Otolaryngologists often recommend tonsillectomy according to history and clinical examination, But is it important to have lab requests e.g. ESR, ASOT, CRP,etc for the decision?
Moreover, if the results are within normal limits, and the clinical situation suggests to perform the surgery, what is the final decision?
I think there is little place for lab tests - the main indications for tonsillectomy are recurrent acute tonsillitis (with frequency of episodes rated according to SIGN guidelines), where results of lab testing will be normal between episodes, or sleep disordered breathing.
We also use the antistreptolysin titer in some cases as an indicator to perform tonsillectomy.
To rule out gross Anemia and bleeding disorders espacialy in patients that have such history is the only time where lab tests become important in my practise.My decision to perform tonsillectomy is primarily based on history and clinical examination.
There is little or no place for lab tests prior to tonsillectomy unless there is a bleeding disorder or a medical problem.
In such an instance you have to review the decision to go ahead with tonsillectomy.
The decision to perform tonsillectomy in chronic tonsillitis is clinical. However as per requirement for anaesthesia routine labs are done. There is no need for APTT/PT or BT/CT unless there is a history of bleeding tendency specially in males.
In my idea to rule out Anemia and bleeding disorders for surgery lab tests is nessary, but indication for tonsillectomy is primarily based on history and clinical examination.
I think the decision is clinical and the only place for lab exams is preoperative ones, i normally ask for a cbc, coagulation test including ivi bleeding test
Hey all,
here, indication of adenotonsillectomy is based on clinical history and exam (main reasons for indication are OSA or sleep disordered breathing, recurrent infection in a minor frequency) we rule out just anemia, coagulation test is hospital-dependent as there is low evidence of its necessity (only when there is a hystory). Beside this, if there are signs/symptoms for severe OSA, we perform polysomnography and echocardiography (possibility of cardiorespiratory complication at pos-op).
There is no real evidence that any laboratory test indicates/negates the need for tonsillectomy. ASOT is greatly over-rated especially by pediatricians. It has no real bearing on disease severity or even the risk of rheumatic fever.It only indicates an immune reaction to old or ongoing GABHS infection. Titres usually persist for some timeeven after treatment or tonsillectomy. Tonsillectomy is basically a clinical decision depending on the symptoms and history of the patient
Hy all,
there is still a lot of controversy in literature if and which laboratory test would be necessary. The indication of tonisilectomy is based on clinical history and physical examinations, mostly related to obstructive breathing disorders or recurrent tonsillitis/previous abcess. For surgical preparation and complete bood count is necessary to rule out previous anemia. there is no evidence that coagulation tests will help to predict intra or post-operative bleeding. Polysomnography, cardiorespiratory monitoring or oxymetry has been indicated in children with suspicion of severe OSA to plan perioperative monitoring in a ICU or Semi-ICU (possible respiratory comlications in children with severe OSA, with neuroologic disease, genetic disorders..).
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