PubMed · 2340130
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G M Meredith. 1990. Adenotonsillectomy.. https://doi.org/10.1001/archotol.1990.01870060099022
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OBJECTIVE: To study the effect of day care and tube type, as well as other risk factors related to ventilation tube insertion and reinsertion. DESIGN: A case series of 456 consecutive cases with 162 controls from a well-baby examination group evaluated for age, sex, smoking history and day care attendance. SETTING: Private practice in a mid-sized, southeastern university town. PATIENTS AND CONTROLS: This was a referred sample of patients who were entered consecutively in a private-practice setting. All children were age five or less at entry into the study. INTERVENTIONS: Children underwent ventilation tube insertion with or without adenoidectomy, using standing indications. MAIN OUTCOME MEASURES: The primary outcome measures were whether or not a child had the need for a second set of tubes, and also determining the status of the child's ears for at least 1 year after tubes had extruded. RESULTS: Day care and younger age were both identified as risk factors associated with initial ventilation tube insertion. Only 11% (seven out of 63) of home care children, as compared with 31% (108 out of 346) day care children, had the insertion of ventilation tubes (P = 0.000). Day care children who had tubes inserted and adenoidectomy (with or without tonsillectomy) had a significantly lower rate of reintubation than children who had tube insertion alone (P = 0.00). Day care and young age are significant risk factors for any child, both with a first set of tubes and for ventilation tube reinsertion. Children in day care had a reintubation rate of 36% as compared to 11% for those in home care. Parents should be aware that day care can represent a two-fold hazard both in the observed connection between day care and tube insertion and the demonstrated increased probability of reinsertion. Any studies looking at ventilation tube outcomes need to make certain to monitor for day care attendance.
OBJECTIVE: Evaluate the effectiveness of surgical treatment of obstructive sleep apnea in a diverse population of children. DESIGN: A retrospective case series of pre and post operative polysomnograms (PSG) of pediatric patients with obstructive sleep apnea (OSA). SETTING: Tertiary care children's hospital. PATIENTS: 48 patients in whom sleep studies were performed pre-operatively for either an unclear history and/or physical findings or complicated OSA. Thirteen patients had no complicating medical factors, 35 patients had various associated medical problems, including 20 with morbid obesity, five with Down syndrome, four with asthma, two with cerebral palsy, and four other. The average age was 7.5 years with a range of 1.5-20 years. INTERVENTIONS: Thirty-one patients had a tonsillectomy and adenoidectomy (T and A) only, 13 had T and A with uvulopalatopharyngoplasty (UPPP), and three had tonsillectomy and UPPP. MAIN OUTCOME MEASURES: Pre and postoperative PSG results including apnea/hypopnea index (AHI), percent of sleep with oxygen saturation below 90%, and percent sleep time with end-tidal pCO2 > 50. RESULTS: The mean pre-operative (AHI) was 27 +/- 4 (mean +/- S.E.M.) and post operatively was 6 +/- 1 (P < 0.001). Twenty six of 48 (54%) had a postoperative AHI of less than five. Pre-operative percent of sleep with oxygen saturation below 90% was 17.9 +/- 4.5%, post-operatively it was 1.4 +/- 0.1% (P < 0.001). Pre-operative percent sleep time with end-tidal pCO2 > 50 was 22.3 +/- 3.4%, post operatively it was 12.6 +/- 2.9% (P < 0.01). UPPP was performed more commonly in patients with Down syndrome. There was a trend toward more improvement in patients who had T and performed than those undergoing UPPP (post op AHI of 4.7 vs. 7.4 respectively). CONCLUSIONS: Tonsillectomy, adenoidectomy and UPPP are effective in the treatment of OSA in a diverse group of pediatric patients. Patients with asthma, cerebral palsy, Down syndrome, morbid obesity, and hereditary syndromes all improved significantly with surgical management.
To determine subjective parental impressions following routine tonsillectomy we have interviewed the parents of 80 children 1 year following the procedure. Results show that the procedure carried a 100% parental satisfaction rating. All parents felt their child's symptoms of recurrent acute tonsillitis had improved and over 90% of parents felt their child's general health had improved. Sixty-four percent of the parent population reported a noticeable improvement in their child's sleeping pattern and over 30% described an improvement in their child's general behavior. Although this study reports subjective data, and we do not have a comparable control population, these findings provide an interesting insight into parental impressions regarding alterations in their child's health, sleep pattern and behaviour following this procedure.