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PubMedDate not supplied

Spontaneous DNA synthesis in adenoidal lymphocytes from healthy children and from children with otitis media with effusion.

Spontaneous DNA synthesis (SDS) in adenoidal lymphocytes was investigated in 37 children with particular attention to the relationship between the adenoids and otitis media with effusion (OME). The SDS was measured by [3H]thymidine incorporation under a certain culture condition without any mitogens. Adenoidal lymphocytes showed an extremely higher uptake of [3H]thymidine than did peripheral lymphocytes. SDS in adenoidal lymphocytes was much greater in the 3-5-year-old age group than in the older groups. SDS in patients with OME was also significantly greater than that in patients with no complications. Patients who recovered from OME within 3 months following adenoidectomy showed significantly greater SDS than those with recurrent effusion over 6 months. These results might indicate a relationship between the adenoids and OME.

Adenoidectomy↗
PubMedDate not supplied

Effect of erythromycin on adenoid bacteria.

Seventy-eight patients with secretory otitis media were given erythromycin ethylsuccinate 50 mg/kg/day, divided into 2 doses, for 7-8 days before undergoing adenoidectomy and tympanostomy. Nasopharyngeal swabs for bacterial culture were obtained before medication and at surgery and the adenoid homogenate was also studied for bacteria. Pneumococci and Branhamella strains became significantly reduced, while Hemophilus influenzae showed no change. Pneumococcus and Branhamella strains partially returned one month after surgery and in part were found in patients who had not had these strains before antimicrobial therapy. Erythromycin ethylsuccinate can sterilize neither the adenoids nor the middle ear space if the causative agent is Hemophilus influenzae.

Adenoidectomy↗
PubMed1993

Quantitative bacterial culture from adenoid lymphatic tissue with special reference to Haemophilus [corrected].

Homogenized adenoid tissue from 55 children (28-153 months) undergoing adenoidectomy because of nasopharyngeal obstruction was investigated by means of quantitative aerobic bacterial culture. The children were divided into two groups, the hypertrophy alone group--AH (n = 29)--and the hypertrophy with longstanding secretory otitis media group--SOM (n = 26). A nasopharyngeal culture was obtained preoperatively from 38 of the cases. Non-typeable H. influenzae (NTHI) was found in twice as many cases in the AH group as in the SOM group, 21/29 (72%) compared to 11/26 (42%) (p < 0.05) and in a significantly higher mean concentrations, 5.7 x 10(5) CFU/g compared to 1.9 x 10(5) CFU/g (p = 0.02). For the other aerobic potentially pathogenic bacteria no such difference was found. The bulk of the NTHI-positive cases and the cases with the highest concentrations were found in the children below the age of 6 years. In the nasopharyngeal cultures NTHI alone or together with S. pneumoniae and/or B. catarrhalis was found in 29% of the cases in both the AH group and SOM group. NTHI was found in only 50% of the nasopharyngeal cultures corresponding to a positive quantitative culture (10/20). These findings suggest that NTHI is harboured within the adenoid and could thereby chronically stimulate the local immune defense. However, the present study indicates that there is no aerobic bacterial overload in the adenoid tissue in children with SOM compared to children without middle-ear disease.

Adenoidectomy↗
PubMed1995

Bacteria in middle ear effusions in children treated with tympanostomy; a 10-year series.

During the 10-year period, 1983-92, altogether 7,411 ears of 5,291 children with recurrent or chronic otitis media problems were treated with tympanostomy at our hospital in central Finland, The series was divided into three groups: i) infants aged 6-12 months undergoing primary tube treatment. ii) children aged 1 year or more receiving their first ventilation tube(s) in connection with adenoidectomy, and iii) children who had already had ventilation tubes inserted at least once before the present tympanostomy. Middle ear effusion (MEE) samples were obtained from 4,769 (64.3%) of the affected ears, 69.5% of all MEE cultures were negative for bacteria, whereas 20.2% grew pathogenic bacteria. S. pneumoniae was the most frequent pathogen in group 1, whereas H. influenzae was more frequent than S. pneumoniae in groups 2 and 3. In only 3.7% of MEE cultures were beta-lactamase-producing strains of pathogenic bacteria found, either H. influenzae (0.9%) or M. catarrhalis (2.8%). Comparison of the first and second 5-year periods ( 1983-87 vs. 1988-92) showed no significant changes in the occurrence of the various pathogenic bacteria. An increase was observed in beta-lactamase production for M. catarrhalis but not for H. influenzae strains.

Acute Disease↗
PubMed1997

Snoring children: factors predicting sleep apnea.

Many snoring children present obstructive symptoms according to their parents. The seriousness of the symptoms and the possibility of the obstructive sleep apnea syndrome (OSAS) in these children may be difficult to judge on the basis of the clinical findings and the patient's history only. In order to evaluate snoring children's relative risk (RR) to have OSAS, their symptoms and signs, as reported by the parents, and clinical findings were compared with the results of overnight polysomnography (PSG). An obstructive apnea index (AI) > or = 1 in PSG was regarded as the criterion for OSAS. The mean AI was 1.55 (range 0-15), and 29 children had a pathological AI, while 49 had a normal PSG recording. Apneic episodes every night detected by the parents was the most important single risk factor for OSAS (RR 3.6, 95% confidence interval (CI) 1.7-7.7). The RR ratio decreased when apneas appeared less frequently, but any detected apnea was still a single risk factor (RR 1.4, CI 1.2-1.8). The other risk factors of night-time symptoms were constant snoring (RR 1.5, CI 1.0-2.1) and restless sleep (RR 2.1, CI 1.1-4.0). Of the daytime symptoms, absence of excessive sleepiness was a protective factor against OSAS (RR 0.3, CI 0.1-1.0). Previous adenoidectomy was found to be a risk factor (RR 1.7, CI 1.1-2.7), as was tonsillar enlargement (RR 1.4, CI 1.1-1.8). These two findings suggest that the epipharyngeal space does not play a central role in the development of OSAS in children. OSAS cannot be reliably diagnosed without PSG, which is the most important examination for snoring children with obstructive symptoms. For clinical decisions, the consideration of risk factors is essential.

Adenoidectomy↗
PubMed1977

The eustachian tube function in secretory otitis media in children: a follow-up study.

Twenty-three patients suffering from secretory otitis media were examined. The mean age of the group was 6 years. Adenoidectomy and insertion of polyethylene tympanostomy tubes was made. The tubal function was studied by measuring the middle ear pressure on the morning after operation and once a month during the following five months by using the air pressure equilibration technique. In 23 ears (79%) the pressure was considered to be normal and in 10 ears (30%) abnormal at the first measurement. After 5 months the corresponding groups were 26 (79%) and 7 (21%).

Adenoidectomy↗
PubMedDate not supplied

The behavior of preschoolers during and after brief surgical hospitalizations.

This qualitative study describes the behavior of preschool children during and after very brief hospitalizations for tonsillectomies and/or adenoidectomies. Structured, open-ended home interviews were conducted with 23 parents 5 to 7 days after their children's hospital discharge. Parents were asked to describe their children's behaviors during hospitalization and the first week at home. Approximately half of the parents and children had attended an optional surgical preadmission teaching program. The remaining parents had prepared their children for hospitalization using toy doctor kits and library books. Preoperatively, children who had attended the program behaved similarly to those who had not: They either cooperated fully, resisted initially, or completely refused to cooperate with admission procedures. Most children separated easily from their parents to enter the operating room, whereas some (n = 5) demonstrated great anxiety. However, immediately after surgery, most children who had not attended the program appeared more distressed than those who had attended. Finally, despite their relatively minor surgeries and brief hospitalizations, after discharge the majority of children (83%), regardless of whether they had attended the program, exhibited signs of distress. In comparison with their prehospitalization behavior, parents reported that their children were more irritable, had more nightmares, had appetite changes, and experienced more separation anxiety. Implications for nursing practice and research are discussed.

Adenoidectomy↗
PubMed1996

New prospects in the prevention of otitis media.

Otitis media is the most common bacterial infection in children, accounting for a substantial economic burden to the health care system. Together with concern for long-term developmental sequelae, prevention of otitis media has become a high priority area of research. A wide range of factors has been associated with an increased risk of acute otitis media. Most of these factors, however, predispose to upper respiratory tract infection which, in turn, can be considered the most important risk factor for acute otitis media. Conventionally, antimicrobial prophylaxis, tympanostomy tubes and adenoidectomy have been used for prevention of otitis media. At present, the vaccine approach seems to hold the greatest promise for ultimate prevention of otitis media. In addition to the bacterial vaccines, vaccines against the most common viruses predisposing to acute otitis media may also prove valuable in the prevention of otitis media.

Adenoidectomy↗
PubMedDate not supplied

Parent and child views of an ENT ward.

This is a descriptive field study concerning the reported experience of parents and their children who were admitted for tonsillectomy or adenoidectomy to a northern hospital. Twenty parents and 20 children were asked to record the five most liked and disliked aspects of being in hospital. It was found that staff were considered salient and evaluated positively by both parents and children. Children found the most negative experience to be the postoperative period. There was no evidence of preoperative anxiety. It is recommended that further research should focus on ameliorating the negative experience of the postoperative period for children.

Adenoidectomy↗
PubMed1998

The importance of sleep following ENT surgery.

This study reviewed a group of 48 children following ENT surgery and considered the implications of too little sleep after their operation. All the children had either an adenoidectomy, a tonsillectomy, or an adenotonsillectomy. Their post-operative sleep was timed and their state of nausea was recorded when they awoke. There appeared to be a correlation between the length of undisturbed sleep and the incidence of nausea or vomiting. It is suggested that this result should influence the advice given to parents of the benefits about sleep for their child in the post-operative period.

Adenoidectomy↗
PubMed1976

Middle ear effusions -- complications of disease and treatment.

The results of treatment of secretory otitis media with commonly found disease in Finland is described. Treatment includes adenoidectomy and/or insertion of tympanostomy tubes with mastoidectomy in selected cases. Tympanostomy tube treatment results in an increased amount of visible tympanic membrane scar formation and tympanosclerosis, but these are of no major functional importance. In about 10 per cent of the glue ears a mastoid disease process complicates the disease. Here thorough mastoidectomy at an early stage is the treatment of choice. Cholesteatoma formation appears in about two per cent, but in the majority of cases this is not related to tympanostomy treatment but is due to the disease process itself.

Adenoidectomy↗
PubMed1975

Current concepts of treatment of ear disease in cleft palate children and adults.

This author had demonstrated that the incidence of conductive hearing loss in adults who have had cleft palates approximates 50%. That their ear disease arises during infancy has been well documented by Stool and Paradise. The serous otitis media which develops in infancy and persists through adolescence is presently best treated by tympanic aeration tubes. Whether or not a limited adenoidectomy is a useful adjunct in treatment remains to be conclusively demonstrated. That cleft palate repair and/or pharyngeal flap surgery is helpful in the eventual outcome of ear disease would seem to be so. The end product of recurrent serous effusions and/or ear infections can be a chronic draining ear and/or cholesteatoma which following the attainment of adolescence is best treated by mastoid tympanoplasty with ossicular reconstruction. The effect of hearing on the speech of palate patients is discussed and a new method for using visual cues in helping palate patients speak less hypernasally offered.

Adenoidectomy↗
PubMed1999

[Pediatric day surgery of the respiratory tract--indications and prioritization].

Ear, Nose and Throat (ENT) procedures are the most common types of surgery in children and include adenoidectomy, tonsillectomy, myringotomy, ventilation tube insertion or combinations of these. In order to study disease profile and routines for referral and treatment in outpatient otolaryngologic surgery, data were collected from 178 children operated consecutively during a six-week period in 1998. Median time from referral to surgery was less than four months. The majority of children operated for recurrent acute otitis media, tonsillitis or upper respiratory infections had suffered from the disease for 12 months or less. Obstructive symptoms were registered in 18% of these children. Most patients were referred to the hospital by specialists in otolaryngology or paediatric medicine. Surgery was more common in male than female-children, and median age at the time of surgery was 4.2 years. There was an equal distribution of middle ear and pharyngeal surgery.

Adenoidectomy↗
PubMed2000

Choanal adenoid syndrome--a preliminary report.

A series of 19 patients with long-lasting nasal stenosis despite repeated treatment attempts, including, in many cases, repeated adenoidectomy, was found to have ectopic adenoid tissue inside the choanae. The choanal adenoid tissue could not be removed by curettage, only transnasally using forceps. The treatment was successful in all 19 patients. It is estimated that in at least 2% of the patients with long-lasting nasal stenosis, attention should be focused on the bottleneck of the nasopharyngeal airway represented by the choanae, primarily by fibre optic endoscopic examination.

Adenoidectomy↗
PubMed2000

Factors associated with post-tonsillectomy hemorrhage.

Despite the otolaryngologist's most diligent efforts to prevent it, hemorrhage is the most common, albeit sporadic, significant complication of tonsillectomy. For this retrospective study of post-tonsillectomy hemorrhage rates, we examined the charts of 430 consecutive tonsillectomy patients who had been operated on by one of two general otolaryngologists at our institution. The two surgeons used the same removal technique (cold dissection and snare), but slightly different methods of hemostasis. We found that the overall bleeding rate was 4%; the primary (< 24 hr) hemorrhage rate was 0.23%, and the secondary rate was 3.7%. Factors that were positively correlated with postoperative bleeding were the patient's sex, the time of year the surgery was performed, the length of the procedure, the amount of blood lost during surgery, and the use of intraoperative vasoconstrictors and steroids. However, we believe the use of steroids can probably be discounted as a causative factor. The chi 2 test was used to determine statistical significance. None of the 21 patients who were operated on for peritonsillar abscess experienced any delayed postoperative bleeding. The mean decrease in hemoglobin was 2.3 grams; the lowest postoperative level was 6.6 grams. The highest incidence of delayed bleeding occurred on the eighth postoperative day. Two patients required transfusions, and both recovered without any adverse consequences. It appears that one controllable variable in preventing delayed bleeding following tonsillectomy and adenoidectomy might be related to certain details of hemostatic technique. Vasoconstrictors and "field" cauterization might be associated with an increased temporal and spatial application of coagulating current. Although this technique is very effective in preventing primary hemorrhage, it does result in a deeper and more extensive zone of necrosis and the exposure of more and larger vessels when sloughing of the eschar occurs.

Adenoidectomy↗
PubMedDate not supplied

[Serum immunoglobulin levels in tonsillectomized patients. An unsolved mystery].

In a prospective study of 117 patients scheduled for tonsillectomy, with or without adenoidectomy, immunoglobulin levels were measured preoperatively and 1 to 6 months after intervention. Small deficiencies in IgG levels were observed, but levels were within normal limits. We have attempted to clarify the controversial topic of the immunological disturbances that may appear after this common intervention.

Adenoidectomy↗
PubMed1999

Postoperative tonsillectomy/adenoidectomy hemorrhage: a retrospective chart review.

Post-operative hemorrhage is the most serious and life-threatening complication of tonsillectomy. A medical records review was conducted of patients who underwent a tonsillectomy with or without an adenoidectomy over a five year period at the New York Eye and Ear Infirmary. This quality assurance project aimed to examine the incidence, etiology, contributing factors, and management of primary vs. secondary postoperative hemorrhage at this 100-bed tertiary care facility. The findings of this retrospective review parallel those published from other centers. This paper will discuss findings and implications for otorhinolaryngology nursing practice.

Adenoidectomy↗
PubMed2001

Comparative study of diclofenac sodium and paracetamol for treatment of pain after adenotonsillectomy in children.

OBJECTIVE: To compare the analgesic efficacy of diclofenac sodium and paracetamol on post adenotonsillectomy postoperative pain and oral intake. METHODS: Between January 1999 and July 2000, 80 children aged 3-14 years, underwent tonsillectomy and adenoidectomy for either recurrent tonsillitis or adenotonsillar hypertrophy in Prince Zeid Ben Al-Hussein Hospital and Prince Rashid Ben Al-Hussein Hospital. Forty-one children received diclofenac sodium suppositories (1-3mg/kg) postoperatively, whereas 39 children received only paracetamol syrup (10-15 mg/kg) in 4 divided doses. All children were observed for postoperative pain, oral intake, vomiting, temperature and complications. RESULTS: Children who received diclofenac sodium had significantly less pain, less elevation of temperature, more oral intake, and started drinking significantly sooner than the paracetamol group. Two children in the diclofenac group experienced nausea and vomiting compared to 12 children in the paracetamol group in the first day. The time to first solid intake was significantly earlier in the diclofenac sodium group (p < 0.0001). With regard to complications, one patient in each group developed secondary hemorrhage, one child developed otitis media in the 2nd group. Each group had one readmission, and 2 children from the paracetamol group had an emergency department visit for pain and dehydration. CONCLUSION: Diclofenac sodium has a significant effect on decreasing the pain associated with swallowing postoperatively and on the general condition of the patient. Improved oral intake resulted in a lower incidence of nausea and vomiting and allowed safer and earlier hospital discharge.

Acetaminophen↗