PubMed · 8502880
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A Hazan. 1993. [Serous otitis].. https://pubmed.ncbi.nlm.nih.gov/8502880/
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PURPOSE: To determine, in a subset of children previously reported, if the time of day when adenotonsillectomy for severe obstructive sleep apnea syndrome (OSAS) was performed affected the incidence of postoperative respiratory complications. CLINICAL FEATURES: Children having adenotonsillectomy were included if they had a polysomnographic diagnosis of severe OSAS within six months prior to operation. Patients who met the inclusion criteria were grouped by the occurrence of postoperative desaturation into a saturated (SAT) and desaturated (deSAT) group. The charts of children in group deSAT were reviewed. The clock time of the surgical procedure was recorded and categorized as morning (AM) or afternoon (PM). RESULTS: Eighty-eight patients met the inclusion criteria. There were 31 girls and 57 boys. The mean +/- SD age (yr) and weight (kg) were 4.6 +/- 2.9 yr and 20.8 +/- 14.5 kg respectively. There were 63 children in the SAT group and 25 in the deSAT group. Differences in age, weight and gender were not significant. The preoperative oxygen saturation (SaO2) nadir for the SAT and deSAT groups was 80.8 +/- 10.2% and 67.6 +/- 17.5% (P < 0.05) respectively. The preoperative obstructive apnea and hypopnea index was 15.8 +/- 10.2 and 35.7 +/- 34.6 events.hr(-1) (P < 0.05), respectively. Surgery in 63 (71.6%) children was performed in the AM. Univariate logistic regression identified PM surgery [odds ratio (OR) 4.6, 95% confidence interval (CI) 1.7 to 12.6, P = 0.002] and a preoperative SaO2 nadir < 80% (OR 3.6, 95% CI 1.4 to 9.4, P = 0.009) as risk factors predicting postadenotonsillectomy desaturation. CONCLUSION: Children with severe OSAS whose surgery is performed in the AM are less likely to desaturate following adenotonsillectomy than children whose surgery is performed in the PM.
OBJECTIVE: To compare the efficacy of adenoidectomy in children with Down syndrome and control patients. METHODS: Medical records were reviewed for preoperative symptoms, ear complaints, date and reason for adenoidectomy, and postoperative symptoms in 27 children (mean age, 6.0 years; range, 1.6-14.5 years) with Down syndrome and 53 age- and sex-matched controls who had adenoidectomy between January 1978 and September 1997. Long-term follow-up was aided by telephone interviews. Improvement in nasal and middle ear symptoms after adenoidectomy was calculated as the percentage of patients symptom-free postoperatively among those with symptoms preoperatively. RESULTS: After adenoidectomy, more controls than patients with Down syndrome had improvement in symptoms, including nasal obstruction (86.7% versus 50.0%; P=0.005); snoring (73.2% versus 40.9%; P=0.01); mouth breathing (84.1% versus 40.9%; P<0.001); and middle ear disease (68.0% versus 23.1%; P<0.001). Patients with Down syndrome were 7.7 times (95% confidence interval, 2.3-25.3) more likely to have chronic ear drainage after adenoidectomy. CONCLUSIONS: The results of the study suggest that the efficacy of adenoidectomy in children with Down syndrome is significantly less than that in controls and should influence surgical decision making in these children.
PURPOSE: To report a case of iatrogenic open globe eye injury occurring during endoscopic sinus surgery. DESIGN: Case report and literature review. METHODS: A 10-year-old boy presented with periorbital swelling and subconjunctival hemorrhage of the left eye following bilateral nasal adenoidectomy. Funduscopic examination showed evidence of a full-thickness open globe injury at the equator in the inferior nasal midperiphery. RESULTS: The injury most likely was secondary to inadvertent perforation of the lamina papiracea with entrance into the orbit and subsequent penetration of the globe. CONCLUSION: Sinus surgery has been reported previously in association with severe orbital complications. We are unaware of previous reports of open globe injury following sinus surgery.