Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ADENOIDECTOMY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,405 records · Page 78Linked to original sources
PubMed2005

Ligasure versus cold knife tonsillectomy.

OBJECTIVE: To assess parameters related to ligasure tonsillectomy (LT) versus cold knife tonsillectomy (CKT) procedure. STUDY DESIGN: Prospective randomized study. METHODS: A prospective study was conducted on 200 consecutive adult patients undergoing tonsillectomy. Indications included chronic tonsillitis and obstructive sleep apnea syndrome. Patients undergoing adenoidectomy, or any procedure together with tonsillectomy, and patients with peritonsillar abscess history or bleeding disorders were excluded. Patients were randomly assigned to either the LT or CKT group. Intraoperative bleeding, operative time, postoperative pain using a visual analogue scale, and complication rates were evaluated. RESULTS: The LT and CDT groups consisted of 108 and 92 individuals, respectively. In the LT group, there was no measurable intraoperative bleeding, whereas mean bleeding for CKT group was 125 mL. The mean operative time was 15 +/- 1.43 minutes for the LT group and 21 +/- 1.09 minutes for the CKT group (P < .001). The overall mean pain score for the LT group was 3.63, whereas for the CKT group it was 5.09 (P < .001). Primary hemorrhage occurred in one subject of the CKT group. Secondary postoperative hemorrhage was noticed two subjects of the LT group and two subjects of the CKT group. In 21 subjects of the LT group, limited peritonsillar edema was noticed. No other complication occurred in both groups. CONCLUSION: LT procedure provides sufficient hemostasis, lower postoperative pain, and reduced operative time, as well as safety against Creutzfeld Jakob disease transmission.

Adolescent↗
PubMed2006

Postobstructive pulmonary edema after laryngospasm in the otolaryngology patient.

CONTEXT: Post-obstructive pulmonary edema (PPE) is an uncommon complication which develops immediately after the onset of acute airway obstruction such as laryngospasm or epiglottitis (type I) or after the relief of chronic upper airway obstruction such as adenotonsillar hypertrophy (type II). OBJECTIVE: To describe the development of type I PPE following laryngospasm in pediatric and adult patients undergoing otolaryngologic surgical procedures other than those for treatment of obstructive sleep apnea. DESIGN: Retrospective case series of 13 otolaryngology patients from 1996 to 2003. SETTING: Tertiary care teaching hospital and its affiliates. PATIENTS: 13 patients (4 children, 9 adults, 5 males, 8 females) ranging in age from 9 months to 48 years. RESULTS: Operative procedures included adenoidectomy, tonsillectomy, removal of an esophageal foreign body, microlaryngoscopy with papilloma excision, endoscopic sinus surgery, septorhinoplasty, and thyroidectomy. Six patients required reintubation. Treatment included positive pressure ventilation, oxygen therapy, and diuretics. Seven patients were discharged within 24 hours and the others were discharged between 2 and 8 days postoperatively. There were no mortalities. CONCLUSION: Laryngospasm resulting in PPE may occur in both children and adults after various otolaryngologic procedures. Among the subgroup of children, our study is the first to report its occurrence in healthy children without sleep apnea undergoing elective surgery.

Adolescent↗
PubMed2006

Acoustic rhinometry: should we be using it?

PURPOSE OF THE REVIEW: The purpose of this review is to examine the role of acoustic rhinometry in clinical practice. Although acoustic rhinometry was first described for clinical use in 1989, it is not in common use today. Should we be using it? Yes. I think we should be using it more often. This review provides an update of the new standard for interpretation and expanded clinical uses. RECENT FINDINGS: The most significant advances in the past year in this area have been the publication of standards for its clinical use. In addition, the repertoire of clinical problems that can be analyzed objectively with acoustic rhinometry has expanded to include turbinoplasty, sleep disorders, more types of cosmetic/reconstructive procedures, sinus surgery, vasomotor rhinitis, maxillofacial expansion procedures, and aspirin and methacholine challenge. (Its ability for pediatric disorders, such as adenoidectomy, has been reaffirmed.) Some case examples are included to demonstrate the utility of acoustic rhinometry for 'mixed' pathology. SUMMARY: Acoustic rhinometry is a rapid, objective, painless, noninvasive technique for assessing nasal airway obstruction. Recently, standards have been developed that aid its expansion for clinical use. Expanded clinical applications include sleep disorders, cosmetic/reconstructive and maxillofacial disorders, sinus and turbinate procedures, and pediatrics. Acoustic rhinometry should be utilized to improve our ability to practice evidence-based medicine in rhinology.

Adult↗
PubMed2006

Black/white differential use of health services by young children in a rural Mississippi community.

BACKGROUND AND OBJECTIVES: Use of health services in rural communities has not been well studied. We explored how black and white children used health services in a rural Mississippi community. METHODS: Data were prospectively collected for 396 children attending a private practice to determine if race was associated with the use of health services in this community. RESULTS: White children made more sick contacts than black children (P < 0.001). Black children (36%) were more likely to be treated in the emergency room than white children (24%; P = 0.013). There was no black-white difference in the hospitalization rates, although white children were more likely to undergo ear-nose-throat (ENT) surgery for pressure equalizing tube (PET) placement, and/or tonsillectomy and adenoidectomy (T and A; P < 0.001). Even after controlling for various confounders, the frequency of all physician sick contacts was twice as high for white children than for black children (RR = 2.17; 95% C.I. = 1.32-3.58). CONCLUSION: Overall, black children used disproportionately fewer health services than their white counterparts, but used significantly higher emergency room services. Private insurance coverage was the single most significant variable that accounted for the black-white differential use of the emergency room.

Adult↗
PubMed1985

Are the tonsils and adenoids a reservoir of infection in otitis media with effusion (glue ear)?

In a prospective investigation of the treatment of glue ear in children, the possible role of persistent infection in the tonsils and adenoids was assessed by comparing bacterial cultures of swabs and resected tissue from the tonsils and adenoids of patients with cultures of swabs from similar sites in control subjects without ENT abnormality. For almost all potential pathogens, including Streptococcus pneumoniae and Haemophilus influenzae, no statistically significant differences were demonstrated between patients and controls. The same was true of Streptococcus pyogenes in tonsil specimens, while in adenoid specimens rather more isolates were obtained in patients than controls. This difference was just statistically significant at the 5% level, but only when all isolations, including very scanty growths, were compared. On present evidence, persistent infection should not be invoked to explain the success of adenoidectomy in otitis media with effusion or to justify adenotonsillectomy.

Adenoids↗
PubMed1987

Adenoid infection: its relationship to otitis media, glue ear and tonsillitis.

In a prospective study, 69 children admitted for adenoidectomy were divided into 4 subgroups according to their symptomatology. These were: nasal obstruction alone; glue ear; recurrent ear aches and probable otitis media; and recurrent sore throats and probable tonsillitis. The adenoids removed were bacteriologically analysed to assess both the spectrum of organisms present and the colony counts per gram of adenoid tissue (10(5) organisms per gram was regarded as representing infection). There was no significant difference between the subgroups with regard to either the presence of infection or the spectrum of organisms grown. We conclude that while infection in the adenoid bed must be involved in the pathogenesis of bacterial otitis media, the concentration of organisms present in the adenoids is unimportant and other factors must be responsible for the migration of organisms up the Eustachian tube.

Adenoids↗
PubMed1989

Digital and mirror assessment of the adenoids at operation.

The size of an adenoid is generally considered to be a significant factor in the causation of Eustachian tube dysfunction and glue ear in children. We studied 120 consecutive cases of children undergoing adenoidectomy. Our aim was to assess the accuracy of the digital and mirror examinations in identifying adenoid size. Two surgeons of 1 and 2 years' experience in the speciality were found to have a statistically significant correlation between mirror examination and the amount of adenoid removed at operation. One surgeon of 4 years' experience was found to have a higher degree of correlation for both mirror and digital examinations.

Adenoids↗
PubMed1991

Otitis media with effusion in children shows a progressive resolution with time.

The course of chronic otitis media with effusion (OME) was studied in 117 children (207 ears). Diagnosis was based on otoscopy and a flat (type B) tympanogram. This was compared with the presence or absence of middle ear effusion at myringotomy carried out 0-3, 3-6, 6-9 and more than 9 months after diagnosis. There was a highly significant reduction in the number of effusions diagnosed at myringotomy in those patients who had waited longer for operation. The effects of previous ventilation tube insertion, adenoidectomy, medical treatment between diagnosis and operation, month of diagnosis and month of admission on the results were examined. Tympanosclerosis and atelectasis occurred in 7.3 and 6.3% of ears respectively and in most cases were associated with previous grommet insertion.

Adolescent↗
PubMed1995

The effect of recurrent tonsillitis and tonsillectomy on growth in childhood.

The aim of this study was to determine if children with recurrent tonsillitis are smaller than expected before tonsillectomy and if they have an altered height or weight gain 1 year post-operatively. All (204) children attending the hospital for tonsillectomy with or without adenoidectomy had their height and weight measured pre-operatively and 1 year after operation. The results of 2204 children in local schools were used as a control population. Analysis was by comparison of each population with the Tanner charts. This study suggests that our population of children listed for tonsillectomy were not lighter or smaller than expected before operation but that one year after tonsillectomy, there was an increase in their weight gain. The height gain was no different than expected after operation. Overweight seems to be a medium term complication of tonsillectomy. It may be necessary to redefine the indications for tonsillectomy in children who are already obese.

Body Constitution↗
PubMed1991

Oral atropine enhances the risk for acid aspiration in children.

Two modes of administration of an anticholinergic drug were compared in 58 healthy children undergoing adenoidectomy. The study was double-blind and randomized. All children were premedicated with oral midazolam 0.5 mg/kg. Twenty-nine children received oral atropine 0.03 mg/kg (Group A) and the rest were given i.v. glycopyrrolate 0.005 mg/kg at the induction of anaesthesia (Group G). In Group A, of 29 children, the stomach was empty in 2, pH was less than 2.5 in 23, the gastric volume was greater than 0.4 ml/kg in 19, and both these risk factors were present in 17 children. The same figures in Group G were 5 (NS), 14 (P less than 0.05), 10 (P less than 0.05) and 9 (P less than 0.05) children, respectively. The antisialagogue effect was similar in both groups.

Administration, Oral↗
PubMed1993

Comparison of cardiovascular changes during anaesthesia and recovery from propofol-alfentanil-nitrous oxide and thiopentone-halothane-nitrous oxide anaesthesia in children undergoing otolaryngological surgery.

Propofol/alfentanil anaesthesia was compared with thiopentone/halothane anaesthesia in 86 midazolam-atropine premedicated children undergoing minor otolaryngological surgery. The study was randomised, and evaluation of recovery from anaesthesia was double-blind. The children were divided into two age groups: 1-3 years and 4 years and older. Particular attention was paid to ECG changes during anaesthesia and to the rapidity of recovery. One minute after alfentanil 15 micrograms.kg-1, the children in the propofol group received propofol 2.0-3.0 mg.kg-1 followed by propofol infusion 15 mg.kg-1.h-1. In addition, 0.1% suxamethonium 6 mg.kg-1.h-1 was infused during operation. The other children received thiopentone 5-7 mg.kg-1 followed by halothane (0.5-2%) immediately after endotracheal intubation. Junctional rhythm occurred in 5-35% of the children independent of anaesthesia method, and ventricular ectopic beats were seen in 20% of the older children during halothane anaesthesia. Recovery with respect to times to eye opening or response to verbal contact was significantly faster after propofol/alfentanil anaesthesia than after thiopentone/halothane anaesthesia in the older but not in the younger age group. Furthermore, in the younger age group significantly more crying occurred after propofol/alfentanil than after thiopentone/halothane anaesthesia. On the basis of this study, thiopentone/halothane anaesthesia is recommended for children aged 1-3 years and propofol/alfentanil anaesthesia for older children undergoing adenoidectomy and/or tonsillectomy.

Alfentanil↗
PubMed1987

Upper airway obstruction with hypoxaemia and sleep disruption in Down syndrome.

Six of 12 children with Down syndrome (DS) tested by means of long-term tape-recordings of oxygen saturation, breathing movements and expired CO2 were found to have previously undetected and severe upper airway obstruction during sleep. In five cases the obstruction occurred in the pharynx and in the sixth it was due to bilateral choanal stenosis. When compared with age-matched controls, overnight tape-recordings showed episodes of abnormal arterial hypoxaemia and an abnormally elevated end-tidal CO2. Episodes of obstruction were most marked during sleep associated with a non-regular breathing pattern. Abnormal episodes of hypoxaemia were associated with continued breathing movements. Sometimes there was no airflow (complete obstruction); at other times airflow continued normally or was reduced in amplitude (partial obstruction). During episodes of partial or complete airway obstruction the inspiratory waveform showed a characteristic shape. These results show sleep-related upper airway obstruction to be an often undetected complication of DS and all necessary measures should be taken to overcome the obstruction when it reaches the stage of producing abnormal hypoxaemia. Choanal dilatation and tracheostomy were successful in treating two of the children. Tonsillectomy and adenoidectomy were successful for one child, but only of marginal benefit for two others.

Airway Obstruction↗
PubMed1985

A 5-year prognosis of childhood asthma.

A series of 207 asthmatic children aged 4-10 years studied during the years 1976-1978 were called for a follow-up study 4-6 years later. Of these, 53 (26%) children were completely symptom-free and 154 still had symptoms. The proportion of symptom-free patients was highest (45%) among those having attacks only during respiratory infections. The prognosis was worsened by such factors as a high rate of attacks, an association with eczema and a history of otitis media or adenoidectomy. The clinical picture of disease among children having attacks only during respiratory infections (wheezy bronchitis) was distinctive from that in asthma and may be separated as its own entity. Subgrouping of childhood asthma is beneficial for a clinician when considering the intensity of therapy or the need for controls.

Asthma↗
PubMed1986

Type 4 renal tubular acidosis (sub-type 2) associated with idiopathic interstitial nephritis.

An 18-month-old girl presenting with anorexia and failure to thrive, was referred for adenoidectomy. Arterial hypertension was discovered on physical examination. Laboratory results revealed hyperkalaemic, hyperchloraemic, metabolic acidosis, with slight azotemia. Urinary aldosterone excretion and plasma renin were decreased. Renal biopsy showed idiopathic interstitial nephritis. The diagnosis of type 4 renal tubular acidosis, sub-type 2, i.e. primary hyporeninaemic secondary hypoaldosteronism was proposed. According to our knowledge, this disease has not previously been reported in young children, but is well known in azotaemic adults. We therefore propose the inclusion of this uncommon renal disease in the differential diagnosis of failure to thrive in childhood.

Acidosis, Renal Tubular↗
PubMed1998

T-cell subsets in adenoids and peripheral blood related to age, otitis media with effusion and allergy.

Adenoids and peripheral blood samples from 29 children (20-120 months of age) undergoing adenoidectomy for long-standing otitis media with effusion (OME) (n=16) or obstructive adenoid hyperplasia (n=13) were investigated by flow cytometry for their T-lymphocyte profile. Eleven of the enrolled children were allergic to inhalant and/or food allergens. For the whole group, the percentage of helper T cells belonging to the memory phenotype (CD4+/CD45RO+ cells) was significantly higher in adenoids than in blood (p<0.0001), while the same cell category increased with age in peripheral blood (p<0.01). A highly significant negative regression (p<0.001) was found between age and the percentage ratio of CD4+ cells that were CD45RO+ in adenoids and blood. Allergic children had a higher CD4+/CD8+ ratio for cells expressing CD45RO+ (p<0.05) in adenoids. The results of this study indicate that adenoids participate in the development of an immunological memory. Our findings support a relationship between allergy and memory cells in adenoids.

Adenoids↗
PubMed1978

Strain-specific local and systemic cell-mediated immune responses to cytomegalovirus in humans.

Employing the techniques of complement fixation, immunofluorescence, and in vitro lymphocyte transformation assay, the antibody and cell-mediated immunity to cytomegalovirus (CMV) were studied in the serum, peripheral blood lymphocytes, tonsillar lymphocytes, and cord blood lymphocytes. The study population consisted of 32 children undergoing tonsillectomy and adenoidectomy. In the lymphocyte transformation assay, three strains of CMV (AD-169, ADH-1-41, and Davis), herpes simplex type 1, and phytohemagglutinin were employed as antigens. Sixty-five percent of the subjects were found to have CMV-specific antibody activity. The lymphocyte transformation response to phytohemagglutinin was similar in all subjects. No CMV-specific lymphocyte transformation activity was detected in cultures of cord blood lymphocytes. Significant cell-mediated immunity was observed in the tonsillar lymphocytes of 30% (3/10) of the seronegative individuals and in the peripheral blood lymphocytes obtained from one such subject. Over 75% (16/21) of the seropositive subjects demonstrated cell-mediated immunity against one or more strains of CMV in the peripheral blood lymphocytes and tonsillar lymphocytes. In the lymphocyte transformation assay, no cross-reactivity was apparent between CMV and herpes simplex type 1. These studies demonstrate the presence of strain-specific systemic and mucosal cell-mediated immune response to CMV in humans. The frequency and distribution of lymphocyte transformation responses to the three CMV strains suggest antigenic heterogeneity of CMV.

Adolescent↗
PubMed2002

Immune responses to novel pneumococcal proteins pneumolysin, PspA, PsaA, and CbpA in adenoidal B cells from children.

Studies of mice suggest that pneumococcal proteins, including PspA, pneumolysin, PsaA, and CbpA, are promising vaccine candidates. To determine whether these proteins are good mucosal immunogens in humans, adenoidal lymphocytes from 20 children who had adenoidectomies were isolated and tested by ELISpot for antigen-specific antibody-secreting cells (ASCs). Cells were also cultured for 7 days in the presence of a concentrated culture supernatant (CCS) from a type 14 strain of pneumococcus which contained secreted pneumococcal proteins, including PspA, pneumolysin, PsaA, and CbpA, and then tested by ELISpot. ELISpot assays done on freshly isolated cells detected ASCs to all four antigens in most children studied. However, there were differences both between antigens and between isotypes. The densities of immunoglobulin G (IgG) ASCs against both PsaA and CbpA were significantly higher than those of ASCs for PspA and PdB (pneumolysin toxoid B) (P < 0.001). For all antigens, the numbers of IgA ASCs tended to be lower than those of both IgG and IgM ASCs. The numbers of anti-CbpA and -PsaA IgA ASCs were higher than those of anti-PdB IgA ASCs (P < 0.01). Concentrations of IgA antibodies to PspA and PsaA in saliva correlated with the numbers of IgA ASCs to PspA and PsaA in freshly isolated adenoidal cells, but no such correlation was found between salivary IgG antibody concentrations and IgG ASCs to the four antigens in adenoidal cells. In cultured cells, anti-PspA, -PsaA, and -CbpA IgG ASCs proliferated significantly, but only two of eight samples showed >2-fold increases in anti-CbpA and -PspA IgA ASCs after CCS stimulation. The results suggest that CbpA, PsaA, and PspA may be good upper respiratory mucosal antigens in children. Adenoids may be important inductive sites for memory IgG responses and important sources of salivary IgA. Some protein antigens may also prime for mucosal IgA memory. These data support the effort to explore mucosal immunization against pneumococcal infection.

Adenoids↗
PubMed2002

Prevalence and quantitation of species C adenovirus DNA in human mucosal lymphocytes.

The common species C adenoviruses (serotypes Ad1, Ad2, Ad5, and Ad6) infect more than 80% of the human population early in life. Following primary infection, the virus can establish an asymptomatic persistent infection in which infectious virions are shed in feces for several years. The probable source of persistent virus is mucosa-associated lymphoid tissue, although the molecular details of persistence or latency of adenovirus are currently unknown. In this study, a sensitive real-time PCR assay was developed to quantitate species C adenovirus DNA in human tissues removed for routine tonsillectomy or adenoidectomy. Using this assay, species C DNA was detected in Ficoll-purified lymphocytes from 33 of 42 tissue specimens tested (79%). The levels varied from fewer than 10 to greater than 2 x 10(6) copies of the adenovirus genome/10(7) cells, depending on the donor. DNA from serotypes Ad1, Ad2, and Ad5 was detected, while the rarer serotype Ad6 was not. When analyzed as a function of donor age, the highest levels of adenovirus genomes were found among the youngest donors. Antibody-coated magnetic beads were used to purify lymphocytes into subpopulations and determine whether viral DNA could be enriched within any purified subpopulations. Separation of T cells (CD4/8- expressing and/or CD3-expressing cells) enriched viral DNA in each of nine donors tested. In contrast, B-cell purification (CD19-expressing cells) invariably depleted or eliminated viral DNA. Despite the frequent finding of significant quantities of adenovirus DNA in tonsil and adenoid tissues, infectious virus was rarely present, as measured by coculture with permissive cells. These findings suggest that human mucosal T lymphocytes may harbor species C adenoviruses in a quiescent, perhaps latent form.

Adenoids↗