Taming Troublesome Tonsils

New technique shrinks tonsils using radiofrequency energy

SATURDAY, Jan. 26, 2002 (HealthDayNews) -- Despite massive doses of antibiotics, you find yourself in the doctor's office several times a year with strep throat.

Or you wake up each morning feeling like you've just run a marathon because sleep apnea kept you from getting a refreshing night's rest.

Sound familiar? Then chances are good you've had at least one conversation with your doctor about having your tonsils taken out. But chances are also good you know someone who's had a tonsillectomy and scared you with descriptions of excruciating pain, bleeding, and being unable to eat or drink for days.

For the 400,000 Americans who undergo tonsillectomies every year, there's a new alternative. It's called "tonsillar coblation" and it uses radiofrequency energy, instead of a scalpel, to heat the tonsils and shrink them, much like a microwave shrinks certain foods.

Performed with a local anesthetic and a mild sedative in the doctor's office, the procedure only takes a couple of minutes. Best of all, proponents say, there's no bleeding, there's minimal pain, and patients are back to work or school and eating and drinking normally the next day.

Dr. Mansoor Madani, director of the Center for Corrective Jaw Surgery and an associate professor of oral and maxillofacial surgery at Temple University in Philadelphia, pioneered the procedure. In a recent follow-up of 60 patients, he found that none had experienced any bleeding, another throat infection or had the zapped tissue grow back. The average reduction in tonsil size was 65 percent, he says.

"It's a great option," says Madani, whose patients have ranged in age from 13 to 65. Because the procedure requires patients to hold their head still, he doesn't perform it on young children.

Madani discovered the technique a few years ago while using radiofrequency energy to treat problem snoring. "We studied tissues we were treating on the roof of the mouth," he says.

Using probes, Madani would use radiofrequency energy to heat the tonsils in several places for 10 to 15 seconds at a time.

"When you heat those tissues, which are very similar to fat, they atrophy and shrink," he says. "It breaks down to smaller molecules and vaporizes the water."

After clearance from the U.S. Food and Drug Administration, Madani began offering the procedure to patients in 1999.

Dr. Kelvin C. Lee, an associate professor of otolaryngology at New York University, also uses coblation, but in the operating room to perform "tonsillotomies" -- a less-invasive version of a tonsillectomy.

A tonsillectomy removes the entire tonsil. A tonsillotomy is a partial removal of the tonsil, down to the capsule that attaches to the throat muscle. That leaves a protective layer of tissue over the muscle to reduce pain and bleeding. With coblation, the tissue is disintegrated and sucked away.

"We just finished a study comparing tonsillectomy and tonsillotomy, and the pain is about half as much," Lee says. "After a couple of days, the majority of people were back to normal activity. After a traditional tonsillectomy, it took up to eight days."

Lee says he has concerns about performing any kind of procedure on the tonsils in an office setting.

"I'm afraid of going too far in because there are major blood vessels in the tonsils," he says. "To have those bleed in the office makes me nervous."

Madani says he knows he's breaking new ground, and spends a lot of time lecturing to oral surgeons and ear, nose and throat specialists like Lee.

"Because it's so new and revolutionary, some surgeons are skeptical, but radiofrequency has been used in medicine for over 100 years," he says. "This is a new way for utilizing it."

Lee agrees that the procedure has possibilities and should be studied further.

"When I do this procedure, right now the majority of patients have the big tonsils," he says. "I think it's a very good technique for them. For people with recurrent infections, it's unclear whether this makes sense. We need more data to recommend it wholeheartedly."

What to Do: For more information on tonsillar coblation, check Dr. Madani's Web site, Snorenet. To learn more about tonsils, visit the American Academy of Otolaryngology - Head and Neck Surgery.

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