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PubMed1977

Surgery and anesthesia in Ontario.

Operative and case-fatality rates in Ontario for eight elective (discretionary) and seven nonelective (nondiscretionary) operations and the proportions of these operations and their anesthetic procedures performed by general practitioners were calculated. Cholecystectomy increased in frequency 32% from 1968 through 1973, tonsillectomy and adenoidectomy decreased 37%, and hysterectomy increased 41%. Except for colectomy the rates for nonelective operations changed only slightly over the 6 years. Case-fatality rates (hospital deaths per 10000 operations) for the discretionary operations in 1973 were as follows: extraction of lens, 23.1; tonsillectomy and adenoidectomy, 0.4 (2 deaths among 52938 operations); varicose vein stripping, 6.1; nonrecurrent inguinal herniorrhaphy, 21.9; cholecystectomy, 61.0; hemorrhoidectomy, 9.8; prostatectomy, 115.9; and hysterectomy, 9.6. In 1973 general practitioners did 32% of tonsillectomies and adenoidectomies (61% in 1971), 10 to 20% of inguinal herniorrhaphies, hemorrhoidectomies and appendectomies and 6% or less of the other operations. However, they performed 35% or more of the anesthetic procedures for these four operations as well as for varicose vein stripping, cholecystectomy and hysterectomy. Rates of general-practice surgery and anesthesia in an urban centre in Ontario were substantially less than those for the province as a whole.

Adolescent↗
PubMed2000

Postoperative tonsillectomy pain in pediatric patients: electrocautery (hot) vs cold dissection and snare tonsillectomy--a randomized trial.

OBJECTIVE: To determine the effect of the method of tonsillectomy on postoperative pain in pediatric patients. DESIGN: Prospective, randomized, single-blind, controlled clinical trial. SETTING: A university pediatric hospital in Aberdeen, Scotland. PATIENTS: A volunteer sample of 54 children, aged 3 to 12 years, with recurrent tonsillitis or symptomatic adenotonsillar hypertrophy. Two patients withdrew consent. INTERVENTIONS: Twenty-six children underwent a nonelectrical (ie, cold) dissection tonsillectomy with cold steel instruments, 5 of whom also had adenoidectomy by curettage. Monopolar diathermy forceps were used for tonsillar bed hemostasis. Twenty-four children had electrocautery (ie, hot) dissection tonsillectomy, 7 of whom underwent adenoidectomy by curettage without a suction coagulator. MAIN OUTCOME MEASURES: Postoperative analgesic consumption, time to regain normal diet and activity levels, and complications. RESULTS: Patients who underwent hot dissection tonsillectomy showed no difference in time to first drink or analgesic use within the first 24 postoperative hours compared with children undergoing cold nonelectrical dissection tonsillectomy. The hot dissection tonsillectomy group took 7.5 (95% confidence interval [CI], 1-14.1) more doses of analgesics than the cold dissection group over the next 12 days (P<.05). The hot dissection tonsillectomy group took 2.5 more days than the cold dissection tonsillectomy group to regain normal diet (P<.05). Thirteen children (54%; 95% CI, 34-74) in the hot dissection tonsillectomy group and 6 (23%; 95% CI, 7-39) in the cold dissection tonsillectomy group sought outpatient care for throat pain, otalgia, poor diet, pyrexia, and/or bleeding (P<.05). Throat pain delayed in onset or of prolonged duration affected 9 children (38%; 95% CI, 19-57) in the hot dissection tonsillectomy group as opposed to 3 children (12%; 95% CI, 0-24) in the cold dissection tonsillectomy group (P<.05). CONCLUSION: Hot dissection tonsillectomy increases morbidity in pediatric patients in the recovery period following hospital discharge.

Adenoidectomy↗
PubMed2000

Periodic fever and pharyngitis in young children: a new disease for the otolaryngologist?

OBJECTIVE: A clinical entity consisting of periodic fever associated with aphthous stomatitis, pharyngitis and cervical adenitis termed "PFAPA syndrome" in young children (<5 years old) may be unfamiliar to otolaryngologists. We present our 5-year experience of PFAPA syndrome. DESIGN: Case series. SETTING: Tertiary academic. PATIENTS: A 5-year retrospective chart review for children (<5 years old) who have undergone tonsillectomies with and without adenoidectomies was conducted. Medical records from subjects who underwent the procedures for recurrent pharyngitis were reviewed with reference to a history of periodic fever and stomatitis associated with pharyngitis. INTERVENTIONS: Tonsillectomy with and without adenoidectomy. MAIN OUTCOME MEASURE: The objective measure was a comparison of the number of visits to the primary care physician for pharyngitis associated with fever in a 3-month period before and after the surgical intervention. The subjective measure was a telephone interview evaluating preoperative and postoperative symptoms. RESULTS: Of the 117 patients identified, 22 (19%) underwent surgery for recurrent pharyngitis. Five subjects (average age, 2.5 years) were identified as having PFAPA syndrome. The average number of preoperative PFAPA-related complaints was 11.6 compared with 0.2 for the number of postoperative PFAPA-related complaints (P=.03). CONCLUSIONS: Our experience suggests that PFAPA syndrome is an uncommon disease. Most of these children have undergone workup(s) for sepsis performed by their pediatricians because of the associated high fever. The clinical history of this cohort was quite distinctive. This small sample suggests a significant decrease if not cessation of pharyngitis following surgical intervention.

Adenoidectomy↗
PubMed2002

Asymmetric tonsil size in children.

OBJECTIVE: To assess the clinical implications of asymmetrically enlarged tonsils in children. DESIGN: A prospective controlled study of asymmetric tonsil size in children scheduled for tonsillectomy with or without adenoidectomy. Data were recorded on tonsil size and position, tonsillar fossa depth, degree of asymmetry, and pathological findings. Control patients were matched for age, sex, race, diagnosis, and surgical procedure. PATIENTS: A total of 258 children, aged 2 to 18 years, scheduled for tonsillectomy with or without adenoidectomy during a 27-month period. SETTING: A tertiary care academic medical center. RESULTS: Forty-seven children (18.2%) were determined to have asymmetric tonsils. There were 43 matched controls with symmetric tonsils. Three-dimensional quantitative measurements of the resected tonsils revealed little or no actual asymmetry in tonsil size even though preoperative intraoral observations gave the impression that one tonsil was larger than the other. Statistically, tonsillar asymmetry was more apparent than real. When measured by volume, there was asymmetry in both groups. However, there was no statistical difference in the degree of asymmetry between the groups (P =.50). A difference in the depth of the tonsil fossa contributed to the putative asymmetry (P<.001). No malignant neoplasms were identified on microscopic examination in either group. CONCLUSIONS: Tonsillar asymmetry in children may often be an illusion secondary to a difference in the depth of the tonsillar fossa. Tonsillar asymmetry in children in the absence of other findings such as ipsilateral cervical adenopathy or other constitutional symptoms may not indicate a malignancy.

Adenoidectomy↗
PubMed2005

Child behavior and quality of life in pediatric obstructive sleep apnea.

OBJECTIVE: To assess behavior and quality of life in children with obstructive sleep apnea (OSA) undergoing tonsillectomy and adenoidectomy compared with control children. DESIGN: Prospective controlled study. SETTING: Hospital-based pediatric otolaryngology practice. PARTICIPANTS: Forty-two children (25 boys and 17 girls; mean [SD] age, 5.8 [2.5] years) with OSA confirmed by positive findings on polysomnography undergoing tonsillectomy and adenoidectomy and 41 control children (29 boys and 12 girls; mean [SD] age, 7.3 [3.8] years) with no history of snoring undergoing unrelated elective surgery. INTERVENTIONS: Parents completed the standardized Child Behavior Checklist and a validated pediatric OSA quality-of-life survey before and 3 months after surgery. MAIN OUTCOME MEASURES: Child Behavior Checklist T scores and score classifications and quality-of-life survey mean scores. RESULTS: Change in mean total problem T score was significantly greater in the OSA group (from 51.6 at baseline to 48.3 at follow-up) than in controls (from 45.5 at baseline to 46.7 at follow-up) (P = .03). The improvement in total T score classification (normal vs borderline or abnormal) was significant for children with OSA compared with control children (P = .009). Children with OSA had significant improvements in the quality-of-life survey mean total score and all individual domain scores compared with controls (P<.001). CONCLUSIONS: Behavioral and emotional difficulties are found in children with documented OSA compared with control children, and they improve after treatment. Large improvements in disease-specific quality of life are also found. Scores on a standardized measure of behavior assessment demonstrated significant correlation with scores on a validated quality-of-life instrument.

Adenoidectomy↗
PubMed1991

The prevention of postoperative stridor and laryngospasm with topical lidocaine.

Tonsillectomy and adenoidectomy can predispose to stridor and laryngospasm in the immediate postextubation period. A prospectively randomized study of 133 patients undergoing tonsillectomy and adenoidectomy was undertaken to determine if the topical application of 4 mg/kg of 4% lidocaine at the time of intubation would decrease the incidence of postoperative stridor and laryngospasm. Taken together, eight (12%) of 67 control patients suffered stridor or laryngospasm vs two (3%) of 66 patients receiving lidocaine. It is concluded that lidocaine administered topically at the time of intubation for adenotonsillectomy helps prevent postoperative stridor and laryngospasm. Surgery of the upper aerodigestive tract often involves not only the technical aspects of the surgical procedure but also concomitant management of the airway. This can present a challenge to even the most adept otolaryngologist and anesthesiologist. Accidental extubation is always possible, and reintubation can be difficult in the presence of blood and saliva. The difficulty is often compounded with a patient who is not completely paralyzed.

Adenoidectomy↗
PubMed1996

Antiemetic efficacy of granisetron and metoclopramide in children undergoing ophthalmic or ENT surgery.

PURPOSE: The purpose of this study was to compare the effectiveness of granisetron, metoclopramide and placebo in reducting the frequencies of retching and vomiting in children who had undergone strabismus repair and tonsillectomy with or without adenoidectomy. METHODS: In a randomized, double-blind study, 70 healthy subjects, 4-10 yr of age, were given a single dose of either placebo (saline, n = 24), metoclopramide 0.25 mg.kg-1 (n = 23) granisetron 40 micrograms.kg-1 (n = 23) iv over two to five minutes after the induction of anaesthesia. All subjects received inhalation anaesthesia with sevoflurane and nitrous oxide in oxygen. Rescue antiemetics were administered if two or more episodes of vomiting occurred. Acetaminophen pr or pentazocine iv was given as needed for postoperative pain. All subjects remained in hospital for two days. During the first three and the next 21 hr after anaesthesia, the frequencies of retching and vomiting were recorded by nursing staff. RESULTS: There was no difference among groups with regard to demographic characteristics, surgical procedures, anaesthetics administered, postoperative managements, or adverse effects. During 0-3 hr after anaesthesia, the frequencies of retching and vomiting were: placebo 62%, metoclopramide 22% and granisetron 13% (P < 0.05). The corresponding frequencies during 3-24 hr after anaesthesia were: placebo 50%, metoclopramide 39% and granisetron 13% (P < 0.05). Four children who had received placebo and three who had received metoclopramide required another rescue antiemetic. CONCLUSION: Granisetron 40 micrograms.kg-1 is more effective than either metoclopramide or placebo in reducing the frequencies of postoperative retching and vomiting during the first 24 hr after anaesthesia in children who have undergone strabismus surgery and tonsillectomy with or without adenoidectomy.

Adenoidectomy↗
PubMed1999

Sevoflurane-maintained anesthesia induced with propofol or sevoflurane in small children: induction and recovery characteristics.

PURPOSE: To compare the induction and recovery characteristics of sevoflurane anesthesia induced with either propofol or sevoflurane in pediatric outpatients. METHODS: Fifty-two children, aged 1-3 yr, presenting for ambulatory adenoidectomy were randomly allocated to receive 3 mg.kg-1 propofol i.v. or sevoflurane 8% inspired concentration for induction of anesthesia. Tracheal intubation was facilitated with 0.2 mg.kg-1 mivacurium. Anesthesia was maintained with nitrous oxide/oxygen (FiO2 0.3) and sevoflurane approximately 3-5% inspired concentration with controlled ventilation. Intubation was assessed by an anesthetist blinded to the induction method. Recovery characteristics were compared using the modified Aldrete scoring system, the Pain/Discomfort scale and measuring specific recovery times. A postoperative questionnaire was used to evaluate the children's well-being at home. RESULTS: Intubating conditions were similar in both groups. Emergence from anesthesia occurred earlier with sevoflurane for induction than with propofol (11 +/- 4 vs 17 +/- 7 min (mean +/- SD), P = 0.0002). More children in the sevoflurane group achieved full points on the modified Aldrete scoring system during the first 20 min after anesthesia (P < 0.05). However, children in the sevoflurane group scored higher in the Pain/Discomfort scale at 10 min after anesthesia (P = 0.04) and were given postoperative analgesics earlier than children in the propofol group (13 +/- 5 min vs 18 +/- 11 min, P = 0.03). The time to meet discharge criteria and recovery at home were similar. CONCLUSIONS: Induction of sevoflurane anesthesia with propofol for day-case adenoidectomy results in longer, but more calm, early recovery but does not delay discharge or affect recovery at home.

Adenoidectomy↗
PubMed2007

[Histology after adenoidectomy/tonsillectomy? No conformity in Germany concerning the histopathological examination of adenoids or tonsils in children up to the age of 10 years].

BACKGROUND: It is more and more doubted that adenoids or tonsils have to be examined histologically in pediatric cases, in which history and clinical signs and symptoms are conclusive for chronic inflammation or hyperplasia. It is unknown whether there is any conformity about this question in Germany. METHOD: The heads of all clinical departments of otorhinolaryngology (n=149) and a similar number of ENT specialists from the Berufsverband Deutscher HNO-Arzte (n=150) were surveyed by a simple questionnaire. They were asked if they would routinely send resected tissue for histopathological examination in the case of a child, up to 10 years old, presenting with a history and a status of chronic inflammation or hyperplasia and undergoing adenoidectomy or tonsillectomy. Furthermore they were asked whether they remembered any unusual or surprising report in this group of patients. RESULTS: Feedback was 79%. All tissue was sent for examination by 59% of the colleagues answering this evaluation; palatine tonsils only were sent for examination by 14%, and 27% of the physicians did not send any tissue for histological work-up. During their professional career 17% of the responding ENT specialists had received a surprising result from the histopathological examination. CONCLUSION: We do not have any consensus practiced in Germany concerning the necessity to send tissue for histopathological examination following adenoidectomy or tonsillectomy in children. It seems helpful to seek such consensus of opinion for medicolegal and socioeconomic reasons.

Adenoidectomy↗
PubMed1999

The role of acoustic rhinometry in the diagnosis of adenoidal hypertrophy in pre-school children.

UNLABELLED: Adenoidal hypertrophy is a common problem in pre-school children and diagnosis depends mostly on evaluation of clinical symptoms and signs. Investigative techniques to assess adenoidal size often do not add to this information. Recent reports have suggested a role for acoustic rhinometry in this situation. A total of 49 children consecutively referred to the Department of Otorhinolaryngology, University of Mainz, with evidence of adenoidal enlargement underwent acoustic rhinometry pre- and post-operatively and were compared to an age-matched control group from a local kindergarten school. Adenoidal size was visually estimated at surgery and questionnaires were completed by parents of symptomatic children. Acoustic rhinometry was not able to differentiate controls (mean nasopharyngeal cross-sectional area 1.34+/-0.47 cm2, n = 35) from symptomatic children admitted for adenoidectomy (mean nasopharyngeal cross-sectional area 1.66 +/- 0.83 cm2, n = 42, P = 0.53). Acoustic rhinometry was advantageous for patients with adenoidal hypertrophy in two situations. Firstly a sub-group of patients with complete nasopharyngeal obstruction could be identified (P = 0.03) and secondly all patients with a postnasal space less than 1.2 cm2 clinically benefited from adenoidectomy. CONCLUSIONS: Acoustic rhinometry, in general, is not suitable for assessing adenoidal size in pre-school children. Physical limitations of currently available acoustic rhinometers are likely to explain the limited clinical value of this investigative technique.

Acoustics↗
PubMed1980

Pulmonary function studies in adenoid hypertrophy.

Tests of pulmonary function were performed on children with severe adenoid hypertrophy, before and one month after adenoidectomy. Five types of subjects were selected: (1) normal; (2) cases with isolated increase of residual volume (RV); (3) supernormal type with increased RV; (4) obstructive type of ventilatory defect, and (5) restrictive type of ventilatory defect. Following adenoidectomy there is an objective evidence of improved pulmonary function. The data suggest that 65.7% of clinically normal children with adenoid hypertrophy show pulmonary function abnormalities.

Adenoidectomy↗
PubMed1995

Comparison of sevoflurane and halothane anesthesia in children undergoing outpatient ear, nose, and throat surgery.

STUDY OBJECTIVE: To compare the induction, maintenance, and recovery characteristics of sevoflurane and halothane in pediatric ambulatory patients undergoing adenoidectomy with or without myringotomies (BMTs). To compare the hemodynamic effects of the two drugs. DESIGN: Open, randomized study. SETTING: University-affiliated pediatric hospital. PATIENTS: 39 ASA physical status I children aged 12 months to 12 years undergoing adenoidectomies with or without BMTs. INTERVENTIONS: Patients were randomized to receive sevoflurane or halothane in 60% nitrous oxide (N2O) for induction and maintenance of anesthesia. All patients received midazolam 0.5 mg/kg orally as premedication, as well as fentanyl 1 mcg/kg intravenously (i.v.) immediately following induction. Tracheal intubation was facilitated with mivacurium 0.2 mg/kg i.v. Anesthesia was maintained with an end-tidal concentration corresponding to 1 minimum alveolar concentration (MAC) of each drug until the end of surgery, at which time all anesthetic gases were discontinued simultaneously. Emergence (extubation), recovery (Steward score = 6), and discharge times were compared among patients in both groups. Heart rate (HR) and mean arterial pressure were compared at predetermined intervals. Additional fentanyl was administered after full recovery was documented for an objective pain score of at least 6. MEASUREMENTS AND MAIN RESULTS: Emergence from anesthesia was significantly faster (7.11 +/- 3.05 minutes vs. 9.58 +/- 5.12 minutes) and recovery (19.89 +/- 10.07 minutes vs. 31.08 +/- 9.81 minutes) more rapid in the sevoflurane group. However, there was no difference in the time to meet home discharge criteria (184 +/- 49 minutes vs. 189 +/- 48 minutes). HR was consistently maintained at or above baseline in the sevoflurane group. Blood pressure was significantly more depressed after fentanyl administration in the halothane group. There were no significant differences in the incidence of postoperative vomiting between the two groups. CONCLUSION: Sevoflurane provides a faster anesthetic emergence and recovery than halothane in premedicated patients but it does not expedite meeting current home discharge criteria.

Adenoidectomy↗
PubMed2004

The role of free oxygen radicals on the development of otitis media with effusion.

OBJECTIVE: The purpose of this study was to determine if free oxygen radicals (FORs) and antioxidant enzyme activities have some role in pathogenesis of otitis media with effusion (OME) in children with adenoid hyperplasia. METHODS: Seventy-four patients were enrolled in three groups of this study. The study group (Group I) included 26 patients who had adenoidectomy with ventilation tube placement due to chronic OME. The control adenoid group (Group II) consisted of 28 age-matched patients who had adenoidectomy without ventilation tube insertion. Twenty children were included in the healthy control group (Group III). Erythrocyte malondialdehyde (MDA) levels, superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px) enzyme activities were investigated in the venous blood sample. RESULTS: Erythrocyte MDA level and GSH-Px enzyme activity in the blood samples of study group (Group I) were significantly higher than those of Group II and Group III (P < 0.05). SOD enzyme activity in the blood samples of Group I was significantly lower than Group II (P < 0.05), and were significantly higher than Group III (P < 0.05). CAT enzyme activity of Group I was significantly lower than that of Group III (P < 0.05). However, there was no statistically significant difference between Group I and Group II regarding CAT antioxidant enzyme activity (P < 0.05). CONCLUSIONS: The inflammation of the middle ear increases the level of FORs in erythrocyte. FOR level is normally maintained at a steady state by antioxidant enzymes. When the antioxidant defense system is weakened, the increased FORs may contribute to OME formation. We supposed that, antioxidant vitamins C and E, and scavenger enzymes such as CAT, SOD and GSH-Px may be added in the management of OME.

Adenoidectomy↗
PubMed2004

The role of oxidants and antioxidants in chronic tonsillitis and adenoid hypertrophy in children.

OBJECTIVE: To determine the possible role of oxidants and antioxidants in the pathogenesis of chronic tonsillitis (CT) and adenoid hypertrophy (AH) in children. METHODS: Randomized, prospective, controlled. The study group was made up of children with chronic tonsillitis and adenoid hypertrophy who are to undergo tonsillectomy and adenoidectomy. The control group was constructed with otherwise healthy children with normal ENT examination. The blood levels of antioxidants (retinol, beta-carotene, alpha-tocopherol, laycopene, ascorbic acid, superoxide dismutase, glutathione peroxidase, GSH) and peroxidation products (malondialdehyde) were determined before and 1 month after the operation in the study group and once only in the control group. These antioxidants and peroxidation products were also measured in the tonsil and adenoid tissue that were obtained during operation. RESULTS: In the study group, the blood levels of antioxidants and oxidant before and after the operation were significantly different when compared to the control group (P < 0.05). In the study group, the blood antioxidant levels increased and oxidant level decreased significantly after the operation (P < 0.05). These levels after the operation never reached those of the control group. CONCLUSIONS: Oxidants and antioxidants played a significant role in the pathogenesis of chronic tonsillitis and adenoid hypertrophy in children. These children are under significant oxidative stress. Tonsillectomy and adenoidectomy significantly decreased the oxidative stress in these patients, but could not normalize it completely. Further studies are necessary to evaluate their possible therapeutic role in preventing recurrent tonsillitis and treating postoperative patients to help normalize their blood levels of antioxidants.

Adenoidectomy↗
PubMed2005

Myofunctional evaluation after surgery for tonsils hypertrophy and its correlation to breathing pattern: a 2-year-follow up.

OBJECTIVES: To evaluate the myofunctional status in children submitted to adenoidectomy or adenotonsillectomy, correlating the pre and post-surgical patterns throughout a 24-month-period. To correlate the myofunctional alterations to the sort of surgery performed (adenoidectomy versus adenotonsillectomy) and to the predominant post-surgical breathing pattern (predominantly nasal versus allergic rhinitis). METHODS: Forty children were assessed by the otorhinolaryngologist and speech therapist before and 1-24 months after surgery. In order to evaluate myofunctional status, a pre-structured protocol was designed, which included observations regarding facial posture, tonicity, mastication, deglutition and respiration. A score from 0 (normal pattern) to 12 (highly altered) was set. RESULTS: There was a partial, but progressive decrease of the score after surgery (p < 0.001). This decrease was markedly observed during the first 6 months following surgical procedure (p < 0.001), after which it was no longer significant. There was no correlation between the myofunctional progress and the sort of surgery performed. The myofunctional improvement was more accentuated in nasal breathers when compared to those with allergic rhinitis. CONCLUSIONS: Improvement of myofunctional status seems to be observed in children after surgery. In this study, the improvement was predominantly accomplished during the first 6 months following surgical procedure. Persistent pattern of mouth breathing due to allergic rhinitis may difficult recovery of the myofunctional status. The most adequate post-surgical moment for the otorhinolaryngologist to refer the patient to speech therapist for myofunctional therapy seems to be crucial, as well as the recognition by the speech therapist of the persistence of the obstructive symptoms, re-referring this patient to the physician.

Adenoidectomy↗
PubMed2006

Identification of adenoid biofilms in chronic rhinosinusitis.

OBJECTIVE: To compare the percent mucosal surface area of adenoids removed from children with chronic rhinosinusitis (CRS) and those with obstructive sleep apnea (OSA) infected with biofilms. DESIGN: Comparative micro-anatomic investigation of adenoid mucosa using scanning electron microscopy from patients with CRS and OSA. SUBJECTS: 4 females and 12 males ranging from 3 months to 10 years of age. RESULTS: Adenoids removed from patients with CRS had dense mature biofilms covering the mucosal surface. More specifically, adenoids removed from patients with CRS had an average of 94.9% of their mucosal surface covered with mature biofilms vs. an average of 1.9% coverage on the adenoids removed from patients with OSA. These differences were statistically significant at the p<0.001 level. CONCLUSIONS: It is well established that adenoidectomy is useful in the treatment of CRS resistant to antibiotics. Adenoids removed from patients with CRS had almost their entire mucosal surface covered with biofilms vs. scant coverage for patients with OSA (p<0.001). Decreased metabolic activity, decreased growth rate, and transmission of resistance genes all contribute to the antibiotic resistant nature of the biofilms. These metabolically sessile communities shed planktonic microorganisms on an intermittent basis. Therefore biofilms in the nasopharynx of children with CRS may act as a chronic reservoir for bacterial pathogens resistant to standard antibiotics. Also, the mechanical debridement of the nasopharyngeal biofilms may explain the observed clinical benefit associated with adenoidectomy in this subset of pediatric patients.

Adenoidectomy↗
PubMed2004

The role of oxidants and antioxidants in otitis media with effusion in children.

OBJECTIVE: Determine the possible role of oxidants and antioxidants in the pathogenesis of otitis media with effusion in children. STUDY DESIGN AND SETTING: Randomized controlled trial, tertiary referral center. The study group was made up of children with otitis media with effusion who were to undergo bilateral ventilation tube insertion and adenoidectomy. The control group was comprised of otherwise healthy children. The blood levels of antioxidants (retinol, beta-carotene, alpha-tocopherol, laycopene, ascorbic acid, superoxide dismutase, glutathione peroxidase, GSH) and oxidation products (malondialdehyde) were determined before and 1 month after the operation in the study group and once only in the control group. These substances were also measured in the adenoid tissue and middle ear fluids. RESULTS: In the study group, the blood levels of antioxidants and oxidants before and after the operation were significantly different when compared with the control group (P < 0.05). In the study group, the blood antioxidant levels increased and oxidant levels decreased significantly after the operation (P < 0.05). The levels after the operation never reached those of the control group. CONCLUSIONS AND SIGNIFICANCE: Oxidants and antioxidants played a significant role in the pathogenesis of otitis media with effusion in children. These children are under significant oxidative stress. Insertion of a ventilation tube and adenoidectomy significantly decreased the oxidative stress in these patients, but could not normalize it completely. Additional studies are necessary in the clinical use of antioxidants in otitis media with effusion.

Adenoidectomy↗
PubMed2003

[Cost-efficiency analysis of treatment of otitis media with effusion in children].

Otitis media with effusion is a common disorder in children, associated to hearing loss and recurrent acute otitis media. It has three basic treatments: Spontaneous resolution, oral antibiotics and surgery including adenoidectomy and/or grommets insertion. Through a sensibility analysis on a theoretical group of 1000 patients our aim is to study the cost-effectiveness of the different therapeutic options, evaluating direct and indirect costs, and identifying the most efficient option (cost-effective). We analysed effectiveness and variable costs of each arm of the decision tree, considering initial and rescue treatments. As expected, effectiveness grows up to the most through treatment, including adenoidectomy and grommets insertion, from 92% to 98% of children treated. Nevertheless, unitary cost of each child treated also increases, from 302 to 401 euros; that is, choosing the most cost-effective treatment enables to save approximately 100 euros per child. But, fixed costs, which are much higher (600 euros per child), will not change, limiting our management resources.

Adenoidectomy↗