Albucasis (936-1013), a pioneer in tonsillectomy.

BACKGROUND: The surgical removal of tonsils has been performed from as long as three thousand years ago, as mentioned in Hindu literature. The role medieval physicians like Albucasis played in the history of tonsillectomy is very important. This article aims to show the contributions Albucasis made to this procedure. METHODS: The present library-documentary research relied on the third chapter of the book al-Tasrif, Albucasis' surgical text, as the main information source. RESULTS: Albucasis discussed the conditions necessary for tonsillectomy, he introduced three surgical tools for this operation, and he also described the surgical method. Albucasis succeeded in inventing and discovering new tools and methods for tonsillectomy. CONCLUSION: The comparison of the tonsil surgery introduced by Albucasis and those of earlier and later surgeons reveals Albucasis' superiority in both operation performance and equipment used. Some of his methods are comparable with approaches to operations used in the 20th century.

David Alexander Draffin: An Irish ENT Surgeon and Inventor.

David Alexander Draffin was an Irish ENT surgeon and inventor of the internationally famous ENT instrument used in tonsillectomy, which carries his name and is called Draffin's rods. His story is not as well-known as his eponymous ENT instrument and this article attempts to shed a light into his life. He studied in Queen's University in Belfast and was a medical officer in World War II. During that time, he demonstrated great courage and spirit. On his return from the war, he worked in many hospitals as an ENT surgeon and published multiple articles. His career was an unconventional one though, since due to multiple extracurricular activities he never became a consultant! He was actually struck off the medical register for drink-driving charges just a little before his early death. His life was evidence of his bravery, innovative spirit and mischief and his legacy shaped the way tonsillectomies are done to this day.

The impact of new evidence on regional variation in paediatric tonsillectomy and adenoidectomy: a historical review.

BACKGROUND: Tonsillectomy and adenoidectomy have been among the most commonly performed procedures in children for approximately 100 years. These procedures were the first for which unwarranted regional variation was discovered, in 1938. Indications for these procedures have become stricter over time, which might have reduced regional practice variation. METHODS: This paper presents a historical review on practice variation in paediatric tonsillectomy and adenoidectomy rates. Data on publication year, region, level of variation, methodology and outcomes were collected. RESULTS: Twenty-one articles on practice variation in paediatric tonsil surgery were included, with data from 12 different countries. Significant variation was found throughout the years, although a greater than 10-fold variation was observed only in the earliest publications. CONCLUSION: No evidence has yet been found that better indications for tonsillectomy and adenoidectomy have reduced practice variation. International efforts are needed to reconsider why we are still unable to tackle this variation.

The shifting relationship between weight and pediatric obstructive sleep apnea: A historical review.

OBJECTIVES: For more than a century, pediatric obstructive sleep apnea (OSA) was associated with failure to thrive. However, that association has faded over the last few decades. A 21st century child with OSA is much more likely to be overweight than underweight. This raises the question: Has pediatric OSA changed over time, or has the rise of childhood obesity in the United States created a new, separate disease? This literature review explores the historical shift in the relationship between weight and OSA, and the associated changes in treatment. RESULTS: We demonstrate a clear transition in the prevalence of failure to thrive and obesity in the OSA literature in the mid-2000s. What is less clear is whether these two clinical phenotypes should be considered two distinct diseases, or whether subtle differences in one set of pathophysiologic pathways-adenotonsillar hypertrophy, altered inflammation, and increased energy expenditure-can lead to divergent metabolic outcomes. More research is needed to fully elucidate the pathophysiology of OSA in children with obesity. CONCLUSIONS: We may need new and different treatments for obesity-associated OSA as adenotonsillectomy-which is effective at reversing failure to thrive in OSA-is not as effective at treating OSA in children with obesity. One option is drug-induced sleep endoscopy, which could personalize and improve surgical treatment of OSA. There is some evidence that therapies used for OSA in adults (e.g., weight loss and positive airway pressure) are also helpful for overweight/obese children with OSA. Laryngoscope, 129:2414-2419, 2019.

Treatment of IgA Nephropathy: Evolution Over Half a Century.

Fifty years into the original description of IgA nephropathy, there is still no specific therapy for this condition and general measures including blood pressure control with blockers of the renin-angiotensin-aldosterone system and salt restriction remain the cornerstone to slow disease progression. Although the paucity in treatment advances could be related to the disease's complex pathogenesis, which requires multiple hits, heterogeneity as reflected by diverse ethnic differences, and genetic predisposition and histopathologic variations, many nonspecific and immunomodulatory agents have been tested with variable degrees of success and tribulations. Here, we review the evolution of these different therapeutic approaches over time that culminated in the 2012 Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for Glomerulonephritis that presently is being updated, and provide an appraisal of recent data on various forms of immunosuppressive agents. Finally, we discuss the theoretical basis of ongoing and upcoming clinical trials that are more pathway- or cell-type-specific as knowledge in disease mechanisms advances.

'A Wicked Operation'? Tonsillectomy in Twentieth-Century Britain.

Histories of twentieth-century surgery have focused on surgical 'firsts' - dramatic tales of revolutionary procedures. The history of tonsillectomy is less glamorous, but more widespread, representing the experience and understanding of medicine for hundreds of children, parents and surgeons daily. At the start of the twentieth century, tonsillectomy was routine - performed on at least 80 000 schoolchildren each year in Britain. However, by the 1980s, public and professional discourse condemned the operation as a 'dangerous fad'. This profound shift in the medical, political and social position of tonsillectomy rested upon several factors: changes in the organisation of medical institutions and national health care; changes in medical technologies and the criteria by which they are judged; the political, cultural and economic context of Britain; and the social role of the patient. Tonsillectomy was not a mere passive subject of external influences, but became a potent concept in medical, political, and social discourse. Therefore, it reciprocally influenced these discourses and subsequently the development of twentieth-century British medicine. These complex interactions between 'medical' and 'non-medical' spheres question the possibility of demarcating what is internal from what is external to medicine.

Garnett Passe and the tonsillectomy gag.

Kevin Kane has written about the painting by Barbara Hepworth of Garnett Passe performing a tonsillectomy, and wondered about the way in which the gag appears to be suspended. This article traces historically the various methods of holding the gag for tonsillectomy, and postulates that what is illustrated in the Hepworth painting is a jack owned by the late Dr Sydney Cocks, who not only was a friend of Passe but who also commenced the discussions with Passe's widow, Barbara, concerning the formation by her of a trust to support young Australian ENT surgeons, which eventually became The Garnett Passe and Rodney Williams Memorial Foundation.

Who has been hiding in your tonsillectomy tray? Eponymous instruments in tonsillectomy surgery.

BACKGROUND: Surgeons regularly use eponymous instruments when performing tonsillectomies, yet the stories behind each are not commonly known. METHOD AND RESULTS: This paper presents the instruments within the tonsillectomy tray, providing a brief biography of their respective surgeon namesakes. The list captures over two centuries of surgical history, and spans the disciplines of ENT, general surgery, gynaecology, anaesthetics and paediatric surgery. CONCLUSION: This is the first publication to undertake a historical study of the ensemble of surgeon inventors responsible for the instruments in the tonsillectomy tray as it is today. In furthering knowledge of our forbearer surgeon inventors, who have shaped the tonsillectomy procedure as it is safely performed today, we enrich our understanding of the history of our profession and build appreciation for the instruments employed daily. We may even be inspired to continue the tradition of evolving the craft.

Factors influencing the indication for tonsillectomy: a historical overview and current concepts.

Tonsil surgery has been performed for more than 3,000 years. During the 19th century when anesthesia became available, techniques were refined and the number of procedures performed increased. Repeated throat infections often causing big tonsils was the reason why parents asked for the procedure. During the preantibiotic era, scarlet fever was feared since potential heart or kidney complications were life-threatening. The technique used before 1900 was tonsillotomy since neither a fingernail, snare nor the later 'guillotine' were used extracapsularly. Bleeding was small and the surgery ambulatory. Extracapsular tonsillectomy developed around the turn of the 20th century with the purpose of avoiding remnants - the 'focal infection theory' was prevailing. The whole tonsil was now extirpated with good visibility of the tonsillar area in a deeply anesthetized patient. During the first half of the 20th century, the two methods competed, but by 1950, total tonsillectomy had become the only 'correct' tonsil surgery. The indication was still recurrent infections. The risk for serious bleeding increased; therefore large clinics arose where patients remained for at least a week after tonsillectomy. When oral penicillin for children became available during the 1960s, the threat of throat infection decreased and the number of tonsillectomies declined. The awareness of obstructive problems in children rose at the same time when obstructive sleep apnea syndrome became a disease for adults (1970s). Tonsillotomy was revived during the 1990s and is today used increasingly in many countries. The indication is mainly obstructive sleep apnea syndromeor sleep-disordered breathing, especially in small children. Total tonsillectomy is still preferred for recurrent infections, which include periodic fever/adenitis/pharyngitis/aphthous ulcer syndrome and recurrent peritonsillitis.

Barbara Hepworth and the tonsillectomy.

The Garnett Passe and Rodney Williams Foundation, a major medical research foundation in Melbourne, has recently acquired a hitherto unknown and uncatalogued painting by Dame Barbara Hepworth, the celebrated British sculptor and artist. It is of the Foundation's nominal patron Garnett Passe performing a tonsillectomy, probably at the London Clinic, in 1948. This article gives an account of Barbara Hepworth and her relationships with Garnett Passe and Norman Capener, the two surgeons who introduced her to this subject and who led to the creation of this unique work of art.

On the history of modern tonsillectomy: the contribution of Nikolaos Taptas.

The earliest reports on removal of the entire tonsil using a method of careful dissection came in the early 1900 s by American and British otorhinolaryngologists. These descriptions are credited as the first of the so-called modern tonsillectomy. In this report we present a technique of tonsillectomy conceived by Nikolaos Taptas, a Greek physician and citizen of the Ottoman Empire, which was introduced at the same period with the ones previously mentioned. Taptas practiced his technique in the very early 1900 s. He used his own instruments and reported excellent post-operative results with very few complications. He should therefore be considered among the pioneers of modern tonsillectomy.

The art of tonsillectomy: the UK experience for the past 100 years.

Tonsillectomy is one of the commonest ear, nose, and throat procedures performed in the United Kingdom. In the drive to reduce complication rates and improve patients' satisfaction, numerous adaptations to the traditional technique have evolved. In this article, the authors explore the changes that have been happening in the United Kingdom during the past 100 years and conclude that revisiting the traditional techniques may still be the answer to a successful procedure.