Post-tonsillectomy problems: Read all about it!

The use of a colorful, easy-to-read, two-page visual handout can decrease post-operative phone calls about side effects of minor concerns that occur following the removal of tonsils, a study presented in Toronto at the annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery Foundation has found.

The genesis of the initiative came from the observation that medical residents received many late-night phone calls about ear pain following tonsillectomy, explained Dr. David Mandell, an assistant professor at the University of Pittsburgh School of Medicine.

"What we didn't understand is that parents do get a long print out with small text describing what to expect in their children following tonsillectomy," said Dr. Mandell, a pediatric otolaryngologist at the Children's Hospital of Pittsburgh and supervisor of the project. "We did learn that they paid more attention to handouts if they contain pictures and do not contain an excess of text and information."

Dr. Mandell noted that several studies have shown that most surgical patients or parents of surgical patients in pediatrics do not demonstrate that they retain the information that is relayed to them in a post-operative consultation. The handout stratified serious concerns, such as bleeding, and minor concerns, such as low-grade fever, using a color-coded system, with serious concerns colored in red and minor concerns colored in green.

"We found overall that the distribution of the handout to parents did not reduce the number of post-operative calls to medical residents, but did reduce the number of calls about minor concerns like low-grade fever or ear pain following tonsillectomy," said Dr. Mandell. "The main idea is the calls are indicative of parents' anxiety, and we would want to reduce their level of anxiety. It may also reduce calls to the pediatrician who referred patients for the procedure."

Dr. Mandell said the project is an example of why a pediatrician would opt to refer a patient who needs a tonsillectomy to a subspecialist like a pediatric otolaryngologist instead of an adult otolaryngologist, who does not typically treat children.

Investigators found the top reasons cited for calls following tonsillectomy included fever, otalgia, throat pain, otorrhea, minor bleeding, and poor oral intake.