title: Emerging trends in tonsillectomy.
abstract: OBJECTIVE
  To describe the tonsillectomy techniques and management used by practicing otolaryngologists in the United States.
  
  
  METHODS
  Anonymous 18-question postal survey of pediatric and general otolaryngologists on their current tonsillectomy practices.
  
  
  METHODS
  Tertiary academic medical center.
  
  
  METHODS
  Current preoperative, perioperative, and postoperative practices in tonsillectomy were queried with multiple-choice and open-ended questions. Pediatric otolaryngologists and general otolaryngologists were compared.
  
  
  RESULTS
  Eighty percent of respondents perform subcapsular (total tonsillectomy) dissection. Most otolaryngologists trained with either monopolar cautery (52%) or cold steel (42%). The Coblator (ArthroCare ENT, Austin, Texas) is the most common single instrument used for tonsillectomy (27.5%), followed by monopolar cautery (26%), but in combination with other instruments, monopolar cautery was still more common (33.5%) than coblation (28.9%). Coblation was more common among private practice and general otolaryngologists. The majority of those surveyed do not use intraoperative local anesthesia, but most do use intraoperative steroids (67%). Compared with generalists, pediatric otolaryngologists were less likely to use coblation, were less likely to use local anesthetic, managed postoperative pain slightly differently, and were more likely to recommend diet ad libitum after surgery. Otolaryngologists were more likely to admit medically compromised patients postoperatively.
  
  
  CONCLUSIONS
  Coblation is becoming a more commonly used instrument for tonsillectomy. Pediatric otolaryngologists perform more tonsillectomies than do general otolaryngologists and manage their patients differently.
authors.affiliation: Division of Otolaryngology–Head and Neck Surgery, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA. dsetabutr@hmc.psu.edu
authors.forename: Dhave
authors.initials: D
authors.lastname: Setabutr
authors.forename: Eelam A
authors.initials: EA
authors.lastname: Adil
authors.forename: Tabrez K
authors.initials: TK
authors.lastname: Adil
authors.forename: Michele M
authors.initials: MM
authors.lastname: Carr
mesh_terms: D002648:Child; D002983:Clinical Competence; D006801:Humans; D010038:Otorhinolaryngologic Diseases / Q000601:surgery*; D011795:Surveys and Questionnaires; D014068:Tonsillectomy / Q000706:statistics & numerical data / Q000639:trends*; D014481:United States