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At least 973 records · Page 54Linked to original sources
PubMed1997

Sickle cell disease and tonsillectomy. Preoperative management and postoperative complications.

BACKGROUND: Patients with sickle cell disease are recognized as having a relatively higher risk for postoperative complications, including fever, atelectasis, pneumonia, or sickle cell vas-occlusion. OBJECTIVE: To present a protocol for preoperative management of patients with sickle cell disease undergoing tonsillectomy, including the use of transfusions and intravenous hydration. DESIGN: Retrospective chart review. SETTING: Academic, tertiary care referral medical center. PATIENTS: Seventy-five patients with sickle cell disease who underwent tonsillectomy with or without adenoidectomy were included for review. Preoperative management was documented, and risk factors were assessed. Intraoperative management was reviewed, and postoperative complications were identified and compared with preoperative data and management. RESULTS: Preoperative management consisted of transfusions to a hemoglobin S ratio (hemoglobin S-total hemoglobin) less than 40% or a hemoglobin level greater than 100 g/L. Aggressive intravenous hydration of 1.5 times the maintenance fluid was given 24 hours before surgery. Increased complications were associated with a preoperative hemoglobin S ratio greater than 40% (P < .05) and an age younger than 4 years (P < .05). Operative time, technique, and blood loss were not statistically significant risk factors. The average length of hospitalization was 4.8 days. CONCLUSIONS: Children with sickle cell disease presenting for elective tonsillectomy should be given a transfusion to a hemoglobin S ratio less than 40% in an attempt to reduce postoperative complications. Additional factors, such as age and presence of obstructive sleep apnea, only increase the potential risks.

Adenoidectomy↗
PubMed1997

Utilization of services for otitis media by children enrolled in Medicaid.

OBJECTIVE: To provide population-based information about the utilization of ambulatory visits, antibiotic prescriptions, and surgical procedures related to the diagnosis and management of otitis media. DESIGN: A descriptive study in which utilization rates per child and per child-year were calculated. Child-year rates stratified by age were calculated only for children having at least 1 ambulatory visit with a diagnosis of otitis media. SETTING: Administrative data from Colorado Medicaid for the 1991 and 1992 calendar years. PATIENTS: All children enrolled in Medicaid who are younger than 13 years and not participating in a prepaid health care plan during the study years (n = 131,169 and n = 157,065) were included in the analysis. RESULTS: Approximately 22% of children made at least 1 ambulatory visit with a diagnosis of otitis media, with the peak prevalence (46.8%) occurring between ages 1 and 2 years. Among all children younger than 13 years enrolled in Medicaid, there were 0.5 ambulatory visits for otitis media per child (0.7 ambulatory visits per child-year), with 70% occurring in a physician office setting, 14.8% in a hospital clinic or community health center, and 15.2% in a hospital emergency department. For all children enrolled in Medicaid, the rate of antibiotic courses for otitis media was 0.34 per child (0.48/child-year). Each child with otitis media had an annual average of 1.55 antibiotic courses (1.82 antibiotic courses per child-year). The average ratio of antibiotic courses to ambulatory visits related to otitis media was 65%. There was an annual rate of 12 surgical procedures related to otitis media per 1000 children (16.6/1000 child-years). The peak rate of ventilating tube insertion occurred in children ages 1 to 2 years and for adenoidectomy in children 3 to 6 years. Mastoidectomy rates were low, 92% occurring in children older than 2 years. CONCLUSIONS: This study represents preliminary techniques to profile the care of children with otitis media. Our findings support the need to measure volatility of enrollment in an insured population before calculating rates of utilization. Additional research is needed to measure the effects of discontinuous eligibility, access to a regular source of primary care, site of treatment, and physician preferences on the quantity and quality of treatments for otitis media.

Adenoidectomy↗
PubMed2000

Cartilaginous choristoma of the nasopharynx.

A 21-year-old white male presented with persistent adenoiditis. A computed tomography (CT) scan with contrast was performed and was interpreted as normal. An adenoidectomy was performed, and histologic examination demonstrated the unexpected presence of a mature island of hyaline cartilage surrounded by lymphoid hyperplasia. The nature of this anomaly is considered in respect to the embryological development of the base of the skull and nasopharynx.

Adenoidectomy↗
PubMed1982

Adenotonsillar hypertrophy and upper airway obstruction in evolutionary perspective.

Primary care physicians have become increasingly reluctant to refer children for tonsillectomy and adenoidectomy (T and A) during the past years while antimicrobial therapy for pharyngotonsillitis and otitis media has become more common. Consequently, more children retain tonsils and adenoids throughout the childhood years. Airway compromise from adenotonsillar hypertrophy is reported in 11 cases-8 with insidious onset, 3 with acute onset. Typical symptoms occurring during sleep include snoring, snorting, enuresis and obstructive apnea. Daytime symptoms included hyponasal speech, oral respiration and morning cephalgia. Methods of assessing children with adenotonsillar hypertrophy and airway compromise included polysomnography and acoustic analysis of respiratory sounds. It appears that airway compromise from adenotonsillar hypertrophy is more common now that fewer children are undergoing T and A, is being more commonly recognized because of improved methods of assessment, or both.

Adenoidectomy↗
PubMed1979

Current management of nasopharyngeal stenosis: indications for Z-plasty.

Nasopharyngeal stenosis is not commonly seen at present. Formerly most often due to various severe infections of the upper respiratory tract, the most common current etiology is involvement of posterior pillars at the time of tonsillo-adenoidectomy. A brief review of the historical evolution of treating this problem is summarized. Various degrees of stenosis may occur with varying handicaps requiring surgical correction, utilizing plastic and reconstructive surgical techniques. Three such individuals treated by individually designed flaps with successful outcome are reviewed. Caveats regarding the primary surgical procedure and recommendations appropriate to the secondary surgical correction are outlined.

Adenoidectomy↗
PubMed2007

Extramedullary plasmacytoma of the adenoids.

Extramedullary plasmacytomas are extremely rarely diagnosed in children. We report two cases of extramedullary plasmacytoma detected coincidentally in the adenoidectomy specimens of children younger than 4 years. We show that these children are disease-free after local excision as the only treatment. Surgical treatment without anti-neoplastic therapy in pediatric plasma cell dyscrasias of the pharyngeal lymphoid tissue may be a sufficient curative therapy.

Adenoidectomy↗
PubMed1981

Temporal bone pneumatization. A planimetric study.

This present study is based on the results of a planimetric investigation of temporal bone pneumatization in 73 children (with and without middle ear pathology). Radiologic and clinical follow-up studies indicate a definite inhibition of pneumatization due to chronic secretory or recurrent suppurative otitis media. This process is partially reversible if the underlying pathologic ventilation of the middle ear spaces is cured by an adequate treatment, such as direct adenoidectomy and/or long-term middle ear ventilation (6 months indispensable).

Adenoidectomy↗
PubMed1981

[On open nasal speech following operative procedures in the oro- and nasopharynx. A combined speech and cephalometric analysis (author's transl)].

A combined speech and cephalometric analysis was performed on 60 patients with class III malocclusion to evaluate the interaction between the cranio-facial skeleton and the disorder of an open nasal speech. There was an increase of durable open nasal speech after tonsillectomy but not after adenoidectomy. This predisposition to open nasal speech in class III patients appeared to be increased by the formation of the surrounding bony structures. In dependency to the cranio-facial morphology in the vertical dimension, the configuration of the bony nasopharynx and the sagittal jaw relationship were of significant importance. The cephalometric measurements confirmed the results of the speech analysis that the position and function of the soft palate are of essential significance for the development of an open nasal speech.

Adenoidectomy↗
PubMed1979

Tonsillectomy in Manitoba: who are the patients? the surgeons? the hospitals?

Although tonsillectomy-adenoidectomy rates are declining across North America, this paper suggests they are not falling fast enough. More than half the cases coming to surgery fail to meet accepted standards regardless of who performs the surgery, or where it takes place. Family surgery is still fairly common and is almost never indicated. While younger physicians have higher standards of selection, they are not doing any less T and A surgery than their older colleagues; in fact younger general surgeons are doing more. This study concludes that non-indicated T and A surgery is still a prevalent problem, deserving of widespread attention.

Adenoidectomy↗
PubMed1982

Children and nocturnal snoring: evaluation of the effects of sleep related respiratory resistive load and daytime functioning.

Twenty-five children, age range 2 to 14 years (mean age = 7), were referred to the Stanford University Sleep Disorders Clinic for various clinical symptoms, including excessive daytime somnolence, heavy nocturnal snoring, and abnormal daytime behavior. All children (10 girls and 15 boys) were polygraphically monitored during sleep. No sleep apnea syndrome or oxygen desaturation was revealed. However, each child presented significant respiratory resistive load during sleep associated with electrocardiographic R-R interval and endoesophageal pressure swings. The most laborious breathing occurred during REM sleep. Second degree atrioventricular blocks were also noted. Tonsillectomy and/or adenoidectomy was performed in every case and resulted in a complete disappearance or substantial amelioration of the reported symptoms. Objective evaluation by Multiple Sleep Latency Test and Wilkinson Addition Test confirmed the beneficial effect of surgery.

Adenoidectomy↗
PubMed1982

The penetration of erythromycin into Waldeyer's ring--tonsil and adenoid tissue.

Erythromycin ethylsuccinate was given orally (30-60 mg/kg/day) to 72 otherwise healthy children for different intervals before adenoidectomy. The concentration of erythromycin was assessed in homogenized tissue, in whole blood and in plasma, making it possible to calculate blood-free tissue levels. The tissue levels (1.5-2.0 mg/l) were the same as the plasma levels. Six patients with chronic tonsillitis were given 1000 mg erythromycin ethylsuccinate via a gastric tube, and tonsillectomy à froid was performed three to five hours later. This unusual mode of administration was chosen to avoid tonsil surface contamination, which might cause artificially high values. The concentration of erythromycin was assessed as described above. The levels of erythromycin in the tonsil tissue were the same as the concomitant plasma levels. Erythromycin has been shown to penetrate into adenoid and tonsil tissue and to attain levels similar to the simultaneous plasma levels. It may be inferred from this study that erythromycin penetrates into other lymphatic localities to the same degree.

Adenoidectomy↗
PubMed1986

Social factors and professional attitudes as determinants of the frequency of small surgical procedures among children in Greece.

Data concerning histories of Adenoidectomy (Ad), Tonsillectomy (T) and Appendectomy (Ap) were collected from the escorts (mainly mothers) of 2296 children 3-12 years-old. The children were admitted as outpatients at the First Department of Paediatrics of the University of Athens or the Polyclinic of the Children's Welfare Center of PIKPA in Pireaus, during the last six months of 1983. Among children with median age of about six years, 12 percent had already had at least one operation (Ad, T or Ap); this proportion increased to about 25 percent among children with median age of about 10 years. The cumulative incidence of Ad and/or T was higher among boys, whereas the cumulative incidence of Ap was higher among girls. The age adjusted cumulative incidence of Ap was significantly higher in the lower social class, whereas there was no social gradient with respect to Ad or T. There were strong intra-individual correlations among the three studied operations; in particular the age adjusted cumulative incidence of Ap was 2.9 times higher among children with Ad and/or T than among children without any of these operations. Since there are no apparent biomedical reasons to account for the observed intra-individual associations, it appears likely, that these associations reflect parental or physician's attitudes leading to unjustifiable operations in some of the children.

Adenoidectomy↗
PubMedDate not supplied

Effect of adeno-tonsillectomy on hearing threshold and middle ear pressure.

Out of 50 children (100 ears) undergoing adeno-tonsillectomy, 34 ears had hearing threshold 20-50 dB (20 dB is normal) and 32 ears showed negative middle ear pressure of 100 to 400 mmH2O (100 mmH2O is normal). Post-operatively only 7 ears had hearing threshold of 20-30 dB and negative middle ear pressure of 100 to 200 mmH2O. Thus adenoidectomy improves eustachian tube functions.

Acoustic Impedance Tests↗
PubMed1988

Pharmacokinetics and clinical efficacy of intrarectal solution of acetaminophen.

Acetaminophen is frequently administered orally to children for its analgesic properties, although its potency has never been clearly evaluated in this population. In certain situations (patients vomiting or unconscious), acetaminophen has to be given rectally. However, the rectal absorption of suppositories is frequently erratic. We undertook this study first, to measure the absorption of an aqueous solution of acetaminophen administered rectally. Secondly, we evaluated acetaminophen's postoperative analgesic effects in children aged 1 to 8 years old undergoing adenoidectomy and/or tonsillectomy and compared its efficacy to meperidine. Twenty children received 20 mg.kg-1 of acetaminophen at the time of induction of anaesthesia while 20 others received 1 mg.kg-1 of meperidine intramuscularly. Thirty-two patients required meperidine in the Recovery Room. There was no statistical difference between the patients who received acetaminophen (18), and those who received meperidine (14). The absorption of acetaminophen was incomplete (peak serum concentration: 70.8 mumol.L-1) and delayed. We conclude that the rectal administration of acetaminophen at the induction of anesthesia results in incomplete and delayed absorption and does not prevent the occurrence of immediate postoperative pain in children undergoing adeno-tonsillectomy.

Acetaminophen↗
PubMed1999

Midazolam premedication delays recovery from propofol-induced sevoflurane anesthesia in children 1-3 yr.

PURPOSE: To study the effect of midazolam premedication on the recovery characteristics of sevoflurane anesthesia induced with propofol in pediatric outpatients. METHODS: Sixty children, one to three years, presenting for ambulatory adenoidectomy were randomly assigned , in a double-blind fashion, to receive either 0.5 mg x kg(-1) midazolam (Group M) or placebo (Group P) p.o. 30 min before anesthesia. Anesthesia was induced with 10 microg x kg(-1) atropine, 10 microg x kg(-1) alfentanil, and 3-4 mg x kg(-1) propofol i.v.. Tracheal intubation was facilitated with 0.2 mg x kg(-1) mivacurium. Anesthesia was maintained with nitrous oxide/oxygen (FiO2 0.3) and sevoflurane with controlled ventilation. Recovery characteristics were compared using the modified Aldrete scoring system, the Pain/Discomfort scale and measuring specific recovery end-points (emergence, full Aldrete score, discharge). A postoperative questionnaire was used to evaluate the children's well-being at home until 24 hr after discharge. RESULTS: Emergence from anesthesia (22 +/- 9 vs 16 +/- 6 min (mean +/- SD), P = 0.005) and achieving full Aldrete scores (30 +/- 11 vs 24 +/- 16 min, P = 0.006) were delayed in patients receiving midazolam. Children in the placebo group were given postoperative analgesia sooner than those in the midazolam group (18 +/- 11 vs 23 +/- 8 min, P = 0.009). More children premedicated with midazolam suffered from arousal distress (20% vs 3%, P = 0.04) and scored higher on the Pain/Discomfort scale (P = 0.004) at 20 min after arrival in the recovery room. Discharge was not affected by premedication and well-being at home was similar in the groups. CONCLUSIONS: Oral premedication with midazolam delays early recovery but not discharge after ambulatory sevoflurane anesthesia induced with propofol in children one to three years. Midazolam did not improve the quality of recovery.

Adenoidectomy↗
PubMed1997

Subhypnotic propofol does not treat postoperative vomiting in children after adenotonsillectomy.

PURPOSE: To investigate the efficacy of a subhypnotic dose of propofol to treat vomiting in children after adenotonsillectomy. METHODS: Two hundred and fifty-two children, aged 2-12 yr, underwent a standardized anaesthetic opioid administration, and postoperative care after adenotonsillectomy, adenoidectomy or tonsillectomy. A prospective, double-blinded, placebo-controlled study was performed in 70 of the patients who retched or vomited after surgery and who had intravenous access. Patients were assigned randomly to receive either 0.2 mg.kg-1) propofol (n = 35), or placebo (intralipid 10%, n = 35). RESULTS: The overall incidence of vomiting during the first 18-24 hr was 50%. Of those who had received propofol after the first episode of vomiting, 63% relapsed requiring a rescue antiemetic compared with 57% of those who had received intralipid (P = NS). Of the children who received propofol, 54% experienced pain on injection and 46% were mildly sedated compared with 3% and 11%, respectively, in the placebo group (P < 0.003). CONCLUSION: We conclude that an intravenous bolus of 0.2 mg.kg-1 propofolis not effective in the treatment of postoperative vomiting in children after adenotonsillectomy when a standardized anaesthetic with thiopentone, halothane, nitrous oxide, and 1.5 mg.kg-1 codeine phosphate is used, but it does cause sedation and pain on injection.

Adenoidectomy↗
PubMed2005

Is Helicobacter pylori really present in the adenoids of children?

Adenoid hyperplasia is a common cause of nasal obstruction in the pediatric age group. Recently, the adenoids were shown to harbor Helicobacter pylori (HP) based only on the rapid urease test (RUT). We conducted this pilot study to identify the presence of HP in the adenoids histologically and assess the reliability of both the RUT and histology in detecting HP in an extragastric location, using nested (two-steps) polymerase chain reaction (nPCR). Consecutive patients undergoing adenoidectomy for obstructive adenoid hyperplasia were enrolled. Adenoid specimens were subjected to the RUT. Histological sections stained with hematoxylin and eosin, Giemsa and Warthin-Starry were examined. We then used nPCR to detect the presence of HP in the studied specimens. Twenty-five patients (3-10 years; mean of 5.5 years) were enrolled. Twenty-one (84%) adenoids were positive by the RUT. Seventeen (68%) had bacteria on histological sections; four (16%) contained HP-like organisms. However, all specimens were negative by nPCR. No patient had a history of symptoms suggestive of laryngopharyngeal reflux within 6 months of the study. In conclusion, the children enrolled in this study did not have HP in their adenoids. High false positive results can occur with the RUT when used on adenoid tissues. It is not possible to rely solely on morphology to detect HP in an extragastric location. The nPCR remains the best way to identify HP accurately, but does not imply its presence in an active role.

Adenoidectomy↗
PubMed1988

Effects of nasal obstruction on facial development.

The relationship between nasal obstruction and facial growth is controversial. Much of the controversy relates to the lack of sophistication in quantifying nasal versus oral respiration and the lack of longitudinal data. Nevertheless, a number of studies in laboratory animals, nonhuman primates, and humans have shown a relationship between nasal airway obstruction and aberrant facial growth. In monkeys, occlusion of the nares with silicon plugs triggered deviant muscle function and altered morphogenesis. In general, the nasally obstructed animals had longer faces and unusual dental malocclusions. In human studies allergic, mouth-breathing children have longer, narrower faces and retrognathic jaws, compared with control subjects. Medical intervention has not been shown to influence the pattern of facial growth in children with allergies. Surgical therapy to relieve nasal airway obstruction in children (whether adenoidectomy or turbinectomy) has not been shown to predictably affect ultimate facial form. Therefore, although an increasing body of literature demonstrates a relationship between nasal airway obstruction and facial growth, the clinician should be cautious in prescribing aggressive therapy or in promising dramatic results.

Adenoidectomy↗