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PubMed2006

Comparison of lingual tonsil size as depicted on MR imaging between children with obstructive sleep apnea despite previous tonsillectomy and adenoidectomy and normal controls.

BACKGROUND: Cine MRI has become a useful tool in the evaluation of patients with persistent obstructive sleep apnea (OSA) despite previous surgical intervention and in patients with underlying conditions that render them susceptible to multilevel airway obstruction. Findings on cine MRI studies have also increased our understanding of the mechanisms and anatomic causes of OSA in children. OBJECTIVE: To compare lingual tonsil size between children with OSA and a group of normal controls. In addition, a subanalysis was made of the group of children with OSA comparing lingual tonsils between children with and without underlying Down syndrome. MATERIALS AND METHODS: Children with persistent OSA despite previous palatine tonsillectomy and adenoidectomy and controls without OSA underwent MR imaging with sagittal fast spin echo inversion-recovery images, and lingual tonsils were categorized as nonperceptible at imaging or present and measurable. When present, lingual tonsils were measured in the maximum anterior-posterior diameter. If lingual tonsils were greater than 10 mm in diameter and abutting both the posterior border of the tongue and the posterior pharyngeal wall, they were considered markedly enlarged. RESULTS: There were statistically significant differences between the OSA and control groups for the presence vs. nonvisualization of lingual tonsils (OSA 33% vs. control 0%, P=0.0001) and mean diameter of the lingual tonsils (OSA 9.50 mm vs. control 0.0 mm, P=0.00001). Within the OSA group, there were statistically significant differences between children with and without Down syndrome for the three lingual tonsil width categories (P=0.0070) and occurrence of markedly enlarged lingual tonsils (with Down syndrome 35% vs. without Down syndrome 3%, P=0.0035). CONCLUSIONS: Enlargement of the lingual tonsils is relatively common in children with persistent obstructive sleep apnea after palatine tonsillectomy and adenoidectomy. This is particularly true in patients with Down syndrome.

Adenoidectomy↗
PubMed1987

Efficacy of tonsillectomy and adenoidectomy as an outpatient procedure: a preliminary report.

One of the recent trends in medical practice has been the use of ambulatory surgery for a substantial number of surgical procedures. A prospective evaluation of tonsillectomy and tonsillectomy with adenoidectomy as outpatient procedures at the Children's Hospital Medical Center in Cincinnati, OH, is reported. Patients who were felt to be inappropriate candidates for adenotonsillectomies as outpatients included patients under 3 years of age, patients who lived more than one hour from the hospital and patients who demonstrated obstructive sleep apnea or who had other significant medical problems. A review of this 9-month experience indicates that outpatient surgery for adenotonsillectomy is both safe and cost-effective in most circumstances. In an analysis of complications requiring readmission to the hospital (bleeding, dehydration, poor social situation), patients who had their original surgery performed on an ambulatory basis had no more complications than patients who were hospitalized following their surgery. Excluding the professional fees for the surgeon and anesthesiologist, a savings of approximately 50% can be expected from the performance of a tonsillectomy and adenoidectomy on an outpatient basis.

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PubMed1993

Tonsillectomy and adenoidectomy pain reduction by local bupivacaine infiltration in children.

Experimental data in humans and animals suggest that during surgery, pain impulses enter the CNS creating a hyperexcitable state in spite of general anesthesia. In a prospective double blind study, pain levels in 22 children undergoing tonsillectomy and adenoidectomy under general anesthesia were compared from day of surgery to Day 10. Patients received pre-incisional infiltration with either bupivacaine (A) or saline (B). Subjective pain was assessed by visual analog scale, and objective pain by deglutition time (100 ml). Subjective constant pain was less (P < 0.05) in group (A) on Day 1: 16 (A) vs. 59 (B) and Day 5: 4 (A) vs. 45 (B). We conclude that local nerve blockade by bupivacaine reduces short- and long-term pain in children undergoing tonsillectomy and adenoidectomy in the presence of general anesthesia.

Adenoidectomy↗
PubMed1995

Methods of selection for adenoidectomy in childhood otitis media with effusion.

We have examined the implications of selecting children with otitis media with effusion (OME) for adenoidectomy using different criteria. Data were collected pre-operatively on 125 consecutive cases of OME. Ages 1-13 years, mean = 4.9 years; 68 males and 57 females. The criteria used were: (1) obstructive nasal symptoms, (with three sub-categories); (2) age: and (3) nasopharyngeal airway size. The three sub-categories of obstructive nasal symptoms were based on the clinical practices of colleagues in the UK. Thus we analysed five criterion groups in all. These were: (1) snoring; (2) snoring + mouth breathing; (3) snoring + nasal obstruction; (4) age = 4-8 years and (5) nasopharyngeal airway < 4 mm. We found that applying each criterion separately to the group of children would result in widely differing numbers of children being selected for adenoidectomy. Of the 125 children, the percentage selected by each method varied considerably, ranging from 35-70%. In addition, there was only limited overlap, (43-71%) between the composition of the groups. This helps to explain the variations in surgical rates in different centres. In the absence of any universally acceptable guidelines, therefore, the importance of individual assessment of children can not be overemphasised.

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PubMed2004

Effects of tonsillectomy and adenoidectomy on hemoglobin and iron metabolism.

OBJECTIVES: To investigate a possible effect of adenoidectomy, tonsillectomy, or both operations combined in children on hemoglobin concentration and iron metabolism. METHODS: Children eligible for surgery due to recurrent tonsillitis or upper airway obstruction had a venous blood sample drawn at the time of the operation and 6 months later. One hundred and three preoperative and 91 blood samples at follow-up from patients not given iron supplementation were available for analysis of hemoglobin concentration, serum-ferritin and protoporphyrin-IX in erythrocytes. RESULTS: A 1.4g/dl median increase in hemoglobin concentration during the observation period was associated with a significant reduction of protoporphyrin-IX, while serum-ferritin remained unchanged and low. A preoperative prevalence of anemia of 56.3% was reduced to 7.71%. All combinations of normal and pathological values of serum-ferritin and protoporphyrin-IX were found in anemic and non-anemic patients. CONCLUSIONS: A beneficial effect of tonsillectomy and adenoidectomy on hemoglobin and iron metabolism was demonstrated. Iron deficiency was common.

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PubMed2005

How do children with adenoid hypertrophy smell and taste? Clinical assessment of olfactory function pre- and post-adenoidectomy.

OBJECTIVE: To assess the ability to smell and appreciate food in children with adenoid hypertrophy pre and post-adenoidectomy. METHODS: A total of 35 children with adenoid hypertrophy admitted for adenoidectomy (aged 5-9.3 years, mean age 5.9 years) were tested preoperatively. In a follow up appointment 3 months postoperatively, 28 of them returned and were tested again. The control group consisted of 30 healthy children (aged 5-10.2 years, mean age 6.1 years). Orthonasal olfactory function was assessed psychophysically using "Sniffin sticks" 12 item odor identification test. Retronasal olfaction was assessed using a collection of 12 grocery available powders applied to the oral cavity. RESULTS: Both orthonasal and retronasal olfactory function of the study group preoperatively were significantly lower in comparison with the results of the control group (p<0.0001). The difference in retronasal olfaction between groups was significantly higher in comparison with the difference in orthonasal odor identification (p=0.048). There is a strong correlation between adenoid hypertrophy grade and retronasal testing results (t=-5.461, p<0.0001), but not with the orthonasal results (t=-1.677, p=0.9). Significant improvement of orthonasal and retronasal olfaction was observed in the follow-up appointment (p<0.0001). Relative increase postoperatively was higher for the retronasal olfaction compared to orthonasal olfaction (p=0.0029). CONCLUSIONS: Children with adenoid hypertrophy have a reduced ability to smell, with retronasal olfactory function being more affected. Surgery had a greater impact on retronasal olfaction.

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PubMed1986

Mucociliary function and nasal resistance evaluation before and after adenoidectomy.

Thirty-four children with clinically and radiologically confirmed adenoid hypertrophy underwent otoscopy, impedance tests, active anterior rhinomanometry and nasal mucociliary clearance evaluation before and 6 months after adenoidectomy. Mucociliary clearance velocity increased significantly while binasal resistances decreased after surgery. The authors conclude that mucociliary evaluation and objective measurements of nasal resistances should be added to impedance tests as indicators to adenoidectomy.

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PubMed1998

Endoscopic adenoidectomy in a case of Scheie syndrome (MPS I S).

The mucopolysaccharidoses (MPS) are a heterogeneous group of relatively rare, progressive, inherited lysosomal storage disorders, characterized by a deficiency of lysosomal enzymes which are responsible for the stepwise degradation of glycosaminoglycans. Their deficiency leads to the accumulation of glycosaminoglycans in various organs causing progressive disruption of cellular functions and multiple systemic effects including otolaryngological problems, upper airway obstructive disease being the most common. Scheie syndrome (MPS I S) is due to the deficient activity of alpha-L-iduronidase leading to the intralysosomal accumulation of dermatan sulfate and heparan sulfate. We present our experience in one such case occuring in a 6-year-old girl with ENT manifestations and who underwent a successful endoscopic adenoidectomy for symptomatic adenoid hypertrophy. This procedure was preferred over a conventional adenoidectomy in order to avoid complications associated with abnormal cervical vertebrae.

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PubMed1999

Effects of tonsillectomy and/or adenoidectomy on vocal function: laryngeal, supralaryngeal and perceptual characteristics.

A prospective, non-randomized study evaluated the effects of tonsillectomy and/or adenoidectomy (T +/- A) on acoustic and perceptual aspects of vocal function. Thirty-one children, ranging in age from 4 to 15 years participated and measurements were made prior to and 3 months following surgery. Twenty-three children had T +/- A and eight had adenoidectomy alone. Quantitative acoustic measures included: laryngeal (vocal fundamental frequency, FO) and supralaryngeal characteristics of sustained vowels (F1 and F2 formants, formant bandwidths, two-dimensional measures of vowel space) and temporal properties of consonant-vowel productions (diadochokinetic syllable rates). Perceptual measures were based on samples of continuous speech, using the Buffalo voice profile (BVP) and parental interviews/questionnaires were used to evaluate other aspects of surgery (i.e. subjective speech changes, protracted pain, difficulty swallowing, bleeding, etc.). Based on ANOVA, no significant post-surgical changes were detected for the majority of acoustic speech measures studied (vocal F0, formant bandwidths, measures of vowel space or diadochokinetic rates). However, the F2 formant frequency for vowels /i/ and /a/ increased and F1 decreased for /o/ following surgery. These changes had the largest effect on the structure of vowel /i/, which became more acute and diffuse following surgery. Furthermore, of the majority of perceptual measured studied with the BVP, 92% showed no change postoperatively. However, in the category of resonance, a significant decrease in hyponasality was detected. These results demonstrate that removing soft tissue from the oropharynx has only minimal impact on quantitative or qualitative (perceptual) aspects of vocal function, when measurements are made approximately 15 weeks post surgery.

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PubMed1999

Postoperative bilevel positive airway pressure ventilation after tonsillectomy and adenoidectomy in children--a preliminary report.

Obstructive sleep apnea (OSA) in children, characterized by hypoventilation secondary to upper airway obstruction, often results from tonsil and adenoid hypertrophy. Adenotonsillectomy is the standard therapy in this patient population. The immediate postoperative period is complicated occasionally by respiratory difficulties that may require intubation and mechanical ventilation. Recently, physicians have provided temporary airway support using continuous and bilevel positive airway pressure (BiPAP) devices. Reported complications of positive airway pressure devices include local abrasions to the nose and mouth; dryness of the nose, eyes, and mouth; sneezing; nasal drip, bleeds, and congestion; sinusitis; increased intraocular pressure; non-compliance; and pneumocephalus. Subcutaneous emphysema following facial trauma, dental extractions, adenotonsillectomy, and sinus surgery has been reported. There is also a hypothetically increased risk of subcutaneous emphysema following the use of positive airway pressure ventilation in the tonsillectomy patient. Between January 1997 and July 1998, 1321 patients underwent tonsillectomy and/or adenoidectomy at our institution. In reviewing the records of all pediatric intensive care unit admissions during that time period, we identified nine patients, of the 1321, who required BiPAP postoperatively. Of these, four children were obese, four had preexisting neurological disorders, and one underwent endoscopic sinus surgery and adenoidectomy. Three children were asthmatic, and three were less than 3 years of age. Two obese children were discharged with home BiPAP, one of whom had been on BiPAP prior to surgery. All patients tolerated BiPAP without complications. This preliminary report suggests that BiPAP is a safe and effective method of respiratory assistance in the adenotonsillectomy patient with preexisting conditions who is predisposed to postoperative airway obstruction. Furthermore, with BiPAP, the risks of intubation and ventilator dependence are avoided.

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PubMed1998

The use of preoperative lidocaine to prevent stridor and laryngospasm after tonsillectomy and adenoidectomy.

The most important complications from tonsillectomy and adenoidectomy are bleeding, stridor, and laryngospasm. This controlled, double-blind study was designed to investigate the effects of topical and intravenous lidocaine on stridor and laryngospasm. A total of 134 patients scheduled for elective tonsillectomy and/or adenoidectomy were randomly separated into four groups. In the topical lidocaine group 4 mg/kg of 2% lidocaine was applied to subglottic, glottic, and supraglottic areas before endotracheal intubation. Normal saline solution was used topically for the first control group. In the intravenous lidocaine group, patients were given 1 mg/kg of 2% lidocaine before extubation, and the same amount of 0.9% NaCl was given to the second control group. Postoperative stridor, laryngospasm, cyanosis, bleeding, sedation degree, and respiratory depression were observed, and plasma lidocaine levels were measured. Both topical and intravenous lidocaine groups revealed less stridor and laryngospasm than the control groups, and no difference was found between the topical and intravenous lidocaine groups except the higher sedation scores in the early postoperative period for the intravenous lidocaine group.

Adenoidectomy↗
PubMed2005

Pre and postoperative psychological profile of children submitted to adenoidectomy and/or tonsillectomy.

UNLABELLED: Adenoidectomy and/or tonsillectomy are the most frequent surgeries in otorhinolaryngology. Infantile psychological trauma may be caused by surgeries and anesthesia. AIM: To estimate the preoperative service offered to children and their responsible people by examining their psychological profile pre and postoperatively. STUDY DESIGN: Clinical perspective. MATERIAL AND METHOD: We have evaluated the medical chart of children between two and twelve years old who were submitted to adenoidectomy and/or tonsillectomy during February to December of 2003 and analyzed the psychological profile applied to the children and their responsible person. RESULTS: Out of the total of 78 patients, 32 (41.0%) were in pre-school age and 46 (59.0%) in school age. The predominant feeling in pre-school age was fear (59.4%), while in school-aged children and their responsible guardian it was trust: 63.0% and 48.72%, respectively. As to expectation of surgery results, both children (73.08%) and their responsible people (96.15%) showed optimism. Introverted emotional temperament was observed in the majority of the children (52.56%) and their responsible people (51.28%). The emotional reaction at the immediate postoperative period of children and their guardians was calm: 68.18% and 97.73%, respectively. All children were psychologically apt to be submitted to the surgery. CONCLUSION: Independent of the predominant feeling or emotional temperament, good preoperative guidance is required. We have to offer preoperative teaching program that includes verbal descriptions of the procedures among the sensations to be experienced, allied with the interaction of children and parents, looking for reduction of anxiety, response to surgical stress and possible postoperative sequelae.

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PubMed1989

Nasopharyngeal bacterial flora before and after adenoidectomy.

Fifty patients (23 males and 27 females), with chronically hypertrophied and infected adenoids were subjected to adenoidectomy. Pre- and post-operative nasopharyngeal swabs were taken to study bacterial colonization of the nasopharynx both quantitatively and qualitatively. Twenty healthy controls were included in this study. The swabs were cultured on MacConkey's and Columbia blood agar plates. The rate of isolation of potentially pathogenic microorganisms decreased markedly following operation, while normal inhabitant organisms showed notable increase in their numbers post-operatively to reach a near normal level. It is concluded from this work that adenoidectomy produces a physiological effect on the nasopharyngeal microflora by conversion of an abnormal flora to a nearly normal one.

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PubMed1994

Alterations to the oropharyngeal and nasopharyngeal microbial flora of children after tonsillectomy and adenoidectomy.

The oropharyngeal and nasopharyngeal microbial flora of 40 children with chronically hypertrophied and infected tonsils or adenoids, was studied. Twenty of the children were treated by tonsillectomy and 20 by adenoidectomy. Swabs were taken from the surgical field pre-operatively and from the oropharynx or the nasopharynx 10 and 30 days-post-operatively. The swabs were cultured on suitable culture media and identification as well as quantitative estimation of the isolated bacteria, was carried out. Most of the potentially pathogenic bacteria exhibited beta-lactamase production. Interestingly, after surgical treatment, the respective microorganisms were quantitatively reduced and it was observed that their isolation rate was also lower. Furthermore, bacteria considered as normal inhabitants regularly showed an increase in their frequency of isolation despite the fact that a quantitative decrease was in some instances observed. These findings suggest that tonsillectomy and adenoidectomy result in an alteration to the abnormal oropharyngeal and nasopharyngeal microbial flora producing an almost normal one. It appears that, in cases of the failure of antimicrobial treatment, surgical procedures should be seriously considered.

Adenoidectomy↗
PubMed1984

Post-operative haemorrhage in tonsillectomy and adenoidectomy in children.

A second anaesthetic for bleeding after adeno-tonsillectomy in children represents a significant hazard. The true incidence of this complication is assessed for over 20,000 operations. The incidence of bleeding after adeno-tonsillectomy was found to be the sum of bleeding post-adenoidectomy and post-tonsillectomy. Bleeding post-adenoidectomy is at least as common as post-tonsillectomy and both occur most frequently within 12 hours of operation. No reason for the bleeding occurring in these particular patients could be found.

Adenoidectomy↗
PubMed2000

Efficacy and safety of premedication with oral ketamine for day-case adenoidectomy compared with rectal diazepam/diclofenac and EMLA.

BACKGROUND: Because of its pain-attenuating and sedative properties oral ketamine has been used as premedication in children and adults. We wanted to compare in children scheduled for adenoidectomy safety and efficacy of oral ketamine with a premedication that causes similar preoperative sedation and relief of pain at the venepuncture site. We also evaluated the effect of i.v. glycopyrrolate added to these combinations. METHODS: One hundred children between 10 and 15 kg of body weight scheduled for day-case adenoidectomy were randomly assigned to one of four groups: groups DG and DS received diclofenac 12.5 mg and diazepam 0.5 mg/kg rectally, EMLA cream at the venepuncture site, and placebo orally; groups KG and KS received ketamine 6.0 mg/kg orally, placebo cream at the puncture site, and placebo rectally; additionally, groups DG and KG received glycopyrrolate 5 microg/kg, and groups DS and KS received placebo intravenously. We recorded perioperatively scores (open scale 1-9) for stridor, sedation, bleeding, nausea, pain, heart rate, the need for analgesics and registered psychotomimesis and well-being at home. RESULTS: The children of the K-groups became more tearful during separation from their parents (P=0.0072). No other differences were found between the ketamine and diazepam/diclofenac groups before and after premedication until induction of anaesthesia. Oral ketamine produced unpleasant psychotomimesis in four out of 59 children. During the first 10 min postoperatively, the score for stridor was significantly higher in group KS than in the D-groups; stridor scores > or = 6 were seen in one child of the D-groups (DS) and in six children of the K-groups (n.s.), of whom three developed laryngospasm (one reintubation). Glycopyrrolate diminished salivation in all groups, but had no effect on stridor scores. Additionally, glycopyrrolate delayed the onset of eating at home. CONCLUSION: Premedication with racemic oral ketamine 6 mg/kg does not seem to be suitable for upper airway procedures. Addition of i.v. glycopyrrolate before the induction of anaesthesia significantly reduced the scores for salivation.

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PubMed2002

Parenteral ketoprofen for pain management after adenoidectomy: comparison of intravenous and intramuscular routes of administration.

BACKGROUND: Different parenteral routes of administration of NSAIDs such as ketoprofen have not been properly compared in children. This study was designed to compare the analgesic efficacy of intravenous and intramuscular ketoprofen for pain management in children after day-case adenoidectomy. METHODS: A total of 120 children, aged 1-9 years, who were scheduled to undergo adenoidectomy, were randomized to receive ketoprofen 2 mg/kg either intravenously with intramuscular placebo (n = 40) or ketoprofen 2 mg/kg intramuscularly with intravenous placebo (n = 40), or both intravenous and intramuscular placebo (n = 40) at induction of anesthesia. The study design was prospective and double-blind with parallel groups. Pain was assessed at rest and during swallowing using the Maunuksela pain scale during 3 h after surgery, and fentanyl i.v. was given for rescue analgesia. RESULTS: Children in the Placebo group needed significantly more doses of fentanyl (72 doses) than either children in the intravenous group (47 doses) or children in the intramuscular group (51 doses) (P = 0.021). In addition, a higher proportion of children in the Placebo group than in the two ketoprofen groups (P = 0.03) demanded rescue analgesic. No difference in the need for rescue analgesia or in pain scores was found between the two ketoprofen groups. Children in the intravenous group had less pain than children in the Placebo group. The difference was significant during swallowing at 1 h after surgery (P = 0.046) and for the worst pain observed during swallowing for 3 h after surgery (P = 0.022). There were no differences between the three groups with respect to operation times, amount of perioperative bleeding, or rate or extent of adverse events. CONCLUSION: The efficacy of intravenous and intramuscular ketoprofen was similar, and they both differed from placebo.

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PubMed1998

A prospective study of the length of stay of 150 children following tonsillectomy and/or adenoidectomy.

This is a prospective study of the length of stay in 150 children who underwent adenoidectomy, tonsillectomy and adenotonsillectomy with and without grommets. Seventeen children were unsuitable for same-day discharge because of coexisting medical conditions and 39 because of social factors, which meant that 94 children were potentially suitable for same-day discharge. All patients received a standardized surgical and anaesthetic technique. Twenty-eight of the 94 children were kept in for postoperative complications thus 66 (70%) were treated as day cases. Haemorrhage occurred in one (1%); nausea and vomiting prevented discharge of 11 cases; and a further seven were kept overnight since the children were reluctant to eat and drink. Pain control was a problem with nine children (two had nausea and vomiting as well). Two patients had other complications. These results are compared to those found in the literature. Children who have adenoidectomy without tonsillectomy are more suitable for day surgery (P < 0.001). Because of the high risk of minor complications, the authors recommend that children who have tonsillectomy as part of the procedure should be treated from inpatient beds even when discharged on the same day.

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