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PubMedDate not supplied

Improved somatic growth following adenoidectomy and tonsillectomy in young children. Possible pathogenetic mechanisms.

The effect of Adenotonsillectomy on somatic growth was studied prospectively in 57, randomly selected children (31 boys, 26 girls), aged 5.03+/-1.32 (mean+/-1SD) years. The indication for surgery was adenotonsillar hypertrophy with or without recurrent infections. Weight, height, triceps skinfold thickness, and Body Mass Index were measured prior to the operation and 6-13 months afterwards. Weight was significantly improved following T&A in all children. The improvement in height was significantly only for children under 5 years. In an attempt to uncover the pathogenetic mechanisms, lactic acid, pyruvic acid, somatomedin-C (IGF-I), growth hormone(GH), insulin, glucose, pH, hemoglobin (Hbeta). and white cell count (WBC) were also determined in the last 18 children, prior to and 6-8 months post operatively. For the comparison of pre and post operative values the paired t test was applied. Although the values of GH and IGF1 did not significantly increase post-op the IGF-1/GH ratio increased, possibly indicating improved IGF1 generation. There was also a rise in Hbeta values and a lowering of WBC, probably reflecting the lower frequency of infections. All other metabolic indices did not change. In conclusion, linear grow post-Adenotonsillectomy improved in children aged <5 years and was associated with improved with IGF-1/GH ratio, increased Hbeta values and decreased in WBC.

Adenoidectomy↗
PubMed1988

Immunological basis of indications for tonsillectomy and adenoidectomy.

The tonsils are immune organs. The necessity for T & A should have a more rational approach for selected cases. The tonsils have a large immune function. The defense function of the tonsils is much greater in children than in adults. The children develop their resistance to infection by the time they are 7-8 years old. Tonsils and adenoids should not be removed below the age of eight unless there are absolute indications. Tonsillectomy has little or no effect on allergy. It is being done on account of tonsillar sepsis, and no other results are to be expected. In cases of obstructive tonsillar hypertrophy in young children, unilateral tonsillectomy is indicated. T & A are two separate operations, each with their own indications. Tonsillar focality could be regarded as a qualitative alteration in tonsillar antibody formation. The treatment of recurrent tonsillitis is related to the age of the patient. The solution to the problem up to an age of about 12 is quite different from that in older people. Alternatives to surgery are immunotherapy, intermittent chemotherapy and observation.

Adenoidectomy↗
PubMed1991

[Follow-up study of secretory otitis media after adenoidectomy and tonsillectomy].

Questionnaires concerning the pre- and post- operative conditions were conducted on 92 patients with secretory otitis media who underwent adenotomy or adeno-tonsillectomy. Fifty-three patients of them further received microscopic inspection of the eardrum and hearing tests. The questionnaires indicated that episodes of fever-up or cold decreased markedly after the operations. However, even after the operations, one-third of the patients experienced acute otitis media, and one-fourth complained of nasal symptoms such as nasal obstruction and nasal discharge. About a half of the patients showed normal findings of the eardrum after the operations. Secretory otitis media was cured in almost all cases; 80% of the ears showed type A tympanograms. However, about 35% of the ears showed unfavorable prognoses after the operations; recurrence and elongated cure were found in 75% and 25% of these ears, respectively. The younger the patients, the higher the incidence of unfavorable prognosis became. Recurrence was most frequently observed in patients younger than 6-year-old, and it usually occurred 4-9 months after the operations mainly in winter. The present study suggested that patients must be followed for at least 1 year after operation and that nasal symptoms must be carefully treated in patients not older than 5 years.

Adenoidectomy↗
PubMed1976

[Technics and indications of general anesthesia for tonsillectomy and adenoidectomy. Apropos of an experience using anesthetic perfusion and cold loop technic].

The authors present the results of an enquiry carried out in University and regional hospitals in France and recall the interest of general anaesthesia with tracheal intubation during tonsillectomy. This makes possible, even in young children, the use of the technique of cold loop dissection. Its main advantage is in the absolute control of the airways which permits the operator to carry out careful hemostasis. Propanidide used in perfusion, allows these patients to wake up rapidly and the awakening is of good quality; this is essential in this type of operation.

Adenoidectomy↗
PubMed1999

Negative pressure pulmonary edema after a tonsillectomy and adenoidectomy in a pediatric patient: case report and review.

Negative pressure pulmonary edema (NPPE) continues to be reported as a complication of upper airway obstructions seen by anesthesia providers during induction or emergence. The majority of patients reported to have experienced NPPE have been healthy, without underlying pulmonary or cardiac disease. Factors associated with the formation of NPPE include young male patients and patients with long periods of airway obstruction. Overzealous intraoperative fluid administration and preexisting heart and lung disease also have been implicated as predisposing factors. Negative pressure pulmonary edema is the result of a marked decrease in intrathoracic pressure caused by ventilatory efforts against a closed glottis resulting in a disruption of the normal intravascular Starling mechanism, ultimately leading to the transudation of intravascular proteins and fluid into the pulmonary interstitium. The onset of NPPE is usually rapid, and without prompt recognition and intervention, the outcome can be fatal. A case of NPPE in a pediatric patient after an otherwise uncomplicated surgical procedure was observed in our institution and is described in this report.

Adenoidectomy↗