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Adult Tonsillectomy: Current Indications And Outcomes

Elizabeth Kathryn Hoddeson, Christine G. Gourin

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Objective With increased antibiotic usage, the indications for pediatric tonsillectomy have shifted from infection to treatment of airway obstruction. Limited data exists regarding the current prevalence of indications for tonsillectomy in adults. We sought to determine the indications for tonsillectomy in an adult population and identify factors associated with postoperative complications. Methods The medical records of all adult patients (18 or more years of age) who underwent tonsillectomy from 2001–2007 were reviewed. Patients who underwent concurrent procedures were excluded. Results A total of 361 patients met study criteria. Indications for surgery were chronic infection in 207 patients (57%), upper airway obstruction secondary to tonsillar hypertrophy in 98 patients (27%), and suspected neoplasm in 56 patients (16%). Postoperative complications occurred in 54 cases (15%) with hemorrhage in 19 patients (5%), followed by pain and dehydration in 16 patients (4%) and admission for postoperative oxygen desaturations in 11 patients (3%). Hospitalization beyond 24 hours occurred in 18 cases (5%), with emergency room visits for pain and dehydration in 16 patients (4%), and readmission for pain control in 17 cases (5%). Patients who underwent tonsillectomy for upper airway obstruction had an increased incidence of prolonged hospitalization or readmission (19% vs. 6%; P=0.01), while patients who underwent tonsillectomy for infection had an increased incidence of post-operative bleeding (6% vs. 4%; p=0.02). Conclusions Chronic infection remains the most common indication for adult tonsillectomy, in contrast to the pediatric population. Complication rates vary according to the indication for surgery. These data may provide useful information for preoperative counseling.