New Minimally Invasive Technique to Treat Tonsil Stones Developed by Dr. Chang

Dr. Chang developed an innovative minimally invasive technique to treat tonsil stones using coblation technology. His findings have been published in this month's ENT Journal. In fact, his research made the front cover of the journal! Dr. Richard Thrasher of ENT Centers of Texas was a co-author in the study.

This technique called coblation tonsil cryptolysis is unique in that it can be performed in adult patients without sedation using only local anesthesia, much like laser tonsil cryptolysis. As with laser cryptolysis, pain is significant for only a few days and most adults can resume normal diet and activity within 1 week. In contrast, tonsillectomy entails significant morbidity for several weeks. However, coblation avoids the significant disadvantages of laser use, including the potential for airway fire, retinal damage from reflected scatter, dealing with plume from vaporized tissues, oral/facial burns, and the high cost of purchasing and maintaining laser equipment. After a single session of coblation tonsil cryptolysis, a significant decrease and even elimination of tonsil stones can potentially be achieved.

Read more about this mode of treatment here.

Read the research article here.

Tonsillectomy Airway Fire

ABC News reported in 2008 about a California family suing doctors as well as Conmed, an electro-surgical instrument company, for an airway fire that occurred on April 18, 2003 on an 8 years old child during a routine tonsillectomy surgery.

Apparently, an electrocautery device was being used to remove the tonsils when the endotracheal tube caught fire resulting in burns to the child's mouth and airway (no death). It is suspected that the electrocautery device during the surgery either burned a hole into the endotracheal tube where it encountered oxygen resulting in the fire or there was a leak around the endotracheal tube which caught fire. The jury found the surgeon to be negligent, but returned a defense verdict for the device manufacturer Conmed. The other defendants settled.

Use of electrocautery is still popular among ENT surgeons removing tonsils, but has been abandoned by an increasing number of surgeons (including our practice) over the past few years due to risk of airway fire as well as concern for unnecessary thermal injury to surrounding normal peritonsillar tissues. Electrocautery produces temperatures between 400 to 600 degrees Centigrade which both cuts and stops bleeding simultaneously. However, as can be seen in this unfortunate case, it can also burn through an endotracheal tube and cause an airway fire.

Airway fire is another reason why laser tonsillectomy is rarely performed as the risk is the same if not greater than electrocauterization.

Our office uses coblation technology to remove tonsils. Coblation uses a radiofrequency plasma field to cut and stop bleeding simultaneously at near room temperatures thereby avoiding risk of airway fire as well as thermal injury to surrounding oral tissues.

Of note, there are about 500 cases of operating room fires related to use of electrosurgical instruments every year of which 20-30 causes serious injuries.

Read the ABC News report here.

Innovative Research to Treat Tonsil Stones by Dr. Chris Chang Accepted for Publication

There are some unfortunate individuals who suffer from an annoying problem called tonsil stones. This aggravating problem is when the tonsils produce tiny stones that extrude into the mouth resulting in chronic bad breath and throat discomfort. When it does pop out into the mouth, the stone itself tastes terrible. For many individuals, this may occur every few weeks. In others, it can happen on a daily basis causing significant quality of life issues.

In the past, there has been only 3 ways to address this problem:

1) Conservative management with gargles and manual expression (kind of like popping a pimple, but it's the tonsil)

2) Tonsillectomy (no tonsils to produce the stones than)

3) Laser cryptolysis (a laser beam is used to obliterate the tonsil surface causing the crypts and holes where tonsils stones are produced to disappear)

However, there are disadvantages to each of these different methods. For tonsillectomy, the pain during recovery is excruciating and can last up to 3+ weeks. Also, the surgery has to be performed under general anesthesia. Laser cryptolysis is rarely performed mainly because of the risks associated with laser use (eye damage, facial and lip burns, bleeding, etc).

As such, Dr. Chang has developed a new technique that minimizes the drawbacks with these methods called coblation cryptolysis. Pain does not typically last more than 1 week and does not have any of the risks associated with laser use. Furthermore, it can be done without any sedation. Only local anesthesia is used.

His technique and findings has been accepted for publication in ENT Journal, a peer-reviewed specialty journal, and hopefully will be available to read in the near future! Stay tuned!