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PubMed1979

The occurrence of negative middle ear pressure in children: an analysis of supposed associated factors.

This study analyzed the occurrence of negative middle ear pressure in various groups of children by comparing them with control groups. A screening procedure recording middle ear pressure and screening audiogram was performed several times throughout the year in an unselected group of 352 seven-year-old children. From about 4000 measurements of middle ear pressure an average value for each child was calculated. By applying thresholds of pathology of -160 mm H2( and -240 mm H2O, the occurrence of pathology in the different groups was analyzed. A medical history of each child was obtained by questionnaires answered by parents, giving information concerning allergy, previous adenoidectomy, previous exposure to respiratory tract infections and the social group of the family. A score of dental caries was obtained in each child. Furthermore, the relationship to antibiotic treatment and the child's use of swimming pools was analyzed, based on single measurements. The use of swimming pools seems to be beneficial to children suffering from a negative middle ear pressure. However, the other variables showed no relationship to negative middle ear pressure. It is concluded that other unknown factors must be involved in the development of negative middle ear pressure and chronic OME in children.

Adenoidectomy↗
PubMed1980

Chronic secretory otitis media.

Of 242 children and teenagers treated surgically for chronic secretory otitis media in 1972, 212 presented for evaluation 5 years later. Although the pure-tone audiometric threshold was 20 dB HL or better in 87.7% of the ears, only 40.6% were judged to be otoscopically normal. The findings at the first myringotomy for insertion of tympanostomy tubes were of no prognostic value for the course of the disease, and the presence of characteristics of middle ear fluid at subsequent myringotomies varied unpredictably. Adenoidectomy performed at an early stage, and in the presence of nasal obstruction, resulted in a significant reduction in the need for re-insertion of tympanostomy tubes.

Acoustic Impedance Tests↗
PubMed1982

Inferior dacryocystorhinostomy in severe congenital dacryostenosis.

Inferior dacryocystorhinostomy is a simple and effective method in the treatment of such cases of congenital dacryostenosis in which conservative treatment and probing have failed and in which the atresia is located at the level of the nasolacrimal duct. The operative technique is described in detail. The series treated by this method consists of 8 patients, 3 of whom showed bilateral stenosis. On 2 patients adenoidectomy was performed in connection with the dacryocystorhinostomy. The follow-up time ranged from 2 to 34 months, and a good result was obtained in 7 cases. In one case the passage produced closed soon after the operation. Endonasal dacryocystorhinostomy was then successfully carried out by West's method. The operative technique described is well suited for patients under two years of age.

Adenoidectomy↗
PubMed1987

A comparison of tonsillar size and oropharyngeal dimensions in children with obstructive adenotonsillar hypertrophy.

Hypertrophy of the tonsils and adenoids is the most common cause of obstructive sleep apnea in children. There is relatively little known about the occurrence of subclinical variations in the dimensions of the oropharynx which may predispose to the development of obstructive sleep apnea in children without obvious craniofacial abnormalities. Fifty-one children (3-10 years) were divided into two groups: the first group consisted of 18 patients with small tonsils and no history of snoring who underwent tonsillectomy for chronic tonsillitis. They were compared to a second group of 33 patients with large tonsils who underwent tonsillectomy and adenoidectomy for symptoms of obstructive sleep apnea. Age, height, weight, body surface area and tonsil weight were correlated to the dimensions of the oropharynx obtained by direct measurement intraoperatively including the length of the soft palate, anterior-posterior depth of the nasopharynx and the distances between the medial tonsillar surfaces, anterior tonsillar pillars and lateral pharyngeal walls at mid-tonsil level. Increased patient height, weight and surface area correlated positively to increased distance between the lateral pharyngeal walls and to the length of the soft palate in the patients with small tonsils. No such correlation existed in the patients with obstructive adenotonsillar hypertrophy. In addition, the distance between the lateral pharyngeal walls was significantly decreased in the group with large, obstructing tonsils as compared to those with small tonsils and no history of obstruction (P less than 0.01). However, the patients with small tonsils and no obstruction had significantly longer soft plates (P less than 0.01) and less depth tot eh nasopharynx (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoidectomy↗
PubMed1995

Child preferences for post-tonsillectomy diet.

Dietary advice for children who have undergone tonsillectomy and adenoidectomy (T&A) is divergent. We studied dietary preferences in 2 series of children who underwent T&A. The first group of 50 subjects was offered a variety of types of food the morning after surgery and they preferred liquids, followed by soft foods and were least likely to choose rough foods. When only liquids and soft foods were offered to a second group of 50 subjects, less food was wasted compared with the first group. A liquid/soft diet enhances food consumption and should continue to be advocated to facilitate recovery from T&A after surgery.

Adenoidectomy↗
PubMed1995

The adenoid as a key factor in upper airway infections.

The adenoids (and the nasopharynx) play a key role in the normal functioning and in various pathologies of the upper respiratory tract. In this paper the role of adenoidal pathology and the beneficial effect of adenoidectomy in some upper respiratory tract and facial anomalies and diseases are discussed; otitis media with effusion, recurrent acute otitis media, sinusitis, snoring and sleep apnea and abnormal patterns in the midface growth and development.

Adenoidectomy↗
PubMed1996

Post-tonsillectomy hemorrhage: an assessment of risk factors.

Hemorrhage is the most frequent complication of tonsillectomy and is responsible for the majority of post-tonsillectomy fatalities. The incidence of this hemorrhage has been reported to be as high as 20% [6]. Despite continued efforts to reduce this problem, it remains a persistent risk. The charts of 1138 patients who underwent tonsillectomy with or without adenoidectomy from 7-1-89 to 6-30-93 were reviewed. Post-tonsillectomy hemorrhage occurred in 36 patients (3%). Preoperative, intraoperative and postoperative risk factors were assessed. Postoperative bleeding occurred more often in older patients (69% over age 11 years). Seventy-five per cent of these patients were operated on for chronic tonsillitis as compared to 11% operated on for upper airway obstruction. The majority of these patients presented after postoperative day 1 (83%). Four patients required blood transfusions. Postoperative hemorrhage occurred in 14% of patients with elevated postoperative mean arterial pressures. Intraoperative blood loss that exceeded 50 cm3 was also a significant risk factor for post-tonsillectomy hemorrhage. It is concluded that older age, a history of chronic tonsillitis, excessive intraoperative blood loss and elevated postoperative mean arterial pressure are significant risk factors for post-tonsillectomy hemorrhage. An awareness of these risk factors can help identify patients with potential to bleed postoperatively.

Adenoidectomy↗
PubMedDate not supplied

The role of IgE-mediated hypersensitivity in otitis media with effusion.

INTRODUCTION: The role of immunoglobin (Ig) E-mediated hypersensitivity in otitis media with effusion (OME) has been the subject of much controversy and personal bias. Uncontrolled studies report the incidence of respiratory allergy in children with OME to range from 4% to over 90%. MATERIALS AND METHODS: Children 1 to 18 years old who had OME requiring a myringotomy and tubes from January 1, 1987, through July 1, 1988, were the subjects of this study. The history of allergic and radioallergosorbent test (RAST) analysis of specific serum IgE levels was undertaken for 26 allergens on 89 children in the study group and 59 children in the control group. RESULT: The incidence of allergen as diagnosed by RAST score was higher in children with OME than children in the control group (P > .05). There was no correlation between positive RAST scores and the number of polyethylene-ventilating (PE) tubes previously placed, history of tonsillectomy, history of adenoidectomy, or the character of the effusion (mucous v serous). CONCLUSION: Respiratory allergy is a factor involved in the pathogenesis of OME.

Adenoidectomy↗
PubMed1985

Succinylcholine-induced ventricular arrhythmia during halothane anesthesia.

A case of ventricular tachycardia in a healthy child subsequent to onset of a succinylcholine infusion is described. A 9-year-old male patient was scheduled for an adenoidectomy and bilateral tonsillectomies. There was no history of cardiac arrhythmia. Anesthesia was induced by mask with nitrous oxide and halothane. Immediately after the infusion of 20 mg of succinylcholine, the heart rate was 150 beats/min and then the electrocardiograph (ECG) revealed a short run of ventricular tachycardia. The patient was given 1 mg of propranolol, and enflurane and 100% oxygen were administered. Soon after the propranolol was given, normal sinus rhythm returned. Ventricular tachycardia may occur after a single dose of succinylcholine in a healthy anesthetized child without predisposing disease.

Adenoidectomy↗
PubMed1993

Bacteriology of tonsil and adenoid and sampling techniques of adenoidal bacteriology.

The value of pernasal swabs and direct adenoid swabs in chronic adenoid and adenotonsillar disease was assessed in 175 patients. Prior to adenoidectomy (53 patients) or adenotonsillectomy (122 patients), pernasal and direct adenoid swabs were taken. Adenoid currettings and tonsil tissue were cultured. Haemophilus influenzae was the bacterium most frequently isolated from adenoid currettings and from the centre (core) of the resected tonsil. There was a close relationship between the bacteriology of the pernasal swab and the adenoid tissue and tonsil core in 72 and 71% of patients, respectively. There was an identical profile of pathogens in 52 and 49%, respectively. We suggest that in children with adenoiditis or adenotonsillitis and hypertrophy of the adenoid, a pernasal swab should be used in preference to a throat swab in selecting appropriate antimicrobial therapy. Penicillin and ampicillin are not appropriate blind therapy in chronic adenoid and adenotonsillar infections because of the prevalence of beta-lactamase-producing aerobes (40%) in adenoid and tonsil core in these conditions.

Adenoidectomy↗
PubMedDate not supplied

Tracheomalacia secondary to obstructive sleep apnea.

Tracheomalacia (TM) is abnormal flaccidity of the trachea caused by inadequate cartilaginous support by the C-shaped tracheal rings. This defect generally results in various degrees of dynamic narrowing of the airway lumen. TM usually presents with expiratory stridor, wheeze, and respiratory obstruction. TM is usually associated with tracheoesophageal fistula and esophageal atresia or with other thoracic lesions of vascular rings and tumors. We report a well-documented case of a 20-month-old boy who presented to our institution with a severe history of obstructive sleep apnea and adenotonsillar hypertrophy. On direct laryngoscopy/bronchoscopy, severe TM was noted. Tonsillectomy and adenoidectomy was performed, and by the 37th postoperative day, the TM had completely resolved. We review the literature, discuss the differential diagnosis and clinical evaluation, and propose a new pathophysiological mechanism by which obstructive sleep apnea causes TM.

Adenoidectomy↗
PubMedDate not supplied

Management of refractory chronic rhinosinusitis in children.

OBJECTIVE: Pediatric chronic rhinosinusitis (CRS) continues to be a difficult problem for the medical community. Traditionally, oral antibiotic therapy has been the cornerstone of treatment, but some patients, who are resistant to multiple trials of oral antibiotics, require alternative therapeutic modalities. One such option, the use of intravenous (IV) antibiotics, has shown a high success rate in a limited study. Our goal is to estimate the success of a therapy consisting of culture directed IV antibiotics, adenoidectomy, and sinus aspiration in ameliorating long-term (>12 months) clinical symptoms of CRS in pediatric patients who are resistant to oral antibiotic therapy. METHODS: We conducted a retrospective review of the medical records of 22 patients who received treatment, focusing on patient age, initial CRS presenting symptoms, computed tomography scan finding, length, duration, and type of prior oral antibiotic treatment, length and type of IV antibiotic treatment, and long-term follow-up of clinical symptom resolution. RESULTS: Initial clinical improvement after cessation of IV therapy was achieved in all 22 (100%) patients. Seventeen (77%) of the patients demonstrated long-term resolution of clinical symptoms of CRS. Excluding 4 immunocompromised patients, 16 of 18 (89%) of patients demonstrated long-term amelioration of CRS symptoms. CONCLUSIONS: The results suggest that IV antibiotics may prove beneficial for pediatric patients who demonstrate CRS not responsive to traditional oral therapy. Although other treatment options are currently available for this subpopulation of patients, this IV antibiotic therapy provides both a maximally effective outcome while using a relatively minimally invasive intervention.

Adenoidectomy↗
PubMed2003

Adenoid tissue rhinopharyngeal obstruction grading based on fiberendoscopic findings: a novel approach to therapeutic management.

OBJECTIVE: A grading into four classes of hypertrophied adenoid rhinopharyngeal obstructions in children on the basis of fiberendoscopic findings to outline an effective therapeutic program according to this classification. METHODS: Ninety-eight children with chronic nasal obstruction and oral respiration were examined by anterior rhinoscopy, and fiberendoscopy. During the investigation, the fiberendoscopic images of the choanal openings were divided into four segments from the upper choanal border to the nasal floor. In view of clinical findings, 78 patients also underwent active anterior rhinomanometry. RESULTS: In eight patients (8.2%), the fiberendoscopic imaging revealed that the adenoid tissue occupied only the upper segment in the rhinopharyngeal cavity (< 25%). Therefore, choanal openings were free (first degree obstructions). In 20 patients (20.4%), the adenoid tissue was confined to the upper half (< 50%) of the rhinopharyngeal cavity (second degree obstructions) and in 63 patients (64.3%) the tissue extended over the rhinopharynx (< 75%) with obstruction of choanal openings and partial closure of tube ostium (third degree obstructions). Only in seven cases (7.14%), the obstruction was almost total. As a consequence, both the tube ostium and the lower choanal border could not be observed (fourth degree obstructions). CONCLUSIONS: In the first two classes of obstructions, characterized by moderate or discrete adenoid hypertrophy, adenoidectomy should not be performed. In these conditions, the causes of possible nasal obstructions are usually due to either dysmorphic, allergic or phlogistic pathologies. For the fourth degree adenoid obstructions, surgery is always recommended. The most important therapeutic problems occur in the third degree obstructions which include most patients who suffered from hypertrophied adenoids. Moreover, the therapeutic strategy can be conditioned not only by nasal respiratory difficulties but also by frequent concomitant complications such as otitis, sinusitis, sleep apnea, etc. These disorders may be caused by both nasal obstruction and/or phlogistic problems (adenoiditis).

Adenoidectomy↗
PubMed2003

Is there a future for pediatric sinus surgery? An American perspective.

The role of pediatric sinus surgery in chronic sinusitis continues to evolve. By the early 1990s, endoscopic sinus surgery was being touted as a primary intervention of chronic pediatric sinusitis. Around this same time these endoscopic techniques were being attempted in congenital nasosinus malformations, acute orbital complications of sinusitis and other areas. In 1996 the Brussels consensus paper on pediatric sinusitis recommended that the latter set of nasal disorders were "absolute" indications, and ironically, chronic sinusitis was a "possible indication". This report reviews some of the changes which have impacted the use of sinus surgery during the last decade including the perception of nasal symptoms during the era of antibiotic resistance in bacteria, improved instrumentation, the role of adenoidectomy, research on the effects of sinus surgery on facial growth, and the research on surgical outcomes.

Adenoidectomy↗
PubMed2005

Effects of inhalant anesthesia: tympanometry validation (R98/217).

OBJECTIVES: The purpose of this study was to determine the best time to assess middle ear status with tympanometry for tympanometric instrument validation. The research question addressed three logical times for tympanometric reading prior to myringotomy. METHODS: Fifty-one children, ranging in age from nine months to 10 years, were recruited for this investigation. Participants underwent inhalant anesthesia for myringotomy and grommet placement with or without adenoidectomy and/or tonsillectomy. Tympanometry data was analyzed across three time periods. RESULTS: Findings indicated that tympanometric readings prior to anesthesia produced the most accurate results. CONCLUSIONS: Implicated in findings, in order to ensure that tympanometric instruments are reliable, typanometric measurements should be taken prior to the administration of any anesthesia.

Acoustic Impedance Tests↗
PubMed2006

Growth failure and sleep disordered breathing: a review of the literature.

OBJECTIVE: While otolaryngologists consider growth failure an absolute indication for tonsillectomy and adenoidectomy (T&A), they may not be accustomed to screening for poor growth, and thus unlikely to consider it when recommending a T&A. This paper will (a) familiarize otolaryngologists with the definition, prevalence, and etiology of growth failure and (b) review the published findings that examine the inter-relationship among sleep disordered breathing, growth failure, and adentonsillar hypertrophy in children. METHODS: This paper is divided into three sections. The first section presents a brief overview of growth failure for the otolaryngologist. The second section reviews the evidence base linking sleep disordered breathing, growth failure, and adenotonsillar hypertrophy in children. The anthropometric outcomes of children presenting for T&A, or having sleep symptoms assessed, are presented. The third section presents pilot data (n=28) on the prevalence of growth failure and sleep disordered breathing among children presenting for T&A at our institution. RESULTS: Among children presenting for T&A or having sleep symptoms assessed, growth failure was at least twice the expected rate in six of eight published studies. Across these six studies, this rate ranged from a low of 6% of children <3rd percentile for weight and 6% <3rd percentile for height in one study, to a high of 52% who were <3rd percentile in weight in a second study, and 44% who were <or= 5th percentile for height in a third. Among children presenting for T&A at our own institution, 14% were <or=5th percentile in height, and 11% were <or=5th percentile in weight. Among children under 6 years of age, 21% were either <or= 5th percentile in weight and/or height. CONCLUSIONS: Published studies, as well as our own pilot data support the hypothesis that SDB, secondary to adenotonsillar hypertrophy increases the risk of growth failure in children. Adenotonsillar hypertrophy and sleep disordered breathing may be unrecognized risk factors in the etiology of growth failure. Otolaryngologists can play an important role in identifying growth failure, and referring children to the appropriate specialists.

Adenoidectomy↗
PubMed2006

Adenotonsilectomy improves enuresis in children with obstructive sleep apnea syndrome.

OBJECTIVES: To evaluate the prevalence of nocturnal enuresis (NE) in children diagnosed with obstructive sleep apnea syndrome (OSAS) and the effect of tonsillectomy and adenoidectomy on enuresis. DESIGN, SETTING, AND PARTICIPANTS: All children 4-18 years of age who underwent polysomnography (PSG) between January 2003 and May 2004 were included (n=161). The evaluation was based on a retrospective review of a standard sleep questionnaire and a full overnight PSG, followed by an additional structured telephone questionnaire performed 9 months after adenotonsillectomy (T&A) (range 5-14). RESULTS: We identified 144 (89%) children with an apnea hypopnea index >1. Of these 144 children, 42 [29.2% (95% CI, 21.8-36.6)] were reported to have enuresis, 27 of these 42 underwent T&A. Among the 27 enuretic children who had undergone adenotonsillectomy, 74.1% had 3 or more wet nights per week before the procedure compared to 37%, 1 month after [n=27 (chi2=3.308, McNemar pv<0.0001)]. Of the 27 children who underwent adenotonsillectomy, any decrease in enuresis severity was reported by 70.4% (95% CI 53.2-87.62), while in 56% of these 27 (95% CI 41.96-70.06) it occurred 1 month postoperatively. In 11/27 children (41%), enuresis totally disappeared within 1 month, while in 3/27 (11%) enuresis disappeared throughout the remaining time of follow-up. CONCLUSIONS: Obstructive sleep apnea in children is frequently associated with nocturnal enuresis. Adenotonsillectomy has a favorable therapeutic effect on enuresis in children with obstructive sleep apnea presenting this symptom.

Adenoidectomy↗
PubMed2006

Quality of life after surgical treatment of children with obstructive sleep apnea: long-term results.

OBJECTIVES: To measure the long-term impact of tonsillectomy and/or adenoidectomy (T&A) on children with obstructive sleep apnea (OSA). METHODS: A controlled study on 101 OSA children, operated between June 1999 and January 2001. The OSD-6 was used to assess the results. The caregivers of these patients were asked about their subjective impression prior to surgery (first evaluation), 8 days after the procedure (second evaluation), and with a minimum follow-up of 3 years after the operation (third evaluation). RESULTS: Mean of follow-up was 61.9+/-13.1 months (range, 36-75 months). The total mean survey score showed a highly significant improvement when comparing first evaluation versus second evaluation, first evaluation versus third evaluation, and second evaluation versus third evaluation (p<0.001). In the same way, we found a favourable outcome in the six domains when visits were compared. Only sleep disturbance between second and third evaluation did not show a significant improvement (p>0.05). There were not differences in the postsurgical outcome of quality of life (QOL) according to the remaining factors studied (p>0.05). CONCLUSIONS: Children with OSA who undergo surgery show a significant long-term improvement in QOL.

Adenoidectomy↗