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PubMed2001

[Asthma and chronic diseases of the upper respiratory airway].

There is enough evidence of an epidemiological, etiological and physiopathological link between chronic rhinitis (usually allergic) and asthma, and also between chronic sinusitis (generally bacterial) and this disease. Allergic inflammation of nasal mucosa could favor the development of chronic sinusitis. Indeed, some authors believe that the term "rhinosinusitis" should be used as nasal and sinus mucosa are one and the same thing. Some studies have demonstrated that treatment of chronic rhinitis or chronic sinusitis produces a benefit in the evolution of asthma when both diseases co-occur in the same patient, which suggests a therapeutic link. However, there is insufficient evidence that adenoidectomy and/or tonsillectomy worsen the evolution of asthma. When managing the asthmatic child, physicians should not forget to pay attention to the upper respiratory tract, evaluating and treating diseases in this area if necessary, as such therapeutic measures will also benefit asthma control.

Adenoidectomy↗
PubMed1998

[Secretory otitis media].

Secretory otitis media is defined as the presence of effusion behind an intact eardrum without symptoms of acute infections. It is a common problem of infants between 1 to 5 years old. Most of cases of secretory otitis media are asymptomatic and discovered during child check up. The diagnosis is otoscopic and confirmed by tympanometry. A proportion of secretory otitis media resolves spontaneously or with the treatment of upper respiratory infections. The failures require the surgical solution of ventilating tube and adenoidectomy which leads to more 90% resolution with very low side effects.

Acoustic Impedance Tests↗
PubMed2000

Ultrasonic tonsillectomy.

High-frequency ultrasound is an effective mechanism for cutting and coagulating tissue. It is widely used in laparoscopic surgery and may have advantages in tonsillectomy. Twenty-five consecutive cases of tonsillectomy were performed using an ultrasonic scalpel; these were compared with a similar previous consecutive group performed by conventional cold dissection and monopolar electrocautery. There was no undue primary bleeding in either group and no immediate or late postoperative bleeding. Since adenoidectomy was often performed and the total blood loss in each group was so small, no statistical difference could be determined between the groups. No complications were noted in either group. The ultrasonic scalpel has the potential to produce a bloodless tonsillectomy and less collateral tissue damage and is easy to use. There may be less postoperative pain, although this could not be shown statistically in this retrospective study. Ultrasonic tonsillectomy appears to be a safe, and possibly a superior, method of performing this common operation.

Adenoidectomy↗
PubMed2002

[Adenotonsillectomy in children: not yet scientifically validated].

Tonsillectomy, in 90% of cases combined with adenoidectomy, is one of the most frequently carried out operations on children in the Netherlands: in 1998 there were 33,471 operations in children aged 0-14 years. This high frequency is in stark contrast to the scientific basis for the efficacy of this intervention. A meta-analysis carried out recently revealed just one good study. The lack of scientifically based clinical guidelines, partly explains the large international and regional differences in the number of operations carried out. In the Netherlands only 35% of the children operated on satisfy one of the criteria for which the effectiveness of (adeno)tonsillectomy has been established: frequent recurrent tonsillitis or obstructive sleep apnoea. A project has been started in the Netherlands to further study the effectiveness of this intervention, the results of which must contribute to a more thoroughly substantiated indication.

Adenoidectomy↗
PubMed1975

[A persistent craniopharyngeal canal combined with a meningoencephalocele (author's transl)].

The anatomical and embryological facets of the persistent craniopharyngeal canal combined with a meningoencephalocele are reviewed, and the case of a 6 year old girl is reported. Postnatal dyspnea and cyanosis improved after perforation of nasopharyngeal cyst, and adenoidectomy was performed at the age of 8 months. The second episode of meningitis led to its radiological assessment and correct diagnosis. Surgical treatment is limited because the location of the pituitary in this child is not known.

Adenoidectomy↗
PubMed2001

Nocturnal enuresis and obstructive sleep apnoea in two children.

Nocturnal enuresis was a symptom of childhood obstructive sleep apnoea, OSAS. We reported two children with secondary nocturnal enuresis which disappeared after tonsillectomy and adenoidectomy for proven OSAS. Pathogenesis of secondary nocturnal enuresis in OSAS was discussed.

Adenoidectomy↗
PubMed2002

[Pediatric flexible endoscopy of the upper airway in the outpatient clinic].

Flexible nasopharyngoscopy has become an important examination of the upper airway in children. It is performed in the outpatient clinic in children of all ages under local anesthesia. We reviewed 190 consecutive examinations of children aged 3 days to 17 years, that were referred to the pediatric ENT clinic between 1999 and 2000. The following parameters were analyzed: demographic details, indications, physical findings, patient cooperation, reliability, and recommendations for further evaluation or treatment. The most common indication for endoscopy was nasal obstruction in 56 patients (30.1%). In this group 25 had an obstructing adenoid and were referred for adenoidectomy. Hoarseness was the second most common complaint in 40 patients (21.5%). Thirty-one of those patients had vocal cord nodules. The most common finding was adenoid hypertrophy in 56 patients (30.1%). No pathology was found in 34 examinations (18.3%). Although a significant correlation between patient cooperation and examination reliability was seen, in most cases good reliability was obtained even in the presence of poor cooperation. The procedure was easy to perform and had no complications. This study emphasizes the advantages of awake flexible nasopharyngolaryngoscopy in the diagnosis of upper airway pathologies in children.

Adenoidectomy↗
PubMed1975

Hypoventilation secondary to chronic upper airway obstruction in childhood.

A 6-year-old child manifested symptoms and signs of alveolar hypoventilation and signs of cor pulmonale caused by obstruction of the upper airway. These symptoms and signs disappeared after tonsillectomy and adenoidectomy. The relationship of upper airway obstruction to hypoventilation and cor pulmonale is discussed in the hope of renewing interest in this problem and alerting physicians to think of this possiblity early in the evaluation of such patients.

Adenoidectomy↗
PubMed2002

Incidence of post-tonsillectomy hemorrhage in children and adults: a study of 4,848 patients.

We conducted a retrospective study of 4,848 patients to evaluate the age-specific incidence of post-tonsillectomy hemorrhage that required surgical treatment. We reviewed the charts of 2,567 patients younger than 15 years (pediatric group) and 2,281 patients aged 15 years and older (adult group) who had undergone tonsillectomy with or without adenoidectomy. We found that post-tonsillectomy hemorrhage occurred significantly more often in the adult group (3.9 vs 1.6%; p < 0.001). Moreover, primary hemorrhage (< 24 hr postoperatively) was also significantly more common in the adult group than in the pediatric group (82.9 vs 65.9%, p = 0.023). Analysis of other parameters revealed that post-tonsillectomy hemorrhage was significantly more common in males and in patients who had a history of chronic or recurrent throat infection. Awareness of these risk factors should help improve patient care and outcomes.

Adenoidectomy↗
PubMed2002

[Laser myringotomy].

The aim of the study was assessment of the qualities of laser-assisted myringotomy (LAM) as a treatment for acute and secretory otitis media. Laser-assisted myringotomy was performed on 65 children (113 ears) mean age 6.2 years diagnosed with secretory otitis media (80%), recurrent secretory otitis media (11%) and acute otitis media (9%). Myringotomy was performed under general anesthesia using the OtoLAM device (ESC/Sharplan, Israel). In 64 ears pressure equalisation tubes were inserted after fenestration of the tympanic membrane with laser. Adenoidectomy alone or with tonsillectomy was performed at the same time in 51 cases. Laser tympanostomies remained patent for 7-32 days. All tympanostomies healed with no noticeable scarring. LAM appears to be a safe, and easy to performed, alternative technique in the treatment of otitis media.

Acute Disease↗
PubMedDate not supplied

Inferior turbinectomy in children.

BACKGROUND: Inferior turbinectomy on patients of all ages is a controversial procedure. Its effect on children has been reported little in the literature and the few studies that are available involved relatively older children, i.e., >10 years old. Nasal obstruction caused by extensive hypertrophy of the inferior turbinates is not an uncommon observation in the pediatric population. The clinical manifestations might present as snoring, noisy breathing, mouth breathing, and, possibly, sleep apnea. METHODS: In this study, we followed 227 children <10 years of age who underwent inferior turbinectomy (27 children also underwent a revision of an earlier adenoidectomy), of whom 179 children had significant relief of nasal obstruction at the 1-year follow-up. RESULTS: Nocturnal breathing was reported to be more regular and otherwise improved in the 36 children with a suspected history of sleep apnea. Forty-two of 47 children who had thick nasal secretions and did not respond to antibiotic therapy before the operation had significant relief postoperatively. Postoperative complications were few and their number did not exceed that of adults. CONCLUSIONS: A complete inferior turbinectomy should be considered in children <10 years of age who have hypertrophied inferior turbinates that cause major interference with nasal breathing.

Adenoidectomy↗
PubMed1992

Transtympanic ventilator tubes in the treatment of seromucous otitis. Indications and results.

400 patients with bilateral secretory otitis media (SOM) were treated with ventilating tubes (VT) in a prospectiv study. The ear drums were normal on both sides before VTs treatment thus allowing ear drum changes and complications during VT treatment to be recorded. 618 VT were placed in the ear drum after suction of the fluid. In 182 patients unilateral myringotomy with suction of fluid were done and VT placed in the contralateral ear. Adenoidectomy with myringotomy, with an obstructing adenoid, gave 30% better chance. 10 different VTs were used. The most frequent pathology found in the ear drum after one period of VT treatment was tympanosclerosis. In the ears only treated with myringotomy tympanosclerosis occurred in 1%. 3 factors seemed to give more tympanosclerosis: metal (stainless steel or titanium), polyethylene and prolonged stay-time in the ear drum. Chronic perforations of the ear drum occurred with great variations between the different tubes. The Goode modified T-tube caused perforations in 17%. In the other VTs the perforations occurred in 2.1%. Chronic perforation together with tympanosclerosis will happen more often when the VT is made of polyethylene compared to silicone or fluoroplastic (p < 05). 90% of the perforations were located at the site of the VT. The ideal VT will stay in for 8-18 months at an average and it can be shown to improve middle ear function better than only waiting or myringotomy. Long-term VTs should not be used at the first VT procedures.

Adenoidectomy↗
PubMed1992

Sleep apnea syndrome in children--secondary to adenotonsillar hypertrophy?

In this study we investigated the relationship between the size of adenoids and/or tonsils and obstructive sleep apnea syndrome (OSAS) in 19 children aged 3 to 7 years. After clinical examination by an ENT specialist, electrocardiogram (ECG), vectorcardiogram (VCG) and echocardiogram (EC) were performed while the patients were awake, and static charge sensitive bed (SCSB) method recording (noninvasive monitoring of ballistocardiogram, respiration and body movements) while asleep. After adenoidectomy and/or tonsillectomy, the volume of the tonsils and the adenoids was determined. RVH was found in 4 out of 19 children (21%). RVH findings correlated highly with the number of apneas but, surprisingly, not with measured adenotonsillar size in those children. However, at 6 months of follow-up, the VCG and EC changes had returned to normal. These results suggest that RVH is more common in children suffering from upper airway obstruction than previously believed, and that factors other than adenotonsillar size also have an influence on upper airway obstruction.

Adenoidectomy↗
PubMed2004

Survey of children with obstructive sleep apnea syndrome in Hong Kong of China.

BACKGROUND: Obstructive sleep apnea affects up to 2.9% of children. This study was to determine demographic and clinical characteristics of a group of children with obstructive sleep apnea syndrome (OSAS) as defined by sleep polysomnography (PSG). METHODS: A prospective study was conducted in a public-funded general hospital in Hong Kong of China. Children confirmed to have OSAS by PSG were followed up between January 1997 and December 1998. Tonsillectomy and adenoidectomy (T&A) was offered to those with moderate to severe OSAS, and medication was offered to those with mild OSAS. All children were followed up regularly in the sleep clinic and sleep PSG was repeated for those with marked relapse in symptoms. RESULTS: Eighty-nine children (64 boys and 25 girls, mean age 7 years) were confirmed to have OSAS out of 352 children who underwent PSG during the study period. The most common symptoms of OSAS were snoring (100%) and sweating (81%) during sleep and nasal blockage (61%) and sleepiness (34%) during daytime. Severe OSAS occurred in 15 children. Moderate OSAS occurred in 33 children. Forty-one children had mild OSAS. Forty-nine children underwent T&A, 5 (boys, < 5 years) out of whom were found to have recurrent OSAS within 1 year. CONCLUSION: A male predominance has been found in a group of Hong Kong children with OSAS. Boys undergoing T&A at an early age (< 5 years) will be more likely to develop repeated OSAS.

Adenoidectomy↗
PubMed2004

Acoustic rhinometry in the assessment of adenoid hypertrophy in allergic children.

BACKGROUND: Due to the difficulties involved in assessing adenoidal tissue and the nasopharyngeal airway in children, it is necessary to find an accurate pre-operative method of measuring these structures. MATERIAL/METHODS: We used acoustic rhinometry and endoscopy both to the evaluate results of surgical and medical treatment in allergic children with adenoid hypertrophy and to evaluate the influence of pollination on adenoid size in children with seasonal allergic rhinitis. Three separate groups of children were examined. The first group consisted of nine children with adenoid hypertrophy and positive skin-prick test results of year-round allergens. In this group we examined the influence of adenoidectomy on the rhinometric curve. The second group consisted of sixteen children with adenoid hypertrophy and perennial allergic rhinitis. In this group we examined the influence of medical treatment (topical nasal steroid and antihistaminic) on the adenoid size and rhinometric curve. The third group consisted of twelve birch pollen-sensitive children who had symptoms of seasonal allergic rhinitis. In this group we examined the influence of pollination on the nasopharyngeal period of rhinometric curve. RESULTS: In the two first groups we observed a significant increase of the nasopharyngeal cavity after surgical removal of the adenoids and medical treatment of the allergy. In the third group most of the children experienced a significant decrease in nasopharyngeal cavity volume during pollination. CONCLUSIONS: Acoustic rhinometry seems to be a very promising method of assessment of the amount of adenoid, and allergy can play an important role in adenoid hypertrophy in hypersensitive children.

Adenoidectomy↗
PubMed1992

Serum immunoglobulin changes in relation to tonsil and adenoid surgery.

In the course of clinical trials of tonsillectomy, adenoidectomy, and adenotonsillectomy, we measured serum levels of immunoglobulins G, A, and M by rate nephelometry in 268 subjects at baseline and at intervals after receipt or nonreceipt of surgery. Up to 30 months after baseline we observed a consistent pattern of change only in levels of immunoglobulin G, decreases in which tended to occur more commonly and be of greater magnitude in subjects who received tonsillectomy or adenotonsillectomy than in corresponding control subjects. However, in both surgical and control subjects the subsequent incidence of throat infection showed no relationship to either contemporaneous immunoglobulin levels or changes from baseline levels. A decline in serum immunoglobulins following tonsillectomy appears not to be a risk factor for developing throat infection, and may reflect a reduction in antigenic stimulation.

Adenoidectomy↗
PubMed2004

[Reduction of overgrown lymphatic system among children as a method of restoration of upper airways].

It was concluded, that airway stenosis in the pharyngeal area is the most frequent cause of sleep apnea syndrome among children. The basis of research were children treated at The Clinic from 1999-2002 and it was stressed that the best way to cure is surgical therapy. Partial tonsillectomy or adenoidectomy is a stable method of dilatation of the airway. Proper treatment depends on correct recognition made by the laryngologist based on interview, clinical examination and pulsoxymetry examination. The less extensive procedures were stressed specially among children because of role of pharyngeal and palatine tonsil, which are the most significant factors of lymphoid tissue of Waldeyer's ring.

Adenoidectomy↗