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PubMed2003

The prevention of fire during oropharyngeal electrosurgery.

We report the results of our study of 25 children who underwent tonsillectomy and/or adenoidectomy under endotracheal general anesthesia with respect to their risk of fire in the oropharynx. We also attempt to explain the reasons for the difference between the relatively high incidence of airway explosions and fires that have occurred during tracheostomy with electrosurgery and electrocautery and the low incidence of these events during electrosurgical dissection of the tonsils. Finally, we review the precautions that physicians can take to lower the risk of operating-room fires and explosions.

Child↗
PubMed2003

The value of radiological examination in the management of adenoidal hypertrophy in a pediatric population.

OBJECTIVE: The objective of this study is to evaluate the role of radiological examination in the management of adenoidal hypertrophy. METHODS: A retrospective study was carried out in the North West Armed Forces Hospital, Tabuk, Kingdom of Saudia Arabia on pediatric patients who had x-ray of lateral naso pharynx to exclude adenoidal hypertrophy, January 2001 to December 2001. The study included; age of the patient, sex and reason for radiology examination and the management rendered. RESULTS: A total of two hundred and ninety-seven pediatric patients were involved. Two hundred and thirteen males (71.7%) and 84 (28.3%) females, age ranged between 2 months and 12 years. The reason given for radiological examination was one or more of the following symptoms, snoring, mouth breathing, recurrent tonsillitis, runny nose, deafness and obstructive sleep apnea. Small adenoids reported in 63 patients (21.2%) and were treated for their complaints by their primary physician. Two hundred and thirty-four patients (78.8%) with large adenoids were referred to the otolaryngology department of these 33 patients lost follow up. One hundred and nineteen referred (40.1%) patients were treated conservatively, while 82 patients (27.6%) who showed resistance to medical treatment under went adenoidectomy with or without other related surgical procedures. CONCLUSION: It was concluded that radiological examination in the management of adenoidal hypertrophy had a limited role, increased Radiological Department workload, wastage of resources in addition to unnecessary radiation exposure.

Adenoids↗
PubMed1992

[Why and how should serous otitis media be treated?].

Serous otitis media is an extremely commonplace condition in pediatric patients and tends to resolve spontaneously. Only some forms warrant treatment. Indications for treatment include frequent superinfections, lasting hearing impairment with adverse consequences on socialization, or debilitation of the tympanic membrane carrying a risk for the ear. Tympanostomy tubes are a palliative treatment for serous otitis which restores hearing within a few hours and eliminates unfixated retractions of the tympanic membrane within a few weeks. Tympanostomy tubes may lead to complications including otorrhea and perforation of the tympanic membrane and should therefore be used only in patients with severe otitis media. Etiologic treatment of serous otitis rests on restoration of satisfactory nasal ventilation (education to improve nose-blowing, adenoidectomy), improvement of eustachian tube patency (corticosteroids), and modification of the characteristics of middle ear secretions (mucolytic agents and mucomodifying agents).

Acoustic Impedance Tests↗
PubMed2003

[Frequency of adenoid hypertrophy in children with allergic diseases].

Tonsils and adenoid are part of Waldeyer's ring, the basic function of which is antibody formation, they react later against a great variety of antigens. The role of enlarged adenoids and tonsils in upper airway obstruction has become well-established earlier, thus, adenoidectomy with, or without, tonsillectomy is one of the most commonly performed surgical procedures in the paediatric population. Research done in respect to Waldeyer's ring on people dealing at the same time with allergy, is seldom the subject of dissertation in polish as well as world wide medical literature. To examine the influence of atopy on the adenoid hypertrophy we studied 115 children ages 4 to 9 years, with an average age of 5.9 who had allergic rhinitis asthma or atopic dermatitis. The study suggested that allergic rhinitis is an important risk factor for an adenoid hypertrophy (AH) in children, therefore, early prevention of exposure to them may help reduce occurrence of AH.

Adenoids↗
PubMed2003

[The present methods of diagnosing adenoidal hypertrophy in children].

The role of enlarged adenoids and tonsils in upper airway obstruction has become well-established earlier, thus, adenoidectomy with, or without, tonsillectomy is one of the most commonly performed surgical procedures in the paediatric population. Since the difficulty to objectively assess the adenoidal tissue and the nasopharyngeal airway in children, it is necessary to find out an accurate method of measuring these structures pre-operatively. In this work, the following methods are described: recording of obstructive symptoms, transoral posterior rhinoscopic examination, radiological evaluation, such as lateral radiography of the adenoid and nasopharyngeal magnetic resonance imaging, transnasal fiberoscopic examination, acoustic rhinometry and other.

Adenoids↗
PubMed2003

[Clinical characteristics of obstructive sleep apnea syndrome in children].

OBJECTIVE: To explore the clinical features and diagnosis of obstructive sleep apnea syndrome (OSAS) in children. METHODS: Sixty children with OSAS were reviewed, every patient was monitored with polysomnography (PSG) for 7 hours at night for 11 parameters, including the longest apnea time (LAT), apnea and hypopnea index (AHI), the lowest oxygen saturation (SaO(2)), and snore index etc., the parameters of the 2 groups were compared. Meanwhile, tonsillectomy and adenoidectomy were performed for 40 cases of OSAS, and the parameters obtained before and after operation were analyzed. RESULTS: Adenotonsillar hypertrophy and the loud snoring during sleep were found in all cases. The mean values of the PSG parameters were as follows: the longest apnea time was 53 (8-178) seconds (s); the total time of apnea was 310.5 (26-5,260) s; the time of apnea was 26 (3-240) s; the longest hypopnea time was 41 (5-94) s; the total times of hypopnea was 170 (5-2,860) s; the time of hypopnea was 10 (1-85); the apnea index was 4.1 (0.5-25.9); the hypopnea index was 1.4 (0-16.1); the apnea and hypopnea index (AHI) was 6.8 (0.5-38.2); the snore index was 81.7 (1.3-414.8); the lowest saturation of oxygen was 0.78 (0.25-0.93). There was not statistically significant difference in the parameters between 2-7 year group and over 7 year group (P > 0.05). The parameters of postoperation group: the mean value of the longest apnea time was 15.5 (0-60) s; the total time of apnea was 56.4 (60-205) s; the time of apnea was 10.33 (0-40); the longest hypopnea time was 13.25 (0-30) s; the total times of hypopnea was 44.6 (0-73); the hypopnea time was 4.32 (0 - 30) s; the apnea index was 0.6 (0-12); the hypopnea index was 0.62 (0-4); the apnea and hypopnea index (AHI) was 1.25 (0.1-12); the snore index was 30.08 (1.8-102); the lowest oxygen saturation was 93.5% (64%-97%). Compared with preoperation groups there was a statistically significant difference (P < 0.01). Clinically effective rate of the surgeries was over 90%. CONCLUSION: Adenotonsillar hypertrophy seemed to be an important cause of OSAS in children. Snoring, dyspnea, apnea and low ventilation are the major clinical characteristics of OSAS in children. Confirmed diagnosis of the syndrome in children requires PSG recordings.

Child↗
PubMed1992

Lateral cervical radiographs and adenoid size: do they correlate?

Clinicians have questioned the value of lateral soft tissue neck x-ray (LSTN) in assessing adenoid size. Elaborate cephalometric assays have been devised to measure degree of nasopharyngeal obstruction secondary to adenoid hypertrophy. This study prospectively studied 73 children, aged 11 months to 13 years, with clinical evidence of adenoid hypertrophy to assess how well a LSTN correlates with direct intraoperative observation of adenoid size and nasopharyngeal obstruction. We found a relatively weak correlation (Pearson coefficient r = 0.34) between x-ray and operative observations. We conclude that LSTN is an appropriate examination in the preoperative assessment of children being considered for adenoidectomy. However, this test must be interpreted by recognizing the inherent limitations of evaluating a dynamic structure, such as the nasopharynx, through a non-dynamic modality.

Adenoids↗
PubMed1992

[Acute otitis media. Current therapeutic and clinical aspects].

Otitis media acuta is defined as an acute inflammation of the pneumatic spaces of the temporal bone, that means the middle ear including the mucous membranes of the mastoid cells and of the Eustachian tube; it is caused mainly by bacteria, rarely by viruses. When treated properly by antibiotics, otitis media acuta heals in the rule within two to three weeks completely. If more than three episodes of otitis media occur within one year, the disease is called recurrent otitis media. Secretory otitis media (mucoserotympanon) may be proceeded by an otitis media acuta, but it can also develop without any fore-going disease. If the inflammation of the middle ear is quite symptomless, it is called an occult otitis media or an occult mastoiditis; the causes are often insufficient antibiotic therapies. In these cases an operative treatment (paracentesis, mastoidectomy, antrotomy, adenoidectomy, ventilating tubes) may be necessary. If the defense of the mucous membranes respectively of the whole body is weak or the antibiotic treatment insufficient, there may develop some other sequelae like chronic otitis media, atelectasis, otitis media chronica adhesive, tympanosclerosis, with or without development of cholesteatoma. The typical clinical symptoms, possible complications and the recommended antibiotic and physical treatment are referred.

Acute Disease↗
PubMed2003

[Efficacy of the medical treatment of adenoid hypertrophy in children with house dust mite allergy].

Allergic sensitisation of the airways occurs in the mucosa of the shock organ, or in the lymphatic stations draining these structures. The lymphatic structure closest to the nasal mucosa in humans is the adenoid. Pediatric adenoidal obstruction of the nasal airway is associated with significant morbidity and is a frequent indication for surgery. Because efficacious medical alternatives to adenoidectomy are lacking, we assessed the potency of standard-dose topical nasal fluticasone propionate and Cetirizine in reduction of adenoidal obstruction of the nasal airway. To examine the influence of these medicines on the adenoid hypertrophy (AH) we studied 43 children ages 4 to 9 years, who had AH and house dust mite allergy. Properly administered aqueous nasal fluticasone propionate and Cetirizine in standard doses can significantly reduce adenoidal hypertrophy and nasal airway obstructive symptoms in atopic children.

Adenoids↗
PubMedDate not supplied

[The catarrhal child].

The first seven years of a child's development are often described as the catarrhal stage. This is because of the increased incidence of upper respiratory tract infections. Nasal obstruction in the children is common and symptoms are often distressing. The authors report a rational approach to this problem to produce effective treatment of recurrent nasal obstruction. In particular clinical features, diagnosis, and therapy of recurrent rhinitis, adenoid hypertrophy, and tonsillar obstruction are described. The indications for adenoidectomy, tonsillectomy or adenotonsillectomy has been questioned.

Child↗
PubMed2004

[Pediatric obstructive sleep disordered breathing].

The most common sleep disorder in children is obstructive sleep apnea syndrome (OSAS). The majority of children with OSAS improve following tonsillectomy and adenoidectomy. Diagnosis of OSAS in children and adults has difference in criteria if disease and clinical picture.

Child↗
PubMed2004

[Additional diagnostic methods for recording of adenoid hypertrophy in children with allergic rhinitis].

The role of enlarged adenoids and tonsils in upper airway obstruction has become well-established earlier, thus, adenoidectomy with or without tonsillectomy is one of the most commonly performed surgical procedures in the paediatric population. Direct assessment of adenoidal size is difficult and no definitive method is so far available to complement clinical assessment. The most important diagnostic techniques are recording of obstructive symptoms, transoral posterior rhinoscopic examination, radiological evaluation, such as lateral radiography of the adenoid and nasopharyngeal magnetic resonance imaging, transnasal fiberoscopic examination, acoustic rhinometry and others. In this study we compare acoustic rhinometry, fiberoscopy and Cohen and Konac radiological method. Spearman's correlation test was used to evaluate the degree of correlation between these three methods. We concluded that acoustic rhinometry and radiology are good and objective methods for measuring adenoid sizes in allergic children.

Adenoids↗
PubMed1992

[Muco-serous otitis media].

Typical symptoms of the otitis media with effusion (OME)--synonym (secretory otitis media--SOM)--are fluid (serous/mucoid) in the middle ear space and a conductive hearing loss. Its most incidence can be found in infants and kids, during this period often bilaterally, but also in adolescents and adults. Etiopathological factors are infections of the upper respiratory tract, obstructing adenoids, tumors of the nasopharynx, cleft palate patients, allergological and immunological influences. As most important anatomical factor ventilation problems, respectively insufficiency of drainage of the eustachian tube is considered. Especially in childhood, OME reveals high spontaneous remission. Thus in many cases is no need for treatment. Persists OME over a longer period (some months) or in patients with recurrent disease, therapy is necessary: decongestant nasal drops, local heat during concomitant upper air way infections, long term application of low dose antibiotics, adenoidectomy with myringotomy, or insertion of ventilating tubes.

Audiometry, Pure-Tone↗
PubMed1992

Snoring children, sleep apnoea, and tonsillectomy.

Upper airway obstruction in children caused by tonsillar and adenoidal hypertrophy is an indication for tonsillectomy alone or with adenoidectomy. In most children this will cure sleep apnoea, snoring, daytime sleepiness and other symptoms.

Child↗
PubMed1992

Management of recurrent otitis media.

Recurrent otitis media is defined as three or more episodes of acute otitis media in six months or four or more episodes in one year, with the bouts of acute infection separated by intervals of full resolution. The disorder is common in children and is different from otitis media with effusion, the other frequently encountered chronic ear disease. Daily low-dose antibiotic therapy is recommended as initial prophylaxis against recurrent otitis media. Pressure-equalizing tubes may be used in patients who have more than one episode of breakthrough otitis media while receiving antibiotics. Adenoidectomy should be reserved for use when pressure-equalizing tubes fail or when insertion of a second set of tubes is required.

Acute Disease↗
PubMed2005

Immunohistochemical analysis of CD71, CD98 and CD99 activation antigens in human palatine and nasopharyngeal tonsils.

OBJECTIVE: Tonsils (palatine and nasopharyngeal) are immunologically active tissues. Due to their anatomical location, they are considered to be the initial defense barrier against the antigens entering into the respiratory and gastrointestinal tract. Tonsils act against these antigens by producing and activating the lymphocytes, which are responsible for the immune response. In order to get information regarding the distribution of cell surface antigens on the epithelial, stromal and lymphoid cells of these organs, we performed immunohistochemical staining by using antibodies against CD99, CD71 and CD98 activation antigens. METHODS: Tissue samples of 20 patients undergoing tonsillectomy and adenoidectomy who presented with recurrent tonsillitis and adenoid hypertrophy in the Otorhinolaryngology Department, Hacettepe University Medical Faculty Hospital, Ankara, Turkey in 2001, were obtained as partial tissue samples apart from pathological examination. Tissues were immunostained by the indirect immunoperoxidase method. RESULTS: Strong CD71 reactivity in macrophages was observed as an indicator of the active role of the macrophages in immunoresponse in the chronic inflammation reaction. The CD98 reactivity on the proliferative basal layer of epithelium was a usual finding, as its detection in epithelial neoplasms and proliferative states is well known. We did not observe any reactivity of CD98 in nasopharyngeal tonsil epithelium and lymphoid cells of either nasopharyngeal or palatine tonsils. The CD99 reactivity was observed in the T-cell dependent area. CONCLUSION: We determined some topographic difference in the expression of some activation antigens in the epithelial, stromal and lymphoid components of the palatine and nasopharyngeal tonsils. Further detailed studies directed to determine the role of these antigens in tonsils would help to understand the role of these molecules in inflammatory events.

Adolescent↗
PubMed2004

[The occurrence of food allergy and bacteria allergy in chiidren with tonsilar hypertrophy].

The diagnosis of food allergy is difficult because it is a multifaceted problem and is incompletely understood. Both upper and lower respiratory tracts can be affected by food allergy. The importance of bacterial allergy of the upper respiratory tract is however one of the most controversial problems in allergology. The palatine tonsils play an important role in immunologic surveillance and resistance to infection in the upper aerodigestive tract. The role of enlarged adenoids and tonsils in upper airway obstruction has become well-established earlier, thus, adenoidectomy with, or without, tonsillectomy is one of the most commonly performed surgical procedures in the paediatric population. Research done in respect to Waldeyer's ring on people dealing at the same time with allergy, is seldom the subject of dissertation in Polish as well as world wide medical literature. To examine the influence of food and bacterial allergy on the tonsilar hypertrophy (TH) we studied 136 children ages 3 to 7 years, who had TH. On the basis of allergic and immunological examinations, in 28.6% food allergy was confirmed as the main cause of the complaints. We conclude that large tonsillar tissues sometimes with upper airway obstruction may by caused or aggravated by food allergies, therefore, early prevention of exposure to them may help reduce occurence of TH.

Bacteria↗
PubMed1992

A role for prostacyclin in bruising symptomatology.

The relationship between bleeding and bruising and the production of prostacyclin and thromboxane was assessed in children who were to have a tonsillectomy and/or an adenoidectomy. Eicosanoids in the blood oozing from the bleeding time incision were measured and correlated with the reported frequency of bruising and epistaxis. A striking association (P = .0003) between prostacyclin production and the frequency of bruising was found; children reporting bleeding at least biweekly had the highest prostacyclin synthesis. Successively lower levels of the prostacyclin metabolite, 6-keto-prostaglandin F1 alpha, were found in children reporting less frequent bruising. Prostacyclin production in bleeding time blood was also correlated inversely with systolic blood pressure and hemoglobin level, although neither of these variables could explain the association between prostacyclin production and bruising. There was no correlation between thromboxane formation, systolic blood pressure, hemoglobin level, age, or bleeding time and the frequency of bruising. The ratio of thromboxane B2 to 6-keto-prostaglandin F1 alpha was correlated inversely with the length of the bleeding time (P = .016). It is concluded that vascular prostacyclin production may have a role in bruising symptomatology. It is suggested that prostacyclin formed at the injured vessel surface collects within the first few seconds after injury inside the tissue space at the site of the bruise and, by influencing the formation of the platelet/fibrin plug and/or the leakage of blood from the vessels, plays a significant role in modifying the development of bruising.

6-Ketoprostaglandin F1 alpha↗