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PubMedDate not supplied

[Emergency amygdalectomy and adenoidectomy in children with upper respiratory obstruction].

Hypertrophy of the adenoids and tonsils in children sometimes produces life-threatening upper airway obstruction that requires emergency endotracheal intubation followed by adenotonsillectomy. Four patients, age range 18 months to 3 years, who required emergency treatment in the Pediatric Intensive Care Unit were studied for acute respiratory distress syndrome with cyanosis and use of accessory respiratory muscles. Two had orotracheal intubation to stabilize their cardiorespiratory situation before surgery. One presented cardiomegaly and secondary pulmonary arterial hypertension. The third remained stable and adequately ventilated with naso-hypopharyngeal ventilation. The fourth remained in intensive care for its clinical situation, but did not require exceptional measures.

Adenoidectomy↗
PubMed1979

[Adenoidectomy].

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Adenoidectomy↗
PubMed1998

[Is the laryngeal mask a viable alternative to endotracheal intubation in adenoidectomies in children?].

Based on our results and experiences, we consider the laryngeal mask anaesthesia a recommendable alternative to endotracheal intubation anaesthesia for adenotomies in children. Prerequisites with regard to the highest possible safety for the patient are specialist's knowledge, close anaesthesiological-otolaryngological cooperation and continuous clinical and apparative monitoring in order to detect possible accidental dislocations of the laryngeal mask without any delay. Using the laryngeal mask, disadvantages of endotracheal intubation, such as lesions of the vocal cords and damages to the tracheal mucous membrane can be avoided and the total time of narcosis can be reduced on average by about five minutes, particularly by shortening the recovery time of anaesthesia.

Adenoidectomy↗
PubMedDate not supplied

[Cor pulmonale caused by hypertrophic adenoid glands and tonsils: indications for tonsillectomy and adenoidectomy in a 2-year-old child].

A 23-month-old boy with the syndrome of hypoventilation, obstructive sleep-apnea, pulmonary hypertension and cor pulmonale due to chronic upper airway obstruction resulting from adenotonsillar hypertrophy, is presented. After the surgical removal of obstructing tissue rapid clinical improvement ensued and signs of cor pulmonale returned to normal within a few days. The relationship between the upper airway obstruction and hypoventilation and cor pulmonale is discussed and the importance of early recognition and removal of enlarged tonsils before life-threatening complications occur, is stressed.

Adenoids↗
PubMed1989

Chronic secretory otitis media: effects of surgical management.

To study the effectiveness of adenoidectomy and tympanostomy tubes in the treatment of chronic otitis media with effusion, we randomly assigned 578 4- to 8-year-old children to receive one of the following: bilateral myringotomy and no additional treatment (group 1), tympanostomy tubes (group 2), adenoidectomy and myringotomy (group 3), or adenoidectomy and tympanostomy tubes (group 4). The 491 who accepted surgical treatment were evaluated at 6-week intervals for up to 2 years. Treatment effect was assessed by four main outcomes: time with effusion, time with hearing loss, time to first recurrence of effusion, and number of surgical re-treatments. For the groups (in order), the mean percent of time with any effusion in either ear was 49, 35, 30, 26 (p less than .0001); the mean percent of time with hearing thresholds 20 dB or greater was 19, 10, 8, and 7 (p less than .0001) in the better ear; and 38, 30, 22 and 22 in the worse ear (p less than .0001); the median number of days to first recurrence was 54, 222, 92, and 240 (p less than .0001); and the number of surgical re-treatments was 66, 36, 17, and 17 (p less than .0001). The most notable adverse sequela, purulent otorrhea, occurred in 22%, 29%, 11%, and 24% of the patients assigned to groups 1 through 4, respectively (p less than .001). In severely affected children who have chronic otitis media with effusion resistant to medical therapy, adenoidectomy is an effective treatment. Adenoidectomy plus bilateral myringotomy lowered posttreatment morbidity more than tympanostomy tubes alone and to the same degree as did adenoidectomy and tympanostomy tubes. Adenoidectomy appears to modify the underlying pathophysiology of chronic otitis media with effusion. This effect is independent of the preoperative size of the adenoid. Tympanostomy tube drainage and ventilation of the middle ear provide adequate palliation so long as the tubes remain in place and functioning. We recommend that adenoidectomy be considered in the initial surgical management of 4- to 8-year-old children with hearing loss due to chronic secretory otitis media that is refractory to medical management and, further, that the size of the adenoid not be used as a criterion for adenoidectomy. Concomitant bilateral myringotomy with suction aspiration of the middle ear contents also should be done, with or without placement of tympanostomy tubes at the discretion of the surgeon.

Acoustic Impedance Tests↗
PubMed1988

Tonsils and adenoids. Their relation to secretory otitis media.

This study demonstrates a significant resolution of effusions which is maintained for at least 3 years. Improvement results both from adenoidectomy alone and in combination with tonsillectomy. Significant audiometric hearing gain also occurs. There is a slight but statistically insignificant trend in favour of the combined operation, compared with adenoidectomy alone. Similar improvements can be achieved by use of a ventilation tube. But re-insertion is required twice as frequently with a tube alone than in cases where it is combined with adenoidectomy or adeno-tonsillectomy. The relative rates for mortality and morbidity of ventilation tube alone, adenoidectomy or adeno-tonsillectomy are well recognised. Taking these into account and considering the findings of this study there would seem to be little additional benefit from combination of tonsillectomy with adenoidectomy compared with adenoidectomy alone. The necessity for a second or subsequent anaesthetic in cases treated with a tube alone must also be considered. These results give some support to the suggestion that the treatment of choice for established bilateral SOM may be adenoidectomy in selected cases, combined with unilateral insertion of a ventilation tube. The latter procedure effects immediate but short-lived hearing gain. Unilateral compared with bilateral insertion reduces the overall complication rate due to the tube by 50%. The former procedure effects sustained improvement which persists following extrusion of the tube. Further prospective studies are required to predict more precisely those cases in which adenoidectomy should be recommended.

Adenoidectomy↗
PubMed1995

Pilot study of outcomes in pediatric rhinosinusitis.

OBJECTIVE: To determine outcomes achieved by treating refractory pediatric rhinosinusitis with a stepped protocol of additional antibiotics, adenoidectomy, and functional endoscopic sinus surgery (FESS). DESIGN: Prospective cohort with follow-up at 2 to 3 months and at 10 to 12 months. SETTING: Hospital-based pediatric otolaryngology practice with community satellite offices. PARTICIPANTS: Consecutive 10-month sample of 41 children aged 2 to 13 years who met the following criteria: (1) roentgenographically documented sinusitis, (2) at least one 3-week course of a beta-lactamase stable antibiotic, (3) 3 months or more of clinical symptoms or three or more annual recurrences, (4) no obstructive adenoid hyperplasia, and (5) no cystic fibrosis. INTERVENTIONS: Fifteen children (37%) received additional antibiotics alone. Nonresponders underwent adenoidectomy (n = 10) when adenoids were present or FESS (n = 16) when adenoids were scant or if adenoidectomy did not provide relief (n = 2). MAIN OUTCOME MEASURES: Unblinded, oral survey of symptomatic response, caregiver expectations, and quality-of-life issues. Responses from the 12 survey questions were combined to produce a sinusitis response score. RESULTS: Caregiver expectations were met in 88% of children 1 year after treatment but were more often exceeded in patients undergoing FESS (50%) compared with those receiving antibiotics with or without adenoidectomy (13%). Functional endoscopic sinus surgery improved all major symptoms in 100% of children compared with 67% of those receiving antibiotics alone and 75% of those receiving antibiotics and undergoing adenoidectomy. In contrast, complete symptom resolution occurred in only 27% of patients, with no significant differences among groups. The median sinusitis response score of 84% was not associated with treatment level but was negatively associated with male gender. CONCLUSIONS: A stepped treatment approach to refractory sinusitis can improve quality of life for children and caregivers. Additional antibiotic therapy and adenoidectomy should be considered before FESS, even if the adenoids are nonobstructing.

Adenoidectomy↗
PubMed1983

Chronic otitis media with effusion and adeno-tonsillectomy--a prospective randomized controlled study.

Otitis media with effusion (OME) is one of the commonest, chronic otological conditions of early childhood. There is considerable variation in management in different centres throughout the world. Surgical treatment of the ears, adenoids, tonsils and sinuses is frequently employed and the condition constitutes one of the main indications for adenoidectomy and to a lesser extent for tonsillectomy. To date no randomized prospective, adequately controlled study has demonstrated the effect of these operations on established OME. The present work reports the results at 6 weeks, 3 months, 6 months, 9 months and one year following adenoidectomy and adenotonsillectomy performed randomly and prospectively with a controlled no-surgery group on a cohort of 103 children with established OME, unresponsive to medical treatment. Following adenoidectomy the rate of resolution of OME increases from 39% at 6 weeks, to 72% at one year; and following adeno-tonsillectomy the rate increases from 59% at 6 weeks to 62% at one year. In the no-surgery group the rate increases from 16% at 6 weeks to 26% at one year. Compared with the no-surgery group the effect of adenoidectomy alone at one year is highly significant (P less than or equal to 0.001) and similarly the effect of adenotonsillectomy is significant (P less than or equal to 0.01). However, there is no increased benefit from the addition of tonsillectomy compared with adenoidectomy alone. Thus adenoidectomy resolves established OME in 36-46% of cases for up to 12 months.

Adenoidectomy↗