Solutions Offered for Tonsil Healing

Monday, September 25th 2000, 12:00 am
By: News On 6

WASHINGTON (AP) — Dr. Renee Walker was stunned: Her 3-year-old patient munched Cheetos instead of easy-on-the-throat ice cream the day after his tonsils were removed.

Every parent knows that's highly unusual. A tonsillectomy is very painful, limiting what you swallow for up to a week. But now doctors like Walker are hunting new surgical techniques that may ease the sting — and it's none too soon.

Tonsil removal, which went from a rite of passage in the 1960s to an operation discouraged for all but the most repeatedly ill kids by the 1980s, is on the upswing again. And no longer is it done just to fight recurring throat infections. Surprisingly, the breathing disorder sleep apnea, long considered a bane of middle-aged snorers, today is sending thousands of children under the knife.

With surgery again inching up, doctors hoping to speed recovery are testing everything from laser-like devices to shrinking tonsils with microwaves, so far all unproven. Now Walker says her own research shows a simple change in surgery — using a tool powered by ultrasonic vibrations that cut tissue and stop bleeding simultaneously — can get kids swallowing normally again faster than a standard tonsillectomy.

``Once they start eating, they heal faster and feel better,'' says Walker, a Joplin, Mo., ear, nose and throat surgeon who presents preliminary results from her study of 316 patients to an American Academy of Otolaryngology meeting this week. ``Amazingly, these little kids I have eating green beans and macaroni and chicken and pizza'' in 24 to 72 hours.

About 390,000 people, the vast majority children, undergo tonsillectomies each year. It's recommended for chronic throat infections, considered six in a single season or four to five infections a year for several years.

Yet surgeons say unlike in previous decades, half to three-fourths of today's operations are not for infections but for obstructive sleep apnea. That disorder causes short stops in breathing when something blocks airflow during sleep. In kids, the blockage often is large tonsils; adult apnea usually has other causes.

``Years ago, kids got their tonsils out sooner so you never saw (youthful apnea) or people didn't recognize it,'' says Dr. Ralph Wetmore of the University of Pennsylvania, who suspects the problem when parents complain of unusually loud snoring or sleepiness despite an early bedtime.

Tonsillectomies typically are performed by electrocautery, sticking a long device in the throat that cuts and burns away the tissue, searing blood vessels to stop bleeding.

The ``Harmonic Scalpel,'' in contrast, uses ultrasonic vibrations that move a cutting blade 55,000 times per second. The vibrations break up tissue proteins that in turn seal bleeding at far lower temperatures than cauterizing does.

The theory: Less deep-tissue burning means less pain. But doctors were skeptical. The Food and Drug Administration approved the tool last year as a substitute for standard tonsillectomy devices, but manufacturer Johnson & Johnson didn't prove it better than the old method and it adds $100 to the surgery's cost.

So Walker, surprised by that 3-year-old's response when she tried the tool out of curiosity, asked J&J to fund the first comparison. For a year, she randomly used the Harmonic Scalpel on half her patients and electrocautery on half.

Medical records show no difference between the two methods in blood loss, dehydration, hospitalization or painkillers. But parents' questionnaires found the new method significantly sped recovery: 44 percent of children returned to a regular diet within a day, and 74 percent within three days — compared with 23 percent and 47 percent, respectively, of standard tonsillectomy patients. The scalpel-operated kids also returned to normal play or school routines faster.

Wetmore, the otolaryngology academy's tonsil chairman, calls Walker's findings promising but says more study is needed. ``Different people are doing tonsillectomies different ways now,'' he warns parents, so consider options carefully.

Walker cautions her own patients that the new technique won't have every child feeling good in days. ``But the numbers are showing the odds are in your favor.''


EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.