BRYN MAWR, Pa. (May 2005) - The days when children could only eat ice cream, Popsicles, and soft foods after having their tonsils removed may soon be coming to an end, thanks to a new tonsillectomy procedure available at Bryn Mawr Hospital.

"The reaction of parents is excitement and joy-because if their child was having 10 days of discomfort, they were having 10 days of discomfort," said Laurence Cramer, DO, an otolaryngologist and attending physician.
 
Cramer is now performing tonsillectomies using a technique called Powered Intracapsular Tonsillectomy (PIT), a partial tonsillectomy that removes about 98 percent of the tonsils and leaves a thin layer of tonsil tissue intact to project the throat muscles.

"The layer of tissue acts as a physiologic Band-aid, preventing harm to the delicate throat muscles," Cramer explained. "In a traditional tonsillectomy, we completely remove the tonsils, exposing the throat muscles, and then we cauterize the exposed muscles to stop bleeding. All of this leads to the post-operative pain and a slow recovery."

The new procedure, which Cramer has been performing during the past year, is accomplished with a microdebrider, a powered instrument with a rotating tip that allows the surgeon to carefully shave off the desired amount of diseased tonsil tissue.

Patients undergoing this partial tonsillectomy experience significantly less pain, make a faster recovery and return to normal activity, and have fewer hospital readmissions for complications such as dehydration and bleeding, Cramer says. PIT is an outpatient procedure, unless the patient has sleep apnea, then an overnight stay at the hospital is required.

"I have some patients who are eating food the next day, which was unheard of before," said Cramer. "I used to tell parents that as long as the kids are drinking liquids, I wouldn't be concerned about solid foods for two weeks. Now, I call my patients the next day and they're eating. I think I've called the wrong house!"

The tonsils are lymph glands on the back of each side of the throat that catch germs entering the breathing passage and prevent infection. Often removed along with tonsils are the adenoids, associated lymph glands located high in the back of the throat behind the nose. Repeated infections of the throat, ears, and sinuses and sleep apnea are the most common reasons for the removal of tonsils and adenoids.

"Generally, we recommend removal of the tonsils if a patient has seven infections in one year, five infections in two consecutive years, or three infections in three years, or if the patient suffers from sleep apnea," said Cramer.     

According to Cramer, there is no difference in outcomes between a full and partial tonsillectomy. Initial fears that the rim of tonsil tissue left behind might regrow or become reinfected appear unfounded, he said.

For much of the last century, tonsils had been routinely removed during childhood until the development of antibiotics became the preferred treatment for infections related to tonsils. Then the operation became relatively rare, and Cramer says many people who should have had their tonsils out as children suffer as adults.

"What happened was we regressed in the other direction," he said of the growing reluctance to perform tonsillectomies. "So now, for every child between age 5 and 8 whose tonsils we take out, there's an adult between 20 and 40 we missed who's been suffering for years and years, and years."

For adults, the new procedure may not be as effective as it is in children because the tonsils will have become scared and rubbery from repeated infections, compared with the fluffy tonsils of a child. "Adult tonsils don't shave out as easily, but we will try the partial tonsillectomy first," he said. "If the procedure becomes difficult, we can convert to a traditional tonsillectomy."

Marketing/Public Relations/communications
130 S. Bryn Mawr Avenue
Bryn Mawr, PA 19010
Contact: Frieda Schmidt, 610-526-8763

Published:  5-10-2005