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PubMed1991

Fiberoptic examination of the nasal cavity and nasopharynx in children.

A flexible fiberoptic nasolaryngoscope with color video camera was used to study the nasal cavity and nasopharynx in 243 pediatric patients. The size of the adenoid tissue was judged by endoscopy and classified into three types according to the distance from the vomer to the adenoid tissue. The condition of the nasopharyngeal orifice of the Eustachian tube was also classified into three types relating to the condition of adenoid tissue. Assessment was performed by correlating these measurements with the type of tympanogram, lateral X-ray and clinical complaints. The authors conclude that: (1) Fiberoptic examination allows direct visualization of the size and condition of the adenoid tissue, as well as of the condition of the nasopharyngeal orifice of the Eustachian tube. (2) The size of the adenoid tissue correlates very well with the nasal obstruction complaint as well as with the type of tympanogram. (3) The condition of the nasopharyngeal orifice of the Eustachian tube significantly corresponds with the type of tympanogram. (4) For the indication of adenoidectomy, fiberscopy gives more accurate information than standard X-ray. (5) With a correct choice of premedication and local anesthesia, it is a minor invasive technique which is very well tolerated by children. It is possible in all cases provided it is performed by a skilled endoscopist and preceded by careful explanation to the child. (6) Finally, thanks to the possibility of direct visualization of the fiberscopic image via a monitor, it allows a better explanation of the indication for adenoidectomy to the child's parents.

Acoustic Impedance Tests↗
PubMed1990

Hodgkin's disease in the nasopharynx.

Nasal obstruction due to adenoid hypertrophy is extremely common in the pediatric age group and is generally successfully treated by adenoidectomy. The case report of the incidental finding of Hodgkin's disease in an adenoidectomy specimen will be presented. Overall, for all age groups and stages of disease, fewer than 75 cases of Hodgkin's disease with nasopharyngeal involvement have been reported in the world literature. Further, fewer than 15 cases had isolated primary involvement. Although unusual, the occurrence of primary adenoidal Hodgkin's disease in our patient supports the submission of adenoidal tissue for micropathological examination when a relatively large amount of tissue is found at the time of surgery.

Adenoids↗
PubMed1993

[Prospective payment per case and length of stay at coordinated private hospitals].

BACKGROUND: In 1991 the Valencian Health Service (SVS) introduced a system of prospective payment per process to reimburse some surgical interventions to coordinated private hospitals which, until then, had invoiced by retrospective payment per hospital stay. The impact of this change on the mean length of stay in seven groups of surgical interventions is evaluated. METHODS: Retrospective analysis of the mean stay of 2025 admissions in private hospitals coordinated under both systems of payment (payment per process 66%, October 91 to February 92; payment by stay 64%, March 91 to February 92) for seven groups of surgical procedures: cataract surgery, cholecystectomy, hernioraphy, prostate resection, tonsillectomy-adenoidectomy, varicose vein and proctologic procedures was carried out. RESULTS: Mean hospital stay decreased (mean = 5.4 days; p < 0.001) in all the groups reimbursed under PRP (from 72% in proctologic conditions to 43% for adenoidectomy-tonsillectomy) avoiding 8727 stays. The coinciding period under both systems demonstrated a decrease of mean hospital stay similar to the total period. CONCLUSIONS: The coordinated hospitals demonstrated a surprisingly rapid capacity to modify their organizative behaviour or influence the styles of clinical practice or both to adopt the patterns of length of stay which optimize profits according to the system of payment used by the SVS.

Hospitals, Private↗
PubMed1995

[The endoscopic assessment of the pharyngeal opening of the auditory tube in recurrent exudative otitis media in children].

In a group of 227 children endoscopic assessment of the auditory tube function and its pharyngeal opening anatomy was performed. The mentioned group was isolated from 2965 undergoing adenoidectomy. Preoperative endoscopy revealed impaired functioning of the auditory tube and also abnormal appearance of its pharyngeal opening in 71.3% of cases. Within the group adenoidectomy wasn't effective in 32 patients.

Adenoids↗
PubMed1976

[Diagnosis and treatment of conductive deafness due to middle-ear effusion in childhood (author's transl)].

Results of follow-up examinations of 132 ears with serous or mucous middle ear effusions indicate that this disease is common in childhood and is also found in adults. In childhood adenoid growth as well as repeated catarrhal infection of the paranasal sinuses and the weakness of the levator palati play an important role in the development of middle ear effusions and deafness. With the aid of the operation microscope we were able to recognize this characteristic disease through the tympanic membrane. We perform regularly adenoidectomy together with paracentesis in this condition. In cases which had undergon several adenoidectomies we limit our treatment in the first instance to paracentesis. If cure is not so achieved we insert an inert tube into the tympanic membrane after the paracentesis. In persistent and difficult cases of glue ear radiation of the eustachion tube and antrotomy may be necessary.

Age Factors↗
PubMed2000

Snoring and obstructive sleep apnea in children: a 6-month follow-up study.

BACKGROUND: Snoring children may present symptoms suggestive of obstructive sleep apnea syndrome (OSAS). Different and controversial methods to establish the diagnosis and to choose the treatment modalities have been proposed. OBJECTIVES: To study children with symptoms raising the suspicion of OSAS with overnight polysomnography (PSG). To evaluate the efficacy of adenotonsillectomy as treatment of pediatric OSAS and to elucidate the natural history of OSAS and primary snoring. DESIGN: A controlled, prospective, nonrandomized clinical trial. SETTING: Academic medical center. SUBJECTS: Fifty-eight snoring but otherwise healthy children aged 3 to 10 years with symptoms suggestive of OSAS underwent PSG twice, 6 months apart. Thirty healthy children served as controls. RESULTS: Twenty-seven children had OSAS with an obstructive apnea/hypopnea index greater than 1, while 31 had primary snoring. There were statistical differences in the symptoms and signs among the 3 study groups. Adenotonsillectomy was curative in the 21 children with OSAS who were operated on. Obstructive apneas and hypopneas in the healthy, nonsnoring children were almost nonexistent in this study. CONCLUSIONS: Half of the children or fewer with symptoms suggestive of OSAS actually had the condition. Clinical symptoms may raise the suspicion, but it is not possible to establish the diagnosis without PSG. Because snoring and obstructive symptoms may resolve over time, a normal PSG finding may help the clinician decide on an observation period. Adenotonsillectomy is curative in most cases of pediatric OSAS. Obstructive symptoms may continue after adenoidectomy alone.

Adenoidectomy↗
PubMed2001

Influence of minor ear surgery on infrared tympanic thermometry.

BACKGROUND: Infrared tympanic thermometry (ITT) is often used for postoperative recovery room monitoring regardless of recent minor otologic surgery. OBJECTIVE: To evaluate the use of ITT in pediatric patients who have undergone bilateral myringotomy with insertion of pressure-equalizing tubes. DESIGN: A prospective cohort study. SETTING: Tertiary care academic medical center. PATIENTS: Consecutive patients of a staff pediatric otolaryngologist (M.A.R.): (1) ear surgery group, children aged 10 years or younger undergoing bilateral myringotomy with insertion of pressure-equalizing tubes and (2) non-ear surgery group, children aged 10 years or younger undergoing bilateral tonsillectomy with or without adenoidectomy. INTERVENTIONS: Immediate preprocedure temperature measurements included right and left ear ITT. Immediate postprocedure temperature measurements included right and left ear ITT and thermistor probe rectal temperature. MAIN OUTCOME MEASURES: The average difference between the preprocedure and postprocedure tympanic temperature in the ear surgery group was compared with that in the non-ear surgery group. The average difference between postprocedure rectal and ear temperature in the ear surgery group was compared with that in the non-ear surgery group. RESULTS: There were 20 patients (40 ears) in the ear surgery group and 20 patients (40 ears) in the non-ear surgery group. In the ear surgery group, the average difference between the preprocedure and postprocedure tympanic temperature (0.55 degrees C) was not significantly different from that (0.62 degrees C) in the non-ear surgery group (P =.66, 1-way analysis of variance). In the ear surgery group, the average difference between postprocedural rectal and ear temperature (1.94 degrees C) was not significantly different from that (1.89 degrees C) in the non-ear surgery group (P =.76, 1-way analysis of variance). CONCLUSION: Recent minor ear surgery (bilateral myringotomy with insertion of pressure-equalizing tubes) does not have a significant effect on ITT measurements in pediatric patients.

Adenoidectomy↗
PubMed2005

Helicobacter pylori in children who are prone to upper respiratory tract infections.

OBJECTIVE: To examine the presence of Helicobacter pylori infection in children with recurrent upper respiratory infections, including acute otitis media. DESIGN: A prospective clinical trial. SETTING: Tertiary referral center. PATIENTS: A total of 20 children who were prone to upper respiratory infections and acute otitis and who were admitted for elective adenoidectomy and/or tympanostomy were included in the study. MAIN OUTCOME MEASURES: Samples of adenoid tissue and middle ear fluid were cultured for H pylori. Serologic analysis and fecal antigen detection testing were also carried out to determine the presence of H pylori. RESULTS: The results of serologic and antigen detection tests were positive for H pylori in 4 children (20%), but cultures of adenoid tissue and middle ear fluid samples were negative for H pylori in all children. CONCLUSION: An association between H pylori infection and recurrent upper respiratory infections and otitis media could not be established.

Acute Disease↗
PubMed2006

Microdebrider tonsillotomy vs electrosurgical tonsillectomy: a randomized, double-blind, paired control study of postoperative pain.

OBJECTIVE: To examine whether microdebrider intracapsular tonsillotomy (MT) results in less postoperative pain compared with electrosurgical extracapsular tonsillectomy (ET). DESIGN: Prospective, randomized, double-blind, matched pair, clinical trial. SETTING: Specialty care hospital. Patients Twelve male (48%) and 13 female (52%) children aged 5 to 15 years, with obstructive tonsillar hyperplasia were randomized to have one tonsil removed by MT and the other by ET. INTERVENTIONS: An angled endoscopic microdebrider was used to perform MT, and ET was performed by standard monopolar cautery technique. Parents and children were blinded to the side of MT and ET. Children rated the pain 0 to 5 by side using the Faces Pain Scale-Revised. Blinded data collection was via telephone daily for 2 weeks by a study nurse. MAIN OUTCOME MEASURES: Primary: postoperative pain as recorded by Faces Pain Scale-Revised; secondary, presence or absence of otalgia and postoperative bleeding. RESULTS: Twenty-two children (88%) had tonsillectomy and adenoidectomy, while 3 children (12%) had tonsillectomy alone. On postoperative days 1 to 9, children reported significantly less pain on the MT side compared with the ET side (paired t test; P<.01). By postoperative days 10 to 14, the difference between sides disappeared. Twenty children (80%) reported otalgia, and it was always unilateral. For those children reporting otalgia, there was a 100% correlation between the side of otalgia and the side of ET. There was no posttonsillectomy bleeding among the 25 children. CONCLUSION: Microdebrider intracapsular tonsillotomy is significantly less painful compared with electrosurgical ET in children undergoing surgical intervention for obstructive tonsillar hypertrophy.

Adenoidectomy↗
PubMed1982

Elective surgery in patients with sickle cell anemia.

Between July 1977 and October 1981, nine patients with sickle cell anemia underwent tonsillectomy or tonsillectomy with adenoidectomy without operative or postoperative morbidity or mortality. Appropriate management is necessary to prevent vaso-occlusive events. The current protocol for elective surgery used at the Medical College of Georgia, Augusta, consists of the following: (1) preoperative transfusion and hydration, (2) intraoperative prevention of hypothermia and maintenance of blood volume, and (3) postoperative oxygen therapy and hydration. The critical requirement of this protocol is the preoperative transfusion of these patients with packed cells consisting of hemoglobin A erythrocytes to lower the percentage of Hb S to less than 45% as determined by quantitative hemoglobin electrophoresis.

Adenoidectomy↗
PubMed1985

Nasopharyngeal stenosis.

Nasopharyngeal stenosis in children is a serious problem. Formerly a result of syphilis, it is now more commonly seen as an unusual complication of tonsillectomy and adenoidectomy or pharyngoplasty. The surgical correction of this problem continues to be a challenge. Seven cases required surgical repair because of the severity of symptoms. A new method of repair, using a laterally based pharyngeal flap, was used with good results in six cases.

Adenoidectomy↗
PubMed1985

Airway obstruction in an immunosuppressed child.

Recipients of organ transplants who require continuous immunosuppression appear to have an increased incidence of lymphoproliferative disorders. A case of severe upper airway obstruction resulted from adenotonsillar hypertrophy in a 2-year-old girl following liver transplantation. Tonsillectomy and adenoidectomy dramatically reversed the airway problem and confirmed a transplant-associated lymphoproliferative disorder. A generalized lymphadenopathy also regressed with reduction of cyclosporine immunosuppression. We urge vigilance in monitoring transplant recipients, particularly children, for problems of upper airway obstruction and advocate prompt biopsy of persistently enlarged lymphoid tissue in all immunosuppressed individuals who fail to respond to conventional medical therapy.

Adenoidectomy↗
PubMed1986

Markedly delayed postoperative malignant hyperthermia.

Malignant hyperthermia (MH) may be triggered by exposure to commonly employed anesthetic agents and muscle relaxants, and often manifests itself during the period of anesthesia. Delayed-onset MH occurring one to four hours postoperatively has been described in isolated case reports. A case of delayed-onset MH occurred 11 hours following routine tonsillectomy and adenoidectomy. The patient demonstrated tachypnea, tachycardia, hyperthermia, and metabolic acidosis. Prompt intravenous administration of dantrolene sodium was therapeutic. Serial serum creatine phosphokinase evaluation verified the diagnosis of MH. The implications of delayed-onset MH and the importance of preoperative screening for potentially susceptible individuals are discussed.

Adenoidectomy↗
PubMed1986

Patterns of otolaryngologic surgery utilization in Syracuse, NY.

Utilization of otolaryngologic surgical procedures performed in Syracuse, NY, during 1983 and 1984 was evaluated. Both inpatient and outpatient procedures were included; classification was according to diagnosis related groups. The system-wide portion of the analysis demonstrated that 62.5% of otolaryngologic operations carried out during the study were performed in outpatient settings. Total utilization was highest for myringotomies, tonsillectomies, and adenoidectomies, over 80% of which were performed on an outpatient basis. The program-specific portion of the analysis indicated that the highest volumes for these procedures were produced by a free-standing ambulatory surgery program with dedicated facilities and staff. However, a hospital-integrated program, which made use of inpatient resources, also served a majority of total hospital cases for several types of procedures.

Adenoidectomy↗
PubMed1988

Microbiology of the tonsils and adenoids in a pediatric population.

To investigate the microbial flora of the tonsils and adenoids, the core tissue from the tonsils and adenoids of 50 children undergoing tonsillectomy and adenoidectomy for either recurrent infection or airway obstruction was cultured aerobically and anaerobically, and the number of bacterial colonies was quantitated. The most common organisms isolated were alpha-hemolytic streptococci, nonpathogenic Neisseria species, Haemophilus species, Staphylococcus aureus, and Corynebacterium species. No anaerobes were identified. Bacterial isolates from the tonsils and adenoids were similar in number and frequency of occurrence. Potential pathogenic bacteria (Haemophilus species, S aureus, beta-hemolytic streptococci, and Streptococcus pneumoniae) were identified in 40 patients. Seventy-three percent of these patients shared a common pathogen in tonsil and adenoid tissue. Haemophilus species were recovered in 54% of patients and S aureus in 46%. No significant difference exists between the type and number of pathogens in patients undergoing adenotonsillectomy for recurrent infection or obstruction.

Adenoidectomy↗
PubMed1989

Hearing loss in tympanosclerosis caused by grommets.

The aim of the present study was to determine the degree of hearing impairment caused by tympanosclerosis of the eardrum as a result of grommet insertion. During the period 1977 to 1978 we treated 146 children who had bilateral secretory otitis with adenoidectomy, insertion of a ventilation tube on the right side, and myringotomy on the left. The children were reexamined 2 to 3 years and again 6 to 7 years postoperatively, and hearing was evaluated at 250, 1000, and 4000 Hz. Tympanosclerosis was demonstrated in 59% of the children on the side with grommet insertion compared with 13% in the contralateral ear. Hearing was slightly inferior in ears with tympanosclerosis compared with ears without tympanosclerosis, but the difference was small and nonsignificant. The hearing impairment caused by tympanosclerosis was less than 0.5 dB, which is inconsequential and cannot serve as an argument against the use of ventilation tubes. However, further studies with longer observation periods are warranted.

Acoustic Impedance Tests↗
PubMed1996

Sizing up the adenoid.

In almost any operating room in the country, one is likely to see on the surgical list a procedure entitled something like "bilateral myringotomy and tympanostomy tube insertion with possible adenoidectomy" abbreviated "BMT, poss Ad" or equivalent. In practice, this means that after inserting the tubes, the surgeon will examine the nasopharynx by palpation or mirror inspection, and if the adenoid is deemed to be enlarged, it will be removed.

Adenoidectomy↗
PubMed1996

Upper airway obstruction in children with Down syndrome.

OBJECTIVES: To analyze the complex nature of upper airway obstruction (UAO) and the response to surgery in children with Down syndrome. DESIGN: Retrospective medical chart review of all patients with Down syndrome who had UAO during a 5-year period. SETTING: Academic tertiary care children's hospital. PATIENTS: Seventy-one pediatric patients with Down syndrome who had significant UAO. Thirty-four patients had pulmonary artery hypertension; 44 patients had multiple sites of airway obstruction. The obstructive problems included lymphoid hyperplasia, macroglossia, narrow nasopharynx, laryngomalacia, congenital subglottic stenosis, tracheobronchomalacia, and tracheal stenosis. INTERVENTIONS: Children with Down syndrome and UAO underwent surgical procedures including tonsillectomy, adenoidectomy, tonsillar pillar plication, uvulopalatopharyngoplasty, anterior tongue reduction, tonguehyoid suspension, laryngotracheoplasty, and tracheotomy. MAIN OUTCOME MEASURES: Postoperative symptoms found on medical chart review, or parental telephone survey, or both, and results of postoperative diagnostic tests. Patients were grouped as "improved" or having "significant residual symptoms." RESULTS: Twenty-seven of the 55 surgical patients had mild obstructive symptoms, and most improved after tonsil or adenoid surgery, or both. The remaining patients were younger and had more severe symptoms, multiple sites of obstruction, and a high incidence of cardiac disease. Eleven (39%) of the 28 patients in this group had significant residual symptoms after surgery. Four children are tracheotomy-dependent. Five deaths occurred; 3 were attributable to the upper airway. CONCLUSIONS: Upper airway obstruction in children with Down syndrome often is a complex process with multifocal causes. Residual symptoms of airway obstruction are common after surgery. A comprehensive and individualized approach is important in the management of UAO in Down syndrome.

Adenoidectomy↗