Easing the Pain of Tonsillectomies

New radiofrequency technique spares kids long recovery times

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HealthDay Reporter

SUNDAY, July 18, 2004 (HealthDayNews) -- Like many rites of childhood, tonsillectomies are painful procedures that kids would happily skip if they had a choice.

However, doctors have started using a new technique that appears to make the experience a lot easier to swallow.

In so-called coblation tonsillectomies, doctors use a wand-like device and radiofrequency energy to obliterate the tonsils. While the procedure doesn't sound appealing, it's an improvement over the traditional approaches, which require doctors to either burn the tonsils or literally cut them out of the throat, said Dr. Udayan Shah, an otolaryngologist at The Children's Hospital of Philadelphia.

"It's not a pretty picture," he said. "There's a rough recovery. That's where the idea of coblation comes in. People are always looking for a better way to do things when they anticipate a painful recovery."

As bad as tonsillectomies can be, the alternatives are worse. Doctors typically turn to the operations to prevent continued cases of strep-throat infections or, more recently, to stop breathing problems during sleep.

"It's still a very common procedure," Shah said. Children with breathing difficulties may even have the operation before the ages of 5 to 7. Often, tonsillectomies are scheduled during summer to give kids time to recuperate before school.

Tonsillectomies were more common in the 1950s and 1960s when the potential risk of complications from strep infections was higher, explained Dr. Nina Shapiro, an assistant professor of pediatric otolaryngology at the University of California, Los Angeles. If children had one or two strep infections, their tonsils would come out, she said.

While the number of the surgeries went down for some time, they've risen in the last five to 10 years because they can correct breathing problems. An estimated 500,000 American children have the procedure each year.

The tonsils are lymph nodes, part of the immune system. But they're troublesome because they can block the breathing passages when infected. Removal doesn't seem to harm people, Shapiro said.

Doctors typically perform tonsillectomies with a "hot" approach -- cauterizing -- or a "cold" approach in which they cut out the tonsils with a tool. "For years, and even now, people refer to their technique as 'I do a cold tonsillectomy' or 'I do a hot tonsillectomy,' " Shah said.

Doctors also have to figure out how to control bleeding. A variety of approaches are used, including sutures and even applications of vinegar or tannic acid.

Since its introduction in 2000, the coblation technique has become more popular; an estimated 80,000 surgeries have been performed worldwide. During the procedures, surgeons break up the tonsils using the energy from a radio-frequency wand to dissolve tissue.

Patients who have the procedure seem to bleed less and recover more quickly, although it can still take two weeks for full recovery in some cases, Shapiro said.

"With the traditional tonsillectomy, patients suffered sore throats, needed more pain medication and took a week or two to recuperate," Shapiro said. "Now, I'm finding that with this technique, patients can drink and eat a few hours after surgery, require less pain medication, and return to normal activity within a few days."

It's not entirely clear which factors -- the child, the surgeon or the technique used -- are most important in reducing recovery time, Shapiro said. She cautioned that parents should not shop around for doctors who perform a specific tonsillectomy technique.

"My advice to parents is that they first pick a doctor they can trust and worry about the technique second," she said.

Shah agreed. "The most important thing is to pick a doctor you trust. Go with what that doctor says. Every surgeon has their own experience. You want them doing what they're great at doing and believe in."

More information

Learn more about coblation tonsillectomies from the University of California, Los Angeles.

SOURCES: Udayan Shah, M.D., otolaryngologist, The Children's Hospital of Philadelphia, and assistant professor, University of Pennsylvania School of Medicine, Philadelphia; Nina Shapiro, M.D., assistant professor, pediatric otolaryngology, University of California, Los Angeles

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