LOS ANGELES—The technique of temperature-controlled radiofrequency (TCRF) ablation has been used to treat apnea by shrinking enlarged tonsils; however, its use in tonsillectomy for recurrent or chronic tonsillitis has not been well documented. Recent evidence suggests that not only is this treatment safe and effective in treating tonsillitis but it also results in significantly less postoperative pain and a faster recovery time than the traditional (cold knife, electrocautery, or coblation) tonsillectomy.[1]

TCRF differs from conventional tonsillectomy in that it reduces tissue size by delivering low-temperature (60°C to 85°C) energy to the tonsil instead of excising the tissue. After the operation, tissue resorption occurs over an eight- to 12-week period. Consequently, there is less postoperative pain because there is no wound requiring mucosalization.

SYMPTOMS DECREASE

Marc Kerner, MD, Chief of Surgery at the Northridge Hospital Medical Center and an Assistant Clinical Professor of Surgery at the UCLA School of Medicine, has performed TCRF tonsillectomy on 85 patients (73 adults and 12 children) who had obstructive tonsillar hypertrophy, apnea, or tonsillitis. All adults in the study with sleep-disordered breathing underwent a sleep study. Apnea patients had had symptoms including snoring, witnessed gasping, or daytime sleepiness. Patients with tonsillitis had had either three months of continuous episodes of infection, repeated positive streptococcal cultures, five or more episodes of tonsillitis in the preceding year, or a history of recent peritonsillar or parapharyngeal abscess. The mean age of all patients was 28.3, and follow-up lasted 17.4 months.

Overall, there was a 92% improvement in tonsil symptoms among patients. All patients noticed a reduction in tonsil size beginning at two weeks postsurgery. Continued tissue shrinkage occurred for up to nine months in some patients.

Among tonsillitis patients, sore throat symptoms and antibiotic use decreased within six months. Patients who had snored noticed a significant postoperative reduction in snoring. There was little pain associated with the procedure: Most patients used narcotic pain relief for the first 24 to 72 hours postoperatively, then switched to either acetaminophen or to NSAIDs.

Adverse effects were minimal. There was little bleeding, and no postoperative hemorrhages were reported. Two adult patients coughed out tonsil tissue and oropharyngeal blood on the sixth postoperative day; these symptoms resolved with saltwater swishes. Two other patients reported severe dysgeusia that resolved within six months. Three patients required re-treatment with local anesthetic but were able to return to work the next day.

Overall, most patients stated that they would undergo the procedure again or would recommend it to others. Dr. Kerner believes TCRF tonsillectomy has benefits over the traditional surgery and that future research should be conducted to assess the long-term outcomes of conventional versus TCRF tonsillectomy.

—Tamara Gibb