The Impact of Tobacco Smoking Upon Chronic/Recurrent Tonsillitis and Post Tonsillectomy Bleeding
05 February 2016
04 September 2016
26 October 2016 (online)
Introduction Smoking has many adverse effects on the oral and pharyngeal mucosa. Outcomes may be developing tonsillar infections and predisposing for post tonsillectomy bleeding (PTB).
Objective The objective of our study was to determine whether smokers have more chronic/recurrent tonsillitis indicating for tonsillectomy or develop more PTB episodes.
Methods We conducted a retrospective study on two groups of adults (age ≥18 years). Cohort 1: Smoking among patients who underwent tonsillectomy for recurrent/chronic tonsillitis. Cohort 2: Smoking among patients requiring control of PTB that were operated primarily for recurrent/chronic tonsillitis. Cohort 1 served as a population-reference for the second. We retrieved the data from medical records.
Results Cohort 1: 206 adults aged 18–50 years (mean 26 ± 7.6). 28% (57 patients) were smokers, versus 24% and 20% in the general population (in the years 2000 and 2010; p = 0.5, p = 0.18, respectively). Cohort 2: 114 adults aged 18–73 years (mean 26 ± 7.6). 43% were smokers, double the incidence in the general population (p = 0.004, p = 0.0004, in 2000 and 2010, respectively), and 1.5 times cohort 1 (p = 0.02). Smoking rates among bleeders on post-operative days 8–10 and later than day 10 were 53% and 60% (p = 0.0005 and p < 0.0001, respectively). Five of ten patients presenting a second PTB were smokers. Timing of re-bleedings was similar to their first PTB and dated similarly as first PTB of the entire group, mean 5.6 days (SD ± 3.2).
Conclusion Smokers may encounter more chronic/recurrent tonsillitis episodes, indicating tonsillectomy and significantly are more prone for PTB. Smoking cessation may perhaps diminish recurrent/chronic tonsillitis. Whether pre-operative abstinence or its length would reduce PTB incidence is yet to be determined.
- 1 Taybos G. Oral changes associated with tobacco use. Am J Med Sci 2003; 326 (04) 179-182
- 2 Torre V, Bucolo S, Giordano C. , et al. Palatine tonsils in smoker and non-smoker patients: a pilot clinicopathological and ultrastructural study. J Oral Pathol Med 2005; 34 (07) 390-396
- 3 Brook I, Gober AE. Recovery of potential pathogens and interfering bacteria in the nasopharynx of smokers and nonsmokers. Chest 2005; 127 (06) 2072-2075
- 4 Brook I. The impact of smoking on oral and nasopharyngeal bacterial flora. J Dent Res 2011; 90 (06) 704-710
- 5 Michaud DS, Izard J, Rubin Z. , et al. Lifestyle, dietary factors, and antibody levels to oral bacteria in cancer-free participants of a European cohort study. Cancer Causes Control 2013; 24 (11) 1901-1909
- 6 Rad M, Kakoie S, Niliye Brojeni F, Pourdamghan N. Effect of Long-term Smoking on Whole-mouth Salivary Flow Rate and Oral Health. J Dent Res Dent Clin Dent Prospect 2010; 4 (04) 110-114
- 7 Marom T, Cinamon U, Itskoviz D, Roth Y. Changing trends of peritonsillar abscess. Am J Otolaryngol 2010; 31 (03) 162-167
- 8 Hidaka H, Kuriyama S, Yano H, Tsuji I, Kobayashi T. Precipitating factors in the pathogenesis of peritonsillar abscess and bacteriological significance of the Streptococcus milleri group. Eur J Clin Microbiol Infect Dis 2011; 30 (04) 527-532
- 9 Klug TE, Rusan M, Clemmensen KK, Fuursted K, Ovesen T. Smoking promotes peritonsillar abscess. Eur Arch Otorhinolaryngol 2013; 270 (12) 3163-3167
- 10 Tolska HK, Takala A, Pitkäniemi J, Jero J. Post-tonsillectomy haemorrhage more common than previously described--an institutional chart review. Acta Otolaryngol 2013; 133 (02) 181-186
- 11 Bhattacharyya N, Kepnes LJ. Revisits and postoperative hemorrhage after adult tonsillectomy. Laryngoscope 2014; 124 (07) 1554-1556
- 12 Lopatin AS, Chuchueva ND. [Hemorrhage following tonsillectomy: analysis of the prevalence and risk factors]. Vestn Otorinolaringol 2013; (03) 71-75
- 13 Akin RC, Holst R, Schousboe LP. Risk factors for post-tonsillectomy haemorrhage. Acta Otolaryngol 2012; 132 (07) 773-777
- 14 Mösges R, Hellmich M, Allekotte S, Albrecht K, Böhm M. Hemorrhage rate after coblation tonsillectomy: a meta-analysis of published trials. Eur Arch Otorhinolaryngol 2011; 268 (06) 807-816
- 15 Sarny S, Ossimitz G, Habermann W, Stammberger H. Hemorrhage following tonsil surgery: a multicenter prospective study. Laryngoscope 2011; 121 (12) 2553-2560
- 16 Eski E, Dogan I, Yilmaz I. Seasonal variation of secondary post tonsillectomy hemorrhage rates. B-ENT 2011; 7 (03) 165-168
- 17 Hessén Söderman AC, Ericsson E, Hemlin C. , et al. Reduced risk of primary postoperative hemorrhage after tonsil surgery in Sweden: results from the National Tonsil Surgery Register in Sweden covering more than 10 years and 54,696 operations. Laryngoscope 2011; 121 (11) 2322-2326
- 18 Leonard DS, Fenton JE, Hone S. ABO blood type as a risk factor for secondary post-tonsillectomy haemorrhage. Int J Pediatr Otorhinolaryngol 2010; 74 (07) 729-732
- 19 Tomkinson A, De Martin S, Gilchrist CR, Temple M. Instrumentation and patient characteristics that influence postoperative haemorrhage rates following tonsil and adenoid surgery. Clin Otolaryngol 2005; 30 (04) 338-346
- 20 Morton RP, Mak V, Moss D, Ahmad Z, Sevao J. Risk of bleeding after thyroid surgery: matched pairs analysis. J Laryngol Otol 2012; 126 (03) 285-288
- 21 Richstone L, Montag S, Ost MC. , et al. Predictors of hemorrhage after laparoscopic partial nephrectomy. Urology 2011; 77 (01) 88-91
- 22 Mjøen G, Øyen O, Holdaas H, Midtvedt K, Line PD. Morbidity and mortality in 1022 consecutive living donor nephrectomies: benefits of a living donor registry. Transplantation 2009; 88 (11) 1273-1279
- 23 de la Fuente SG, Khuri SF, Schifftner T, Henderson WG, Mantyh CR, Pappas TN. Comparative analysis of vagotomy and drainage versus vagotomy and resection procedures for bleeding peptic ulcer disease: results of 907 patients from the Department of Veterans Affairs National Surgical Quality Improvement Program database. J Am Coll Surg 2006; 202 (01) 78-86
- 24 Erickson BK, Larson DR, St Sauver JL, Meverden RA, Orvidas LJ. Changes in incidence and indications of tonsillectomy and adenotonsillectomy, 1970-2005. Otolaryngol Head Neck Surg 2009; 140 (06) 894-901
- 25 Hoddeson EK, Gourin CG. Adult tonsillectomy: current indications and outcomes. Otolaryngol Head Neck Surg 2009; 140 (01) 19-22
- 26 The Israeli Ministry of health. The minister of health report of smoking is Israel, 2003. Available at: http://www.health.gov.il/PublicationsFiles/smoke2003_2002.pdf" [Hebrew]. Accessed Dec 7, 2015.
- 27 The Israeli Ministry of health. The minister of health report of smoking in Israel, 2010. Available at: http://www.old.health.gov.il/download/pages/smoke10_290511.pdf . [Heberew]. Accessed Dec 7, 2015.
- 28 Demars SM, Harsha WJ, Crawford JV. The effects of smoking on the rate of postoperative hemorrhage after tonsillectomy and uvulopalatopharyngoplasty. Arch Otolaryngol Head Neck Surg 2008; 134 (08) 811-814
- 29 Washington Tobacco facts 2013. Tobacco Prevention & Control Program. Washington state department of health DOH 340–149. January 2014. Available at: http://www.doh.wa.gov/Portals/1/Documents/Pubs/340-149-washingtontobaccofacts.pdf
- 30 Kramarow EA, Pastor PN. The health of male veterans and nonveterans aged 25-64: United States, 2007-2010. NCHS Data Brief 2012; (101) 1-8
- 31 Nelson JP, Pederson LL. Military tobacco use: a synthesis of the literature on prevalence, factors related to use, and cessation interventions. Nicotine Tob Res 2008; 10 (05) 775-790
- 32 Ashcroft DW. Haemorrhage following Tonsillectomy. BMJ 1938; 2 (4064): 1079-1082
- 33 Kontorinis G, Schwab B. Significance of advanced haemostasis investigation in recurrent, severe post-tonsillectomy bleeding. J Laryngol Otol 2011; 125 (09) 952-957
- 34 Schrock A, Send T, Heukamp L, Gerstner AO, Bootz F, Jakob M. The role of histology and other risk factors for post-tonsillectomy haemorrhage. Eur Arch Otorhinolaryngol 2009; 266 (12) 1983-1987
- 35 Sørensen LT. Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg 2012; 255 (06) 1069-1079
- 36 Larose TL, Chen Y, Camargo Jr CA, Langhammer A, Romundstad P, Mai XM. Factors associated with vitamin D deficiency in a Norwegian population: the HUNT Study. J Epidemiol Community Health 2014; 68 (02) 165-170
- 37 Baeke F, Takiishi T, Korf H, Gysemans C, Mathieu C. Vitamin D: modulator of the immune system. Curr Opin Pharmacol 2010; 10 (04) 482-496
- 38 Nseir W, Mograbi J, Abu-Rahmeh Z, Mahamid M, Abu-Elheja O, Shalata A. The association between vitamin D levels and recurrent group A streptococcal tonsillopharyngitis in adults. Int J Infect Dis 2012; 16 (10) e735-e738
- 39 Gill JF, Yu SS, Neuhaus IM. Tobacco smoking and dermatologic surgery. J Am Acad Dermatol 2013; 68 (01) 167-172
- 40 Deliaert AE, Van den Kerckhove E, Tuinder S, Noordzij SM, Dormaar TS, van der Hulst RR. Smoking and its effect on scar healing. Eur J Plast Surg 2012; 35 (06) 421-424
- 41 McRobert J. Smoking and its effects on the healing process of chronic wounds. Br J Community Nurs 2013; ; Suppl: S18 , S20–23.
- 42 Warner MA, Offord KP, Warner ME, Lennon RL, Conover MA, Jansson-Schumacher U. Role of preoperative cessation of smoking and other factors in postoperative pulmonary complications: a blinded prospective study of coronary artery bypass patients. Mayo Clin Proc 1989; 64 (06) 609-616
- 43 Cavichio BV, Pompeo DA, Oller GA, Rossi LA. [Duration of smoking cessation for the prevention of surgical wound healing complications]. Rev Esc Enferm USP 2014; 48 (01) 174-180
- 44 Rinker B. The evils of nicotine: an evidence-based guide to smoking and plastic surgery. Ann Plast Surg 2013; 70 (05) 599-605
- 45 Rodrigo C. The effects of cigarette smoking on anesthesia. Anesth Prog 2000; 47 (04) 143-150
- 46 Nicod P, Rehr R, Winniford MD, Campbell WB, Firth BG, Hillis LD. Acute systemic and coronary hemodynamic and serologic responses to cigarette smoking in long-term smokers with atherosclerotic coronary artery disease. J Am Coll Cardiol 1984; 4 (05) 964-971
- 47 Lee SM, Landry J, Jones PM, Buhrmann O, Morley-Forster P. The effectiveness of a perioperative smoking cessation program: a randomized clinical trial. Anesth Analg 2013; 117 (03) 605-613
- 48 Wong J, Lam DP, Abrishami A, Chan MT, Chung F. Short-term preoperative smoking cessation and postoperative complications: a systematic review and meta-analysis. Can J Anaesth 2012; 59 (03) 268-279