{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:57:02Z","timestamp":1785427022836,"version":"3.56.0"},"reference-count":30,"publisher":"Michigan State University College of Osteopathic Medicine Statewide Campus System","issue":"1","license":[{"start":{"date-parts":[[2023,12,5]],"date-time":"2023-12-05T00:00:00Z","timestamp":1701734400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"\n INTRODUCTION<\/jats:title>\n Tonsillectomy with or without adenoidectomy is one of the most common ambulatory procedures performed in children under 15. One rare yet serious complication of tonsillectomy is postoperative hemorrhage. Chronic tonsillitis, which is an indication for tonsillectomy, has been shown to have an increased risk for postoperative hemorrhage. Tonsilloliths or tonsil stones have been associated with cryptic tonsillitis. This 2020-2021 study examined whether tonsilloliths were a risk factor for post-tonsillectomy hemorrhage in a convenience sample of 187 pediatric patients.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n This was a cross-institutional 12-month retrospective cohort study investigating pediatric patients who had undergone tonsillectomy. Exclusion criteria included patients who had received prior airway surgeries (e.g., supraglottoplasty), patients with significant comorbidities such as chromosomal abnormalities or congenital disorders, and patients with pre-existing bleeding disorders. Demographic, clinical, and operative data was extracted from each chart. Postoperative adverse events and bleeding were also recorded. These factors were then compared between the tonsillolith and no tonsillolith patient groups.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n A total of 187 pediatric patients met the inclusion criteria. Seventy-three (39%) of the patients had tonsilloliths and 114 (61%) did not have tonsilloliths at the time of surgery. The tonsillolith subgroup had a higher median age (10 vs 3, P < 0.001) when compared to the no tonsillolith subgroup. The most common indication for tonsillectomy was obstructive sleep apnea\/sleep disordered breathing (N= 148, 79.1%). There was no statistical difference found between presence of tonsillolith and indication for surgery (P = 0.06). Only five (2.7%) of sample patients experienced postoperative bleeding and there was no association found between postoperative bleeding and presence of tonsilloliths (P = 0.38).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSION<\/jats:title>\n In the current study there was no association found between the presence of tonsilloliths (indicating low grade chronic inflammation) and hemorrhage after tonsillectomy. Continued larger sample evaluations of possible risk factors for post-tonsillectomy hemorrhage patterns are encouraged.<\/jats:p>\n <\/jats:sec>","DOI":"10.51894\/001c.57320","type":"journal-article","created":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T11:00:22Z","timestamp":1710241222000},"source":"Crossref","is-referenced-by-count":2,"title":["Secondary Postoperative Hemorrhage in the Pediatric Tonsillectomy Patient- is there a correlation between hemorrhage and tonsilloliths?"],"prefix":"10.51894","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2523-5431","authenticated-orcid":false,"given":"Andrew","family":"Ross","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05hs6h993","id-type":"ROR","asserted-by":"publisher"}],"name":"Michigan State University","department":["College of Osteopathic Medicine"]},{"id":[{"id":"https:\/\/ror.org\/05gehxw18","id-type":"ROR","asserted-by":"publisher"}],"name":"Detroit Medical Center","department":["Department of Otolaryngology \u2013 Head and Neck Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ani","family":"Mnatsakanian","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05hs6h993","id-type":"ROR","asserted-by":"publisher"}],"name":"Michigan State University","department":["College of Osteopathic Medicine"]},{"name":"Ascension Macomb-Oakland Hospital","department":["Department of Otolaryngology \u2013 Head and Neck Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Markovicz","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05hs6h993","id-type":"ROR","asserted-by":"publisher"}],"name":"Michigan State University","department":["College of Osteopathic Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sruti","family":"Desai","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05hs6h993","id-type":"ROR","asserted-by":"publisher"}],"name":"Michigan State University","department":["College of Osteopathic Medicine"]},{"id":[{"id":"https:\/\/ror.org\/05gehxw18","id-type":"ROR","asserted-by":"publisher"}],"name":"Detroit Medical Center","department":["Department of Otolaryngology \u2013 Head and Neck Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Anderson","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05hs6h993","id-type":"ROR","asserted-by":"publisher"}],"name":"Michigan State University","department":["College of Osteopathic Medicine"]},{"name":"Ascension Macomb-Oakland Hospital","department":["Department of Otolaryngology \u2013 Head and Neck Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly","family":"Shifman","sequence":"additional","affiliation":[{"name":"Oakland University","department":["William Beaumont School of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Engebretsen","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05hs6h993","id-type":"ROR","asserted-by":"publisher"}],"name":"Michigan State University","department":["College of Osteopathic Medicine"]},{"id":[{"id":"https:\/\/ror.org\/05gehxw18","id-type":"ROR","asserted-by":"publisher"}],"name":"Detroit Medical Center","department":["Department of Otolaryngology \u2013 Head and Neck Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carissa","family":"Wentland","sequence":"additional","affiliation":[{"name":"Children's Hospital of Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prasad","family":"Thottam","sequence":"additional","affiliation":[{"name":"Michigan Pediatric Ear Nose and Throat Associates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Haupert","sequence":"additional","affiliation":[{"name":"Michigan Pediatric Ear Nose and Throat Associates"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"29343","published-online":{"date-parts":[[2023,12,5]]},"reference":[{"issue":"6","key":"ref1","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1001\/jamaoto.2019.0269","article-title":"Comparison of Ibuprofen vs Acetaminophen and Severe Bleeding Risk After Pediatric Tonsillectomy: A Noninferiority Randomized Clinical Trial","volume":"145","author":"Gillian R. 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Johnson","year":"2002","journal-title":"The Laryngoscope","ISSN":"https:\/\/id.crossref.org\/issn\/0023-852X","issn-type":"print"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.ijporl.2016.03.005","article-title":"Risk factors for pediatric post-tonsillectomy hemorrhage","volume":"84","author":"Zorik Spektor","year":"2016","journal-title":"International Journal of Pediatric Otorhinolaryngology","ISSN":"https:\/\/id.crossref.org\/issn\/0165-5876","issn-type":"print"},{"issue":"7","key":"ref28","doi-asserted-by":"publisher","first-page":"1554","DOI":"10.1002\/lary.24541","article-title":"Revisits and postoperative hemorrhage after adult tonsillectomy","volume":"124","author":"Neil Bhattacharyya","year":"2014","journal-title":"The Laryngoscope","ISSN":"https:\/\/id.crossref.org\/issn\/0023-852X","issn-type":"print"},{"issue":"2","key":"ref29","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/j.ajme.2015.06.004","article-title":"Post-tonsillectomy hemorrhage after bipolar diathermy vs. cold dissection surgical techniques in Alahsa region, Saudi Arabia","volume":"52","author":"Ibrahim K. 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