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PubMedDate not supplied

[Effects of adenoidectomy and tonsillectomy on the bacterial flora of the nose and oropharynx].

The oropharyngeal and nasopharyngeal microbial flora was studied in 55 children with recurrent tonsillitis and in 85 with chronic adenoiditis. Swabs were made of both regions one day before surgical removal and on postoperative days 10 and 30, swabs were cultured on suitable media and processed for identification and quantitative estimation. Most of the potentially pathogenic species exhibited beta-lactamase production. After adenoidectomy or tonsillectomy this potentially pathogenic flora showed a quantitative decrease in the number identified and in their growth rate. In contrast, Bacteria considered part of the normal flora showed an increase in their were isolated more frequently although a quantitative decrease was observed in some instances. These findings suggest that adenoidectomy and tonsillectomy result in evident modifications in potentially pathogenic flora in these sites as a result of replacement by the normal flora. There are microbiological findings that justify surgical procedures in case of failure of antibiotic treatment.

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PubMed1998

[Tonsillectomy and adenoidectomy in a private clinic].

In order to examine whether the risk is higher when these types of surgery are conducted in private clinics compared to outpatient surgery in hospitals, we conducted a review of 404 patients referred from a public hospital for surgery in a private practice. There were no complications among the 101 adenoidectomy cases reviewed. Out of a total of 303 patients with tonsillectomy, eight had postoperative bleedings. Four patients (1.3%) were reoperated with ligature in the clinic within a few hours, and four were admitted to hospital for observation. Only two patients disliked being referred to a private clinic for surgery. The findings are comparable to other series and indicate that performing tonsillectomies and adenoidectomies in private practice does not imply higher risk than outpatient procedures in hospitals if selection criteria are carefully used.

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PubMed2000

Impact of tonsillectomy and adenoidectomy on child behavior.

OBJECTIVE: To measure the impact of tonsillectomy and adenoidectomy (T&A) on children's behavioral and emotional problems using a standardized assessment. DESIGN: Prospective study. SETTING: Tertiary care children's hospital. PATIENTS: Thirty-six children, aged 2 through 18 years, with symptoms of nighttime snoring, observed apneas, and daytime mouth breathing and physical examination results demonstrating 3+ or 4+ tonsils scheduled for T&A. INTERVENTION: Parents completed a standard survey of their children's symptoms of sleep apnea and a standardized measure of children's competencies and problems, the Child Behavior Checklist for ages 2 through 3 years or 4 through 18 years, before T&A and 3 months postoperatively. MAIN OUTCOME MEASURE: The Child Behavior Checklist total problem score. RESULTS: The preoperative Child Behavior Checklist total problem score was consistent with abnormal behavior for 10 children (28%). After T&A (n = 15), only 2 scores were abnormal, but the change was not statistically significant. In contrast, the mean total problem score was 7.5 points lower after surgery (95% confidence interval, 5.1-9.7), indicating a significant decrease (P<.001, matched t test). CONCLUSIONS: This pilot study demonstrates a high prevalence (28%) of abnormal behavior in children undergoing T&A for chronic upper airway obstruction. Scores on a standardized measure of behavior improve following T&A, but larger studies with increased statistical power are needed to clarify the degree of improvement and its clinical importance.

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PubMed1980

Premedication for outpatient adenoidectomy: comparison between ketamine and pethidine.

A comparison of intramuscular ketamine and pethidine as premedicants was carried out in a series of 32 children under two years of age who were given thiopentone-N2O-O2-succinyl choline anesthesia for elective outpatient adenoidectomy. Fourteen (87.5%) of the 16 children premedicated with ketamine (3 mg./kg.) were calm or asleep when brought into the operating room as compared to 4 (25.0%) of the 16 children (p less than 0.001) premedicated with pethidine (1 mg/kg.). Immediate recovery was similar in the groups premedicated with ketamine and pethidine. These two small groups of children did not differ significantly in their emotional state during recovery room observation, nor during the 48 postoperative hours at home, either. It is suggested that ketamine administered intramuscularly is a suitable agent for outpatient premedication of small children because of its rapid action, excellent sedative and analgesic properties and low incidence of side-effects.

Adenoidectomy↗
PubMed2000

[Tropisetron for prevention of nausea and vomiting in children undergoing tonsillectomy and/or adenoidectomy].

BACKGROUND: Postoperative nausea and vomiting (PONV) after tonsillectomy is a common problem in children. Tropisetron is a new 5HT3 receptor antagonist and is successfully used in paediatric patients receiving cancer therapy. The aim of the study was to assess efficacy and safety of a single intravenous dose of tropisetron for prevention of PONV in paediatric patients at risk for postoperative vomiting. METHODS: In a randomised, double-blind, placebo-controlled trial, we studied 98 children aged 2-12 years undergoing tonsillectomy or adenotonsillectomy. Patients received placebo or tropisetron 0.1 mg (= 0.1 ml)/kg body weight immediately after induction of anesthesia. A standard general anesthetic technique (Sevoflurane/N2O/O2 without neuromuscular blockers or opioids) was used. Perioperative vital signs, grade of sedation and episodes of postoperative nausea and vomiting were recorded. RESULTS: No vomiting episodes occurred in 65.3% of the tropisetron treated patients compared to 34.7% of the placebo group (p = 0.0024). Only 10.2% of the tropisetron treated patients vomited more than 3 times compared to 22.4% of the control patients (p = 0.0004). The need for antiemetic rescue medication was significantly lower in the study group (10.4%) compared to 28.6% (p = 0.025). No significant adverse effects of the study medication were shown. CONCLUSION: A single intravenous prophylactic dose of tropisetron effectively reduces the incidence of PONV during the first 24 postoperative hours after tonsillectomy and/or adenoidectomy. Because of the low incidence of adverse effects, the prophylactic use of tropisetron seems to be safe and justified in paediatric surgical patients at high risk for postoperative vomiting.

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PubMed2006

Adenoidectomy and tympanostomy tubes in the management of otitis media.

Otitis media is one of the most common childhood infections and the most frequent cause for antibiotic prescriptions in children. As respiratory infections are also associated with childhood asthma, children with recurrent otitis media or with persistent middle-ear effusion are also at an increased risk for developing asthma, which should be appreciated when a child with middle-ear disease is evaluated. The first choice of surgery in chronic middle-ear inflammatory disease is the insertion of tympanostomy tubes. It is warranted when the middle-ear effusion has lasted for 3 or more months. When chronic adenoid infection is suspected, adenoidectomy may be beneficial in treating otitis media in children who are older than 4 years of age and who have previously undergone tympanostomy-tube insertion.

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PubMed1987

An assessment of preoperative coagulation screening for tonsillectomy and adenoidectomy.

Preoperative coagulation studies are commonly employed in order to try to identify the 2-4% of all patients undergoing tonsillectomy/adenoidectomy surgery who experience hemorrhagic complications. In an atmosphere of increasing cost consciousness, evaluation of the efficacy of screening tests is warranted. The records of 994 out of 1050 patients consecutively scheduled for tonsillectomy, adenoidectomy or T&A over a 2.5-year period were retrospectively reviewed in order to determine the usefulness of partial thromboplastin (PTT) and prothrombin time (PT) screening in predicting surgical and postsurgical bleeding. For patients with no history or clinical signs indicating possible bleeding disorder, preoperative PT and PTT failed to predict bleeding as an outcome. Also no patients were identified in this series to have previously undiagnosed coagulopathies on the basis of screening PT/PTT. The purpose of any screening test is to identify disease early enough for therapeutic intervention to be effective. Although preoperative PT/PTT will occasionally identify an unsuspected von Willebrand's or other coagulopathy, the prevalence of bleeding disorders in patients with negative history and examination is low enough that PT/PTT has essentially a zero predictive value for surgical bleeding. Screening PT/PTT should therefore be reserved for patients with known or suspected coagulopathies.

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PubMed1990

Moderation of morbidity following tonsillectomy and adenoidectomy: a study of awareness under anesthesia.

Sixty-seven children between the ages 3 and 10, undergoing tonsillectomy and adenoidectomy, were randomly assigned to one of 3 groups. Therapeutic suggestions recited in English (n = 31), French (n = 19), or continuous white noise (n = 18) were repetitively administered by means of earphones in a double blind design. Randomization to the English condition was associated with a more favorable outcome with respect to all parameters evaluated by physicians and nurses. However, statistical significance could not be demonstrated. Should this observed favorable outcome be legitimate, cortical interpretation of language context was inferred as recovery was not influenced by randomization into the French or white noise conditions. Preoperative behavior, as defined by preoperative upset and cooperation scores, may be predictive of postoperative convalescence. The favorable outcome imparted by the English condition appeared most significant with respect to those patients at highest risk for poor convalescence i.e. poor status preoperative patients.

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PubMed1993

The effect of post-operative instructions on recovery after tonsillectomy and adenoidectomy.

The effect of postoperative diet and activity instructions on the recovery rate after tonsillectomy and adenoidectomy (T & A) was assessed in 92 children ages 3 to 14 years. Two types of postoperative instruction were randomly assigned: 'Restricted', which advised limited, stay at home activities and a soft food liquid diet for 7-10 days, and 'nonrestricted', which advised return to activity and diet as tolerated by the child. Parental evaluation of the levels of pain, activity, and diet using an equal intervals scale was obtained. The number of doses of pain medication, the types of food eaten and postoperative complications were also recorded. No significant differences were found between the two groups in pain level, activity tolerance, return to normal diet, and numbers of doses of pain medication at day 3 and day 7 after surgery. More 'junk' food and spicy foods were eaten in the 'nonrestricted' group. Postoperative hemorrhage requiring intervention occurred in one child in each group. Implications for the children and their families undergoing T & A are discussed with attention to a review of the literature.

Acetaminophen↗
PubMed1994

Coagulation profile as a predictor for post-tonsillectomy and adenoidectomy (T + A) hemorrhage.

The risk of hemorrhage after tonsillectomy and adenoidectomy (T + A) was studied in 1061 children. Twenty-seven (2.5%) had at least one abnormality on a preoperative coagulation profile consisting of a prothrombin time (PT), partial thromboplastin time (PTT), bleeding time (BT) and platelet count (PC). Of these 27 who had an initially abnormal test (PTT or bleeding times only), 8 had diagnosed coagulopathies by hematology evaluation (Group A), and 17 had repeat tests which returned to normal (Group B). Two borderline tests (PTT) were not repeated (Group C). Sixty-four patients (6.0%) bled after T + A. Six of these (9.3%) had an initially abnormal coagulation profile--one in Group A (12.5%), four in Group B (23.5%) and 1 in Group C (50%). This is in contrast to the bleed rate of 5.7% for the 1034 children with normal coagulation profiles. Although it is not surprising that 6 (22.2%) children with an initially abnormal coagulation profile bled, of note is that 4 of them had an initially abnormal coagulation profile which upon repeat testing returned to normal. However, none of these four bleeders required active intervention for control. Coagulopathies were newly diagnosed in 7 (0.57% of total group; 25.9% of 27 with abnormal laboratory values). One additional child had a known intrinsic platelet dysfunction prior to surgery. Only one child was newly identified by a positive family history for abnormal bleeding. These results suggest that new hematologic disorders were diagnosed infrequently. An initially abnormal coagulation profile may identify those more likely to bleed after surgery (22.6% vs. 5.5%). A coagulation profile which includes a PTT and BT may be a valuable screening tool for children undergoing T + A.

Adenoidectomy↗
PubMed1994

Outpatient tonsillectomy and adenoidectomy: complications and recommendations.

An example of cost-effective alternatives in medical care is the increasing use of out-patient surgery for those children requiring tonsillectomy, or tonsillectomy with adenoidectomy rather than an in-patient procedure. Two studies were carried out to answer questions about the complications, in addition to post-operative hemorrhage, and also the questions about the parental views and concerns relating to providing at-home care for their children following surgery. A triad, including recent history of upper airway infection, knife dissection technique, and increased intra-operative blood loss of 100 ml or more should be used to help identify the risk of post-operative hemorrhage.

Adenoidectomy↗
PubMed1995

The effect of post-operative diet on recovery in the first twelve hours after tonsillectomy and adenoidectomy.

The effect of post-operative diet selection on the recovery rate of 100 children ages 3-17 years undergoing tonsillectomy and adenoidectomy (T & A) was studied. In the first 12 h after T & A children were allowed either a 'restricted' diet of only soft foods and liquids or a 'non-restricted' diet of foods preselected and usually eaten by the child. Parental evaluation of the child's general well being, pain level and nausea were evaluated. The number of episodes of emesis, doses of acetominophen and the list of foods and drinks consumed were also recorded. No significant differences in any aspect of recovery were noted between groups. However, a trend towards decreased nausea and parental perception of a more successful general recovery was noted at 12 h in the 'non-restricted' group. Children in the 'non-restricted' group were able to eat foods more often associated with their regular diet. No child from either group experienced any immediate or delayed complications. Implications for children and their families undergoing T & A are discussed.

Acetaminophen↗
PubMedDate not supplied

The effects of tonsillectomy and adenoidectomy on pulmonary arterial pressure in children.

PURPOSE: It is well known that hypertrophic tonsils and adenoids may cause upper-airway obstruction. The aim of this study is to determine the mean pulmonary arterial pressure (mPAP) in children with hypertrophic tonsils and adenoids and to clarify whether tonsillectomy and adenoidectomy (T&A) has any effect on mean pulmonary arterial pressure of these children. MATERIALS AND METHODS: Fifty-two randomly selected children (36 male, 16 female) aged between 4 and 11 (mean 7.7+/-2.5) a with a diagnosis of upper-airway obstruction resulting from hypertrophied tonsils and adenoids were included in our study. Thirty-three children were assigned as controls with similar age and sex distribution with the study groups. Mean pulmonary arterial pressure was measured by using Doppler echocardiography preoperatively and mean 5.4+/-2.9 months postoperatively in all subjects. RESULTS: When the mean pulmonary arterial pressure values of study and control group compared preoperatively, the mean pulmonary arterial pressure levels of the children in the study group were significantly higher than the mean pulmonary arterial pressure levels of the children in the control group (P<.05) (study group mean PAP=23.13+/-7.68, control group mean PAP=16.11+/-7.24) (Levene's test, P<.05). When the preoperative and postoperative results were compared, it was found that there was a statistically significant decrease in mean pulmonary arterial pressures in these 52 children (preoperative mean PAP=23.13+/-7.68, postoperative mean PAP=17.00+/-6.99) (paired sample t test, P<.05). Twenty-seven of the 52 subjects in the study group were pulmonary hypertensive preoperatively. mPAPs of 18 of these children decreased to normal range yielding 9 subjects, and this was also found ststistically significant (McNemar test, P<.001). CONCLUSION: This study showed that obstructive adenoid and tonsillar hypertrophy causes higher mPAP values in children and revealed that T&A is an effective therapeutic measure in such patients.

Adenoidectomy↗
PubMed2004

Pre- and postoperative evaluation by acoustic rhinometry of children submitted to adenoidectomy or adenotonsillectomy.

INTRODUCTION: Nasal obstruction is a common symptom in children and its etiology includes septal deviation, choanal atresia, allergic rhinitis and hypertrophy of the adenoids. Hypertrophy of the adenoids and hypertrophic rhinitis are the most frequent causes of nasal obstruction in the pediatric population, with adenoidectomy being the main surgery carried out during childhood. OBJECTIVE: To analyze the rhinograms of children with nasal obstruction before and after surgery and to compare them with those obtained for children without respiratory complaints. STUDY DESIGN: A clinical prospective study. METHODS: Thirty-five patients with adenoid or adenotonsillar hypertrophy were submitted to otolaryngologic examination and acoustic rhinometry before and 30-60 days after surgery. The control group consisted of 18 children without nasal complaints. RESULTS: Significant differences in the rhinograms were observed before and after surgery, but not between patients and the control group. CONCLUSION: We conclude that acoustic rhinometry is well tolerated by children, and is a rapid and noninvasive method. The technique is valuable for interindividual comparisons, but not for the assessment of different groups.

Adenoidectomy↗
PubMed2005

The clinical and organisational appropriateness of tonsillectomy and adenoidectomy-an Italian perspective.

The objective of the document is to define the most appropriate indications and health-care procedures for tonsillectomy and adenoidectomy and is intended for use by paediatricians, general practitioners, and otolaryngologists involved in the treatment of adenotonsillar pathologies. After a systematic review and grading of evidences from the literature, the document was drafted by a multidisciplinary panel with identified key clinical questions related to indications for surgery, surgical and anaesthesiology procedures, clinical management and organizational issues. It should be stressed that the document was not aimed at providing graded recommendations per se, but to offer suggestions and advices. The document will be updated within December 2006.

Adenoidectomy↗
PubMed2004

The effect of tonsillectomy and adenoidectomy on inattention and impulsivity as measured by the Test of Variables of Attention (TOVA) in children with obstructive sleep apnea syndrome.

OBJECTIVE: To evaluate children with obstructive sleep apnea syndrome (OSAS) for features of attention deficit disorder (ADD) using an objective test of inattention and impulsivity: Test of Variables of Attention (TOVA) and then to determine whether tonsillectomy and adenoidectomy (T+A) results in an improvement in TOVA scores. STUDY DESIGN AND SETTING: This study was a prospective interventional comparative trial in a tertiary care children's hospital. Nineteen children ages 5 to 14 years with OSAS, and otherwise healthy, with a clinical indication for T+A. Preoperative and 2 months postoperative OSA-18, CBCL questionnaires, and TOVA scores were evaluated. RESULTS: The preoperative TOVA scores were in the abnormal range in 12/19 (63%) of the children. The mean preoperative TOVA score was -2.9 (+/- 3.1). The mean postoperative TOVA score was -0.4 (+/-2.8). The improvement in the TOVA scores was significant ( P < 0.0001, t -test). CONCLUSION: This preliminary data suggests that treatment of OSAS with T+A results in significant improvement in objective parameters of inattention and impulsivity. Significance These findings may be important in understanding the impact of OSAS and therapeutic interventions on behavioral problems in children.

Adenoidectomy↗
PubMed1995

Pediatric tonsillectomy and adenoidectomy procedures.

The most common pediatric surgical procedures performed in the United States today are tonsillectomies and adenoidectomies (T&A). Surgical team members must be highly trained and efficient to ensure optimal patient outcomes, reduce surgical costs, and decrease the risk and potential complications inherent in T&A procedures. The authors review current surgical indications for T&A procedures; recommended preoperative, intraoperative, and postoperative patient care; and the management of potential complications.

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PubMed1989

Tonsillectomy and adenoidectomy. Laser procedures.

Laser tonsillectomy and adenoidectomy appear to be gaining popularity. Benefits of such procedures include reduced pain and edema, minimum scar tissue, and hemostasis. The benefits to the surgeon include accuracy and a clear, dry operative field. Recently, some surgeons have used lasers on a routine basis. The role of the perioperative nurse in such procedures is rapidly changing. He or she as a patient advocate must be informed of technical advances as well as benefits, risks, and costs to patients.

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