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Rossi NA, Freeman CG, Ohlstein JF, Daram S, Darling RA, McKinnon BJ, Pine HS. Surgeon Preference on Sending Routine Tonsillectomy Specimens for Pathological Evaluation. EAR, NOSE & THROAT JOURNAL 2022:1455613221112761. [PMID: 35939505 DOI: 10.1177/01455613221112761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Despite the presence of a growing body of literature suggesting cost-ineffectiveness of routine pathologic analysis of tonsillectomy specimens, little is known about common institutional policies and practice patterns of pediatric otolaryngologists. The objectives of this study were to determine the prevalence of routine pathological evaluation of tonsillectomy specimens for uncomplicated pediatric adenotonsillectomy procedures and to evaluate opinions regarding this controversy among board-certified pediatric otolaryngologists. METHODS This was a cross-sectional survey study sent to board-certified pediatric otolaryngologists currently practicing and registered with the American Society of Pediatric Otolaryngology (ASPO) assessing their institutions' or practices' current policies on sending routine tonsillectomy specimens for pathology, their experience with this practice, and their opinions on whether routine pathologic analysis should be employed. Basic statistical analysis was then conducted. RESULTS Respondents mostly practiced in an academic setting (68.4%), with the next most common being academically affiliated private practice (21.8%), and private practice was the least common (9.8%). Most respondents (85.1%) did not agree with routine pathologic analysis of otherwise uncomplicated pediatric tonsillectomy specimens. CONCLUSION Most pediatric otolaryngologists who responded to this survey do not support routine pathological analysis of otherwise uncomplicated pediatric tonsillectomy specimens. However, the results are likely biased and should be interpreted carefully, since only a small percentage of pediatric otolaryngologists responded to the survey. Potential cost savings could be seen by patients, payers, and hospital systems with judicious use of surgical pathology, specifically in cases with concurrent signs or symptoms suspicious for malignancy.
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Affiliation(s)
- Nicholas A Rossi
- Department of Otolaryngology - Head & Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Cecilia G Freeman
- Department of Otolaryngology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Jason F Ohlstein
- Department of Otolaryngology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Shiva Daram
- Department of Otolaryngology - Head & Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Robert A Darling
- Department of Otolaryngology - Head & Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Brian J McKinnon
- Department of Otolaryngology - Head & Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Harold S Pine
- Department of Otolaryngology - Head & Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA
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Nemati S, Mohammadghasemi F, Mojtahedi A, Habibi AF, Rouhi S, Leili EKN, Moroosi M. The effects of radiofrequency on the bacteriological and histological characteristics of tonsils in patients with chronic and persistent tonsillitis. Am J Otolaryngol 2020; 41:102657. [PMID: 32829058 DOI: 10.1016/j.amjoto.2020.102657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Tonsillotomy with radiofrequency (RF) is one of the newest treatments for chronic tonsillitis, but the mechanism of RF effects and complications are still pending. The aim of this study was to evaluate the effects of RF on the histological and bacteriological characteristics of the tonsils (Case-control study). MATERIALS AND METHODS In fifty-two patients with chronic tonsillitis in 2017-2018, immediately after tonsillectomy, the tonsils were divided into 2sections; one sample treated with RF, and the other one considered as control, without intervention. All tonsil samples sent for histological and bacteriological study: morphometric assays made by Digitizer software, and type of bacterial colonies identified by microbiological and biochemical tests. Willcoxon and McNemar tests were used for statistical analysis and level of significance was p ≤ .05. RESULTS Tonsil mucosal thickness (2202.98 ± 323.09 vs. 2463.94 ± 357.61 μm) and size of the tonsil nodule (28,000.42 ± 9608.75 vs. 36,692.81 ± 7040.74 μm2) were significantly lower in the RF+ group than other group (p = .001 and p = .01, respectively). There was no significant differences in thickness of the tonsil epithelium (p = .075), number of lymphoid nodules (p = .860), and the number of reticular tonsil epithelium (p = .813) between the two groups. Bacterial growth in RF- and RF+ groups had no statistically significant difference (p = .06), however, the average colony count of S. aureus in RF+ tonsils were significantly lower, and total number of bacterial colonies were significantly lower in RF+ group(1405 ± 156 vs. 2471 ± 156), (p = .001). CONCLUSION RF surgery has significant effects on size of the nodules, thickness of the mucous layer and bacteriological characteristics of tonsil tissue. Especially S. aureus seems to be more sensitive to RF effects.
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YAPRAK BAYRAK B, MUTLU F. Tonsillektomi ve Adenoidektomi Yapılan Olguların Retrospektif İncelenmesi ve Karşılaştırmalı Klinikopatolojik Analizi. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2020. [DOI: 10.30934/kusbed.693112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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AYDIN S, BOLDAZ E. Tonsillektomi spesmenlerinin Histopatolojik Retrospektif Analizi. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2020. [DOI: 10.17944/mkutfd.521354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Syme N, Brettfeld S, Dorneden A, Samedi V, Bocklage T, Myers O, Herzon F, Meiklejohn DA. Occult Malignancy in Adult Tonsillectomy for Benign Indication. Ann Otol Rhinol Laryngol 2020; 130:356-362. [PMID: 32840127 DOI: 10.1177/0003489420952474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE National pathology guidelines recommend full pathologic analysis for all adult tonsillectomy specimens. We evaluated the available data on occult malignancy in adult tonsillectomy for benign indication, and created a screening system to reduce the risk of missed malignancies if routine histopathologic examination were to be discontinued. STUDY DESIGN Retrospective chart review and systematic review of the literature. SETTING Tertiary care academic hospital and multi-hospital private healthcare system. SUBJECTS AND METHODS A systematic literature review identified case series of adult tonsillectomy. Retrospective chart review at our institutions from 2000 to 2016 produced an additional case series. The pooled rate of occult malignancy was determined, and re-analyzed using criteria based on preoperative risk factors designed to identify patients requiring full pathologic analysis. The predicted effects of prospective application of the proposed criteria were calculated. Pooled occult malignancy prevalence was estimated. RESULTS Literature review and our own case series yielded 12,094 total cases. Occult malignancy prevalence in the combined data was 0.033%, representing four occult malignancies. Three out of the four would have been selected for full pathology preoperatively with use of the proposed criteria. Statistical analysis indicates that the predicted frequency of occult malignancy incidence in cases negative for the criteria is 0.01%, or 1/10,000. CONCLUSION Application of the proposed criteria to adults undergoing tonsillectomy for benign indication identifies a subset of patients with an estimated incidence of occult malignancy similar to that reported for pediatric tonsillectomy, and potentially may permit safe elimination of pathologic analysis of their tonsil specimens. LEVEL OF EVIDENCE Pooled analysis of case series from the literature and a single institution, level 4.
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Affiliation(s)
- Noah Syme
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Stefan Brettfeld
- Department of Pathology, University of Colorado, Denver, CO, USA
| | - Ashley Dorneden
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Von Samedi
- Department of Pathology, University of Colorado, Denver, CO, USA
| | - Therese Bocklage
- Department of Pathology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Orrin Myers
- Department of Family and Community Medicine, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Fred Herzon
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Duncan A Meiklejohn
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of New Mexico Hospital, Albuquerque, NM, USA
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Affiliation(s)
- T Schrom
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Plastische Operationen, Pieskower Str. 33, 15526, Bad Saarow, Deutschland.
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Aksakal C, Müslehiddinoğlu A. Comparison of Routine Histopathological Examination Results in Children and Adults After Tonsillectomy and/or Adenoidectomy. Turk Arch Otorhinolaryngol 2018; 56:170-173. [PMID: 30319875 DOI: 10.5152/tao.2018.3391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/17/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Tonsillectomy and/or adenoidectomy is one of the most common otolaryngologic surgical procedures. There is still an ongoing debate as to whether or not histopathological examination should be performed in which cases after these surgeries. The aim of this study is to compare the histopathologic examination results of routine tonsillectomy and/or adenoidectomy surgical specimens of children and adults. Methods The routine histopathological examination results of patients who had adenoidectomy and/or tonsillectomy between April 2010 and April 2017 in Tokat State Hospital were evaluated from medical records retrospectively. The results were compared in terms of malignancy between children and adult patients. Results A total of 1849 histopathological examination results were included in the present study. Of the patients, 1574 were children, and 275 were adults. All of the patients who underwent adenoidectomy were diagnosed with reactive lymphoid hyperplasia. Of the 1356 patients who underwent tonsillectomy, only two were detected with malignancies. These two patients were adults. Conclusion While routine histopathologic examination is necessary for every case in adult population, risk factors should be considered in pediatric patients after tonsillectomy and/or adenoidectomy.
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Affiliation(s)
- Ceyhun Aksakal
- Department of Otorhinolaryngology, Tokat State Hospital, Tokat, Turkey
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Video Nasoendoscopic-Assisted Transoral Adenoidectomy with the PEAK PlasmaBlade: A Preliminary Report of a Case Series. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1536357. [PMID: 28459055 PMCID: PMC5387823 DOI: 10.1155/2017/1536357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 03/06/2017] [Indexed: 11/17/2022]
Abstract
Objectives. The primary objective for this study is to evaluate the advantages, disadvantages, surgical applicability, and outcome of the pulsed electron avalanche knife (PEAK) PlasmaBlade in transoral adenoidectomy under direct visualization using video nasoendoscopy. Patients and Methods. In this series, six cases of adenoid hypertrophy showing varying clinical presentations in relation to its clinical course were surgically treated using a PEAK PlasmaBlade. Before and after surgery, all patients underwent nasal endoscopy to define the grading of hypertrophic adenoids and postoperative outcome. Pure tone audiometry and tympanometry tests were carried out to investigate the change in middle and inner ear functions. Results. The mean follow-up period was 23.8 months. Postoperatively, symptoms of otitis media with effusion were all relieved with closure of the air-bone gap (6/6). Other relevant ear complaints like tinnitus were resolved (1/1) and aural fullness disappeared in 87.5% of ears (7/8). Nasal obstruction (2/2) and postnasal drip (2/2) were improved after surgery. Conclusions. Based on this preliminary report of a case series in a limited sample size, we suggest that using the transoral PEAK PlasmaBlade for adenoidectomy guided by video nasoendoscopy is a safe and feasible surgical technique, allowing remarkable outcomes by providing precise tissue removal, effective hemostasis, and painless postoperative recovery.
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Malignancy in routine tonsillectomy specimens: a systematic literature review. Eur Arch Otorhinolaryngol 2014; 271:2851-61. [DOI: 10.1007/s00405-014-2902-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/17/2014] [Indexed: 10/25/2022]
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Windfuhr JP. Malpractice claims and unintentional outcome of tonsil surgery and other standard procedures in otorhinolaryngology. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2013; 12:Doc08. [PMID: 24403976 PMCID: PMC3884543 DOI: 10.3205/cto000100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Septoplasty, tonsillectomy (with and without adenoidectomy) and cervical lymph node excision are amongst the most common 50 inpatient operations in Germany. Intracapsular tonsillectomies (i.e. tonsillotomies) are increasingly performed. The aim of this study was to evaluate technical traps and pitfalls as well as alleged medical malpractice associated with tonsillectomy (TE), adenoidectomy (AE), tonsillotomy (TT), septoplasty (SP) and cervical lymph node excision (LN). METHODS A questionnaire was sent to the Regional Medical Conciliation Boards, Medical Services of the Health Insurance Companies (MDK) and Regional Institutes of Forensic Medicine in Germany to collect anonymized cases of complications following TE, TT, AE, LN and SP. The results were discussed in the light of the contemporary medical literature and published trials and verdicts in Germany. RESULTS The response rate of our survey was 55.9%. The Institutes of Forensic Medicine contributed nine cases, 49 cases were submitted by the Regional Conciliation Boards and none by MDK. All forensic cases were associated with exsanguinations following tonsillectomy including two children (5 and 8 years of age) and seven adults (aged 20 to 69 years). The fatal post-tonsillectomy hemorrhage (PTH) had occurred 8.7 days on average; four patients experienced the bleeding episode at home (day 5, 8, 9 and 17, respectively). Repeated episodes of bleeding requiring surgical intervention had occurred in 6 patients. Three Conciliation Boards submitted decicions associated with TT (1), AE (4), LN (3), SP (16) and TE (25). Cases with lethal outcome were not registered. Only three of the 49 cases were assessed as surgical malpractice (6.1%) including lesion of the spinal accessory nerve, wrong indication for TE and dental lesion after insertion of the mouth gag. The review of the medico legal literature yielded 71 published verdicts after AE and TE (29), LN (28) and SP (14) of which 37 resulted in compensation of malpractice after LN (16; 57%), TE (10; 37%), SP (8; 57%) and AE (2; 100%). There were 16 cases of PTH amongst 27 trials after TE resulting either in death (5) or apallic syndrome (5). Bleeding complications had occurred on the day of surgery in only 2 patients. 16 trials were based on malpractice claims following SP encompassing lack of informed consent (6), anosmia (4), septal perforation (2), frontobasal injury (2) and dry nose (2). Trials after LN procedures were associated exclusively with a lesion of the spinal accessory nerve (28), including lack of informed consent in 19 cases. 49 cases (69%) were decided for the defendant, 22 (31%) were decided for the plaintiff with monetary compensation in 7 of 29 AE/TE-trials, 9 of 28 LN-trials and 6 of 14 SP-trials. Lack of informed consent was not registered for AE/TE but LN (11) and SP (2). CONCLUSION Complicated cases following TE, TT, ATE, SP and LN are not systematically collected in Germany. It can be assumed, that not every complicated case is published in the medical literature or law journals and therefore not obtainable for scientific research. Alleged medical malpracice is proven for less than 6% before trial stage. Approximately half of all cases result in a plaintiff verdict or settlement at court. Proper documentation of a thourough counselling, examination, indication, informed consent and follow-up assists the surgeon in litigation. An adequate complication management of PTH is essential, including instructions for the patients/parents, instructions for the medical staff and readily available surgical instruments. Successful outcome of life-threatening PTH is widely based on a proper airway management in an interdisciplinary approach. Electrosurgical tonsillectomy techniques were repeatedly labeled as a risk factor for bleeding complications following TE. Institutions should analyse the individual PTH rate on a yearly basis. Contradictory expert opinions and verdicts of the courts concerning spinal accesory nerve lesions following LN are due to a lack of a surgical standard.
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Affiliation(s)
- Jochen P. Windfuhr
- Department of Otorhinolaryngology, Plastic Head and Neck Surgery, Kliniken Maria Hilf, Mönchengladbach, Germany
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Courville EL, Lew M, Sadow PM. Routine Evaluation of Adult Tonsillectomy Specimens. Int J Surg Pathol 2011; 19:469-75. [DOI: 10.1177/1066896911402069] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tonsil excision is a common surgery for both children and adults. Prior studies have consistently shown that the rate of malignancy in tonsil specimens is low and that the possibility of true, occult malignancy is remote. Practice trends accept triage of pediatric tonsillectomies for exemption or gross exam only. However, for adults, despite a low malignancy rate, routine histological evaluation of tonsillectomy specimens is standard of care at most health care facilities. The authors performed a retrospective review of all tonsil specimens received in their department over 45 months with categorization of pathological diagnosis and surgical indication. Of 1746 adult tonsillectomy specimens removed during this time, there were no incidental/occult malignancies. These data indicate that gross examination of adult tonsillectomy specimens excised for chronic tonsillitis or sleep apnea is sound practice, and this, taken together with other published data, provides a basis for consensus-derived practice guidelines.
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Affiliation(s)
| | - Madelyn Lew
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Peter M. Sadow
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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