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PubMed2006

Efficacy of tonsillectomy and adenoidectomy in Asian childhood obstructive sleep apnea/hypopnea syndrome: a case control study.

OBJECTIVE: To evaluate the efficacy of tonsillectomy and adenoidectomy (T & A) in Asian childhood obstructive sleep apnea/hypopnea syndrome (OSAHS). METHODS: The medical data of the OSAHS patients in the Sleep Center of the Duchess Kent Children's Habilitation Institute from May 1999 to May 2003 were retrospectively reviewed. OSAHS was diagnosed according to the abnormal sleep monitoring results. The clinical outcomes were followed up and compared between the Operation and Non-operation groups (Control) in OSAHS children with adenotonsillar hypertrophy (ATH). Sleep endoscopy was performed for those who had residual OSAHS for the purpose of detecting the underlying causes. RESULTS: Sixty-one patients were diagnosed with OSAHS. Among the OSAHS patients, 39 were associated with ATH, and 25 of the 39 patients underwent T & A. The desaturation dip rate and minimum saturation in the Operation group were significantly improved after T & A. Six out of 25 (24%) patients in the Operation group had residual OSAHS whereas 11 out of the 13 (85%) patients in the Control group had unchanged or worsening clinical symptoms (OR=15.4, 95%CI 2.7- 87.5). Residual OSAHS after surgery were attributable to obesity, achondroplasia, upper airway structure anomaly and airway dynamic problems. CONCLUSIONS: T & A was effective in the majority of Asian childhood OSAHS associated with ATH. Upper airway structure or dynamic abnormalities can result in residual OSAHS in parts of children. Further investigation is required to detect the underlying problems.

Adenoidectomy↗
PubMed1991

[Neurological sequelae caused by surgical procedures during adenoidectomy under anesthesia].

A five-year old boy with good risk was anesthetized with nitrous-oxide and halothane under orotracheal intubation for adenoidectomy and tubing of bilateral middle-ear cavities. Patient was on supine position with extension of neck. A mouth-gag was applied and the pharynx was packed with gauze. After long unskilled surgical procedures, severe neurological complications which were initiated with severe arrhythmias and followed by signs of paralysis of bilateral IX, X, XI, XII cranial nerves at their nuclei in medulla oblongata, were observed during the post-anesthetic period. The patient was saved with neurological sequelae of the cranial nerves and is alive after 6 years from the incident. The causes of this complications were discussed.

Adenoidectomy↗
PubMed1990

Tonsillectomy and adenoidectomy: changing trends.

A review of 1,722 tonsil and adenoid procedures performed between 1978 and 1986 is presented. Each year there has been a progressive decrease in the number of procedures performed; the incidence of adenoidectomy has declined particularly. Although infection remains the predominant indication for surgery, there has been a dramatic rise in obstructive sleep apnea as a significant indication, from 0% in 1978 to 19% in 1986. At present, this trend promises to continue as physicians become increasingly aware of the prevalence and seriousness of adenotonsillar hypertrophy as a cause of sleep apnea, particularly in the general pediatric population.

Adenoidectomy↗
PubMedDate not supplied

[Post-adenoidectomy velopharyngeal insufficiency in children with velopalatine clefts].

The influence of adenoidectomy on speech has been well documented, essentially in cleft palate children. A revision of the speech outcome in 7 adenoidectomized cleft palate children reveals 4 cases of deteriorated speech. The need of a preoperative evaluation to look for risk factors is outlined, specially in cases of submucous cleft palate. The evolution of cases with permanent postadenoidectomy velar insufficiency with nasometry, shows increasing severity of nasality .

Adenoidectomy↗
PubMed1979

Pediatric adenoidectomy and tonsillectomy--personal viewpoints.

A report on experience with adenoidectomies, tonsillectomies, and adenotonsillectomies carried out at the Hospital for Sick Children, Toronto in the period 1968-75. Operations were performed on 25,443 patients during this period. Reasons for the reduction in T&A operations in recent years are considered, and views are expressed regarding when such operations are indicated, age of patient for surgery, the allergic child, cleft palate patient, the presence of quinsy, cardiopulmonary changes, subluxation of cervical spines, anesthesia, and postoperative care and complications.

Adenoidectomy↗
PubMed1988

Controversy over tubes and adenoidectomy.

Dr. Bluestone then summarized the panelists' discussion by stating that there is now evidence that myringotomy alone for chronic otitis media with effusion has some efficacy but is probably no better than watching the child and not performing surgery. He also stated there are now some data to show that myringotomy and tube insertion for chronic otitis media with effusion appear to be more beneficial than either watching a child over a long period of time or performing myringotomy alone. However, the panelists made a plea that each child should be individualized on the basis of the duration of the effusion, the child's response to medication, the time of the year, distance from health care providers and other factors. Dr. Gates stressed that hearing loss was an important factor, but if hearing loss is a deciding factor, then serial audiograms or at least some assessment of hearing in the clinician's office should be performed. He also stated that there is now evidence that adenoidectomy is effective in certain children, but there is still an 80% recurrence rate and a 15% rate of failure in which children require repeat surgery. Dr. Bluestone suggested that parents and the child (if old enough) should be informed of what is known about the risks, costs and benefits of these surgical procedures. He recommended the clinician discuss with the parents the pros and cons of performing or not performing surgery, including the complications and sequelae of otitis media and also of tube insertion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoidectomy↗
PubMed1988

Obstructive sleep apnea: a polysomnographic study of sleep apnea before and after tonsillectomy and adenoidectomy.

We report about polysomnographic studies including EEG, EOG, EMG, ECG, measurement of oropharyngeal airflow, recording of chest wall movements and transcutaneous measurements of pO2 and pCO2 in a 4-year-old girl with severe obstructive sleep apnea. Her sleep profile was characterized by a disturbed cyclic pattern of sleep stages with onset of sleep at stage 4, shortening of REM-sleep periods and of sleep stages 1 and 2, and an increased quantity of sleep stage 4. The total time spent in apneic episodes was 11.3% of the total sleep period (only obstructive events). Apneic attacks were recorded mainly in REM and light NREM sleep states. Tonsillectomy and adenoidectomy resulted in marked improvement without further evidence of abnormal sleeping pattern or of sleep apneas.

Adenoidectomy↗
PubMed1988

Post-tonsillectomy and adenoidectomy hemorrhage.

This is a retrospective review of 6842 tonsillectomies and adenoidectomies performed over a seven-year period at the Montreal Children's Hospital. The total incidence of postoperative bleeding was 2.5%. The incidence of primary post-tonsillectomy hemorrhage was 1.0%, with 78% of these children having developed bleeding within 12 hours of surgery. The overall incidence of secondary post-tonsillectomy hemorrhage was 1.2%. Twenty-nine percent of children with primary hemorrhage required a second general anesthetic, and 40% required blood component transfusion. Eight percent of children with secondary hemorrhage required a second general anesthetic and 24% received transfusions. Based on these findings, primary and secondary hemorrhage can be classified further into major and minor. The criteria for a major post-tonsillectomy hemorrhage are: requirements of a general anesthetic to control and repair the bleeding, or blood loss that is sufficient to require blood component transfusion therapy. The relevance of these findings with regard to outpatient adenotonsillectomies is discussed.

Adenoidectomy↗
PubMed1987

The use of suction cautery in adenoidectomy.

The use of a malleable curved disposable suction cautery for the control of any persistent bleeding at the conclusion of adenoidectomy in over 1000 cases has prevented any primary postoperative hemorrhages from the nasopharynx, and obviated the need for post-nasal packing.

Adenoidectomy↗
PubMed1987

Laser tonsillectomy and adenoidectomy.

The use of the laser for performing tonsillectomy and adenoidectomy has proved to be a very effective method in terms of reducing postoperative pain, bleeding, and operative time. With use of the laser, most patients can be treated on an outpatient basis. However, the treating physician must balance the medical gains against the increase in cost for laser use before embarking on this approach for patient care.

Adenoidectomy↗
PubMed1985

[Adenoidectomy and tonsillectomy in children with hemophilia and von Willebrand disease].

Hemophilia type A or B is due to deficiency in factor VIII C or IX C, but whatever the type and whether the affection is severe or attenuated the risk of hemorrhage after surgery is identical. Willebrand's disease is due to either a qualitative or quantitative anomaly of willebrand's factor. Between 1979 and 1984, 15 children with these diseases were operated upon for removal of tonsils and adenoids. Surgery was performed under cover of substituted therapy with frozen cryoprecipitate for Willebrand's disease, either frozen or dried cryoprecipitate together with F VIII concentrates for hemophilia A, and PPSB for hemophilia B. This treatment was continued pastoperatively for 7 days after adenoidectomy and 10 days after tonsillectomy. Follow up examinations enabling possible adjustment of transfusional needs included determination of CKT and assay of factors VIII C or IX C in the hemophiliac children, and assay of factors F VIII R, AG, F VIII RCF and F VIII C in those will willebrand's disease.

Adenoidectomy↗
PubMed1985

Acute pulmonary edema complicating tonsillectomy and adenoidectomy.

In summary, we have presented two cases to illustrate the problem of postoperative pulmonary edema following tonsillectomy and adenoidectomy. Furthermore, we have discussed the difficulty in predicting those patients who will develop this complication. Because of the potential seriousness and unpredictability of acute pulmonary edema following tonsillectomy for chronic obstruction, it is important that medical personnel, including pediatricians caring for patients after tonsillectomy, be able to readily recognize this phenomenon of acute onset of congestive heart failure and treat it rapidly with diuretics, continuous positive airway pressure, and respiratory support as needed.

Acute Disease↗
PubMed1984

[Adenoidectomy and tonsillectomy in allergic patients].

A retrospective study of results of adenoidectomy, tonsillectomy, or their association in 80 of 35% cases of children with allergic affections showed that operation was successful in 2 out of 10 cases, resulted in complications in one out of 10 and was ineffective in 7 out of 10. This emphasizes the need for selection of children with allergy before deciding to operate, failures with complications being rarely observed when correct decisions have been made. Poor results can be avoided if contact of harmful allergens is prevented during healing. This involves the eviction of allergens, with isolation of the patient for one week and antidegranulation treatment of the ketotifen type, and accelerated densensitization during the isolation period. Antibiotics and polyvalent vaccination may be necessary to treat infection. Four-year follow up of 65 patients operated upon under these conditions demonstrated excellent results.

Adenoidectomy↗
PubMed1981

[For prevention of complications, especially postoperative bleeding, in tonsillectomy and adenoidectomy (author's transl)].

Hemorrhages after tonsillectomy and adenoidectomy are the most frequent lethal complications except of the mortality due to incidents of anaesthesia. A precise clinical, personal and family history regarding bleeding disorders must be taken. We preoperatively perform laboratory tests on each patient (Platelet count, PTT, Quick, Thrombintest, Fibrinogen, Bleeding Time) to detect possible bleeding disorders. Furthermore, we ask for previous medications, such as analgetics, sedatives and antiarthritics. A careful surgical technique for removal of tonsils and adenoids and meticulous hemostasis reduce the danger of postoperative bleeding. An exact control after the operation helps prevent serious complications.

Adenoidectomy↗
PubMed1995

[Middle ear pressure changes following adenoidectomy. Contribution to the etiopathogenic study of serous otitis media].

This paper deals in the pursuit done on endotympanic pressures in children operated upon adenoidectomy, a lot of them simultaneously suffering from serious otitis media. The obtained results are compared with those of healthy children, with the aim of set up the pressure changes within the middle ear due to surgery and as well the knowledge of the natural evolvement of the serious otitis. In accordance with date registered and the perusal of the Bibliography at hand, the AA. try to find out the possible influence of the adenoid hypertrophy on this type of otitis. But all without arguing the role played by other causes (split palate, neoplastic obstruction, ciliar dyskinesy, etc.). Finally a new etio-pathogenic mechanism, in order to explain the negative pressures inside the middle ear due to adenoid hyperplasty, is proposed.

Adenoidectomy↗
PubMedDate not supplied

Quality improvement study of day surgery for tonsillectomy and adenoidectomy patients.

Ongoing efforts to contain costs in health care have had an impact on the delivery of care in the ambulatory setting. Many patients previously admitted to the hospital for an overnight stay are now discharged home within hours of surgery. In response to concerns raised by nursing staff about same-day discharge of patients undergoing tonsillectomy and adenoidectomy (T&A), a quality improvement (QI) study was conducted. Data from more than 150 families over a 2-year period were collected, using the clinical indicator of safe discharge. The data were obtained during the patient's recovery room stay, the first post-operative day, and 2 weeks after surgery. Findings suggested that some of the teaching done by nurses was useful and some needed revision to meet patients' needs. Changes regarding pain management, fluid management, and post-operative bleeding were addressed.

Adenoidectomy↗
PubMed1995

Retropharyngeal abscess after adenoidectomy.

In this paper, we describe a case of retropharyneal abscess with atlantoaxial joint subluxation after an adenoidectomy. This is a rare complication of which the otolaryngologist must be aware because of its potential consequences.

Adenoidectomy↗