Are Bodybuilders at Higher Risk of Suffering Post-Tonsillectomy Haemorrhage?

Elective tonsillectomy remains one of the most commonly performed operations in otolaryngology, with postoperative hemorrhage (PTH) being the most significant potential complication. Anecdotal evidence among ENT Surgeons suggested that bodybuilding athletes may be at increased risk of suffering from PTH, a notion corroborated by a recent case report, regarding primary PTH. The problem has been attributed to muscle-enhancing dietary supplements, or androgenic anabolic steroid abuse, albeit without satisfactory explanation regarding the mechanism of potential action. That is because, blood coagulation tests performed preoperatively are typically normal, and extensive blood coagulation workup postoperatively is not suggestive of any bleeding tendency. We recently came across two cases of PTH in male patients practicing body building. Both were in their mid-twenties, had regularly been using muscle enhancing dietary supplements, and occasionally androgenic anabolic steroids; the first up to four months preoperatively, whereas the second was still an active user at the time of the tonsillectomy.