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PubMedDate not supplied

Tonsillectomy, adenoidectomy, and myringotomy in sickle cell disease: perioperative morbidity. Preoperative Transfusion in Sickle Cell Disease Study Group.

PURPOSE: To compare the rates of perioperative morbidity of patients with sickle cell anemia who were randomly assigned to 2 preoperative transfusion regimens and to identify predisposing factors for perioperative complications. PATIENTS AND METHODS: Investigators at 36 centers enrolled 118 patients who were scheduled to have elective surgery and agreed to randomization between 2 preoperative transfusion regimens. Forty-seven subjects were enrolled but not randomized, including 20 who were not transfused before surgery. Perioperative management was based on a prescribed care plan. RESULTS: Tonsillectomy and/or adenoidectomy (TA) were performed on 136 persons, and 29 had myringotomy as their primary procedure. There were no differences in the frequency of complications between the randomized groups. The serious, non-transfusion complication rates for randomized patients were 32% (34 of 107) for TA and 36% (4 of 11) for myringotomy. A history of pulmonary disease was a predictor of postoperative sickle cell-related events for patients undergoing TA surgery. CONCLUSIONS: The more intensive transfusion regimen did not result in fewer perioperative complications. The high frequency of complications emphasizes the need for anticipatory management of persons undergoing TA. A history of pulmonary disease identifies patients at increased risk for sickle cell-related events after TA surgery. Patients undergoing myringotomy have a low frequency of sickle cell-related events but a significant frequency of other serious perioperative complications.

Adenoidectomy↗
PubMed2004

A survey on the management of reactionary haemorrhage following adenoidectomy in the UK and our practice.

We present the results of a nation-wide survey in the management of reactionary haemorrhage following adenoidectomy, in the absence of specific national guidelines for this complication in the UK. We have reported the practice of the consultant members of the BAO-HNS through a confidential postal questionnaire with regard to their preferred method of management and experience. Valid replies were received from 285 ENT surgeons, of which 87.3% (249) prefer to manage reactionary haemorrhage with post-nasal packs and 223 (78.2%) would use an overnight post-nasal pack. 7.7% (22) use other techniques, and 9.1% (26) leave post-nasal packs for as short time as possible. Our experience of using a post-nasal pack for 4 h appears equally as effective as a post-nasal pack left for 24 h and reduces the discomfort and subsequent risks related to overnight post-nasal packing.

Adenoidectomy↗
PubMed1992

The effect of paracetamol or diclofenac administered before operation on postoperative pain and behaviour after adenoidectomy in small children.

We compared the effects of rectally administered diclofenac (12.5 mg) with paracetamol (125 mg) on pre- and postoperative behaviour and the need for supplementary analgesia in 44 children scheduled for adenoidectomy (with or without myringotomy). The study drugs were given in combination with diazepam (0.5 mg.kg-1) about 20 min before the children were taken to the operating theatre. On arrival there, the children who had received diclofenac were significantly quieter (< 0.05), easier to handle (p < 0.01) and cried less (p < 0.05) than those in the paracetamol group. During recovery, children in the diclofenac group needed fewer supplementary doses of intravenous pethidine than those receiving paracetamol (p < 0.001). There were no obvious differences between the groups in intra-operative bleeding (as estimated by the surgeon), or in measured blood loss. No postoperative complications became evident. The pre-operative rectal administration of diclofenac for pain relief after adenotomy is safe and effective.

Acetaminophen↗
PubMed1989

An objective method of assessing nasality: a possible aid in the selection of patients for adenoidectomy.

We present an appraisal of an objective technique for assessing nasality, or the nasal component of speech. Evidence suggests that a subjective impression of hyponasal speech is related to the adenoid volume and the radiographic palatal airway, although clinical assessments may have poor inter- and intra-observer agreement. Determination of the oral and nasal acoustic ratio or 'Nasalance' is quick, painless, and non-invasive. There was good agreement and reproducibility within normal subjects when test phrases were used. Words such as 'bananas' which contain nasal consonants showed large reductions in the Nasalance score when the nostrils were occluded and are of use in clinical assessment. This method may be of use in refining the selection of children for adenoidectomy.

Adenoidectomy↗
PubMed1990

Identification of hypoxaemia in children having tonsillectomy and adenoidectomy.

A series of children having tonsillectomy and adenoidectomy was investigated for hypoxaemia during sleep and to assess the value of signs and symptoms as predictors of hypoxaemia. Forty-four children were studied the night before surgery. Oxygen saturation (SaO2) was measured whilst the child was awake using a pulse oximeter and when the child was asleep oxygen saturation. ECG and chest impedance were continuously monitored and recorded. In addition, 20 control children having urological surgery were studied in the same way. All the measures of hypoxaemia (awake SaO2, baseline asleep SaO2, number of hypoxaemic episodes) differed significantly between patients and controls (P less than 0.01). When significant hypoxaemia was defined as a baseline sleeping SaO2 below 90% or one dip in SaO2 of at least 10% below the baseline per hour 15 children were found to have abnormal studies. These children could not be identified from history or clinical examination but using the criteria of mouth breathing, audible respiration at rest and an awake SaO2 of less than 96%, 14 of the 15 children were accurately identified (93% sensitivity, 86% specificity). Thus a combination of the physical signs of mouth breathing and measurement of oxygen saturation whilst awake may provide a useful clinic screening test for children suspected of suffering from sleep apnoea.

Adenoidectomy↗
PubMed2004

Velopharyngeal insufficiency following adenoidectomy.

Velopharyngeal insufficiency (VPI) is a well recognized but rare complication of adenoidectomy. Twenty children with this condition were seen and assessed at Great Ormond Street Hospital between 1993 and 2000. The commonest aetiology was occult submucous cleft palate (n = 5) but there was a wide range of other causes. Two children with severe behavioural disorders and normal palates developed mild symptoms, an aetiology not previously reported. Only two children had a classical submucous cleft palate. Nine children required surgical intervention and three revision procedures. Of the 15 treated children for whom follow-up data was available, 13 regained normal or near-normal speech. Many cases of postadenoidectomy VPI was not foreseeable. Following referral to a specialist cleft unit, normal or near-normal speech can be achieved in the majority with a combination of surgery and speech therapy.

Adenoidectomy↗
PubMed1983

Cardiac arrhythmias in intubated children during adenoidectomy. A comparison between enflurane and halothane anaesthesia.

In 75 children undergoing adenoidectomy, occurrence of cardiac arrhythmias and influence of anaesthesia on respiration were studied during halothane and enflurane anaesthesia. All the children were intubated orally. In 25 children halothane, and in another 25 children enflurane was used during spontaneous ventilation. Twenty-five children were also followed during halothane anaesthesia with manually controlled ventilation. The overall incidence of cardiac arrhythmias was higher during halothane anaesthesia (72% at spontaneous breathing and 68% with controlled ventilation) than during enflurane anaesthesia (32%, P less than 0.05). Ventricular arrhythmias were noted in 20% of the spontaneously breathing children in 12% of those with controlled ventilation during halothane anaesthesia. Three children breathing spontaneously during halothane anaesthesia developed ventricular tachycardia. During enflurane anaesthesia the incidence of ventricular arrhythmias was lower (8%) in spite of higher end-tidal CO2 tensions and an anaesthetic depth that was only just the level needed to allow intubation. The incidence of ventricular arrhythmia during halothane anaesthesia was shown to be influenced by the anaesthetic technique used, which was not found with enflurane anaesthesia. The greater stability in cardiac rhythm with enflurane indicates a more favourable effect of this agent on the myocardium as well as a decreased sympathetic response to anaesthesia and surgery as compared with halothane anaesthesia.

Adenoidectomy↗
PubMed1987

Halothane, enflurane and isoflurane anaesthesia for adenoidectomy in children, using two different premedications.

In 48 children subjected to adenoidectomy, comparisons of airway problems, heart rates, cardiac arrhythmias, ventilation and stress hormone reactions were studied during halothane, enflurane and isoflurane anaesthesia. Sixteen children were anaesthetized with either of the three agents and eight patients in each group received diazepam 0.25 mg kg-1 and atropine 0.015 mg kg-1 rectally (DA) as premedication and the remainder diazepam 0.5 mg kg-1, morphine 0.15 mg kg-1 and scopolamine 0.01 mg kg-1 (DMS) rectally. All children were intubated and breathing spontaneously. Equianaesthetic inspired concentrations of halothane, enflurane and isoflurane were used. Airway problems were of the same magnitude during halothane and isoflurane anaesthesia but were less frequent with both agents compared with enflurane anaesthesia. DMS reduced the number of airway reactions in all groups. Respiratory rates were uninfluenced by anaesthesia, intubation and surgery during enflurane anaesthesia. Cardiac arrhythmias were less frequent with enflurane and isoflurane than with halothane. Plasma ACTH and cortisol were similar with all three agents. During induction of anaesthesia in the DA-premedicated halothane group, however, plasma catecholamines were higher than in the group which received DMS, in contrast to the findings during enflurane and isoflurane anaesthesia. The DMS premedication decreased the response of plasma ACTH, cortisol and plasma catecholamines to surgery.

Adenoidectomy↗
PubMed2006

Early vs late intraoperative administration of tropisetron for the prevention of nausea and vomiting in children undergoing tonsillectomy and/or adenoidectomy.

BACKGROUND: Tropisetron is a long-acting 5HT3 receptor antagonist and was shown to be effective in the prevention of postoperative nausea and vomiting (PONV) after tonsillectomy. The aim of the study was to compare the effects of early vs late intraoperative administration of tropisetron with regard to prevention of PONV during the first 48 h after extubation. METHODS: In a randomized double-blind study, we investigated 120 children aged 1-12 years undergoing general anesthesia for tonsillectomy or adenotonsillectomy. Patients received 0.1 mg x kg(-1) tropisetron (maximum 2 mg) immediately after inhalational induction (early) and establishment of intravenous access or after the end of surgery before extubation (late). PONV and the need for antiemetic rescue medications were recorded within the following 48 h. Patient data were analyzed using t-test, chi-squared test (significance level of alpha = 0.05) and Spearman rank correlation test. RESULTS: The overall incidence of vomiting was 55.3%, with 60% (36/60) in the early treatment and 51.6% (31/60) in the late treatment group (P = 0.46). The observed time course 48 h postoperatively showed no difference regarding the number of vomiting episodes between the two groups and the need for antiemetic rescue medication. The incidence of nausea was higher in the late application group in the first 6 h after extubation (P = 0.001) and higher in the early application group between 24 and 48 h after extubation (P = 0.02). Morphine and the age over 3 years had a strong influence on the incidence of vomiting. CONCLUSION: The intraoperative time point (early vs late) of intravenous administration of a single prophylactic dose of tropisetron has no impact on the incidence of PONV during the first 48 h after tonsillectomy and/or adenoidectomy in children.

Adenoidectomy↗
PubMed2001

PCR-based detection, restriction endonuclease analysis, and transcription of tonB in Haemophilus influenzae and Haemophilus parainfluenzae isolates obtained from children undergoing tonsillectomy and adenoidectomy.

We developed and evaluated a PCR-based-restriction endonuclease analysis method to detect and analyze the tonB gene of Haemophilus influenzae and Haemophilus parainfluenzae from pediatric patients undergoing tonsillectomy and adenoidectomy. Multiple sites from the same patient, including the surface of adenoids and tonsils, as well as the core of tonsils, were cultured on chocolate agar and identified using standard procedures and the API NH Kit. A total of 55 H. influenzae isolates were recovered from different sites of 20 patients, and 32 H. parainfluenzae isolates were recovered from various sites of 12 patients. DNA was extracted from American Type Culture Collection strains and test isolates by the PureGene kit. Two primers, G1 (21-mer) and G2 (23-mer), were designed by us to amplify by PCR the tonB gene that consists of an 813-bp fragment. A nested PCR using primers T1 (23-mer) and T2 (24-mer) that flank an internal sequence to the gene of the order of 257 bp and restriction endonuclease digestion using XhoI and BglII were done to detect whether heterogeneity within the gene exists between the two species. Reverse transcription-PCR (RT-PCR) was finally done to detect transcription of the gene in both species. Our data have shown that the tonB gene was detected in both species. It is known to encode a virulent protein, TonB, in H. influenzae; however, demonstration of its presence in H. parainfluenzae is novel. Nested-PCR and restriction endonuclease analysis have shown that the tonB gene is apparently structurally the same in both species, with possible differences that may exist in certain H. parainfluenzae isolates. RT-PCR done on selected numbers of H. influenzae and H. parainfluenzae have shown that the tonB gene was transcribed in both species. This shows that the TonB protein, if expressed, may play a different role in the virulence in H. parainfluenzae since it is not needed for heme or heme complexes uptake as with H. influenzae.

Adenoidectomy↗
PubMed1978

Adenoidectomy: an evaluation of the indications.

A group of 76 children who had been listed for adenoidectomy was investigated by scoring the symptoms and signs usually attributed to adenoidal hypertrophy, and removing the adenoids and weighing them. With the possible exception of snoring there was no correlation between the size of the adenoids and the symptoms usually attributed to hypertrophy of this organ. We wish to acknowledge our gratitude to those consultants who allowed us access to their patients, to Dr Ian McDicken, Department of Pathology, University of Liverpool who did the histological examination, and to Mrs P. O'Brien who did the typing.

Adenoidectomy↗
PubMedDate not supplied

The effects of adenoidectomy and tonsillectomy on speech and nasal resonance.

This article presents a review of literature concerning speech and nasal resonance following adenoidectomy and/or tonsillectomy. In order to comprehend speech-related postoperative changes, the role of the adenoid and the tonsils in speech is discussed as well as the concept of veloadenoidal closure separating oral and nasal cavities. Moreover, the effects of adenoidal and tonsillar hypertrophy on speech and nasal resonance are debated.

Adenoidectomy↗
PubMedDate not supplied

Adenoidectomy for otitis media with mucoid effusion.

This random controlled study was undertaken to determine the extent to which nonsurgical treatment can control otitis media with effusion (OME); and if surgical treatment is indicated, and myringotomy, removal of middle ear liquid with insertion of aeration tubes is carried out, and whether removal of the adenoids produces any beneficial effect. A preparatory two-month nonsurgical treatment consisting of measures to improve the functional state of the nose was undertaken to eliminate from the study those children (42%) who would respond to medical treatment alone. The cure rate was similar in each of the operation groups with a greater relapse rate in the nonadenoidectomy groups who required 9% more aeration tube insertions. An estimation from x-rays of the size of the adenoids, shows that the group cured without surgery has a tendency towards the smaller adneoids. The relapse rate in the nonadenoidectomy group was independent of the size of the adenoids, and the study failed to show that any benefit accrued though adenoidectomy. Accordingly, the removal of adenoids should cease to be indicated in cases of OME as a primary form of treatment.

Adenoidectomy↗
PubMed1994

Mycoplasma and Chlamydia in adenoids and tonsils of children undergoing adenoidectomy or tonsillectomy.

The prevalence of mycoplasmal and chlamydial infection was assessed in 83 children undergoing adenoidectomy, tonsillectomy, or both procedures for recurrent adenotonsillitis or obstructive symptoms. Throat smears (surface specimens) and minced adenoids and tonsils (core specimens) were cultured for Mycoplasma spp and for Chlamydia spp. Isolation rates in adenoidal specimens were as follows: Mycoplasma hominis, surface 7.1% core 2.9%; and Ureaplasma urealyticum, surface 1.4%, core 2.9%. Mycoplasma hominis was also found in tonsillar specimens: surface 14.3%, core 20%. Chlamydia trachomatis was isolated only from a single core adenoidal specimen. The rate of mycoplasma isolation was significantly higher in children with recurrent adenotonsillitis (34.5%) than in those with obstructive symptoms (3.7%). Our findings document colonization of genital mycoplasmas in adenoids and tonsils of children with recurrent adenotonsillitis. Further studies are needed to evaluate the possible pathogenetic role of these microorganisms in adenotonsillar infection.

Adenoidectomy↗
PubMed1996

Meningitis after adenoidectomy: an anatomic explanation.

Meningitis is a rare complication of adenoidectomy. During a 5-month period, two children at St Christopher's Hospital for Children developed meningitis within days following this surgical procedure. The potential causes of this complication that we investigated include coincidence, systemic hematogenous spread of bacteria to the central nervous system, and direct or indirect contamination of the cerebrospinal fluid by bacteria introduced by retropharyngeal injection of lidocaine hydrochloride and epinephrine. Based on statistical analysis of the available literature and anatomic studies of the pediatric nasopharyngeal region, we conclude that a retrograde flow of bacteria via a newly described anastomotic network of veins was the most likely cause of this sequela.

Adenoidectomy↗
PubMed1980

Familial clustering of tonsillectomies and adenoidectomies.

Eighty-one children undergoing tonsillectomies and adenoidectomies (T and A) were compared with a control group of 88 hospital patients. A significantly higher incidence of prior T and A was found to have been performed on the siblings and parents of the T and A group than the controls. Environmental, genetic or attitudinal factors could be responsible for this familial clustering.

Adenoidectomy↗
PubMedDate not supplied

Tonsillectomy and adenoidectomy: incidence and mortality, 1968--1972.

To determine the number of tonsillectomies and adenoidectomies (T-As) from 1968 to 1972 and their associated morbidity and mortality rates, a questionnaire was sent to all the hospitals listed in the Directory of the American Hospital Association (6,759). The data were analyzed and statistical projections were made. An analysis was also made of the summary report of the "Study on Surgical Services for the United States," with regard to the incidence of T-A was also made. The results are presented in the following report.

Adenoidectomy↗
PubMed2004

The incidence of laryngospasm with a "no touch" extubation technique after tonsillectomy and adenoidectomy.

UNLABELLED: In this case series, we evaluated the incidence of laryngospasm using a clearly defined awake tracheal extubation technique in 20 children undergoing elective tonsillectomy with or without adenoidectomy. This technique required patients to be turned to the recovery position at the end of the procedure before discontinuing the volatile anesthetics. No further stimulation, besides continuous oximetry monitoring, was allowed until the patients spontaneously woke up ("no touch" technique). The incidence of laryngospasm, oxygen saturation, and coughing was recorded. No cases of laryngospasm, oxygen desaturation, or severe coughing occurred in our patient population. IMPLICATIONS: This study re-emphasizes the importance of a sound anesthetic technique in tracheally extubating pediatric patients.

Adenoidectomy↗