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COMPARATIVE STUDY OF TONSILLECTOMY TECHNIQUES: COLD DISSECTION
VS. COBLATION IN PEDIATRIC PATIENTS
¹Fayzullayev Amirjon Baxodirovich
²Xolmurodov Ergash Zavkiyevich
³Juraqulov Muhammadali Mirsharof o‘g‘li
¹'²'³Samarkand State Medical University, Department of Otorhinolaryngology No. 2, 1st Year
Clinical Residents.
https://doi.org/10.5281/zenodo.15507409
Research Objective
The main goal of this study is to compare the outcomes, intraoperative parameters, and
postoperative recovery profiles of two widely used surgical methods—cold dissection
tonsillectomy (CDT) and coblation tonsillectomy (CT)—in pediatric patients. The study evaluates
intraoperative blood loss, operative time, postoperative pain, healing duration, and complication
rates to determine the safer and more effective technique. The primary objective of this study is to
comprehensively investigate the clinical characteristics, diagnostic challenges, and therapeutic
outcomes of Chronic Otitis Media with Effusion (COME) in the pediatric population. This
research aims to:
Systematically characterize the typical clinical manifestations and risk factors associated
with COME in children aged 2 to 12 years, including the influence of environmental and
immunological factors.
Evaluate the efficacy and safety of different management strategies such as conservative
medical therapy, including antibiotics and nasal corticosteroids, versus surgical interventions like
tympanostomy tube placement.
Assess the impact of COME on auditory function through audiological assessments and its
subsequent effects on speech development, academic performance, and social interaction in
children.
Identify the rates and causes of treatment failure or recurrence and analyze factors
contributing to these outcomes.
Formulate evidence-based clinical guidelines aimed at early diagnosis, appropriate
intervention, and long-term follow-up to minimize complications and improve quality of life for
affected children and their families.
Materials and Methods
:
A prospective, comparative clinical study was conducted from January to December 2024
in the Department of Pediatric Otorhinolaryngology at Samarkand State Medical University.
Population and Sample Size
:
Sixty children aged 4–12 years diagnosed with recurrent tonsillitis or obstructive sleep
apnea (OSA) due to tonsillar hypertrophy were included.
Group Division
:
Group A (n=30): Underwent conventional cold dissection tonsillectomy
Group B (n=30): Underwent coblation tonsillectomy using low-temperature
radiofrequency ablation
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Parameters Measured:
a.
Operative time (in minutes)
b.
Intraoperative blood loss (in mL)
c.
Postoperative pain (measured using FLACC pain scale)
d.
Time to resume normal diet
e.
Rate of postoperative complications (bleeding, infection)
Data Analysis:
Statistical analysis was performed using SPSS version 25.0. Student’s t-test and chi-square
test were used. A p-value <0.05 was considered statistically significant.
Results
Demographics:
a.
Mean age: 7.3 ± 2.4 years
b.
Male/Female ratio: 1.2:1
c.
No significant demographic differences between groups
Key Findings
:
a.
Coblation significantly reduced blood loss and operative time
b.
Postoperative pain and recovery time were shorter in coblation group
c.
No statistically significant difference in complication rates
Discussion
Tonsillectomy remains one of the most frequently performed pediatric surgeries globally.
The choice of surgical technique plays a pivotal role in minimizing intraoperative and
postoperative morbidity. In this study, coblation tonsillectomy showed clear advantages in terms
of reduced operative time, less intraoperative bleeding, and faster postoperative recovery.
These findings are consistent with international literature suggesting that coblation, by
operating at lower temperatures (40–70°C), causes less collateral thermal damage compared to
electrocautery or cold steel dissection. Furthermore, children undergoing coblation experienced
less pain and resumed their normal diet sooner, which is an essential indicator of improved
postoperative quality of life.
However, coblation requires specific equipment and is costlier. The marginally lower
incidence of bleeding, although not statistically significant, may be clinically relevant in high-risk
cases.
Conclusion
Coblation tonsillectomy in pediatric patients provides superior outcomes compared to
traditional cold dissection in terms of operative time, intraoperative bleeding, pain, and recovery.
Although both techniques are effective and safe, coblation appears to offer better
perioperative comfort and faster healing, making it a favorable choice in centers where technology
is accessible.
This study confirms that Chronic Otitis Media with Effusion is a prevalent and significant
cause of hearing impairment in children, which can negatively affect speech development and
overall quality of life if not properly managed. Our findings highlight that timely diagnosis, aided
by thorough clinical and audiological evaluation, is essential for effective treatment planning. Both
conservative and surgical treatments have distinct roles in managing COME.
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While medical therapy may be beneficial in select cases, surgical intervention via
tympanostomy tube placement remains the most effective approach for persistent effusions and
hearing restoration. Importantly, individualized treatment based on patient age, severity, and risk
factors optimizes outcomes.
The research also underscores the importance of long-term monitoring to promptly identify
recurrences and manage complications. Early intervention not only improves auditory function but
also enhances communication skills and social development in children, reducing the risk of
academic and psychosocial difficulties. In conclusion, multidisciplinary care combining
otolaryngological, audiological, and pediatric expertise is paramount in managing COME, and the
establishment of standardized protocols will contribute to better health outcomes and patient
satisfaction.
Further randomized controlled studies with larger populations and long-term follow-up are
needed to fully validate these advantages and evaluate the cost-benefit balance in resource-limited
settings.
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