Management of tonsillectomy hemorrhage: results of a survey of pediatric otolaryngology fellowship programs.

PURPOSE

To reach a consensus on the preoperative evaluation and management of intraoperative and postoperative tonsillectomy hemorrhage.

METHOD

A survey on the preoperative evaluation and the management of intraoperative and postoperative tonsillectomy hemorrhage was given to one of the faculty members at each of the pediatric otolaryngology fellowship programs in the United States.

RESULTS AND CONCLUSIONS

Seventeen surveys were distributed with 100% response. The majority obtained preoperative laboratory evaluation. Nearly an equal number of respondents preferred either cold or electrocautery dissection techniques, but the majority used electrocautery to control hemorrhage. After a postoperative bleeding episode, the results are as follows. (1) The majority favor admission for observation. (2) Little difference exits in the management of immediate and delayed hemorrhage. (3) When clot exists in the tonsillar fossae, removal is recommended. (4) Approximately two thirds of respondents attempt control of active bleeding in the emergency room, whereas the remaining proceed directly to the operating room. (5) After multiple episodes, a full hematologic evaluation is warranted. (6) Age and cooperativeness of the child is an important determinant in the decision-making process.