JOURNAL OF MEDICAL RESEARCH
SIGNS AND SYMPTOMS BEFORE AND AFTER TONSILLECTOMY Dao Pham Thi Bich, Anh Pham Tran Department of Otolaryngology, Hanoi Medical University Tonsillectomy is the highest proportion in the ENT surgery, with many different indications. However, surgeons often noticed indications of the patient before tonsillectomy. The study was conducted in 180 patients who underwent tonsillectomy at the National ENT Hospital from May 2014 to May 2016. Patients described the symptoms before surgery and following after 6 months, 12 months and 24 months. The results indicated that percentage of recurrent throat infections (7 times /year, 5 times /2 years, 3 times in 3 years) was 60.1% (109 patients), terrible smell breath was 3.3% (6 patients), Odynophagia was 7.8% (14 patients), difficulty swallowing was 11.7% (21 patients), snoring was 10.6% (19 patients), physical retardation was 6.5% (11 patients). 82.1% Glossal tonsil before tonsillectomy: 2 nd degree. The signs and symptoms after tonsillectomy at 6 months, 12 months, 24 months: recurrent throat infections 7/109 patients (6.4%), 8/109 patients (7.3%), 7/109 patients people (6.4%). 3/6 patients with terrible smell breath (50%), 4/6 patients (66.7%), 4/6 patients (66.7%). Odynophagia 11/14 patients (78.6%), 12/14 patients (85.7%), 12/14 patients (85.7%). Difficulty swallowing 15/21 patients (71.4%), 16/21 patients (76.2%), 15/21 patients (71.4%). Snorers 17/19 patients (89.5%), 17/19 patients (89.5%), 17/19 patients (89.5%). Weight: 86.7% increase. Appearing add voice changing 12.7%, 9.4%, 9.4%. Glossal tonsil after tonsillectomy (87.5%): 3 rd degree.
Keywords: Tonsillectomy, recurrent throat infections, odynophagia, voice changes
I. INTRODUCTION sillectomy [3]. The tonsillectomy operation has Tonsillectomy is a surgical procedure to
been taken place in many forms over the last
remove the tonsils. Tonsils are two small
2000 years since first described by Celsius in
glands located in the back of your throat.
50 AD [4]. While much has changed for the
Tonsils house white blood cells that help fight-
better during that time, there is currently no
ing infection, but sometimes the tonsils
clear, evidence - based guideline for tonsillar
themselves become infected. Tonsillectomy
surgery in children. Instead, parents and their
can also be
breathing
otorhinolaryngologists make decisions about
problems such as heavy snoring and sleep
tonsil surgery based on the best available
apnea. Tonsillitis is a common disease in the
knowledge and practice [5]. In January 2011,
ENT specialty and tonsillectomy can be
the American Academy of Otolaryngology
performed periodically to reduce the frequency
released
of inflammation [1]. On the 1923, ENT doctors
(Oto-HNS, v144 S1, January 2011) to help
performed the first tonsillectomy [2]. In the
physicians and parents navigate through a
US,children under 15 years of age accounts
maze of data and help them to better under-
for 15% of patients who have undergone ton-
stand the clear indications of surgery, identify
a treatment for
a Clinical
Practice
Guideline
children who are suited for tonsillectomy surCorresponding author: Pham Thi Bich Dao, Department of Otorhinolaryngology - Hanoi Medical University E-mail:
[email protected] Received: 20 October 2016 Accepted: 10 December 2016
82
gery, and how tobest care (both before and after) for children undergoing tonsillectomy [6]. Many patients expect tonsillectomy technique maycompletely cure their disease. Such unre-
JMR 105 E1 (7) - 2016
JOURNAL OF MEDICAL RESEARCH alistic expectation puts immense pressure on
at the 6 - month mark, 12 - monthS mark and
the physicians who perform tonsillectomy to
24 - months mark after surgery.
live up to these patients’ desire [7]. Surgical tonsillectomy results incertain complications
All patients had their medical records monitored.
such as bleeding, shock due to allergies to
- The designated tonsillectomy: by recur-
some medicines used during surgery, and
rent tonsillitis (7 times/year, 5 times/2 years, 3
even death from acute blood loss [8]. Besides,
times/3 years), bad smell, odynophagia, swal-
patients may experience certain side - effects
lowing problems, snoring, physical retardation.
after tonsillectomy such as hypertonsil glossal,
- Exclusion criteria: patients in the contra-
possibly swallow and snoring problems, wider
diction and who did not follow - up at 3 time
throat cavity. Especially for singers, these
points (6 months, 12 months, 24 months).
effect smight cause a change in tone [9]. Therefore, it is very important to decide whether a particular patient should or should not undergo tonsillectomy [10]. Thus, the main purpose of this study was to evaluate the
2. Methods A cross-sectional follow - up design and following study has been conducted. Research process included interviewing patients, establishing track record for each
effectiveness of tonsillectomy.
subject through medical research, examining
II. SUBJECTS AND METHODS
and asking the symptoms. Statistics, reviews and comment at three times.
1. Subjects 180 patients who underwent tonsillectomywere selected from the clinical departments of
3. Research ethics Research subjects were informed of study
Hospital
goals and voluntarily agreed to participate in
from 5/2014 to 5/2016. Their tonsillectomy
research. All personal information was kept
records were collected and checked regularly
confidential.
the
National
Otorhinolaryngology
III. RESULTS 1. Tonsillectomy indications
Chart 1. The designated tonsillectomy JMR 105 E1 (7) - 2016
83
JOURNAL OF MEDICAL RESEARCH The results indicated that the most common of tonsillectomy indication was recurrent throat infections (60.1%). While, bad smell was counted less (3.1%). 2. The age of the patients with tonsillectomy
Under 6y From 6 - 15 y From 16 - 25y Over 25y
Graph 2. The age of the patients with tonsillectomy Age of tonsillectomy was mainly in two age groups: 54.4% aged 6 to 15 years old. Under 6 age group was accounted only 31.1%. 3. The relationship between age and the reasons for tonsillectomy Age indications
Under 6 ages
From 6 to 15 ages
Over 16 to 25 ages
Recurrent throat infections
34 (31.2 %)
59 (54.1 %)
8 (7.3 %)
Bad smell
8 (7.3 %) 6 (100%)
Difficulty swallowing
5 (23.8%)
Odynophagia
16 (76.2%) 3 (21.4%)
Snorers
12 (63.2%)
6 (31.6%)
Physical retardation
2 (18.2%)
9 (81.8%)
48
79
Sum
Over 25 ages
11 (78.6%) 1 (5.2%)
11
42
The age of patient’s group from 6 to 15 years old with the recurrent throat infections was the most common (54.1%) then following by the age group under 6 years old (31.2%). Meanwhile, inflammation symptom of 2 groups at the age of 15+ with tonsillectomy were only counted for 7.35%. 100% of bad smell was observed in the group over 25 years old. While number of the patients had difficulty in swallowing and odynophagia were 76.2% and 78.6%, respectively in the group over 25 years old. 63.2% patients under 6 years of age had snoring and 81.8% of patients in the age group of 6 to 15 years old had physical retardation. 84
JMR 105 E1 (7) - 2016
JOURNAL OF MEDICAL RESEARCH 4. Grading glossal tonsils before and after tonsillectomy surgery Table 1. Grading of the glossal tonsil 1st
2nd
3rd
4th
Grading of the glossal
Before
After
Before
After
Before
After
Before
After
Glossal tonsil
43 (23.9%)
9 (5.1%)
125 (69.4%)
15 (8.3%)
12 (6.7%)
132 (73.3%)
0 (0.0%)
24 (13.3%)
Before tonsillectomy, glossal tonsil at 2nd degree was accounted for 96.4% but with no degree was observed at 4th.After tonsillectomy, glossal tonsil at grade 3rd and grade 4th were reached 73.3% and 13, 3%, respectively. 5. The follow - up at 6, 12 and 24 months after tonsillectomy Table 2. Improvement of the symptoms after tonsillectomy 6 months - 12 months - 24 months Signs and Symptoms
6 months
12 months
24 months
7/109 (6.4%)
8/109 (7.3%)
7/109 (6.4%)
Bad smell
3/6 (50.0 %)
4/6 (66.7%)
4/6 (66.7%)
Odynophagia
11/14 (78.6%)
12/14 (85.7%)
12/14 (85.7%)
Difficulty swallowing
15/21 (71.4%)
16/21 (76.2%)
15/21 (71.4%)
Snoring
17/19 (89.5%)
17/19 (89.5%)
17/19 (89.5%)
Recurrent throat infections
The symptoms improved after tonsillectomy mostly recurrent throat infections frequency, after surgery 24 months was observed (6.4%). Other symptoms did not improve significantly: bad smell (66.7%), odynophagia (85.7%) swallowing problems (71.4%) and snoring (98.5%).
IV. DISCUSSION
indicated that indications of tonsillectomy due
180 patients with tonsillectomy were in-
to recurrent throat infections were counted for
volved in this research in national ENT Hospi-
60.1%. The prevalence was decreased after
tal from May 2014 to May 2016. Our results
24 months, only 6.4% of tonsillectomy patients
JMR 105 E1 (7) - 2016
85
JOURNAL OF MEDICAL RESEARCH hadpharyngitis. Parker and colleagues studied
andglossal tonsil becoming hypertrophy after
90 patients tonsillectomy also found 4.7% of
tonsillectomy, which narrows the airway and
patients still have recurrent throat infections
causes snoring and swallowing problems [13].
even more than before.Therefore, it is neces-
In this study, the analysis of the glossal tonsil
sary for clinicians to explain to his/her patients
we relied before tonsillectomy,glossal tonsil
the symptoms that may or may not disappear
weremainly grade 2nd, accounting for 96.4%,
after tonsillectomy [3]. In contrast other symp-
no 4th grade. After tonsillectomy, glossal tonsil-
toms during surgery designated as bad smell
shad grade 3rd were 73.3% and 13.3% of 4th
was 66.7%, while 85.7% reported odyno-
grade. According to Edmonson MB, the
phagia. Swallowing problems was 71.4%.
number of tonsillectomies performed for recur-
Snoring was 98.5%. Thus, the implementation
rent throat infections has been decreasing,
surgically tonsillectomy because of these rea-
while they’ve been increasing for children with
sons were less likely to succeed. Patel said
sleep-disordered breathing.
that only 31.9% bad smell was caused by ton-
After tonsillectomy, at 6 months some pa-
sillitis but very difficult to distinguish the
tients had voiced change about 12.7% and
source, infact, many patients apply tonsillec-
after 24 months was 9.4%. In study of Georga-
tomy for this reason [4]. It is common if
las, after tonsillectomy, the pharynx become
patients have bad smell for a few weeks after
large so that changed voice and articurate but
surgery. This
this problem can be restored if there is method
is
due to
accumulation of
bacteria within the sluth. Sluth is material that
to talk after surgery [14].
collects at the area where the tonsils have been taken from and is quite normal. By eating
V. CONCLUSION
and drinking as much as possible, particularly
Our results indicated that tonsillectomy was
rough foods, the amount of sluth will be
effective for recurrent throat infection. After
reduced and this will lead to better breath [9].
tonsillectomy, glossal tonsils alternative devel-
Odynophagia remained 85.7% after tonsillec-
opment was replaced.
tomy because majority ofodynophagia cases are due to gastroesophageal reflux according
Acknowledgement
to Bathala S analysis [11]. Swallowing prob-
The author would like to thank the staff par-
lems were 71.4% and most common in those
ticipated in this research. The authors would
aged over 25 because this symptom was
like to thank members of Editorial board for
mainly caused by reflux or neck syndrome
editing manuscript and critical comments. We
according to Paradise JL, Bluestone [12].
declare no conflicts of interest.
Snoring was common in children under 6
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