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Sample records for adenoidectomy

  1. Coblation adenoidectomy our experience

    Balasubramanian Thiagarajan

    2014-03-01

    Full Text Available Aim of our study is to compare the efficacy and safety of coblation adenoidectomy versus conventional cold steel adenoidectomy. The study design included 40 children between age groups 4 – 8. Twenty of these children underwent coblation adenoidectomy while the other group of 20 underwent conventional cold steel adenoidectomy. The parameters taken into consideration for comparison included Post operative pain, operating time, intraoperative bleeding and presence of residual adenoid tissue 6 weeks after surgery. In this study the coblation group demonstrated less post operative pain, less intraoperative bleeding and more complete removal of adenoid tissue. Operative time was found to be significantly higher in coblation group when compared to conventional cold steel adenoidectomy group.

  2. Adenoidectomy: current approaches and review of the literature.

    Türkoğlu Babakurban, Seda; Aydın, Erdinç

    2016-01-01

    Adenoid is a secondary lymphoid organ located in the nasopharynx. Due to its location, it plays an important role in the host defense of the upper respiratory tract. Immunoglobulin G3 and immunoglobulin A1 antibodies are prevalent antibodies in the adenoid tissue. Adenoidal hypertrophy is a common condition in children causing symptoms such as mouth breathing, nasal discharge, snoring, sleep apnea, and hyponasal speech. It also plays a role in the pathogenesis of rhinosinusitis, recurrent otitis media, and otitis media with effusion. Currently, adenoidectomy is one of the most commonly performed pediatric surgical procedures worldwide. Although there is still poor evidence in the literature, recurrent upper respiratory infections, otitis media with effusion, and obstructive sleep apnea syndrome are considered to be the main indications of adenoidectomy. Adenoidectomy can be carried out with several techniques and instruments. Although rare, surgery possesses some risks and may cause emotional distress both for the patient and the family. Non-surgical treatments such as intranasal steroids are also used in the treatment of adenoid hypertrophy. In this review, we discuss the current literature on the adenoid function, adenoidectomy indications, and treatment of adenoid hypertrophy. PMID:27107607

  3. Hematology Expert System (HES) For Tonsillectomy/Adenoidectomy Patients

    Pizzi, Nicolino J.; Kapoor, Sandhya; Gerrard, Jon M.

    1989-03-01

    The purpose of this expert system is to assess a predisposition to bleeding in a patient undergoing a tonsillectomy and/or adenoidectomy as may occur with patients who have certain blood conditions such as hemophilia and von Willebrand's disease. This goal is achieved by establishing a correlation between the patients' responses to a medical questionnaire and the relative quantities of blood lost during the operation.

  4. Bacteremia during adenoidectomy: a comparison of suction diathermy adenoid ablation and adenoid curettage.

    Casserly, Paula

    2010-08-01

    Transient bacteremia is induced by adenoidectomy when the integrity of the nasopharyngeal membrane is broken. The aim of this study was to determine the incidence of bacteremia in patients undergoing adenoidectomy, to identify the causative organisms, and to compare the incidences of bacteremia between the two techniques suction diathermy and curettage.

  5. Effectiveness of adenoidectomy in children with recurrent upper respiratory tract infections

    van den Aardweg, M.T.A.

    2013-01-01

    This thesis focuses on the effects of adenoidectomy in children with recurrent upper respiratory tract infections (URTIs).Despite being one of the most frequent operations performed in children, evidence for the effectiveness of adenoidectomy is scarce and guidance in particular for children with re

  6. Adenoid facies and chronic refractory rhinosinusitis managed by endoscopic-assisted adenoidectomy

    Sudhir M Naik

    2015-12-01

    Full Text Available Background /Objectives: To study 30 cases of patients of chronic adenoiditis with adenoid facies and refractory chronic rhinosinusitis managed by endoscopic assisted adenoidectomy. Materials and method: 7 cases of adenoid facies and 23 cases of chronic refractory rhinosinusitis with adenoiditis were managed by endoscopic assisted adenoidectomy during the study period of 12 months from August 2012 to July 2013. Result: endoscopic assisted adenoidectomy proves to be more effective in managing adenoid facies and chronic refractory rhinosinusitis with adenoid hyperplasia. Conclusion: visualization of the adenoid mass using endoscope helps complete removal of the diseased adenoids. Endoscopic assisted adenoidectomy is treatment of choice in adenoid facies and chronic refractory rhinosinusitis with adenoid hyperplasia and more effective than conventional adenoidectomy.

  7. ROLE OF ADENOIDECTOMY IN THE MANAGEMENT OF OTITIS MEDIA WITH EFFUSION

    Avinash

    2014-06-01

    Full Text Available OBJECTIVE: To study the role of adenoidectomy in the management of otitis media with effusion. TYPE OF STUDY: A prospective clinical study. MATERIALS AND METHODS: 20cases studied in department of ENT, GMCH. The duration of study was from February 2011 to December 2011. Hearing loss assessment in the form of PTA & TYMPANOMETRY before and after adenoidectomy was done. OBSERVATIONS AND RESULTS: Children <14 years were included in the study. Sex wise distribution was observed. Patients categorized according to the symptoms, gender and degree of hearing loss. Satisfactory results observed after adenoidectomy in relation to the improvement in hearing loss. There can be some complications after adenoidectomy but in our studies proper precautions were taken and no complications seen. CONCLUSION: Adenoidectomy is a very effective surgical modality of treatment in patients who are having otitis media with effusion due to adenoid hypertrophy. Conservative management has no role and grommet insertion is not of much value. Adenoidectomy alone has been shown to produce otoscopic clearance of middle ear effusion, alteration of tympanometric status and improvement of hearing loss.

  8. Anesthetic management of adenoidectomy and tonsillectomy assisted by low-temperature plasma technology in children

    Meng-meng LI

    2014-10-01

    Full Text Available Objective To explore the anesthetic management strategy in children undergoing adenoidectomy and tonsillectomy using low-temperature plasma technology. Methods Sixty ASA status I children scheduled for adenoidectomy and tonsillectomy with plasma technology in the First Affiliated Hospital of General Hospital of PLA from September to December of 2013 were enrolled in this study. After induction with propofol, sufentanil and cisatracurium, the children were randomly divided into combined inhalation and intravenous anesthesia group (CIIA group, n=30 and total intravenous anesthesia group (TIVA group, n=30. In CIIA group, anesthesia was maintained with continuous infusion of propofol and remifentanil combined with sevoflurane inhalation during the surgery. In TIVA group, anesthesia was maintained only with continuous infusion of propofol and remifentanil. The hemodynamic changes and time for extubation and leaving operating room were recorded, and the emergence agitation was assessed using Pediatric Anesthesia Emergence Delirium (PAED scale. Results There was no significant difference in hemodynamic changes between the two groups (P>0.05. The total dosages of propofol and remifentanil in TIVA group [10.5±3.4 mg/(kg.h and 16.1±5.3μg/(kg.h, respectively] were significantly higher than those of CIIA group [6.6±2.8 mg/(kg.h, 10.4±4.2 μg/(kg.h, P<0.05]. The times for extubation and leaving operating room were significantly shorter in TIVA group (8.8±3.7min, 6.2±2.9min than in CIIA group (19.8±4.3 min, 13.7±5.2 min, P<0.05, and the rate of emergence agitation during the recovery period in TIVA group (1/30 was significantly less than that in CIIA group (9/30, P<0.05. Conclusion  Total intravenous anesthesia with tracheal intubation could shorten the recovery time and lessen the emergence agitation during the recovery period, and it may be used as a safe, feasible and convenient anesthetic strategy for adenoidectomy and tonsillectomy with

  9. Effects of adenoidectomy on markers of endothelial function and inflammation in normal-weight and overweight prepubescent children with sleep apnea

    Roya Kelishadi; Neshat Nilforoushan; Ahmadreza Okhovat; Babak Amra; Parinaz Poursafa; Mehrdad Rogha

    2011-01-01

    BACKGROUND: This trial study aimed to assess the effects of adenoidectomy on the markers of endothelial function and inflammation in normal-weight and overweight prepubescent children with obstructive sleep apnea (OSA). METHODS: This trial study was conducted in Isfahan, Iran in 2009. The study population was comprised of 90 prepubescent children (45 normal-weight and 45 overweight children), aged between 4-10 years old, who volunteered for adenoidectomy and had OSA documented by validated qu...

  10. Nasopharyngeal and Adenoid Colonization by Haemophilus influenzae and Haemophilus parainfluenzae in Children Undergoing Adenoidectomy and the Ability of Bacterial Isolates to Biofilm Production.

    Kosikowska, Urszula; Korona-Głowniak, Izabela; Niedzielski, Artur; Malm, Anna

    2015-05-01

    Haemophili are pathogenic or opportunistic bacteria often colonizing the upper respiratory tract mucosa. The prevalence of Haemophilus influenzae (with serotypes distribution), and H. parainfluenzae in the nasopharynx and/or the adenoid core in children with recurrent pharyngotonsillitis undergoing adenoidectomy was assessed. Haemophili isolates were investigated for their ability to biofilm production.Nasopharyngeal swabs and the adenoid core were collected from 164 children who underwent adenoidectomy (2-5 years old). Bacteria were identified by the standard methods. Serotyping of H. influenzae was performed using polyclonal and monoclonal antisera. Biofilm formation was detected spectrophotometrically using 96-well microplates and 0.1% crystal violet.Ninety seven percent (159/164) children who underwent adenoidectomy were colonized by Haemophilus spp. The adenoid core was colonized in 99.4% (158/159) children, whereas the nasopharynx in 47.2% (75/159) children (P parainfluenzae and 14 isolates of other Haemophilus spp. were selected. In 20.1% (32/159) children 2 or 3 phenotypically different isolates of the same species (H. influenzae or H. parainfluenzae) or serotypes (H. influenzae) were identified in 1 child. 67.2% (129/192) isolates of H. influenzae, 56.3% (54/96) isolates of H. parainfluenzae and 85.7% (12/14) isolates of other Haemophilus spp. were positive for biofilm production. Statistically significant differences (P = 0.0029) among H. parainfluenzae biofilm producers and nonproducers in the adenoid core and the nasopharynx were detected.H. influenzae and H. parainfluenzae carriage rate was comparatively higher in the adenoid core than that in the nasopharynx in children undergoing adenoidectomy, suggesting that their involvement in chronic adenoiditis. The growth in the biofilm seems to be an important feature of haemophili colonizing the upper respiratory tract responsible for their persistence. PMID:25950686

  11. Nasopharyngeal vs. adenoid cultures in children undergoing adenoidectomy: prevalence of bacterial pathogens, their interactions and risk factors.

    Korona-Glowniak, I; Niedzielski, A; Kosikowska, U; Grzegorczyk, A; Malm, A

    2015-03-01

    Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus colonization of the adenoids and nasopharynx in 103 preschool children who underwent adenoidectomy for recurrent upper respiratory tract infections was examined. Bacterial interactions and risk factors for bacterial colonization of the nasopharynx and adenoids, separately, were analysed statistically. The prevalence of simultaneous isolation from both anatomical sites was 45·6% for S. pneumoniae, 29·1% for H. influenzae, 15·5% for M. catarrhalis and 18·4% for S. aureus. Three pathogens were significantly more frequent together from adenoid samples; nasopharyngeal swabs more often yielded a single organism, but without statistical significance. M. catarrhalis and S. aureus significantly more frequently co-existed with S. pneumoniae and H. influenzae than with each other and a positive association of S. pneumoniae and H. influenzae in adenoid samples was evident. Several differences between risk factors for nasopharyngeal and adenoid colonization by the individual pathogens were observed. We conclude that the adenoids and nasopharynx appear to differ substantially in colonization by pathogenic microbes but occurrence of H. influenzae and S. pneumoniae in the nasopharynx could be predictive of upper respiratory tract infections. PMID:25703401

  12. Effects of adenoidectomy on markers of endothelial function and inflammation in normal-weight and overweight prepubescent children with sleep apnea

    Kelishadi, Roya; Nilforoushan, Neshat; Okhovat, Ahmadreza; Amra, Babak; Poursafa, Parinaz; Rogha, Mehrdad

    2011-01-01

    BACKGROUND: This trial study aimed to assess the effects of adenoidectomy on the markers of endothelial function and inflammation in normal-weight and overweight prepubescent children with obstructive sleep apnea (OSA). METHODS: This trial study was conducted in Isfahan, Iran in 2009. The study population was comprised of 90 prepubescent children (45 normal-weight and 45 overweight children), aged between 4-10 years old, who volunteered for adenoidectomy and had OSA documented by validated questionnaire. The assessment included filling questionnaire, physical examination, and laboratory tests; it was conducted before the surgery and was repeated two weeks and six months after the surgery. RESULTS: Out of the 90 children evaluated, 83 completed the 2-week evaluation and 72 patients continued with the study for the 6-month follow up. Markers of endothelial function, i.e., serum adhesion molecules including endothelial leukocyte adhesion molecule (E-selectin), intercellular cell adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (sVCAM-1), and the markers of inflammation, i.e., interleukin-6, and high-sensitive C-reactive protein (hsCRP) decreased significantly in both normal-weight and overweight children after both two weeks and six months. After six months, the total and LDL-cholesterol showed a significant decrease in the overweight children. CONCLUSIONS: The findings of the study demonstrated that irrespective of the weight status, children with OSA had increased levels of the endothelial function and inflammation markers, which improved after OSA treatment by adenoidectomy. This might be a form of confirmatory evidence on the onset of atherogenesis from the early stages of the life, and the role of inflammation in the process. The reversibility of endothelial dysfunction after improvement of OSA underscores the importance of primordial and primary prevention of chronic diseases from the early stages of the life. PMID:22247723

  13. Effects of adenoidectomy on markers of endothelial function and inflammation in normal-weight and overweight prepubescent children with sleep apnea

    Roya Kelishadi

    2011-01-01

    Conclusions: The findings of the study demonstrated that irrespective of the weight status, children with OSA had increased levels of the endothelial function and inflammation markers, which improved after OSA treatment by adenoidectomy. This might be a form of confirmatory evidence on the onset of atherogenesis from the early stages of the life, and the role of inflammation in the process. The reversibility of endothelial dysfunction after improvement of OSA underscores the importance of primordial and primary prevention of chronic diseases from the early stages of the life.

  14. Comparison of lingual tonsil size as depicted on MR imaging between children with obstructive sleep apnea despite previous tonsillectomy and adenoidectomy and normal controls

    Cine MRI has become a useful tool in the evaluation of patients with persistent obstructive sleep apnea (OSA) despite previous surgical intervention and in patients with underlying conditions that render them susceptible to multilevel airway obstruction. Findings on cine MRI studies have also increased our understanding of the mechanisms and anatomic causes of OSA in children. To compare lingual tonsil size between children with OSA and a group of normal controls. In addition, a subanalysis was made of the group of children with OSA comparing lingual tonsils between children with and without underlying Down syndrome. Children with persistent OSA despite previous palatine tonsillectomy and adenoidectomy and controls without OSA underwent MR imaging with sagittal fast spin echo inversion-recovery images, and lingual tonsils were categorized as nonperceptible at imaging or present and measurable. When present, lingual tonsils were measured in the maximum anterior-posterior diameter. If lingual tonsils were greater than 10 mm in diameter and abutting both the posterior border of the tongue and the posterior pharyngeal wall, they were considered markedly enlarged. There were statistically significant differences between the OSA and control groups for the presence vs. nonvisualization of lingual tonsils (OSA 33% vs. control 0%, P=0.0001) and mean diameter of the lingual tonsils (OSA 9.50 mm vs. control 0.0 mm, P=0.00001). Within the OSA group, there were statistically significant differences between children with and without Down syndrome for the three lingual tonsil width categories (P=0.0070) and occurrence of markedly enlarged lingual tonsils (with Down syndrome 35% vs. without Down syndrome 3%, P=0.0035). Enlargement of the lingual tonsils is relatively common in children with persistent obstructive sleep apnea after palatine tonsillectomy and adenoidectomy. This is particularly true in patients with Down syndrome. (orig.)

  15. Comparison of lingual tonsil size as depicted on MR imaging between children with obstructive sleep apnea despite previous tonsillectomy and adenoidectomy and normal controls

    Fricke, Bradley L. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Emory University School of Medicine, Department of Radiology, Atlanta, GA (United States); Donnelly, Lane F. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Cincinnati Children' s Hospital Medical Center, Department of Pediatrics, Cincinnati, OH (United States); Shott, Sally R. [Cincinnati Children' s Hospital Medical Center, Division of Otolaryngology, Cincinnati, OH (United States); Kalra, Maninder; Poe, Stacy A.; Chini, Barbara A.; Amin, Raouf S. [Cincinnati Children' s Hospital Medical Center, Department of Pediatrics, Cincinnati, OH (United States)

    2006-06-15

    Cine MRI has become a useful tool in the evaluation of patients with persistent obstructive sleep apnea (OSA) despite previous surgical intervention and in patients with underlying conditions that render them susceptible to multilevel airway obstruction. Findings on cine MRI studies have also increased our understanding of the mechanisms and anatomic causes of OSA in children. To compare lingual tonsil size between children with OSA and a group of normal controls. In addition, a subanalysis was made of the group of children with OSA comparing lingual tonsils between children with and without underlying Down syndrome. Children with persistent OSA despite previous palatine tonsillectomy and adenoidectomy and controls without OSA underwent MR imaging with sagittal fast spin echo inversion-recovery images, and lingual tonsils were categorized as nonperceptible at imaging or present and measurable. When present, lingual tonsils were measured in the maximum anterior-posterior diameter. If lingual tonsils were greater than 10 mm in diameter and abutting both the posterior border of the tongue and the posterior pharyngeal wall, they were considered markedly enlarged. There were statistically significant differences between the OSA and control groups for the presence vs. nonvisualization of lingual tonsils (OSA 33% vs. control 0%, P=0.0001) and mean diameter of the lingual tonsils (OSA 9.50 mm vs. control 0.0 mm, P=0.00001). Within the OSA group, there were statistically significant differences between children with and without Down syndrome for the three lingual tonsil width categories (P=0.0070) and occurrence of markedly enlarged lingual tonsils (with Down syndrome 35% vs. without Down syndrome 3%, P=0.0035). Enlargement of the lingual tonsils is relatively common in children with persistent obstructive sleep apnea after palatine tonsillectomy and adenoidectomy. This is particularly true in patients with Down syndrome. (orig.)

  16. Association between tonsillectomy, adenoidectomy, and appendicitis Asociación entre amigdalectomía, adenoidectomía y apendicitis

    J. C. Andreu Ballester

    2005-03-01

    Full Text Available Introduction: tonsillectomy, with or without adenoidectomy, is one of the most frequent surgical procedures generally performed, especially in young patients. Several studies suggest that there is a relationship between tonsillectomy and altered MALT immune system. Objective: to examine the possible association between tonsillectomy or adenoidectomy and the risk of subsequent appendicitis. Material and method: a cross-sectional study was performed in 650 patients admitted to the emergency department of a general hospital in Valencia, Spain. Previous history of tonsillectomy and/or adenoidectomy was related to a history of appendectomy. A descriptive study and an analysis of the relationship between previous operations and appendicitis was performed. A multivariable analysis controlled for age and sex was also performed, including the possible interaction of the gender variable. The independent effect of each of the procedures (tonsillectomy, adenoidectomy was tested. Results: the 25.5% of patients had undergone tonsillectomy and 11.5% adenoidectomy; 17.5% had had an appendectomy. On average, women were operated on more frequently than men. In the bivariate analysis, both tonsillectomy and adenoidectomy were significantly associated with subsequent appendectomy. In the multivariate analysis, this association was only maintained for tonsillectomy (OR: 3.23; 95% CI: 2.11-4.94. A stratified analysis controlling for sex showed a modification of this effect, with a higher association in women (OR: 5.20; 95% CI: 2.91-9.28 than in men (OR: 1.74; 95% CI: 0.90-3.39. Conclusions: a clear association has been found, especially in women, between previous tonsillectomy and subsequent acute appendicitis. Due to a lack of data on acute appendicitis there should be further studies to explain the findings of this study, as this could be the first described risk factor of acute appendicitis.Introducción: la amigdalectomía, sola o acompañada de adenoidectom

  17. The effect of ketamine versus fentanyl on the incidence of emergence agitation after sevoflurane anesthesia in pediatric patients undergoing tonsillectomy with or without adenoidectomy

    Ashraf Arafat Abdelhalim

    2013-01-01

    Full Text Available Background: Emergence agitation (EA has been documented as a common side-effect of sevoflurane anesthesia. This prospective, randomized, double-blind, placebo-controlled study was designed to compare the effects of ketamine versus fentanyl, administered 10 min before the end of surgery on the development of EA. Methods: A total of 120 children aged 3-7 years of American Society of Anesthesiologists I-II physical status were randomly assigned to one of three equal groups receiving either ketamine 0.5 mg/kg (Group K, fentanyl 1 μg/kg (Group F or saline (Group C at 10 min before the end of surgery. Post-operative EA was assessed with Aono′′s four point scale. Recovery times, the post-operative pain and adverse reactions were assessed. Results: There was no significant difference between the three groups regarding recovery and discharge times from post-anesthesia care unit. The incidence of EA was significantly low in Group K and Group F (15% and 17.5%, respectively compared to the control group (42.5%, with no significant difference between Group K and Group F. There were no significant differences in Children′s Hospital of Eastern Ontario Pain Scale between the three groups. The incidence of nausea or vomiting was significantly more in Group F compared to that in other two groups. However, no complications such as somnolence, oxygen desaturation or respiratory depression occurred during the study period and there were no episodes of hallucinations or bad dreams in the ketamine group. Conclusion: The intravenous administration of either ketamine 0.5 mg/kg or fentanyl 1 μg/kg before the end of surgery in sevoflurane-anesthetized children undergoing tonsillectomy with or without adenoidectomy reduces the incidence of post-operative agitation without delaying emergence.

  18. 间接喉镜在小儿腺样体吸切术中的应用%The application of indirect laryngoscope in the young child with adenoidectomy

    卢书轩; 汪红明; 姜顺明

    2012-01-01

    目的 探讨间接喉镜在小儿腺样体吸切术中的应用及治疗效果.方法 35例腺样体肥大患者全身麻醉后用导尿管悬吊软腭,在间接喉镜直视下,采用吸切器将肥大腺样体切除.结果 所有患儿术后打鼾、憋喘等症状明显改善,术后均无并发症发生.结论 间接喉镜下腺样体吸切术即安全有效又简单易行、经济实惠.%Objective To explore the effect of the indirect laryngoscope in the young child adenoidectomy.Methods 35 young children with adenoidoctomy were given the general anesthesia and the suspension of soft palateby catheter,looking straight ahead under the indirect laryngoscope,the large adenoid body was cutted and attracted.Results Aftersurgery,both the snort and suppressed breath symptoms were improved significantly,none complication occured.Conclusion Under the indirect laryngoscope,adenoidectomy was not only safe and effective but also easy,feasible and economical.

  19. Perfil psicológico de crianças submetidas a adenoidectomia e/ou amigdalectomia no pré e pós-operatório Pre and postoperative psychological profile of children submitted to adenoidectomy and/or tonsillectomy

    Ilana Fukuchi

    2005-08-01

    Full Text Available A adenoidectomia e/ou amigdalectomia são os procedimentos cirúrgicos mais realizados na Otorrinolaringologia. Traumas psicológicos infantis podem ser decorrentes das cirurgias ou da anestesia. OBJETIVO: Avaliar a assistência pré-operatória dada aos pacientes pelo perfil psicológico das crianças e de seus responsáveis, no pré e pós-operatório. TIPO DE ESTUDO: Clínico retrospectivo. MATERIAL E MÉTODO: Realizou-se um levantamento dos prontuários dos pacientes (entre 2 e 12 anos submetidos à adenoidectomia e/ou amigdalectomia de fevereiro a dezembro de 2003 e analisado o Protocolo de Assistência Psicológica Breve aplicado a esses pacientes e responsáveis. RESULTADO: Do total de 78 pacientes, 32 (41,0% se encontravam na faixa etária pré-escolar e 46 (59,0% em idade escolar. O sentimento predominante na idade pré-escolar foi o medo (59,4%, enquanto na escolar e de seus familiares foi a confiança: 63,0% e 48,72%, respectivamente. Quanto à expectativa do resultado cirúrgico tanto as crianças (73,08% quanto seus familiares (96,15% demonstraram otimismo. O temperamento emocional introvertido foi observado na maioria das crianças (52,56% e dos acompanhantes (51,28%. A reação emocional delas e dos acompanhantes foi de tranqüilidade: 68,18% e 97,73%, respectivamente, no pós-operatório imediato. Todas as crianças encontraram-se, num parecer psicológico final, sem contra-indicações para a cirurgia. CONCLUSÃO: Independente do sentimento predominante ou do temperamento emocional, uma assistência pré-operatória faz-se necessária. Devemos ter um programa educacional contendo uma descrição verbal do procedimento juntamente com as sensações a serem experimentadas, associadas à interação dos pais com as crianças, visando diminuir o nível de ansiedade, a resposta ao estresse cirúrgico e possíveis seqüelas pós-operatórias.Adenoidectomy and/or tonsillectomy are the most frequent surgeries in otorhinolaryngology

  20. The effect of ketamine versus fentanyl on the incidence of emergence agitation after sevoflurane anesthesia in pediatric patients undergoing tonsillectomy with or without adenoidectomy

    Ashraf Arafat Abdelhalim; Ahmed Mohamed Alarfaj

    2013-01-01

    Background: Emergence agitation (EA) has been documented as a common side-effect of sevoflurane anesthesia. This prospective, randomized, double-blind, placebo-controlled study was designed to compare the effects of ketamine versus fentanyl, administered 10 min before the end of surgery on the development of EA. Methods: A total of 120 children aged 3-7 years of American Society of Anesthesiologists I-II physical status were randomly assigned to one of three equal groups receiving either keta...

  1. Hemorragia na adenoidectomia e/ou amigdalectomia: estudo de 359 casos Hemorrhage in adenoidectomy and/or tonsillectomy: 359 cases study

    Fernando M. J. Vieira; Flávia L. Diniz; Cláudia R. Figueiredo; Luc L. M. Weckx

    2003-01-01

    A adenoidectomia e a amigdalectomia são historicamente os procedimentos cirúrgicos mais realizados na especialidade otorrinolaringológica, tendo incidência principal sobre a população pediátrica. A mais freqüente e mais grave das complicações deste procedimento é a hemorragia no período pós-operatório. FORMA DO ESTUDO: Clínico prospectivo. OBJETIVO: O objetivo deste estudo é o de contribuir para o manejo da principal complicação da adenoamigdalectomia, o sangramento no intra-operatório e no p...

  2. 77 FR 24716 - Scientific Information Request on Medical Devices To Treat Otitis Media With Effusion

    2012-04-25

    ... following elements: Study number, study period, design, methodology, indication and diagnosis, proper use... tubes b. Adenoidectomy with or without myringotomy c. Myringotomy d. Oral or topical nasal steroids...

  3. THE PRESENCE OF ADENOID VEGETATIONS AND NASAL SPEECH, AND HEARING LOSS IN RELATION TO SECRETORY OTITIS MEDIA

    Gabriela KOPACHEVA

    2004-12-01

    Full Text Available This study presents the treatment of 68 children with secretory otitis media. Children underwent adenoid vegetations, nasal speech, conductive hearing loss, ventilation disturbance in Eustachian tube. In all children adenoidectomy was indicated.38 boys and 30 girls at the age of 3-17 were divided in two main groups: * 29 children without hypertrophic (enlarged adenoids, * 39 children with enlarged (hypertrophic adenoids.The surgical treatment included insertion of ventilation tubes and adenoidectomy where there where hypertrophic adenoids.Clinical material was analyzed according to hearing threshold, hearing level, middle ear condition estimated by pure tone audiometry and tympanometry before and after treatment. Data concerning both groups were compared.The results indicated that adenoidectomy combined with the ventilation tubes facilitates secretory otitis media heeling as well as decrease of hearing impairments. That enables prompt restoration of the hearing function as an important precondition for development of the language, social, emotional and academic development of children.

  4. Children selected for adenotonsillectomy; experimental and non-experimental studies

    Staaij, B.K. van

    2004-01-01

    Tonsillectomy with or without adenoidectomy is one of the most commonly performed surgical procedures in children in western countries. Its indications, however, remain uncertain as is reflected by the large variation in surgical rates across countries. Partly, this variation is explained by cultura

  5. [Giant tonsillolith in a child].

    Zhu, Guochen

    2015-01-01

    We describe a case of a 7-year-old child with Down syndrome who presented with loud snoring and cessation of breath during sleep and was found to have a large calculus (20 mm X 12 mm X 12 mm) in her left tonsil by CT scan for which tonsillectomy with adenoidectomy were done. This is one of the youngest reported cases in the literature. PMID:25989675

  6. Adenoid and tonsil surgeries in children: How relevant is pre-operative blood grouping and cross-matching?

    Lucky Onotai; Opubo da Lilly-Tariah

    2013-01-01

    Background: As a part of pre-operative evaluation, several otolaryngologists group and cross-match blood routinely for children undergoing adenoid and tonsil surgeries. This practice has generated several debates either in support or against this practice. The aim of this study is to critically evaluate the incidence of post-tonsillectomy (with or without adenoidectomy) bleeding and blood transfusions in otherwise healthy children with adenoid/tonsil pathologies conducted in the University of...

  7. Danish guidelines on management of otitis media in preschool children

    Heidemann, C. H.; Lous, J.; Berg, J.;

    2016-01-01

    Introduction: Otitis media is one of the most common diseases in small children. This underlines the importance of optimizing diagnostics and treatment of the condition. Recent literature points toward a stricter approach to diagnosing acute otitis media (AOM). Moreover, ventilating tube treatmen....... Conclusion: Recommendations for AOM diagnosis, surgical management for RAOM and COME, including the role of adenoidectomy and treatment of ventilating tube otorrhea, are proposed in the guideline....

  8. Post Tonsillectomy Pain: Can Honey Reduce the Analgesic Requirements?

    Boroumand, Peyman; Zamani, Mohammad Mahdi; Saeedi, Masoumeh; Rouhbakhshfar, Omid; Hosseini Motlagh, Seyed Reza; Aarabi Moghaddam, Fatemeh

    2013-01-01

    Background Tonsillectomy with or without adenoidectomy is one of the most common surgical procedures performed worldwide, especially for children. Oral honey administration following tonsillectomy in pediatric cases may reduce the need for analgesics via relieving postoperative pain. Objectives The aim of this study was to evaluate the effects of honey on the incidence and severity of postoperative pain in patients undergoing tonsillectomy. Patients and Methods A randomized, double blind, pla...

  9. High prevalence of Streptococcus pneumoniae in adenoids and nasopharynx in preschool children with recurrent upper respiratory tract infections in Poland – distribution of serotypes and drug resistance patterns

    Niedzielski, Artur; Korona-Glowniak, Izabela; Malm, Anna

    2013-01-01

    Background Streptococcus pneumoniae is one of the major bacterial pathogens colonizing nasopharynx, and often causes upper respiratory tract infections in children. We investigated the prevalence of S. pneumoniae in nasopharynx and adenoid core in 57 children aged 2–5 years who underwent adenoidectomy for recurrent pharyngotonsillitis, and we determined serotypes and antibiotic resistance patterns of the isolated pneumococci. Material/Methods The nasopharyngeal specimens obtained before adeno...

  10. 间接喉镜明视下经鼻腔行腺样体切除术%Adenoid hypertrophy exsection through nasal cavity under indirect laryngoscopy

    吕怀庆; 陈彦林; 王永强

    2011-01-01

    目的 评估间接喉镜明视下经鼻底进入鼻息肉钳行腺样体切除术的疗效.方法 对80例腺样体肥大患者采用间接喉镜明视下经鼻底进入直头鼻息肉钳切除腺样体,采用双极或单极电凝经鼻或口行鼻咽部创面止血.结果 术中术野清楚,术后无出血,腺样体切除彻底,无周围正常组织损伤,无任何并发症出现.结论 间接喉镜下经鼻腔行腺样体切除术所需设备简单,易于操作,腺样体切除彻底,安全,无并发症.%Objective To evaluate curative effects of adenoidectomy in which nasal polypus forceps are put in through the nasal cavity under an indirect laryngoscope.Methods 80 patients suffering from adenoid hypertrophy were enrolled in this study.Adenoidectomy was operated on by putting nasal polypus forceps through the nasal cavity with direct vision under an indirect laryngoscope and bipolar electrocoagulation or mono-polar electro-coagulation was used to stop bleeding on the nasopharyngeal surface through the nasal cavity or oral cavity.Results The operation field was clear and the operation process was short.The adenoid was completely removed without any damage to surrounding tissues and any complications.Conclusion Adenoidectomy through the nasal cavity under an indirect laryngoscope is easy to do.

  11. Are Histologic Studies of Adenotonsillectomy Really Necessary?

    Rebechi, Giseli; Pontes, Thiago Euênio; Braga, Elias Lobo; Matos, Willian Maduel; Rebechi, Fernando; Matsuyama, Cícero

    2013-01-01

    Introduction In most ear, nose, and throat services, it is routine to send the material extracted from tonsillectomy for histologic study to research malignancy, to analyze suspect material, or to provide medical-legal documentation. Recent studies have shown that this routine analysis is dispensable. Objective To evaluate the actual need and perform a cost–benefit analysis of routine histopathologic examination in tonsillectomy with no signs or symptoms of malignancy. Methods A retrospective observational study evaluated the charts of patients undergoing adenotonsillectomy, tonsillectomy, or adenoidectomy from January 2008 to September 2009 at the Institute of Otorhinolaryngology CEMA-SP. Costs of this test for the public health system were analyzed and the literature reviewed. Results We studied 281 patients between 2 and 22 years of age; 142 (50.5%) were male and 139 (49.5%) were female. Of the surgeries, 201 were adenotonsillectomies (71.5%), 41 were tonsillectomies (14.5%), and 39 were adenoidectomies (14%). The most common indication for surgery was recurrent infection (63.3%). None of study patients had clinical suspicion of malignancy. The tests showed a cost of R$20.03 per tonsil analyzed. Conclusion Routine histopathologic examination in patients undergoing adenotonsillectomy with no signs or symptoms of malignancy is dispensable and increases the cost of the surgeries. PMID:25992042

  12. Are Histologic Studies of Adenotonsillectomy Really Necessary?

    Rebechi, Giseli

    2013-09-01

    Full Text Available Introduction: In most ear, nose, and throat services, it is routine to send the material extracted from tonsillectomy for histologic study to research malignancy, to analyze suspect material, or to provide medical-legal documentation. Recent studies have shown that this routine analysis is dispensable. Objective: To evaluate the actual need and perform a cost–benefit analysis of routine histopathologic examination in tonsillectomy with no signs or symptoms of malignancy. Methods: A retrospective observational study evaluated the charts of patients undergoing adenotonsillectomy, tonsillectomy, or adenoidectomy from January 2008 to September 2009 at the Institute of Otorhinolaryngology CEMA-SP. Costs of this test for the public health system were analyzed and the literature reviewed. Results: We studied 281 patients between 2 and 22 years of age; 142 (50.5% were male and 139 (49.5% were female. Of the surgeries, 201 were adenotonsillectomies (71.5%, 41 were tonsillectomies (14.5%, and 39 were adenoidectomies (14%. The most common indication for surgery was recurrent infection (63.3%. None of study patients had clinical suspicion of malignancy. The tests showed a cost of R$20.03 per tonsil analyzed. Conclusion: Routine histopathologic examination in patients undergoing adenotonsillectomy with no signs or symptoms of malignancy is dispensable and increases the cost of the surgeries.

  13. Effects of Obstructive Sleep Apnea in Children as a Result of Adenoid and/or Adenotonsillar Hypertrophy on Maternal Psychologic Status.

    Ozbay, Isa; Ozturk, Ahmet; Kucur, Cuneyt; Erdogan, Onur; Oghan, Fatih

    2015-11-01

    The authors aimed to evaluate the effects of obstructive sleep apnea in children as a result of adenoid and/or adenotonsillar hypertrophy on maternal psychologic status. The study sample comprised the mothers of 66 children aged 3 to 15 years (mean age: 7.55 ± 2.94 years) who were scheduled to undergo curette adenoidectomy or adenotonsillectomy because of airway obstruction. The mothers completed the 14-item Hospital Anxiety and Depression Scale (HADS), 20-item State-Trait Anxiety Inventory-1 (STAI-1), and 20-item State-Trait Anxiety Inventory-2 (STAI-2) questionnaires before the operation and 10 days afterwards. Mothers who were under psychiatric treatment or declined to fill the questionnaires were excluded from the study. The results obtained postoperatively by day 10, when all the children had considerable improvement in their breathing, were analyzed as control data. The mean postoperative HAD-A and HAD-D scores of the mothers were significantly lower than the mean preoperative scores (P < 0.001). Mothers' mean STAI-1 and STAI-2 scores were also significantly lower postoperatively (P < 0.001). Pediatric adenoidectomy or adenotonsillectomy to relieve airway obstruction has a beneficial effect not only on the health of pediatric patients but also on the psychologic status of their mothers. PMID:26501971

  14. Demystifying Septoplasty in Children

    Martins, Mariane Barreto Brandão

    2014-01-01

    Full Text Available Introduction Septum deviation in children may alter the early physiologic process of breathing, causing obligatory oral breathing and consequently changing craniofacial development and even intellect. Because of these consequences, septoplasty should be performed as early as possible. Materials and Methods The retrospective study reviewed the results of septoplasty in 40 children under 12 years old who had follow-up after surgery for a maximum period of 7 years. The research was submitted to the ethics committee and approved with protocol number 10331912.0.0000.0058. Results Forty patients underwent septoplasty, 39 (97.5% had cauterization of inferior turbinate and associated procedure, 20 (50% had adenotonsillectomy, and 17 (42.5% had adenoidectomy. Conclusion Nasal septum deviation should be corrected early to provide the harmonious growth of the face and to enable normal development of the child, without the occurrence of nasal deformity.

  15. Unexpected ST segment changes in children--a case report.

    Alfirevic, Andrej; Mossad, Emad; Niezgoda, Julie

    2005-01-01

    In children, myocardial ischemic changes during anesthesia are a rare event unless there is underlying pathology. The patient in this case report was an apparently healthy child scheduled for adenoidectomy and bilateral tympanostomy. Occurrence of significant ST changes as well as intraoperative and postoperative hypoxemia required further diagnostic work-up. Postoperative echocardiographic findings were suspicious of intrapulmonary right to left shunting. The pulmonary arteriovenous fistula is probably the major pathophysiological factor for the development of hypoxemia and paradoxical air embolism especially during positive pressure ventilation in our patient. Unexpected ST segment changes might also occur in patients with anomalous origin of coronary arteries. Although diagnostic work-up was inconclusive, it is necessary to rule out any underlying pathological process. Further follow-up is also important in order to learn more about these disease states that often have subclinical, but potentially fatal presentation. PMID:15649167

  16. Haemodynamic changes and intubating conditions during tracheal intubation in children under anaesthesia: a comparative study of two induction regiments

    Katarina Šakić

    2009-02-01

    Full Text Available Aim To compare the haemodynamic changes and intubation conditionsfollowing induction of anaesthesia with alfentanil-propofol-rocuronium with those following alfentanil-propofol combinationin children.Methods A prospective, non-randomized and non blinded trialwas performed in 208 children ( ASA I-II, both gender, aged 2-12years undergoing elective adenoidectomy with or without tonsillectomy.Children scheduled for tonsillectomy or adenotonsillectomyreceived alfentanil 0.02 mg kg-1, propofol 2 mg kg-1 androcuronium 0.45 mg kg-1 before tracheal intubation (R-group.Children scheduled for adenoidectomy received alfentanil 0.02mg kg-1and propofol 3 mg kg-1 before intubation (C-group. Haemodynamicvalues (heart rate, systolic arterial pressure, diastolicarterial pressure, mean arterial pressure were recorded at predeterminedtime intervals before surgical incision. The intubatingconditions were evaluated applying the Copenhagen Scoring System(excellent, good, poor.Results There was no statistical difference in haemodynamicbaseline values, neither prior nor after the intubation betweenthe two groups. There was a statistically significant increase inheart rate, systolic and diastolic arterial pressure after intubationin both groups (p<0.05. Mean arterial pressure after the intubationincreased statistically significantly only in R-group (p=0.001.There was no hypotension, bradycardia, hypoxemia or other complications.Overall intubation conditions were scored excellent in72.3%, good in 21.5% and poor in 6.2% patients. There were nosignificant differences in intubation conditions between the twogroups (p=0.244Conclusion Both induction regiments provided the clinically acceptablehaemodynamics and intubation conditions during trachealintubation in children.

  17. [The tonsils and adenoids as a site of infection and the cause of obstruction].

    Battistini, A; Siepe, F; Marvasi, R

    1998-01-01

    The failure to eradicate group A beta-hemolytic streptococci from the pharynx is partly due to a low compliance, but above all, an alteration of the oropharyngeal microbiological flora: reduction of alpha-haemolytic streptococci which inhibit group A beta-hemolytic streptococci and increase of microorganisms such as Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis. These latter act indirectly destroying the beta-lactamic ring of penicillins. However, this obstacle is overcome by the use of antibiotics which do not contain beta-lactamic rings such as macrolides or associating amoxicillin with clavulanic acid or with new cephalosporins which are more resistant to beta lactamases. To restrict the diffusion of resistance to antibiotics, it is essential to limit their use diagnosing streptococcal tonsillopharyngitis more precisely, thanks to an improved use of micro-biological diagnostic tests and by a more extended use of tonsillectomy in recurrent tonsillitis (more than 6-7 in 1-2 years). Adenoiditis is closely related to the post nasal drip syndrome, to recurrent otitis media and to otitis media with effusion. All these situations could, therefore, represent an indication, although not well defined, for adenoidectomy. Nasopharyngeal obstruction due to adeno-tonsillar hypertrophy becomes critical during sleep when the hypotony of the upper airway muscles becomes additional to the anatomical obstruction. At this point the inspiratory effort required and the consequent decrease of intra airway pressure increase the pharyngeal obstruction suctioning the pharyngeal walls toward the median line. The resulting clinical picture is defined as sleep-disordered breathing (SDB) due to adenotonsillar hypertrophy (idiopathic), to be distinguished from SDB due to cranio-facial abnormalities or neuromuscular diseases. SDB includes both the more serious sleep apnea syndrome and the less severe upper airway respiratory resistance syndrome. A combination of

  18. 不同术式对儿童阻塞性睡眠呼吸暂停综合征伴分泌性中耳炎治疗的临床疗效分析%Different Surgical Methods Clinical Curative Effect of Treatment between Obstructive Sleep Apnea Hypopnea Syndrome and Secretory Otitis Media in Children

    邹新博; 梅栩彬; 赵立民; 邹慧中; 陈正岗; 刘文君

    2015-01-01

    目的探讨不同手术方式对儿童阻塞性睡眠呼吸暂停综合征(OSAHS)伴分泌性中耳炎(SOM)治疗的临床疗效。方法采用回顾性研究的方法,选择在我院确诊的儿童OSAHS伴SOM的患儿82例,其中扁桃体+腺样体切除术+鼓室置管术组42例,扁桃体+腺样体切除术组+药物治疗组40例。所有患儿术前均行多导睡眠监测(PSG)、声导抗、鼻咽侧位片、儿童鼻内镜、耳内镜检查;术后1个月、3个月、6个月对所有患儿临床疗效随访观察。采用SPSS17.0软件对数据进行统计分析。结果两种手术方式治疗儿童OSAHS伴SOM均有一定疗效。术后3个月、6个月两组之间比较差异有统计学意义(<0.05)。结论扁桃体+腺样体切除术+鼓室置管术为儿童OSAHS伴SOM的主要治疗方式,值得我们临床医生推广。%Objective To investigate the dif erent surgical methods clinical curative ef ect of treatment between obstructive sleep apnea hypopnea syndrome (OSAHS) and secretory otitis media (SOM) in children .Methods Using the method of retrospective study, We choiced 82 cases children who diagnosised OSAHS with SOM, including tonsil and adenoidectomy and tympanostomy tube surgery group 42 cases, tonsil and adenoidectomy group 40 cases.Al children were checked by polysomnography (PSG), acoustic immit ance, nasopharyngeal lateral slice, children, ear endoscope endoscopy;Al children were fol owed up for clinical curative ef ect observation after 1 month, 3 months, 6 months. The data were analyzed by SPSS 17.0. Results Both types of surgery treatment of children OSAHS with SOM have certain curative ef ect after 3 months, 6 months .There were comparing dif erences between two groups ( <0.05). Conclusion The main treatment for children OSAHS with SOM is tonsil and adenoidectomy and tympanostomy tube surgery.It is worth for clinical doctors.

  19. Parental Ease in Asking Others Not to Smoke and Respiratory Symptoms and Illness among Children

    John Spangler

    2014-02-01

    Full Text Available Objective: Childhood exposure to secondhand tobacco smoke (SHS increases a child’s burden of respiratory conditions, but parental smoking bans may reduce such morbidity. This study evaluated household smoking bans and their relationship to respiratory illness in an outpatient otolaryngology clinic. Methods: The study was performed at the Heim Pal National Children’s Hospital, Ear, Nose and Throat (ENT Department (Budapest, Hungary from July to November, 2010. A consecutive series of children’s caregivers were approached to participate in a survey measuring household smoking bans, upper and lower respiratory tract symptoms and illnesses, and socioeconomic factors. Bivariate and multivariate logistic regression analyses were performed. Results: Of the 215 caregivers recruited for the study, 208 agreed to participate (response rate of 96.7%. More than half of the children were male (54%, and 39% lived in a household with at least one member who smoked. Smoking was frequently banned inside the car (91.3% and home (85.1%. Respondents felt it easiest to ask friends (97.1% and family members not living in the household (98.1% to refrain from smoking inside the home. Respondents also found it easier to ask a stranger (81.7% or a family member (61.1% not to smoke around the child. Logistic regression showed that respondents for children with a history of pneumonia found it less difficult to ask visitors in the home not to smoke compared to children without pneumonia (OR = 0.23, 95% CI = 0.06–0.98. Conversely, respondents for children who had had adenoidectomy found it over three times more difficult to ask strangers not to smoke near the child compared to those of children without adenoidectomy (OR = 3.20, 95% CI = 1.43–6.38. Conclusions: In a population of children visiting an outpatient ENT clinic in Budapest, Hungary, we found a high degree of exposure to SHS. The ease with which caregivers felt towards asking others not to smoke predicted

  20. Assessment of middle ear effusion and audiological characteristics in young children with adenoid hypertrophy

    REN Dong-dong; WANG Wu-qing

    2012-01-01

    Background Otitis media with effusion is a highly concurrent disease in young children with adenoid hypertrophy.The aim of this study was to assess the middle ear effusion and audiological characteristics in children with adenoid hypertrophy and compare the various assessment methods.@@Methods Two hundred and seven candidates who were to undergo adenoidectomy were analyzed using otoscopy,tympanometry,air-conduction auditory steady-state responses (AC-ASSR),and computerized tomography (CT) before adenoidectomy.@@Results About 73.4% (304/414) of ears were confirmed to have middle ear effusion (MEE) by otoscopy; 75.4% (312/414) of ears revealed MEE by CT.CT scan correctly predicted all the myringotomy results,giving 100% accuracy on the diagnosis of MEE.Additionally,CT revealed two children with inner ear malformations.Type B tracing tympanogram provided a sensitivity of 91.7% and a specificity of 92.2%.Type C tympanogram with peak pressure <-200 daPa indicated effusion; type C tympanogram having acoustic stapedius reflex could exclude MEE.We excluded the AC-ASSR results of the 4 ears with malformation; 54.4% (223/410) of ears were confirmed of hearing loss.Furthermore,5.2%(16/310) of the ears with MEE suffered from severe to profound hearing loss.The average threshold level in the 0.25 kHz frequency of children was found to have poorer hearing thresholds than those in the 0.5,1,2,and 4 kHz (P <0.001) frequencies; 29.7% (92/310) of ears with MEE were regarded as normal hearing level.About 55.8% (173/310) of ears with MEE were classified as having slight-mild hearing loss.@@Conclusions The practitioners should pay much attention to the middle ear condition and be aware of a possible development of severe to profound hearing loss during the course of MEE in young children with adenoid hypertrophy.CT scan is good for the assessment of MEE before ventilation tube insertion.

  1. Adenoid and tonsil surgeries in children: How relevant is pre-operative blood grouping and cross-matching?

    Lucky Onotai

    2013-01-01

    Full Text Available Background: As a part of pre-operative evaluation, several otolaryngologists group and cross-match blood routinely for children undergoing adenoid and tonsil surgeries. This practice has generated several debates either in support or against this practice. The aim of this study is to critically evaluate the incidence of post-tonsillectomy (with or without adenoidectomy bleeding and blood transfusions in otherwise healthy children with adenoid/tonsil pathologies conducted in the University of Port Harcourt Teaching Hospital (UPTH. Patients and Methods: A descriptive retrospective study of children who underwent adenoid and tonsil surgeries in the Department of Ear, Nose and Throat (ENT surgery of UPTH from January 2003 to December 2012. Children with family history of bleeding disorders and derangement of clotting profile as well as different co-morbidity like sickle cell disease were excluded from this study. The patients′ data were retrieved from the registers of ENT out-patient clinics, theatre registers and patients case notes. Demographic data, indications for surgery, preoperative investigations, complications and management outcomes were recorded and analyzed. Results: Out of 145 children that had adenoid and tonsil surgeries; only 100 met the criteria for this study. The study subjects included 65 males and 35 females (male: female ratio 1.9:1 belonging to 0-16 years age group (mean age: 3.46 ± 2.82 years. The age group of 3-5 years had the highest (n = 40, 40% number of surgeries. Adenotonsillectomy was the commonest (n = 85, 85% surgery performed on patients who had obstructive sleep apnea (OSA. The commonest (n = 6, 6% complication was haemorrhage, and only few (n = 3, 3% patients had blood transfusion. However, mortality was recorded in some (n = 3, 3% patients. Conclusion: This study confirms that the incidence of post adenoidectomy/tonsillectomy bleeding in otherwise healthy children is low and rarely requires blood transfusion

  2. Surgery for pediatric obstructive sleep apnea hypopnea syndrome-A report of 80 cases%手术治疗儿童阻塞性睡眠呼吸暂停低通气综合征80例

    万京明

    2013-01-01

    Objective To investigate the effect of adenoidectomy and/or tonsillectomy in the treatment of pediatric obstructive sleep apnea hypopnea syndrome. Methods Clinical data of 80 children with obstructive sleep apnea hypopnea syndrome were analyzed retrospectively. Results 3 months after the operation, there were 73 cured cases, 5 effective cases, and 2 moderately effective cases. 6 months after the operation, there were 2 cured cases, 3 effective cases, 2 moderately effective cases, and 3 recurrence cases, including 2 obesity cases and 1 cerebral palsy case. The latter 3 cases got improved after weight reduction and ventilation treatment. Conclusion Adenoidectomy and/or tonsillectomy are mainstays in the treatment of pediatric obstructive sleep apnea hypopnea syndrome. Individualized treatment according to the etiology can improve the therapeutic effects.%目的 探讨腺样体切除术或(和)扁桃体切除术对于儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效,对效果不佳的原因进行分析、讨论.方法 回顾性分析经腺样体切除术或(和)扁桃体切除术治疗的80例儿童OSAHS的临床表现、治疗方法和预后疗效.结果 术后随访3个月时,治愈73例,显效5例,有效2例;术后随访6个月时,治愈72例,显效3例,有效2例,无效3例(其中肥胖患儿2例,脑瘫患儿1例),对无效的3例患儿给予减肥、戴呼吸机治疗,均取得满意效果.结论 手术切除腺样体或(和)扁桃体是治疗儿童OSAHS的重要方法之一.对于治疗效果不佳的患儿应具体问题具体分析,采用个性化治疗,均可进一步提高疗效.

  3. Comparison of Three Methods Used in the Diagnosis of Extraesophageal Reflux in Children with Chronic Otitis Media with Effusion

    Martin Formánek

    2015-01-01

    Full Text Available Objectives. Detection of extraesophageal reflux (EER in children with chronic otitis media with effusion (OME using three different diagnostic methods. Methods. Children between 1 and 7 years with OME who underwent adenoidectomy and myringotomy with insertion of a ventilation tube were included in this prospective study. EER was detected using three methods: oropharyngeal pH was monitored for 24 hours using the Restech system; detection of pepsin in middle ear fluid obtained during myringotomy was done using Peptest, and detection of pepsin in an adenoid specimen was done immunohistochemically. Results. Altogether 21 children were included in the study. Pathological oropharyngeal pH was confirmed in 13/21 (61.9% children. Pepsin in the middle ear fluid was present in 5/21 (23.8% children; these 5 patients were diagnosed with the most severe EER established through monitoring of oropharyngeal pH. No specimen of adenoids tested was positive for pepsin upon immunohistochemical examination. Conclusions. Diagnosis of EER in patients with OME using Restech is sensitive but less specific when compared to the detection of pepsin in middle ear fluid using Peptest. Pepsin in the middle ear was consistently present in patients with RYAN score above 200, and these patients in particular could potentially profit from antireflux therapy.

  4. [Changing the contents of Fe and Mn in the tonsils of children exposed to passive smoking and their local imission example Chorzow].

    Nogaj, Ewa; Kwapuliński, Jerzy; Bazowska, Maria; Krawczyk, Łukasz; Ahnert, Bozena; Rzepka, Jerzy; Nogaj, Piotr; Olender, Jacek; Paprotny, Łukasz

    2010-01-01

    The subject of the research were samples of overgrown adenoids removed by adenoidectomy 56 children, including 30 boys and 26 girls, exposure and unexposure from passive smoking, living in the administrative area of Chorzów. The statistic characteristic of Fe and Mn occurrence is presented in the thesis. The studies were carried out on the changes of Fe and Mn and other elements, (B, Al, La, Cd, Co, Cr, Cu, Ni, Pb, Zn, As, Se, Hg, V, Be, Mo, Sn, V, Ti, Sb, Bi, TI, Zr, Ca, Mg, Na, Ba, Sr, Li) respectively. The elemental composition of adenoids was determined with ICP-AES method (Inductively Coupled Plasma - Atomic Emission Spectroscopy). The studies on Fe and Mn occurrence in adenoids showed the presence of its higher concentrations in exposure boys (Fe - 116.13 microg/g; Mn - 0.70 microg/g), in comparison with exposure girls from passive smoking (93.06 microg/g; Mn - 0.57 microg/g). PMID:21360931

  5. Acetaminophen injection: a review of clinical information.

    Jones, Virginia M

    2011-01-01

    Acetaminophen injection is an antipyretic and analgesic agent recently marketed in the United States as Ofirmev. Five published trials directly compare acetaminophen injection to drugs available in the United States. For management of pain in adults, acetaminophen injection was at least as effective as morphine injection in renal colic, oral ibuprofen after cesarean delivery, and oral acetaminophen after coronary artery bypass surgery. In children (3 to 16 years old), single-dose acetaminophen injection was similar to meperidine intramuscular (i.m.) for pain after tonsillectomy; readiness for discharge from the recovery room was shorter with acetaminophen injection (median 15 minutes) compared with meperidine i.m. (median 25 minutes), P = .005. In children (2 to 5 years old) postoperative adenotonsillectomy or adenoidectomy, the time to rescue analgesia was superior with high-dose acetaminophen rectal suppository (median 10 hours) compared with acetaminophen injection (median 7 hours), P = .01. One published trial demonstrated acetaminophen injection is noninferior to propacetamol injection for fever related to infection in pediatric patients. Dosing adjustments are not required when switching between oral and injectable acetaminophen formulations in adult and adolescent patients. Acetaminophen injection represents another agent for multimodal pain management. PMID:21936636

  6. Survey of children with obstructive sleep apnea syndrome in Hong Kong of China

    周建偉; 吳國强; 郭嘉莉; 张美盈

    2004-01-01

    Background Obstructive sleep apnea affects up to 2.9% of children. This study was to determine demographic and clinical characteristics of a group of children with obstructive sleep apnea syndrome (OSAS) as defined by sleep polysomnography (PSG).Methods A prospective study was conducted in a public-funded general hospital in Hong Kong of China. Children confirmed to have OSAS by PSG were followed up between January 1997 and December 1998. Tonsillectomy and adenoidectomy (T&A) was offered to those with moderate to severe OSAS, and medication was offered to those with mild OSAS. All children were followed up regularly in the sleep clinic and sleep PSG was repeated for those with marked relapse in symptoms.Results Eighty-nine children (64 boys and 25 girls, mean age 7 years) were confirmed to have OSAS out of 352 children who underwent PSG during the study period. The most common symptoms of OSAS were snoring (100%) and sweating (81%) during sleep and nasal blockage (61%) and sleepiness (34%) during daytime. Severe OSAS occurred in 15 children. Moderate OSAS occurred in 33 children. Forty-one children had mild OSAS. Forty-nine children underwent T&A, 5 (boys, <5 years) out of whom were found to have recurrent OSAS within 1 year. Conclusion A male predominance has been found in a group of Hong Kong children with OSAS. Boys undergoing T&A at an early age (<5 years) will be more likely to develop repeated OSAS.

  7. ROLE OF ADENOID AND NASOPHARYNGEAL FLORA IN THE ETIOLOGY OF SEROUS OTITIS MEDIA

    Akshay

    2015-09-01

    Full Text Available OBJECTIVES: To identify the common bacteria found in the nasopharynx of patients of serous otitis media, to study the prevalence of adenoiditis in patient of serous otitis media and to study the bacteria isolated from operated adenoid tissue of patients of serous otitis media. METHOD AND MATERIA LS : Study was carried out on clinically diagnosed 40 cases of serous otitis media. Patients were operated under general anaesthesia. At the commencement of the surgery, a sterile swab was taken with an applicator from the surface of the adenoid. Prior to surgery, the adenoid tissue was palpated and confirmed. Adenoidectomy was done by curettage method using adenoid curette and the specimen was immediately transported in normal saline to the microbiology lab in a sterile bottle along with the surface swab. RESULT: 95% culture shows bacterial growth , males are more common in serous otitis media and most bacteria isolated from nasopharyngeal swab and adenoid are Gram positive bacteria includes Streptococcus pneumoniae, Staphylococcus aureus, Enterococcus species, Streptococcus viridians, Streptococcus pyogenes and Gram negative bacteria includes Moraxella catarrhalis, Klebsiella pneumonia. CONCLUSION: T he nasopharyngeal and adenoid bacterial flora is polymicrobial in nature and there is no difference in the pathogens isolated from nasopharynx swab or adenoid culture in patients of serous otitis media.

  8. Evaluation of nasopharyngeal microbial flora and antibiogram and its relation to otitis media with effusion.

    Nourizadeh, Navid; Ghazvini, Kiarash; Gharavi, Vahideh; Nourizadeh, Niloufar; Movahed, Rahman

    2016-04-01

    Acute otitis media and otitis media with effusion (OME) are the main causes of hearing impairment in children which require proper treatment, mainly antibiotic therapy. Patients whom were appropriate candidates for adenoidectomy were divided into two groups regarding the presence of middle ear effusion. Adenoid tissue specimens were cultured in both groups and the bacterial flora and anti-microbial resistance pattern were determined. 72 patients were studied, 42 % had OME while 58 % did not. The following bacteria were isolated and cultured from both groups with no meaningful difference in prevalence: Streptococcus viridans (p = 0.265), Staphylococcus aureus (p = 0.72), H. influenza (p = 0.806), Entrococcus. spp (0.391), Streptococcus pneumonia (p = 0.391), nonhemolytic Streptococcus (p = 0.230). Bacterial sensitivity was similar for Amoxicillin-clavulanate (p = 0.935), Amoxicillin (p = 0.935), Cephalexin (p = 0.806), Cefixime (p = 0.391) and Azithromycin in both groups. The two groups showed no meaningful difference considering the bacterial flora of nasopharynx and their sensitivity. Bacteria in both groups were sensitive to Amoxicillin and Amoxicillin-clavulanate and resistant to Azithromycin, Cefixime and Cephalexin. PMID:25929414

  9. Cephalometric norms for the upper airway in a healthy North Indian population

    Dipti Shastri

    2015-01-01

    Full Text Available Objective: The aim was to obtain normative data for cephalometric measurements of the upper airway in the North Indian population. Design: Observational study. Setting: University department and teaching hospital out-patient clinic. Subjects and Methods: A total of 180 healthy patients were included out of which 90 were males (age range, 8-16 years, and 90 were females (age range, 8-16 years, with normal skeletal facial profile, no history of snoring, sleep apnea, upper airway disease, tonsillectomy or adenoidectomy, obesity, or pathology in the pharynx. Twenty cephalometric airway measurements, including size of the tongue, soft palate, nasopharynx, oropharynx, hypopharynx, and relative position of the hyoid bone and valleculae were obtained. Landmarks on cephalometric radiographs were digitized and measurements were made using a specially designed computer program. Error analysis of measurements was performed and comparison of measurements according to sex was made. Results: Significant sex dimorphism was seen for the majority of measurements, with the exception of minimal depth of the airway, oropharyngeal depth of the airway, and the soft palate angle with the hard palate. Conclusion: A minimum sagittal dimension of the upper airway was evident despite differences in measurements between sexes. Findings from this study should be a useful reference for the assessment of sleep apnea in the North Indian population.

  10. Doing without codeine: why and what are the alternatives?

    Benini, Franca; Barbi, Egidio

    2014-01-01

    Codeine is a mild opioid widely used as an analgesic in various age groups, including various pediatric settings. It is a prodrug that owes its analgesic effect almost entirely to the principal metabolite: morphine. The genetic polymorphisms can contribute to making the pharmacokinetics of codeine hard to predict and this it is particularly important in the pediatric population because infants and children have greater susceptibility to the side-effects of morphine. In recent years there have been several reports in the literature on the risks relating to the use of codeine. In August 2012, the American Food and Drugs Administration began to revise its recommendations for the safe use of codeine and in February 2013, established that codeine should not be used for postoperative pain control in children undergoing adenoidectomy and/or tonsillectomy and did restrict the use of this drug in the pediatric population. In June 2013, the European Medicine Agency opted the same decision. In July 2013, the Agenzia Italiana del Farmaco prohibit the use of medicines containing codeine for patients under 12 years old and recommended a limited use of the drug, in many other situations. Complying with these recommendations naturally means changing habits and treatment strategies well established in pediatric practice, but other drugs, tools and techniques available enable us to continue to assure an adequate pain control in pediatric patients, irrespective of their age and situation. The article proposes same alternatives of pain control drugs. PMID:24517264

  11. Adenoidal tissue expression of CD23 (FcεRII: An evaluation with reference to recurrent upper respiratory tract complaints and allergy in children

    Demet Alaygut

    2013-03-01

    Full Text Available Objective: In this study, CD23, low affinity immunoglobulinE receptor, expression in the adenoid tissue was investigatedimmunohistochemically and evaluated with regardto upper respiratory tract infection complaints and allergy.Methods: This retrospective study was performed by theselection of 100 patients aged 2-13 years who underwentadenoidectomy/adenotonsillectomy and in whom the adenoidtissue pathological studies were reported as “lymphoidhyperplasia and chronic infection” were evaluated.Immunohistochemical evaluation of CD23 expressionwas scored semiquantitatively between 0-3 in the tissuesamples.Results: The mean age in the study group was 70.7months; 46% were female; 30% of patients had adenoidectomyonly. Following the operation, the infection frequencydecreased in 91% of patients, whereas allergysymptoms were unchanged in 84%. CD23 expressionwas found significantly lower in patients who had allergicmanifestations, namely urticaria (p=0.041, drug sensitivity(p=0.035 and pollen allergy (p=0.037.Conclusion: A significantly reduced CD23 expressionwas found in adenoidal tissue in patients with allergicsymptoms. These results can be assessed as an underlyingmechanism for the recurrence of respiratory tractcomplaints in these children, despite adenoidectomy. JClin Exp Invest 2013; 4 (1: 1-7Key words: CD23 expression, adenoid tissue, atopy

  12. A new association of multiple congenital anomalies/mental retardation syndrome with bradycardia-tachycardia syndrome: a case report

    Muralidhar Kanchi

    2009-12-01

    Full Text Available Abstract Introduction Congenital bradycardia-tachycardia syndrome is a rare disorder. Its association with multiple congenital anomalies/mental retardation (MCA/MR syndrome is exceptional. Case presentation We report a case of a new association of MCA/MR with bradycardia-tachycardia syndrome in an 18-year-old Indian man. This syndrome is characterized by mental retardation with delayed development of milestones, progressive scoliosis, cryptorchidism, asymmetrical limbs involving both the upper and lower limbs, sleep apnea syndrome, bradycardia-tachycardia syndrome and Dandy-Walker syndrome. Our patient was admitted for septoplasty with adenoidectomy. Patients with MCA/MR with bradycardia-tachycardia syndrome pose a unique challenge to the anesthesiologist. Establishing a good rapport with these patients is imperative. In addition to that, the anesthesiologist should anticipate the difficulty in intubation and rhythm abnormalities during the peri-operative period. Bradycardia or sinus arrest is a well-known complication during the induction and maintenance of anesthesia. Lignocaine should be used with caution in patients with bradycardia-tachycardia syndrome. Monitoring of ventilation parameters (end-tidal CO2, SPO2, airway pressure is essential as these patients are prone to develop pulmonary artery hypertension secondary to sleep apnea syndrome. Conclusion Based on our clinical experience in detailed pre-operative evaluation and planning, we would emphasize peri-operative anticipation and monitoring for dysrhythmias in patients with MCA/MR and bradycardia-tachycardia syndrome undergoing any surgical procedure.

  13. Ictal central apnea and bradycardia in temporal lobe epilepsy complicated by obstructive sleep apnea syndrome

    Yoko Nishimura

    2015-01-01

    Full Text Available We describe the case of a 12-year-old boy who developed temporal lobe epilepsy (TLE with daily complex partial seizures (CPS and monthly generalized seizures. Moreover, he frequently snored while asleep since early childhood. Polysomnography (PSG revealed severe obstructive sleep apnea with apnea–hypopnea index (AHI of 37.8/h. Video-PSG with simultaneous electroencephalography (EEG recording captured two ictal apneic episodes during sleep, without any motor manifestations. The onset of rhythmic theta activity in the midtemporal area on EEG was preceded by the onset of apnea by several seconds and disappeared soon after cessation of central apnea. One episode was accompanied by ictal bradycardia of <48 beats/min which persisted for 50 s beyond the end of epileptic activity. After treatment with carbamazepine and tonsillectomy/adenoidectomy, the seizures were well controlled and AHI decreased to 2.5/h. Paroxysmal discharges also disappeared during this time. Uncontrolled TLE complicated by sleep apnea should be evaluated for the presence of ictal central apnea/bradycardia.

  14. Malpractice claims and unintentional outcome of tonsil surgery and other standard procedures in otorhinolaryngology

    Windfuhr, Jochen P.

    2013-12-01

    Full Text Available [english] Background: Septoplasty, tonsillectomy (with and without adenoidectomy and cervical lymph node excision are amongst the most common 50 inpatient operations in Germany. Intracapsular tonsillectomies (i.e. tonsillotomies are increasingly performed. The aim of this study was to evaluate technical traps and pitfalls as well as alleged medical malpractice associated with tonsillectomy (TE, adenoidectomy (AE, tonsillotomy (TT, septoplasty (SP and cervical lymph node excision (LN. Methods: A questionnaire was sent to the Regional Medical Conciliation Boards, Medical Services of the Health Insurance Companies (MDK and Regional Institutes of Forensic Medicine in Germany to collect anonymized cases of complications following TE, TT, AE, LN and SP. The results were discussed in the light of the contemporary medical literature and published trials and verdicts in Germany. Results: The response rate of our survey was 55.9%. The Institutes of Forensic Medicine contributed nine cases, 49 cases were submitted by the Regional Conciliation Boards and none by MDK. All forensic cases were associated with exsanguinations following tonsillectomy including two children (5 and 8 years of age and seven adults (aged 20 to 69 years. The fatal post-tonsillectomy hemorrhage (PTH had occurred 8.7 days on average; four patients experienced the bleeding episode at home (day 5, 8, 9 and 17, respectively. Repeated episodes of bleeding requiring surgical intervention had occurred in 6 patients. Three Conciliation Boards submitted decicions associated with TT (1, AE (4, LN (3, SP (16 and TE (25. Cases with lethal outcome were not registered. Only three of the 49 cases were assessed as surgical malpractice (6.1% including lesion of the spinal accessory nerve, wrong indication for TE and dental lesion after insertion of the mouth gag. The review of the medico legal literature yielded 71 published verdicts after AE and TE (29, LN (28 and SP (14 of which 37 resulted in

  15. Diseases of the nose and paranasal sinuses in child

    Stenner, Markus

    2014-12-01

    medication. A staged therapeutic concept is followed in CRS based on conservative and surgical methods. Nasal sinus surgery is considered nowadays as effective and safe in children. Based on the assumption that adenoids are a reservoir for bacteria, from which recurrent infections of the nose and nasal sinus originate, the adenoidectomy is still defined as a cleansing procedure in rhinosinusitis. 69.3% of the children had benefit from adenoidectomy. Comorbidities, such as pediatric bronchial asthma, presently play an even more important role in the therapy of rhinosinusitis; therefore, it is often wise to have the support of pediatricians. In western European countries 40% of children presently suffer from allergic rhinitis, in which pronounced nasal obstruction can cause disturbed growth in facial bones. An early therapy with SIT may prevent the development of bronchial asthma and secondary sensitization to other allergens. Therefore, SIT is recommended in treatment of allergic rhinitis whenever, if possible. The assessment of diagnostic tools is for the examiner not often possible due to the lack of evidence. Rhinosurgical approaches are often described in study reports; however, they lack the standard prospective randomized long-term study design required nowadays and can only be evaluated with caution in the literature.

  16. 儿童阻塞性睡眠呼吸暂停低通气综合征麻醉方式的选择%Choose the method of anesthetization for childhood obstructive sleep apnea hypopnea syndrome

    段宗瑾; 朱明

    2010-01-01

    目的 探讨手术治疗儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的麻醉方式.方法 选择98例扁桃体伴腺样体肥大患儿,随机分为局部浸润麻醉组(局麻组)和全身静脉麻醉组(全麻组).局麻组行扁桃体挤切、腺样体刮除;全麻组行扁桃体剥离术,小儿鼻内镜直视下腺样体刮除.对两组出血量、手术时间、进食时间、术后残体、住院费用及手术疗效进行比较.结果 全麻组术中出血多,手术时间长,住院费用高;而局麻组术后残体多,个别患儿不配合需改用全麻.但两种麻醉方式下,术后睡眠打鼾、张口呼吸、憋气等症状明显改善,手术疗效几乎相同.结论 两种麻醉方式各有优缺点,但局麻下手术治疗儿童OSAHS与全麻一样安全有效,应针对不同情况选择.%Objective To discuss how to choose the method of anesthetization for childhood obstructive sleep apnea hypopnea syndrome(OSAHS).Methods 98 children with tonsillar and adenoidal hypertrophy were seleted,and were randomly divided into two groups.Tonsillectomy and adenoidectomy were performed for the group with local infiltration anesthesia,while Tonsil dissection and endoscopic-assisted adenoidectomy through nose were for the group with intravenous general anesthesia.Then blood loss,operation time,intake time,operation damage,psychological trau-ma,hospitalization fares and operative efficacy were compared.Results The group with general anesthesia lost more blood,underwent longer operations with higher cost;the group with local anesthesia had more operation damage,grea-ter psyhologieal trauma and sometimes general anesthesia was necessary for the children who didn't cooperate.But these two methods of anesthetization almost had the same operative efficacy,and the symptoms such as snoring,oral breathing and suffocating were significantly improved after surgery.Condusion Every method had own advantages and disadvantages.Local anesthesia was as effective as

  17. Natural history and clinical assessment of Taiwanese patients with mucopolysaccharidosis IVA

    2014-01-01

    Background Mucopolysaccharidosis IVA (MPS IVA) is a rare lysosomal storage disorder caused by N-acetylgalactosamine-6-sulfatase deficiency, which catalyzes a step in the catabolism of glycosaminoglycans, keratan sulfate and chondroitin-6-sulfate. This disease has a variable age of onset and rate of progression. Methods A retrospective analysis of medical records of 24 patients with MPS IVA (11 males, 13 females; current mean age ± SD, 12.6 ± 6.6 years; age range, 1.4-29.4 years) seen at 6 medical centers in Taiwan from January 1996 through June 2013 was performed. Results Mean ages of onset of symptoms and confirmed diagnosis were 2.0 ± 1.6 and 5.7 ± 4.5 years, respectively. The most prevalent clinical manifestations were kyphosis (100%), pectus carinatum (96%), abnormal gait (93%), striking short trunk dwarfism (92%), genu valgum (92%), and valvular heart disease (91%). Eight patients (33%) experienced at least one surgical procedure with the most common being ear tube insertion (25%), adenoidectomy (17%), tonsillectomy (13%), supraglottoplasty (13%), spinal decompression (13%), and spinal fusion (13%). The most prevalent cardiac valve abnormalities were aortic stenosis (45%) and mitral regurgitation (45%). At the time of the study, 8 out of 24 patients (33%) have died at the mean age of 17.2 ± 7.7 years. Conclusions An understanding of the natural history involved in MPS IVA may allow early diagnosis of the disease. All affected Taiwanese patients experienced significant functional limitations. Adequate evaluations and timely management may improve clinical outcomes and quality of life. PMID:24513086

  18. Quality of Life in Under-14-Year-Old Children After Adenotonsillectomy

    Fathollah Behnoud

    2010-10-01

    Full Text Available Introduction: Tonsillectomy with or without adenoidectomy is one of the most frequent surgical procedures especially in children. Several indications and contraindications have been suggested for this procedure. The benefits and the negative results of this operation have been studied by different researchers; nevertheless, to date, it is still a common procedure. The main purpose of this study is to obtain extensive information on the outcomes of adenotonsillectomy, according to the patient's physical, emotional and behavioral changes and also on the overall changes in his/her quality of life (QOL. Materials and Methods: All the children, aged 1-14, referred to the Besat Hospital clinics (Hamadan, Iran between March 2008 and March 2009 were included in this study. Overall, 86 children with documented indications underwent adenotonsillectomy, and were followed up for one year.  Two modified standard questionnaires for QOL were completed before and one year after the tonsillectomy. Upon the completion of this two-year study, statistical analyses were performed, and the demographic data of the study groups were compared with those of a same-age group. Results: Changes were observed in five main complaints as follow: Acute Recurrent tonsillitis was present in 86 patients preoperatively, but in only three cases postoperatively (pharyngitis. Confirmed chronic sinusitis was present in 24 patients preoperatively, but only in three cases during the year after the surgery. Oral breathing was seen in 82 patients preoperatively, but only in one patient during the year after the surgery. Nocturnal snoring was seen in 83 children preoperatively, but in 25 cases during the year after the surgery. Halitosis was present in 71 patients, while and halitosis was seen in 27 during the year after the surgery. Conclusion: Overall, the majority of the parameters studied showed significant differences after surgery.

  19. Genetics of otitis media.

    Post, J Christopher

    2011-01-01

    There is a growing body of evidence, both from animal and human studies, that host genetic factors can influence the risk of developing otitis media (OM). The role of genetics in OM has been elucidated through studies with monozygotic and dizygotic twins, analyses linking genetic polymorphisms to OM susceptibility, and genome scans. Several twin studies have shown a strong genetic component to middle ear effusion risk, with the estimate of the role of heredity for the proportion of time with middle ear effusions being around 0.7. Genetic polymorphisms in plasminogen activator inhibitor-1, interleukin-6, tumor necrosis factor-α, human leukocyte antigen, and mannose-binding lectin have been variously linked with OM and upper respiratory infection susceptibility. Several genome linkage studies have identified chromosomal regions associated with chronic OM, including 3p, 10q, 10q22.3, 17q12 and 19q. A number of candidate genes are associated with these sites. Given the current state of understanding of the role of genetics in OM, a family history of OM should be ascertained for all patients. Children with a strong family history of OM should be considered as candidates for a more aggressive early treatment of OM, particularly if other risk factors are present. These children may be earlier candidates for the placement of tympanostomy tubes and/or adenoidectomy. Existing data do not support routine genetic testing to determine a child's susceptibility to OM; however, given the advances in whole genome sequencing, such testing may someday play a role in the management of the OM patient. PMID:21358196

  20. Evaluation of Children with Chronic Rhinosinusitis after Adenotonsillectomy

    Fatholah Behnoud

    2011-01-01

    Full Text Available Introduction: Chronic rhinosinusitis (CRS, defined as an inflammatory process involving the paranasal sinuses that continues for at least three months, is a major cause of morbidity in the pediatric population and a difficult entity to treat with a poorly defined pathophysiology. The cornerstone of treatment for children with CRS remains aggressive antibiotic therapy, but many patients fail to improve even after extended courses of broad-spectrum oral antibiotics.  However, good treatment results with adenoidectomy alone have been reported in pediatric patients with CRS. The purpose of this study was to evaluate the effect of adenotonsillectomy on chronic rhinosinusitis in children.   Materials and Methods: In this clinical trial the study population was 40 children under 14 years old who had been selected for adenotonsillectomy. Prior to the procedure, a Waters’ view radiograph was performed on individuals that suffered from CRS and displayed symptoms such as rhinorrhea, halitosis, and chronic cough. Only patients with bilateral clouding of the maxillary sinuses were enrolled in study. A further radiograph was performed on the 28th day following the procedure and the outcome of the treatment evaluated. Results: Of the 40 patients under 14 years old who were evaluated, 22 (55% were female and 18 (45% were male. The mean age of the patients was 7.22 years while the oldest was 14 and the youngest was 4 years old.  Nasal congestion, rhinorrhea, post nasal drip, and chronic cough were present in all of the patients. Following the adenotonsillectomy, these symptoms were significantly reduced and were present in only 15.5%, 0%, 20%, and 20% of the patients, respectively. Multivariate analyses were performed using McNemar’s test. Conclusion: According to the results of this study, where 72.5% of patients showed a complete recovery following treatment, an adenotonsillectomy can be considered as a treatment modality for CRS.

  1. Rinosseptoplastia em crianças Septorhinoplasty in children

    José Victor Maniglia

    2002-05-01

    Full Text Available Introdução: desvio do septo do nariz e/ou da pirâmide nasal ocorre menos freqüentemente em crianças, podendo ser causado no período pré-natal, no parto ou durante o desenvolvimento. A deformidade septal é uma das causas principais de obstrução respiratória, podendo ser responsável por episódios de rinossinusites, otites, dificuldade alimentar e as graves seqüelas do respirador bucal. Podem ocorrer isoladas ou combinadas com desvios da pirâmide nasal. A correção cirúrgica deve ser realizada precocemente na vida. Forma de estudo: Clínico retrospectivo. Material e método: Em estudo retrospectivo foram analisados 80 pacientes, 54 do sexo masculino e 26 do feminino, com idades entre 4 a 14 anos, e submetidos à septoplastia 65 casos, rinoseptoplastia, 11 casos, rinoplastia, 4 casos e procedimentos associados como adenoidectomia, adenotonsilectomia e cauterização intra-turbinal das conchas. Resultado: Recidivas do desvio do septo acorreram em 4 casos, desvio da pirâmide nasal em 4, sinéquias em 3, perfuração do septo e infecção em 1. Conclusão: Os desvios de septo do nariz e ou da pirâmide nasal devem ser corrigidos precocemente e as cirurgias associadas podem ser realizadas no mesmo ato cirúrgico.Introdução : nasal septal deformity is one of the most important causes of respiratory obstruction in children, responsible for chronic rinossinusites, otites media, feeding difficulty and complications of oral breathers. Surgical correction should be performed, early in life, when indicated. Study design: clinical retrospective. Material and method: A series of 80 patients, between 4 and 14 years of age, on whom Septoplasty, Septorrinoplasty, Rhinoplasty associated with others surgical procedures, as adenoidectomy, adenotonsilectomy and turbinectomy is presented. Resultado: recurrence of septal deviation occurred in 4 cases, pyramid deviation in 4, sinechiae in 3, septal perforation in 1 and infection in 1. Conclus

  2. Mecasermin (recombinant human insulin-like growth factor I).

    Rosenbloom, Arlan L

    2009-01-01

    Growth hormone (GH) exercises its growth effects by stimulating insulin-like growth factor I (IGF-I) synthesis in the liver (endocrine IGF-I) and by inducing chondrocyte differentiation/replication and local production of IGF-I (paracrine/autocrine IGF-I). Injectable recombinant human (rh)IGF-I (mecasermin) has been available for nearly 20 years for treatment of the rare instances of GH insensitivity caused by GH receptor defects or GH-inhibiting antibodies. Full restoration of normal growth, as occurs with rhGH replacement of GH deficiency, is not seen, presumably because only the endocrine deficiency is addressed. RhIGF-I has also been effective as an insulin-sensitizing agent in severe insulin-resistant conditions. Although the insulin-sensitizing effect may benefit both type 1 and type 2 diabetes, there are no ongoing clinical trials because of concern about risk of retinopathy and other complications. Promotion of rhIGF-I for treatment of idiopathic short stature has been intensive, with neither data nor rationale suggesting that there might be a better response than has been documented with rhGH. Other applications that have either been considered or are undergoing clinical trial are based on the ubiquitous tissue-building properties of IGF-I and include chronic liver disease, cystic fibrosis, wound healing, AIDS muscle wasting, burns, osteoporosis, Crohn's disease, anorexia nervosa, Werner syndrome, X-linked severe combined immunodeficiency, Alzheimer's disease, muscular dystrophy, amyotrophic lateral sclerosis, hearing loss prevention, spinal cord injury, cardiovascular protection, and prevention of retinopathy of prematurity. The most frequent side effect is hypoglycemia, which is readily controlled by administration with meals. Other common adverse effects involve hyperplasia of lymphoid tissue, which may require tonsillectomy/adenoidectomy, accumulation of body fat, and coarsening of facies. The anti-apoptotic properties of IGF-I are implicated in cancer

  3. Controlled study on the effect of practicing clinical pathway in children with obstructive sleep apnea hypopnea syndrome%儿童阻塞性睡眠呼吸暂停低通气综合征临床路径应用效果的对照研究

    钟建文; 刘大波; 黄振云; 刘少锋; 仇书要; 邵剑波; 周婧

    2012-01-01

    Objective To investigate the effect of practicing clinical pathway in controlling medical expenses and reduced hospital stay ( day ) of hospitalization in children with obstructive sleep apnea hypopnea syndrome ( OSAHS ), and to support normalization, standardization and homogenization of the treatment to the same disease. Methods Based on the clinical pathway recommended by Ministry of Health, combined with the actual conditions, OSAHS clinical pathway was made and installed into the computer system. All patients were enrolled into two groups, 300 cases in each group. One that accepted treatment following clinical pathway was taken as the study group, the cases that not following clinical pathway were grouped as the control group. All of them received coblation-assisted adenotonsillectomy or adenoidectomy. Comprehensive satisfaction survey was carried out after their discharging from the hospital, and the total cost of hospitalization, medication and hostpitalization days were compared between two groups. Results The patients' average age was 3. 5 years, 198 ( 66. 0% ) of them were males, 268( 89. 3% ) were with mild to moderate OSAHS, 251 ( 83.7% ) were treated by adenotonsillectomy, and 49( 16. 3% ) were treated by adenoidectomy in the study group, and the corresponding numbers were 3. 6 years old, 204 ( 68. 0% ) cases, 276 ( 92% ) cases, 238( 79. 3% ) cases and 62 ( 20.7% ) cases in the control group, respectively. There were no significant differences between two groups, P >0. 05. 96. 3% and 90.7% cases had satisfactory results in the study group and control group. The average length of hospitalization, total hospitalization costs, average expense of accommodation, average medical expense, average laboratory fee, average treatment cost in the study group were (3. 8 ±1.2) days, ¥ ( 7 959 ± 1 224 ), ¥ ( 164 ±52 ), ¥( 1 001 ±695 ), ¥ ( 661 ±84 ) and ¥( 1 586 ±spitalizat 703) respectively. They were(4.4±l.6) days, ¥( 8 652 ± 1 314 ), ¥ ( 189

  4. Clinical practice guideline: Otitis media with effusion.

    Rosenfeld, Richard M; Culpepper, Larry; Doyle, Karen J; Grundfast, Kenneth M; Hoberman, Alejandro; Kenna, Margaret A; Lieberthal, Allan S; Mahoney, Martin; Wahl, Richard A; Woods, Charles R; Yawn, Barbara

    2004-05-01

    language delay, learning problems, or a significant hearing loss is suspected in a child with OME; (5) children with persistent OME who are not at risk should be reexamined at 3- to 6-month intervals until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected; and (6) when a child becomes a surgical candidate, tympanostomy tube insertion is the preferred initial procedure. Adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); repeat surgery consists of adenoidectomy plus myringotomy, with or without tube insertion. Tonsillectomy alone or myringotomy alone should not be used to treat OME. The subcommittee made negative recommendations that (1) population-based screening programs for OME not be performed in healthy, asymptomatic children and (2) antihistamines and decongestants are ineffective for OME and should not be used for treatment; antimicrobials and corticosteroids do not have long-term efficacy and should not be used for routine management. The subcommittee gave as options that (1) tympanometry can be used to confirm the diagnosis of OME and (2) when children with OME are referred by the primary clinician for evaluation by an otolaryngologist, audiologist, or speech-language pathologist, the referring clinician should document the effusion duration and specific reason for referral (evaluation, surgery), and provide additional relevant information such as history of AOM and developmental status of the child. The subcommittee made no recommendations for (1) complementary and alternative medicine as a treatment for OME based on a lack of scientific evidence documenting efficacy and (2) allergy management as a treatment for OME based on insufficient evidence of therapeutic efficacy or a causal relationship between allergy and OME. Last, the panel compiled a list of research needs based on limitations of the evidence

  5. Otitis media with effusion.

    2004-05-01

    , or a significant hearing loss is suspected in a child with OME, 5) children with persistent OME who are not at risk should be reexamined at 3- to 6-month intervals until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected, and 6) when a child becomes a surgical candidate (tympanostomy tube insertion is the preferred initial procedure). Adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); repeat surgery consists of adenoidectomy plus myringotomy with or without tube insertion. Tonsillectomy alone or myringotomy alone should not be used to treat OME. The subcommittee made negative recommendations that 1) population-based screening programs for OME not be performed in healthy, asymptomatic children, and 2) because antihistamines and decongestants are ineffective for OME, they should not be used for treatment; antimicrobials and corticosteroids do not have long-term efficacy and should not be used for routine management. The subcommittee gave as options that 1) tympanometry can be used to confirm the diagnosis of OME and 2) when children with OME are referred by the primary clinician for evaluation by an otolaryngologist, audiologist, or speech-language pathologist, the referring clinician should document the effusion duration and specific reason for referral (evaluation, surgery) and provide additional relevant information such as history of acute otitis media and developmental status of the child. The subcommittee made no recommendations for 1) complementary and alternative medicine as a treatment for OME, based on a lack of scientific evidence documenting efficacy, or 2) allergy management as a treatment for OME, based on insufficient evidence of therapeutic efficacy or a causal relationship between allergy and OME. Last, the panel compiled a list of research needs based on limitations of the evidence reviewed

  6. Growth of the nasopharynx and adenoidal development in Brazilian subjects Crescimento da nasofaringe e desenvolvimento da adenóide em brasileiros

    Beatriz de Souza Vilella

    2006-03-01

    Full Text Available The purpose of this research was to study the growth of the nasopharynx and adenoid development. Lateral cephalometric radiographs obtained from 320 white Brazilian subjects between 4 and 16 years of age were used. All the participants were nose breathers and none of them had previously undergone adenoidectomy. Tracings were made from the radiographs and cephalometric measurements were performed. The results showed that adenoid sagital thickness is larger in the age group 4 - 5 years and decreases progressively. There is a slight increase in the age group 10 - 11 years, but afterwards the decrease continues. However, the nasopharyngeal free airway space does not decrease in the age group 10 - 11 years, despite the increasing thickness of the adenoid. This is attributable to the downward displacement of the hard palate, resulting in an increase of the free airway space due to growth. Although the nasopharynx follows a growth pattern similar to that of the rest of the body, adenoid tissue does not. Adenoidal development seems to differ from that of other lymphatic tissues, showing a peculiar pattern that can be revealed when hypertrophy due to infections and allergies is eliminated.O objetivo da pesquisa foi estudar o crescimento da nasofaringe e o desenvolvimento da adenóide. Foram utilizadas as radiografias cefalométricas de perfil obtidas de 320 indivíduos brasileiros brancos, cujas idades variavam entre 4 e 16 anos. Todos os participantes apresentavam respiração predominantemente nasal e não haviam sido submetidos previamente à adenoidectomia. A partir das radiografias foram feitos traçados cefalométricos, sobre os quais foram realizadas medições. Os resultados revelaram que a espessura sagital da adenóide é maior na faixa etária de 4 a 5 anos, regredindo, então, progressivamente, até a faixa etária de 10 a 11 anos, quando ocorre um leve aumento, voltando a diminuir em seguida. O espaço aéreo livre nasofaríngeo, entretanto

  7. Pediatras e os distúrbios respiratórios do sono na criança Pediatricians and sleep-disordered breathing in the child

    Aracy Pereira Silveira Balbani

    2005-04-01

    state of São Paulo, Brazil. A survey mailed to them included questions regarding: their professional profile, knowledge about SDB in childhood, opinions and practices for diagnosis and treatment of these diseases. RESULTS: 112 anonymous completed surveys were returned (21.7%. The teaching of SDB during medical school and pediatric residency raining was considered unsatisfactory respectively by 65.2% and 34.8% of the pediatricians. Forty-nine respondents (43.8% rated their knowledge about SDB in children as regular, 39 (34.8% as good and 17 (15.2% as unsatisfactory. The most important sleep-related questions were: mouth breathing, breathing pauses, sleep amount, excessive daytime sleepiness and nocturnal wheezing. Clinical aspects regarded as the most significant for suspecting obstructive sleep apnea syndrome (OSAS were: breathing pauses, adenoid hypertrophy, mouth breathing, craniofacial anomaly and snoring. The most frequent practices for evaluation of OSAS in children were: cavum radiography with referral to an otorhinolarnygologist (25% and nocturnal pulse oximetry (14.2%. Only 11.6% of pediatricians recommended overnight polysomnography and 4.5%, nap polysomnography. The most effective practices for SDB were considered to be: adenoidectomy and adenotonsillectomy, parents counseling, weight loss and sleep hygiene. CONCLUSIONS: there is a gap between research on SDB in childhood and pediatric practice.

  8. 治疗男性乳房发育症两种不同术式比较%Comparison of Two Operative Methods for Treating Gynecomastia

    贺飞龙; 施开德

    2013-01-01

    目的 比较局部肿胀麻醉下施行乳晕小切口腺体切除术与吸脂联合小切口乳腺切除术治疗男性乳腺发育症的手术效果.方法 将31例脂肪腺体型男性乳腺发育症患者按手术方式的不同分为两组,观察组13例共21侧乳房行吸脂联合小切口腺体切除术,对照组18例共32侧乳房行乳晕小切口腺体切除术,比较两组患者切口长度、手术时间、带管时间、并发症例数、手术疤痕隐蔽程度等指标.结果 观察组患者切口明显小于对照组(P<0.05),两组患者手术时间、带管时间、并发症例数、手术疤痕隐蔽程度等指标比较差异均无统计学意义(P>0.05),随访0.5 ~2a,两组均无复发.结论 肿胀吸脂联合小切口乳腺切除术治疗脂肪腺体型男性乳房发育症创伤小、胸部塑形满意、无复发,是治疗脂肪腺体型男性乳房发育症的理想术式.%Objective To compare curative effects of adenoidectomy via micro-incision of areola and adenomammectomy with liposuction through a small circum-areola incision under tumescent anesthesia on gymecomastia. Method Based on the surgical method,31 patients with gynecomastia were randomly divided into two groups, observation group and control group. In the observation group, 21 sides of breast of 13 patients underwent the adenomammectomy through a small circum-areola incision after liposuction. 21 sides of breast of 18 patients in the control group were received adenomammectomy only. Several indexes of patients in the two groups, including incision length, operative time, drainage tube-keping time, complications and the hidden degree of scar, were compared. Results The incision length of patients in the observation group was smaller than that in control group significantly ( P 0. 05 ). The patients in both groups were followed up for a.half of year to 2 years, in which no recurrence was found. Conclusion The adenomammectomy with the tumescent liposuction through a small

  9. Antibióticos em tonsilectomias: terapêutico ou profilático? Necessário ou abusivo? Antibiotic use in tonsillectomies: therapeutic or prophylactic? Required or excessive?

    Otávio Bejzman Piltcher

    2005-10-01

    Full Text Available A adenotonsilectomia é uma das cirurgias mais comumente realizadas na população pediátrica e adulta jovem. A morbidade pós-operatória de tal procedimento cirúrgico é importante incluindo odinofagia, disfagia, otalgia, febre, halitose, perda ponderal e redução da aceitação por via oral. Após a tonsilectomia, com ou sem adenoidectomia, a colonização da loja tonsilar aberta pela flora bacteriana oral causaria uma exacerbação da reação inflamatória local, piorando a dor pós-operatória. A hipótese de que a redução da população bacteriana na ferida cirúrgica aberta possa diminuir a inflamação local, promover o processo cicatricial e acelerar a recuperação pós-operatória determinou inúmeros estudos que abordaram a relação entre o uso perioperatório de antibióticos e a morbidade pós-operatória da adenotonsilectomia. Apesar desses estudos se definirem como avaliadores do uso profilático cirúrgico de antibióticos nessas cirurgias, não houve seguimento das normas de antibioticoprofilaxia cirúrgica internacionalmente aceitas, sendo que a maioria utiliza antibióticos por sete dias pós-operatórios. Através de uma revisão crítica da literatura, os autores discutem os prós e contras do uso de antibiótico nas tonsilectomias ou adenotonsilectomias, assim como a correta definição para sua utilização.Adenotonsillectomy is one of the most commonly performed surgeries in the pediatric and young adult populations. The postoperative morbidity of this surgical procedure is often significant, including odynophagia, dysphagia, fever, halitosis, loss of weight and reduced oral intake. After tonsillectomy, with or without adenoidectomy, the colonization of the open tonsillar fossae by the bacterial population of the oral cavity would cause an exacerbation of the local inflammatory response worsening postoperative pain. The hypothesis that a reduction of the bacterial population of an open surgical wound could

  10. Influence of early operation treatment for snoring children on intelligence development%早期手术治疗对鼾症患儿智力发育的影响

    陈伟南; 覃兴龙; 邓丽芳

    2014-01-01

    目的 探讨早期手术治疗对鼾症患儿智力发育的影响,为小儿鼾症早期手术提供重要依据.方法 对鼾症患儿40例行双侧扁桃体和/或腺样体切除术(观察组),采用中国-韦氏幼儿智力量表(C-WYCSI)进行术前和术后6个月的智力测试,包括语言智商和操作智商两部分共11项分测试;操作智商又包括视觉分析测验(VA)和几何图形测验(GD)两类.按照1∶1匹配选择同性别、同年龄(±3个月)、家庭条件相当的健康体检学龄前期儿童40例作为对照组进行比较.结果 观察组术前总智商、言语智商、操作智商分别为82、81、83,均低于对照组的101、101、101(t=4.131、3.952、3.842,均P<0.05);术后总智商、言语智商及操作智商分别为98、98、99,均在正常范围,与对照组差异均无统计学意义(均P>0.05).结论 鼾症患儿早期手术治疗可以改善患儿智力;鼾症患儿影响呼吸并有手术指征者,宜早期手术治疗.%Objective To explore the early surgical treatment for sleep apnea in children with the influence of mental development,provide important basis for children with sleep apnea early surgery.Methods 40 children with sleep apnea underwent bilateral amygdala and/or adenoidectomy (observation group).The Chinese wechsler intelligence scale for children (C-WYCSI) was used for preoperative and postoperative 6 months of intelligence tests,including language IQ and operation IQ test two parts,a total of 11 points.Operation IQ but also contain visual analysis test(VA) and two categories,including geometry test (GD).According to the 1 ∶ 1 matching selection of the same gender,and age(± 3 months),family condition was quite healthy check-up preschool children comparing 40 cases as control group.Results Observation group preoperative total intelligence quotient (IQ),verbal IQ,IQ operation was 82,81,83,respectively,which were lower than those of the control group 101,101,101 (t =4.131,3.952,3.842,all P

  11. Paracetamol e dipirona por via endovenosa aplicados à analgesia pós-operatória de pacientes pediátricos submetidos à amigdelectomia em hospital-dia: um estudo prospectivo, randomizado, duplo-cego, placebo controlado Intravenous paracetamol and dipyrone for postoperative analgesia after day-case tonsillectomy in children: a prospective, randomized, double blind, placebo controlled study

    Aysu Inan Kocum

    2013-02-01

    Full Text Available O manejo da dor pós-amigdelectomia pode ser feito com uma série de medicamentos. OBJETIVO: O presente estudo duplo-cego placebo controlado pretendeu avaliar a eficácia de paracetamol e dipirona administrados por via endovenosa na analgesia de pacientes pediátricos pós-amigdelectomia. MÉTODO: Cento e vinte crianças com idades entre três e seis anos submetidas à amigdelectomia com ou sem adenoidectomia e/ou entubação foram randomizadas para receber infusões de paracetamol (15 mg/kg, dipirona (15 mg/kg ou placebo (0,9% NaCl durante a cirurgia. As avaliações foram executadas com 0,25, 0,50, 1, 2, 4, 6h de pós-operatório. Petidina 0,25 mg/kg foi utilizada como analgésico de resgate. Dose acumulada de petidina foi o desfecho primário. Medições de intensidade da dor, alívio da dor, nível de sedação, náusea e vômitos, hemorragia no pós-operatório e outros efeitos adversos foram anotados. RESULTADOS: Nenhuma diferença significativa foi encontrada na dose acumulada de petidina entre os grupos paracetamol e dipirona. A dose acumulada de petidina foi significativamente menor nos grupos paracetamol e dipirona em comparação ao grupo placebo. Nenhuma diferença significativa foi observada entre os escores de dor no pós-operatório dos grupos durante o estudo. CONCLUSÃO: Paracetamol endovenoso tem eficácia analgésica semelhante à da dipirona endovenosa; ambos ajudam a reduzir a necessidade de opioides na analgesia pós-operatória de pacientes pediátricos submetidos à amigdelectomia em hospital-dia.Tonsillectomy is associated with severe postoperative pain for which, several drugs are employed for management. OBJECTIVE: In this double-blind, placebo-controlled study we aimed to evaluate the efficacy of intravenous paracetamol and dipyrone when used for post-tonsillectomy analgesia in children. METHOD: 120 children aged 3-6 yr, undergoing tonsillectomy with or without adenoidectomy and/or ventilation tube insertion were

  12. A radiological study on the velopharyngeal movement of dysarthric patients

    Velopharyngeal incompetency may be the main cause of dysarthria. Velopharyngeal incompetency can be induced by congenital anomalies, such as cleft palate and short soft palate and deformity of soft palte, or complication of adenoidectomy, and neuromuscular disorders affecting the velopharyngeal movement. The present study is aimed to evaluate the velopharyngeal movement in dysarthric patients. The material consisted of 38 cases of dysarthric patients and 30 cases of non-dysarthric control persons examined at the Department of Radiology, Yonsei University College of Medicine from September, 1982 through August, 1983. The radiologic examinations of the soft palate and pharynx were done at neutral and phonation state using Toshiba 500mA Imaging Intensifier. All cases were subjected to morphometric analysis by measuring the soft palate and pharynx. Results obtained were as follows: 1. In control group, the length of the soft palate was 40.7±0.71mm in neutral state and increased 11% in vowel sound, 13% in consonant sound. The thickness of the soft palate was 9.4±0.19mm in neutral state and increased 17% in vowel sound, 16% in consonant sound. The distance between the lateral pharyngeal walls was 36.2±0.92mm in neutral state and decreased 8% in vowel sound, 11% consonant sound. The gap between the soft palate and posterior pharyngeal walla was not present and the levator eminence was higher than the level of the hard palate in phonation. 2. Among the dysarthric patients, 1) In group of dysarthric patients patients with morphological abnormality, the thickness of soft palate was minimally changed in relation to the control group, while the distance between the lateral pharyngeal walls was more decreased than the control group. The gap between the soft palate and posterior pharyngeal wall was more than 3 mm in 90.9% of these cases, and the levator eminence was at or below the level of hard palate. 2) In group of dysarthric patients with functional abnormality, the

  13. 普鲁泊福复合瑞芬太尼控制性降压在小儿鼻内镜手术中的应用%Controlled hypotension with remifentanil and propofol in children during endoscopic sinus surgery

    孙梅杰; 边雯; 李刚; 章玉菊; 时光刚

    2011-01-01

    Objective To observe the effect of remifentanil combined with propofol to induce and sustain controlled hypotension in children during endoscopic sinus surgery(ESS). Methods Forty ASA Ⅰ children undergoing adenoidectomy in ESS were divided into control group and controlled hypotension group by random digits table with 20 cases in each group. No controlled hypotension in control group. Anesthesia was induced with propofol,remifentanil and atracurium, and maintained with continuous infusion of propofol 2 min until the target mean arterial pressure (MAP)(55 - 60 mm Hg, 1 mm Hg = 0.133 kPa) was reached,and MAP was maintained at this level during operation in controlled hypotension group. During 15 min before surgical procedure pharynx nasalis blood flow was measured and recorded with laser Dopper flowmetry continuously. The quality of the surgical field in term of blood loss and dryness was established at 15 min after operation starting. Results Controlled hypotension was induced within (2.5 ± 0.3 ) min, the infusion rate ofMAP and heart rate at 15 min after controlled hypotension and 15 min after operation starting were significantly lower than those at controlled hypotension instantly in controlled hypotension group and control group (P < 0.05 ). The pharynx nasalis blood flow decreased at 15 min after controlled hypotension from baseline [(68.3 ± 8.3 )% vs. (99.8 ± 7.9 )%] (P < 0.05 ). The operation time and the quality of the surgical field in term of blood loss and dryness in controlled hypotension group were better than those in control group [(21 ± 4) min vs. (32 ± 6) min and ( 1.8 ± 0.1 ) scores vs. (3.5 ± 0.5) scores] (P < 0.05 ). The awakeextubate time was within 10 min in two groups, and there were no anesthesia related complications.Conclusion Remifentanil combined with propefol can induce and sustain controlled hypotension,reduce pharynx nasal is blood flow and provide good surgical conditions in children for ESS.%目的 观察普鲁泊福

  14. Tonsillitis and sore throat in children

    Stelter, Klaus

    2014-12-01

    aspiration with asphyxia. A massive haemorrhage is an extreme challenge for every paramedic or emergency doctor because of the difficult airway management. Intubation is only possible with appropriate inflexible suction tubes. All different surgical techniques have the risk of haemorrhage and even the best surgeon will experience a postoperative haemorrhage. The lowest risk of haemorrhage is after cold dissection with ligature or suturing. All “hot” techniques with laser, radiofrequency, coblation, mono- or bipolar forceps have a higher risk of late haemorrhage. Children with a hereditary coagulopathy have a higher risk of haemorrhage. It is possible, that these children were not identified before surgery. Therefore it is recommended by the Society of paediatrics, anaesthesia and ENT, that a standardised questionnaire should be answered by the parents before tonsillectomy and adenoidectomy. This 17-point-checklist questionnaire is more sensitive and easier to perform than a screening with blood tests (e.g. INR and PTT. Unfortunately, a lot of surgeons still screen the children preoperatively by coagulative blood tests, although these tests are inappropriate and incapable of detecting the von Willebrand disease, which is the most frequent coagulopathy in Europe. The preoperative information about the surgery should be done with the child and the parents in a calm and objective atmosphere with a written consent. A copy of the consent with the signature of the surgeon and both custodial parents has to be handed out to the parents.

  15. Edema pulmonar assimétrico por pressão negativa pós-obstrução de via aérea superior: relato de caso Edema pulmonar asimétrico por presión negativa pós-obstrucción aguda de vía aérea superior: relato de caso Asymmetric negative pressure pulmonary edema after acute upper airway obstruction: case report

    Aldo José Peixoto

    2002-06-01

    ventilatorio con PEEP o CPAP, no necesitando de cualquier otra terapia. El pronóstico es bueno, con mejoría en la mayoría de los casos en las primeras 24 horas.BACKGROUND AND OBJECTIVES: Negative pressure pulmonary edema after acute upper airway obstruction is a well-described event, though infrequently diagnosed and reported. This report aimed at presenting a case of upper airway obstruction negative pressure pulmonary edema following acute upper airway obstruction characterized by pulmonary edema asymmetry, being more prominent in the right lung. CASE REPORT: A 4-year-old boy, 17 kg, phisical status ASA I submitted to combined tonsillectomy, adenoidectomy and turbinate cauterization under general anesthesia with sevoflurane/nitrous oxide/O2. Surgery duration was 90 minutes without complications. During anesthetic recovery and spontaneously breathing, patient reacted to tracheal tube, which was removed. Following, ventilatory efforts resulted in chest wall retraction without apparent air movement, being impossible to ventilate him with facial mask. Symptoms evolved to severe hypoxemia (50% SpO2 requiring reintubation. At this point, it was observed that the lung was stiffer and there were bilateral rales characterizing pulmonary edema. A chest X-ray showed diffuse bilateral infiltrates, right upper lobe atelectasis and marked pulmonary edema asymmetry (right greater than left. Patient was mechanically ventilated with PEEP for 20 hours when he was extubated. There was a progressive pulmonary edema improvement and patient was discharged 48 hours later. CONCLUSIONS: Negative pressure pulmonary edema (NPPE is a rare event with high morbidity risk. It is often not diagnosed and requires from the anesthesiologist an updated knowledge and adequate management. It is usually bilateral, rarely unilateral, and exceptionally asymmetric as in this case. Most cases are treated by mechanical ventilation with PEEP or CPAP without any other therapy. The prognosis is favorable, with most