From the Guidelines
Coblation tonsil treatment is not the first-line treatment for tonsil stones, and should only be considered for severe, recurrent cases that significantly impact quality of life and have not responded to conservative measures. The management of tonsil stones typically involves less invasive approaches, such as gargling with salt water, gentle removal with cotton swabs, water flossers, or oral irrigators 1. For persistent cases, antibacterial mouthwashes containing chlorhexidine may help reduce bacterial growth.
Key Considerations
- Tonsil stones are usually managed with conservative measures, and surgery is typically reserved for severe cases.
- Coblation tonsillectomy is a surgical procedure that uses radiofrequency energy to remove tonsil tissue at lower temperatures than traditional methods, resulting in less post-operative pain compared to cold dissection and electrocautery dissection techniques 1.
- The procedure carries risks, including pain, bleeding, and infection, with a recovery period of about two weeks.
- Most patients with tonsil stones can manage them effectively without surgery, making coblation an option primarily for those with severe, treatment-resistant cases.
Evidence-Based Recommendations
- Conservative measures, such as gargling with salt water and using antibacterial mouthwashes, should be tried first for tonsil stones.
- Coblation tonsillectomy may be considered for severe, recurrent tonsil stones that significantly impact quality of life and have not responded to conservative measures, due to its potential to reduce post-operative pain compared to traditional techniques 1.
- Patients should be informed of the risks and benefits of the procedure, and alternative treatment options should be discussed.
From the Research
Coblation Tonsil Treatment for Tonsil Stones
- Coblation tonsil cryptolysis is a novel approach in the treatment of tonsil stones, which can be performed in adult patients without sedation using only local anesthesia 2.
- This technique has been shown to be effective in reducing and even eliminating tonsil stones after a single session 2.
- The use of Coblation technology avoids the significant disadvantages of laser use, including the potential for airway fire, retinal damage, and high cost of equipment 2.
Comparison with Other Surgical Techniques
- A systematic review compared the effects of Coblation tonsillectomy with other surgical techniques and found that the evidence supporting the use of Coblation is of low or very low quality 3.
- The review found that Coblation may cause less pain on postoperative day 1, but the difference is small and may be clinically meaningless 3.
- The risk of primary bleeding was similar between Coblation and other surgical techniques, but the risk of secondary bleeding was greater in the Coblation group 3.
Safety and Efficacy
- A retrospective study evaluated the safety of lingual tonsillectomy using Coblation and found that it is a safe procedure with a relatively low rate of postoperative complications 4.
- Another study reviewed the evidence on Coblation for tonsillectomy and found that it allows for tonsillectomy using plasma-mediated ablation 5.
- However, the current evidence is limited, and well-conducted randomized controlled trials are needed to establish the benefits and risks of Coblation tonsil treatment for tonsil stones 3, 6.
Diagnosis and Management of Tonsillitis and Tonsilloliths
- Tonsillitis is caused by a viral infection in 70% to 95% of cases, and bacterial infections caused by group A beta-hemolytic streptococcus account for tonsillitis in 5% to 15% of adults and 15% to 30% of patients five to 15 years of age 6.
- Tonsilloliths are managed expectantly, and small tonsilloliths are common clinical findings, but rarely, surgical intervention is required if they become too large to pass on their own 6.