Cold versus hot tonsillectomy: state of the art and recommendations

An investigation of the risk factors for haemorrhage after tonsillectomy with particular reference to the use of bipolar diathermy for tonsillar dissection and haemostasis, diathermy power settings and coblation tonsillectomy. The findings of the National Prospective Tonsillectomy Audit and subsequent related research are summarised and discussed with reference to the issue of use of hot versus cold tonsillectomy techniques. Additional unpublished data on coblation tonsillectomy is presented. Overall, increased haemorrhage rates were noted for diathermy dissection tonsillectomy (adjusted odds ratio 2.47, p < 0.0001) and coblation tonsillectomy (adjusted odds ratio 3.07, p < 0.0001) compared to the reference category of cold steel tonsillectomy. Use of bipolar diathermy for haemostasis only carried an intermediate risk of haemorrhage (adjusted odds ratio 1.57, p = 0.004). Further investigation of diathermy power settings demonstrated a quantitative relationship between increasing power usage and subsequent haemorrhage. Use of diathermy for haemostasis at the lowest effective setting may carry a comparable risk of haemorrhage to that of cold steel tonsillectomy. Recommendations are given on the optimum tonsillectomy technique for both the older child or adolescent and the particularly young or low weight child.