الفهرس 
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Abstract
Tonsillectomy is among the oldest and most commonly performed procedures in the pediatric population. Hemorrhage is the most frequent complication of tonsillectomy and is responsible for the majority of post-tonsillectomy fatalities.
It was reported that the risk factors for post-tonsillectomy hemorrhage include sex, age, tonsillectomy indication, surgical technique and device, the use of antibiotics and steroids, and postoperative dietary and activity restrictions. Therefore, the ultimate goal of this study is to assess the incidence of hemorrhage after tonsillectomy in our facility, as well as, to evaluate and identify possible associated risk factors and make a new scoring system for the possibility of PTH.
This is a cross-sectional prospective study that was carried out on 100 patients presented who were subjected to elective or emergency tonsillectomy with or without adenoidectomy and then presented with post-tonsillectomy hemorrhage, at Sohag University Hospital, ENT Head and Neck Surgery Department, from April 2022 to April 2023, after being approved by the local Ethics Committee of the Faculty of Medicine, Sohag University, Sohag, Egypt.
All patients were subjected to complete history taking including Personal history, Present history, Medical and family history of any bleeding disorders, surgical history, and post-operative hemorrhage and its characterization.
All patients are subjected to the following examination: 1) General examination 2) Local ENT examination especially tonsillar fossae to detect any bleeding point, blood clot, or slough.
All patients’ data were collected and evaluated to make a new scoring system that assesses patients according to several preoperative and postoperative factors to know the possibility of patients developing post-tonsillectomy hemorrhage.
Post tonsillectomy hemorrhage factors score was interpreted according to the following factors; age (child=1, Adult=2), sex (Female=1, Male=2), Hb Level Preoperative (Above 12 G/Dl=1, Between 12:10 G/Dl=2), Wbcs Cont. During Admission (Normal=1, Leukocytosis=2), Preoperative NSAID (Not Used=1, Used=2), Techniques (Cold Dissection=1, Electrocautery=2), Postoperative Fever (Not Present=1, Present=2), Smoking (Non-Smoker=1, Smoker=2) and Postoperative Nutrition (Good=1, Bad=2). Patients who took a score of 9 have no risk for PTH, while patients who took a score of more than 9 have a risk.
As regard demographic data of studied patients, ranged from 3 to 48 years with a mean of 13 years. Out of 100 patients, 74 presented under the age of 18 years. Regarding patients’ sex, 61 patients were male, and 13 patients were female. Sixty-six of the patients were rural residents, and only 5 of the patients had a history of smoking.
Regarding indications of tonsillectomy, chronic tonsillitis was the most common indication which presented in 76 patients, followed by repeated tonsillitis in 18 patients, then tonsillar hyperplasia in 4 patients, and acute severe tonsillitis in 2 patients. The bipolar technique was done in 92 patients, while the cold dissection technique was done in 8 patients.
As regards the clinical presentation of post-tonsillectomy bleeding, the post-tonsillectomy bleeding score ranged from 10 to 16 with a mean of 12.67 ± 1.37. Out of 100 patients, 95 presented with 2ry post-tonsillectomy bleeding. According to the severity of bleeding, severe bleeding presented in 18 patients, moderate in 80 patients, and mild in 2 patients. Seventy-nine patients received medical treatment, while, 21 patients received surgical management, and 40 patients received post-operative NSAID treatment.
As regard post-tonsillectomy bleeding complications, 57 patients had a history of bad nutrition, however, 28 patients had a history of fever.
Regarding the relation between post-tonsillectomy bleeding score and demographic data of studied patients, there was a significant direct correlation between post-tonsillectomy bleeding score with the age of patients and WBCs, also, there was a significant inverse correlation between post-tonsillectomy bleeding score with Hb and RBCs. Moreover, there was a significant increase in post-tonsillectomy bleeding scores among patients aged≥ 18 years, male gender, smokers, patients who needed NSAID treatment, patients subjected to bipolar technique, patients with a history of fever, and patients with a history of bad nutrition.
Conclusion
from our results, we can conclude that older patients, male sex, patients with a history of smoking, bipolar dissection technique, leukocytosis, low Hb and RBCs levels, patients who needed NSAID treatment, patients with a history of fever and patients with a history of bad nutrition, were found to be risk factors for post-tonsillectomy hemorrhage and high post-tonsillectomy bleeding score above 9. According to the new scoring system, we can rely on it in evaluating cases of tonsillectomy through the degree of the patient, according to the availability of some factors, or not to reduce the occurrence of post-tonsillectomy bleeding and reduce the risks.