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Is bacterial colonisation of the tonsillar fossa a factor in post-tonsillectomy haemorrhage?

Published online by Cambridge University Press:  20 April 2007

J C Stephens ,
C Georgalas ,
M Kyi  and
K Ghufoor
J C Stephens*
Affiliation:
Department of ENT, Charing Cross Hospital, London, UK
C Georgalas
Affiliation:
Department of ENT, St Mary's Hospital, London, UK
M Kyi
Affiliation:
Department of Microbiology, West Middlesex Hospital, London, UK
K Ghufoor
Affiliation:
Department of ENT, St Bartholomew's Hospital, London, UK.
*
Address for correspondence: Miss Joanna C Stephens, 68b Gascony Avenue, West Hampstead London, NW6 4NE, UK. Fax: 44 (0)208 321 5904 E-mail: jstephens@doctors.org.uk
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Abstract

Objectives:

To identify if there is a link between bacterial colonisation of the tonsillar fossa and post-tonsillectomy haemorrhage.

Study design and setting:

Prospective non-interventional study of 105 patients who underwent tonsillectomy during a seven-month period. The study took place in a secondary care centre, the West Middlesex University Hospital.

Participants:

The participants were 105 patients who consecutively underwent tonsillectomy. The exclusion criteria were any patients with suspected or known malignancy, or known bleeding dyscrasias. The participants underwent microbiological sampling of the tonsil pre-operatively.

Main outcomes measures:

The outcome measures were primary or secondary bleeding, defined as any evidence of haemorrhage in the tonsillar fossae.

Results:

Twenty-four per cent of patients undergoing tonsillectomy had positive cultures from their tonsils pre-operatively. Patients with bacterial colonisation of the tonsillar fossa pre-operatively had an increased rate of post-tonsillectomy haemorrhage (odds ratio: 3.8, 1.1–12.1, 95 per cent confidence intervals, p = 0.04).

Conclusion:

This prospective study has found a relationship between bacterial colonisation of the tonsillar fossa and post-tonsillectomy haemorrhage. This suggests that there may be an argument for the use of antibiotics in those cases with positive pre-operative cultures. In view of the types of pathogens isolated, we feel that the management of a post-tonsillectomy bleed should include a beta lactamase inhibiting antibiotic.

Keywords

TonsillectomyHaemorrhageMicrobiologyInfection
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 4 , April 2008 , pp. 383 - 387
Copyright
Copyright © JLO (1984) Limited 2007

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References

1 Myssiorek, D, Alvi, A. Post-tonsillectomy haemorrhage: an assessment of risk factors. Int J Paediatr Otorhinolaryngol 1996;37:35–43CrossRefGoogle ScholarPubMed
2 Shah, G, Ghani, R, Ayub, J. Frequency of post tonsillectomy haemorrhage following tonsillectomy with bipolar diathermy- an experience at a teaching hospital, Abbottabad. Med Coll Abbottabad 2004;16:38–9Google Scholar
3 Gaffney, RJ, Freeman, DJ, Walshy, MA, Cafferkey, MT. Differences in tonsil core bacteriology in adults and children: a prospective study of 262 patients. Respir Med 1991;85:383–8CrossRefGoogle ScholarPubMed
4 Brook, I, Foote, PA Jr. Microbiology of “normal” tonsils. Department of Paediatrics, National Naval Medical Centre, Bethesda Maryland. Ann Otol Rhinol Laryngol 1990;99:980–3CrossRefGoogle Scholar
5 Surow, JB, Handler, SD, Telian, SA, Fleisher, GR, Baranak, CC. Bacteriology of tonsil surface and core in children. Department of Otorhinolaryngology and Human Communication, Children's Hospital of Philadelphia, PA 19104. Laryngoscope 1989;99:261–6CrossRefGoogle ScholarPubMed
6 Telian, SA, Handler, SD, Fleisher, GR, Baranak, CC, Wetmore, RF. The effect of antibiotic therapy on recovery after tonsillectomy in children. A controlled study. Arch Otolaryngol Head Neck Surg 1986;112:610–15CrossRefGoogle Scholar
7 O'Reilly, BJ, Black, S, Fernandes, J, Panesar, J. Is the routine use of antibiotics justified in adult tonsillectomy? J Laryngol Otol 2003;117:382–5CrossRefGoogle ScholarPubMed
8 Burkart, CM, Steward, DL. Antibiotics for reduction of post-tonsillectomy morbidity: a meta-analysis. Laryngoscope 2005;115:997–1002CrossRefGoogle Scholar
9 British Association of Otorhinolaryngolgists – Head and Neck Surgeons Comparative Audit Group, Clinical Effectiveness Unit, The Royal College of Surgeons of England. National Prospective Tonsillectomy Audit: Final Report of an audit carried out in England and Northern Ireland between July 2003 and September 2004. London: The Royal College of Surgeons of England, 2005.Google Scholar
10 Tami, TA, Parker, GS, Taylor, RE. Post tonsillectomy bleeding: an evaluation of risk factors. Laryngoscope 1987;11:1307–11CrossRefGoogle Scholar
11 Bhattacharyya, N. Evaluation of post tonsillectomy bleeding in the adult population. Ear Nose Throat J 2001;80:544–9CrossRefGoogle ScholarPubMed
12 Kumar, VV, Kumar, NV, Isaacson, G. Superstition and post-tonsillectomy haemorrhage. Laryngoscope 2004;114:2031–3CrossRefGoogle Scholar
13 Van der Muelen, J. Tonsillectomy technique as a risk factor for post operative haemorrhage. Lancet 2004;364:697–703CrossRefGoogle Scholar
14 Stjernquist-Desatnik, A, Holst, E. Tonsillar microbial flora: comparison of recurrent tonsillitis and normal tonsils. Acta Otolaryngol 1999;119:102–6Google ScholarPubMed
15 Yuldririm, I, Okur, E, Ciragil, P, Aral, M, Kilic, MA, Gul, M et al. Bacteraemia during tonsillectomy. J Laryngol Otol 2003;117:619–23CrossRefGoogle Scholar