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PubMed1981

Variations in tympanograms in children attending group-care during a one-year period.

During a 1-year period, 151 children, 1/2-6 years old, attending group care, were followed by monthly tympanometry in order to describe spontaneous variations in the tympanograms in relation to age and time of the year. Furthermore, the number of spontaneous variations during the year was assessed. Significantly more flat curves were seen in children 1/2-1 year old than in the older age groups, indicating a high frequency of spontaneous remission about the age of 2 years. In all age groups more normal tympanograms were seen during late summer than during the rest of the year. Spontaneous variations in the tympanograms were taking place 2.9 times (mean) during the period of observation. Correlation was found between the presence of catarrh and flat curves. Furthermore, in children greater than or equal to 3 years old, a correlation between case history signs of enlarged adenoids and flat curves lasting for 3 months or more was found. It was concluded that persistence of flat curves in children 1/2-1 (2) years old usually requires no treatment, as spontaneous remission can be expected, whereas persistence of flat curves for greater than or equal to 3 months in children greater than or equal to (2) 3 years old indicates that treatment (adenoidectomy) should be performed.

Acoustic Impedance Tests↗
PubMed2000

Surgical management of uncomplicated otitis media in a pediatric Medicaid population.

The objective of this study was to document the frequency and timing of otitis media-related visits, audiological consultations, and surgical interventions following a new episode of otitis media. A retrospective descriptive study was performed on a Medicaid administrative database that follows individual patients over time. The study included 14,453 children enrolled in Medicaid during 1991 and 1992 who were 30 months of age or younger and had a "new" episode of otitis media. Among 14,321 patients with an uncomplicated episode of otitis media, there were 10,443 with additional otitis media visits. Audiological testing was performed in 1,134 (10.9%). The testing occurred within 2 months of the onset of otitis media in 52.2% of the children and within 3 months in 66.6%. Physicians referred 400 children (3.8%) to an otolaryngologist; 299 (75%) underwent 1 or more surgical procedures. These surgical interventions included placement of ventilating tubes in 296 children, adenoidectomy in 34 children (all of whom also had placement of ventilating tubes), mastoidectomy in 2 children, and tympanoplasty in 1 child. The proportion of children who underwent surgical placement of ventilating tubes who had prior audiological testing was 174 of 296 (58.8%). The overall surgical rate for ventilating tubes was 2.9%. Among children who underwent surgery, the procedure occurred within 2 months of the onset of otitis media in 21.4% of children. Attempts to rationalize the management of otitis media in early childhood must deal with the difficulties in distinguishing among the otitis media conditions. The findings of this study suggest a need to know whether insertions of ventilating tubes within 3 months after a new episode of otitis media are related to unresponsive or recurrent infections.

Acute Disease↗
PubMed2002

Otolaryngological surgery and upper respiratory tract infections in children: an epidemiological study.

The objective of the study was to assess the occurrence of different procedures of upper airway surgery and estimate their relationship to specific upper respiratory tract infections and constitutional factors. In a population-based cross-sectional study in Oslo. Norway, of 3,763 preschool children 3 to 4 years of age, the otolaryngological surgeries adenoidectomy, tonsillectomy, myringotomy, ventilation tube insertion, and combinations of these were the outcome measures. The results showed that by 4 years of age, 13% (n = 501) had undergone operation, and approximately two thirds of the operations involved middle ear surgery. Although surgery was related to the occurrence of upper respiratory tract infections, the type of surgery was not related to the specific infection. In the children with operations, the occurrence of recurrent otitis media (> or = 3 infections in the previous 12 months) was almost fivefold higher than in children without operations (adjusted adds ratio [ORadj] = 5.19 [3.15 to 8.54]). A low level of maternal education (ORadj = 1.61 [1.05 to 2.7] compared to the group with a high level of education) and atopy on the part of the child (ORadj = 1.58 [1.20 to 2.07]) increased the probability for upper airway surgery independently of the experience of infections. In conclusion, early pediatric otolaryngological surgery is common. The decisions for surgical treatment vary substantially and are not closely related to the specific infections. The influence of other factors such as maternal education indicates that decisions for surgery are not entirely based on medical evidence.

Adenoidectomy↗
PubMedDate not supplied

Microbiology in serous otitis media.

It is now established that serous otitis media (SOM) is an inflammatory reaction of the mucosa of the middle ear. A number of microbiological factors are contributory causes. It is clear, among other things, that the microbiologic environment in the nasopharynx in SOM is the same as that in acute otitis media. Neither adenoidectomy and tonsillectomy nor treatiment with conventional chemotherapeutics has proved effective for eradicating pathogenic bacteria from the nasopharynx. Intense research to find new antibiotics and effective means may be one way of getting us out of our present therapeutic dilemma. Other possibilities are to try to produce polyvalent bacterial vaccines and to increase our knowledge of the immunology of the nasopharynx.

Adenoidectomy↗
PubMedDate not supplied

Tympanostomy tubes: the conservative approach.

The clear advantage accruing from the use of tympanostomy tubes in the treatment of otitis media with effusion is immediate improvement in hearing; there are also disadvantages entailed, such as scarring of the drum risk of continuing otorrhea and interference with the patient's normal physical activities. All possible forms of medical treatment should be exhausted (antihistamine decongestants, politzerization) before resorting to tympanostomy tubes. There is a small group of children with severe chronic nasal obstruction and otitis media with effusion for whom adenoidectomy is likely to be required.

Adenoidectomy↗
PubMed1990

Malignant hyperthermia in the otolaryngologic patient: prospective anesthetic and surgical management of eight children.

Malignant hyperthermia (MH) is a rare genetic myopathy whose hallmark is rise in body temperature. This hypermetabolic state is triggered by inhalational anesthetics and/or depolarizing muscle relaxants such as succinylcholine. Even the use of dantrolene may not be protective against the hypermetabolic crisis. Eight patients at risk for MH undergoing tonsillectomy, adenoidectomy, and/or myringotomy with ventilation tube insertion were anesthetized with nitrous oxide, barbiturates, opiates, tranquilizers, and nondepolarizing muscle relaxants without dantrolene and without complication. Cardiac monitoring and rectal temperatures were followed. In order to provide additional evidence, all eight patients had vastus lateralis muscle biopsies with subsequent caffeine-halothane contracture studies performed. The contracture study showed positive results in seven of eight patients studied, indicating MH-susceptible muscle. No anesthetic or operative complications were encountered. This study demonstrates that patients at risk of developing MH crisis can have otolaryngologic procedures performed relatively safely while undergoing appropriately selected anesthesia.

Adenoidectomy↗
PubMed1994

Possible role of adenoid mast cells in the pathogenesis of secretory otitis media.

The distribution of mast cells in the adenoidectomy specimens of 76 children with enlarged adenoids was studied. Forty of the patients had secretory otitis media; the remaining 36 had normally aerated middle ears. The mast cells were identified on the basis of the metachromatic staining of their cytoplasmic granules with toluidine blue. Patients with secretory otitis media had a twofold increase of their mast cell population compared to those without middle ear disease. Statistical analysis confirmed that the difference between the two groups is significant (p = .0001). The results of the study are consistent with the previous finding of increased histamine concentration in adenoids of children with secretory otitis media and lend support to the adenoid mediator release hypothesis, whereby the adenoid mast cells degranulate and release histamine and other inflammatory mediators that induce eustachian tube insufficiency and otitis media with effusion.

Adenoidectomy↗
PubMed1994

Preventing otitis media.

Recurrent acute otitis media (AOM) is an extremely prevalent disease in young children. Epidemiologic associations suggest that primary prevention or reduction of AOM frequency may be achieved with breast-feeding during infancy, elimination of household tobacco smoking, and use of small rather than large day-care arrangements for infants and toddlers. Secondary antimicrobial prophylaxis with amoxicillin or sulfisoxazole reduces the frequency of recurrent AOM by about 50%, but it does not appear to reduce the duration of otitis media with effusion (OME). Tympanostomy tube insertion is not as effective as amoxicillin in reducing AOM frequency in children without OME. Adenoidectomy appears to be warranted for children who develop recurrent AOM after extrusion of tubes. Vaccines against the common bacteria and viruses causing AOM hold the greatest promise of preventing AOM and blocking the sequence of pathologic events leading to chronic OME and middle ear sequelae. The greatest progress has been made recently with pneumococcal protein conjugate vaccines, and clinical testing is in progress.

Acute Disease↗
PubMed1999

Radiographic evaluation of children with nasopharyngeal obstruction due to the adenoid.

The adenoidal-nasopharyngeal ratio (ANR) was proposed as a convenient and practical method to evaluate adenoidal enlargement. We analyzed cephalometric radiographs of 150 children divided into 6 subgroups according to clinical assessment (possible adenoidectomy candidates [PACs] and controls) and age. Our purpose was to investigate the predictive reliability of different ANRs calculated on the same reference line. Each of the ANRs described in this study presented statistically significant differences between PACs and control groups, and highly significant correlations with clinical symptoms of nasal obstruction. Further, the mean adenoidal depth was significantly larger in PACs than in normals, and it was found that the adenoidal depth in PACs did not show a significant decrement with age. in contrast to normals. On the other hand, although nasopharyngeal depth was not different between PACs and normals, an age-dependent increment was observed in PACs, in contrast to normals. Thus, it could be said that the ANR is a more reliable method for determining whether adenoidal hyperplasia is clinically significant or not, rather than the size of the adenoid or nasopharynx.

Adenoidectomy↗
PubMed1977

The "chubby puffer" syndrome. Upper airway obstruction and obesity, with intermittent somnolence and cardiorespiratory embarrassment.

Upper airway obstruction and obesity can produce cardiopulmonary distress in susceptible children. Three such children with chronic airway obstruction due to hypertrophied tonsillar and adenoidal tissue developed pronounced obesity, which in turn helped to provoke sleep alterations, cardiac signs, and abnormal arterial blood gas values. After tonsillectomy and adenoidectomy the symptoms were relieved.

Adenoidectomy↗
PubMed1997

Sleep apnea in patients receiving growth hormone.

Among 145 patients treated with recombinant human growth hormone (GH), four developed sleep apnea (two obstructive, two mixed) associated with tonsillar and adenoidal hypertrophy in three. These four patients had no local risk factors predisposing to upper airway obstruction (i.e., frequent pharyngitis or sinusitis). Clinical and/or polysomnographic features of sleep apnea improved following cessation of GH therapy in one patient, and following tonsillectomy and adenoidectomy in all patients. The present observations indicate that, albeit rarely, obstructive and/or central sleep apnea may occur in children treated with GH. Polysomnography should be considered if symptoms of snoring, interrupted sleep, daytime somnolence-particularly if associated with tonsillar hypertrophy-appear in children during GH therapy.

Adenoidectomy↗
PubMed1990

Bacterial findings in middle ear effusion in children.

During 1983-87, tympanostomy tubes were inserted in a total of 4952 ears of 2575 children remitted to the ENT Department of our hospital because of chronic or recurrent otitis media problems. The children were included in a prospective study and referred to one of three groups for comparison of findings. Group 1 included all 6- to 12-month-old infants undergoing primary tube treatment; group 2, all children 1 year or older who had their first ventilation tube(s) inserted in connection with adenoidectomy; and group 3, all children in whom tympanostomy had been performed one or more times previously. Middle ear effusion was aspirated from 2392 ears (48%); 67.6% of all ears were negative for bacteria and 22.1% of the ears with effusion grew pathogenic bacteria. S. pneumoniae was the most frequently cultured pathogen among the 6 to 12 month olds in group 1, but in groups 2 and 3 H. influenzae occurred more frequently than S. pneumoniae. Beta-lactamase-producing strains of pathogenic bacteria were formed in only 4% of all ears with effusion: H. influenzae in 1.2% and B. catarrhalis in 2.8%. Compared with figures from the United states, the frequency of beta-lactamase-producing strains is low in the present series. This is probably explained by differences in antimicrobial treatment practices; in Finland and the Scandinavian countries, penicillin V is the primary drug for acute otitis media. In light of present results, it seems well-suited for treatment of otitis media in young children.

Acute Disease↗
PubMed1986

Water intoxication and death associated with the use of posterior pituitary injection for surgical hemostasis.

Posterior pituitary injection is an extract prepared from the dried posterior lobe of the pituitary gland from domestic animals containing two octapeptide hormones, oxytocin and vasopressin. Posterior pituitary injection carries an approved therapeutic indication as an adjunct measure for achieving surgical hemostasis. We report a case of cerebral edema and death attributed to water intoxication in a child who had received a large volume of free water concurrent with posterior pituitary injection to control bleeding after tonsillectomy and adenoidectomy.

Adenoidectomy↗
PubMed2004

Upper airway dynamic responses in children with the obstructive sleep apnea syndrome.

Normal children have a smaller upper airway than adults, but, nevertheless, snore less and have less apnea. We have previously shown that normal children have an upper airway that is resistant to collapse during sleep. We hypothesized that this resistance to collapse is due to preservation of upper airway neuromotor responses during sleep. Furthermore, we hypothesized that upper airway responses would be diminished in children with the obstructive sleep apnea syndrome (OSAS). We therefore compared the upper airway pressure-flow relationship during sleep between children with OSAS and controls. Measurements were made by correlating maximal inspiratory airflow with the level of nasal pressure applied via a mask. Neuromotor upper airway activation was assessed by evaluating the upper airway response to 1) hypercapnia and 2) intermittent, acute negative pressure. We found that children with OSAS had no significant response to either hypercapnia or negative pressure during sleep, compared with the normal children. After treatment of OSAS by tonsillectomy and adenoidectomy, there was a trend for normalization of upper airway responses. We conclude that upper airway dynamic responses are decreased in children with OSAS but recover after treatment. We speculate that the pharyngeal airway neuromotor responses present in normal children are a compensatory response for a relatively narrow upper airway. Further, we speculate that this compensatory response is lacking in children with OSAS, most likely due to either habituation to chronic respiratory abnormalities during sleep or to mechanical damage to the upper airway.

Adenoidectomy↗
PubMed1994

Information-seeking coping and anxiety in school-age children anticipating surgery.

This study examined the relation between coping behavior and anxiety among school-age children anticipating an elective tonsillectomy and/or adenoidectomy. The demographic variables of age, gender, previous hospitalization, and birth order were also studied in relation to both coping and anxiety. Interview methods were utilized to measure information-seeking and information-limiting coping behaviors and feelings of anxiety. The results of this study indicate that children who used primarily information-seeking or information-limiting strategies were successful (as measured by low anxiety levels) in managing the stress of anticipated hospitalization. Children using information-seeking strategies for some, but not all, aspects of the hospitalization experience reported the greatest anxiety. The demographic variables were not related to either anxiety or coping.

Adaptation, Psychological↗
PubMed2001

Ectopic adenoid tissue in the choanae.

A series of 19 patients with often long-lasting nasal stenosis despite repeated treatment attempts, including in many cases repeated adenoidectomy, were found to have ectopic adenoid tissue in the choanae which could only be removed transnasally by forceps. It did not emerge from the rhinopharynx but from the roof of the choanae, the posterior part of the nasal septum and in some cases also from the lateral wall of the choanae. The diagnosis was established by anterior rhinoscopy using a flexible rhinopharyngo-laryngoscope. The treatment was successful in all 19 patients, many of whom had had symptoms for years. It is estimated that about two per cent of patients with adenoid symptoms have such ectopic choanal adenoid tissue, that cannot be removed by the usual oral approach. In young patients with long-lasting nasal stenosis attention should be focused on the bottleneck of the nasopharyngeal airway formed by the choanae, primarily by fibre-optic endoscopic examination.

Adenoidectomy↗
PubMed2001

Endoscopy in the assessment of children with nasal obstruction.

Nasal obstruction is common in children, and is often attributed to adenoid enlargement. This prospective study was performed to determine whether routine nasal endoscopy is of value for children undergoing surgery for nasal obstruction. Forty-eight children aged two to nine years undergoing adenoidectomy, and six normal controls, were examined under general anaesthesia with a 4 mm rigid endoscope. A video of the endoscopy was subsequently assessed independently by an observer blinded to the original findings and the presence of nasal symptoms. The endoscopist and independent assessor were in agreement regarding 86 per cent of the findings. Three quarters of the children had abnormalities on endoscopy in addition to enlarged adenoids, and in 23 per cent these were potentially of major clinical significance (unsuspected foreign body, gross septal deviation, gross hypertrophy of the turbinates). Endoscopy produced no post-operative complications and was possible in children as young as two years of age, without decongestants. Nasal endoscopy is a safe, objective and useful means of identifying potentially significant abnormalities in children with nasal obstruction.

Adenoidectomy↗
PubMed2005

Course and long-term outcome of 'refractory' secretory otitis media.

OBJECTIVE: The course and the long-term outcome of 'refractory' secretory otitis media (SOM), defined as continuous SOM for more than 6 years, were studied in 52 young patients. They had during childhood been treated for bilateral SOM on average for 12 years (range 6 to 26 years). The mean interval between resolution of SOM and examination was 7 years. METHODS: At follow up the patients' medical records were scrutinized with regards to transmyringeal ventilation tubes, adenoidectomy, sequelae and complications, and a questionnaire was filled in to document other diseases. RESULTS: The onset of SOM showed two peaks, one at the age of one year and one at the age of 3.5 years. Patients whose onset of SOM was related to an episode of acute otitis media (AOM) were younger at SOM onset than those who had no such relation. Otorrhoea and AOM episodes were more frequent during the SOM periods, with blocked or expelled tubes, than during periods with patent tubes. Cholesteatoma were seen in 3 per cent and perforations in 5 per cent of patients. CONCLUSIONS: Extremely long-standing SOM does not necessarily result in myringeal perforation or cholesteatoma to a greater extent than that seen in patients with shorter durations of SOM. However, at follow up one-third of the patients reported hearing impairment and a majority felt discomfort when flying or diving.

Acute Disease↗