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PubMed1974

Tonsillectomies: in dollars and cents.

Over the last quarter of a century, much controversy has been generated on the indications for tonsillectomy and adenoidectomy. The economic aspects of this operation have received comparatively little attention. The rate per 10,000 children 0 to 19 years of age for the whole province of Ontario for the year 1971 was 174 and ranged from a high of 307 in one county to a low of 59 in another. The total cost of these operations to the health insurance plan was 11.4 million dollars. National studies on the indications for these operations, their benefits and hazards are urgently required.

Adolescent↗

PubMed1979

[Rhinolalia aperta after the use of a postnasal pack as a medico-legal problem (author's transl)].

A 23 year old patient needed a postnasal pack after tonsillectomy and adenoidectomy for control of severe postoperative bleeding. After removal of the pack on the sixth day, the patient had rhinolalia aperta. The patient could still swallow normally and there was no nasal regurgitation when swallowing solids or fluids. The patient sued for damage when 6 months of speech therapy failed to give any improvement of the nasal speech. The patient argued that the surgeon was negligent in leaving the postnasal pack in position for too long, and resulted in a paresis of the soft palate. However, a careful review of the record indicates that no real paresis of the musculature of the soft palate had occurred since the nasopharynx could be closed by the soft palate during deglutition. The patient's complaints were more likely psychologically induced, although there is no known case in the otolaryngologic literature on this syndrome in which phoniatric function did not recover spontaneously or after speech therapy.

Adult↗

PubMed1983

Determinants of hospital use: a cross-diagnostic analysis.

This article estimates the effects of personal, clinical, physician, and hospital characteristics in a simultaneous equations model of length of stay and ancillary services use for five narrowly defined medical and surgical conditions. These are tonsillectomy and adenoidectomy, gastroenteritis and colitis, inguinal hernia, coronary heart disease, and cholelithiasis. The data are derived from a sample survey of medical and financial records of patients discharged from any of 63 New England short-term general hospitals during the period July 1, 1969 through June 30, 1970. The results confirm the importance of a simultaneous equations formulation of utilization analysis and of inclusion of detailed measures of severity. Length of stay and ancillary services are significantly interrelated for all five conditions, corroborating results of a previous study of obstetric cases. Results for patient's employment status and value of time, attending physician specialty and mode of practice, and hospital size, control, and nature of teaching activities were less conclusive, but suggest differential effects across diagnoses, thus emphasizing the importance of a diagnostic-specific approach to utilization analysis.

Costs and Cost Analysis↗

PubMed1984

The development of asthma after tracheobronchial aspiration of a foreign body.

To evaluate whether a tracheobronchial foreign body (TBFB) itself or its removal by bronchoscopy with the patient under general anesthesia predisposed children to asthma, we surveyed 58 children who had a TBFB removed at the Mayo Clinic between 1970 and 1978. A control group included children who had undergone tonsillectomy or adenoidectomy. Asthma developed in four children in each group. Children with a TBFB do not seem to be predisposed to the development of asthma.

Adolescent↗

PubMed1984

M-cells in the epithelium of the nasopharyngeal tonsil.

Electron-microscope investigation on the epithelium was carried out in 23 nasopharyngeal tonsils. Adenoidectomy was performed on the ground of recurrent adenoiditis in the interattacks period in 13 boys and 10 girls between the ages of 2 to 4. The presence of five characteristic cellular types was found on the surface of the adenoid epithelium: tall cylindrical ciliated cells; cylindrical cells covered only with microvilli; secretory cells with the predominance of the so-called "dark granules"-producing cells; flat epithelial cells; cubic cells with microvilli on the surface and many vesicles in the cytoplasm. The last type of cells rank together with the M-cells, described by Owen and Jones in the epithelium of Peyer's patches in human beings and found in the palatal tonsil by various authors. A discussion is made on the pinocytary and secretory activity of the M-cells that is being linked with the immunogenesis of the nasopharyngeal tonsil. It is pointed out that in normal conditions the reticulation of the epithelium of the adenoid is found only in the zones that had their surface covered by M-cells.

Adenoids↗

PubMed1983

Penetration of cefaclor to adenoid tissue and middle ear fluid in secretory otitis media.

Seventy-nine patients that had persistent or recurrent secretory otitis media for over 3 months and were scheduled for myringotomy and/or adenoidectomy received a single dose of cefaclor (20 or 40 mg/kg) orally 0.5-4 hours before surgery. Cefaclor concentrations were determined in serum, middle ear fluid and/or blood-free adenoid tissue homogenate using microbiological methods. Concentrations in adenoid homogenate ran parallel to those in serum, indicating a rapid penetration to adenoid tissue. Penetration to middle ear fluid was delayed in comparison. In the 51 patients receiving 20 mg/kg, peak levels occurred after 0.5 hour in serum as well as in adenoid homogenate and middle ear fluid with mean values of 29, 7.5 and 5.1 mg/l, respectively. Concentrations in the middle ear fluid were greater than 2.0 mg/l from 0.5 to 3 hours after this dose. In the 28 patients receiving 40 mg/kg, concentrations levelled after 0.5 hour in serum and in adenoid homogenate, with mean values of 21-33 mg/l and 6.3-12 mg/l, respectively. Concentrations in the middle ear fluid reached 7.8 mg/l 2 hours after this dose. A dose of 20 mg/kg appears to be suitable for treatment of respiratory tract infections on a b.i.d. basis.

Adenoids↗

PubMed1983

Management of chronic otitis media with effusion.

Chronic otitis media with effusion ('secretory') is one of the most common diseases of childhood. Pathogenesis related to Eustachian tube dysfunction. Bacteria have been isolated from approximately 50 percent of chronic middle ear effusions. Diagnosis by pneumatic otoscopy or tympanometry, or both. Efficacy yet to be shown for antimicrobial therapy, decongestants, antihistamines, hydrocortisone, myringotomy with or without tympanostomy tubes, and adenoidectomy with or without tonsillectomy. However, a 10-day trial with an antimicrobial agent, such as amoxicillin (erythromycin and sulfonamide, trimethoprim-sulfamethoxazole, or cefaclor, are reasonable alternatives), should be prescribed before surgical intervention. Attendant conductive hearing loss may be related to abnormalities in cognition, language, and learning. Since the prevalence and incidence of otitis media decrease with advancing age, palliative management options would appear to be appropriate at present, reserving the more aggressive options for those infants and children who have frequently recurrent or chronic disease or the complications or sequelae of otitis media with effusion.

Acoustic Impedance Tests↗

PubMed1982

[A new surgical method for the treatment of velopharyngeal overgrowth].

The obstruction between meso- and epipharynx--caused by scarification--is to be considered as a major complication after tonsillectomy or adenoidectomy. Up to recently, this complication was paid little attention in medical publications. A new method in reconstructing the pars oralis pharyngis and the isthmus faucium by pedicled mucosal flaps, is presented here. By designing the adequate flaps, a normal nasopharyngeal passage can easily be achieved with this method, even in cases of total obstruction.

Airway Obstruction↗

PubMed1982

Acute sinusitis in children - results of different therapeutic regimens.

The clinical material consisted of 92 children aged 1-15 years with symptoms and signs of acute sinusitis, roentgenologically verified. Sixty-one were treated with penicillin-V, 16 with pivampicillin, and 15 with erythromycin. Decongesting therapy was given to all. Altogether 77 (83.7%) were cured by a single 10-day course of treatment. The initial success rate did not vary with the type of antibiotic used. Children treated with penicillin-V had, however, a high relapse rate with H. influenzae. Because of growth of H. influenzae, 15 patients required 2 or 3 courses of treatment. The study shows that acute sinusitis in children is usually an uncomplicated disease. Almost all children will improve during a single 10-day course of treatment with antibiotics and decongestants provided that the antibiotic chosen is one to which H. influenzae is susceptible. It is therefore stressed that if penicillin-V is used as the drug of choice in acute sinusitis, the dose must be large enough to eradicate H. influenzae. As judged from this study, adenoidectomy and intranasal antrostomy are rarely indicated.

Acute Disease↗

PubMedDate not supplied

The lateral port control pharyngeal flap: a versatile approach to velopharyngeal insufficiency.

The surgical therapy for velopharyngeal incompetence has always been a challenging problem. In spite of the surgical choices of palatal pushback, pharyngeal flap, pharyngoplasty, muscle transfers, and pharyngeal wall implants, the reported failure rate has varied from 10% to 50%. A group of ten patients with velopharyngeal insufficiency is presented, two posttonsillectomy and adenoidectomy, three secondary to congenital deficiencies, and five following palatal and pharyngeal paralysis secondary to severe closed head injuries. The technique and experience with the lateral port control pharyngeal flap is discussed.

Adolescent↗

PubMed1982

Measuring surgical decision-making with hypothetical cases.

Hypothetical clinical cases were used to investigate surgical decision-making in relation to surgical rates across Ontario. Six procedures were studied (cholecystectomy, colectomy, inguinal herniorrhaphy, hysterectomy, cesarean section and tonsillectomy-adenoidectomy), and substantial differences of opinion regarding the choice of surgical or nonsurgical treatment were recorded. The decision to operate, however, was not made more frequently in Ontario counties with high operative rates, and none of the demographic variables studied were correlated with the decision to operate. Other variables that might have affected operative rates were not taken into account. There were also differences of opinion in referral decisions, but generally internists and pediatricians were less likely to refer the hypothetical cases to surgeons than were family physicians.

Cesarean Section↗

PubMed1982

Middle ear effusion and risk factors.

In 373 randomly selected four year old children tympanometric measurements were correlated with the medical history and the results of an otorhinological examination. The purpose of the study was to demonstrate potential risk factors in the evolution of secretory otitis media (SOM). The tympanometric results represent related as well as independent data, making an appropriate choice of statistical model essential. Therefore the tympanometric results were expressed both per child and per ear. Statistical analysis showed that frequent and severe episodes of catarrhalia and hyperplasia of the adenoids must be considered as two separate and predominant risk factors. As a cofactor, previous attacks of acute otitis media were correlated to catarrhalia. Previous adenoidectomy did not positively influence the middle ear pressure. Children who since infancy had been nursed in public day-care centres, showed an increased frequency of Eustachian tube dysfunction and SOM compared with the children cared for in their own homes. Infectious diseases in general, allergy, age, and housing condition did not appear to be influential risk factors.

Acoustic Impedance Tests↗

PubMed1981

[Creatininphosphokinase isoenzymes in anaesthesia-induced myoglobinuria (AIM) (author's transl)].

During a three year period, pediatric patients 4 to 16 years old were post-operatively screened for anaesthesia-induced myoglobinuria. All investigated cases had general anaesthesia and received succinylcholine prior to intubation. Anaesthetics were predominantly performed for tonsillectomies and/or adenoidectomies. Of a total of 1704 anaesthetics, 7 (0.4%) resulted in postoperative myoglobinuria without hyperthermia. Anaesthesia-induced myoglobinuria occurs more often than previously presented. This abnormal reaction to succinylcholine is not harmless in all cases. The possible genetic influence on total CPK and its isoenzymes is discussed.

Anesthesia, General↗

PubMed1980

A survey of Canadian otolaryngologists on the management of middle ear effusions.

Members of the Canadian Otolaryngological Society were surveyed by way of a questionnaire regarding their treatment of the middle ear effusion. Sixty-seven per cent of the members polled replied. The majority of respondents utilized similar conservative measures, but for varied time periods, before proceeding to surgical management. Surgery generally involved insertion of a ventilating tube plus an additional procedure which was most frequently an adenoidectomy. Other aspects surveyed included the role of allergy, type of tube used, site of tube insertion, and the question of swimming with the tube in place. The survey indicated widespread agreement in both conservative and surgical management of this common problem.

Attitude of Health Personnel↗

PubMed1978

[Cor pulmonale due to upper airway obstruction by hypertrophied tonsils and adenoids (author's transl)].

A case of cor pulmonale is reported, due to chronic nasopharyngeal obstruction by hypertrophied tonsils and adenoids. This syndrome is characterized by stridor, somnolence, arterial hypoxia and hypercarbia, pulmonary and right heart failure. The pathogenesis of this syndrome is due to pulmonary hypoventilation. After tonsillectomy and adenoidectomy the symptoms disappeared.

Adenoids↗

PubMed1995

[The influence of nasopharyngeal obstruction on gasometric parameters in children].

The examinations were performed before and one month after adenoidectomy Comparison of the obtained results did not show significant changes in gasometric results due to operation. No correlation also was shown between the weight of the adenoid and changes in gasometric parameters after operation. In all children the improvement in clinical stage after operation was observed. Based on obtained results it seems that about nasopharyngeal obstruction in children with enlarged adenoid decides not its weight (size) only but the ratio between its size and nasopharyngeal capacity.

Adenoids↗

PubMed1995

Airway problems in children--can the orthodontist help?

The adequacy of the nasopharyngeal airway has been found to be related to craniofacial development. Obstruction of the airway by adenoid tissue, nasal septal deviation or abnormal morphology of the area is associated with characteristic changes in craniofacial morphology such as long anterior face height, facial retrognathism, and a steep inclination of mandibular plane often with a high vaulted palate and crossbite. Some studies have shown the changes to be reversible after adenoidectomy which improves nasal airway patency and a control mechanism for facial growth has been proposed to account for the relationships between airway adequacy, craniofacial morphology and craniocervical postural relationships. It is therefore important to be able to measure nasal respiratory resistance so that the effect of operative procedures in the area such as rapid maxillary expansion (RME) can be determined. Nasal respiratory resistance (NRR) is a measure of airway adequacy. It can be recorded by rhinomanometry, a non-invasive technique which measures resistance to airflow by simultaneous recording of flow and pressure drop over the nose. Recent technical advances based on microcomputer technology have made recording easier, but most studies have used threshold values for pressure or flow to calculate nasal respiratory resistance. At the Rhinomanometric Meeting in Berlin in 1987 proposals were made concerning the accurate determination of the laminar and turbulent flow coefficients using a mathematical model known as the Rohrer equation. The equipment is now available to enable such recordings to be made and is providing valuable and accurate data which form the basis for the improved understanding of the effect of rapid maxillary expansion on nasal airway adequacy.

Airway Resistance↗

PubMedDate not supplied

[Study of the nasopharyngeal microflora obtained by a cotton swab].

Whether or not a representative sample of the nasopharyngeal microflora can be obtained by introducing a cotton swab through the nasal cavity has been evaluated. Also, a correlation between these results and those achieved from the middle ear effusions, has been searched. Ninety adenoidectomy-pending children, fifty of whom also presented otitis media with effusion, were included in the study. The research showed that there were a coincidence (p < 0.001) among the results obtained from the nasal cotton swab, those obtained from cultures of adenoid biopsies and the middle ear effusions.

Adenoids↗