) asked to participate. Of all participants, 83.8 percent were based in academic environments, 14.5 percent were from private practices, and 0.9 percent were from military settings. Physicians reporting being in practice for 15-20 years comprised 25.6 percent of total respondents. Additionally, 65.5 percent said they perform more than 200 adenotonsillectomy procedures a year. Of the children these procedures were performed on, children between the ages of four and 10 years old comprised 33.6 percent, while 31.9 percent were performed on children between 11 and 18, and 29.3 percent were performed on children between zero and three years old.

ResultsAt the time of the study in the fall of 2005, 97.4 percent of pediatric otolaryngologists reported performing total tonsillectomies. In cases of obstruction, 2.6 percent of those surveyed always perform a subtotal tonsillectomy, and 72.6 percent always perform a total tonsillectomy. In cases of infection, 97.4 percent will perform a total tonsillectomy while 11.3 percent would perform a subtotal tonsillectomy in appropriate cases.

As total tonsillectomies are widely performed, in cases of obstruction or infection, several methods emerged as those most commonly used. Among these, monopolar electrocautery (ME) was reported to be used by 53.1 percent, 54.5 percent of doctors, coblation (CT) by 16.0 percent, 16.1 percent of doctors, and cold dissection/touch-up ME was used by 10.6 percent, 11.6 percent of doctors. While less utilized than total tonsillectomies, in cases of obstruction or infection, some doctors elect to perform subtotal tonsillectomies. As for the most commonly used instruments in performing this procedure, microdebrider (Debrider) was used by 51.4 percent, 30.8 percent of doctors, coblation (CT) was used by 11.4 percent, 30.8 percent of doctors and bipolar electrocautery (BE) was used by 11.4 percent, 23.1 percent of doctors.

Other findings reveal interesting trends in use for both procedures, as more information is garnered about each specific method. For example, while 15 years ago, adenotome was used by 8.3 percent of doctors, today it is used by less than two percent. Debrider use with touch-up ME was non-existent 15 years ago and today, is used by 22.9 percent of doctors because of minimal trauma during tissue removal. This is due to angled blades which allow for better navigation of the nasopharynx. CT is also more widely used today than 15 years ago. Its flexible wand makes it ideal for both tonsillectomies and adenoidectomies as the wand can effectively reach the posterior choanal regions. This method also uses a lower temperature which causes less possibility for tissue damage and therefore reduced postoperative pain and speedier recovery time. As more advanced methods such as these have emerged, the use of certain older methods has fallen off. Cold dissection is now less utilized due to concerns surrounding increased blood loss which other methods can now prevent.

ConclusionsThe findings show that over the past 15 years, while the use of coblation has increased, monopolar electrocautery has remained the most preferred method rising in use from 7.1 percent to 25 percent today. The speed, affordability, and safety of this method likely contribute to its preferred use.

It is important to note that with more options, the decision to employ a specific method is not based solely on the proven findings. Other influential factors include which method is most commonly used at the time and the method with which each particular doctor is most comfortable.