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PubMedDate not supplied

Adenoidectomy versus tympanostomy in chronic secretory otitis media.

Fifty-eight consecutive charts of children suffering from mucoid middle ear effusion proven by myringotomy who were followed for two years were reviewed. Half of the group underwent adenoidectomy and the other half, with similar age distribution, had tympanostomy. Only 20.7% of the adenoidectomized children had normal hearing and aerated middle ears during the two-year follow-up, whereas 59% had normal hearing following tympanostomy. Adenoidectomy had no additional beneficial effect on the cure rate obtained by tympanostomy, which proved to be more effective in all age groups, and in the nonallergic child. In the atopic child, however, both modalities yielded similarly poor results.

Adenoidectomy↗
PubMed1991

Adenoidectomy in otitis media. A review.

For many years adenoids were thought to affect adversely middle ear (ME) aeration by obstructing the eustachian tube opening, leading to ME infections and effusions. Consequently, the adenoids have often been removed in children suffering from ME diseases; indeed, adenoidectomy is still performed around the globe on millions of children annually. Opinions vary, however, on the usefulness of the operation in various ME diseases. The purpose of this study is to review the available studies concerning the relationship of adenoids to the ME as well as the effect and benefit of adenoidectomy on ME effusions and ME infections.

Acute Disease↗
PubMed1985

Factors affecting adenoidectomy for otitis media with effusion (glue ear).

One hundred and fifty-five children suffering bilateral otitis media with effusion (OME) and observed for three months have been followed postoperatively for twelve months. Surgery was randomly allocated into three groups: adenotonsillectomy; adenoidectomy; and no surgery. In all cases unilateral myringotomy and grommet insertion was performed. The contralateral unoperated ear was assessed subsequently for clearance of the effusion. Adenoidectomy produced resolution of the effusion in 31-45% of cases at one year, but tonsillectomy conferred no additional benefit. There was improved resolution in those with longer compared with shorter histories, and in older as opposed to younger children. Assessment of preoperative lateral cephalometric radiographs show improved resolution of the effusion following removal of larger, compared with smaller adenoids, but this effect was only demonstrable for three months. The effect of age was longer-lasting for up to one year postoperatively.

Adenoidectomy↗
PubMed1990

Safety of outpatient tonsillectomy and adenoidectomy.

Recent changes in reimbursement for tonsillectomy and adenoidectomy have resulted in a large number of these procedures being done on an outpatient basis. There is still considerable controversy, however, as to the safety of this concept. We reviewed the charts of 1000 consecutive patients who underwent these procedures. Three hundred ninety-six procedures were performed as inpatient surgery and 604 were performed as outpatient surgery. Patients were considered as candidates for outpatient surgery if they met specific criteria, such as good overall medical health, no central apnea, normal bleeding history and profile, and had adequate social considerations. The inpatient group included those patients who did not meet the criteria to be outpatients. We compared the complication rates of these two groups with regard to age, type of procedure performed (tonsillectomy, adenoidectomy, adenotonsillectomy), and indication for surgery in order to determine if there was any increased risk of outpatient surgery, despite strict selection criteria. The two groups were similar in their distribution with regards to age, sex, type of procedure, and indication for surgery. The overall complication rate for the entire group was 7.9%, with an 11.8% complication rate for inpatients and 4.1% complications for outpatients. The higher complication rate among the inpatient group is probably a direct result of the selection process because this group included the higher-risk patients. On the basis of these findings, we believe that surgery of the tonsils and adenoids can be performed safely as an outpatient procedure, regardless of age, indication, or procedure, if the candidates for ambulatory surgery are carefully selected by the surgeon.

Adenoidectomy↗
PubMed1998

Effect of environmental tobacco smoke on cough in children with a history of tonsillectomy or adenoidectomy.

We examined the possible impact of tonsillectomy or adenoidectomy (T/A) on the relationship between environmental tobacco smoke (ETS) exposure and respiratory outcomes. This study was conducted in Humboldt, Saskatchewan, in 1993. The target population included all residents aged 6-17 yrs. Of the 1,019 eligible subjects, 892 participated (88%). Estimates of ETS exposure were based on the reported smoking habits of the children's household members. We defined current cough as a positive response to the question: "Does this child usually have a cough?". Information also included morning cough, night cough and a history of T/A. For children with no history of T/A, the prevalence of current cough was 8.9%, 12.2% and 14.5% for those living in families with 0, 1, and 2+ smokers respectively. The corresponding prevalence was 7.0%, 30.2% and 36.8% for children with history of T/A. Similar effects of ETS exposure were observed on morning cough and night cough. The results did not change significantly when we used various ETS measures and controlled for confounding factors. Compared to children living in nonsmoking families and without history of T/A, the adjusted odds ratio for children with a history of T/A was 7.19 (p<0.001) if they were living in families smoking >20 cigarettes x day(-1) at home. The corresponding odds ratio was only 1.64 (p=0.11) for children without a history of T/A. We concluded that children living in smoking family were more likely to cough than those living in nonsmoking families and tonsillectomy or adenoidectomy increased the apparent influence of environmental tobacco exposure on cough.

Adenoidectomy↗
PubMed2003

The effects of common airway maneuvers on airway pressure and flow in children undergoing adenoidectomies.

UNLABELLED: Obstruction of the upper airway occurs frequently in anesthetized, spontaneously breathing children, especially in those with adenoidal hyperplasia. To improve airway patency, maneuvers such as chin lift (CL), jaw thrust (JT), and continuous positive airway pressure (CPAP) are often used. In this study, we examined the comparative efficacy of these maneuvers in children scheduled to undergo adenoidectomy. Sixteen children aged 2-9 yr were anesthetized with sevoflurane. During spontaneous breathing, the flows and pressures in the mask (ma), oropharynx (op), and esophagus (es) were measured simultaneously, and maximal pressure differences during inspiration (DeltaP) were calculated. After baseline recording, CL and JT maneuvers were performed in random order without and with CPAP (5 cm H(2)O). The observed DeltaP(ma) - P(es) of 12.3 +/- 3.4 cm H(2)O at baseline decreased with all airway maneuvers (P < 0.05). This resulted from decreases of DeltaP(ma) - P(op) (P < 0.05) and DeltaP(op) - P(es) (P < 0.05) in all interventions except CL, in which DeltaP(ma) - P(op) remained similar. In contrast, significant improvements of minute ventilation and maximal inspiratory peak flow (P > 0.05) were observed only with JT (with and without CPAP). We conclude that CL may improve airway patency and ventilation, whereas JT with or without CPAP was the most effective maneuver to overcome airway obstruction in children with adenoidal hyperplasia. IMPLICATIONS: Airway maneuvers are often used in anesthetized children to relieve airway obstruction during spontaneous ventilation. Compared with chin lift and continuous positive airway pressure, the jaw thrust maneuver was the most effective to improve airway patency and ventilation in children undergoing adenoidectomy.

Adenoidectomy↗
PubMed1993

The effect of tonsillectomy and adenoidectomy on neutrophil chemotaxis.

Although tonsillectomy and adenoidectomy are common surgical procedures, the effects of these operations on the immune system have not been thoroughly determined. Our data on neutrophil chemotaxic functions in a group of 17 patients with chronic tonsillitis and adenoid hypertrophy show that chronic tonsillitis and adenoid hypertrophy impair neutrophil chemotaxic functions and that there is a subsequent normalization of these values following tonsillectomy and adenoidectomy.

Adenoidectomy↗
PubMedDate not supplied

The effect of adenoidectomy on nasal resistance to airflow.

The aim of the research was to determine whether the operation of adenoidectomy affected the nasal resistance to airflow. The total nasal respiratory resistance (TNR) was measured in forty-four children admitted for adenoidectomy and myringotomies, with or without tonsillectomy. The measurement was repeated three months post-operatively. There was significant correlation between the pre-operative TNR and the weight of adenoid removed at operation. A history of snoring pre-operatively, which was absent after operation, was related to a high pre-operative TNR and large adenoids. Those children in whom at least one gram of adenoid tissue was removed, were found to have a mean reduction in nasal resistance of 19%.

Adenoidectomy↗
PubMed1995

Acoustic rhinometry in the pre-operative assessment of adenoidectomy candidates.

Claims have been made for the potential of acoustic rhinometry (AR) in the evaluation of adenoidectomy patients. Little evidence has been presented to support such claims, and evidence is accumulating that AR is inaccurate in reflecting anatomical reality in the nasopharynx. We set out to establish whether acoustic rhinometry studies could predict operative decision-making sufficiently for it to be of assistance to the clinician, despite these theoretical and practical obstacles. A total of 101 patients aged 2-13 years were examined by AR using the impulse technique. Parameters were chosen from the area-distance function to indicate nasopharyngeal volumes and areas (decongested and non-decongested). This information was compared with findings at EUA (examination under anaesthesia-obstruction categories: A-'good airway' to D-'severe obstruction'), operative decision (2 categories-'obstructive' = remove, versus 'non obstructive' = leave in situ) and parents' symptom scores. Twenty-one patients were also evaluated post-operatively. There was considerable overlap between the AR parameters in the groups classified at EUA as 'obstructive' or 'non obstructive', but this overlap diminished after decongestion. Logistic regression demonstrated that the decongested volume and area parameters were of significant predictive value with respect to operative decision (odds ratio for unit change in volume = 0.82; 95% C.I. = 0.70-0.97; p = 0.018). Parents' analogue scores for snoring and for [snoring+obstruction+ mouthbreathing] were also of significant predictive value. The presence of rhinitis diminishes the predictive value of AR. Acoustic rhinometry has potential as a pre-operative evaluation of the nasopharyngeal airway in adenoidectomy candidates, but the predictive value is low unless combined with clinical factors.

Acoustics↗
PubMedDate not supplied

[New indication for adenoidectomy-tonsillectomy in children: elimination of obstruction in obstructive sleep apnea syndrome].

Obstructive sleep apnea syndrome (OSAS) in children produces serious organic consequences that affect pharyngeal breathing and functional development. The high rate of incidence of this problem is important. In children, the most frequent cause of OSAS is hypertrophy of the tonsils, adenoids, or both. We think that a new indication for pediatric adenoidectomy and tonsillectomy is pharyngeal breathing obstruction by hypertrophic lymphoid formations in the Waldeyer ring. In a statistical analysis of 180 children with OSAS who underwent tonsillectomy and adenoidectomy, the disappearance of most symptoms 7 months after surgery was significant.

Adenoidectomy↗
PubMed2005

Grisel's syndrome: a rare complication following adenoidectomy.

Grisel's syndrome, defined as subluxation of the atlanto-axial joint, not associated with trauma or bone disease, is found primarily in children. There are few references to this syndrome in the ENT literature but it may occur in association with any condition that results in hyperaemia and pathological relaxation of the transverse ligament of the atlanto-axial joint. Several common otolaryngeal conditions have been associated with the syndrome: pharyngitis, adenotonsillitis, tonsillar abscess, cervical abscess, and otitis media. Moreover, the syndrome has been observed after numerous otolaryngologic procedures such as tonsillectomy, adenoidectomy and mastoidectomy. Non-traumatic subluxation of the atlanto-axial joint should be suspected in cases of persistent neck pain and stiffness. X-rays and computed tomography scans of the cervical spine can confirm the diagnosis. Early management, consisting of cervical immobilization and medical treatment, is considered the key factor for a satisfactory outcome. Inappropriate treatment may result in a permanent and painful neck deformity that may even require surgical fusion. Neurological complications have been reported in the literature, with outcome ranging from mild paresthesia, clonus, to quadriplegia or acute respiratory failure and death. The case is described of an 8-year-old boy who developed Grisel's syndrome following adenoidectomy. The pathogenesis, classification, diagnosis, and treatment of this condition are discussed.

Adenoidectomy↗
PubMed2006

[Effects of remifentanil in children undergoing endoscopic-assisted adenoidectomy].

OBJECTIVE: To observe the effect of remifentanil on hemodynamic and angiotentratin- II in children undergoing endoscopic-assisted adenoidectomy. METHOD: Thirty patients, ASA I -II , were randomly divided into two groups , remifentanil group and fentanyl group. Remifentanil group received remifentanil combined with propofol anesthesia, fentanyl group received fentanyl combined with propofol anesthesia . Vecuronium was given as muscle relaxant in both groups. ECG, HR, BP, Sa02 were monitored in both groups during operation,and peripheral venous blood samples were taken on 1d before operation(T1),at the time of endotracheal intubation (T2 ), 10 minutes after operation beginning (T3 ),5 minutes after extubation (T4 ) for check angiotentratin- II , then recorded the time of anesthesia, the time of recovery from anesthesia and the time of extubation. RESULT: Comparing with T1, T2, and T3 were significant lower in both group about the HR, BP and angiotentratin-II. There was no significant difference in two groups about SaO2. HR and BP is little lower in remifentanil group than in fentanyl group . The anesthesia time was significantly longer in Remifentanil group than that in fentanyl group. The recovery time was significantly shorter in Remifentanil group than that in fentanyl group. The extubation time was significantly shorter in remifentanil group than that in fentanyl group. CONCLUSION: Remifentanil is better than fentanyl for stabilizing hemodynamic,decreasing the stress responses,reducing the time of recovery and extubation in children undergoing endoscopic-assisted adenoidectomy.

Adenoidectomy↗
PubMed1991

Indications for tonsillectomy and adenoidectomy.

Tonsillectomy and adenoidectomy are separate procedures that should be performed for distinct reasons. Studies now indicate that severe, recurrent pharyngitis responds well to tonsillectomy. According to separate recommendations from the American Medical Association and the American Academy of Pediatrics, patients are candidates for tonsillectomy if they have four or more episodes of pharyngitis a year. Recurrent otitis media and chronic otitis media are improved by adenoidectomy, although placement of pressure-equalizing tubes remains the preferred initial treatment for these conditions. Adenotonsillectomy improves severe upper airway obstruction (cor pulmonale and obstructive sleep apnea), as well as milder forms of airway obstruction (loud snoring). The effectiveness of these procedures in proposed indications, such as sinusitis and adenoiditis, is less well substantiated.

Adenoidectomy↗
PubMed1990

Abnormal coagulation profiles in tonsillectomy and adenoidectomy patients.

Preoperative coagulation profile screening is routinely performed in otolaryngology before tonsillectomy and adenoidectomy surgery in the United States. Recently there has been controversy as to whether this routine testing is necessary. To evaluate the need for this testing, we reviewed a series of patients with particular attention to abnormal coagulation profiles. Of 91 consecutive patients undergoing tonsillectomy, adenoidectomy, or both, four had abnormal preoperative coagulation profiles. Of these patients, one had von Willebrand disease, one had hypofibrinoginemia, and two had a transient acquired lupus-like anticoagulant. The latter condition, which causes a temporary prolongation of the activated partial thromboplastin time, is discussed in detail along with a review of the pertinent literature. We conclude that coagulopathies occur frequently enough to justify preoperative screening even in the absence of a positive history.

Adenoidectomy↗
PubMed1986

Complications of tonsillectomy and adenoidectomy in 9409 children observed overnight.

In attempts to minimize the cost of health care, physicians are reducing the duration of hospital stay. Traditionally, at the Hospital for Sick Children, Toronto, otherwise healthy children undergoing adenoidectomy, tonsillectomy or adenotonsillectomy have been admitted the morning of surgery and discharged from hospital at 7 am the next day. The nursing records of 9409 patients aged 17 years or less who were managed in this way between 1980 and 1984 were reviewed to determine the occurrence of complications during the observation period. A total of 202 patients (2.15%) bled during the observation period. Of the 202, 6 (0.06% of all the patients) required a second general anesthetic for hemostasis; 1 of these 6 patients and 5 others required blood transfusions. Discharge was delayed for 42 patients (0.45% of all the patients) because of postoperative bleeding and for 57 patients (0.6%) for a variety of other reasons. Delayed discharge for reasons other than hemorrhage was more frequent among children less than 2 years of age and those over 12 years of age. The authors concluded that children undergoing adenoidectomy could safely be discharged the same day after 6 hours of observation following surgery. However, as a substantial number of children bled from the tonsillar fossa more than 6 hours after surgery, the efficacy of periodic examination of the oral cavity during the observation period in reducing the rate of hemorrhage after 6 hours must be evaluated before a same-day discharge program is established for children undergoing adenotonsillectomy.

Adenoidectomy↗
PubMed1985

Cephalometric radiographs, nasal airway resistance, and the effect of adenoidectomy.

Cephalometric radiographs and nasal airway resistance values of 67 children were compared--correlation between each of several measurements of the postnasal airway and airway resistance from anterior nares to oropharynx was poor. At the 5% level of significance, the averaged shortest distance between the anterior face of the adenoid mass and the posterior wall of the antrum was related to be averaged airway resistance of the 67 subjects. Nasal airway resistance measurements in 22 children prior to and following adenoidectomy established that nasal airway resistance was reduced following adenoidectomy.

Adenoidectomy↗
PubMed1996

[On adenoidectomy].

The paper deals on the advantages for the rhinopharynx following adenoidectomy. The AA. explain their procedure for its removal under visual control. Both a radiological and microbiological study was done in 90 children waiting for the removal with the aim of realizing the changes derived to the upper air-way. The surgery enhances the adenoidal expression and significatively improves the rhinopharyngeal air-way (p < 0.001). Furthermore the pathogenic flora of epipharynx changes for benefit of the saprophytic flora (p < 0.001). The adenoidectomy is indicated when the adenoidal mass hinder the nasopharyngeal breathing, when causes adenoid outbreaks and also in those cases of stubborn secretory otitis not yielding to conservative treatment.

Acute Disease↗
PubMed1997

Effects of adenoidectomy on sinusitis.

Effect of adenoidectomy on sinusitis was investigated in 78 children (aged 5 to 7) with adenoid vegetation, sinusitis and otitis media with effusion. After a 6 month period, improvement of the sinusitis was observed in 25 of the 45 children (56%) in the adenoidectomized group, and only in 8 of the 33 children (24%) in the non-adenoidectomized group. This was statistically significant in the adenoidectomized group (mean 2 = 7.65, p < .01). Through nasopharyngeal endoscopy in the adenoidectomized children in the 6 months following surgery, we noted decreased evidence of infection and/or inflammation. These findings may indicate that adenoidectomy is effective for sinusitis in children.

Adenoidectomy↗