Albucasis (936-1013), a pioneer in tonsillectomy.

BACKGROUND: The surgical removal of tonsils has been performed from as long as three thousand years ago, as mentioned in Hindu literature. The role medieval physicians like Albucasis played in the history of tonsillectomy is very important. This article aims to show the contributions Albucasis made to this procedure. METHODS: The present library-documentary research relied on the third chapter of the book al-Tasrif, Albucasis' surgical text, as the main information source. RESULTS: Albucasis discussed the conditions necessary for tonsillectomy, he introduced three surgical tools for this operation, and he also described the surgical method. Albucasis succeeded in inventing and discovering new tools and methods for tonsillectomy. CONCLUSION: The comparison of the tonsil surgery introduced by Albucasis and those of earlier and later surgeons reveals Albucasis' superiority in both operation performance and equipment used. Some of his methods are comparable with approaches to operations used in the 20th century.

The impact of new evidence on regional variation in paediatric tonsillectomy and adenoidectomy: a historical review.

BACKGROUND: Tonsillectomy and adenoidectomy have been among the most commonly performed procedures in children for approximately 100 years. These procedures were the first for which unwarranted regional variation was discovered, in 1938. Indications for these procedures have become stricter over time, which might have reduced regional practice variation. METHODS: This paper presents a historical review on practice variation in paediatric tonsillectomy and adenoidectomy rates. Data on publication year, region, level of variation, methodology and outcomes were collected. RESULTS: Twenty-one articles on practice variation in paediatric tonsil surgery were included, with data from 12 different countries. Significant variation was found throughout the years, although a greater than 10-fold variation was observed only in the earliest publications. CONCLUSION: No evidence has yet been found that better indications for tonsillectomy and adenoidectomy have reduced practice variation. International efforts are needed to reconsider why we are still unable to tackle this variation.

The shifting relationship between weight and pediatric obstructive sleep apnea: A historical review.

OBJECTIVES: For more than a century, pediatric obstructive sleep apnea (OSA) was associated with failure to thrive. However, that association has faded over the last few decades. A 21st century child with OSA is much more likely to be overweight than underweight. This raises the question: Has pediatric OSA changed over time, or has the rise of childhood obesity in the United States created a new, separate disease? This literature review explores the historical shift in the relationship between weight and OSA, and the associated changes in treatment. RESULTS: We demonstrate a clear transition in the prevalence of failure to thrive and obesity in the OSA literature in the mid-2000s. What is less clear is whether these two clinical phenotypes should be considered two distinct diseases, or whether subtle differences in one set of pathophysiologic pathways-adenotonsillar hypertrophy, altered inflammation, and increased energy expenditure-can lead to divergent metabolic outcomes. More research is needed to fully elucidate the pathophysiology of OSA in children with obesity. CONCLUSIONS: We may need new and different treatments for obesity-associated OSA as adenotonsillectomy-which is effective at reversing failure to thrive in OSA-is not as effective at treating OSA in children with obesity. One option is drug-induced sleep endoscopy, which could personalize and improve surgical treatment of OSA. There is some evidence that therapies used for OSA in adults (e.g., weight loss and positive airway pressure) are also helpful for overweight/obese children with OSA. Laryngoscope, 129:2414-2419, 2019.

'A Wicked Operation'? Tonsillectomy in Twentieth-Century Britain.

Histories of twentieth-century surgery have focused on surgical 'firsts' - dramatic tales of revolutionary procedures. The history of tonsillectomy is less glamorous, but more widespread, representing the experience and understanding of medicine for hundreds of children, parents and surgeons daily. At the start of the twentieth century, tonsillectomy was routine - performed on at least 80 000 schoolchildren each year in Britain. However, by the 1980s, public and professional discourse condemned the operation as a 'dangerous fad'. This profound shift in the medical, political and social position of tonsillectomy rested upon several factors: changes in the organisation of medical institutions and national health care; changes in medical technologies and the criteria by which they are judged; the political, cultural and economic context of Britain; and the social role of the patient. Tonsillectomy was not a mere passive subject of external influences, but became a potent concept in medical, political, and social discourse. Therefore, it reciprocally influenced these discourses and subsequently the development of twentieth-century British medicine. These complex interactions between 'medical' and 'non-medical' spheres question the possibility of demarcating what is internal from what is external to medicine.

Who has been hiding in your tonsillectomy tray? Eponymous instruments in tonsillectomy surgery.

BACKGROUND: Surgeons regularly use eponymous instruments when performing tonsillectomies, yet the stories behind each are not commonly known. METHOD AND RESULTS: This paper presents the instruments within the tonsillectomy tray, providing a brief biography of their respective surgeon namesakes. The list captures over two centuries of surgical history, and spans the disciplines of ENT, general surgery, gynaecology, anaesthetics and paediatric surgery. CONCLUSION: This is the first publication to undertake a historical study of the ensemble of surgeon inventors responsible for the instruments in the tonsillectomy tray as it is today. In furthering knowledge of our forbearer surgeon inventors, who have shaped the tonsillectomy procedure as it is safely performed today, we enrich our understanding of the history of our profession and build appreciation for the instruments employed daily. We may even be inspired to continue the tradition of evolving the craft.

Factors influencing the indication for tonsillectomy: a historical overview and current concepts.

Tonsil surgery has been performed for more than 3,000 years. During the 19th century when anesthesia became available, techniques were refined and the number of procedures performed increased. Repeated throat infections often causing big tonsils was the reason why parents asked for the procedure. During the preantibiotic era, scarlet fever was feared since potential heart or kidney complications were life-threatening. The technique used before 1900 was tonsillotomy since neither a fingernail, snare nor the later 'guillotine' were used extracapsularly. Bleeding was small and the surgery ambulatory. Extracapsular tonsillectomy developed around the turn of the 20th century with the purpose of avoiding remnants - the 'focal infection theory' was prevailing. The whole tonsil was now extirpated with good visibility of the tonsillar area in a deeply anesthetized patient. During the first half of the 20th century, the two methods competed, but by 1950, total tonsillectomy had become the only 'correct' tonsil surgery. The indication was still recurrent infections. The risk for serious bleeding increased; therefore large clinics arose where patients remained for at least a week after tonsillectomy. When oral penicillin for children became available during the 1960s, the threat of throat infection decreased and the number of tonsillectomies declined. The awareness of obstructive problems in children rose at the same time when obstructive sleep apnea syndrome became a disease for adults (1970s). Tonsillotomy was revived during the 1990s and is today used increasingly in many countries. The indication is mainly obstructive sleep apnea syndromeor sleep-disordered breathing, especially in small children. Total tonsillectomy is still preferred for recurrent infections, which include periodic fever/adenitis/pharyngitis/aphthous ulcer syndrome and recurrent peritonsillitis.

On the history of modern tonsillectomy: the contribution of Nikolaos Taptas.

The earliest reports on removal of the entire tonsil using a method of careful dissection came in the early 1900 s by American and British otorhinolaryngologists. These descriptions are credited as the first of the so-called modern tonsillectomy. In this report we present a technique of tonsillectomy conceived by Nikolaos Taptas, a Greek physician and citizen of the Ottoman Empire, which was introduced at the same period with the ones previously mentioned. Taptas practiced his technique in the very early 1900 s. He used his own instruments and reported excellent post-operative results with very few complications. He should therefore be considered among the pioneers of modern tonsillectomy.

The art of tonsillectomy: the UK experience for the past 100 years.

Tonsillectomy is one of the commonest ear, nose, and throat procedures performed in the United Kingdom. In the drive to reduce complication rates and improve patients' satisfaction, numerous adaptations to the traditional technique have evolved. In this article, the authors explore the changes that have been happening in the United Kingdom during the past 100 years and conclude that revisiting the traditional techniques may still be the answer to a successful procedure.

Legacies of the Tonsil Hospital.

In response to a unique societal need, a dedicated tonsil hospital was established in New York City in 1921. Its contributions were both medical and moral. The hospital's director, Robert Fowler, impressed by the variability of available surgical techniques, undertook a quest for the "better tonsil operation." His findings, published in an exhaustive text, highlighted several obscure anatomic relationships. Emphasis was on the primacy of anatomic mastery over the allure of new technology, with attention to the path leading from better surgery to better outcomes. Fowler's advocacy of both technical excellence and specialized patient care prefigured similar concerns held by otolaryngologists today.

Unwarranted variation in pediatric medical care.

This article provides a survey on the concepts, methods, and applications of the study of unwarranted variation in health care with particular attention to children's medical services.

[History of the tonsil surgery]. / Historia de la cirugía amigdalar.

Tonsillectomy is one of the more frequent surgical techniques in the otolaryngological practice. In the first century A. D., Cornelius Celsus in Rome described the removal of the tonsils. Since them, devices used for tonsillectomy included a wide variety of instruments as snares, guillotines, scalpels ("cold" and ultrasonic), forceps and lasers. Likewise, the improvement of the anesthetic procedures and the perioperative management have contributed greatly to success with this surgical procedure. To sum up, the instruments and procedures used for tonsillectomy have evolved to render it a precise operation.

The rise and decline of tonsillectomy in twentieth-century America.

This article explores the rise and decline of tonsillectomy/adenoidectomy (T&A) in twentieth-century America. Between 1915 and the 1960s, T&A was the most frequently performed surgical procedure in the United States. Its rise was dependent on novel medical concepts, paradigms, and institutions that were in the process of reshaping the structure and practice of medicine. The driving force was the focal theory of infection, which assumed that circumscribed and confined infections could lead to systemic disease in any part of the body. The tonsils in particular were singled out as "portals of infection," and therefore their removal became a legitimate therapy. Nevertheless, what kinds of evidence could prove that tonsils were portals of infection? How could the effectiveness of tonsillectomy be determined? An inherent difficulty was the absence of any consensus on the criteria that would be employed to judge its efficacy. Yet tonsillectomy persisted despite ambiguous supportive evidence. Although criticisms of the procedure were common by the 1930s, its decline did not begin until well after 1945 and involved debates over the nature of evidence, the significance of clinical experience in the validation of a particular therapy, and the role of competing medical specialties.

The evolution of tonsil surgery and rethinking the surgical approach to obstructive sleep-disordered breathing in children.

Within the last 10 to 15 years, a significant amount of research in tonsil surgery has focused on reduction of post-operative pain and recovery time. In order to minimize or avoid morbidity, a number of otolaryngologists in the United States and Europe have revived a historical procedure, previously known as 'tonsillotomy', specifically for those patients with obstructive sleep-disordered breathing (OSDB) due to adenotonsillar hypertrophy. More recently, surgeons have used terms such as partial tonsillectomy, partial intracapsular tonsillectomy or subtotal tonsillectomy to describe their procedure and have employed a variety of modern instrumentation. This return to a 'partial' procedure has generated a debate similar to that which occurred amongst tonsil surgeons about 100 years ago, when tonsillotomy was the most commonly performed procedure. Today, concerns about regrowth and problems with infection of the remaining tonsillar tissue have been raised. Such concerns, combined with an incomplete understanding of why the 'partial' procedure was abandoned in the early twentieth century, may explain why tonsil surgeons hesitate to change their approach to patients with OSDB due to adenotonsillar hypertrophy. These issues can be addressed in a meaningful way only through a detailed review of the evolution of tonsil surgery, which is presented here. This information, along with a summary of the last 10 years' experience with these techniques, supports the use of a 'partial' procedure in children with OSDB due to adenotonsillar hypertrophy. Future areas of research are also discussed.

Tonsillectomy: haemorrhaging ideas.

Tonsil surgery has been described for over 3000 years. Haemorrhage following tonsillectomy remains the most serious complication of surgery. Over recent years several audits have been gathering data on current trends in tonsil surgery and clinical outcomes throughout England, Scotland and Northern Ireland. The results support a return to traditional dissection with ties to reduce the risk of post-operative haemorrhage. We describe the changes that have occurred to improve efficacy and safety during the evolution of the modern tonsillectomy.

[Postoperative hemorrhage after tonsillectomy in Denmark]. / Efterblødninger ved fjernelse af mandler i Danmark i 1900-tallet.

Removal of the tonsils, or tonsillectomy, is a very frequent surgical procedure in Denmark (5 million inhabitants). Nowadays, about 7-8,000 patients are operated on each year. The indications for surgery and the surgical principles have largely remained the same for a century, but different techniques have been employed. As in all surgical procedures, there are complications to tonsillectomy, first and foremost postoperative bleeding which occurs in 4-8% of all operated patients. In the last 100 years many studies have been undertaken to shed light on the frequency of postoperative bleeding following tonsillectomy. It is noteworthy that the studies have been carried out at times where there was a certain interest in the subject whereas in other periods of time, the subject has been of little interest to researchers. The definition of postoperative hemorrhage is not unambiguous. Despite the fact that various surgical techniques have been applied, no significant change in the incidence of postoperative hemorrhage after tonsillectomy has been shown over the past 100 years. The study calls for caution when evaluating new surgical techniques since the incidences of postoperative hemorrhage have been shown to change between high and low percentages through the entire 100 year period.

On the origin of tonsillectomy and the dissection method.

OBJECTIVES: To identify the person or persons responsible for the conception and description of the operation that we know of today as tonsillectomy and to determine whether this was accomplished by an American otolaryngologist(s) before the description by George Waugh of London in 1909. STUDY DESIGN: A review of the English language medical literature from 1879 to 1910. METHODS: Three hundred seventy-five articles relating to tonsil surgery or instrumentation for tonsil surgery were identified. It was possible to obtain and review only 67 articles. In addition, 20 textbooks relating to the tonsils and tonsil surgery (published between 1880 and 1966) were identified and reviewed. RESULTS: An attempt to remove the entire tonsil intact was described by Edwin Pynchon in 1890 with the use of galvanocautery. He recommended that only one tonsil be removed at one time with approximately 2 weeks between operations. In 1903, Charles Robertson advocated the removal of both tonsils at one operation using scissors but did not mention the capsule. J. Gordon Wilson published a description of the tonsillar capsule in 1906 but did not comment on tonsil surgery or the importance of any particular structure as a surgical landmark. In that same year, William Lincoln Ballenger of Chicago, Illinois, clearly recommended the complete removal of the tonsil with its capsule intact but commented that he usually used an écraseur-tonsillotome to finally remove the tonsil. Also in 1906, Ovidus Arthur Griffin of Ann Arbor, Michigan, described the use of a knife and a specially designed pair of scissors to remove the tonsils in their entirety in one operation without the use of a guillotine or an automatic instrument. CONCLUSION: The operation that we know of today as tonsillectomy, the removal of the entire tonsil with the capsule intact, and the term tonsillectomy itself were conceived, described, and published by American otolaryngologists before the description by George Waugh of London in 1909.

History and current practice of tonsillectomy.

OBJECTIVE: To review important developments in the history of adenotonsillectomy and describe current methods and results for the operation. STUDY DESIGN: Review. METHODS: Tonsillectomy practices since antiquity were reviewed, with emphasis on introductions of new surgical tools and procedures, anesthesia methods, and patient care practices. Past and current indications for and complications associated with tonsillectomy were also reviewed. RESULTS: Devices used for adenotonsillectomy have included snares, forceps, guillotines, various kinds of scalpels, lasers, ultrasonic scalpels, powered microdebriders, and bipolar scissors. General anesthesia, the Crowe-Davis mouth gag, and methods for controlling bleeding have contributed greatly to success with the operation. Past and current indications for adenotonsillectomy are similar, although the relative importance of some indications has changed. The complication rate has declined, but the problems that do occur remain the same. Currently, cost-effectiveness is a principal concern. CONCLUSION: The instruments and procedures used for adenotonsillectomy have evolved to render it a precise operation. Today, the procedure is a safe, effective method for treating breathing obstruction, throat infections, and recurrent childhood ear disease.

Surgery on the larynx and pharynx in Byzantium (AD 324-1453): early scientific descriptions of these operations.

We present the techniques of various operations on the larynx and pharynx (incision of abscesses of the tonsils, tonsillectomy, tracheotomy, uvulectomy, and removal of foreign bodies) found in the Greek texts of Byzantine physicians. The techniques of these operations were the first to be so meticulously described and were compiled from the texts, now lost, of the ancient Greek physicians. These medical texts, which followed and enriched the Hippocratic, Hellenistic, Roman, and Galenic medical traditions, later influenced medieval European surgery, either directly through Latin translations or indirectly through works of Arab physicians.