Laboratory Studies
Coagulation parameters should be assessed if the patient's history reveals a potential bleeding problem.
The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNS) suggests that all patients receive a basic coagulation workup.
In one study, coagulation tests produced abnormal results in 4% of 1706 children. [2] The disturbing factor in this study was that the patient's preoperative history did not help in identifying children with abnormal coagulation. This is a point of ongoing debate.
With a negative family history for bleeding, routine preoperative coagulation studies are not recommended. With a positive family history, a bleeding time or a consultation with a hematologist is prudent.
Imaging Studies
Imaging studies include plain radiography, CT scanning, and MRI in an appropriate patient with a tonsillar mass suggestive of malignancy.
In addition, a patient with a pulsatile area adjacent to the tonsil should undergo magnetic resonance arteriography (MRA) before routine tonsillectomy to evaluate for an aberrant internal carotid artery.
Other Tests
Antibodies for streptolysin-O (ASLO) have been studied as possible indicators for tonsillectomy. [3]
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These antibodies are correlated with previous infection with group A beta-hemolytic streptococcus (GABHS).
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To the authors’ knowledge, no recent work has been published concerning this issue.
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When the diagnosis of recurrent GABHS is questioned, high ASLO titers can shed light on the patient's history.
Historically, GABHS cultured on blood agar and use of a Bacitracin disc has been used to identify the most important agent that causes tonsillitis.
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More recently, several rapid tests for detecting group A streptococcal antigen have been used.
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The rapid tests are specific but not uniformly sensitive; therefore negative results need to be confirmed with a routine culture.
Several studies have shown a higher-than-expected incidence of allergy in children with adenotonsillar disease. Therefore, evaluation for allergy may be helpful, but only in children with the signs and symptoms of allergic disease.
Histologic Findings
Histologic examination of the tonsils is unnecessary unless cancer is suspected. If tonsils are asymmetric, they should be submitted separately and examined histologically to rule out cancer.
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Typical appearance on the morning after tonsillectomy, which was performed by using a blunt dissection method.
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Tonsillectomy performed with the cautery technique. A Colorado needle-tip bovie is used to dissect the tonsil from its underlying muscular bed.
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A suction bovie is used to achieve hemostasis. Ideally, the least amount of cautery necessary for hemostasis is used. Staying in the proper dissection plane limits the amount of bleeding, and possibly postoperative pain.
