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PubMed2003

Effect of amoxicillin or clindamycin on the adenoids bacterial flora.

OBJECTIVE: We sought to compare the effect on the adenoid bacterial flora of patients with recurrent otitis media of antimicrobial therapy with amoxicillin (Am) or clindamycin (C). Patients and methods Forty-five children scheduled for elective adenoidectomy participated in a prospective randomized study. They were divided into 3 groups of 15 each to receive either no therapy (control) or 10 days of therapy with Am or C. Core adenoid tissues was quantitatively cultured for aerobic and anaerobic bacteria. RESULTS: Polymicrobial aerobic-anaerobic flora were present in all instances. The predominant aerobes in all groups were alpha-hemolytic and gamma-hemolytic streptococci, Haemophilus influenzae, Staphylococcus aureus, group A beta-hemolytic streptococci, and Moraxella catarrhalis. The prominent anaerobes were Peptostreptococcus, Prevotella, and Fusobacterium spp. The number of isolates was significantly reduced in those treated with Am (n = 110, P < 0.05) or C (n = 58, P < 0.001) compared with control (n = 148). The number of bacteria per gram/tissue was lower in those treated with either antibiotics. The number of potential pathogens was lower in those treated with C compared with the other 2 groups (P < 0.001). The number of beta-lactamase-producing bacteria was lower in those treated with C than in those treated with Am (P < 0.025) or control (P < 0.001). CONCLUSIONS: These data illustrate the ability of C and, to a lesser degree, of Am to reduce the bacterial load as well as potential pathogens and beta-lactamase-producing bacteria from the adenoids of children with recurrent otitis media.

Adenoidectomy↗
PubMed1998

Diagnosing and treating pediatric allergy.

Allergy is a significant problem in as much as 60% of patients seeking care at an otolaryngologist's office. This raises the issue of the most effective means of diagnosing allergy, especially in pediatric patients, who often may not tolerate skin testing. The RAST and CAP (Pharmacia) tests have been shown to be quite comparable with skin testing in diagnosing allergy. This study was undertaken to assess the effectiveness of treatment of children with allergies who had undergone in vitro testing. This was done by obtaining subjective symptom scores both before and after treatment. These were obtained from patients with different in vitro results, including some with negative testing. Overall, 77 of 155 mailed questionnaires were returned. Results showed overall improvement of 38.81 points in 12 symptoms (p = 0.001; n = 62). Each symptom was rated on a visual scale of 1 to 10. A small portion of the patient population received surgical treatment (tympanostomy tube placement with or without adenoidectomy) in addition to medical treatment and avoidance. These patients did not have significantly higher pretreatment scores and did not have a higher improvement rate for all symptoms. We believe this study shows the validity of in vitro testing and treatment of allergy in children.

Adenoidectomy↗
PubMedDate not supplied

Identification and assessment of velopharyngeal inadequacy.

PURPOSE: To review current literature with respect to the diagnosis and assessment of velopharyngeal inadequacy (VPI), including present knowledge about the most common causes of VPI. METHODS: Data sources include published reports over the past 20 years derived from computerized databases and bibliographies of pertinent articles and books. Indexing terms used were "velopharyngeal incompetence," "velopharyngeal inadequacy." "velopharyngeal insufficiency." CONCLUSION: VPI is most commonly associated with cleft palate, submucous cleft palate, and following adenoidectomy. The otolaryngologist can prevent the latter by preoperative identification of physical stigmata associated with VPI. Perceptual assessment is the criterion standard for diagnosis of VPI. Multiview videofluorography and flexible nasal endoscopy provide the best direct assessments to help plan and direct the optimal treatment of VPI.

Adenoidectomy↗
PubMedDate not supplied

Adenoids and otitis media with effusion: a morphological study.

PURPOSE: Adenoidectomy, especially for the treatment of suppurative otitis media, has been used for a very long time. In this study, the role of adenoids in the origin of otitis media with effusion was investigated by using light microscopy, immunocytochemistry, enzyme chemistry, and electron microscopy. MATERIALS AND METHODS: A group of 28 children with otitis media with effusion (OME) was identified. Ages ranged from 3 to 12 years. A control group of 10 age-matched children without any middle ear and upper respiratory tract infection served as the basis for comparison. Specimens obtained at surgeries from both groups were divided into groups for light microscopy, immunocytochemistry, enzyme cytochemistry, and electron microscopy and then all were examined blindly. Also, quantitative analysis of antigen-presenting cells was performed blindly on 10 patients and 10 controls. RESULTS: There was an increase in the number of lymphocytes, mast cells, plasma cells, macrophages, dendritic cells, and M cells in the adenoids of patients with OME when compared with the normal cases. Stratified squamous epithelial areas, collagenous fibers, and fibrocytes were also increased in the patient group. Antigen-presenting functions of epithelial cells are shown by major histocompatibility complex (MHC) class II positivity of some ciliated-columnar epithelial cells in the patient group. CONCLUSION: Adenoid tissues of patients with OME in this study seem to be infectious foci, aggravating immune reactions, which might attack the middle ear through an ascending route.

Adenoidectomy↗
PubMed2000

Surgical prevention of otitis media.

Increasing concerns over drug-resistant bacteria mandate that alternative methods of treatment and prevention, including surgery, be considered to reduce antibiotic usage for acute otitis media (AOM). Meta-analysis of five randomized trials of tubes versus no surgery showed a mean absolute decrease in AOM incidence of 1.0 episode per child-year (95% CI, 0.4-1.6), with a relative decrease of 56%. Similarly, the prevalence of middle-ear effusion decreased by 115 days per child-year (95% CI, 11-220). Within several weeks of tube placement 79% of children had improved quality of life, 17% had trivial change, and 4% were worse. Systematic review of 134 articles revealed transient post-operative otorrhea in 16% of patients with tubes, and later in 26%; recurrent otorrhea occurred in 7.4% of patients and chronic otorrhea in 3.8% Adenoidectomy reduced AOM incidence by 0.32 episodes per child-year (95% CI, 0.03-0.61) for a 3-year period in one study (26% relative decrease), but the effect was only significant for children with prior tubes. Surgical therapy of otitis media offers significant benefits and is an effective prevention strategy in selected children.

Adenoidectomy↗
PubMed1998

Timing for removal of tympanic ventilation tube in children.

The medical records of 220 ears of 137 pediatric patients (85 male and 52 female) in which three kinds of ventilation tubes were inserted for treating otitis media with effusion (OME) were reviewed. The tubes selected were the Shepard grommet (75 ears), Goode-T (39 ears), and Paparella type II tube (106 ears). The criteria for tube placement were as follows: (1) continuous conductive hearing loss with over 25 dB air-bone gap, (2) resistance to conservative therapy for over 6 months, and (3) retracted and glue-colored tympanic membrane with type B tympanogram. The tubes that remained in place for over 18-24 months were removed intentionally in combination with a freshening of the perforation edge and tape-patch technique using Steri-Strip tape (3M) for preventing permanent eardrum perforation, because the incidence of persistent perforation became higher after long-term intubation. Shepard grommets tended to be extruded earlier, while Paparella type II tubes tended to stay longer. The OME recurrence rate decreased 12 months or more after tubal insertion. There was a tendency for the recurrence rate to decrease the longer the tube stayed in the eardrum. The number of recurrences decreased when the patient's age at the tube removal or extrusion was 7-8 years old. Adenoidectomy did not influence the recurrence rate of OME. Although the Goode-T and Paparella tube II tubes showed high perforation rates, the perforation rate after extrusion or removal of the tube was decreased by the use of the tape patch technique in combination with a freshening of the perforation edge. From these findings, it was concluded that the appropriate intubation period for the treatment of OME in children is over 12 months with the use of a long-term tube, and that if the patient's age at the time of tube insertion was below 6 years, it might be better that the removal of the tube is postponed until the patient is 8 years of age.

Adenoidectomy↗
PubMed1999

[Recurrent otitis: what is the place of complementary examinations].

Recurrent otitis media is defined by the occurrence of three episodes of acute otitis media in a year. Several risk factors are now well recognized, particularly the occurrence before six months of age of a first episode of otitis media, day care centers, and upper respiratory tract infections (rhinopharyngitis). In most cases biological or radiological investigations are of little interest. They are only indicated in case of persistent recurrent episodes, despite eviction of all risk factors and adenoidectomy, and mainly in case of association with bronchopulmonary pathology.

Adenoidectomy↗
PubMedDate not supplied

Bleeding predisposition assessments in tonsillectomy/adenoidectomy patients using fuzzy interquartile encoded neural networks.

A fuzzy set theoretic methodology is described that serves as a classification preprocessing strategy for supervised feed-forward neural networks. This methodology, fuzzy interquartile encoding, determines the respective degrees to which a feature belongs to a collection of fuzzy sets that overlap at the respective quartile boundaries of the feature. These membership values are subsequently used in place of the original feature. This transformation has a normalizing effect on the feature space and is more robust to feature outliers. Its effectiveness is scrutinized using several synthetic data sets with various underlying distributions. Fuzzy interquartile encoding is shown to consistently improve the discriminatory power of the underlying classifiers. The methodology is also applied to two biomedical data sets relating to tonsillectomy and/or adenoidectomy patients who may or may not have had a predisposition to excessive bleeding during their operation. The features of the first data set are blood sample test results acquired from a coagulation laboratory and the class labels are one of three hemostatic defects as identified by the reference tests. The second data set consists of patient responses to queries from a bleeding tendency questionnaire. Normal and abnormal class labels were derived from a hematology expert system designed in consultation with a pediatric hematologist. Fuzzy interquartile encoding effected an 11% improvement in the classification accuracy of the underlying neural network classifier with the former data set and 18% with the latter.

Adenoidectomy↗
PubMed2002

Pain assessment following general anesthesia using the Toddler Preschooler Postoperative Pain Scale: a comparative study.

STUDY OBJECTIVES: To evaluate the reliability of the Toddler Preschooler Postoperative Pain Scale (TPPS) following general anesthesia as a guide to analgesic administration, and to compare the validity of this scale with other observational measures of pain in children. DESIGN: Prospective, consecutive, single-blinded observational study. SETTING: Operative and radiology suites at a community hospital. PATIENTS: 51 ASA physical status I and II patients aged 1 to 5 years requiring general anesthesia. INTERVENTIONS: Patients emerging from general anesthesia following elective otolaryngology, urology, and nonpainful radiology procedures were observed. Persons caring for the children were blinded as to the purpose of the observers. The observers recorded pain scores during recovery, before and after analgesic administration and at discharge. MEASUREMENTS: The TPPS was used in three sequential stages. The initial stage (n = 20) examined pain scores from emergence through discharge from hospital following myringotomy, adenoidectomy, or tonsillectomy. The second stage compared these pain scores to those observed on emergence from nonpainful diagnostic radiologic procedures (n = 11) and patients receiving caudal analgesia following urological procedures (n = 8). The third stage studied the clinical utility of the TPPS in comparison to the face, legs, activity, crying, consolability (FLACC) scale and a modified COMFORT scale using simultaneous measurements (n = 12). MAIN RESULTS: TPPS scores varied in a categorical fashion with the intensity of pain and significantly decreased following opioid administration. All three scales reliably demonstrated pain reduction following opioid administration. Initial TPPS scores tended to be lower in patients who did not require treatment for pain. CONCLUSIONS: Following procedures that are likely to produce pain, TPPS, FLACC, and the COMFORT scale, modified as a purely behavioral tool, can be recommended for postoperative assessment of patients aged 1 to 5 years. The TPPS may be preferred for the discrimination between painful and nonpainful states.

Adenoidectomy↗
PubMed1999

Establishment of a pediatric surgery center: increasing anesthetic efficiency.

STUDY OBJECTIVE: To examine whether the establishment of dedicated pediatric operating rooms (ORs) staffed exclusively by pediatric anesthesiologists has had a significant impact on anesthetic efficiency during surgery. STUDY DESIGN: Before and after design. SETTING: General and pediatric operating rooms at Yale-New Haven Hospital. MEASUREMENTS AND MAIN RESULTS: Using Operating Room Information System data (1991 to 1997), we examined whether the anesthesia-controlled time, the time it takes for induction and emergence of anesthesia of a selected surgical procedure (tonsillectomy and adenoidectomy), was affected by the change of practice from general to pediatric ORs. The average length of anesthesia induction decreased by 30% (p = 0.0007). Similarly, the average length of emergence from anesthesia decreased by 42% (p = 0.01) and anesthesia-controlled time decreased by 31% (p = 0.0008). Of particular importance is the decrease by 75% in the anesthesia-controlled time range (maximum-minimum). CONCLUSIONS: The establishment of dedicated pediatric ORs resulted in significantly shorter anesthesia induction and emergence times. Furthermore, the decreased variability of anesthesia-controlled time may allow for better scheduling of surgical cases and for better surgeon and patient satisfaction.

Adenoidectomy↗
PubMed2006

Antibiotic use in tonsillectomies: therapeutic or prophylactic? Required or excessive?

Adenotonsillectomy is one of the most commonly performed surgeries in the pediatric and young adult populations. The postoperative morbidity of this surgical procedure is often significant, including odynophagia, dysphagia, fever, halitosis, loss of weight and reduced oral intake. After tonsillectomy, with or without adenoidectomy, the colonization of the open tonsillar fossae by the bacterial population of the oral cavity would cause an exacerbation of the local inflammatory response worsening postoperative pain. The hypothesis that a reduction of the bacterial population of an open surgical wound could minimize the local inflammation, stimulate the healing process and hasten recovery triggered a considerable number of studies addressing the relation between the use of perioperative antibiotics and postoperative morbidity of adenotonsillectomy. In spite of the fact that those studies claim to perform an assessment of the surgical prophylactic use of antibiotics, their outline is not in compliance with the worldwide-accepted principles of surgical antibiotic prophylaxis. By performing a critical review of the literature, the authors discuss the advantages and disadvantages of using antibiotics in tonsillectomies or adenotonsillectomies, as well as the most appropriate definition for its utilization.

Adenoidectomy↗
PubMed1979

Iron deficiency in children undergoing adenoid-tonsillectomy.

Following a preliminary study of peripheral blood values in 30 children undergoing tonsillectomy and adenoidectomy, a biochemical survey of the iron status of another 108 children also undergoing this operation was made utilizing an automated micro-method. It was shown that 8.4% of these children were frankly iron-deficient but there was no statistical relationship between the levels of serum iron and iron-binding capacity, the incidence of throat infections and the levels of the plasma immunoglobulins. Assessment of all children undergoing this operation for the presence of iron deficiency is advocated as a possible routine screening procedure.

Adenoidectomy↗
PubMed1979

Use of middle ear ventilation tubes in recurrent acute otitis media.

A method of treatment of recurrent acute otitis media with polythene middle ear ventilation tubes in young children is presented. 56 ears in which infection had persisted for one to six months despite antibiotic therapy and multiple myringotomies were included in the study. The tubes were inserted under topical anaesthesia and cure within one week was obtained in 73 per cent of ears. In another 9 per cent the otorrhoea stopped within 3 weeks, but in 18 per cent reinsertion of the tube became necessary and in this latter group 11 per cent resolved in two weeks following adenoidectomy as well. In 7 per cent the problem remained unresolved. Therefore with this regimen a total of 93 per cent of recurrent infections settled. It is emphasized that the ventilation tube should remain 'in situ' for over 3 months.

Acute Disease↗
PubMed1980

Middle ear effusion and sinusitis.

The present investigation comprises a retrospective and a prospective study on children with middle ear effusion (MEE). It is shown that, in the majority of patients, middle ear effusion was found in combination with an infective disease of other parts of the upper respiratory system, especially in the maxillary sinuses. Lavage of the infected sinuses resulted in resolution of the middle ear effusion in about 85 per cent of the cases, while adenoidectomy, in patients in whom adenoid enlargement was found together with middle ear effusion, had only a minor effect.

Adenoidectomy↗
PubMed1981

Diagnosis of subacute maxillary sinusitis in children.

The prevalence of subacute, occult maxillary sinusitis in children undergoing adenoidectomy, adenotonsillectomy or tympanostomy was 27 per cent as confirmed by antral puncture. A-mode ultrasound examination and radiographic examination with the occipito-mental projection were used as preoperative screening tests for the detection of maxillary sinus discharge. 135 children aged 4--10 years were examined. An abnormal radiographic finding was found in 40 per cent of children. When punctured these sinuses yielded discharge in 62 per cent of cases. A normal radiographic finding proved to be reliable (98 per cent). The total agreement between puncture and radiographic finding was 73 per cent. The total agreement between puncture and A-mode ultrasound finding was 94 per cent. The A-scan was positive in 88 per cent of the sinuses with discharge. A-mode ultrasonic examination proved to be a simple, non-ionizing reliable means of monitoring retained secretion within maxillary sinuses of children.

Adenoidectomy↗
PubMed1983

Unilateral tonsillectomy--indications and results.

Seventy-six cases of unilateral tonsillectomy performed over the last 20 years are reported. The average age was 3.75 years. Fifty per cent had adenoidectomy. A review of their case notes and of 54 questionnaires returned by parents, asking their opinion of the change in symptoms before operation and two years after operation, showed that they could be allotted into three groups: Group 1 35 cases (65 per cent) had dramatic improvement in the symptoms of allergy, colds, otitis, sore throats, eating, meat eating and sleep. Group 2 of nine cases (17 per cent) had considerable improvement in most symptoms. Group 3 of 10 cases (18 per cent) had minimal improvement. Post-tonsillectomy hypertrophy of the remaining tonsil occurred within two to four years in nine cases, necessitating removal. Four (11 per cent) in Group 1, (22 per cent) in Group 2, and three (30 per cent) in Group 3. The three secondary tonsillectomies in Group 3 gave good results in two cases. In five cases the other tonsil was removed six to 15 years later. This series of cases has demonstrated that a tremendous decrease in incidence of throat and upper respiratory tract infection in young children, apparently prone to infection can occur in over 80 per cent of cases following unilateral tonsillectomy, in spite of the continued presence of the remaining large tonsil.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoidectomy↗
PubMed1985

Adenoid histamine and its possible relationship to secretory otitis media.

We have shown that adenoid tissue contains large amounts of the inflammatory mediator histamine. Children with fluid present in both ears at operation were found to have increased amounts of histamine in their adenoid tissue compared to a group with no signs or symptoms of SOM. Also mouth breathing and nasal obstruction were associated with adenoid histamine content whereas other signs and symptoms were not. No significant differences in adenoid weight were seen between SOM and non SOM patients. Histamine, both free and cell-associated, was found in nasopharyngeal secretions and middle-ear fluid although the source and mechanism of release has not yet been identified. We suggest that the benefits of adenoidectomy in children with SOM may possibly come from removing a potential source of inflammatory mediators in the vicinity of the Eustachian tube.

Adenoidectomy↗
PubMed1986

Efficacy of medical treatment as an adjunct to surgery in the treatment of secretory otitis media.

In a pilot controlled randomised trial of 38 children who had bilateral secretory otitis media, with effusion demonstrated at operation, we compared the efficacy of a six-week course of an oral decongestant--antihistamine combination and a mucolytic preparation with a control group in preventing the presence of middle-ear effusion six weeks after myringotomy and adenoidectomy. The mucolytic preparation decreased the presence of middle-ear effusion when compared to the decongestant-antihistamine combination and the control group (p = 0.06).

Adenoidectomy↗