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PURPOSE: Transoral robotic surgery (TORS) of the tongue base with or without epiglottoplasty represents a novel treatment for obstructive sleep apnea (OSA). The objective was to evaluate the clinical efficacy of TORS of the tongue base with or without epiglottoplasty in patients who had not tolerated or complied with conventional treatment (continuous positive airway pressure or oral appliance). METHODS: Four-year prospective case series. The primary outcome measure was the apnea-hypopnea index (AHI) in combination with the Epworth Sleepiness Score (ESS). Mean oxygen saturation levels (SaO2) before and after TORS on respective sleep studies were also recorded. Secondary outcome measures included operative time and complications. Patient reported outcome measures (PROMs) assessed included voice, swallow and quality of life. RESULTS: Fourteen patients underwent TORS for tongue base reduction with ten having additional wedge epiglottoplasty. A 64 % success rate was achieved with a normal post-operative sleep study in 36 % of cases at 6 months. There was a 51 % reduction in the mean AHI (36.3 ± 21.4 to 21.2 ± 24.6, p = 0.02) and a sustained reduction in the mean Epworth Sleepiness Score (p = 0.002). Mean SaO2 significantly increased after surgery compared to pre-operative values (92.9 ± 1.8 to 94.3 ± 2.5, p = 0.005). Quality of life showed a sustained improvement 3 months following surgery (p = 0.01). No major complications occurred. CONCLUSIONS: TORS of the tongue base with or without epiglottoplasty represents a promising treatment option with minimal morbidity for selected patients with OSA. Long-term prospective comparative evaluation is necessary to validate the findings of this study.
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Endoscopia/instrumentação , Epiglote/cirurgia , Procedimentos Cirúrgicos Robóticos/instrumentação , Apneia Obstrutiva do Sono/cirurgia , Língua/cirurgia , Adulto , Idoso , Pressão Positiva Contínua nas Vias Aéreas , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Polissonografia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Fatores de Risco , Equipamentos CirúrgicosRESUMO
CONTEXT: Preoperative localization studies are standard practice in patients undergoing parathyroidectomy for primary hyperparathyroidism (pHPT). The most common modalities are neck ultrasound (US) and sestamibi scanning. However, the nature of pHPT is changing, with imaging increasingly yielding negative results. Numerous studies suggest unlocalized disease is associated with poor outcomes, calling into question whether such patients are best treated conservatively. OBJECTIVE: This study aims to correlate parathyroidectomy outcomes with preoperative imaging in a single, high-volume institution. METHODS: Data from a prospectively maintained departmental database of operations performed from 2017 to 2019 were analyzed. All patients undergoing first-time surgery for sporadic pHPT were included. Data collected included patient demographics, preoperative imaging, surgical strategy, and postoperative outcomes. RESULTS: A total of 609 consecutive parathyroidectomies were included, with a median age of 59 years (range 20-87 years). The all-comer cure rate was 97.5%; this was 97.9% in dual localized patients (those with positive US and sestamibi), compared to 95.8% in the dual unlocalized group (those with negative US and sestamibi) (Pâ =â 0.33). Unilateral neck exploration was the chosen approach in 59.9% of patients with double-positive imaging and 5.7% of patients with double-negative imaging (otherwise, bilateral parathyroid visualization was performed). There was no significant difference in postoperative complications between patients undergoing unilateral or bilateral neck exploration. CONCLUSIONS: Patients with negative preoperative imaging who undergo parathyroidectomy are cured in almost 96% of cases, compared to 98% when the disease is localized. This difference does not reach statistical or clinical significance. These findings therefore support current recommendations that all patients with pHPT who are likely to benefit from operative intervention should be considered for parathyroidectomy, irrespective of preoperative imaging findings.
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Hiperparatireoidismo Primário/diagnóstico , Glândulas Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/diagnóstico , Paratireoidectomia/estatística & dados numéricos , Tomografia Computadorizada de Emissão de Fóton Único/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Feminino , Humanos , Hiperparatireoidismo Primário/etiologia , Hiperparatireoidismo Primário/cirurgia , Masculino , Pessoa de Meia-Idade , Glândulas Paratireoides/cirurgia , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia/normas , Guias de Prática Clínica como Assunto , Período Pré-Operatório , Estudos Prospectivos , Compostos Radiofarmacêuticos/administração & dosagem , Tecnécio Tc 99m Sestamibi/administração & dosagem , Resultado do Tratamento , Ultrassonografia/estatística & dados numéricos , Adulto JovemRESUMO
After our coauthors described the first remote-access parathyroidectomy (RAP) series in 2000, several other approaches were developed. No systematic review has been performed to classify and evaluate RAP techniques. We performed a literature search using PubMed and Cochrane Library (CENTRAL). A total of 71 studies met our inclusion/exclusion criteria. RAP can be categorized into five approaches: (1) endoscopic and robotic axillary, (2) anterior chest, (3) transoral, (4) retroauricular, and (5) a combination of these approaches. The limited data in the literature suggest that the cure rates and safety of RAP are in no way inferior to those of open parathyroidectomy. Each approach has its advantages and disadvantages, and the recommendations for the selection of each approach are listed. The selection of approach methods might depend on the surgeon's experience and familiarity and the patient's preference and disease status.
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Paratireoidectomia , Robótica , Axila , Endoscopia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Paratireoidectomia/métodosRESUMO
The incidence of differentiated thyroid cancer (DTC) is rising, mainly because of an increased detection of asymptomatic thyroid nodularity revealed by the liberal use of thyroid ultrasound. This review aims to reflect on the health economic considerations associated with the increasing diagnosis and treatment of DTC. Overdiagnosis and the resulting overtreatment have led to more surgical procedures, increasing health care and patients' costs, and a large pool of community-dwelling thyroid cancer follow-up patients. Additionally, the cost of thyroid surgery seems to increase year on year even when inflation is taken into account. The increased healthcare costs and spending have placed significant pressure to identify potential factors associated with these increased costs. Some truly ground-breaking work in health economics has been undertaken, but more cost-effectiveness studies and micro-cost analyses are required to evaluate expenses and guide future solutions.
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OBJECTIVE: To establish the presence of live virus and its association with polymerase chain reaction (PCR) positivity and antibody status in patients with COVID-19 undergoing tracheotomy. STUDY DESIGN: Prospective observational study. SETTING: Single institution across 3 hospital sites during the first wave of the COVID-19 pandemic. METHODS: Patients who were intubated for respiratory wean tracheotomy underwent SARS-CoV-2 PCR nasal, throat, and endotracheal tube swabs at the time of the procedure. These were assessed via quantitative real-time reverse transcription PCR. The tracheal tissue excised during the tracheotomy was cultured for SARS-CoV-2 with Vero E6 and Caco2 cells. Serum was assessed for antibody titers against SARS-CoV-2 via neutralization assays. RESULTS: Thirty-seven patients were included in this study. The mean number of days intubated prior to undergoing surgical tracheotomy was 27.8. At the time of the surgical tracheotomy, PCR swab testing yielded 8 positive results, but none of the 35 individuals who underwent tissue culture were positive for SARS-CoV-2. All 18 patients who had serum sampling demonstrated neutralization antibodies, with a minimum titer of 1:80. CONCLUSION: In our series, irrespective of positive PCR swab, the likelihood of infectivity during tracheotomy remains low given negative tracheal tissue cultures. While our results do not undermine national and international guidance on tracheotomy after day 10 of intubation, given the length of time to procedure in our data, infectivity at 10 days cannot be excluded. We do however suggest that a preoperative negative PCR swab not be a prerequisite and that antibody titer levels may serve as a useful adjunct for assessment of infectivity.
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COVID-19/imunologia , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , SARS-CoV-2/imunologia , Traqueotomia , Animais , Anticorpos Antivirais/sangue , Teste Sorológico para COVID-19 , Células CACO-2 , Chlorocebus aethiops , Feminino , Humanos , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Prospectivos , Reação em Cadeia da Polimerase em Tempo Real , Células VeroRESUMO
The advent of trans-oral robotic surgery (TORS) has facilitated removal of tumors previously deemed unresectable, by providing access to the deep structures of the head and neck. Despite this, the wider dissemination of TORS has been restricted due to issues with line of access, as the da Vinci robot was never designed with head and neck surgery in mind. Flexible instruments and novel energy delivery devices offer great potential in overcoming some of the existing challenges surrounding TORS. This review aimed to summarize the existing literature surrounding energy delivery in TORS and highlight areas of future innovation. MEDLINE was searched for studies relating to energy delivery in TORS in November 2019. The existing literature surrounding monopolar and bipolar electrocautery, LASER (CO2, Tm:YAG and blue LASER), Ligasure and Harmonic was reviewed. Additionally, the latest iteration of the da Vinci; the SP, and the FLEX robot were evaluated as novel methods of energy delivery in TORS. Overall, these novel energy devices and robotic systems are predicted to further improve energy delivery to the head and neck. The use of flexible LASER in particular is well substantiated in the literature. This has the potential to achieve treatment de-escalation, based on the excellent outcomes demonstrated for disease-free margins and post-operative morbidity.
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The aim of this study was to determine the magnitude of the risks associated with cochlear implantation. Results from a pool of thirty clinical studies involving cochlear implantation in over 6300 children were obtained from an internet search. The relevant data were transformed to a common time base (patient time) to allow an evaluation of events following implantation. The main outcome measure was cumulative survival probability for all-cause revision surgery. Over 10 years this was estimated to be 0.71. Thus, at 10 years post-implantation close to 30% of children with unilateral implants will have undergone revision surgery. This figure is considerably greater than that commonly reported for overall revision rates and illustrates the importance of interpreting results with respect to the relevant time frame. When non and low-use is incorporated into the analysis the above figure rises to about 37% of children affected. The findings raise concerns about the information provided to both individuals and regulatory bodies regarding the risks associated with cochlear implantation. The consequences for bilateral implantation are apparent. Our recommendations are i) a full disclosure to parents and children of the true magnitude of the risks and ii) for a body with significant expertise in reliability and systems engineering, and no conflicts of interest, to play a major role in the regulatory management of this service.
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The aim of this study was to investigate the adequacy of the reporting of cochlear implant device failures. Data from a parallel study involving over 6300 children [1] was used to calculate the instantaneous failure rate for explantations. We found that this is comparable to what manufacturers term 'Cumulative Failure Percentage' (CFP). This finding raises concerns about the information provided by manufacturers on the reliability of their implants.
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The energy needed to drive airflow through the trachea normally constitutes a minor component of the work of breathing. However, with progressive tracheal compression, patient subjective symptoms can include severe breathing difficulties. Many patients suffer multiple respiratory co-morbidities and so it is important to assess compression effects when evaluating the need for surgery. This work describes the use of computational prediction to determine airflow resistance in compressed tracheal geometries reconstructed from a series of CT scans. Using energy flux analysis, the regions that contribute the most to airway resistance during inhalation are identified. The principal such region is where flow emerging from the zone of maximum constriction undergoes breakup and turbulent mixing. Secondary regions are also found below the tongue base and around the glottis, with overall airway resistance scaling nearly quadratically with flow rate. Since the anatomical extent of the imaged airway varied between scans-as commonly occurs with clinical data and when assessing reported differences between research studies-the effect of sub-glottic inflow truncation is considered. Analysis shows truncation alters the location of jet breakup and weakly influences the pattern of pressure recovery. Tests also show that placing a simple artificial glottis in the inflow to a truncated model can replicate patterns of energy loss in more extensive models, suggesting a means to assess sensitivity to domain truncation in tracheal airflow simulations.
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Resistência das Vias Respiratórias , Simulação por Computador , Modelos Biológicos , Ventilação Pulmonar , Mecânica Respiratória , Tomografia Computadorizada por Raios X , Traqueia , Feminino , Humanos , Masculino , Traqueia/diagnóstico por imagem , Traqueia/fisiopatologia , Traqueia/cirurgiaRESUMO
BACKGROUND: Revision parathyroid is challenging due to possible diagnostic uncertainty as well as the technical challenges it can present. METHODS: A multidisciplinary panel of distinguished experts from the American Head and Neck Society (AHNS) Endocrine Section, the British Association of Endocrine and Thyroid Surgeons (BAETS), and other invited experts have reviewed this topic with the purpose of making recommendations based on current best evidence. The literature was also reviewed on May 12, 2017. PubMed (1946-2017), Cochrane SR (2005-2017), CT databases (1997-2017), and Web of Science (1945-2017) were searched with the following strategy: revision and reoperative parathyroidectomy to ensure completeness. RESULTS: Guideline recommendations were made in 3 domains: preoperative evaluation, surgical management, and alternatives to surgery. Eleven guideline recommendations are proposed. CONCLUSION: Reoperative parathyroid surgery is best avoided if possible. Our literature search and subsequent recommendations found that these cases are best managed by experienced surgeons using precision preoperative localization, intraoperative parathyroid hormone (PTH), and the team approach.
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Hiperparatireoidismo Primário/cirurgia , Glândulas Paratireoides/cirurgia , Paratireoidectomia , Reoperação , Densidade Óssea , Cálcio/sangue , Colecalciferol/uso terapêutico , Competência Clínica , Diagnóstico Diferencial , Hospitais com Alto Volume de Atendimentos , Humanos , Hiperparatireoidismo Primário/diagnóstico , Monitorização Neurofisiológica Intraoperatória , Anamnese , Glândulas Paratireoides/diagnóstico por imagem , Seleção de Pacientes , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios , Recidiva , Sociedades Médicas , Deficiência de Vitamina D/tratamento farmacológico , Vitaminas/uso terapêuticoRESUMO
This publication offers modern, state-of-the-art International Neural Monitoring Study Group (INMSG) guidelines based on a detailed review of the recent monitoring literature. The guidelines outline evidence-based definitions of adverse electrophysiologic events, especially loss of signal, and their incorporation in surgical strategy. These recommendations are designed to reduce technique variations, enhance the quality of neural monitoring, and assist surgeons in the clinical decision-making process involved in surgical management of recurrent laryngeal nerve. The guidelines are published in conjunction with the INMSG Guidelines Part II, Optimal Recurrent Laryngeal Nerve Management for Invasive Thyroid Cancer-Incorporation of Surgical, Laryngeal, and Neural Electrophysiologic Data. Laryngoscope, 128:S1-S17, 2018.
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Complicações Intraoperatórias/prevenção & controle , Monitorização Neurofisiológica Intraoperatória/normas , Traumatismos do Nervo Laríngeo Recorrente/prevenção & controle , Nervo Laríngeo Recorrente/cirurgia , Tireoidectomia/normas , Paralisia das Pregas Vocais/prevenção & controle , Humanos , Complicações Intraoperatórias/etiologia , Monitorização Neurofisiológica Intraoperatória/métodos , Traumatismos do Nervo Laríngeo Recorrente/etiologia , Glândula Tireoide/inervação , Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos , Paralisia das Pregas Vocais/etiologiaRESUMO
The purpose of this publication was to inform surgeons as to the modern state-of-the-art evidence-based guidelines for management of the recurrent laryngeal nerve invaded by malignancy through blending the domains of 1) surgical intraoperative information, 2) preoperative glottic function, and 3) intraoperative real-time electrophysiologic information. These guidelines generated by the International Neural Monitoring Study Group (INMSG) are envisioned to assist the clinical decision-making process involved in recurrent laryngeal nerve management during thyroid surgery by incorporating the important information domains of not only gross surgical findings but also intraoperative recurrent laryngeal nerve functional status and preoperative laryngoscopy findings. These guidelines are presented mainly through algorithmic workflow diagrams for convenience and the ease of application. These guidelines are published in conjunction with the INMSG Guidelines Part I: Staging Bilateral Thyroid Surgery With Monitoring Loss of Signal. Level of Evidence: 5 Laryngoscope, 128:S18-S27, 2018.
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Monitorização Neurofisiológica Intraoperatória/normas , Nervo Laríngeo Recorrente/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/normas , Paralisia das Pregas Vocais/prevenção & controle , Humanos , Monitorização Neurofisiológica Intraoperatória/métodos , Laringe/patologia , Laringe/fisiopatologia , Invasividade Neoplásica , Nervo Laríngeo Recorrente/fisiopatologia , Traumatismos do Nervo Laríngeo Recorrente/etiologia , Traumatismos do Nervo Laríngeo Recorrente/prevenção & controle , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/fisiopatologia , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos , Paralisia das Pregas Vocais/etiologiaAssuntos
Hipocalcemia/diagnóstico , Hormônio Paratireóideo/sangue , Complicações Pós-Operatórias/diagnóstico , Tireoidectomia , Deficiência de Vitamina D/complicações , Humanos , Hipocalcemia/complicações , Projetos Piloto , Valor Preditivo dos Testes , Estudos Retrospectivos , Vitamina D/análogos & derivados , Vitamina D/sangueRESUMO
This American Head and Neck Society (AHNS) consensus statement discusses the techniques of laryngeal examination for patients undergoing thyroidectomy and parathyroidectomy. It is intended to help guide all clinicians who diagnose or manage adult patients with thyroid disease for whom surgery is indicated, contemplated, or has been performed. This consensus statement concludes that flexible transnasal laryngoscopy is the optimal laryngeal examination technique, with other techniques including laryngeal ultrasound and stroboscopy being useful in selected scenarios. © 2016 Wiley Periodicals, Inc. Head Neck 38: 811-819, 2016.
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Laringoscopia/métodos , Laringe/diagnóstico por imagem , Paratireoidectomia , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia , Adulto , Humanos , Laringoscopia/instrumentação , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Estroboscopia , UltrassonografiaRESUMO
OBJECTIVE: To determine the construct validity of cadaveric temporal bones in mastoidectomy training. STUDY DESIGN: A prospective observational study. METHODS: Trainees from the North London otolaryngology training program performed step-wise modified radical mastoidectomy on cadaveric temporal bones under faculty supervision. Performance was assessed using a validated mastoidectomy assessment tool. A longitudinal assessment of nine trainees was also carried out over two sessions separated by 12 months. The main outcomes measures were task-specific (TS) and global skills (GS). RESULTS: Twenty-six intermediate and eight novice trainees participated and were assessed by a minimum of two assessors each. Intermediate trainees performed significantly better than novices in TS and GS (P < 0.001). Performance correlated well with training level using Spearman rank correlation coefficient (r(s)) (TS r(s) 0.265 and GS r(s) 0.503). The number of otological procedures performed, and in particular mastoidectomies, correlated well with performance (TS r(s) 0.327 and GS r(s) 0.528). Longitudinal assessment showed significant improvement with iteration (TS P = 0.008 and GS P = 0.008). Attending otological courses also improved performance significantly (TS r(s) 0.345 and GS r(s) 0.469). CONCLUSIONS: The cadaveric temporal bone demonstrated construct validity and can be used to detect progress in performance of otolaryngology trainees. This is a keystone in moving toward a competency-based training system. LEVEL OF EVIDENCE: N/A.
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Otolaringologia/educação , Procedimentos Cirúrgicos Otorrinolaringológicos/educação , Osso Temporal/cirurgia , Cadáver , Competência Clínica , Educação Baseada em Competências , Humanos , Processo Mastoide/cirurgia , Estudos ProspectivosRESUMO
OBJECTIVES/HYPOTHESIS: To demonstrate construct validity of the ovine model as a tool for training in endoscopic sinus surgery (ESS). STUDY DESIGN: Prospective, cross-sectional evaluation study. METHODS: Over 18 consecutive months, trainees and experts were evaluated in their ability to perform a range of tasks (based on previous face validation and descriptive studies conducted by the same group) relating to ESS on the sheep-head model. Anonymized randomized video recordings of the above were assessed by two independent and blinded assessors. A validated assessment tool utilizing a five-point Likert scale was employed. Construct validity was calculated by comparing scores across training levels and experts using mean and interquartile range of global and task-specific scores. Subgroup analysis of the intermediate group ascertained previous experience. Nonparametric descriptive statistics were used, and analysis was carried out using SPSS version 21 (IBM, Armonk, NY). RESULTS: Reliability of the assessment tool was confirmed. The model discriminated well between different levels of expertise in global and task-specific scores. A positive correlation was noted between year in training and both global and task-specific scores (P < .001). Experience of the intermediate group was variable, and the number of ESS procedures performed under supervision had the highest impact on performance. CONCLUSIONS: This study describes an alternative model for ESS training and assessment. It is also the first to demonstrate construct validity of the sheep-head model for ESS training.
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Educação Médica Continuada/métodos , Endoscopia/educação , Otolaringologia/educação , Procedimentos Cirúrgicos Otorrinolaringológicos/educação , Doenças dos Seios Paranasais/cirurgia , Seios Paranasais/cirurgia , Animais , Estudos Transversais , Modelos Animais de Doenças , Avaliação Educacional , Seguimentos , Estudos Prospectivos , Reprodutibilidade dos Testes , OvinosRESUMO
OBJECTIVES/HYPOTHESIS: To investigate the reliability and construct validity of procedure-based assessment (PBA) in assessing performance and progress in otolaryngology training. STUDY DESIGN: Retrospective database analysis using a national electronic database. METHODS: We analyzed PBAs of otolaryngology trainees in North London from core trainees (CTs) to specialty trainees (STs). The tool contains six multi-item domains: consent, planning, preparation, exposure/closure, technique, and postoperative care, rated as "satisfactory" or "development required," in addition to an overall performance rating (pS) of 1 to 4. Individual domain score, overall calculated score (cS), and number of "development-required" items were calculated for each PBA. Receiver operating characteristic analysis helped determine sensitivity and specificity. RESULTS: There were 3,152 otolaryngology PBAs from 46 otolaryngology trainees analyzed. PBA reliability was high (Cronbach's α 0.899), and sensitivity approached 99%. cS correlated positively with pS and level in training (rs : +0.681 and +0.324, respectively). ST had higher cS and pS than CT (93% ± 0.6 and 3.2 ± 0.03 vs. 71% ± 3.1 and 2.3 ± 0.08, respectively; P < .001). cS and pS increased from CT1 to ST8 showing construct validity (rs : +0.348 and +0.354, respectively; P < .001). The technical skill domain had the highest utilization (98% of PBAs) and was the best predictor of cS and pS (rs : +0.96 and +0.66, respectively). CONCLUSIONS: PBA is reliable and valid for assessing otolaryngology trainees' performance and progress at all levels. It is highly sensitive in identifying competent trainees. The tool is used in a formative and feedback capacity. The technical domain is the best predictor and should be given close attention. LEVEL OF EVIDENCE: NA.
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Competência Clínica , Otolaringologia/educação , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
Tissue engineering is the development of biological substitutes for the repair and regeneration of damaged tissues. We explain the principles of this emerging field of biotechology. The present and potential applications of tissue engineering technologies in ENT surgery are then reviewed.
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Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Engenharia Tecidual/métodos , Animais , Humanos , Procedimentos de Cirurgia Plástica/métodosRESUMO
INTRODUCTION: The definition of severe recurrent throat infections is arbitrary, but recent criteria have defined severe tonsillitis as: five or more episodes of true tonsillitis a year; symptoms for at least 1 year; and episodes that are disabling and prevent normal functioning. Diagnosis of acute tonsillitis is clinical, and it can be difficult to distinguish viral from bacterial infections. Rapid antigen testing has a very low sensitivity in the diagnosis of bacterial tonsillitis, but more accurate tests take longer to deliver results. Bacteria are cultured from few people with tonsillitis. Other causes include infectious mononucleosis from Epstein-Barr virus infection, cytomegalovirus, toxoplasmosis, HIV, hepatitis A, and rubella. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of tonsillectomy in children and adults with acute recurrent or chronic throat infections? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 15 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review, we present information relating to the effectiveness and safety of the following interventions: cold-steel tonsillectomy and diathermy tonsillectomy.