ABSTRACT
OBJECTIVES: Tonsillectomy is the most common operation performed by otolaryngologists in the UK, despite this we have a poor understanding of the post-operative recovery. We aimed to investigate post-operative bleeding and pain following paediatric tonsillectomy using a patient diary. DESIGN: Prospective observational cohort study. SETTING: Multi-centre study involving 12 secondary and tertiary otolaryngology units across the North of England. Patients were recruited from 1st March 2020 to 30th June 2022. Multilevel ordered logistic regression model statistics were performed. PARTICIPANTS: Children (≥4 years, ≤16 years) undergoing tonsillectomy (with or without adenoidectomy) for benign pathology. MAIN OUTCOME MEASURES: Frequency and severity of post-operative bleeding. Intensity and pattern of post-operative pain. RESULTS: In total 297 children were recruited, with 91 (30.6%) diaries eligible for analysis. Post-operative bleeding occurred in 44% of children. Most frequently blood in the saliva was reported (82.9%). Increasing age significantly increased bleeding odds by 17% per year (p = .001). Bleeding frequency decreased with higher surgeon grade (p = .003) and when performing intracapsular coblation tonsillectomy (p = .02) compared with other techniques. Lower age and intracapsular coblation tonsillectomy, against other techniques, significantly reduced rates of pain post-operatively (p < .0001 and p = .0008). CONCLUSION: A high level of low-level post-operative bleeding was observed. Pain scores remained high for 5 days post-operatively then gradually reduce to normal by day 13. Intracapsular coblation tonsillectomy appears to be superior to all other techniques in terms of reducing post-operative bleeding and pain. These findings should be used to guide patients in the consent process to inform them of the expected nature of post-surgical recovery.
Subject(s)
Tonsillectomy , Child , Humans , Tonsillectomy/adverse effects , Tonsillectomy/methods , Cohort Studies , Prospective Studies , Adenoidectomy/adverse effects , Adenoidectomy/methods , Postoperative Hemorrhage/epidemiology , Postoperative Hemorrhage/etiology , Pain, Postoperative/epidemiology , Pain, Postoperative/etiologyABSTRACT
The most cost-effective test is fine needle aspiration cytology (FNAC). Many surgeons use intraoperative frozen section to confirm the FNAC findings and to guide the extent of thyroid surgery. Though it is a valuable tool in the diagnosis of the thyroid lesion and determining the extent of thyroid surgery, still in certain cases diagnosis can be incorrect or inconclusive, so histopathology of the excised specimen remains the most reliable test. The purpose of this study will be to compare the result attained by FNAC and frozen section of the thyroid to the final histopathological diagnosis, in order to establish their role in thyroid surgery today. A retrospective study with a total of 140 patients who underwent thyroid surgery at the ENT department, of a tertiary hospital in coastal Karnataka. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for FNAC and frozen section. The sensitivity, specificity, positive predictive rate, and negative predictive rate of frozen section was found to be 66.7%, 88.4%,76.6%, 82.4% respectively for detecting malignancy. This was found to be higher than the results of FNAC for the same which were 64.4%, 77.8%, 64.4%, 77.8% respectively. As the sensitivity of FNAC is similar to frozen section in detecting malignant cases, FNAC is a good tool for screening the patient for determining malignancy in thyroid, but frozen section is more specific in confirming the malignancy.
Subject(s)
Laryngeal Neoplasms/diagnosis , Myofibroblasts/pathology , Otorhinolaryngologic Surgical Procedures/methods , Polyps/pathology , Vocal Cords/pathology , Child , Diagnosis, Differential , Female , Humans , Immunohistochemistry , Laryngeal Neoplasms/physiopathology , Laryngeal Neoplasms/surgery , Treatment Outcome , Vocal Cords/physiopathology , Vocal Cords/surgeryABSTRACT
Neuroblastic tumours are common in childhood and adrenal glands are the most common site. Head and neck ganglioneuroblastomas are extremely rare and nose is a very uncommon site for a ganglioneuroblastoma. The management of this primitive sympathogonic tumour may vary depending on the age of the patient and stage of the tumour. We present a middle-aged man with a ganglioneuroblastoma of skull base, management of this tumour and a review of literature.
