[Hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease) as an example of a rare disease relevant for oto-rhino-laryngology]. / Hereditäre hämorrhagische Teleangiektasie (Morbus Rendu-Osler-Weber) als Beispiel einer seltenen Erkrankung des HNO-Fachgebietes.

Diagnosis and treatment of rare diseases are difficult. Hereditary hemorrhagic telangiectasia (HHT, Rendu-Osler-Weber disorder) is a relatively common rare disease. Because epistaxis is the most frequent manifestation of this disease, affected individuals often approach otorhinolaryngologists first. The latter ones often have a key position for early diagnosis and screening for visceral involvement which can prevent life-threatening complications. Treatment of epistaxis can improve quality of life of affected persons. Diagnosis and treatment of rare diseases can be complex and it can be very helpful to use information resources to ensure a correct management. Various possibilities to access these resources are presented in general and in relation to HHT.

[Brachytherapy for the treatment of head and neck cancer]. / Brachytherapie für die Behandlung von Kopf-Hals-Karzinomen.

Image-Adapted brachytherapy (IABT) is a modern interdisciplinary development of classic radiation therapy, which allows the application of a high radiation dose while avoiding severe adverse events, thereby improving the prognosis of our patients. Indications in head and neck squamous cell carcinoma (HNSCC) include tumours of the floor of mouth, the face, the paranasal sinuses, the naso- and oropharynx, recurrent cancer and incomplete resections due to close vicinity of the tumor to important structures. The application type can be classified as curative, adjuvant, perioperative as a boost with or without external beam radiation (EBRT) or as a palliative treatment. The published results encourage the integration of IABT as part of the therapy of HNSCC, thereby improving the prognosis and quality of life of our patients.

[Brachytherapy in combination with function-preserving surgery of cancer of the paranasal sinus]. / Kombination von Brachytherapie und Chirurgie bei Tumoren mit Orbita-/Schädelbasisinfiltration.

BACKGROUND: Prognosis of patients with advanced/recurrent cancer of paranasal sinuses and orbit with infiltration of the skull base is very bad. Radical surgery does not improve prognosis. A disadvantage of the radical surgery is the functional loss and the residual cosmetic defect. We present the results of a function-preserving surgery in combination with interstitial, image adapted brachytherapy (IABT) for the treatment of these cancers. METHODS AND PATIENTS: Ten patients with paranasal sinus cancer and 16 patients with sarcomas (n=26) were retrospectively analysed. After a maximum tumor resection (mostly R1-R2 resections), 2-12 flexible afterloading plastic tubes were implanted. The postoperative IABT total dose was 10-25 Gy in 2.5 Gy fractions twice daily fractions for 5 days. RESULTS: In all cases the eye was obtained without functional damage. The IABT was well tolerated. The visual and cosmetic results were satisfactory. Postoperative complications occurred in 7 out of 26 cases without a serious long-term adverse event. Significant radiation-induced complications were found in patients with orbital or skull base involvement. The three years overall survival was 60% for rhabdomyosarcoma, and 33% for the paranasal sinus cancers. CONCLUSIONS: These results show that a combined treatment of function-preserving surgery and a IABT is a feasible, successful and well-tolerated option for curative, salvage and palliative therapy for selected patients with advanced or recurrent carcinoma of the paranasal sinuses and orbit.

Differential chemokine expression patterns in tonsillar disease.

Expression profiles of CXC- and CC-chemokines in various forms of tonsillar disease were studied to evaluate whether certain chemokines play a predominant role in a specific subset of tonsillar disease. Total RNA was isolated from 89 biopsies (21 hyperplastic palatine tonsils, 25 adenoids, 16 chronic inflammatory palatine tonsils and 27 chronic inflammatory palatine tonsils with histological prove of acute inflammation), reverse transcribed and subjected to PCR amplifying IL-8, Gro-alpha, eotaxin-1, eotaxin-2, MCP-3, MCP-4 and RANTES. 2% agarose gel electrophoresis revealed a predominance of IL-8 in the chronic inflammatory palatine tonsil group compared to tonsillar hyperplasia. Furthermore, eotaxin-2 was strongly overexpressed in adenoid samples compared to chronic inflammatory specimens. Our data suggest that the majority of diseases related to adenoid formation are mediated via an eotaxin-2 expression, whereas chronic inflammatory tonsillitis is associated with IL-8 upregulation. These data imply that adenoids are related to a Th-2, and chronic inflammatory tonsillitis to a Th-1 based immune response.

Transcriptional repression of the human fibronectin gene in laryngeal squamous cell carcinoma cells.

PURPOSE: The aim of the experiments was to analyze the mRNA expression pattern and verify the repression of FN gene expression in laryngeal squamous cell carcinoma (SCC) cells in comparison with benign mucosal keratinocytes. METHODS: Messenger RNA from SCC cells and benign keratinocytes was reverse transcribed and subjected to PCR following differential display (DD) analysis of the amplicons. Northern hybridization was carried out to confirm the reduction of the FN-mRNA expression in both laryngeal SCC cells and larynx carcinoma biopsies, in contrast to adjacent normal mucosa. Quantitation of protein synthesis was performed with homogenates of fresh tumor biopsies and their normal phenotypes, as well as of benign keratinocytes and laryngeal SCC cell lines, respectively, using ELISA. In the liposome-mediated transient transfection assay, FN promoter activity was analyzed by linking the FN promoter sequence to the chloramphenicol acetyltransferase (CAT) reporter gene. Transfection efficacy was monitored by co-transfection with pGL3 control vector. RESULTS: A 191 bp mRNA fragment revealing a 99% homology with the human FN-mRNA was detected, the expression of which was repressed 20 times as much in SCC cells as compared to benign phenotypes. Northern hybridization confirmed the distinctly reduced expression of FN-mRNA in both laryngeal SCC cells and larynx carcinoma biopsies, in contrast to adjacent normal mucosa. The quantitation experiments showed a correlation between the range of FN synthesis and the expression of FN-mRNA in cell lines and the biopsies which were used. The 1.28 kb FN gene promoter drove expression of the CAT reporter gene, which was similar to the FN-mRNA expression showed by DD and Northern hybridization. CONCLUSIONS: The mechanisms leading to the low level of FN in many tumors have not yet been sufficiently investigated. Our findings suggest that the decrease of FN in laryngeal SCC cells is transcriptionally regulated.

Acoustic rhinometry: validation by three-dimensionally reconstructed computer tomographic scans.

The aim of the present study was a validation of acoustic rhinometry (AR) by computed tomography (CT). Six healthy subjects were examined by CT and AR. The CT data were processed in a computer program (AutoCAD), and a virtual three-dimensional model of each nasal cavity was constructed. This model permitted an individual prediction of the center line of the sound wave propagation through the air volume of the nasal cavity with the cross-sectional areas oriented perpendicularly to this line. The area-distance curves derived from AR and CT were compared. Linear regression analysis revealed a reasonable agreement of AR and CT in the anterior nose below a mean of 6 cm distance from the nostrils [r = 0.839, P < 0.01, m = 1.123, b = -0.113 (AR = m x CT + b)]. The measuring accuracy using CT as gold standard revealed a mean error at the nasal valve of <0.01 cm(2) (4.52%) and at the nasal isthmus of 0.02 cm(2) (1. 87%). Beyond 6 cm, the correlation decreased (r = 0.419), and overestimation of the true area occurred (>100%). In conclusion, the measurements were reasonably accurate for diagnostic use up to the turbinate head region. Certain factors induce an overestimation of the true areas beyond this region. However, these factors are constant and reproducible in a single subject, and intraindividual comparative measurements are possible beyond the turbinate head region.

Overexpression of the human myosin-binding protein-C1 mRNA in laryngeal squamous cell carcinoma cells.

BACKGROUND: To compare gene expression patterns between laryngeal squamous cell carcinoma (SCC) cells and their normal phenotypes to identify genes showing differential expression. MATERIALS AND METHODS: Messenger RNA was isolated from both kinds of cells, reversely transcribed and subjected to differential display reverse transcription (DDRT)-PCR. Gene fragments showing difference in the expression were recovered, reamplified, cloned and sequenced, enabling homology search. Total RNA was isolated from laryngeal SCC cells and adjacent normal mucosa and subjected to Northern hybridization. RESULTS: A 159 bp gene fragment was detected, revealing 96% homology with the human myosin-binding protein-C1 (MYBPC-1) gene. Compared to the benign phenotypes the expression of MYBPC-1 was particularly increased in SCC cells, confirmed by Northern hybridization. CONCLUSION: The results presented in this work may help to extend the diagnostic panoply available for the evaluation of laryngeal tissue conspicuous for malignancy.

p53 analysis of laryngeal cancer in exon 4 to 9.

p53 gene mutations are a common genetic alteration in human cancer and codon 72/exon 4 polymorphism of the p53 gene has been implicated in cancer risk. Therefore in this study the p53 gene status of 32 shock-frozen tumor specimens from larynx carcinomas was analyzed by PCR and sequencing of exon 4 through 9. Four mutations (12.5%) in exon 5, 7, 8 and 9 were detected in the carcinoma specimen. Analysis of codon 72 revealed in eight cases a homozygosity for proline (CCC) and in 24 cases heterozygosity or homozygosity for arginine (CGC). The group with the proline/proline genotype had a median age 10.3 years lower than the remaining patients and included the only two non-smokers. Firstly, these results confirm the p53 mutational status of laryngeal cancer without any clinical correlation and secondly may suggest an oncogenic potential for the proline/proline genotype of codon 72 for laryngeal cancer as has already been assumed for lung cancer.

Cyfra 21-1: a serological help for detection of distant metastases in head and neck cancer.

Local and neck recurrences of squamous cell carcinoma of the head and neck (SCCHN) can mostly be detected early when the patient has regular follow-ups. Distant metastases though usually remain undiscovered until they produce clinical symptoms. Since Cyfra 21-1 correlates with the tumor size and stage in SCCHN, we looked for possible connections between Cyfra 21-1 increases and the development of distant metastases. The sera of 830 patients with SCCHN were tested for Cyfra 21-1. The levels were compared with the clinical run of the patients. When Cyfra 21-1 levels rose above the threshold of 3.3 ng/ml (71 out of 830) staging procedures were performed. Tumor growth was found in 50 out of 71 patients with elevated Cyfra levels (70.4%). Cyfra serum levels in those cases either represented development of distant metastases (27 out of 71), or local and neck recurrences. The results of this study show that Cyfra 21-1 is a suitable and helpful serological parameter for the follow-up of patients with SCCHN. In the event of an elevation of Cyfra 21-1 above the threshold during follow-up, we would recommend the performance of a thoracal CT-scan and abdominal omi ultrasound as staging procedures.

Tracing human papillomavirus DNA in nasal polyps by polymerase chain reaction.

Human papillomavirus (HPV) infections are related to the genesis of various benign and malignant human neoplasias. The HPV types 16 and 18 seem to be causally related to the development of most squamous cell carcinoma of the anogenital tract and a proportion of carcinomas of the upper aerodigestive tract. The near 100% positivity of the HPV types 6 and 11 in laryngeal papillomatosis is well established. We investigated whether HPV also plays a role in non-neoplastic mucosal entities such as sinunasal polyposis, the genesis of which has been discussed as being triggered by viral infections. On DNA from 39 sinunasal polyps (33 patients), polymerase chain reaction (PCR) was performed using beta-globin primers for demonstration of amplifiable DNA in the tissue extracts. Consensus primers for the detection of several different HPV types were applied to the beta-globin-positive samples. The results were confirmed by Southern blot hybridization using consensus probes. Cycle sequencing was performed on the positive cases. All 39 samples showed positive signals for beta-globin. HPV-DNA investigations showed a slight positive signal in only 1 of the 39 investigated cases (2.6%). Further molecular investigations of this sample, including cycle sequencing, could not confirm this result. All the other tissue samples remained HPV-DNA-negative. Therefore, those HPV types readily detectable with the PCR primers and probes used are not frequently associated with sinunasal polyposis. The data confirm the hypothesis that HPV is correlated to a lesser extent to infectious mucosal lesions than to proliferative lesions. Furthermore, the results emphasize that the presence of HPV in specific lesions does not occur by chance, but represents a specific infection of the mucosa leading to proliferation and even to malignancy.

Indication, incidence and management of blood transfusion during sinus surgery: a review over 12 years.

The number of reports about blood transfusion-related HIV and hepatitis virus infections is increasing, presently. Thus, it should seriously be considered to inform the patient of any anticipated blood loss necessitating a transfusion of blood products. This is especially necessary for surgical procedures with only a low risk for high blood loss, such as endonasal surgery as a common otorhinolaryngological procedure. However, reports about the incidence of blood transfusion during this kind of surgery are very rare. The medical histories of 6,296 patients who underwent sinus surgery between 1982-1993 in the Department of Otorhinolaryngology at the University of Kiel were analyzed. Twenty-nine of these patients received a transfusion. Risk factors for required blood, the necessity of pre-operative information and the recommendation policy for pre-operative donation of autologous blood are discussed. The intra-operative blood losses of 120 patients who did not require a transfusion and who underwent sinus surgery in 1986 and 1989, were analyzed. The transfusion rate was 0.46% on average during the 12-year period. The incidence of blood transfusion and the amount of intra-operative blood loss decreased after combination of endonasal surgery with controlled intra-operative hypotension (0.07%; p < 0.01). Risk factors for the necessity of a transfusion in these cases were extensive polyposis and purulent exacerbation of the disease. There are risks for a blood transfusion in endonasal surgery. Every transfusion carries a certain risk for the infection with HIV or hepatitis, therefore every patient should be informed about the possibility of a blood transfusion prior to the operation. Endonasal microscopic sinus surgery performed by well-trained surgeons, combined with controlled intra-operative hypotension lowered the risk for a transfusion significantly (p < 0.01).

Prospective randomized investigation for evaluation of postoperative changes in the microbial climate of paranasal mucosa by the use of different dissoluting techniques during postoperative care.

Endonasal dissolution by the use of NaCl-solution is a common postoperative treatment of the nasal mucosa after endonasal surgery. These procedure involve for example endonasal shower and sterilized solutions. The contamination of nasal shower in case of unprofessional cleaning after treatment was an argument against this technique in earlier discussions. The danger of such an infection should be avoided by the use of sterilized solution. Therefore the dependence of nasal microbial climate on different nasal dissoluting techniques was investigated by the use of such named endonasal shower (Siemens und Co, Bad Ems, Germany) in comparison with sterilized solution (Rhinomer, Zyma SA, Nyon, France). Microbial cultures were investigated of 80 patients after endonasal surgery (53 m, 27 f; 31 +/- 21 age). Surgery was done for the treatment of chronic polypous sinusitis. Pre-, intra- and postoperative samples were taken in 640 cases to proceed microbial cultures. Material was transferred with the use of a Port-A-Cul-transport medium and preparation of the microbial cultures was done during the first four hours. As a result 895 bacterial clones were cultivated. These consisted of 87% aerob and 13% anaerob bacteria. Staphylococcus aureus (39%) and members of the family of Enterobactericae (30%) were the most common microbes. There was neither an evidence for postoperative microbes on the nasal mucosa nor a correlation between the dissoluting technique and the postoperative outcome. The use of sterilized solutions for the postoperative care of endonasal mucosa does not cause an additional worthful effect on neither the postoperative microbial climate nor the outcome in comparison to endonasal shower.

Alpha 1-receptors at pre-capillary resistance vessels of the human nasal mucosa.

The aim of the present study was to further characterise the alpha-adrenoceptors in pre-capillary arteries of the human nasal mucosa. Mucosa was obtained from patients undergoing endonasal surgery. From the isolated conchae small arteries (diameter: 90-220 microns) were dissected, avoiding any direct traumatisation. The arteries were mounted to a Mulvany-Halpern wire myograph allowing isometric registration of the vessel constriction. Receptor subtypes were characterised using the agonists noradrenaline, phenylephrine and oxymetazoline, and the antagonists prazosine and yohimbine. The EC50 values of the three agonists were in the micromolar range, whereas the Emax values differed. When maximal responses to the agonists were expressed as a percentage of a potassium-induced constriction, values for noradrenaline, phenylephrine and oxymetazoline amounted to 110%, 78% and 21%, respectively. The agonist effects were almost completely blocked by the alpha 1-receptor antagonist prazosine, whereas yohimbine, the alpha 2-receptor antagonist, did not affect the agonist responses. From these results it is concluded that the adrenoceptors in pre-capillary arteries of the mucosa in human central concha are of the alpha-type. Since the decongestive effect of alpha 2-receptor agonists is beyond any doubt, this subtype of the adrenoceptor must be present on the venous capacitance vessels.

Fibroblasts but not epithelial cells obtained from human nasal mucosa produce the chemokine RANTES.

RANTES is a chemokine that was already found in tissues obtained from nasal polyps of patients suffering from chronic polypous sinusitis. Its cellular origin is as yet unknown. The aim of this study was to investigate whether human nasal mucosa fibroblasts and epithelial cells are capable to produce RANTES. Fibroblasts and epithelial cells, obtained from healthy human nasal mucosa, were cultured. Expression of RANTES-mRNA and secretion of RANTES-protein in supernatants was investigated after stimulation with 50 ng/ml Tumour Necrosis Factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), interferon-g (IFN-gamma), lipopolysaccharide (LPS), phorbolymyristate acetate (PMA) and serum-free medium (SFM) for 24 h. Cultivated nasal fibroblasts either expressed RANTES-mRNA or secreted RANTES protein upon TNF-alpha, IL-1 beta and IFN-gamma stimulation. The amounts of RANTES-protein production ranged from 23 ng/ml (PMA) to 198 ng/ml (TNF-alpha). Nasal epithelial cells expressed RANTES-mRNA only after stimulation with PMA. Secretion of significant amounts of RANTES protein were not detected in the supernatants from nasal epithelial cells. We conclude that nasal fibroblasts but not epithelial cells could be a cellular source of RANTES in nasal mucosa or in secretions of patients suffering from diseases, where eosinophilic tissue infiltration represents a characteristic histopathological feature.

Technical problems with protein extraction of chemokines featuring RANTES.

Chemokines are known to be one of the sources for eosinophilic tissue infiltration in eosinophilic inflammation. Detection of beta-chemokines such as RANTES was possible in nasal tissue with or without eosinophilic infiltration. The concentration of chemokines which has been measured in the same tissue differs often in the literature. Aim of this study was to compare the different techniques of protein extraction and help to understand and interpret the investigation on RANTES secretion. Tissue of nasal polyps, inferior and middle turbinate was cut into halves and every half on its own pulverized using liquid nitrogen. The protein extraction was performed either with citric acid solution (pH 2.5) or phosphate buffered saline (PBS). The samples were then lyophilized. The concentration of RANTES was measured by a specific double sandwich ELISA. Using the citric acid technique the average concentration of RANTES in middle turbinates was 1.3 ng/mg, in inferior turbinates 1.6 ng/mg and in polyps 2.6 ng/mg tissue, using the PBS technique respectively 0.6 ng/mg, 0.5 ng/mg and 0.8 ng/mg tissue. Our data revealed a mismatch of 3.3:1 for polyps (citric acid: PBS), 3.2:1 for inferior and 2.2:1 for middle turbinates, respectively. Consequent comparison between the results of different techniques was not possible. Of special interest was also the fact that different techniques had different efficiencies of protein extraction in different tissues. Present statements on RANTES concentrations as a prognostic factor in nasal tissues need a technically careful standardization as far as this study shows.

Increased eotaxin-mRNA expression in non-atopic and atopic nasal polyps: comparison to RANTES and MCP-3 expression.

Eosinophilic tissue infiltration of nasal mucosa typical for allergic rhinitis and chronic polypous sinusitis may be due to chemotactic activity of chemokines specific for eosinophils. The CC-chemokines eotaxin, RANTES and MCP-3 have been postulated to be involved in the recruitment of eosinophils to certain inflamed tissues. To explore their possible role in chronic polypous sinusitis we examined eotaxin-, RANTES- and MCP-3-gene expression in human nasal polyps and normal human nasal mucosa of patients undergoing endonasal surgery for treatment of chronic polypous sinusitis. Using gene-specific primers in semi-quantitative reverse-transcriptase polymerase-chain-reaction experiments we found elevated expression of eotaxin- and RANTES-mRNA but no MCP-3-mRNA in non-atopic and atopic nasal polyps when compared to normal nasal mucosa.

[The quality of life in head and neck cancer patients: description of randomized examination formula based on standardized questionnaires EORTC QLQ C-30, EORTC QTQ-H-N35 and Kiel Questionnaire]. / Jakosc zycia u chorych z nowotworami glowy i szyi--wstep do randomizowanych badan opartych na standaryzowanych kwestionariuszach EORTC QLQ C-30, EORTC QLQ-H&N35 i Kwestionariuszu Kilonskim.

The notion of quality of life (QL) was first introduced in the US in the 50-ies. This notion is much broader then health, it is a personal, subjective feeling of well-being that comes from actual, widely-meant life experiences. The QL is not a measurable value, however, it may be assessed by means of appropriate indices. In the contemporary holistic attitude to a patient, in modern oncology, QL has become a parameter of equal importance to other values characterizing the treatment success, as important as numbers describing e.g. mean survival, disease free survival, or neoplasm controlled survival. Head and neck neoplasms bring about deterioration of the basic functions of the organism such as: breathing, swallowing, speaking and senses: hearing, taste and smell. Application of treatment may intensify pain, dyspnea, hoarseness or cause any kind of discomfort. It influences directly the patients' family and social life. Comparison of QL of patients treated for larynx, tongue, tonsill, glands, and paranasal sinuses neoplasms depending on localisation of primary foci, advancement of the disease, the applied treatment and its radicality, age, sex, place of living (town/country), and educational level. Correlation between the subjectively assessed QL and the objectively evaluated condition of the patient is measured. In ENT Dept. K. Marcinkowski University of Medical Sciences 46 patients were examined from May to September 2000. EORTC QLQ C-30, EORTC QLQ-Head and Neck and HAD scale were used. Kiel Questionnaire was introduced in September. The main reason for introducing it was the fact, that surgery is the method of choice in the treatment of head and neck malignancies in our Dept. The team composed of a psychologist and an ENT doctor has been working together on objective assessment of each patient. The QL assessment may be of practical importance when trying to improve the model of health care in cases of oncological patients. This knowledge enables us to learn how the accompanying side effects of therapy influence the QL of our patients, and how these problems may be overcome by proper education, advice, and support provided by the qualified staff. The authors are evaluating the QL in the period of 2, 6 months and 1 year after surgery in patients not supported psychologically. Our goal, in the future, is to introduce the psychological treatment, i.e. repetitive meetings in small groups, conducted by a psychologist. We have contacted 4 major ENT centers in Poland in order to coordinate the research on detailed assessment of QL in Head and Neck Cancer Patients in Poland. The results will be presented in the further publications.

Fibroblasts obtained from human nasal, laryngeal and tracheal mucosa produce the chemokine RANTES.

RANTES is a chemokine that was already found in tissues obtained from nasal polyps of patients suffering from chronic polypous sinusitis and in lung biopsies of patients suffering from bronchial asthma. Nasal fibroblasts could be shown to be a cellular origin of RANTES. The aim of this study was to investigate whether human nasal, laryngeal and tracheal mucosa fibroblasts are differentiated in production of RANTES. Fibroblasts obtained from healthy human nasal, laryngeal and tracheal mucosa, were cultured. Secretion of RANTES-protein in supernatants was investigated after stimulation with 50 ng/ml tumor necrosis factor-alpha (TNF-alpha), interleukin-1-beta (IL-1-beta), lipopolysaccharide (LPS), phorbolmyrisate acetate (PMA), interferon-gamma (IFN-gamma) and serum-free medium (SFM) for 24 hours. Cultivated nasal, laryngeal and tracheal fibroblasts secreted RANTES-protein upon TNF-alpha, IL-1-beta and IFN-gamma stimulation. The amounts of RANTES-protein production ranged from 10 ng/ml (PMA) to 198 ng/ml (TNF-alpha). Secretion of significant amounts of RANTES-protein were detected in the supernatants from either nasal, laryngeal or tracheal fibroblasts. There was no significant difference between the differential fibroblasts. We conclude that nasal, laryngeal and tracheal fibroblasts could be a cellular source of RANTES in nasal and bronchial mucosa or in secrets of patients suffering from diseases where eosinophilic tissue infiltration represents a characteristic histopathological feature. Results suggest that additional local factors are needed to develop asthma bronchiale and chronic polypous sinusitis.

Incidence and clinical background of posttonsillectomy bleeding related blood transfusion over 12 years.

Economies in National Health Systems forces ENT surgeons to review their indications for outpatient tonsillectomy. Therefore, it is important to preoperatively identify special risk groups who frequently have extensive posttonsillectomy bleeding with the need of a blood transfusion. Aim of this study was to estimate the incidence for posttonsillectomy bleeding related blood transfusion, to identify risk factors associated with the need for blood transfusion and to release guidelines for posttonsillectomy bleeding of high risk patients. A retrospective study was done on the medical history of 1720 patients who underwent tonsillectomy for chronic tonsillitis between 1982-1993 in the ENT Department at the University of Kiel. The average transfusion rate was 0.52%. End Stage Renal Disease and hypertension combined with a preoperatively decreased Hb and Hct were the risk factors identified leading to a transfusion. These patients should not get a tonsillectomy as an outpatient procedure. The Hb, Hct, PT, PTT, blood type and crossmatch should be drawn and assessed prior to tonsillectomy. We recommend immediate treatment of secondary hemorrhage in those high risk patients under general anesthesia to avoid severe complications.