Hot Versus Cold Tonsillectomy: A Systematic Review of the Literature

Abstract

OBJECTIVE: We systematically reviewed the literature comparing monopolar electrocautery versus cold knife dissection tonsillectomy.

METHODS: The MEDLINE database was searched using the key words “tonsillectomy,” “hot,” “cold,” “sharp,” “bleeding,” and “cautery.” Selection criteria included prospective trials comparing electro-dissection versus cold knife dissection on posttonsillectomy pain and hemorrhage. Six of the 815 articles met the selection criteria.

RESULTS: Pooled data for the paired studies showed significantly more patients with pain worse on the electrodissection side (148 of 293 = 51%) than the cold knife side (33 of 293 (11%); P = 0.001) on postoperative days 4 to 10. There were significantly more analgesic doses after surgery with electrodissection (means 26.7 versus 19.2; P = 0.028) and higher pain scores for adults undergoing electrodissection (means, 2.6 versus 0.8; significance could not be determined). There were no differences in hemorrhage rates.

CONCLUSIONS: Electrodissection increases pain in comparison to sharp dissection for tonsillectomy. Postoperative hemorrhage rates are not significantly different when comparing the 2 methods. (Otolaryngol Head Neck Surg 2003;129:360–4.)