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PubMed1989

[Acute tonsillectomy in infectious mononucleosis].

Enlargement of the pharyngeal tonsils in infectious mononucleosis (MI) is frequently an important component of the clinical picture but pronounced obstruction of the upper respiratory passages is rare. An analysis of 11 cases of infectious mononucleosis with varying degrees of pharyngeal obstruction is presented. During the acute phase of the disease, tonsillectomy was performed and also adenoidectomy in four of the cases. The patients improved rapidly after the operation and were discharged after an average of four days. No noteworthy complications of the operation occurred. An unexpectedly great number of cases of abscess formation were found at operation. Histological examination of the tonsils revealed changes in the lymphoid tissue which were characteristic but not specific for infectious mononucleosis together with extensive necrosis of the tonsillar surface. On the basis of this investigation, the authors consider that acute tonsillectomy is indicated in infectious mononucleosis with threatening occlusion of the upper airway and in cases of suspected peritonsillar abscess. In cases of slight or moderate respiratory obstruction, acute tonsillectomy may be considered in the therapeutic deliberations if the course of the condition is protracted and steroid treatment does not have the desired effect.

Adenoidectomy↗
PubMedDate not supplied

[Malignant hyperthermia. Apropos of a case].

We present the clinical case of a thirteen-year-old male patient who suffered a malignant hyperthermia syndrome after an adenoidectomy under general anaesthesia. The recovery of the patient was successful with the specific treatment of dantrolene. We believe it is interesting to publish all the cases of malignant hyperthermia in order to have a better knowledge of the real incidence in our country.

Adenoidectomy↗
PubMed1979

Lymphocytes from adenoid vegetations: proliferative responses in vitro as compared to blood lymphocytes.

Thymidine incorporation by lymphocytes obtained from adenoids (AVL) and blood (PBL) were compared in 27 children undergoing adenoidectomy. Optimal conditions as regards cell number and duration of culture were worked out. The spontaneous thymidine incorporation was higher in PBL than in AVL. In cultures stimulated by polyclonal activators or by PPD, the responses of PBL were higher. The dose-response curves for PBL and AVL after stimulation with killed H. influenzae were different: PBL showed a higher response, the optimal antigen concentration was lower for PBL, and the responsiveness to suboptimal antigen concentrations wash higher in PBL than in AVL.

Adenoidectomy↗
PubMed1988

[Diagnosis and incidence of recurrence of chronic tubal secretory otitis media in childhood].

In a comparison of two groups of children undergoing adenoidectomy, the introduction of routine hearing tests revealed 30.8% more patients with secretory otitis media than in a control group in which tests were carried out only if profound hearing loss was suspected. The history and ear examination were insufficient for detection of secretory otitis media. Evaluation of patients not suspected of hearing loss revealed 24.5% more cases of secretory otitis media than by routine hearing tests. In 25.8% the secretory media recurred, requiring paracentesis or insertion of drainage tubes.

Acoustic Impedance Tests↗
PubMed1988

Thermal myringotomy (an alternative to grommet insertion in childhood secretory otitis media?).

Thirty-six children with bilateral secretory otitis media were treated by thermal myringotomy and middle ear aspiration in one ear, and conventional myringotomy, middle ear aspiration and Shepard grommet insertion in the other ear. All children underwent adenoidectomy. Comparing the effectiveness of the two different procedures over a three-month review period, our main findings are as follows. All thermal perforations were closed by 42 days. Elimination of middle ear fluid was achieved in 81 per cent of the thermal myringotomy group, and in 100 per cent of the grommet group. While there was no significant difference in the hearing improvement between the procedures, conventional myringotomy and grommet insertion provided significantly better sustained middle ear ventilation.

Adenoidectomy↗
PubMed1987

Day-care versus inpatient pediatric surgery: a comparison of costs incurred by parents.

The cost-effectiveness for parents of day-care pediatric surgery was assessed by comparing time and financial costs associated with two surgical procedures, one (squint repair) performed exclusively as a day-care procedure, the other (adenoidectomy) performed exclusively as an inpatient procedure. All but 1 of 165 eligible families participated. The children underwent surgery between February and July 1981. The day-care surgery group (59 families) incurred average total time costs of 16.1 hours, compared with 37.1 hours for the inpatient surgery group (105 families), as parents in the latter group remained with their child during the longer hospital stay. Parents from out of town incurred the greater time and financial costs. In both groups parents of younger children tended to spend more time at the hospital than parents of older children. Type of surgical management was not a significant factor in out-of-pocket expenses. Loss of income was associated with employment of the mother as a professional or a manager and may reflect inequalities in access to compassionate leave between men and women in equivalent positions. Opening day-care surgery facilities on weekends might reduce the financial burden on working mothers. Overall, day-care surgery was found to be cost-effective for families.

Adenoidectomy↗
PubMed1986

[Indications for the insertion of ventilating tubes in the mucotympanum of the child].

The influence of adenoidectomy, myringotomy and lavage of the middle ear was studied in children suffering from secretory otitis. The children were controlled by audiograms and tympanograms over a one-year period of time. 89 percent of all children showed normal values one year following surgery, 11 percent had still high negative middle ear pressures and conductive hearing loss. We think that these children only are candidates for ventilating tubes (grommets).

Acoustic Impedance Tests↗
PubMed1985

Grommets versus paracentesis in secretory otitis media. A prospective, controlled study.

One hundred and ninety-three consecutive children with bilateral secretory otitis media were treated by adenoidectomy, bilateral paracentesis, and evacuation of middle ear effusion, but with insertion of a grommet in the right ear only. At follow-up one to three years later, the audiometric and tympanometric results were similar in right and left ears. The primary advantage of grommet insertion was normalization of the hearing ability for as long as the grommet was functioning. Thus, only 1% of the ears with grommets had hearing losses exceeding 30 dB HL, whereas this occurred in about 20% of ears without grommets. The adverse effects of grommet insertion included periodic aural discharge during the functioning period of the grommet in 14% and tympanosclerosis of the drum in 48%. In the group of ears treated with paracentesis only, tympanosclerosis occurred in 10%. However, reinsertion of grommets was indicated in 10% of right ears, and 23% of left ears required grommets as well. Of the various pre- and perioperative factors analyzed, only a granulating mucous membrane and copious middle ear effusion could be correlated to frequent and protracted episodes of secretory otitis that required repeated treatment. The implications of these findings are discussed.

Acoustic Impedance Tests↗
PubMed1984

Management of otitis media with effusion: a review.

The majority of ears affected by otitis media with effusion recover, but whether these recoveries are assisted by noninvasive therapies is not yet established. What is known is that some middle ears affected by otitis media with effusion will eventually develop permanent structural and functional defects in spite of surgical intervention. The role of medications and the arguments for and against adenoidectomy and tympanostomy are reviewed in relation to the author's findings from short- and long-term studies of ears treated surgically.

Adenoidectomy↗
PubMed1984

[The use of neuroleptanesthesia in adenotonsillectomy in children].

Two groups of 100 children each who underwent adenoidectomy and/or tonsillectomy were anaesthetised by halothane 1% or by a neuroleptic technique (NLA) using fentanyl 0.0025 mg/kg and droperidol 0.125 mg/kg as a fixed combination (Thalamonal). Both techniques were supplemented with nitrous oxide/oxygen 4/2 l. All children were premedicated with atropine 0.015 mg/kg, fentanyl 0.0025 mg/kg and droperidol 0.125 mg/kg i.m. Quality of premedication and postoperative behaviour and analgesia were assessed by standardised criteria. 93% of the patients arrived at the theatre sleeping or detached, 75% showed almost no reactions to venipuncture. Heart rate during surgery in both groups increased by 13%, mean arterial blood pressure in the NLA group increased by 9% and in the halothane group dropped by 5%. Postoperatively blood pressure in NLA patients returned to normal, while in the halothane group there was a transient rise by 10%. Protective reflexes and consciousness were restored in the NLA group earlier. After halothane, stridor occurred in eight cases upon extubation. Postoperative analgesia scores in NLA patients were double those in the halothane group. Moderate metabolic acidosis and slight hypercapnia were postoperatively present in both groups twice. Modified neuroleptanaesthesia proved equal to halothane anaesthesia for ENT surgery. No respiratory depression was seen. Advantages like uncomplicated quick recovery and protracted postoperative analgesia are opposed by disadvantages like inferior vegetative blockade and inferior pharmacokinetics. Close postoperative supervision in a recovery room is a prerequisite to using this NLA technique.

Adenoidectomy↗
PubMed1984

[The seromucous tympanum].

In children who underwent adenoidectomy, paracentesis or tympanotomy with tube insertion, secretory otitis media continued in about 30% of 397 ears. In order to prevent degenerative changes of the ear-drum repeated insertion of ventilation tubes had to be performed. Anatomical peculiarities, malformations, hyperplastic adenoids and tonsils, infection of the paranasal sinuses and allergy are discussed as etiologic factors of SOM.

Adenoidectomy↗
PubMed1984

Tympanic effusions. A retrospective and prospective investigation into their aetiology and treatment.

In 498 patients under the age of 10 who underwent adenoidectomy, and in 423 similarly aged ones who underwent adeno-tonsillectomy, the pre- and postoperative presence of a tympanic effusion was assessed. The presence of effusion was correlated with adenoid size, age, sex, haemoglobin count, hearing loss, and eosinophil count, and the results compared with a similar investigation performed some years ago in which the patients had been treated in the same way except that those suspected of having serous otitis media were myringotomized, in contrast to the present group. Myringotomy did not appear to significantly affect the presence of postoperative effusions which seem to occur quite independently of the above mentioned surgical interventions.

Adenoidectomy↗
PubMed1984

Five cases of near-miss sudden infant death syndrome and development of obstructive sleep apnea syndrome.

Five full-term infants were referred for "near miss" sudden infant death syndrome events, which occurred between 3 and 12 weeks of age. After a complete pediatric evaluation and 24-hour polygraphic monitoring, each infant was monitored at home with a cardiorespiratory monitor. Each was followed regularly (with repeat polygraphic recordings) up to 4 years of age. All five infants developed heavy snoring at night and symptoms of obstructive sleep apnea syndrome. The diagnosis of obstructive sleep apnea syndrome was confirmed by polygraphic recordings; surgery was recommended. Four of the five children underwent adenoidectomies between 3 and 4 years of age, and this significantly improved their condition. These five cases are the first polygraphically documented histories of the development of obstructive sleep apnea syndrome.

Adenoidectomy↗
PubMed1981

[Immunological aspects of infantile tonsilloadenoidectomy (T&A) (author's transl)].

Authors studying the frequency of tonsillectomy and adenoidectomy (T&A) have found three times more operations in their country than in the U.S.A. The indication for operation is given by the general practitioner and pediatrician without previous sufficiently long treatment of the underlying disease. The cytological analyses of tonsillar tissues showed a highly active transformation and differentiation of immunologically competent cells and the phagocytes. A close negative correlation between the percentage of the immunologically competent cells and a close positive correlation between the percentage of phagocytes and the frequency of tonsillitis was calculated. The volume, consistency and adhesion of tonsils do not block the highly active transformation and differentiation of the lymphocytes in the tonsillar tissue. The percentage of T-lymphocytes was found to be significantly higher in hypertrophic tonsils, representing a mean value of the percentage of T-lymphocytes in the tonsils of 31 children. Furthermore, in the tonsils with adhesions there was a statistically significant higher percentage of B lymphocytes then in the tonsils which were free from adhesions.

Adenoidectomy↗
PubMed1982

Ten-year trends in Canada for selected operations.

Of 16 operations common in Canada the national rates over a 10-year period for the 9 discretionary procedures varied much more than those for the nondiscretionary operations. The rates of tonsillectomy and adenoidectomy, hemorrhoidectomy, varicose vein stripping and appendectomy decreased substantially, whereas those of extraction of lens, cesarean section and colectomy increased. The rates of hysterectomy and cholecystectomy first increased and then decreased. With the exception of Newfoundland the provinces generally followed these trends. Neither the Canadian nor the provincial rates were significantly associated with the availability of hospital beds or surgeons. Factors other than resources probably accounted for much of the variation among the provinces.

Adenoidectomy↗
PubMed1982

[Actiopathogenic study of per and postoperative haemorrhage in adenotonsillectomy in the child (author's transl)].

This study involved 4 201 records between July 1st 1969 and February 28th 1979. Various parameters represented by specific patient data (age, sex, ENT infections), laboratory examinations, operative findings and weather conditions were studied. Adenoidectomy was found to be more haemorrhagic than adenotonsillectomy, in particular in the presence of a large clump of adenoids and in autumn or winter. Use of a halothane-nitrous oxide-oxygen mixture decreased the number of haemorrhages which by contrast were increased by an operative position in a dorsal horizontal position. Finally, any deviation from standard meterological conditions would appear to be a pejorative factor. The authors conclude by stating that no serious complications were seen and that it is important to undertake a precise and complete preoperative laboratory assessment. Finally, mutual confidence between surgeon and anaesthetist is an additional factor in decreasing risk.

Adenoidectomy↗
PubMed1980

[Ultrasound testing in the diagnosis and management of maxillary sinusitis in children (author's transl)].

A- and B-mode ultrasound testing was used in conjunction with X-ray studies as screening tests for the detection of maxillary sinusitis in 280 children (aged 4-10 years) about to undergo adenoidectomy, and/or tonsillectomy and/or tympanostomy. X-rays were abnormal in 114 (41%) children, while sinus disease with the retention of discharge was diagnosed by ultrasound in 63 (23%) children. These latter children were then treated for ten days with amoxicillin and decongestant (Rinexin). At time of initial surgery, 63 maxillary sinuses (in 43 of the children) were punctured and irrigated. Another group (consisting of 27 sinuses in 20 children) was treated without antral puncture. All children were reexamined after 10, 20 and 30 days with ultrasound and radiography. After 10 days, there was no discharge found in 86% of the sinuses treated by antral puncture and in 85% of the control sinuses. After one month, all sinuses which had been irrigated were found to be free of disease, while three (11%) of the control group contained discharge. However, the healing process in all patients seemed to be slower, as evidenced by sequential sinus X-rays.--We believe that ultrasonic evaluation of the maxillary sinuses is a simple, rapid and reliable method for the diagnosis and followup of maxillary sinusitis in children. With this technique, it is possible to follow the disappearance of residual sinus discharge as well as diagnose cases which need active treatment.

Adenoidectomy↗
PubMed1980

Pectus excavatum: resolution after surgical removal of upper airway obstruction.

A six-year-old child with obstruction of the upper airway and a pectus excavatum defect ("funnel chest") is presented. Correction of the funnel-chest deformity was observed four years after the performance of a tonsillectomy and adenoidectomy to relieve the obstruction of the upper airway. The relationship between chronic upper-airway obstruction and a pectus excavatum deformity is discussed, and the reversibility of such a deformity is documented.

Adenoidectomy↗