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Updated: Aug 17, 2025
CO2-Lasertonsillotomy Under Local Anesthesia in Adults
Published on: November 6, 2019
Does infection play a role in post-tonsillectomy haemorrhage? A narrative review
A Williamson1, H Coleman2, C Douglas2
1Department of Otolaryngology, Head and Neck Surgery, Monklands University Hospital, Glasgow, Scotland, UK.
Objective:
Post-tonsillectomy haemorrhage is an increasingly common cause of morbidity following tonsillectomy. Secondary post-tonsillectomy haemorrhage occurring more than 24 hours after an operation has long been attributed to post-operative infection; however, there is little evidence to support this hypothesis and the associated use of antibiotics in the current literature.
Method:
This study looked at the aetiology and evidence-based management of post-tonsillectomy haemorrhage, and investigated the impact of bacterial infection and antimicrobials on the pathogenesis and clinical course of this complication.
Results:
A number of peri-operative risk factors for post-tonsillectomy haemorrhage exist, and infective pathologies, including recurrent or chronic tonsillitis and group A streptococcus on blood cultures, may predispose to bleeding. Very few studies have shown a link between post-tonsillectomy haemorrhage and objective markers of infection such as pyrexia, raised inflammatory markers or positive microbiology cultures. The role of antibiotics in secondary post-tonsillectomy haemorrhage remains controversial, and numerous randomised, controlled trials of peri-operative antibiotics have shown no significant difference in bleeding rates between antibiotics and controls.
Conclusion:
Further trials investigating the role of antibiotics and more robust studies investigating the presence of bacterial infection at the time of bleeding may be required to determine the true role of infection in post-tonsillectomy haemorrhage.
Insights
Secondary post-tonsillectomy hemorrhage is common, but evidence linking it to infection and antibiotics is weak. Further research is needed to clarify the role of bacterial infection and antimicrobials in this complication.
Area of Science:
- Otolaryngology
- Surgical Complications
- Infectious Diseases
Background:
- Post-tonsillectomy hemorrhage (PTH) is a significant cause of morbidity.
- Secondary PTH, occurring >24 hours post-surgery, is often attributed to infection, but evidence is limited.
Purpose of the Study:
- To investigate the etiology and evidence-based management of PTH.
- To examine the impact of bacterial infection and antimicrobials on PTH pathogenesis and outcomes.
Main Methods:
- Literature review on PTH etiology, management, and infection's role.
- Analysis of studies investigating bacterial infection markers and antimicrobial efficacy.
Main Results:
- Peri-operative risk factors for PTH exist; chronic tonsillitis and Group A Streptococcus may predispose to bleeding.
- Limited evidence links PTH to objective infection markers (fever, inflammatory markers, positive cultures).
- Randomized trials show no significant difference in bleeding rates with peri-operative antibiotics.
Conclusions:
- The role of antibiotics in secondary PTH remains controversial.
- Further trials are needed to investigate antibiotics' role.
- More robust studies are required to determine the true role of bacterial infection in PTH.
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