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Results of a double-blinded, randomized, controlled trial indicate that when children diagnosed with sleep apnea must have their tonsils removed, Coblation-assisted intracapsular technique results in less post-operative pain and a quicker return to normal eating and activity than electrocautery. Interestingly, older children who had Coblation-assisted tonsillectomy exhibited the most dramatic reduction in pain.

Tonsillectomy remains one of the most common childhood surgeries with an increasing number of the surgeries being done to treat obstructive sleep apnea or sleep disordered breathing. In children, untreated obstructive sleep apnea and sleep disordered breathing can result in failure to thrive and behavior and learning problems.

Coblation is a non-heat driven process in which radiofrequency energy is applied to a conductive medium (usually saline) causing a highly focused plasma field to form around the electrodes. The plasma field is comprised of highly ionized particles. These ionized particles have sufficient energy to break organic molecular bonds within tissue. Instead of exploding tissue, Coblation causes a low temperature molecular disintegration, resulting in minimal tissue damage to surrounding areas.

Use of Coblation technology for tonsillectomy has grown in the last several years. A new study, undertaken by a single surgeon at one surgical location, asks the question of how Coblation-assisted intracapsular tonsillectomy compares to the traditional method of removing tonsils by electrocautery. The results of the study “Randomized controlled trial of Coblation versus electrocautery tonsillectomy,” will be presented by author Kay Chang, MD, of the Department of Otolaryngology-Head and Neck Surgery at Standford University School of Medicine at the American Academy of Otolaryngology-Head and Neck Surgery Foundation Annual Meeting & OTO EXPO, being held September 19-22, 2004, at the Jacob K. Javits Convention Center, New York City, NY.

Methodology: This study included 101 children scheduled to have tonsillectomy and adenoidectomy for obstructive sleep apnea or sleep disordered breathing. Patients with significant comorbidities or significant history of recurrent/chronic tonsillitis were excluded. Patients were randomized into two study groups; coblation-assisted intracapsular tonsillectomy and electrocautery tonsillectomy.

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What are the tonsils and adenoids?

The tonsils and adenoids are composed of tissues that are similar to the lymph nodes or glands found in the neck or other parts of the body. Together, they are part of a ring of glandular tissue (Waldeyer’s ring) encircling the back of the throat.

The tonsils are the two masses of tissue on either side of the back of the throat. Normal tonsils are usually about the same size and have the same pink color as the surrounding area. On their surfaces are little depressions, called crypts, which may appear deep and contain pus pockets or stones.

The adenoids are located high in the throat behind the nose and soft palate (the roof of the mouth) and unlike the tonsils, are not easily visible through the mouth. A tonsillectomy and an adenoidectomy (commonly referred to as a T & A) are surgical procedures performed to remove the tonsils and adenoids.

What is the purpose of the tonsils and adenoids?

The tonsils and adenoids are thought to assist the body in its defense against incoming bacteria and viruses by helping the body form antibodies. However, this function may only be important during the first year of life. There is no evidence to support a significant role of the tonsils and adenoids in immunity. Medical studies have shown that children who have their tonsils and adenoids removed suffer no loss whatsoever in their future immunity to disease or ability to ward off infections.

What are common problems affecting the tonsils and adenoids?

The most common problems occurring with the tonsils and adenoids are recurrent or chronic infections and significant enlargement (hypertrophy).

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A sore throat can have many causes including:

1. Common viruses, and even the viruses that cause mononucleosis (mono) and the flu, can cause a sore throat. Some viruses can also produce blisters in the mouth and throat (”aphthous stomatitis”).

1. Breathing through the mouth can produce throat dryness and soreness.

1. Sinus drainage (post nasal drip) may cause a sore throat.

1. A sore throat can also be caused by bacteria. The two most common bacteria to cause a sore throat are Streptococcus (which causes strep throat) and Arcanobacterium haemolyticum. Arcanobacterium causes sore throats mainly in young adults and is sometimes associated with a fine red rash.

1. Sore throat appearing after treatment with antibiotics, chemotherapy, or other immune-compromising medications may be due to Candida, commonly known as “thrush.”

1. A sore throat lasting for more than two weeks can be a sign of a serious illness, such as throat cancer or AIDS.

What can I do at home for a sore throat?

Generally, sore throats must run their course (exception, strep throat will be addressed below.)

Salt water gargles, hard candies, sprays for example, Chloraseptic) and lozenges can provide temporary pain relief. (Caution: Lozenges and hard candy are a choking hazard for children. Avoid their use in young children.)

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“I — can’t — breathe,” the boy gasped. There was panic in his voice and face. He moved restlessly in his hospital bed, tugging at the clear plastic mask covering his nose and mouth. An alarm sounded distantly, alerting the nurses to the boy’s distress in the pediatric intensive-care unit of the Cardinal Glennon Children’s Medical Center in St. Louis. Before the nurses could respond, the boy’s mother replaced the oxygen mask, stroking his face and murmuring reassurances as if he were 7 years old rather than 17.

Dr. Jeremy Garrett, an associate professor of pediatrics at St. Louis University School of Medicine, was worried about the boy. When Garrett first saw him, early that morning, he wondered what this robust man-child was doing in the ward reserved for the very sickest children. At that point, the patient had a fever but otherwise looked well.

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BRUSSELS — Noise from personal music players is a routine annoyance for travelers on buses, trains and planes.

But it also threatens permanent hearing loss for as many as 10 million Europeans who use them, according to a scientific study for the European Union that will be published Monday.

The report said that those who listened for five hours a week at high-volume settings exposed themselves to more noise than permitted in the noisiest factory or work place. Maximum volume on some devices can generate as much noise as an airplane taking off nearby.

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