Swallowing Difficulty after Cold Dissection and Bipolar Cautery Tonsillectomy: The Role of Laryngopharyngeal Reflux...

Swallowing difficulty frequently occurs in the early postoperative period following tonsillectomy. This study primarily aimed to compare postoperative swallowing difficulty between patients undergoing cold dissection and bipolar cautery tonsillectomy as well as to assess the impact of laryngopharyngeal reflux (LPR) and allergic rhinitis on postoperative swallowing difficulty.

This prospective observational study enrolled a total of 184 adult patients diagnosed with either chronic tonsillitis or tonsillar hypertrophy. Patients were divided into two groups based on the tonsillectomy technique: cold dissection (Group 1) and bipolar cautery tonsillectomy (Group 2). Swallowing difficulty was evaluated in all patients using the Eating Assessment Tool (EAT-10), visual analog scale (VAS), and fiberoptic endoscopic evaluation of swallowing (FEES). The Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) and Penetration-Aspiration Scale (PAS) were used to evaluate FEES findings. The effect of LPR and allergic rhinitis on postoperative swallowing difficulty was evaluated both between the two surgical groups and within each group.

EAT-10 scores significantly increased on postoperative day 7 compared to preoperative scores in both groups (p < 0.05). Group 2 showed significantly higher EAT-10 scores, VAS scores, and YPRSRS vallecula parameter scores compared to Group 1 (p < 0.05). LPR patients showed significantly higher postoperative EAT-10 scores with bipolar cautery (p < 0.05). There was a moderate correlation between pain VAS scores and dysphagia VAS scores on the 7th postoperative day.

The tonsillectomy technique affects postoperative swallowing difficulty. Cold dissection results in less swallowing-related morbidity compared to bipolar electrocautery due to reduced thermal tissue injury. LPR is associated with increased swallowing difficulty in both techniques, particularly in the bipolar group, while allergic rhinitis does not affect postoperative swallowing difficulty.