We’re not there yet, but we’re close. The mainstay treatment for recurrent tonsil infections is to remove the tonsils. The major problem with the traditional method of tonsillectomy was the severe pain children (and adults) experienced after surgery. New methods of removing the tonsils focus on decreasing this pain. Coblation uses radiofrequency energy to remove tissues and stop bleeding with less surrounding tissue damage, or “char,” than traditional electrocautery methods. Studies have shown less pain after surgery but also a higher rate of bleeding after surgey that requires a second surgery to control, probably due to the same decrease in tissue char. The Harmonic Scapel uses a small knife blade that vibrates at 55,500 hertz, a frequency in the radiofrequency range. Similar to coblation, while there is less surrounding tissue damage and less pain, there may also be a higher postoperative bleeding rate, though a few studies suggest a lower post-op bleeding rate compared to traditional electrocautery.
The main problem with the harmonic scalpel is the cost; the device is quite expensive and most insurance companies don’t pay for it. My preferred method to remove tonsils is the Powered Intracapsular Tonsillectomy (PIT). This method decreases pain by using a shaving device to remove the tonsil tissue but leaving the cover, or capsule, in place. The capsule works like a protective barrier and decreases postoperative pain and bleeding. Technically this procedure is a “tonsillotomy” instead of a tonsillectomy, meaning that a small amount of tonsil tissue is left in place with the capsule which could cause recurrent infections after surgery. However, studies have shown no difference in the rate of recurrent throat infections after PIT vs. traditional tonsillectomy.
Postop pain from traditional methods of tonsillectomy is severe and lasts for 2 weeks, whereas pain from PIT is mild and lasts 3 to 5 days. For more information, post a questions or call us for an appointment.