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Taking Out Tonsils With Less Pain

Choice of Surgical Instrument May Make a Difference, Study Shows

By Miranda Hitti
WebMD Health News

Reviewed by Louise Chang, MD

Jan. 27, 2006 -- Using a surgical device called a "coblator" to remove tonsils may lessen patients' postsurgery pain, a new study shows.

Researchers compared three different surgical devices for tonsil removal:

Electrocautery device: the most common instrument, which uses intense heat
Harmonic Ultrasonic Scalpel: uses vibrations of ultrasonic energy
Coblator device: passes a current through saltwater

The study included 134 patients who got their tonsils removed by one of those methods. The patients' diaries showed less pain and quicker return to normal diet.

Still, none of the methods was painless, write Stephen Parsons, MD, and colleagues. They work at Indiana University School of Medicine's department of otolaryngology -- head and neck surgery.

The study appears in Otolaryngology -- Head and Neck Surgery.

Bouncing Back

Patients were asked to keep diaries of their pain after tonsil surgery. Children could rate their pain by using a scale of smiling or sad faces.

Food intake, activity level, and phone calls to doctors were also tracked. Tonsil removal is common but often painful due to tissue damage around the tonsils that occurs during the removal process. Afterward, it can hurt to eat for several days, so many patients eat soft foods until they recover.

Within 10 days of tonsil removal, eight in 10 patients were eating normally and nine in 10 had resumed normal activities, Parson's study shows.

The coblation group had lower pain scores. The most follow-up calls to doctors were made by patients in the electrocautery group.

Real Difference?

More than half of participants didn't finish their pain diaries; their results weren't counted. All three groups had patients who dropped out of the study.

With a small group of patients, statistics can seem more important than they really are, note Parson and colleagues. They write that their results reached the lowest level for clinical significance. In other words, the difference in pain levels was small, not dramatic.

"As expected, none of the three surgical methods in this study resulted in a pain-free recovery," the researchers write.

"There are certainly other factors that alter pain aside from the surgical instrument used," they continue. Careful, gentle technique also counts, the doctors note.

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