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PubMed2004

Electrosurgical adenoid ablation.

OBJECTIVE: The technique of adenoidectomy has undergone many refinements over the years with, most recently, the addition of electrosurgery alone as a viable method for removal of adenoid tissue. Several studies have suggested good efficacy with this method. The objective of this study is to examine the effectiveness of adenoidectomy by electrosurgical ablation by the following measures: reduction of the adenoid size, blood loss, and postoperative complications. DESIGN AND METHODS: In this prospective study, we reviewed patients who underwent electrosurgical adenoid ablation for either nasal obstructive symptoms or chronic otitis media with effusion requiring a second or greater set of pressure equalization tubes and adenoidectomy. Preoperative and postoperative videonasopharyngoscopy were performed and evaluated. A grading system for adenoid size for the endoscopic parameters was used. The amount of blood loss and postoperative complications were recorded. RESULTS: On preoperative nasopharyngoscopy, 7 of 23 children had a grade II adenoid size, 15 of 23 had grade III adenoid pads, and 1 of 23 had grade IV adenoid size. Postoperative follow-up at 6 to 8 weeks revealed that 19 of 23 children showed no evidence of adenoid tissue. Three of 23 children had only tiny residual tissue that fell into grade I and one had regrowth of tissue to fit into grade III. Eight patients were seen at 6 months postoperatively, four of whom were followed up to 12 months postoperatively; all showed no evidence of regrowth of adenoid tissue. Average blood loss for the procedure was 2.6 cc. No postoperative complications (postoperative bleed, dehydration requiring hospitalization, infection, velopharyngeal insufficiency) were encountered. CONCLUSIONS: Electrosurgical adenoid ablation is a safe method with minimal intraoperative blood loss and postoperative complications. Follow-up at 6 to 8 weeks and up to 1 year postoperatively suggests that it is an effective method in removing adenoid tissue and alleviating nasal obstruction.

Adenoidectomy↗
PubMed1988

Otitis media with effusion and tubal tonsil (video).

Carbon dioxide laser surgery was performed on children aged 5 to 11 years, on whom either adenoidectomy or tonsilloadenoidectomy had been performed to restore their hearing. We examined 177 ears 18 to 24 months after surgery. Thirty ears (17%) were diagnosed as having otitis media with effusion. Analysis of the endoscopic findings revealed 51% marked tubal tonsil hypertrophy and 33% adenoid tissue hypertrophy. Subjects were operated upon in the dorsal position for a duration of point one second at an amplitude of 15 watts. Six months after surgery, most patients' hearing had returned to almost normal. The tympanograms which were taken 6 months after surgery showed good results in almost every case. Otitis media with effusion was found to have recurred in 3 ears. The effect of adenoidectomy is apparently dependent upon age, the size of adenoids, and the influence of allergies and sinusitis. Furthermore, our cases suggested that tubal tonsil hypertrophy was one of the factors found in recurrent otitis media with effusion in older children. It can thus be inferred that endoscopic examination of the postnasal space is recommended in children with recurrent otitis media with effusion after adenoidectomy, and that carbon dioxide laser surgery is a reliable therapeutic method in the topical treatment of this disease.

Adenoidectomy↗
PubMed2003

[Serum immunoglobulin E levels in relation to Waldeyer's ring surgery].

Tonsils and the adenoid are part of Waldeyer's ring, the basic function of which is antibody formation, they react later against a great variety of antigens. Tonsillectomy and adenoidectomy procedures are among the oldest surgical procedures still performed today. The different immunoglobulin serum levels in patients having undergone extirpation of the tonsils, adenoids or both, have been studied before and after surgery by different authors, with discordant results. Immunoglobulin E (IgE) is important in allergic reactions and host defense against parasites. In this study we measured serum levels of immunoglobulin E before and 3 months after tonsillotomy, adenoidectomy, and adenotonsillectomy. There were statistically significant differences between pre and post-operative levels of serum IgE, which decreased after tonsillotomy, but we have not noticed any statistically significant differences in the IgE values after adenoidectomy and adenoidotonsillotomy with respect to those prior to surgery.

Adenoidectomy↗
PubMed2004

[Diagnosis and treatment of obstructive sleep apnea hypopnea syndrome in children].

OBJECTIVE: To discuss the methods of diagnosis and treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) in children. METHODS: 285 patients diagnosed OSAHS by X-ray for lateral rhinopharyngeal view, fibrorhinopharyngescopy and overnight polysomnography ( PSG) were reviewed retrospectively the clinical symptoms and signs. The patients whose apnea hypopnea index(AHI) > or = 5/h, blood oxygen's saturation reducing over 0.03 are diagnosed as OSAHS. 255/285 cases were performed adenoidectomy and/or tonsillectomy and 9 cases were treated with continuous positive airway pressure (CPAP). RESULTS: The major symptoms of patients with OSAHS are snoring in sleep, breathing opening mouth, apnea, hearing loss. 281/285 cases were diagnosed as adenoid and (or) tonsil hypotrophy. Two hundred- fifty five cases received surgery, adenoidectomy and tonsillectomy in 205, only adenoidectomy in 47, simple tonsillectomy in 3. The clinical symptoms of 248 cases improved evidently after operations. Improved rate is 97.2%. In 1-3 months after surgery,PSG were checked in 105 patients again: AHI, the percentage of the sleep time for saturation monitored by pulse oximetry < 0.90, the longest time of apnea are improved than pre-operation. 9 cases using CPAP received good effects, 7 of 9 cases used CPAP were in pre- and /or post- surgery. Two cases were obesity hypopnea syndrome. CONCLUSIONS: Children with OSAHS has signification them-self; PSG is the major means for diagnosing. Surgery is main method for treating; CPAP can be as the method of treating for serious OSAHS in preoperative preparation and postoperative management.

Adenoidectomy↗
PubMed1985

Influence of antecedent lymphoid surgery on the odds of acquiring rheumatoid arthritis.

The occurrence of rheumatoid arthritis (RA) and the extent of antecedent lymphoid surgeries was examined using case control study methods. Two hundred sixty-four patients with definite or classic RA were considered and 283 patients with rheumatic diseases presumably of nonimmunologic origin were used as controls. The odds for developing RA were found to be significantly higher for patients with multiple lymphoid surgeries (tonsillectomy and adenoidectomy or tonsillectomy and adenoidectomy plus appendectomy) and exhibited a gradient, increasing with more extensive surgery. Significant rank correlations were found in patients with RA between the age at tonsillectomy and the rheumatoid factor (RF) titer. An earlier tonsillectomy correlated with lower titers of RF. A significant decrease of serum RF titer was also seen in patients with RA subjected to tonsillectomy, adenoidectomy and appendectomy. We conclude that antecedent removal of lymphoid tissue from the tonsils, adenoids and appendix constitutes a risk factor predisposing to RA. Moreover, this risk seems related to the quantity of lymphoid tissue removed.

Adenoidectomy↗
PubMedDate not supplied

[Growth retardation and obstructive sleep apnea in infants].

BACKGROUND: Obstructive sleep apnea can induce growth retardation, with cardiac and/or neurologic manifestations. Tonsillectomy and adenoidectomy may improve failure to thrive. CASE REPORTS: Case n. 1: A 11 1/2-month-old boy was admitted because of feeding problems plus chronic nasopharyngeal secretions (eventually purulent) since the first months of life. He showed a low rate of weight gain since the age of 7 months and had been treated treated for gastroesophageal reflux for a few weeks. On admission, his weight was 6,220 g and his height was 70.5 cm. The tonsils were enlarged and the uvula was long. He displayed tachycardia (150/min). Polygraphic recordings during sleep showed numerous episodes of obstructive apnea. Arterial oxygen saturation (SaO2) during the night was low, frequently below 80%. Tonsillectomy and adenoidectomy immediately improved the quality of sleep. Nocturnal SaO2 and cardiac rythm improved one week later; there was a catch-up weight one month after surgery. Case n. 2: A 7-month-old boy, was admitted because chronic manifestations similar to those of case n. 1. His weight was 5,900 g and his height was 67.5 cm. He also had enlarged tonsils. He suffered from episodes of snoring and obstructive sleep apnea followed by waking and sweating. PaO2 was 70 mmHg and PaCO2 was 48 mmHg. Nocturnal SaO2 was frequently below 60%. Tonsillectomy and adenoidectomy resulted in a net improvement in sleep and weight, despite persistent episodes of nocturnal hypoxemia. CONCLUSIONS: Chronic hypertrophic tonsils and adenoids can interfere with weight gain. Growth retardation may dramatically improve after surgery, even if the tonsils and adenoids do not completely obstruct the nasopharynx.

Adenoidectomy↗
PubMedDate not supplied

Serum immunoglobulin E levels in relation to adenoid surgery.

The adenoid tissue is an immunecompetent lymphoid organ, which has the capacity of reacting against numerous antigens. We have studied the influence that the elimination of the said tissue would have on the total IgE serum levels in 33 patients of an average age of 5 and criteria of adenoidectomy and in whom these levels were measured before and after surgery. We have not noticed any statistically significant differences in the IgE values after adenoidectomy with respect to those prior to surgery, which were normal. Adenoidectomy, like other authors have observed after tonsillectomy, does not alter the IgE serum values.

Adenoidectomy↗
PubMedDate not supplied

[The tonsils and adenoids as a site of infection and the cause of obstruction].

The failure to eradicate group A beta-hemolytic streptococci from the pharynx is partly due to a low compliance, but above all, an alteration of the oropharyngeal microbiological flora: reduction of alpha-haemolytic streptococci which inhibit group A beta-hemolytic streptococci and increase of microorganisms such as Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis. These latter act indirectly destroying the beta-lactamic ring of penicillins. However, this obstacle is overcome by the use of antibiotics which do not contain beta-lactamic rings such as macrolides or associating amoxicillin with clavulanic acid or with new cephalosporins which are more resistant to beta lactamases. To restrict the diffusion of resistance to antibiotics, it is essential to limit their use diagnosing streptococcal tonsillopharyngitis more precisely, thanks to an improved use of micro-biological diagnostic tests and by a more extended use of tonsillectomy in recurrent tonsillitis (more than 6-7 in 1-2 years). Adenoiditis is closely related to the post nasal drip syndrome, to recurrent otitis media and to otitis media with effusion. All these situations could, therefore, represent an indication, although not well defined, for adenoidectomy. Nasopharyngeal obstruction due to adeno-tonsillar hypertrophy becomes critical during sleep when the hypotony of the upper airway muscles becomes additional to the anatomical obstruction. At this point the inspiratory effort required and the consequent decrease of intra airway pressure increase the pharyngeal obstruction suctioning the pharyngeal walls toward the median line. The resulting clinical picture is defined as sleep-disordered breathing (SDB) due to adenotonsillar hypertrophy (idiopathic), to be distinguished from SDB due to cranio-facial abnormalities or neuromuscular diseases. SDB includes both the more serious sleep apnea syndrome and the less severe upper airway respiratory resistance syndrome. A combination of symptoms and clinical data detectable both while awake or asleep, make the diagnosis simple. During sleep, both apnea and paradoxical inspiratory movements are highly specific while snoring is highly sensitive. To evaluate nasopharyngeal obstruction radiography and optic fibre endoscopy are both equally reliable. The gold standard test for non idiopathic SDB is the polysomnography, whereas for SDB, due to adenotonsillar hypertrophy, one is limited today to the recording during sleep of O2 saturation or of end tidal CO2. These investigations are, however, generally used up to 2 years of age, when the decision to carry out an adenoidectomy and especially a tonsillectomy is more difficult because of the greater risks which surgery involves at this age. The pharmacological therapy has a purely palliative function and is based on antibiotics, local vasoconstrictors, steroids and theophylline which acts more as an antiflogistic than as a breath stimulant. O2 therapy and nasal continuous positive airway pressure (CPAP) give better results, but are more difficult to carry out, in particular on a long term basis. Adenoidectomy especially if associated with tonsillectomy, leads to the resolution of the symptoms, but not always to a normalization of functional alterations (hypoxia and hypercapnia). For this reason, it is necessary to act on other factors which cause oedema of the nasopharyngeal mucosa contributing to the obstruction. In this area, the prevention of viral infections can be achieved by vaccination against influenza and by preventing the child from attending crowded day care centers. With regard to allergic inflammation, skin prick tests could be a first step in view of allergens avoidance measures. With regard to indoor air pollution, passive smoke must be stopped and the child kept out of the kitchen.

Adenoidectomy↗
PubMed2000

Resistant bacteria in the adenoids: a preliminary report.

OBJECTIVE: To determine the incidence of resistant bacteria in adenoid cultures from children with and without middle ear disease and rhinosinusitis symptoms. DESIGN: Children meeting the requirement for tympanostomy tube placement underwent an adjuvant adenoidectomy for symptoms of adenoid hypertrophy or recurrent rhinosinusitis. Adenoid tissue and coexisting middle ear fluid, if present, were cultured. SETTING: Tertiary referral children's hospital with community-based satellite clinics. PATIENTS: Forty-six patients ranging in age from 1 to 11 years (68% <3 years) with recurrent or persistent otitis media and symptoms of adenoid hypertrophy or rhinosinusitis (study patients) underwent tympanostomy tube placement and adenoidectomy with culture of the adenoids and middle ear effusions. Eighteen patients with adenoid hypertrophy without ear disease or rhinosinusitis were used as controls. INTERVENTIONS: Tympanostomy tube placement and adenoidectomy. MAIN OUTCOME MEASURES: Presence or absence of resistant bacteria. RESULTS: Resistant bacteria were found in cultures of the adenoids in 56% (26/46) of the study group compared with 22% (4/18) of the control patients (P<.02). Also, strains of Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis were found in cultures from 78% (36/ 46) of the study group, compared with 44% (8/18) of those from the control group (P<.01). Resistant isolates were found in 65% (23/35) of the S. pneumoniae, 37% (18/49) of the H. influenzae, and 100% (19/19) of the M. catarrhalis cultures from the adenoids or middle ear spaces. CONCLUSION: Resistant bacteria are present in significant amounts in the adenoids of children with middle ear disease and rhinosinusitis symptoms compared with patients without those diseases or symptoms.

Adenoids↗
PubMed2003

Duration of patency of laser-assisted tympanic membrane fenestration.

BACKGROUND: Laser-assisted tympanic membrane fenestration (LTMF) provides intermediate-duration middle ear ventilation, which benefits selected children with acute otitis media (AOM) and otitis media with effusion (OME). OBJECTIVE: To evaluate clinical and technical factors that may affect duration of LTMF patency. DESIGN: Prospective clinical cohort effectiveness trial. SETTING: Four tertiary care children's hospitals. PATIENTS: Volunteer sample of 251 children (430 ears) followed up at 1, 2, 3, 4, 8, and 12 weeks; time to fenestration closure was evaluable in 201 ears, and assessment of cure at study conclusion was evaluable in 128 ears. INTERVENTIONS: Laser-assisted tympanic membrane fenestration for prospectively defined AOM or OME. The surgeon determined spot size, wattage, and concurrent adenoidectomy based on clinical judgment. MAIN OUTCOME MEASURES: Cure of AOM/OME with effusion at 90 days and duration of LTMF patency relative to spot size (1.8-2.8 mm), fenestration location on tympanic membrane, power (7-22 W), concurrent adenoidectomy, age, diagnosis (AOM vs OME), type of effusion, and preoperative tympanogram characteristics. Results are based on the number of ears that could be evaluated at each data collection interval. RESULTS: Fenestrations remained patent for 2 to 4 weeks (mean = 2.52, median = 2.0, SD = 1.4, n = 201); 97.4% were closed at 6-week follow-up. Spot sizes of 2.4 and 2.6 mm had a higher rate of patency than 2.0-mm spot size at 3 weeks following LTMF. Cure at 90 days was related to duration of patency for all patients combined and for patients treated for AOM and OME, but not for those undergoing adjunctive adenoidectomy. Cure at 90 days was related to larger spot size for all patients combined and those treated for AOM. Other investigated factors did not achieve statistical significance. CONCLUSIONS: Spot size of 2.4 mm or greater results in improved duration of LTMF patency, persisting for up to 3 weeks after LTMF, especially for treatment of AOM. Increased duration of LTMF patency correlates with greater incidence of cure of middle ear effusion at 90 days. Additional investigation is indicated to determine optimum spot size and optimum duration of patency for disease- severity-adjusted populations.

Acute Disease↗
PubMed1993

The otolaryngologist and the patient with velocardiofacial syndrome.

Velocardiofacial syndrome is the most common syndrome associated with clefting of the secondary palate. The endoscopically diagnosed occult submucous cleft palate is the most common palate anomaly associated with this syndrome. Patients with velocardiofacial syndrome present a special challenge to the otolaryngologist, who must be familiar with the diagnostic and therapeutic aspects of this syndrome. We report the findings in 21 patients with velocardiofacial syndrome. Only 11 (52%) had the typical manifestations, and others had only partial phenotype. Adenoidectomy must be avoided in these patients, since undiagnosed occult and overt submucous cleft palate are the most common cause of velopharyngeal insufficiency after adenoidectomy. Three patients had aberrant carotid arteries. This anomaly must be excluded by nasoscopy and computed tomographic scanning before pharyngeal flap surgery is considered in these patients. Criteria for exclusion of high-risk patients from adenoidectomy are presented and discussed.

Abnormalities, Multiple↗
PubMed1999

Size assessment of adenoid and nasopharyngeal airway by acoustic rhinometry in children.

Adenoid hypertrophy is known as the most common cause of nasal obstruction in children; thus, adenoidectomy with, or without, tonsillectomy is one of the most commonly performed surgical procedures in the paediatric population. Although many methods have been suggested, few studies have reported on how to assess adenoid size, pre-operatively. Acoustic rhinometry is an objective technique as well as a non-invasive method, which can be easily used in young children. This study confirmed that acoustic rhinometry is a non-invasive and objective technique for assessing the geometry of the nasal cavity and nasopharynx. Forty children were evaluated using symptomology, two different radiological measurements and acoustic rhinometry; the results were compared with endoscopic findings. Clinical symptoms and A/N ratio measured with Fujioka's method significantly correlated with the endoscopic assessment findings (r = 0.769 and 0.604 respectively). Significant increases in the cross-sectional area and volume of the nasopharynx were observed at the adenoid notch after adenoidectomy (p < 0.005 and p < 0.005, respectively). Acoustic rhinometry showed a high degree of correlation of which adenoid occupied the nasopharyngeal airway under endoscopic examination (r = 0.771). Thus, the study concluded that acoustic rhinometry can be as good an objective method for measuring adenoid sizes as endoscopy and can be used as one of the pre-operative examination tools for adenoidectomy.

Adenoids↗
PubMed1995

[Middle ear ventilation with the Otovent latex membrane system].

Epidemiological studies have shown that up to 80% of all pre-school children develop Eustachian tube dysfunction with middle ear effusion and corresponding conductive hearing loss. The therapy of choice for hyperplastic adenoids is adenoidectomy, often in combination with paracentesis. The objective of this study was to determine whether regular middle ear aeration (Otovent-system) could obviate the need for paracentesis. To this end treatment of 146 children from four to ten years old was conducted within the guidelines of a study protocol. In one group of children, Otovent-supported middle ear aeration was carried out before and after adenoidectomy. In the control group, adenoidectomy was followed by paracentesis. Parents and children were then assigned to follow-up treatment. As additional supportive therapy, children in both groups received decongestant nose drops and a mucolytic agent for a period of 2 weeks. The success of the treatment was evaluated by tympanometry, tone-wave audiometry and ear microscopy. The patients were followed-up at intervals of two and four weeks after the initiation of treatment. The results show that within the study time frame, Otovent treatment compares well to paracentesis. In summary, regular Otovent-supported aeration of the middle ear in many cases can be an alternative to paracentesis.

Child↗
PubMed1999

Role of nasopharyngeal bacterial flora in the evaluation of recurrent middle ear infections in children.

OBJECTIVE: To study the nasopharyngeal colonization in otitis-prone children before and after adenoidectomy. METHODS: The study population consisted of 35 children between 11 months and 4 years of age, undergoing adenoidectomy and tube placement for recurrent acute otitis media. All these children were otitis prone (OP). During general anesthesia, bacteriologic samples were obtained from the nasopharynx and the middle ear fluid, if present. During the follow-up visit, a new nasopharyngeal culture was taken. The control population consisted of 35 children undergoing surgery for non-ear-nose-throat pathology. These children had no history of recurrent upper respiratory tract infections. RESULTS: Colonization of the nasopharynx with potential pathogens (Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae) occurred significantly more in the OP children than in the non-OP children. Adenoidectomy resulted in a substantial decrease of potential middle ear pathogens in the nasopharynx and an increase of normal commensal flora. In about half of the patients, middle ear fluid was still present at the time of tube placement; in most instances, H. influenzae was cultured. Typing with arbitrarily primed PCR indicated substantial genetic diversity among the H. influenzae isolates studied. CONCLUSIONS: Both cross-colonization (between sampling sites within the same patient and between siblings) and turnover appeared to be high.

Journal Article↗
PubMed2006

Bacterial interference of penicillin-sensitive and -resistant Streptococcus pneumoniae by Streptococcus oralis in an adenoid organ culture: implications for the treatment of recurrent upper respiratory tract infections in children and adults.

OBJECTIVES: The role of the viridans group of streptococci (Streptococcus oralis) in the prevention of colonization with Streptococcus pneumoniae was investigated in an adenoid organ culture system. METHODS: The adenoids from 10 patients who were undergoing adenoidectomy for either hypertrophy or recurrent otitis media were used. RESULTS: Streptococcus oralis Parker and S. oralis Booth (two organisms isolated from the nasopharynges of patients undergoing adenoidectomy only and patients undergoing adenoidectomy and bilateral tympanostomy with tubes, respectively) uniformly inhibited both penicillin-sensitive and penicillin-resistant S. pneumoniae. Although both strains of S. oralis inhibited the growth of both S. pneumoniae strains, strain Parker provided more complete inhibition than did strain Booth. CONCLUSIONS: The results indicate that some strains of S. oralis may inhibit the growth of the most serious pathogens in the nasopharynx. It is therefore possible that colonization of inhibitory strains of viridans streptococci may be used in the nasopharynx as a relatively safe and inexpensive approach to prevention of recurrent otitis media in some children and of recurrent suppurative sinusitis in both children and adults.

Adenoids↗
PubMed2006

Clinical manifestations and risk factors of children receiving triple ventilating tube insertions for treatment of recurrent otitis media with effusion.

OBJECTIVE: Our goal was to determine risk factors for children receiving additional ventilating tube insertions after initial tube insertion and to determine the changes of clinical manifestations in children who have undergone 3 ventilating tube insertion procedures. STUDY DESIGN: We retrospectively analyzed medical and operation records of 423 young patients who had ventilating tube insertion because of chronic otitis media with effusion from January 1993 to December 1998. The single-operation group included patients who had 1 ventilating tube insertion only, and the triple-operation group included patients who received ventilating tube insertion 3 times because of recurring chronic otitis media with effusion. RESULTS: At the first operation, there were significant differences between the single- and triple-operation groups in mean age, the proportion who received a concurrent adenoidectomy, the mean indwelling period of the first ventilating tube, the proportion who developed postoperative otorrhea within 1 month, and the proportion who had early extrusion of the ventilating tube within 3 months of surgery. In the triple-operation group, the accumulated number of adenoidectomies, the indwelling period of the ventilating tube, and the time interval before subsequent ventilating tube insertion after ventilating tube extrusion significantly increased as ventilating tube insertion procedures were performed repeatedly. Although there was no difference when compared with the single-operation group, the proportion of glue-like effusion significantly decreased as ventilating tube insertion procedures were performed repeatedly. There were no significant differences between the single- and triple-operation groups in male/female ratio, site of ventilating tube insertion, and the proportion of patients with glue-like effusion at the first ventilating tube insertion. CONCLUSIONS: The probability of receiving additional ventilating tube insertion because of recurrent otitis media with effusion significantly increased in younger patients at the time of first ventilating tube insertion. The concurrent adenoidectomy, duration of the ventilating tube, postoperative otorrhea within 1 month, and early extrusion of the ventilating tube also influenced the probability of additional ventilating tube insertion.

Child, Preschool↗
PubMedDate not supplied

A cross-national study of acute otitis media: risk factors, severity, and treatment at initial visit. Report from the International Primary Care Network (IPCN) and the Ambulatory Sentinel Practice Network (ASPN).

BACKGROUND: Treatment of acute otitis media (AOM) differs worldwide. The Dutch avoid antimicrobials unless fever and pain persist; the British use them for 5 to 7 days, and Americans use them for 10 days. If effects of therapies are to be compared, it is necessary to evaluate rates of risk factors, severity of attacks, and their influence on treatment decisions. We wanted to compare the prevalence of risk factors for AOM and evaluate their association with severity of attacks and of severity with antimicrobial treatment. METHODS: We undertook a prospective cohort study of 2,165 patients with AOM enrolled by primary care physicians; 895 were enrolled from North America, 571 were enrolled from the United Kingdom, and 699 were enrolled from The Netherlands. The literature was searched using the key words "acute otitis media," "severity," and "international comparisons." RESULTS: The prevalence of several AOM risk factors differs significantly among patients from the three country networks; these factors include race, parent smoking habits, previous episodes, previous episodes without a physician visit, tonsillectomy or adenoidectomy, frequency of upper respiratory tract infections, day care, and recumbent bottle-feeding. Dutch children have the most severe attacks as defined by fever, ear discharge, decreased hearing during the previous week, and moderate or severe ear pain. In country-adjusted univariate analyses, increasing age, exposure to tobacco smoke, day care, previous attacks of AOM, previous attacks without physician care, past prophylactic antimicrobials, ear tubes, adenoidectomy, and tonsillectomy all contribute to severity. Only country network, age, history of AOM, previous episode without physician care, and history of adenoidectomy and tympanostomy tubes are independently related to increased severity, while current breast-feeding is protective. Severity of attacks influences treatment decisions. Dutch children are least likely to receive antimicrobials, and even for severe attacks the British and Dutch physicians usually use amoxicillin or trimethoprim-sulfa; North American children with severe attacks are more likely to receive a broad-spectrum second-line antimicrobial. CONCLUSION: Dutch children have the highest ratings in all severity measures, possibly reflecting parental decisions about care seeking for earaches. When comparing groups of patients with AOM, it is necessary to adjust for baseline characteristics. Severity of episode affects physician treatment decisions. Adoption of Dutch guidelines restricting use of antimicrobials for AOM in the United States could result in annual savings of about $185 million.

Acute Disease↗
PubMedDate not supplied

[Evaluation of chronic nasal respiratory obstruction in children using optic fiber rhinopharyngoscopy and rhinomanometry].

Traditional clinical examination is frequently inadequate to evaluate children affected by chronic nasal obstruction: radiology may be of some use but it exposes children to radiation and gives only a limited lateral view of the nasopharynx. Therefore other means need to be tested for the anatomical and functional examination of the nasal and nasopharyngeal cavities. Adenoid hypertrophy and chronic nasal congestion are the most common causes of nasal respiratory impairment in children. The clinical expressions of adenoid enlargement are influenced by the osteo-cartilaginous nasal conformation and by functional alterations of nasal mucosa. Therefore a correct clinical examination is necessary to determine the indications for adenoidectomy so as to prevent unsatisfactory results. The aim of this study was to test the efficacy of rhinopharyngoscopy and rhinomanometry in the quantitative and qualitative evaluation of nasal and nasopharyngeal airways in 50 children (age-range 5-12 years) affected by nasal obstruction. Based on the rhinopharyngoscopic evaluation of adenoid volume, the children were divided into 3 groups affected by choanal obstruction defined as: severe (28 cases); partial (14 cases); minimal (8 cases). In these 3 groups anterior rhinomanometry, performed before and after administration of a nasal decongestant, allowed to evidence the role played by functional and organic factors in determining nasal stenosis. Abnormal values of total nasal resistance were found in 42 of the 50 children in the study. In 12 of these cases there was a marked decrease in nasal resistance following decongestion, evidencing the prevalence of functional factors in determining nasal obstruction and contra-indicating adenoidectomy. Rhinopharyngoscopy and rhinomanometry were well tolerated by all examined patients; the combined use of the two techniques allowed a more accurate diagnostic assessment of functional and anatomical causes of nasal obstruction in order to predict the benefits which can be obtained through adenoidectomy.

Airway Resistance↗