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Does infection play a role in post-tonsillectomy haemorrhage? A narrative review

Published online by Cambridge University Press:  13 December 2022

A Williamson Open the ORCID record for A Williamson [Opens in a new window] ,
H Coleman  and
C Douglas Open the ORCID record for C Douglas [Opens in a new window]
A Williamson*
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Monklands University Hospital, Glasgow, Scotland, UK
H Coleman
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
C Douglas
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
*
Author for correspondence: Mr A Williamson, Department of Otolaryngology, Head and Neck Surgery, Monklands University Hospital, Monkscourt Ave, Airdrie, Glasgow ML6 0JS, Scotland, UK E-mail: andrewjwilliamson@doctors.org.uk
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Abstract

Objective

Post-tonsillectomy haemorrhage is an increasingly common cause of morbidity following tonsillectomy. Secondary post-tonsillectomy haemorrhage occurring more than 24 hours after an operation has long been attributed to post-operative infection; however, there is little evidence to support this hypothesis and the associated use of antibiotics in the current literature.

Method

This study looked at the aetiology and evidence-based management of post-tonsillectomy haemorrhage, and investigated the impact of bacterial infection and antimicrobials on the pathogenesis and clinical course of this complication.

Results

A number of peri-operative risk factors for post-tonsillectomy haemorrhage exist, and infective pathologies, including recurrent or chronic tonsillitis and group A streptococcus on blood cultures, may predispose to bleeding. Very few studies have shown a link between post-tonsillectomy haemorrhage and objective markers of infection such as pyrexia, raised inflammatory markers or positive microbiology cultures. The role of antibiotics in secondary post-tonsillectomy haemorrhage remains controversial, and numerous randomised, controlled trials of peri-operative antibiotics have shown no significant difference in bleeding rates between antibiotics and controls.

Conclusion

Further trials investigating the role of antibiotics and more robust studies investigating the presence of bacterial infection at the time of bleeding may be required to determine the true role of infection in post-tonsillectomy haemorrhage.

Keywords

TonsillectomyTonsillitisPeritonsillar AbscessPostoperative ComplicationPostoperative HaemorrhageSurgical Wound Infection
Type
Review Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 7 , July 2023 , pp. 710 - 717
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Mr A Williamson takes responsibility for the integrity of the content of the paper

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