Sander Joniau - Academia.edu (original) (raw)

Papers by Sander Joniau

B-ENT, 2005

To determine the value of radiological features in the diagnosis of Eosinophilic Fungal Rhinosinu... more To determine the value of radiological features in the diagnosis of Eosinophilic Fungal Rhinosinusitis (EFRS). Retrospective review of the radiological materials of 65 patients with documented Eosinophilic Fungal Rhinosinusitis treated at the same institution. Evaluation by the ENT surgeon and the head and neck radiologist. EFRS was more common in female patients in this series. Fifty-four (83%) patients were above 30 years of age, with a peak of 18 patients (27.7%) in the seventh decade. All the patients except one (98.5%) showed bilateral mucosal thickening on unenhanced CT scans. Thirty-eight patients (58%) showed increased intrasinus attenuation on unenhanced CT scans. Thirty-seven patients (57%) showed opacification of at least one sinus; 25 (38%) showed osteitis; 11 (17%) had erosion of the sinus wall and only one patient showed minor expansion of an involved sinus. In 6 patients, typical hyperattenuation patterns on CT scans, together with distinctive MRI images, were highly ...

Otolaryngology-Head and Neck Surgery, Dec 1, 2007

I welcome the meta-analysis evaluating the utility of extraesophageal pH monitoring by Joniau and... more I welcome the meta-analysis evaluating the utility of extraesophageal pH monitoring by Joniau and colleagues. They reported the presence of extraesophageal reflux in 23 percent of normals and in 38 percent of patients with laryngopharyngeal reflux (LPR) (P 0.079). From this limited information they conclude that “the absence of a good diagnostic tool for reflux laryngitis is problematic. Not only does it prevent an adequate definition of this disease, it also shakes the concept of laryngopharyngeal reflux to its core.” I share their frustration with the often-enigmatic diagnosis of LPR. Their conclusions, however, are misguided and are more likely to rattle the foundation of meta-analysis validity than challenge the notion that reflux disease can affect the larynx. This report is the third meta-analysis to evaluate the utility of extraesophageal pH monitoring. The first two studies were conducted by some of the most respected investigators in reflux disease. Ulualp et al and Merati et al reported significantly more reflux in patients with LPR than in controls. The Joniau et al study, however, suggests that pH testing cannot distinguish patients with LPR. Unlike the first 2 analyses, Joniau excluded patients with associated laryngeal pathology. In our experience, the presence of organic laryngeal pathology (nodules, granuloma, stenosis, etc) makes the presence of LPR more, not less likely. Other investigators have reported similar observations. Excluding these individuals would underreport the presence of extraesophageal reflux and significantly bias a study. The authors assure us, however, that their meta-analysis is superior to those of Ulualp et al and Merati et al because, “during this process, the utmost attention was paid not to compromise the reliability of the data.” As a clinical scientist, I do not want assurances that the investigators were paying attention during data acquisition and analysis. I want assurances that the study design and conduct was valid, unbiased, and based on sound scientific principles. I do not in any way oppose the results of the negative study reported by Joniau. I do, however, object to the unsubstantiated comments provided by the authors in their discussion. The data simply report that, with their specified inclusion criteria, there was marginal difference in the prevalence of “at least 1” hypopharyngeal reflux event at pH 4 between normal controls and those with a clinical diagnosis of LPR; this finding, however, falls far short of their conclusion that the “clinical diagnosis of reflux laryngitis is unreliable and does not warrant the initiation of long-term therapy with PPIs.” Peter C. Belafsky, MD, MPH, PhD, Director Center for Voice and Swallowing University of California, Davis

American Journal of Rhinology

Maxillary sinus puncture is considered the gold standard for diagnosing acute bacterial maxillary... more Maxillary sinus puncture is considered the gold standard for diagnosing acute bacterial maxillary sinusitis (ABMS) and for identifying bacterial pathogens in antimicrobial trials of ABMS. However, sinus puncture and aspiration is all invasive, time-consuming procedure that is limited by discomfort to the patient and possible complications. Therefore, the diagnostic usefulness in clinical practice and patient enrollment in studies of ABMS is hindered and alternatives for maxillary sinus puncture are being investigated. We designed a prospective clinical and microbiological outpatient study. Cultures obtained by endoscopically guided middle meatal aspiration were compared with those from sinus puncture and aspiration in 24 patients with ABMS. Considering puncture and aspiration as the gold standard, endoscopy cultures provided a sensitivity of 80%, specificity of 100%, positive predictive value of 100%, negative predictive value of 78.6%, and correlation of 88.5%. In our study, endosc...

Otolaryngology - Head and Neck Surgery, 2007

B-ENT

To evaluate the prevalence of humoral immunodeficiency in patients with refractory rhinosinusitis... more To evaluate the prevalence of humoral immunodeficiency in patients with refractory rhinosinusitis. All patients with refractory rhinosinusitis, who were treated at or referred to the ENT Dept of the University Hospital in Leuven between January 2002 and December 2004, were retrospectively identified. Patient charts that contained information on humoral immunity testing were selected to calculate the prevalence of IgA deficiency, common variable immunodeficiency (CVID) and IgG2/3 subclass deficiency. A total of 307 subjects (261 adults and 46 children) were included. Overall, 67 patients (21.8%) with refractory rhinosinusitis had laboratory evidence of a humoral immunodeficiency. We found an IgA deficiency in 7 patients (2.2%); CVID was not found in any patient (0%); IgG2 subclass deficiency in 6 patients (2.0%) and IgG3 subclass deficiency in 55 patients (17.9%). Nine patients (2.9%) had combined deficits of major and/or subclass serum immunoglobulin levels. There was no significant difference in the prevalence of humoral immunodeficiency between adults and children. Humoral immunodeficiency is present in a significant proportion of patients with refractory rhinosinusitis. The majority of these deficiencies are subtle IgG subclass deficits, whereas more severe humoral immune disorders are a rare finding. A laboratory evaluation of humoral immune function, including measurement of serum levels of IgA, total IgG and IgG subclasses, should be part of the evaluation of patients with refractory rhinosinusitis.

Acta oto-rhino-laryngologica Belgica

Macrolides are used primarily as antibiotics, but they may have other effects. This was first sug... more Macrolides are used primarily as antibiotics, but they may have other effects. This was first suggested after clinical experience showed that macrolides have an important therapeutic role some inflammatory airway diseases in which infection is not considered as an important etiologic factor. In vitro, ex vivo and in vivo experiments revealed that macrolides reinforce local defense mechanisms in the upper respiratory tract such as mucociliary clearance and epithelial impermeability. In addition, macrolides influence acute inflammation, by altering concentrations of cytokines and changing leucocyte functions. This paper aims to review the current knowledge on the non-antibiotic effects of macrolides on local defense mechanisms and acute inflammation in the upper respiratory tract.

American journal of rhinology

Maxillary sinus puncture is considered the gold standard for diagnosing acute bacterial maxillary... more Maxillary sinus puncture is considered the gold standard for diagnosing acute bacterial maxillary sinusitis (ABMS) and for identifying bacterial pathogens in antimicrobial trials of ABMS. However, sinus puncture and aspiration is all invasive, time-consuming procedure that is limited by discomfort to the patient and possible complications. Therefore, the diagnostic usefulness in clinical practice and patient enrollment in studies of ABMS is hindered and alternatives for maxillary sinus puncture are being investigated. We designed a prospective clinical and microbiological outpatient study. Cultures obtained by endoscopically guided middle meatal aspiration were compared with those from sinus puncture and aspiration in 24 patients with ABMS. Considering puncture and aspiration as the gold standard, endoscopy cultures provided a sensitivity of 80%, specificity of 100%, positive predictive value of 100%, negative predictive value of 78.6%, and correlation of 88.5%. In our study, endosc...

The Laryngoscope, 2006

To evaluate the results of powered turbinoplasty and to compare these with submucosal cauterizati... more To evaluate the results of powered turbinoplasty and to compare these with submucosal cauterization of the inferior turbinates. Prospective, randomized, comparative surgical trial. Nineteen patients with medication-resistant chronic nasal obstruction caused by inferior turbinate hypertrophy were randomized to undergo powered turbinoplasty on one side and submucosal cauterization on the other. For each side, an extensive assessment (symptom scoring, endoscopic scoring, and acoustic rhinometry) was recorded preoperatively and on week 1, week 3, month 3, year 1, and year 5 postoperatively. Powered turbinoplasty was superior to submucosal cauterization on all aspects of the assessment. A significant difference (P < .05) was noted for postoperative crusting, endoscopical scoring of turbinate size, and acoustic rhinometry measurements of nasal cavity volume and mean area at the level of the nasal valve. In addition, the results of powered turbinoplasty were still apparent on long term follow-up, whereas submucosal cauterization was associated with a recurrence of turbinate hypertrophy. Performing a powered turbinoplasty leads to decreased patient morbidity during the postoperative healing and to a better control of long-term results when compared with submucosal cauterization.

Otolaryngology - Head and Neck Surgery, 2007

To investigate and compare the prevalence of pharyngeal reflux (PR) events in normal controls and... more To investigate and compare the prevalence of pharyngeal reflux (PR) events in normal controls and patients with clinically diagnosed reflux laryngitis. METHOD: A systematic review of the literature was performed to identify all prospective studies on the results of 24-hour doubleprobe (pharyngeal and esophageal) pH monitoring in normal controls and in patients with symptoms and/or signs of reflux laryngitis. RESULTS: Eleven relevant studies on 192 normal controls and 13 studies on 512 patients with reflux laryngitis were identified. One or more PR events were detected in 51 normal controls (22.9%; 95% CI, 13.9% to 33.3%) and in 154 of 422 patients (38.3%; 95% CI, 25.4% to 52.1%). There is no significant difference in the prevalence of PR events between normal controls and patients with reflux laryngitis (P ϭ 0.079). In addition, the prevalence of PR events in patients with reflux laryngitis is much lower than reported in previous reviews on this subject. CONCLUSION: This systematic review calculated that (1) only a minority of patients with clinically diagnosed reflux laryngitis will show PR events, and (2) there is no significant difference between the prevalence of PR events in patients with reflux laryngitis and healthy controls. At the moment, there is no reliable means to confirm reflux of gastric juice in patients with suspected reflux laryngitis. This diagnostic vacuum is fundamental and may pose important questions at the current concept of reflux of gastric juice as a common cause of laryngopharyngeal inflammation.

Clinical Otolaryngology, 2009

To compare pepsin, carbonic anhydrase III (CAIII), cyclooxygenase-2 (COX-2) and mucin 5AC (MUC5AC... more To compare pepsin, carbonic anhydrase III (CAIII), cyclooxygenase-2 (COX-2) and mucin 5AC (MUC5AC) expression in children with adenoid hypertrophy and normal controls. A non-randomised, controlled prospective study. Two paediatric hospitals in Adelaide, South Australia. Children aged 2-10 years, 21 undergoing adenoidectomy and 12 controls undergoing routine dental surgery. We measured expression of pepsin, CAIII, COX-2 and MUC5AC levels by real-time RT-PCR, immunohistochemistry, and Western blot to determine any difference between children with hyperplastic adenoids and controls. Pepsin was not detected in any study or control adenoid by immunohistochemistry or Western blot. Real-time RT-PCR analysis showed a statistically significant difference between groups with respect to COX-2 (P = 0.027) and MUC5AC (P = 0.02) but no difference in CAIII expression (P = 0.414). A significant correlation was also found between COX-2 and MUC5AC expression (Kendall Tau = 0.4, P = 0.005). Our results suggest that the biochemical changes seen in adenoid hypertrophy are different to those seen in reflux-affected tissues. The decreased COX-2 and MUC5AC expression may be due to squamous metaplasia and other inflammatory changes associated with adenoid hypertrophy. Our findings infer there is little evidence of reflux being a major contributory factor in the pathophysiology of adenoidal hypertrophy.

ANZ Journal of Surgery, 2006

Tonsillectomy is one of the commonest surgical procedures, with postoperative pain being an impor... more Tonsillectomy is one of the commonest surgical procedures, with postoperative pain being an important source of morbidity. Coblation (cold ablation) is a new technique for tonsillectomy, promoted by claims of reduced postoperative pain levels. This study was designed to compare postoperative pain after tonsillectomy using coblation and tonsillectomy using the standard dissection techniques. Twenty adult patients underwent tonsillectomy, each having one randomly selected tonsil removed by dissection and the other removed by coblation. For each side, subjective pain levels were recorded on a daily basis for 10 postoperative days, using a visual analogue scale. Coblation tonsillectomy was significantly less painful than dissection tonsillectomy on day 1 (P < 0.001), day 2 (P = 0.003) and day 3 (P = 0.018). For all subsequent postoperative days, there was no significant difference in pain levels between the techniques. Coblation tonsillectomy causes significantly less pain during the first three postoperative days, when compared with dissection tonsillectomy. No demonstrable benefit was shown on days 4-10. The beneficial effects of coblation on early postoperative pain make it a potentially attractive technique for day-case tonsillectomy in adults with recurrent or chronic tonsillitis.

B-ENT, 2005

To determine the value of radiological features in the diagnosis of Eosinophilic Fungal Rhinosinu... more To determine the value of radiological features in the diagnosis of Eosinophilic Fungal Rhinosinusitis (EFRS). Retrospective review of the radiological materials of 65 patients with documented Eosinophilic Fungal Rhinosinusitis treated at the same institution. Evaluation by the ENT surgeon and the head and neck radiologist. EFRS was more common in female patients in this series. Fifty-four (83%) patients were above 30 years of age, with a peak of 18 patients (27.7%) in the seventh decade. All the patients except one (98.5%) showed bilateral mucosal thickening on unenhanced CT scans. Thirty-eight patients (58%) showed increased intrasinus attenuation on unenhanced CT scans. Thirty-seven patients (57%) showed opacification of at least one sinus; 25 (38%) showed osteitis; 11 (17%) had erosion of the sinus wall and only one patient showed minor expansion of an involved sinus. In 6 patients, typical hyperattenuation patterns on CT scans, together with distinctive MRI images, were highly ...

Otolaryngology-Head and Neck Surgery, Dec 1, 2007

I welcome the meta-analysis evaluating the utility of extraesophageal pH monitoring by Joniau and... more I welcome the meta-analysis evaluating the utility of extraesophageal pH monitoring by Joniau and colleagues. They reported the presence of extraesophageal reflux in 23 percent of normals and in 38 percent of patients with laryngopharyngeal reflux (LPR) (P 0.079). From this limited information they conclude that “the absence of a good diagnostic tool for reflux laryngitis is problematic. Not only does it prevent an adequate definition of this disease, it also shakes the concept of laryngopharyngeal reflux to its core.” I share their frustration with the often-enigmatic diagnosis of LPR. Their conclusions, however, are misguided and are more likely to rattle the foundation of meta-analysis validity than challenge the notion that reflux disease can affect the larynx. This report is the third meta-analysis to evaluate the utility of extraesophageal pH monitoring. The first two studies were conducted by some of the most respected investigators in reflux disease. Ulualp et al and Merati et al reported significantly more reflux in patients with LPR than in controls. The Joniau et al study, however, suggests that pH testing cannot distinguish patients with LPR. Unlike the first 2 analyses, Joniau excluded patients with associated laryngeal pathology. In our experience, the presence of organic laryngeal pathology (nodules, granuloma, stenosis, etc) makes the presence of LPR more, not less likely. Other investigators have reported similar observations. Excluding these individuals would underreport the presence of extraesophageal reflux and significantly bias a study. The authors assure us, however, that their meta-analysis is superior to those of Ulualp et al and Merati et al because, “during this process, the utmost attention was paid not to compromise the reliability of the data.” As a clinical scientist, I do not want assurances that the investigators were paying attention during data acquisition and analysis. I want assurances that the study design and conduct was valid, unbiased, and based on sound scientific principles. I do not in any way oppose the results of the negative study reported by Joniau. I do, however, object to the unsubstantiated comments provided by the authors in their discussion. The data simply report that, with their specified inclusion criteria, there was marginal difference in the prevalence of “at least 1” hypopharyngeal reflux event at pH 4 between normal controls and those with a clinical diagnosis of LPR; this finding, however, falls far short of their conclusion that the “clinical diagnosis of reflux laryngitis is unreliable and does not warrant the initiation of long-term therapy with PPIs.” Peter C. Belafsky, MD, MPH, PhD, Director Center for Voice and Swallowing University of California, Davis

American Journal of Rhinology

Maxillary sinus puncture is considered the gold standard for diagnosing acute bacterial maxillary... more Maxillary sinus puncture is considered the gold standard for diagnosing acute bacterial maxillary sinusitis (ABMS) and for identifying bacterial pathogens in antimicrobial trials of ABMS. However, sinus puncture and aspiration is all invasive, time-consuming procedure that is limited by discomfort to the patient and possible complications. Therefore, the diagnostic usefulness in clinical practice and patient enrollment in studies of ABMS is hindered and alternatives for maxillary sinus puncture are being investigated. We designed a prospective clinical and microbiological outpatient study. Cultures obtained by endoscopically guided middle meatal aspiration were compared with those from sinus puncture and aspiration in 24 patients with ABMS. Considering puncture and aspiration as the gold standard, endoscopy cultures provided a sensitivity of 80%, specificity of 100%, positive predictive value of 100%, negative predictive value of 78.6%, and correlation of 88.5%. In our study, endosc...

Otolaryngology - Head and Neck Surgery, 2007

B-ENT

To evaluate the prevalence of humoral immunodeficiency in patients with refractory rhinosinusitis... more To evaluate the prevalence of humoral immunodeficiency in patients with refractory rhinosinusitis. All patients with refractory rhinosinusitis, who were treated at or referred to the ENT Dept of the University Hospital in Leuven between January 2002 and December 2004, were retrospectively identified. Patient charts that contained information on humoral immunity testing were selected to calculate the prevalence of IgA deficiency, common variable immunodeficiency (CVID) and IgG2/3 subclass deficiency. A total of 307 subjects (261 adults and 46 children) were included. Overall, 67 patients (21.8%) with refractory rhinosinusitis had laboratory evidence of a humoral immunodeficiency. We found an IgA deficiency in 7 patients (2.2%); CVID was not found in any patient (0%); IgG2 subclass deficiency in 6 patients (2.0%) and IgG3 subclass deficiency in 55 patients (17.9%). Nine patients (2.9%) had combined deficits of major and/or subclass serum immunoglobulin levels. There was no significant difference in the prevalence of humoral immunodeficiency between adults and children. Humoral immunodeficiency is present in a significant proportion of patients with refractory rhinosinusitis. The majority of these deficiencies are subtle IgG subclass deficits, whereas more severe humoral immune disorders are a rare finding. A laboratory evaluation of humoral immune function, including measurement of serum levels of IgA, total IgG and IgG subclasses, should be part of the evaluation of patients with refractory rhinosinusitis.

Acta oto-rhino-laryngologica Belgica

Macrolides are used primarily as antibiotics, but they may have other effects. This was first sug... more Macrolides are used primarily as antibiotics, but they may have other effects. This was first suggested after clinical experience showed that macrolides have an important therapeutic role some inflammatory airway diseases in which infection is not considered as an important etiologic factor. In vitro, ex vivo and in vivo experiments revealed that macrolides reinforce local defense mechanisms in the upper respiratory tract such as mucociliary clearance and epithelial impermeability. In addition, macrolides influence acute inflammation, by altering concentrations of cytokines and changing leucocyte functions. This paper aims to review the current knowledge on the non-antibiotic effects of macrolides on local defense mechanisms and acute inflammation in the upper respiratory tract.

American journal of rhinology

Maxillary sinus puncture is considered the gold standard for diagnosing acute bacterial maxillary... more Maxillary sinus puncture is considered the gold standard for diagnosing acute bacterial maxillary sinusitis (ABMS) and for identifying bacterial pathogens in antimicrobial trials of ABMS. However, sinus puncture and aspiration is all invasive, time-consuming procedure that is limited by discomfort to the patient and possible complications. Therefore, the diagnostic usefulness in clinical practice and patient enrollment in studies of ABMS is hindered and alternatives for maxillary sinus puncture are being investigated. We designed a prospective clinical and microbiological outpatient study. Cultures obtained by endoscopically guided middle meatal aspiration were compared with those from sinus puncture and aspiration in 24 patients with ABMS. Considering puncture and aspiration as the gold standard, endoscopy cultures provided a sensitivity of 80%, specificity of 100%, positive predictive value of 100%, negative predictive value of 78.6%, and correlation of 88.5%. In our study, endosc...

The Laryngoscope, 2006

To evaluate the results of powered turbinoplasty and to compare these with submucosal cauterizati... more To evaluate the results of powered turbinoplasty and to compare these with submucosal cauterization of the inferior turbinates. Prospective, randomized, comparative surgical trial. Nineteen patients with medication-resistant chronic nasal obstruction caused by inferior turbinate hypertrophy were randomized to undergo powered turbinoplasty on one side and submucosal cauterization on the other. For each side, an extensive assessment (symptom scoring, endoscopic scoring, and acoustic rhinometry) was recorded preoperatively and on week 1, week 3, month 3, year 1, and year 5 postoperatively. Powered turbinoplasty was superior to submucosal cauterization on all aspects of the assessment. A significant difference (P < .05) was noted for postoperative crusting, endoscopical scoring of turbinate size, and acoustic rhinometry measurements of nasal cavity volume and mean area at the level of the nasal valve. In addition, the results of powered turbinoplasty were still apparent on long term follow-up, whereas submucosal cauterization was associated with a recurrence of turbinate hypertrophy. Performing a powered turbinoplasty leads to decreased patient morbidity during the postoperative healing and to a better control of long-term results when compared with submucosal cauterization.

Otolaryngology - Head and Neck Surgery, 2007

To investigate and compare the prevalence of pharyngeal reflux (PR) events in normal controls and... more To investigate and compare the prevalence of pharyngeal reflux (PR) events in normal controls and patients with clinically diagnosed reflux laryngitis. METHOD: A systematic review of the literature was performed to identify all prospective studies on the results of 24-hour doubleprobe (pharyngeal and esophageal) pH monitoring in normal controls and in patients with symptoms and/or signs of reflux laryngitis. RESULTS: Eleven relevant studies on 192 normal controls and 13 studies on 512 patients with reflux laryngitis were identified. One or more PR events were detected in 51 normal controls (22.9%; 95% CI, 13.9% to 33.3%) and in 154 of 422 patients (38.3%; 95% CI, 25.4% to 52.1%). There is no significant difference in the prevalence of PR events between normal controls and patients with reflux laryngitis (P ϭ 0.079). In addition, the prevalence of PR events in patients with reflux laryngitis is much lower than reported in previous reviews on this subject. CONCLUSION: This systematic review calculated that (1) only a minority of patients with clinically diagnosed reflux laryngitis will show PR events, and (2) there is no significant difference between the prevalence of PR events in patients with reflux laryngitis and healthy controls. At the moment, there is no reliable means to confirm reflux of gastric juice in patients with suspected reflux laryngitis. This diagnostic vacuum is fundamental and may pose important questions at the current concept of reflux of gastric juice as a common cause of laryngopharyngeal inflammation.

Clinical Otolaryngology, 2009

To compare pepsin, carbonic anhydrase III (CAIII), cyclooxygenase-2 (COX-2) and mucin 5AC (MUC5AC... more To compare pepsin, carbonic anhydrase III (CAIII), cyclooxygenase-2 (COX-2) and mucin 5AC (MUC5AC) expression in children with adenoid hypertrophy and normal controls. A non-randomised, controlled prospective study. Two paediatric hospitals in Adelaide, South Australia. Children aged 2-10 years, 21 undergoing adenoidectomy and 12 controls undergoing routine dental surgery. We measured expression of pepsin, CAIII, COX-2 and MUC5AC levels by real-time RT-PCR, immunohistochemistry, and Western blot to determine any difference between children with hyperplastic adenoids and controls. Pepsin was not detected in any study or control adenoid by immunohistochemistry or Western blot. Real-time RT-PCR analysis showed a statistically significant difference between groups with respect to COX-2 (P = 0.027) and MUC5AC (P = 0.02) but no difference in CAIII expression (P = 0.414). A significant correlation was also found between COX-2 and MUC5AC expression (Kendall Tau = 0.4, P = 0.005). Our results suggest that the biochemical changes seen in adenoid hypertrophy are different to those seen in reflux-affected tissues. The decreased COX-2 and MUC5AC expression may be due to squamous metaplasia and other inflammatory changes associated with adenoid hypertrophy. Our findings infer there is little evidence of reflux being a major contributory factor in the pathophysiology of adenoidal hypertrophy.

ANZ Journal of Surgery, 2006

Tonsillectomy is one of the commonest surgical procedures, with postoperative pain being an impor... more Tonsillectomy is one of the commonest surgical procedures, with postoperative pain being an important source of morbidity. Coblation (cold ablation) is a new technique for tonsillectomy, promoted by claims of reduced postoperative pain levels. This study was designed to compare postoperative pain after tonsillectomy using coblation and tonsillectomy using the standard dissection techniques. Twenty adult patients underwent tonsillectomy, each having one randomly selected tonsil removed by dissection and the other removed by coblation. For each side, subjective pain levels were recorded on a daily basis for 10 postoperative days, using a visual analogue scale. Coblation tonsillectomy was significantly less painful than dissection tonsillectomy on day 1 (P < 0.001), day 2 (P = 0.003) and day 3 (P = 0.018). For all subsequent postoperative days, there was no significant difference in pain levels between the techniques. Coblation tonsillectomy causes significantly less pain during the first three postoperative days, when compared with dissection tonsillectomy. No demonstrable benefit was shown on days 4-10. The beneficial effects of coblation on early postoperative pain make it a potentially attractive technique for day-case tonsillectomy in adults with recurrent or chronic tonsillitis.