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PubMed2006

Improvements in quality of life in children after surgical therapy for sinonasal disease.

OBJECTIVES: To study changes in quality of life in children with chronic sinonasal disease after surgical therapy. STUDY DESIGN AND SETTING: Prospective, nonrandomized quality of life study of children with sinonasal disease who undergo adenoidectomy or functional endoscopic sinus surgery (FESS) at an academic institution. Caregivers completed a preoperative SN-5 quality of life survey and a second survey within 6 months after surgery. RESULTS: Twenty-two children were enrolled in the study (mean, 6.5 years; range, 1.4 to 15.9). The majority (59%) of children underwent adenoidectomy. The mean total score was 25.8 at initial presentation and 12.0 at follow-up (P>0.001). Postoperative scores for all domains were significantly different from preoperative scores. The domains with the greatest change in mean score were nasal obstruction and emotional distress. There were no significant differences in outcome between children who underwent adenoidectomy and those who underwent FESS. CONCLUSIONS: After either adenoidectomy or FESS, caregivers report a dramatic improvement in the quality of life of children with sinonasal disease. EBM RATING: B-3b.

Adenoidectomy↗
PubMed1999

Obstructive sleep apnea in children with achondroplasia: surgical and anesthetic considerations.

OBJECTIVE: To evaluate the prevalence of obstructive sleep apnea in a large population of children with achondroplasia and to evaluate the effectiveness of adenoidectomy and/or tonsillectomy as treatment. METHODS: Retrospective review of 95 children with achondroplasia. RESULTS: Thirty-six patients (38%) had clinical evidence of obstructive sleep apnea. Thirty-four patients underwent surgery, with more than 1 procedure required in 10 children (29%). Adenotonsillectomy was the initial procedure for 22 of 34 patients, and further therapy was required in only 18% of this group. Adenoidectomy was the initial procedure for 10 of 34, with 90% requiring further surgery for recurrent obstructive sleep apnea. Tonsillectomy alone was performed in 2 patients: 1 was effectively treated and 1 later required adenoidectomy. Endotracheal intubation was accomplished in all patients without complication; 53% required a smaller endotracheal tube than would be predicted by their age. Eight postoperative complications were recorded. CONCLUSIONS: Obstructive sleep apnea is very common in children with achondroplasia. Surgery is effective, but recurrent symptoms are common, particularly when the initial procedure is adenoidectomy. The complication rate is higher than that observed in a general pediatric population but is readily managed with standard therapy. Anesthesia can be given safely to these patients with special consideration for limited neck extension and appropriate endotracheal tube size.

Achondroplasia↗
PubMed1993

A randomized study of the surgical management of children with persistent otitis media with effusion associated with a hearing impairment.

The object of this study was to compare the effect on the hearing of the insertion of a grommet, with or without adenoidectomy, against a non-surgically managed control ear in children with persistent hearing impairment due to otitis media with effusion. Seventy-eight children (44 boys, 34 girls, mean age 5.8 years) with documented bilateral otitis media with effusion associated with a bilateral hearing impairment (pure tone average air conduction thresholds over 0.5, 1 and 2 kHz of > or = 25 dB HL) over a three month period were admitted to a randomized, controlled trial. Each child was randomized to have or not to have an adenoidectomy. The ears in each child were then randomly allocated to have a grommet (tympanostomy tube) inserted. The children's hearing status was reviewed six and 12 months post-operatively. During follow-up, should a child redevelop a persistent bilateral hearing impairment (as defined above) for three months they were managed with a hearing aid. Thus no child had repeat insertion of a grommet. Surgery of each type had an effect on the hearing and the presence of otitis media with effusion at six months post-operatively but not at 12 months when it was no different from natural resolution. If resolution of the otitis media with effusion is the outcome measure, then adenoidectomy alone is significantly better than no surgery but only in boys rather than in girls. Even in boys it only resolves about 60 per cent of effusions. However, when combined with a grommet (one insertion) adenoidectomy gives no greater resolution (89 per cent compared with 86 per cent).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoidectomy↗
PubMed1999

Surgical management of obstructive sleep apnea in children with cerebral palsy.

OBJECTIVES: To evaluate the surgical management of obstructive sleep apnea in children with cerebral palsy. STUDY DESIGN: Retrospective review of 27 children with cerebral palsy who underwent surgical treatment for obstructive sleep apnea. METHODS: Charts were reviewed. Data gathered included primary complaint, coexisting illnesses, initial procedure performed, age at initial surgery, number of days the child was monitored postoperatively in the intensive care unit, notation of postoperative respiratory distress and management, and outcome. RESULTS: Nineteen children underwent adenotonsillectomy for initial treatment of obstructive sleep apnea. Three of these children also had a uvulectomy. Six children had an adenoidectomy alone as their initial procedure. Neither uvulopalatopharyngoplasty nor tracheostomy was performed as an initial procedure. Mean follow-up was 34 months. Seventy-six percent of these children have not required any further surgery. Of the six children who have undergone further surgery, one has required a revision adenoidectomy, and another underwent a tonsillectomy and uvulectomy 2 months after the initial adenoidectomy. Four children ultimately required a tracheotomy. CONCLUSIONS: Eighty-four percent of these children were successfully managed without a tracheotomy. We recommend tonsillectomy and/or adenoidectomy for initial surgical treatment of obstructive sleep apnea in children with cerebral palsy.

Adenoidectomy↗
PubMed2004

Surgical management of chronic sinusitis in children.

OBJECTIVES/HYPOTHESIS: The objective was to compare three common surgical modalities in children for the treatment of chronic sinusitis that is refractory to medical management. STUDY DESIGN: Prospective nonrandomized study in a pediatric otolaryngology tertiary service. METHODS: Two hundred two children who satisfied criteria for surgery and were referred over a 10-year period were studied. Children were divided into three surgical groups. Group 1 had both endoscopic sinus surgery and adenoidectomy, group 2 had endoscopic sinus surgery alone, and group 3 had adenoidectomy. After a follow-up period of 12 months, improvement of symptoms was assessed. RESULTS: One hundred eighty-three children had adequate follow-up. Eighty seven percent of children in group 1 had improved symptoms, compared with 75% in group 2 and 52% in group 3 (P < .0001). Multivariate analysis showed that surgical procedure was a predictor of success. Asthma, smoke exposure, and age were independent predictors of success. CONCLUSION: Children who fail medical therapy benefit from surgery. Following certain criteria, one can chose between adenoidectomy alone or endoscopic sinus surgery with adenoidectomy to optimize surgical treatment of these children.

Adenoidectomy↗
PubMed1992

The effect of adenoid and tonsil surgery on nasalance.

The change in nasalance following adenoidectomy, tonsillectomy and adenotonsillectomy was studied in 44 children. A subjective assessment of each child's naso-pharyngeal airway was made preoperatively based on a questionnaire completed by the parents. There was no significant change in the nasalance of children following adenoidectomy, but there was a significant increase in the nasalance following tonsillectomy (P = 0.02) and after adenotonsillectomy (P = 0.001). There was no relationship between the change in nasalance and the adenoid volume removed at operation. There was good agreement between the parental subjective assessment of the naso-pharyngeal airway and the preoperative nasalance score, with the best correlation in the adenoidectomy group (r = -0.8) and the adenotonsillectomy group (r = -0.7). Nasalance is more closely related to the size of the naso-pharyngeal airway than to the actual adenoid volume, and measurements of nasalance are of no benefit in predicting adenoid volume. Tonsillectomy had a significantly greater effect on nasalance than adenoidectomy, and adenotonsillectomy had the greatest effect. Further studies are needed to relate nasalance to the size of the naso-pharyngeal airway, but it appears to relate well to the subjective assessment of the airway and may be of use in patient selection for surgery.

Adenoidectomy↗
PubMed2006

How we do it: laser reduction of peri-tubal adenoids in selected patients with otitis media with effusion.

. The literature supports the benefit of adenoidectomy in patients with otitis media with effusion (OME). . It is difficult to clear adenoid tissue from around the Eustachian tubes using curettes and this conventional method of adenoidectomy is contra-indicated in patients with cleft palates. . Laser reduction of peri-Eustachian adenoid tissue without myringotomies or grommet insertion was performed in three patients with OME. Two patients had previous adenoidectomies performed with curettes and one patient had a cleft palate. . In all three patients, the OME resolved and all had closure of the air-bone gap that was maintained during long-term follow-up (14 months-4 years). . This technique resolved OME without the need for myringotomies or grommet insertion and should be considered particularly in patients who have peri-tubal recurrence of adenoidal tissue following conventional adenoidectomy or in patients with cleft palate where there is concern with regards to palatal incompetence.

Acoustic Impedance Tests↗
PubMedDate not supplied

Influence of adenoid hypertrophy on secretory otitis media.

The prognostic influence of adenoidectomy on the clinical course of chronic secretory otitis media (SOM) is reported after an observation period of five years in 166 children. Adenoidectomy was performed in connection with the first tubulation on the basis of concurrent symptoms of nasal obstruction, and resulted in a significant reduction in the need for repeated insertion of tympanostomy tubes in patients younger than eight years of age. The tubulation rate was also significantly reduced when adenoidectomy was performed in association with the first recurrence of SOM. This effect was, however, absent when the operation was performed at later stages, and both the otoscopic and audiological findings after five years revealed no significant differences between the adenoidectomy and nonadenoidectomy groups. Possible pathogenetic mechanisms leading to the development of SOM in the presence of large adenoids are discussed.

Adenoidectomy↗
PubMed1992

Anatomic correlates of normal and diseased adenoids in children.

In order to better understand the pathogenesis and sequelae of obstructive adenoid hyperplasia in children, the anatomic relationships of the adenoids to the hard and soft palates, oropharynx, and nasopharynx were studied in vivo in 94 children. Direct, intraoperative palatal, nasopharyngeal, and oropharyngeal measurements were performed in 19 children with normal, nondiseased adenoids (controls [C]) and compared to 75 children undergoing adenoidectomy for obstructive adenoid hyperplasia (OAH) (n = 44) or chronic adenoid infection (CAI) (n = 31). As expected, the weight and volume of the adenoids removed were significantly greater in the OAH vs. CAI group (P < .001). Before adenoidectomy, the volume of the nasopharynx was significantly smaller in the OAH group; however, nasopharyngeal volumes after adenoidectomy were quite similar in all three groups and ranged from 5.4 to 6.2 cc. Only the change in the volume of the nasopharynx after adenoidectomy for obstruction was significant (2.5 +/- 1.2 cc, P < .01). Differences in oropharyngeal and palatal dimensions were not associated with longstanding obstruction from adenoid hyperplasia. These data indicate that the nasal obstruction from adenoid hyperplasia is due to an absolute increase in adenoid size rather than a relatively smaller nasopharynx. Differences in palatal and oropharyngeal dimensions usually described and attributed to longstanding nasal obstruction could not be demonstrated in this study.

Adenoidectomy↗
PubMed1988

Etiological role of adenoids upon otitis media with effusion.

To clarify the etiological role of adenoids in OME, the effects of adenoidectomy on Eustachian tube function and nasal sinusitis were examined. Adenoids were found to exert no influence upon tubal opening pressure, nor patency of the Eustachian tube in a static condition. Active function of the tube during swallowing, however, was improved significantly by the adenoidectomy. In addition, adenoidectomy improved nasal sinusitis, and in such patients, their active tubal function was satisfactory. From these results, adenoidectomy was considered to cure OME, partly via improvement of the pathological condition of the nasopharynx represented by nasal sinusitis.

Adenoidectomy↗
PubMed2000

Adenoids and tonsils, indications for surgery and immunological consequences of surgery.

Tonsillectomy and adenoidectomy procedures are among the oldest surgical procedures still performed today. Tonsils and adenoids are part of Waldeyer's ring, the basic function of which is antibody formation. Because of their location at the portal of entry of many airborne and alimentary antigens, the tonsils and adenoids often have been considered as the first line of defense against respiratory infections. Indications for adenoidectomy or tonsillectomy are to date still controversial. The two main indications for tonsillectomy are upper airway obstruction due to tonsillar hypertrophy and recurrent acute or chronic tonsillitis. Adenoid hypertrophy with upper airway or eustachian tube obstruction and recurrent acute or chronic adenoiditis or otitis media are main indications to perform an adenoidectomy. The possible immunological effects of tonsillectomy and adenoidectomy are still controversial. Some authors have found changes in immunoglobulin levels after tonsillectomy, while others failed to find significant changes. In a review of long-term follow-up studies, the authors showed that while tonsillectomy may lead to certain changes in the cellular and humoral immune system, these alterations are clinically insignificant and no increased frequency of immunomodulated diseases should be expected.

Acute Disease↗
PubMed2004

Rhinopharynx endoscopy in the diagnosis of chronic otitis media with effusion in infancy.

Chronic otitis media with effusion is an inflammatory process of the mucosa of the middle ear persisting for more than 3 months, being most frequent in infancy, and is correlated with marked tube obstruction. In infancy, the most frequent cause of this obstruction is adenoid hypertrophy and diagnosis, clinical or radiological, is often not confirmed by rhinopharynx fiberendoscopy. Since, in these cases, treatment is often surgical, it is possible that small patients may be submitted, unnecessarily, to adenoidectomy. In collaboration with the Paediatric Clinic, the present study on an infant outpatient population with nasal respiratory difficulty, associated with chronic otitis media with effusion, was, therefore, aimed at standardizing the endoscopic diagnosis of patients with suspected adenoid hypertrophy. Between October and December 2002, 32 consecutive patients, aged between 4 and 11 years, all oral breathers with OME, were sent to our attention from the Paediatric Clinic. All those patients, with indication for adenoidectomy, have been enrolled in the study and submitted to fiberendoscopic examination of the external ear and nose. Nasal respiration was confirmed with active anterior rhinomanometry. Endoscopic evaluation of the rhinopharynx, aimed at assessing adenoid dimensions and their relationship with the auditory tube, has been expressed in four degrees of increasing severity and adenoidectomy was indicated in those cases, classified, by us, as third and fourth degree. In our experience, endoscopic examination of the rhinopharynx has, however, shown that only 9 children (28.2%) presented an absolute need to undergo adenoidectomy since they were carriers of massive adenoid hypertrophy with tubal obstruction and consequent bilateral glue ear (3rd and 4th degree) while, in all other cases (71.8%), the clinical and radiological findings did not correspond to endoscopic data. Diagnostic accuracy that characterizes rhinopharyngeal fiberendoscopy is, therefore, in our opinion, of fundamental importance to avoid these errors, as far as possible, and in establishing an appropriate therapeutic programme.

Adenoidectomy↗
PubMed2005

[Surgical treatment of obstructive sleep apnea hypopnea syndrome after velopharyngeal ring ligation procedure].

PURPOSE: To evaluate the effect of removal of ligation thread combined adenoidectomy in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) after velopharyngeal ring ligation procedure (VRLP). METHODS: The upper airway was examined with dynamic fiberoptic pharyngoscope in six patients with cleft palate who were diagnosed as OSAHS by polysomnography(PSG) after VRLP. All the patients underwent removal of ligation thread and adenoidectomy. Three months after operation, they were recalled back and were examined with polysomnography and dynamic fiberoptic pharyngoscope. The preoperative and postoperative PSG data were analysed with t test and chi-square test to determine the statistical differences. RESULTS: In patients with OSAHS after VRLP, a ring scar was observed on the upper airway at the soft palate level and a remarkable narrow nasopharyngeal meatus was found mainly because of adenoidal hypertrophy. After removal of ligation thread and adenoidectomy, no velopharyngeal incompetence was found, the upper airway morphology was smooth, respiration disorder during sleeping was completely disappeared and sleep architecture became normal. There were significant differences between preoperative and postoperative PSG data. CONCLUSION: Removal of ligation thread combined adenoidectomy was an effective treatment for OSAHS after VRLP.

Adenoidectomy↗
PubMed2003

Analysis of efficiency of common otolaryngology operations: comparison of operating room vs short procedure room in a pediatric tertiary hospital.

OBJECTIVE: To compare the operative times of routine otolaryngologic procedures performed with 2 different operating room staffing models: the traditional model with 2 staff, a scrub nurse and a circulator, and the short procedure room (SPR) setting, with a circulator only. DESIGN: Retrospective comparison of operative procedure times. Data were extracted from a prospectively maintained database of electronic medical records. SETTING: All data were from procedures performed at a tertiary care children's hospital operating room suite. PATIENTS OR OTHER PARTICIPANTS: Data for the year 2000 were extracted for all outpatient otolaryngology cases of bilateral myringotomy and tube placement (BMT), tonsillectomy and adenoidectomy (TA), and adenoidectomy alone. MAIN OUTCOME MEASURES: The mean +/- SD operative time intervals (operative procedure times and total operative procedure time), anesthesia start times, surgical preparation times, and anesthesia end times of the 2 sites were compared. These time intervals were also compared for the 3 surgeons performing TAs in both settings. RESULTS: Total operative procedure times were significantly shorter in the SPR setting for TA and BMT, but not for adenoidectomy. For TA procedures, operative procedure times and anesthesia end times were significantly shorter in the SPR setting (P<.05). For BMT procedures, all operative times were significantly shorter in the SPR setting. All 3 surgeons who performed TAs in both settings had significantly shorter total operative procedure times in the SPR setting than in the traditional setting. CONCLUSIONS: Despite fewer assisting staff, the SPR setting showed a statistically significant reduction in total operative procedure times for TA and BMT, and results were similar for adenoidectomy. Reducing operating room personnel costs is possible in addition to achieving modest gains in efficiency.

Age Factors↗
PubMed2000

Respiratory difficulty following bismuth subgallate aspiration.

Bismuth subgallate, an agent that initiates clotting via activation of factor XII, has been advocated for use in controlling bleeding during tonsillectomy and adenoidectomy. Direct aspiration of bismuth has produced pulmonary complications in laboratory animals, but no clinical correlation in humans has been previously described. We report 2 cases of bismuth aspiration that resulted in respiratory difficulty after tonsillectomy and adenoidectomy. Neither child's respiratory compromise required airway intubation. This report of pulmonary complications secondary to bismuth aspiration should alert surgeons to the potential for airway problems when using bismuth as a hemostatic agent for tonsillectomy and adenoidectomy.

Adenoidectomy↗
PubMed2006

Temperature-controlled radiofrequency treatment of tonsillar hypertrophy for reduction of upper airway obstruction in pediatric patients.

OBJECTIVES: To determine if temperature-controlled radiofrequency (TCRF) tonsil reduction and adenoidectomy (TCRF&A) and conventional tonsillectomy and adenoidectomy (T&A) are statistically similar in outcome and to compare morbidity between TCRF&A and conventional T&A. DESIGN: Randomized control trial. SETTING: Tertiary care children's hospital. PARTICIPANTS: The study population comprised 23 patients aged 2.6 to 12.5 years with symptoms of obstructive sleep apnea, hypertrophic tonsils with no other areas of upper airway obstruction with the exception of hypertrophic adenoids, and a body mass index (calculated as weight in kilograms divided by the square of height in meters) of less than 30. INTERVENTION: Temperature-controlled radiofrequency tonsil reduction (mean +/- SD, 12.6 +/- 1.5 ablations per patient and 994.68 +/- 91.88 J per insertion) and adenoidectomy or traditional bovie T&A. MAIN OUTCOME MEASURES: Primary outcomes were respiratory distress index and total volume reduction. Secondary outcomes include postoperative pain, daytime sleepiness, speech and swallowing problems, weight and diet, narcotic use, and analogue snoring scale. RESULTS: The respiratory distress index difference for TCRF&A was 5.63 vs 6.56 for standard T&A. On postoperative day 1 for the 13 patients who underwent TCRF&A, 0 reported severe pain, 11 (85%) had mild to moderate pain, and 2 (15%) had no pain. In the 10 patients who underwent standard T&A, 1 (10%) had severe pain and 9 (90%) had mild to moderate pain. By postoperative week 1, all TCRF&A patients experienced mild or no pain, whereas 1 (10%) of the standard T&A patients still had moderate pain. Mean visual analogue snore scores (0-10) 4 weeks after surgery were less than 1 for both groups. The mean +/- SD weight loss at postoperative week 1 for TCRF tonsil reduction patients was 1.0 +/- 3.5 lb (0.45 +/- 1.58 kg) vs 4.6 +/- 3.9 lb (2.07 +/- 1.76 kg) for standard T&A patients. Return to normal diet at postoperative week 1 occurred in 11 TCRF&A patients (85%) and 0 standard T&A patients. CONCLUSIONS: The respiratory distress indexes were similar for TCRF&A patients and standard T&A patients. In addition, there were similar analog snoring scales, decreased pain, and weight loss.

Adenoidectomy↗
PubMed1982

Nasal obstruction. Adenoiditis vs adenoid hypertrophy.

The terms "adenoiditis" and "adenoid hyperplasia" are often used interchangeably to describe posterior nasal obstruction in children, tending to obscure indications for adenoidectomy. To more clearly define the role of the adenoid bed in nasal obstruction and its relationship to aural disease, we examined tissue obtained at adenoidectomy from 22 children via the quantitative bacteriological technique. In three patients, adenoidectomy was performed for nasal obstruction alone, in nine patients for serous otitis media and nasal obstruction, and in ten patients for nasal obstruction with serous otitis media and recurrent bacterial otitis. Using the criteria that 10(5) bacteria per gram of tissue indicates infection, 90% of the patients in the last group had infected adenoids vs 8% of the patients in the first two groups. Quantitative immunoglobulin levels, WBC counts, or preoperative antibiotic therapy was not helpful in determining which patients had infected adenoids. Pressure-equalizing tubes were placed when appropriate. A follow-up of nine to 22 months is included.

Adenoidectomy↗
PubMed1991

Mandibular and maxillary growth after changed mode of breathing.

The amount of maxillary and mandibular growth and the direction of maxillary growth were studied in 38 children during the 5 years after adenoidectomy for correction of severe nasopharyngeal obstruction. The amount of mandibular growth measured between successive gnathion points on superimposed radiographs was significantly greater in the group who had an adenoidectomy than in the matched controls. In the boys the difference was 3.8 mm (p less than 0.001), and in the girls the difference was 2.5 mm (p less than 0.01). The boys also showed a tendency toward greater growth in the maxilla as measured between successive subnasal points (1.2 mm, p less than 0.05). We detected no difference in the direction of maxillary growth between who had undergone adenoidectomy and the controls.

Adenoidectomy↗