|Year : 2009 | Volume
| Issue : 1 | Page : 46-51
Updates in Rhinology and Base of the Skull Prince Salaman Hospital Riyadh, Saudi Arabia 5-6 November 2008
|Date of Web Publication||7-Jan-2020|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Updates in Rhinology and Base of the Skull Prince Salaman Hospital Riyadh, Saudi Arabia 5-6 November 2008. Saudi J Otorhinolaryngol Head Neck Surg 2009;11:46-51
|How to cite this URL:|
. Updates in Rhinology and Base of the Skull Prince Salaman Hospital Riyadh, Saudi Arabia 5-6 November 2008. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2009 [cited 2022 Dec 4];11:46-51. Available from: https://www.sjohns.org/text.asp?2009/11/1/46/275326
| Endoscopic Endonasal DCR: Technique and Instrumentation|| |
Dr.Gerald WOLF University ENT-Hospital Department of General ENT Auenbruggerplatz 26/28 A-8036 Graz / AUSTRIA
Abstract: The endoscopic endonasal approach is an excellent diagnostic and surgical approach to the nasolacrimal system. The most common indications for an endoscopic endonasal approach are obstructions of the nasolacrimal sac and duct following inflammatory processes, trauma and tumors. In acute dacryocystitis it is the acute and definitive procedure in one. In combination with endoscopic endonasal laser assisted DCR for selected cases it is even less invasive. Anatomy, indications, both surgical techniques, the use of instruments, postoperative care and complications are demonstrated.
We studied patients with a follow up of 4 years. All patients were investigated by fluoreszeintest and endoscopic endonasal examination. Reobstruction and complication rates were recorded. Our results indicate, that both techniques offer ENT-surgeons an effective, minimally invasive method to treat obstructions of the nasolacrimal system. If indicated, they are superior to external techniques as they are preserving the pump and suction mechanism of the tear transport.
| RKH Experience CSF Repair|| |
Dr Tariq Tatwani
Consultant ORL, Head & Neck Surgery Riyadh Military Hospital
Abstract: Endoscopic management of skull base defects is relatively new entity since its being popularized in 1990’s the techniques of endoscopic repair of CSF leaks as well as repair of nasal encephalocele becoming the method of choice. The endoscopic sinus surgery has opened a new frontier for management of skull base and intracranial disease not only for rhinilogist but also for neurosurgeons who used to manage these entities by craniotomy in the past. In this paper we will discuss the management of CSF Rhinorrhea and the various methods of management, we will also present series of cases operated in RMH from 2003 till present.
“The Frontal Recess and Frontal Sinus-Anatomy, Variations and Complications of Surgery”
University ENT-Hospital Department of General ENT Auenbruggerplatz 26/28 A-8036 Graz / AUSTRIA
Abstract: The endonasal approach to the frontal recess is one of the most difficult approaches in endoscopic sinus surgery. This approach requires much endoscopic experience, surgical skill, adequate instrumentation and thorough knowledge of the anatomy because of the many structural variations in the region of the frontal recess.
Surgery of the frontal recess is unforgiving of inadequate surgery.
The frontal recess is the pre-chamber to the frontal sinus. Therefore the frontal sinus is completely dependent on what is found or develops in the frontal recess. Furthermore, the frontal sinus is the only sinus that has an active inverted mucocillary transport system. This can result in infectious material from the frontal recess being transported into the frontal sinus. Endoscopic endonasal surgery of the frontal sinus means endoscopic endonasal surgery of the frontal recess. By clearing diseased tissue or obstruction from the frontal recess most of the disease in the dependant frontal sinus can be cured
In the majority of cases complete resection of the uncinate process alone results in adequate opening and clearing of the frontal recess.
Care has to be taken not to be too aggressive in frontal recess dissection to avoid scarring, osteitis, stenosis or postoperative iatrogenic problems.
The frontal sinus, frontal sinus ostium and frontal recess form an hourglass shape with the waist at the ostium of the frontal sinus. The frontal recess can be narrowed by the following anatomic structures:
Obstruction in the Frontal Recess
An uncinate process which is blind ending and forms a terminal recess.
An agger nasi cell, frontal cells and supraorbital cells.
The ethmoid bulla.
An interfrontal sinus septal cell.
A concha bullosa of the middle turbinate.
In addition the frontal recess may be obstructed by polypoid tissue, tumor or scarring from trauma or previous surgery.
As stated previously, complete resection of the uncinate process frequently results in obtaining adequate ventilation and drainage for the frontal recess and frontal sinus. However, variations of the attachment or insertion of the uncinate process may cause problems in identifying and opening the frontal recess. The uncinate process may attach laterally to the lamina papyracea or medially to the middle turbinate. In many cases the uncinate may insert superiorly toward the skull base, and can even have contact with the skull base and block ventilation and drainage of the frontal sinus.
Stammberger compared an obstructive situation in the frontal recess to an egg holder with an egg remaining inside when the holder is turned upside down. Removing the obstruction from the frontal recess was described as “uncapping the egg” by Stammberger. Care has to be taken when removing the cap or shell of the egg so as not to traumatize the surrounding mucosa and not to perforate the thin bone at the skull base creating a CSF leak.
Adequate instrumentation is absolutely crucial when approaching the frontal recess.
The primary goal of the surgery in the frontal recess is to provide adequate drainage and ventilation of the frontal sinus and to avoid scarring, granulation tissue or iatrogenic problems such as a mucocele. To avoid scarring, bone should not be exposed and mucosa should not be traumatized. Mucosa on opposing surfaces has to remain intact, especially in the area of the natural ostium. Circumferential trauma has to be avoided. Mucosal preservation in the frontal recess is the primary goal. Indications should be clear before the frontal recess is approached surgically.
Surgery in the frontal recess should only be performed if there is disease and symptoms in the area of the frontal sinus. In many situations adequate resection of the uncinate process and especially the terminal recess provides sufficient drainage for the frontal sinus and no further dissection is required. If a disease process extends into the frontal sinus such as a frontal cell, a tumor, a polyp or an osteoma, a combined approach has to be considered. Trephination of the frontal sinus and surgery under endoscopic control within the frontal sinus can help to avoid complicated drill-out procedures. In difficult cases the surgeon has to decide when to change to an external procedure.
We have found the following to be the most frequent problems in frontal recess surgery:
- A terminal recess obstructing the frontal recess is left behind causing inflammatory disease in the frontal sinus.
- The medial or superior aspect of an Agger Nasi or Frontal cell may be persisting.
- The middle turbinate has been resected and the remnant of the middle turbinate is completely obstructing the frontal recess with scar formation obstructing the frontal sinus ostium.
Endoscopic nasal surgery: Anatomical bases of nasal surgery
Prof. Mohamed Zaki Hilal
Professor of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Abstract: Successful endoscopic nasal surgery (ENS) is largely dependent on the proper understanding of nasal anatomy and on the ability to accurately diagnose even relatively minor variations in anatomy of the narrow nasal clefts.
Nasal endoscopy provides the ability to accurately assess endoscopic anatomy of these areas for evidence of localized disease, or for anatomic defects. The imaging anatomy is achieved with properly performed CT scans. The anatomical basis of techniques of ENS is highlighted for each sinus.
Endoscopic nasal surgery: Expectations and achievements
Prof. Mohamed Zaki Hilal
Professor of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Abstract: The keystone of endoscopic nasal surgery (ENS) is the ability to accurately diagnose even relatively minor changes in the narrow nasal clefts. Nasal endoscopy provides the ability to accurately assess these areas for evidence of localized disease, or for anatomic defects.
The diagnostic value of nasal endoscopy is great and unquestionable, the same is its role in follow-up of the disease and following treatment.
The expectations of ENS are variable depending on the etiology of the disease. The goal of FESS is to open the diseased sinus at its natural ostium and possibly widen it to improve sinus drainage and ventilation. The final outcome is determined by the etiology of the sinus; being excellent in correcting anatomical defects and depending largely on medical control in post-allergic cases and in polyposis.
ENS for nasal tumors is very beneficial provided the needed skill and equipment are available. Endoscopic skull repair for CSF leaks and meningo-encephaloceles replaced external approaches in the majority of cases. Endoscopic transnasal pituitary surgery is the standard surgical management for pituitary tumors. Transnasal intracranial surgery for tumors invading the brain is rewarding provided the needed skull and equipment are available to the endoscopic rhinologist and the copartner endoscopic neurosurgeon.
| Selected Abstracts On Tonsillitis|| |
Paediatric tonsillectomy: radiofrequency-based plasma dissection compared to cold dissection with sutures.
Di Rienzo Businco L, Coen Tirelli G.
Acta Otorhinolaryngol Ital. 2008 Apr;28:67-72. Department of Otorhinolaryngology, S. Eugenio Hospital, Rome, Italy. [email protected]
Aim of this study was to compare post-operative recovery over 14 days in children submitted to tonsillectomy using a bipolar radiofrequency-based plasma device (Coblation, Evac 70, ArthroCare Corp, Sunnyvale, CA, USA) to cold dissection. Paediatric patients (n = 42) aged 5-16 years old with chronic tonsillitis underwent tonsillectomy using cold dissection with suture ligatures or a plasma device (Evac 70, ArthroCare Corp, Sunnyvale, CA, USA). Pain intensity on the first day, use of analgesics, type of diet, and days of pain, fever, nausea, and absence from school were determined. Groups were compared using time-to-event (Kaplan-Meier) curves and statistically evaluated using the Breslow (generalized Wilcoxon) test. Children undergoing plasma tonsillectomy reported significantly less pain on the first post-operative day (1.2 +/- 0.9 vs. 3.5 +/- 1.5, p < 0.001), fewer days of pain (4.8 +/- 1.5 vs. 9.4 +/- 1.2, p <0.001), pain medication withdrawal (2.6 +/- 1.3 vs. 4.5 +/- 1.3, p <0.001) and earlier use of liquid diet (5.1 +/- 1.4 vs. 8.5 +/- 2.1, p <0.001), and fewer school days lost (5.3 +/- 1.7 vs. 8.9 +/- 1.5, p <0.001). After completing this study, plasma tonsillectomy was adopted for the majority of cases. Benefits of the plasma device include the possibility both to excise tissue and coagulate bleeding vessels using the same device whilst improving quality of post-operative recovery over cold dissection with suture ligatures.
The impact of adenotonsillectomy on children’s quality of life.
Schwentner I, Schmutzhard J, Schwentner C, Abraham I, Höfer S, Sprinzl GM.
Clin Otolaryngol. 2008 Feb;33:56-9.
OBJECTIVES: Although adenotonsillectomy is one of the most frequently performed surgical procedures in the pediatric population, there is little known about its impact on Health-related Quality of Life (HRQL). The aim of this study was to measure children’s HRQL- benefit after adenotonsillectomy. DESIGN AND SETTING: The study was carried out as a retrospective postal survey utilising a proxy rating. PARTICIPANTS: In total, 447 parents of children who underwent adenotonsillectomy for the indication of chronic tonsillitis were included. 43% (n = 191) of the parents returned completed surveys. MAIN OUTCOME MEASURES: To quantify the benefit after pediatric adenotonsillectomy the Glasgow Children’s Benefit Inventory (GCBI) was used. RESULTS: Mean GCBI-total score was 21 +/- 19 (-8 to 77), showing an improvement in all GCBI subscales. CONCLUSIONS: Adenotonsillectomy is a highly effective approach to treat children with tonsil disease. It has a positive impact on children’s HRQL and other areas not directly associated with their tonsil disease. Moreover, this improvement in HRQL is durable and not temporary.
A prospective randomized double-blind trial of fibrin glue for reducing pain and bleeding after tonsillectomy.
Segal N, Puterman M, Rotem E, Niv A, Kaplan D, Kraus M, Brenner H, Nash M, Tal A, Leiberman A.
Int J Pediatr Otorhinolaryngol. 2008 Apr;72:469-73. Epub 2008 Feb 20.
Department of Otolaryngology-Head & Neck Surgery, Box 151, Soroka University Medical Center, Beer Sheva 84101, Israel. [email protected]
OBJECTIVES: Varying surgical techniques as well as a large selection of analgesics and other medications have been evaluated over the years in the hopes of reducing post-tonsillectomy pain. Several publications in recent years have demonstrated the efficacy of fibrin glue in reducing post-tonsillectomy bleeding and pain. The objectives of this study were to evaluate the effect of fibrin glue on pain and bleeding after tonsillectomy.
STUDY DESIGN: A prospective randomized doubleblind study was performed on 168 consecutive patients undergoing tonsillectomy for obstructive sleep apnea and chronic tonsillitis. METHODS: Patients were randomly assigned to the treatment protocol. In the study group, the tonsillar beds were coated with fibrin glue (Quixil, OMRIX biopharmaceuticals) at the end of the operation. Patients in the controlled group underwent tonsillectomy without the use of fibrin glue. The patients were then monitored for postoperative bleeding, and a patient-based pain assessment instrument was used to evaluate pain, ability to eat and analgesics consumption for 10 days after surgery.
RESULTS: Ninety-six patients returned for postoperative follow up and filled in the questionnaire. As our medical center is the only hospital in the southern district of Israel and we hospitalize every person who presents with post-tonsillectomy bleeding, we can assume that any patient from either group who presented with post-tonsillectomy bleeding would be familiar to us. Analysis showed that no statistically significant differences relating to postoperative pain, bleeding, use of analgesics and postoperative eating resumption were detected between the patients treated with fibrin glue and controls. CONCLUSIONS: We cannot substantiate a significant beneficial effect of fibrin glue in post- tonsillectomy pain control, prevention of bleeding or facilitating eating and thus find no indication for the routine use of fibrin glue in tonsillectomy.
Adherent biofilms in adenotonsillar diseases in children.
Al-Mazrou KA, Al-Khattaf AS.
Arch Otolaryngol Head Neck Surg. 2008 Jan;134:20-3. Department of Otolaryngology-Head and Neck Surgery, King Abdul Aziz University Hospital, PO Box 86118, Riyadh 11622, Saudi Arabia. [email protected]
OBJECTIVE: To study biofilm formation on the epithelial surfaces of tonsils and adenoids in children undergoing adenotonsillectomy (T&A). DESIGN: Prospective study. SETTING: Tertiary academic hospital. PATIENTS: Between September 2005 and August 2006, 76 patients (mean [SD] age, 5.7 [3.3] years; age range, 1-18 years; male-female ratio, 1.8:1) undergoing T&A to treat infection, obstruction, or both were included. Of these, 44 had obstruction (58%), 26 had infection (34%), and 6 had both (8%). INTERVENTIONS: Scanning electron microscopy was used to assess for the presence of biofilms. MAIN OUTCOME MEASURE: Presence of adherent biofilms on the surface epithelium of tonsils and adenoids. RESULTS: Adherent biofilm formation was demonstrated in 46 patients (61%). Among 26 patients with infections, adherent biofilm formation was detected in 22 (85%), whereas in the group of 44 patients with obstruction only 18 were found to have biofilms (41%). Comparative analysis of the data revealed that the difference was statistically significant (P = .01). CONCLUSIONS: Biofilms were identified on the surfaces of infected or enlarged tonsils and adenoids in most patients undergoing T&A. The presence of biofilms in a significantly higher proportion of patients with chronically inflamed tonsils and adenoids vs patients with obstruction indicates an association between the presence of biofilms and chronic inflammation.
Relationship between the presence of tonsilloliths and halitosis in patients with chronic caseous tonsillitis.
Rio AC, Franchi-Teixeira AR, Nicola EM.
Br Dent J. 2008 Jan 26;204:E4. Epub 2007 Nov 23. Dental Surgeon/Doctoral Student in Medical Sciences, Department of Otolaryngology, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, São Paulo 13083-970, Brazil. OBJECTIVE: To study the volatile sulphur compounds (VSC) halitometry profile in a population with chronic caseous tonsillitis (CCT) and halitosis and to evaluate the relationship between the presence of a tonsillolith and abnormal halitometry in this population. DESIGN: Clinical prospective non-randomised study. SUBJECTS AND METHODS: Forty-nine patients with halitosis and CCT, 17 male (35%) and 32 female (65%), were selected among patients referred for CO laser cryptolysis. Anamnesis, physical examination and VSC halitometry were carried out. Halitometry values less than 150 ppb of VSC were considered normal. RESULTS: Patients were divided in two groups: Group A - normal halitom- etry (41 patients - 83.7%) and Group B - abnormal halitometry (8 patients - 16.3%). Halitometry results in Group B were 5.2 times (429%) higher than in Group A and the majority of the patients with abnormal halitom-etry presented with a tonsillolith at the moment of examination. A tonsillolith was present in 75% of the patients with abnormal halitometry and only 6% of patients with normal halitometry values. CONCLUSIONS: The presence of a tonsillolith represents a tenfold increased risk of abnormal VSC halitometry and can be considered as a predictable factor for abnormal halitometry in patients with CCT.
Quality-of-life effect of tonsillectomy in a young adult group.
Richards AL, Bailey M, Hooper R, Thomson P.
ANZ J Surg. 2007 Nov;77:988-90. Department of Otolaryngology Head and Neck Surgery, The Alfred Hospital, and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. [email protected]
BACKGROUND: To examine the quality of life after tonsillectomy in a young adult group with chronic or recurrent tonsillitis. METHODS: Retrospective survey of patients aged 15-25 years who underwent tonsillectomy for chronic or recurrent tonsillitis in 2002 or 2003. The Glasgow Benefit Inventory was mailed to patients who were selected from two private general otolaryngology practices. RESULTS: Participants had an overall benefit from the procedure as well as improvement in their general well-being and physical health. A benefit in social function was not imparted. CONCLUSION: Tonsillectomy in a young adult group results in significant improvement in overall quality of life, physical health and general well-being.
Biofilm formation by Haemophilus influenzae olated from adeno-tonsil tissue samples, and its role in recurrent adenotonsillitis.
Galli J, Calò L, Ardito F, Imperiali M, Bassotti E, Fadda G, Paludetti G.
Acta Otorhinolaryngol Ital. 2007 Jun;27:134-8 Institute of Otorhinolaryngology, Catholic University of the Sacred Heart, Rome, Italy.
Aim of the present study was to identify bacterial biofilms in tissue samples obtained from paediatric patients undergoing surgical treatment, for chronic and recurrent adeno-tonsillitis, not responding to repeated cycles of selective medical antibiotic and anti-inflammatory treatment and to assay the ability of Haemophilus influenzae strains, most frequently identified in the culture examinations, to grow as biofilm in vitro. Overall, 25 surgical specimens (15 adenoids, 10 tonsils) were examined from the upper respiratory tract, from 15 paediatric patients (mean age 6 years). All patients were affected by recurrent and/or chronic adenoiditis and adenotonsillitis unresponsive to selective antibiotic and anti-inflammatory therapy. Tissues were cultured using conventional methods and subjected to scanning electron microscopy for detection of biofilm. Haemophilus influenzae strains, were cultured on 96-sterile well polystyrene microtitre plates (CELLSTAR-greiner bio-one) and stained with 1% crystal violet to quantify biofilm production. Bacterial cocci attached to the tissue surface and organized in colonies, with a morphology consistent with bacterial coccoid biofilms, were observed in all adenoid (15/15) and in 6/10 tonsil samples. Haemophilus influenzae isolates from 12/25 (48%) of our tissue samples scored a percent transmittance (%T(bloc)) > 50, displaying a high capacity to form biofilms (level 4). In conclusion identification of bacterial biofilms in chronic and/or recurrent paediatric upper airway inflammatory processes and the capacity to produce biofilm in vitro, demonstrated by Haemophilus influenzae (the most frequently identified bacteria in our samples), could be related to the aetiopathogenic role of biofilms in chronic inflammatory mucosal reactions and to the resistance of these infections to selective antibiotic therapy.
Treatment of hypertrophic palatine tonsils using bipolar radiofrequency-induced thermotherapy (RFITT.).
Pfaar O, Spielhaupter M, Schirkowski A, Wrede H, Mösges R, Hörmann K, Klimek L.
Acta Otolaryngol. 2007 Nov;127:1176-81 Department of Otorhinolaryngology Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, [email protected]
CONCLUSION: Radiofrequency volume reduction of palatine tonsils is a gentle and safe treatment method in selected patients, which should carefully be considered as an alternative to tonsillectomy or tonsillotomy.
OBJECTIVES: The aim of this study was the evaluation of bipolar radiofrequency-induced thermotherapy (RFITT) compared to standard blunt dissection tonsillectomy (TE) for the volume reduction of palatine tonsils in chronic tonsillar hypertrophy. PATIENTS AND METHODS: A total of 137 patients (98 children) were treated in two groups in a prospective controlled, randomized clinical trial. The TE group underwent standard tonsillectomy using blunt dissection. The RFITT group underwent interstitial RF ablation. Perioperative blood loss and duration of surgery were monitored. Tonsil volume reduction in the RFITT group was measured by sonography. Postoperative pain, as well as difficulty in swallowing and speaking, were evaluated using visual analog scales. RESULTS: In the RFITT group, we found an average tonsil volume reduction of 40%, at about 3 weeks after treatment. Postoperative pain, swallowing and speaking difficulties, and perioperative blood loss were significantly lower, and the duration of surgery was significantly shorter (all p<0.05) in the RFITT group. Preservation of the treatment results was monitored until 6 months after treatment, with no after effects during this time period
Impact of tonsillectomy on quality of life in adults with chronic tonsillitis.
Schwentner I, Höfer S, Schmutzhard J, Deibl M, Sprinzl GM.
Swiss Med Wkly. 2007 Aug 11;137(31-32):454-61. Department of Otolaryngology, University Hospital, Medical University, Innsbruck, Austria. Ilona. [email protected] ac.at
OBJECTIVES: Tonsillectomy is one of the most frequently performed surgical procedures. Nevertheless there is less known about the impact of this procedure on Health-Related Quality of life (HRQOL). The two different most common used surgical techniques are “cold” (CT) and “hot” (HT) tonsillectomy. The aim of this study was to measure patients’ HRQOL-benefit after adult tonsillectomy with the indication of chronic tonsillitis and to compare HT and CT. METHODS: The Glasgow Benefit Inventory (GBI) was used to quantify the health benefit of CT and HT retrospectively in 600 patients aged 16 years and older. RESULTS: 227 of the patients returned the completed surveys. Mean total GBI score was 15.8 (18 SD, 13.2-18.4 CI) for CT and 11.6 (15 SD, 7-16.3 CI) for HT (p = 0.214). Patients reported an improvement in HRQOL in all GBI subscales. We could not find a significant difference in reported HRQOL benefit between HT and CT. CONCLUSION: Adult tonsillectomy, HT as well as CT, for the indication of chronic tonsillitis provides an improvement in HRQOL. This positive impact of tonsillectomy in patients with chronic tonsillitis should be considered in the clinical decision-making process for tonsillectomy.
Pilot comparison between potassium titanyl phosphate laser and bipolar radiofrequency in paediatric tonsillectomy.
Hegazy HM, Albirmawy OA, Kaka AH, Behiry AS. J Laryngol Otol. 2008 Apr;122:369-73. Epub 2007 May 23
Department of Otolaryngology, Tanta University Hospital, Egypt.
OBJECTIVES: To compare the advantages and disadvantages of potassium titanyl phosphate laser with those of bipolar radiofrequency techniques, in paediatric tonsillectomy. STUDY DESIGN: Prospective, randomised, clinical study. PATIENTS AND METHODS: From July 2004 to April 2006, 80 patients aged between 10 and 15 years, with tonsillectomy planned for chronic tonsillitis, were included in the study. Children were prospectively randomised into two equal groups: potassium titanyl phosphate laser tonsil- lectomy and bipolar radiofrequency tonsillectomy. Operative time and intra-operative blood loss were recorded. Patients were scheduled for follow up during the first, second and fourth post-operative weeks. They were asked to record their pain and discomfort on a standardised visual analogue scale, from zero (no pain) to 10 (severe pain). Post-operative complications were also recorded and managed. RESULTS: The potassium titanyl phosphate laser group showed a slightly longer operative time (mean 12 minutes) than the bipolar radiofrequency group (mean 10 minutes). Intraoperative blood loss was significantly less in the potassium titanyl phosphate laser group (mean 21 cm3) than in the bipolar radiofrequency group (mean 30 cm3). In the first week, post-operative pain scores were less in the potassium titanyl phosphate laser group than in the bipolar radiofrequency group (means 7.5 and 8.5, respectively). However, in the second week pain scores increased more in the potassium titanyl phosphate laser group than in the bipolar radiofrequency group (means 8.5 and 6, respectively). In the fourth week, both groups showed equal and nearly normal pain scores. No case of reactionary post-tonsillectomy haemorrhage was recorded in either group. Only one case of secondary post-tonsillectomy haemorrhage was recorded, in the potassium titanyl phosphate laser group (2.5 per cent), managed conservatively. CONCLUSION: Both the potassium titanyl phosphate and the bipolar radiofre-quency techniques were safe and easy to use for tonsil- lectomy, with reduced operative time, blood loss and complication rates and better post-operative general patient condition. Potassium titanyl phosphate laser resulted in reduced operative bleeding and immediate post-operative pain, compared with the bipolar radiofre-quency technique. However, potassium titanyl phosphate laser required slightly more operative time and caused more late post-operative pain than the bipolar radiofrequency technique. The low rate of recorded complications showed that both techniques cause little damage to the tonsillar bed during dissection, thus minimising complications.