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 1,567 records · Page 87Linked to original sources
PubMed1995

[Adeno-tonsillectomy after cardiac transplantation in a child].

A case report of a boy who had a heart transplant at age one, and an adeno-tonsillectomy at age 2 years and 2 months, is presented. The patient showed severe episodic hypoxemia and poor weight gain (below 3 SD) due to upper airway obstruction caused by enlarged adenoids and tonsils. He was very active and no signs of congestive heart failure were noted. General anesthesia was induced with thiopental and maintained with a balanced anesthesia of nitrous oxide, oxygen, fentanyl, and vecuronium bromide. The heart rate did not increase with endotracheal intubation nor adenoidectomy but heart rate and blood pressure did increase slowly by the time the tonsillectomy was performed. Arrhythmia did not appear throughout the procedure and anesthesia was uneventful. A nasal endotracheal tube was kept in place for 4 days until surgical edema subsided. Respiratory inductive plethysmography performed before surgery and 2 days after extubation showed improvement of upper airway obstruction. The patient's blood concentration of cyclosporine fell briefly below the optimal level perioperatively due to unavailability of intravenous preparation in Japan. Various aspects of non-cardiac anesthesia for children who have experienced cardiac transplants are discussed.

Anesthesia, General↗
PubMed1995

[Pathological changes in the middle ear and delayed speech development. Preventable sequelae of disordered tube function and seromucotympanum].

Serous otitis media is a frequent disorder, as 80-90% of children up to the age of 8 years experience at least one episode of middle ear effusion. When deciding on a therapeutic strategy, it should be taken into consideration that there is a spontaneous recovery rate of about 95%. Initially, conservative treatment should be given (Valsalva maneuver), as the efficacy of drug therapy is questionable. In our opinion, in cases of persistent middle ear effusion an adenoidectomy plus myringotomy should be performed. In cases of recurrence, a ventilation tube should be inserted to reduce eardrum pathology as well as delayed speech and mental development.

Child↗
PubMedDate not supplied

[An update on the treatment of otitis media with effusion in children. The indications for transtympanic drainage].

Otitis media with effusion (O.M.E.) is a frequent child's condition, with generally spontaneous recovery. Only a few cases, with some complications and chronic-O.M.E., present hearing loss and later verbal and academic delayed performances. We report our experience on treatment by tympanostomy tubes for O.M.E., at the Clinic of otolaryngology of the University of Pisa, since 1981 to 1993, resulting a progressively reduced number of these operations in the last period. We believe that both the inflamed upper airways care, and first choice adenoidectomy can explain the trend. Ventilation tubes must be placed only for persistent picture of O.M.E. and possibility of invalidity.

Adolescent↗
PubMed1995

Otitis media with effusion in infants and children. Primary care concerns addressed from an otolaryngologist's perspective.

In 90% of children, otitis media with effusion resolves within 3 months. When it persists longer, it is considered chronic. Initial treatment of chronic otitis media with effusion is repeated courses of antibiotics, and a short course of steroids may be appropriate. Use of antihistamines and decongestants has not been shown to be efficacious, although they may be beneficial when inhalant allergies contribute to eustachian tube dysfunction. Persistent effusion leads to conductive hearing loss, which may have a significant impact on language, speech, and intellectual development. Thus, surgical therapy consisting of insertion of tympanostomy tubes and, in selected cases, adenoidectomy is indicated to improve hearing and prevent long-term sequelae.

Acute Disease↗
PubMed1995

Increased beta-endorphin but not Leu-enkephalin in plasma due to preoperative stress.

The levels of beta-endorphin and Leu-enkephalin were measured in the plasma of 23 children (16 male, 7 female) who were admitted to the Children's Hospital for elective (non-emergency) surgery, adenoidectomy and/or tonsillectomy. Two blood samples were obtained preoperatively. The first sample was taken during admission to the hospital; the second on 24 h later and just 5 min before the operation, without pre-medication or narcosis. beta-endorphin and Leu-enkephalin levels were measured using a RIA method after solid phase extraction of the samples. Mean beta-endorphin concentrations during admission to the hospital were 11.77 +/- 9.36 pg/ml. Twenty four hours later, and just 5 min before surgery, the mean levels of beta-endorphin were increased to 27.45 +/- 16.66 pg/ml. A statistically significant increase (t-value = -5.42) was found for beta-endorphin levels 5 min before the operation compared with 24 h earlier (2-tail probability p < 0.0001). The Wilcoxon matched-pairs signed-ranks-test also showed p < 0.0001 (Z = -4.197). In contrast, Leu-enkephalin levels remained unchanged. The mean values were 11.44 +/- 1.49 pg/ml on the day of admission, and 12.11 +/- 2.08 pg/ml 5 min before the operation. We did not find statistically significant differences between the paired samples (t-value = -1.53, 2-tail probability p = 0.139). The increase in beta-endorphin could be the result of preoperative anxiety about the narcosis and surgery.

Adolescent↗
PubMed1995

Pediatric adenoidal hypertrophy and nasal airway obstruction: reduction with aqueous nasal beclomethasone.

OBJECTIVE: 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 beclomethasone in reduction of adenoidal obstruction of the nasal airway. METHODS: Seventeen children, 5 to 11 years of age, exhibiting chronic obstructive nasal symptoms and a group mean (+/- SE) adenoid/choana ratio of 91 +/- 1% on rhinoscopic examination, completed an 8-week, double-blind, placebo-controlled crossover study of standard-dose aqueous nasal beclomethasone (total 336 micrograms/day) in the treatment of adenoidal hypertrophy. In a 16-week, open-label, follow-on study, subjects received beclomethasone 1 spray in each nostril twice daily (168 micrograms/day). RESULTS: Over the initial 4 weeks, improvements in the mean adenoidal obstruction of the choanae were significantly greater in the group receiving beclomethasone than in the group receiving placebo (right, -14.0% vs. +0.4%, P = .0002) (left, -15.0% vs. -2.0%, P = .0006). In the subsequent crossover 4 weeks, a significant beclomethasone carryover effect resulted in further adenoid size reduction in both treatment groups. All patients demonstrated a decrease in adenoid size with beclomethasone treatment, compared with a mixed response to placebo. Over the full 8-week crossover study, the mean (+/- SE) obstructive symptom score after beclomethasone treatment (20.5 +/- 3.0) was significantly improved compared to patients' initial (43.1 +/- 2.9) and placebo scores (31.1 +/- 4.2, P < or = .05), despite the active drug carryover effect into the placebo treatment period. Significant improvements in adenoidal obstruction and symptom scores over the 8-week crossover study were enhanced in the subsequent 16-week open-label period (P = .0001). By 24 weeks, an 82% reduction in group mean nasal obstruction symptom score accompanied a 29% mean reduction in adenoid/choana ratio. No clinical or demographic characteristic predicted a patient's degree of response to treatment. CONCLUSIONS: Properly administered aqueous nasal beclomethasone in standard doses can significantly reduce adenoidal hypertrophy and nasal airway obstructive symptoms in children.

Adenoids↗
PubMed1993

[Personal experience in the treatment of chronic secretory otitis in children].

The authors review their experiences in the treatment of secretory otitis in children. They detected a significantly higher number of positive allergometric tests to standard groups of inhalation allergens than expected. The patients were divided into two groups; in the first group the allergometric test was negative, in the second positive. The therapeutical approach was identical, consisting of the initial medicamentous treatment which did not give any results. After this, adenoidectomy, paracentesis with secretion aspiration and aeration tube implantation were performed in general endotracheal anesthesia. The comparison of the results of the treatment showed that allergic disease, being one of the etiological factors, significantly influence the course of the treatment as well as the prognosis of the disease. It has been concluded that allergy, an etiological cause of chronic secretory otitis in children, should be given a special regard to help an adequate approach to the phenomenon.

Adolescent↗
PubMed1994

Managing otitis media with effusion in young children. American Academy of Pediatrics The Otitis Media Guideline Panel.

This reference guide contains highlights from the Clinical Practice Guideline, Otitis Media with Effusion in Young Children. The Otitis Media Guideline Panel, a private-sector panel of health care providers, developed the Guideline after comprehensively analyzing the research literature and current scientific knowledge of the development, diagnosis, and treatment of otitis media with effusion in young children. Specific recommendations are given for the management of otitis media with effusion in young children age 1 through 3 years with no craniofacial or neurologic abnormalities or sensory deficits. The natural history of otitis media with effusion, the functional impairments that may result from otitis media with effusion, and the difficulty of measuring the effects of medical and surgical interventions on long-term outcomes are included. The medical interventions studied involve antibiotic, steroid, and antihistamine/decongestant therapies. The surgical interventions studied involve myringotomy with insertion of tympanostomy tubes, adenoidectomy, and tonsillectomy. Short-term outcomes addressed are resolution of effusion and restoration of hearing.

Algorithms↗
PubMed1994

[Erythrocytosis in a 4 year-old child: diagnostic, prognostic, therapeutical problems].

BACKGROUND: Pure erythrocytosis is rare in children. This report describes such a case. CASE REPORT: A 4 year-old boy was admitted because erythrocytosis had been found routinely before adenoidectomy. He was born in Guatemala, was adopted just after his birth, and had been living in France since that age. Clinical examination was normal. His hemogram showed: erythrocytes: 8,800,000/mm3; hemoglobin: 20.1 g/dl; hematocrit: 66.8%; reticulocytes: 262,000/mm3; platelets: 200,000/mm3; leukocytes: 6,800/mm3. The patient had been given iron salts for the past 3 months without an earlier hemogram. Total red cell mass was 1200 ml (N: 600). The myelogram was normal as was the leukocyte alkaline phosphatases, serum lysozyme and vitamin B12. Blood ferritin was low (3.5 ng/ml). In vitro cultures of erythroid precursors were normal, as was the karyotype of myeloid cells. Blood erythropoietin concentration was 20-293 mU/ml (N:4-14). All the causes of secondary polycythemia were eliminated by appropriate investigations. The patient was treated by phlebotomy in aliquots of 25 ml/kg, twice a month, for 10 months, and was given iron therapy. At the end of treatment, his hemoglobin was 14 g/dl and his hematocrit was 45%. Both progressively increased again one year later, requiring new phlebotomies. The patient was followed for 4 years but no cause for this erythrocytosis was found; it was probably congenital in origin. CONCLUSION: This case of pure erythrocytosis was associated with elevated erythropoietin production. Whether this high secretion is related to receptor dysfunction remains to be determined.

Bloodletting↗
PubMed1994

Managing otitis media with effusion in young children. Agency for Health Care Policy and Research.

This Quick Reference Guide for Clinicians contains highlights from the Clinical Practice Guideline, Otitis Media with Effusion in Young Children. The Otitis Media Guideline Panel, a private-sector panel of health care providers, developed the Guideline after comprehensively analyzing the research literature and current scientific knowledge of the development, diagnosis, and treatment of otitis media with effusion in young children. Specific recommendations are given for the management of otitis media with effusion in young children age 1 through 3 years with no craniofacial or neurologic abnormalities or sensory deficits. The natural history of otitis media with effusion, the functional impairments that may result from otitis media with effusion, and the difficulty of measuring the effects of medical and surgical interventions on long-term outcomes are included. The medical interventions studied involve antibiotic therapy, steroid therapy, and antihistamine/decongestant therapy. The surgical interventions studied involve myringotomy with insertion of tympanostomy tubes, adenoidectomy, and tonsillectomy. Short-term outcomes addressed are resolution of effusion and restoration of hearing.

Child, Preschool↗
PubMed1994

The effect of hypertrophic adenoids and tonsils on the development of posterior crossbite and oral habits.

There are a number of studies in the literature, that associate nasopharyngeal airway obstruction, as a result of adenoid enlargement, to the development of skeletal and dental abnormalities. However, the etiologic role of hypertrophied adenoids and tonsils in developing an aberrant dentofacial growth is not clear, yet. The present investigation attempted to study the incidence of maxillary posterior crossbite and oral habits, in a sample of 120 children, that displayed hypertrophied adenoids with or without enlarged tonsils, and underwent adenoidectomy. An attempt was also made to relate the presence of crossbite to the severity of upper respiratory airway obstruction. The severity of airway obstruction was assessed using radiographic and surgical criteria. A lateral cephalometric radiograph was obtained and studied for each patient. Results indicated, that 47% of the children examined, had developed a posterior crossbite. The presence of crossbite was high in children with severe airway obstruction, particularly in those with hypertrophied adenoids and tonsils. On the contrary, most of the children with a posterior crossbite did not have a history of pacifier or finger sucking. It was also concluded, that the study of a lateral cephalometric radiograph can be a valuable diagnostic method in the evaluation of children with upper airway obstruction.

Adenoids↗
PubMed1994

[Ambulatory anesthesia in ORL. Indication, limits and techniques].

Patients undergoing ENT surgery, mainly children, are excellent candidates for outpatient anaesthesia. Most surgical procedures are simple and do not require complicated techniques. Patient selection criteria have been defined by the "Société Française d'Anesthésie et de Réanimation" e.g. ASA I or II patients, age > 50 weeks, ability to understand and follow specific instructions. Operation selection criteria ought to take into account the duration of surgery (< 1 h 30), and risks of bleeding, airway obstruction, pain, nausea and vomiting. Myringotomy and adenoidectomy and simple nasal or otologic surgery can be performed on an outpatient basis. Indications can be extended to other procedures that do not require hypotension and that meet selection criteria. Tonsillectomy and direct laryngoscopy could be performed on an outpatient basis in definite circumstances which have to be discussed for each patient.

Ambulatory Care↗
PubMed1994

Uvulectomy to prevent throat infections.

It is common practice in many parts of Africa for traditional healers to remove the uvula to prevent infections and other disorders associated with the throat. We report two cases of children presenting with recurrent tonsillitis. On examination both children showed complete absence of the uvula and prominent tonsils. It was later revealed that they both had undergone uvulectomy, performed by traditional healers in Eritrea. We report this because this practice, although commonly performed, is little known to otolaryngologists practising outside Africa. In addition, although velopharyngeal competence seems to be maintained after uvulectomy, it may theoretically be at risk if adenoidectomy is performed in these patients.

Child↗
PubMed1993

[Tympanic effusion].

Since epidemiologic studies have shown, that the majority of middle ear effusions disappear spontaneously and sequelae a less frequent than expected, a more conservative treatment strategy is advisable. In this review pathogenetic factors are discussed and a treatment policy is recommended as it appears logic to the authors. It is stressed that exact audiologic data are difficult to obtain in children. If an effusion persists at least for 3 months, adenoidectomy, paracentesis and aspiration of the middle ear fluid has to be considered. The insertion of middle ear ventilation tubes is not the first step in our treatment. Special strategies for treatment have to be applied in some groups such as children with Francheschetti or Down Syndrome and children with cleft palates as well as in children with retardation in speech development.

Child↗
PubMedDate not supplied

Acute otitis media in adults: a report from the International Primary Care Network.

BACKGROUND: Of 22 million visits annually to United States physicians for acute otitis media, almost 4 million are by patients 15 years old or older. Yet the clinical spectrum and variables related to recovery have not been reported for adults. METHOD: Data originated from 3224 primary care patients with acute otitis media, of whom 500 were 15 years old or older, who were enrolled in a prospective study in eight countries. At the initial visit, history, symptoms, physical findings, and treatment were recorded. At a 2-month follow-up visit, changes in treatment and recovery were recorded. RESULTS: Compared with children, adults sought care more quickly after symptom onset; were more likely to have had a tonsillectomy or adenoidectomy; and were more likely to complain of ear pain, decreased hearing, sore throat, and ear discharge. Children were more likely to have a history of recent upper respiratory tract infection, serous otitis media, and ear tubes; symptoms of fever, diarrhea, and vomiting; and tympanic membrane findings of redness, bulging, and ear tubes in place. History of reduced hearing, allergy, prophylactic antibiotics, and tympanic membrane findings characterized as opaque or dull, fluid, draining pus, perforation, and not visualized were equally frequent in both age groups. For adults, neither type nor duration of antibiotic affected outcome. Patients receiving antibiotics had lower rates of recovery than those who did not. The likelihood of a poor outcome increased with an increasing number of past episodes of acute otitis media and with increasing age. CONCLUSION: Although history and symptoms differ in adults and children, the similarity of tympanic membrane findings is consistent with previous reports of a similar bacterial spectrum in both groups. Recovery is related more to individual patient characteristics and history than to antibiotic therapy. Adults have an increased rate of poor outcome at 2 months compared with children.

Acute Disease↗
PubMed1993

The cloverleaf skull anomaly: managing extreme cranio-orbitofaciostenosis.

The cloverleaf skull anomaly represents the most manifestly extreme form of cranio-orbitofaciostenosis with hydrocephalus that has to date been associated with a uniformly poor outcome and frequent death in infancy. Assessment of the primary deformity and the approach to treatment in a consecutive series of 10 patients with the cloverleaf skull anomaly in the one unit are presented. Early predictable surgical correction of the cranio-stenosis is possible by fronto-orbital advancement and lambdoid craniectomy. Less satisfactory correction of hydrocephalus and orbitostenosis is possible with the attendant increased morbidity. Early survival and the potential for a satisfactory long-term outcome depend on the management of the faciostenosis and an airway that may be anomalous at multiple levels. The initial approach was routine tracheostomy, which provided short-term relief but with the morbidity associated with such airway maintenance in any environment other than the most sophisticated health services. More recently, upper airway surgery (uvulopalatopharyngoplasty, adenoidectomy, and soft palatal split) has ensured airway control and avoided the progression to tracheostomy. When utilized later (1 to 10 years), such surgery may alleviate the symptoms of upper airway obstruction and sleep apnea and permit delay of midfacial advancement.

Child↗
PubMed1993

Variations in surgical rates in Quebec: does access to teaching hospitals make a difference?

OBJECTIVE: To document the geographic variations in the rates of 10 common surgical procedures in Quebec and to examine the relation between surgical rates and level of access to teaching hospitals. DESIGN: Population-based rates standardized for age and sex were calculated from 1985-88 data from MED-ECHO (the provincial hospital discharge database) for each of the 32 community health districts (départements de santé communautaire [DSCs]) in Quebec. Variation across DSCs was analysed with the use of the ratio of the highest to the lowest rate, the coefficient of variation and the systematic component of variation. On the basis of an urbanization index designed by Statistics Canada, DSCs were classified as having a low, medium, high or very high level of access to teaching hospitals. PATIENTS: All Quebec residents except those whose DSC of residence could not be traced (accounting for no more than 1.7% of patients for any study procedure) and aboriginal people from northern Quebec. SURGICAL PROCEDURES STUDIED: Appendectomy, cesarean section, cholecystectomy, coronary artery bypass grafting (CABG), hysterectomy, inguinal hernia repair, prostatectomy, tonsillectomy with or without adenoidectomy, total hip replacement and varicose vein stripping. RESULTS: There was considerable systematic variation in the surgical rates for all 10 procedures. Cesarean section, the rates of which varied the least, still exhibited almost a twofold variation between the highest and lowest rates. The rates of tonsillectomy varied the most, by a factor of more than five. With a few exceptions there was relatively little relation between the rates of the procedures within the DSCs. The rates of appendectomy, cholecystectomy, hysterectomy and tonsillectomy tended to be lower in the DSCs containing teaching hospitals, whereas the reverse was true for CABG. For the other procedures the relation between the rates and the level of access to teaching hospitals was nonsignificant. CONCLUSIONS: The overall consistency of the observed variations with those of previous studies invites a closer look at the practice patterns and the scientific basis of the clinical decisions associated with procedures showing high variations in rates. The lack of a systematic relation between the surgical rates and the level of access to teaching hospitals challenges the belief that remote regions are underserved with respect to the procedures studied.

Female↗
PubMed1996

Rhinologic uses of powered instrumentation in children beyond sinus surgery.

Powered instrumentation is now available for a variety of sinonasal procedures in children. Microdebriders with continuous suction at the operative site allow increased precision for complex procedures that often were difficult in small, fragile, pediatric noses. These instruments can be used for functional endoscopic sinus surgery in children and for such procedures as benign and malignant sinonasal or base of skull tumors, choanal atresia, complicated adenoidectomies, dacrocytorinostomies, septal spurs, and recurrent respiratory papillomatosis. These instruments can remove mucosa, neoplastic tissue, cartilage, thin bony septations, nasal debris, and blood under continuous endoscopic visualization. Edematous mucosa is not stripped, but trimmed and preserved, allowing much more rapid postoperative healing because exposed bone is avoided.

Adolescent↗