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BACKGROUND: For the purpose of keeping the merits of traditional actual cautery, we improved traditional actual cautery and developed a pistollike electrocautery which has the function of heating and spraying oilpreparation (it has been issued national patent, patent number: 17634; patent number of medical electrocautery: 872106187). OBJECTIVE: To observe the effect of unique electrocautery of traditional Chinese medicine (TCM) on treating chronic tonsillitis as compared with cautery.DESIGN: Random sampling and case-controlled study.SETTING: Department of Otolaryngology, Affiliated Hospital of Liaoning College of Traditional Chinese Medicine; Surgical Department of Liaoning Oncology Hospital.PARTICIPANTS: Totally 80 patients with hypertrophy of tonsil were selected from the Department of Otolaryngology of the Affiliated Hospital of Liaoning College of Traditional Chinese Medicine in 1989. Inclusion criteria: degrees Ⅱ and Ⅲ of tonsil hypertrophy, without other serious cardiovascular and cerebral diseases, and consent. Exclusion criteria: attempted cauterization, cease of treatment, incomplete case history having complication, and not acceptance. Totally 40 patients were coincidence with the criteria including 22 males and 18 females aged from 5 to 40 years.METHODS: Mild and potent cauterization was adopted according to whether there was chronic congestion in tonsil. For patients with degree Ⅲ of tonsil hypertrophy without obvious congestion, potent cauterization with large size cautery was adopted at 700-800 ℃, if with chronic congestion,potent cauterization with large or middle size cautery at 500-600 ℃ and mild cauterization was adopted; For patients with degree Ⅱ of hypertrophy of tonsil without obvious congestion, potent cauterization with middle size cautery was adopted at 700-800 ℃, if with chronic congestion, mild cauterization with middle or small size cautery was adopted at 500-600 ℃; for patient with first degree of hypertrophy of tonsil without obvious congestion, potent cauterization with small size cautery was adopted at 600-700 ℃, if with chronic congestion, mild cauterization with small size cautery was used at 500 ℃. Cauterization of TCM was not of rather good therapeutic effect on degree Ⅰ of tonsil hypertrophy than on degrees Ⅱ and Ⅲ of hypertrophy of tonsil. Regardless of which degree of hypertrophy of tonsil and congestion, mild cauterization should be adopted at low degree of heat if there was pain radiating to the ear region or pharyngopalatine arch becoming surface-like structure. The average interval between each cauterization was 2-3 days.MAIN OUTCOME MEASURES: Size of tonsil and histological changes of patients with degrees of Ⅱ and Ⅲll tonsil hypertrophy after cauterization.RESULTS: Totally 40 patients with degrees Ⅱ and Ⅲ of tonsil hypertrophy were treated with cautery without any loss. ① Tissues were thickened after each cautery, 38 cases received only 4-10 times of cauterization, and half of the total number of the patients received 7-8 times of cauterization (9/22.5%, 9/22.5%). ② Electrocautery could reduce course of treatment to 1/4 of that of actual cautery. Degree of hypertrophy of tonsil was of no direct ratio to cauterizing times in that 22 patients with degree Ⅱ of hypertrophy of tonsil received 4-10 times of cauterization; while 18 cases of patients with degree Ⅲ of hypertrophy, 2 patients received 13 times of cauterization, the other received 7-10 times of cauterization. ③ A patch of black and brown cauterized scab was formed after each electrocautery on the surface of tonsil; superfical layer was of faveolate structure with different sized eosin dyed mesh; the deep layer was of dull grey oblique and interdigitating cord like structure with necrotic tissues without being dyed and survival lymphocyte in the space between cord, the lymphocyte had the changes of karyo pyknosis and nuclear fragmentation or disappearing of red dyed nuclear. Compared with actual cautery, cauterization of necrotic layer was obviously thickening and easy to exfoliate in electrocautery of TCM. ④ After 24 hours of cauterization, necrotic tissues migrated to normal lymphatic area presented with such inflammatory changes as vascular dilation, widening of lymphocyte space and infiltration of neutrophil. The degrees of above mentioned changes between electrocautery of TCM and actual cautery achieve no significant difference and the inflammatory changes disappeared in 4-5 days.CONCLUSION: Because of high temperature, few cauterized times and short course, electrocautery of TCM has a remarkable effect on degrees Ⅱ and Ⅲ of tonsil hypertrophy; however, various textures, degrees of hyperemia, ages and co-operations can cause different cauterized times.