What is coblation tonsillectomy for tonsillar crypts?

From the Guidelines

Coblation tonsil cryptolysis is a minimally invasive procedure used to treat tonsil crypts, which are small pockets or crevices in the tonsils that can collect debris and cause chronic tonsillitis or tonsil stones (tonsilloliths). The procedure uses coblation technology, which combines radiofrequency energy with a saline solution to create a plasma field that gently removes or shrinks tissue at relatively low temperatures (40-70°C) 1. Unlike traditional electrocautery which burns tissue at high temperatures (400-600°C), coblation causes less thermal damage to surrounding healthy tissue, resulting in less post-operative pain and faster recovery.

Key Points

• The procedure is beneficial for patients who suffer from recurrent tonsil stones or chronic tonsillitis but don't require complete tonsil removal.
• Recovery typically takes 7-10 days, with patients experiencing mild throat pain that can be managed with over-the-counter pain medications like acetaminophen or ibuprofen.
• Patients should maintain hydration and consume soft foods during recovery to minimize discomfort.
• Clinicians may recommend tonsillectomy for recurrent throat infection with a frequency of at least 7 episodes in the past year, at least 5 episodes per year for 2 years, or at least 3 episodes per year for 3 years with documentation in the medical record for each episode of sore throat 1.
• It is essential to reinforce the need for appropriate documentation of the frequency and clinical features of throat infection episodes to ensure clinical benefits consistent with those achieved in randomized controlled trials.

Considerations

• The decision to perform coblation tonsil cryptolysis or tonsillectomy should be based on the individual patient's needs and medical history.
• Shared decision making between clinicians, patients, and families is crucial in determining the best course of treatment 1.
• The procedure's efficacy and safety have been demonstrated in clinical practice guidelines, but it is essential to consider the latest evidence and guidelines when making treatment decisions 1.

From the Research

Definition of Coblation Tonsil Cryptolysis

• Coblation tonsil cryptolysis is a novel approach in the treatment of tonsil stones using Coblation technology 2.
• This technique is unique in that it can be performed in adult patients without sedation using only local anesthesia 2.
• Coblation tonsil cryptolysis is an alternative method for tonsil caseum treatment, which can cause halitosis 3.

Effectiveness of Coblation Tonsil Cryptolysis

• A significant decrease and even elimination of tonsil stones can potentially be achieved after a single session of Coblation tonsil cryptolysis 2.
• In a study, 23 out of 28 patients (82.1%) had no caseum at the 6th month follow-up after the procedure 3.
• The mean VAS score before coblation cryptolysis was 8.0 ± 1.33, and 6 months after the procedure, the mean VAS score was 1.25 ± 1.78, which was statistically significant (p < 0.001) 3.

Comparison with Other Surgical Techniques

• Coblation tonsillectomy is a popular method because it purportedly causes less pain than other surgical methods, but its superiority is unproven 4.
• The coblation technique may cause less pain on postoperative day 1, but the difference is small and may be clinically meaningless 4.
• By postoperative day 3, the difference decreases further, and by postoperative day 7, there appears to be little or no difference in pain between coblation and other surgical techniques 4.