Tonsillectomy Part 3 - Hot Tonsillectomy vs Interval Tonsillectomy

🩺 Types of Tonsillectomy - Hot Tonsillectomy vs Interval Tonsillectomy

In the previous post, we discussed the different techniques and methods of tonsillectomy.

In this post, we will focus on the types of tonsillectomy, a high yield viva topic commonly asked in ENT practical exams, especially in long cases of acute or chronic tonsillitis.

🔹 Classification of Tonsillectomy

There are two main types of tonsillectomy:

1. Hot tonsillectomy

2. Interval tonsillectomy

🔥 Hot Tonsillectomy

📌 Definition of Hot Tonsillectomy

Hot tonsillectomy is immediate tonsillectomy performed during an active infection.

📍 Indications of Hot Tonsillectomy

Hot tonsillectomy is performed in the following situations:

1. Peritonsillar abscess (Quinsy)
2. Severe airway obstruction due to acute tonsillar hypertrophy

✅ Advantages of Hot Tonsillectomy

• Provides immediate relief of symptoms

• Avoids:

  • Recurrent infections
  • Repeated abscess drainage procedures
  • Waiting period required for interval tonsillectomy

❌ Disadvantages of Hot Tonsillectomy

Hot tonsillectomy has more disadvantages than advantages:

1. Increased risk of bleeding

Why is there an increased risk of bleeding in Hot Tonsillectomy?

1. Difficult dissection

   • Inflamed and highly vascular tissues
   • Difficulty separating tonsil from anterior pillar

2. Increased post-operative pain and morbidity

3. Risk of intra-operative rupture of abscess

   • Leads to loss of dissection plane

   • Poor surgical field visibility

4. Risk of aspiration

   • Aspiration of pus may lead to aspiration pneumonia

📌 Hence, hot tonsillectomy is avoided unless absolutely necessary.

⏳ Interval Tonsillectomy

📌 Definition of Interval Tonsillectomy

Interval tonsillectomy is performed 6–8 weeks after the acute infection has subsided.

📍 Indications of Interval Tonsillectomy

• Following peritonsillar abscess

• After severe tonsillitis where immediate surgery is risky

✅ Advantages of Interval Tonsillectomy

1. Lower risk of bleeding

2. Easier surgical dissection

   • Clear dissection plane between:
     • Tonsil
     • Anterior pillar

3. Better post-operative recovery

❌ Disadvantage of Interval Tonsillectomy

• Risk of recurrent infections during the 6–8 week waiting period

📊 Comparison: Hot vs Interval Tonsillectomy

📌 Viva & Exam Pearls

• Preferred type → Interval tonsillectomy

• Hot tonsillectomy → Only when life-saving or unavoidable

• Waiting period for interval tonsillectomy → 6–8 weeks

• Most common indication for hot tonsillectomy → Peritonsillar abscess

📚 Next Topic: Steps of Tonsillectomy

• Patient positioning
• Instruments used
• Step by step surgical procedure

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