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Sample records for adenoidectomy

  1. Coblation adenoidectomy our experience

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    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. Transoral endoscopic adenoidectomy: initial experience.

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    Jong, Y H; Gendeh, B S

    2008-03-01

    Adenoidectomy is a common ENT procedure performed in hospitals in Malaysia. Adenoidectomy is indicated in patients with recurrent adenoiditis, nasal obstruction or sleep apnoea secondary to adenoid hypertrophy when conservative management has failed. Over the years, there are advances in the techniques of adenoidectomy, from the conventional transoral to endoscopic transnasal/transoral adenoidectomy. The purpose of this article is to describe the technique and emphasize the advantages of this procedure to that of the conventional technique.

  3. Comparison of Transoral/Transnasal Endoscopic-Guided Adenoidectomy with Endoscopic Nasopharyngeal Inspection at the End of Curettage Adenoidectomy.

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    Yaman, Huseyin; Memis, Mehmet; Ilhan, Ethem

    2015-06-01

    The purpose of this study was to evaluate the efficacy of transoral or transnasal endoscopic-guided adenoidectomy compared with endoscopic nasopharyngeal inspection at the end of curettage adenoidectomy. A prospective case series of patients who had adenoidectomy. A total of 27 girls and 34 boys (age range 2.5-18 years) in whom adenoidectomy with or without tonsillectomy procedure was planned were included in the study. The cases were divided into three groups. Group 1 Transoral endoscopic-guided adenoidectomy performed patients. Group 2 Transnasal endoscopic-guided adenoidectomy performed patients. Group 3 Transnasal endoscopic nasopharyngeal exploration performed at the end of the conventional curettage adenoidectomy. The study was completed on 61 children. Mean age and sex frequency were not significant different between the groups. Mean operative time were 11.6 ± 2.9, 15.6 ± 4.4 and 9.7 ± 2 min, respectively (p > 0.05). On the other hand, significant differences were observed in operative time between group 1 and group 2 (p < 0.05), and between group 2 and group 3 (p < 0.05). Transnasal endoscopic examination at the end of curettage adenoidectomy is an appropriate method to assess the residual adenoid tissue after conventional curettage adenoidectomy. Also, operative time of this method is shorter than transoral or transnasal endoscopic-guided adenoidectomy. We recommend transnasal endoscopic inspection in all patients after conventional curettage adenoidectomy.

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

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    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.

  5. Paediatric adenoidectomy: endoscopic coblation technique compared to cold curettage.

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    Di Rienzo Businco, L; Angelone, A M; Mattei, A; Ventura, L; Lauriello, M

    2012-04-01

    The aim of our study was to assess the efficacy and safety of endoscopic coblator adenoidectomy compared to cold curettage in paediatric patients. Forty homogeneous children (4-16 years of age) with adenoid hypertrophy were divided in 2 groups to receive adenoidectomy using cold curettage (A) or coblator (B). After surgery the following outcomes were evaluated: pain score on first day, days reporting pain, analgesic days, liquid diet days, absent from school days, pain score, days with nausea, days with fever, endoscopic adenoid grade and intraoperative bleeding. Forty days after surgery, basal rhinomanometry and nasal decongestion test were measured. The coblation group reported significantly less pain on the first post-operative day, days reporting pain, analgesic days, liquid diet days and absent school days. Patients in group A showed a higher grade of adenoid persistence by rhinoendoscopy, with high values of nasal resistances at the rhinomanometry even after nasal decongestion, consistent with greater adenoid persistence after cold curettage causing air flow obstruction even after turbinate decongestion. Intra-operative bleeding during coblation was significantly less compared the group undergoing cold curettage. Coblator treatment significantly improved patient recovery compared to curettage. Endoscopic coblation adenoidectomy ensures complete removal of adenoids and reduces postoperative adenoid grade. It can also be considered safer because it is under endoscopic control and can reach the cranial portion of the adenoid and its intranasal extension.

  6. How do pediatric adenoidectomy and adenotonsillotomy influence maternal psychological status?

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    Zagólski, Olaf; Kulisiewicz, Jan

    2014-06-01

    We conducted a study to determine the impact that pediatric adenoidectomy or adenotonsillotomy (adenoidectomy with a partial tonsillectomy) had on the short-term psychological status of the children's mothers. Mothers of 100 treated children were examined with the 14-item Hospital Anxiety and Depression Scale (HADS) questionnaire immediately before the operation and 3 days afterward; to establish a baseline for control purposes, they completed another questionnaire 10 days postoperatively. We also compiled data for the mothers' demographic information and the children's physical status. In the preoperative period, we found that (1) the anxiety scores of half the mothers were abnormal, (2) depression scores were higher in the adenotonsillotomy group, and (3) anxiety and depression scores were lower in the mothers with more education and in the mothers who had a personal or family history of previous surgery. At 3 days postoperatively, anxiety and depression scores were again lower in the more educated mothers, and lower in the absence of postoperative fever. We conclude that mothers whose children are undergoing adenoidectomy or adenotonsillotomy, particularly the latter, and those with less education may require some psychological intervention. Such help may also be needed when postoperative complications occur.

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

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    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

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

    LENUS (Irish Health Repository)

    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.

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

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    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.

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

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    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.

  11. ALLERGIC RHINITIS AND ADENOID HYPERTROPHY IN CHILDREN: IS ADENOIDECTOMY ALWAYS REALLY USEFUL?

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    Colavita, L; Miraglia Del Giudice, M; Stroscio, G; Visalli, C; Alterio, T; Pidone, C; Pizzino, M R; Arrigo, T; Chimenz, R; Salpietro, C; Cuppari, C

    2015-01-01

    Allergic rhinitis (AR) and adenoid hypertrophy (AH) are common in children and are often associated with each other. Recent studies have shown improvement of respiratory symptoms and reduction in the adenoid volume after anti-allergic medical therapy (intranasal corticosteroids, antihistamines). The aim of our retrospective study is to evaluate the effectiveness of adenoidectomy on respiratory symptoms in pediatric patients with AR. We recruited 404 pediatric patients with AR, and we divided them into 4 groups (1. intermittent-mild rhinitis; 2. intermittent-moderate/severe rhinitis; 3. persistent-mild rhinitis; 4. persistent-moderate/severe rhinitis), using ARIA classification. For each patient we evaluated: age at onset of AR; family history of allergy; the presence of other allergic diseases; serum total IgE values; skin prick test (SPT) results; presence of AH evaluated by rhino-laringeal fibroscopy; adenoidectomy and its efficacy on respiratory symptoms. Our data show an association between AR and AH: 90 of 404 (22%) children with AR had AH of a degree greater than 2nd. A significant percentage (80%) of children suffering from AR did not present satisfactory benefits from adenoidectomy. They reported persistence or recurrence of rhinitic symptoms after surgery or only partial benefits, especially of recurrent respiratory tract infections and nasal obstruction. The local allergic persistent inflammation on nasal mucosa and adenoid tissue is probably the cause of the unsatisfactory results of adenoidectomy, therefore surgery cannot be the first therapeutic step for these children. It is important to extinguish the local inflammation by medical anti-allergic therapy to obtain improvements of nasal symptoms and to prevent adenoid regrowth.

  12. The protective effect of adenoidectomy on pediatric tympanostomy tube re-insertions: a population-based birth cohort study.

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    Mao-Che Wang

    Full Text Available Adenoidectomy in conjunction with tympanostomy tube insertion for treating pediatric otitis media with effusion and recurrent acute otitis media has been debated for decades. Practice differed surgeon from surgeon. This study used population-based data to determine the protective effect of adenoidectomy in preventing tympanostomy tube re-insertion and tried to provide more evidence based information for surgeons when they do decision making.Retrospective birth cohort study.This study used the National Health Insurance Research Database for the period 2000-2009 in Taiwan. The tube reinsertion rate and time to tube re-insertion among children who received tympanostomy tubes with or without adenoidectomy were compared. Age stratification analysis was also done to explore the effects of age.Adenoidectomy showed protective effects on preventing tube re-insertion compared to tympanostomy tubes alone in children who needed tubes for the first time (tube re-insertion rate 9% versus 5.1%, p = 0.002 and longer time to re-insertions, p = 0.01, especially those aged over 4 years when they had their first tube surgery. After controlling the effect of age, adenoidectomy reduced the rate of re-insertion by 40% compared to tympanostomy tubes alone (aHR: 0.60; 95% CI: 0.41-0.89. However, the protective effect of conjunction adenoidectomy was not obvious among children with a second tympanostomy tube insertion. Children who needed their first tube surgery at the age 2-4 years were most prone to have tube re-insertions, followed by the age group of 4-6 years.Adenoidectomy has protective effect in preventing tympanostomy tube re-insertions compared to tympanostomy tubes alone, especially for children older than 4 years old and who needed tubes for the first time. Nonetheless, clinicians should still weigh the pros and cons of the procedure for their pediatric patients.

  13. Variability of adenoidectomy/tonsillectomy rates among children of the Veneto Region, Italy

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    Andretta Marilisa

    2009-02-01

    Full Text Available Abstract Background Despite national guidelines in 2003 aimed at limiting the recourse to tonsillectomy and/or adenoidectomy (A/T, the latter are among the most frequent pediatric surgeries performed in Italy. Aim of the study is to investigate variability of A/T rates among children of the Veneto Region, Italy. Methods All discharges of Veneto residents with Diagnosis-Related Groups 57–60 and ICD9-CM intervention codes 28.2 (tonsillectomy, 28.3 (adenotonsillectomy, 28.6 (adenoidectomy were selected in the period 2000–2006 for a descriptive analysis. A multilevel Poisson regression model was applied to estimate Incidence Rate Ratios (IRR with 95% Confidence Intervals (CI for A/T surgery among children aged 2–9 years in 2004–2006, while taking into account clustering of interventions within the 21 Local Health Units. Results Through 2000–2006, the overall number of A/T surgeries decreased (-8%; there was a decline of adenoidectomies (-20% and tonsillectomies (-8%, whereas adenotonsillectomies raised (+18%. Analyses on children aged 2–9 resulted in an overall rate of 14.4 surgeries per 1000 person-years (16.1 among males and 12.5 among females, with a wide heterogeneity across Local Health Units (range 8.1–27.6. At random intercept Poisson regression, while adjusting for sex and age, intervention rates were markedly lower among foreign than among Italian children (IRR = 0.57, CI 0.53–0.61. A/T rates in the 10–40 age group (mainly tonsillectomies computed for each Local Health Unit and introduced in the regression model accounted for 40% of the variance at Local Health Unit level of pediatric rates (mainly adenoidectomies and adenotonsillectomies. Conclusion A/T rates in the Veneto Region, especially adenoidectomies among children aged 2–9 years, remain high notwithstanding a decrease through 2000–2006. A wide heterogeneity according to nationality and Local Health Units is evident. The propensity to A/T surgery of each Local

  14. Comparative Study for Efficacy and Safety of Adenoidectomy according to the Surgical Method: A Prospective Multicenter Study

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    Lee, Woo Hyun; Kim, Dong-Kyu; Kim, Sung Wan; Kim, Young Hyo; Nam, Jung Gwon; Park, Seok-Won; Park, Chan-Soon; Bae, Woo Yong; Yeo, Nam-Kyung; Won, Tae-Bin; Lee, Seung Hoon; Lee, Tae-Hoon; Lee, Hyoung Joo; Kim, Sang-Wook; Jeong, Sung-Wook; Choi, Jeong-Seok; Han, Doo Hee; Choi, Ji Ho

    2015-01-01

    Background/Objective There have been several operative techniques for adenoidectomy and their efficacy and morbidity are different according to the technique. This prospective multicenter study was aimed to compare the efficacy and morbidity of coblation adenoidectomy (CA) with those of power-assisted adenoidectomy. Study Design Prospective multi-institutional study. Methods Children who underwent CA, power-assisted adenoidectomy with cauterization (PAA+C) or without cauterization (PAA-C) due to adenoid hypertrophy were enrolled from 13 hospitals between July 2013 and June 2014. Mean operation time, degree of intraoperative bleeding and postoperative bleeding rate were evaluated. Results A total of 388 children (mean age ± standard deviation = 6.6 ± 2.5 years; 245 males and 143 females) were included. According to the adenoidectomy technique, the children were classified into 3 groups: (1) CA (n = 116); (2) PAA+C (n = 153); and (3) PAA-C (n = 119). Significant differences were not found in age and sex among three groups. In the CA group, mean operation time was significantly shorter (P < 0.001) and degree of intraoperative bleeding was significantly less (P < 0.001) compared to PAA+C or PAA-C group. Delayed postoperative bleeding rate of PAA-C group was significantly higher than that of CA or PAA+C group (P = 0.016). Conclusions This prospective multicenter study showed that CA was superior to PAA in terms of mean operation time and degree of intraoperative bleeding. PMID:26267337

  15. Comparative Study for Efficacy and Safety of Adenoidectomy according to the Surgical Method: A Prospective Multicenter Study.

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    Jeong-Whun Kim

    Full Text Available There have been several operative techniques for adenoidectomy and their efficacy and morbidity are different according to the technique. This prospective multicenter study was aimed to compare the efficacy and morbidity of coblation adenoidectomy (CA with those of power-assisted adenoidectomy.Prospective multi-institutional study.Children who underwent CA, power-assisted adenoidectomy with cauterization (PAA+C or without cauterization (PAA-C due to adenoid hypertrophy were enrolled from 13 hospitals between July 2013 and June 2014. Mean operation time, degree of intraoperative bleeding and postoperative bleeding rate were evaluated.A total of 388 children (mean age ± standard deviation = 6.6 ± 2.5 years; 245 males and 143 females were included. According to the adenoidectomy technique, the children were classified into 3 groups: (1 CA (n = 116; (2 PAA+C (n = 153; and (3 PAA-C (n = 119. Significant differences were not found in age and sex among three groups. In the CA group, mean operation time was significantly shorter (P < 0.001 and degree of intraoperative bleeding was significantly less (P < 0.001 compared to PAA+C or PAA-C group. Delayed postoperative bleeding rate of PAA-C group was significantly higher than that of CA or PAA+C group (P = 0.016.This prospective multicenter study showed that CA was superior to PAA in terms of mean operation time and degree of intraoperative bleeding.

  16. Atypical post-adenoidectomy Grisel's syndrome in Crouzon child with kyphotic skull base.

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    Kourelis, Konstantinos; Haronis, Vasileios; Konandreas, Ioannis; Kontrafouri, Athina; Asimakopoulos, Athanasios

    2015-10-01

    Crouzon syndrome is characterized by abnormal craniofacial growth due to craniosynostosis. Skull base may also be involved in the pattern of malformations. Grisel's syndrome, an inflammation-mediated atlanto-axial instability occurs rarely in children after adenoidectomy. We report a 9-year-old female Crouzon patient, without vertebral anomalies, who developed severe torticollis few days after adenoid curettage. A deformity of the skull base alone might have induced an irregular arrangement of the craniocervical junction elements, thus increasing the susceptibility to cervical spine complications. PMID:25805067

  17. Surgeons' exposure to sevoflurane during paediatric adenoidectomy: a comparison of three airway devices.

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    Herzog-Niescery, J; Gude, P; Gahlen, F; Seipp, H-M; Bartz, H; Botteck, N M; Bellgardt, M; Dazert, S; Weber, T P; Vogelsang, H

    2016-08-01

    Although sevoflurane is commonly used in anaesthesia, a threshold value for maximum exposure to personnel does not exist and although anaesthetists are aware of the problem, surgeons rarely focus on it. We used a photo-acoustic infrared device to measure the exposure of surgeons to sevoflurane during paediatric adenoidectomies. Sixty children were randomly allocated to laryngeal mask, cuffed tracheal tube or uncuffed tracheal tube. The average mean (maximum) sevoflurane concentrations within the surgeons' operating area were 1.05 (10.05) ppm in the laryngeal mask group, 0.33 (1.44) ppm in the cuffed tracheal tube group and 1.79 (18.02) ppm in the uncuffed tracheal tube group, (p < 0.001), laryngeal mask and cuffed tracheal tube groups vs. uncuffed tube group. The presence of sevoflurane was noticed by surgeons in 20% of cases but there were no differences between the groups (p = 0.193). Surgical and anaesthetic complications were similar in all three groups. We conclude that sevoflurane can be safely used during adenoidectomies with all three airway devices, but in order to minimise sevoflurane peak concentrations, cuffed tracheal tubes are preferred.

  18. Adenoidectomy with or without grommets for children with otitis media: an individual patient data meta-analysis

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    Boonacker, C.W.; Rovers, M.M.; Browning, G.G.; Hoes, A.W.; Schilder, A.G.M; Burton, M.J.

    2014-01-01

    BACKGROUND: Otitis media (OM) is a leading cause of medical consultations, antibiotic prescription and surgery in children. The surgical procedures offered to children with recurrent or persistent OM are insertion of grommets, adenoidectomy or a combination of the two. There is clear National Instit

  19. Técnica de correção de hipernasalidade causada por adenoidectomia Management of hipernasality caused by adenoidectomy

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    Patrícia Junqueira

    2002-08-01

    Full Text Available A tonsila faríngea quando aumentada, pode causar obstrução nas vias aéreas superiores e levar à respiração bucal de suplência¹. Em alguns casos adenoidectomia e/ou adenoamigdalectomia são indicadas para remoção do fator obstrutivo, possibilitando a respiração nasal. Temos observado que algumas crianças mesmo sem apresentar queixas e/ou alterações vocais no período pré-operatório, desenvolvem uma qualidade vocal hipernasal após adenoidectomia12. Este artigo tem como objetivo descrever um caso de hipernasalidade após adenoidectomia e relatar o tratamento fonoaudiológico, bem como, os possíveis riscos e seqüelas após o procedimento cirúrgico.Hipertrophic adenoid is a frequent cause of obstruction of the upper respiratory tract and may lead to a mouth breathing condition. in some cases, surgical procedures such as adenoidectomy and or tonsillectomy are necessary to reestablish the nasal breathing. We have observed that following adenoidectomy, many children present with vocal hipernasality, even when there is no previous history or complains. In this paper, the authors describe a case of severe hipernasality following adenoidectomy, as well as detailed steps of the speech therapy approach. The risks and sequelae of this vocal condition related to adenoidectomy are also discussed.

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

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    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

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

    OpenAIRE

    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...

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

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    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

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

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    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

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

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    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.

  5. Parental Analgesic Knowledge and Decision Making for Children With and Without Obstructive Sleep Apnea After Tonsillectomy and Adenoidectomy.

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    Schymik, Frank A; Lavoie Smith, Ellen M; Voepel-Lewis, Terri

    2015-12-01

    Tonsillectomy is a common and painful procedure often indicated for children with obstructive sleep apnea (OSA) who are at risk for opioid-related toxicity. Whether parents whose children have OSA understand the risks of opioids is unknown. The purpose of this study was to examine whether parents whose children have OSA have greater opioid risk understanding and would be less likely to give an opioid to a child exhibiting oversedation compared to parents whose children do not have OSA. The study design was a secondary analysis of a prospective observational study. The study was conducted in a large academic, tertiary care children's hospital in the Midwest. 224 parents whose children with or without OSA underwent tonsillectomy with/without adenoidectomy were included. Parents were assessed for opioid adverse event understanding and then made decisions to give/withhold opioids for a child exhibiting adverse effects. After discharge, parents recorded all opioid doses they gave their child. There were no differences in opioid understanding between OSA and non-OSA groups, and nearly half in both would give an opioid to the child exhibiting oversedation. Similar amounts of opioids were given at home. OSA did not predict parents' opioid decisions; however, around-the-clock instruction predicted greater opioid use at home. Parents whose children had OSA had a similar understanding of opioid-related oversedation compared to other parents, and half would give a prescribed opioid when signs of oversedation were present, suggesting a need for improved understanding and recognition of this sign of toxicity, and of what to do should this symptom present.

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

    International Nuclear Information System (INIS)

    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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  8. 鼻内镜下经口径路腺样体切除术62例临床分析%Adenoidectomy through mouse under endoscopy:with a report 62 cases

    Institute of Scientific and Technical Information of China (English)

    姜梁; 胡晓艳

    2014-01-01

    目的:探讨经口径路鼻内镜下腺样体切除术的治疗效果和优点。方法:经口径路在鼻内镜下行腺样体切除术62例,治疗由腺样体肥大引起的咽鼓管功能障碍、小儿鼾症和鼻腔阻塞。结果:术后无腺样体组织残留,鼻咽部组织无损伤和出血等并发症,患者术前症状明显改善或消失。结论:采取该手术方式,能彻底清除病变组织,增加手术的准确性和安全性,疗效好且并发症少。%Objective:To probe into the curative effects,advantages of utilizing nasal endoscopy in adenoidectomy.Meth-od:62 cases with sleep respiratory disorder,nose block,hearing loss caused by adenoid hypertrophy were operated by ad-enoidectomy through mouse under endoscopy.Result:The adenoid gland was removed completely and the anatomic con-figuration of nasopharynx was well viewed after operation.All cases were recovered without complications.Conclusion:Adenoidectomy through mouse under endoscopy provides a direct and clear viewthat allows the surgeon to re -move ade-noid tissue accurately and effectively with few complications. Objective:To probe into the curative effects,advantages of utilizing nasal endoscopy in adenoidectomy.Meth-od:62 cases with sleep respiratory disorder,nose block,hearing loss caused by adenoid hypertrophy were operated by ad-enoidectomy through mouse under endoscopy.Result:The adenoid gland was removed completely and the anatomic con-figuration of nasopharynx was well viewed after operation.All cases were recovered without complications.Conclusion:Adenoidectomy through mouse under endoscopy provides a direct and clear viewthat allows the surgeon to re -move ade-noid tissue accurately and effectively with few complications.

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

    Directory of Open Access Journals (Sweden)

    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

  10. 鼻内镜下腺样体低温等离子消融术和动力切割术的疗效比较%The Clinical Observation of Coblation-assisted adenoidectomy and nasal dynamical system-assisted adenoidectomy for Treatment of Children with Obstructive Sleep Apnea Hypopnea Syndrome

    Institute of Scientific and Technical Information of China (English)

    陈钢; 刘凤荣; 吴慧莉; 孙汝山; 王俊阁

    2014-01-01

    Objective To investigate the clinical efficacy and safety of the adenoidectomy assisted by the coblation-assisted or the nasal dynamical system for the children with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods From January 2008 to December 2011, the adenoidectomy had been done assisted by ENT Coblator surgical instrument or nasal dynamical system for 75 children, aged 3 to 13 years old. The follow-ups were conducted by telephone interview and the follow up time was 6 months after the operation. The responses were recorded on a standardized questionnaire (pediatric OSAHS disease-specific quality of life survey (OSA-18)).Results here was no significant difference in the operation times between two groups and the amount of bleeding of the adenoidectomy assisted by the nasal dynamical system was more than those of the coblation. Both ways decrease the scores of the OSA-18 in patients statistically after 6 months.ConclusionThe adenoidectomy assisted by the coblation-assisted or the nasal dynamical system both had good clinical efficacy and can be especially suitable for surgical treatment of children with OSAHS.%目的:分别通过低温等离子射频消融和鼻动力切割进行腺样体切除,观察两种手术方式的手术时间、出血量及疗效,分析两种手术方式的优缺点。方法收集2008年1月~2011年12月我院收治的儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)中,扁桃体和/或腺样体肥大的患儿共75例,其中30例行鼻动力切割腺样体切除术,45例行低温等离子射频消融腺样体切除术,统计两种术式的手术时间、出血量及术后半年疗效(儿童OSAHS疾病特异性生活质量调查(OSA-18))评估有无差异。结果鼻动力切割组与等离子消融组比较,两者切除腺样体手术时间差异无统计学意义,但是鼻动力切割组出血量明显多于等离子消融组,差异

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

    Directory of Open Access Journals (Sweden)

    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.

  12. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  13. 儿童腺样体切除与分泌性中耳炎术后的复发%Adenoidectomy and postoperative recurrence of secretory otitis media in children

    Institute of Scientific and Technical Information of China (English)

    张志钢; 陈穗俊; 陈斌; 郭焕平; 郑亿庆

    2010-01-01

    Objective To explore the association between adenoidectomy and postoperative recurrence of secretory otitis media in children. Methods A review was conducted for data on 100 pediatric cases of secretory otitis media, registered to Department of Otorhinolarynology-Head and Neck Surgery in our hospital between January 2006 and August 2006. Myringotomy with tube insertion were performed in all cases, including 74 patients who received additional adenoidectomy and the other 26 who did not. All patients were followed up for three months after surgery. Results Seventy-four patients who underwent adenoidectomy were found to have secretory otitis media in 148 ears, with 27 ears experiencing tube dislocation or recurrence at three months after surgery (18.24%). The 26 patients who did not receive adenoidectomy were found to have secretory otitis media in 26 ears, with 17 ears experiencing tube dislocation or recurrence at three months after surgery (65.38%). Of these 17 ears, 8 received a second operation with total resection of the adenoid. None of these had recurrence during next three months of followup. Conclusion Adenoidectomy can reduce the recurrence in children with secretory otitis media.%目的 探讨儿童腺样体切除与分泌性中耳炎术后的复发情况.方法 回顾性分析本院耳鼻咽喉-头颈外科自2006年1月至2006年8月收治的100例分泌性中耳炎患儿.所有患儿都行了鼓膜切开置通气管,其中伴腺样体切除者74例,未行腺样体切除者26例,术后均随访3个月.结果 腺样体切除者74例合并分泌性中耳炎有148耳,术后3个月内脱管和复发有27耳(18.24%).腺样体未切除26例合并分泌性中耳炎26耳,术后3个月内脱管和复发17耳(65.38%).腺样体未切除复发的17耳有8耳(8例患儿)接受2次手术,且腺样体均全部切除,术后随访3个月无1耳复发.结论 切除腺样体可有效控制分泌性中耳炎患儿术后复发.

  14. Clinical value of endoscopic adenoidectomy in the treatment of children with secretory otitis media%经鼻内镜腺样体切除治疗儿童分泌性中耳炎的临床价值

    Institute of Scientific and Technical Information of China (English)

    彭正加

    2011-01-01

    Objective: To explore the impact hearing in children with secretory otitis media treating by endoscopic adenoidectomy. Methods: 180 secretory otitis media patients in our hospital were selected from September 2008 to September 2010, 90 patients treated by endoscopic adenoidectomy were selected as treatment group, the other 90 patients treated by conservative treatment were selected as control group, and their follow-up data of 3 months were retrospectively analyzed.Operative efficacy and complications after operation and changes in hearing threshold at each frequency of the two groups were compared. Results: In the treatment group, 61 cases were significantly effective, 24 cases were effective, the total effective rate was 94.44%; In the control group 52 cases were significantly effective, 22 cases were effective, the total effective rate was 82.22%, the treatment group was better than control group, and there were significant differences between them (P<0.05). Complications incidences of the treatment group (8.89%) were significantly lower than those of control group (36.67%) (P<0.05). After treatment, hearing threshold at each frequency of treatment group were significantly lower than before treatment (P<0.05). Conclusion: Nasal endoscopic adenoidectomy in the treatment of pediatric secretry otitis media has a satisfactory effect, little complication and can significantly improve the quality of children's life. It is worthy of application in clinical%目的:探讨腺样体切除对儿童内分泌性中耳炎听力的影响.方法:选取我院2008年9月~2010年9月收治的180例内分泌性中耳炎患者,采用经鼻内镜腺样体切除术治疗的90例患者为治疗组,采用保守治疗的90例患者为对照组,回顾性分析其3个月的随访资料,比较两组患者的手术疗效、术后并发症以及治疗组各频率听阈变化情况.结果:治疗组患者显效61例,有效24例,总有效率为94.44%;对照组显效52例,有效22

  15. 扁桃体腺样体切除对儿童阻塞性睡眠呼吸暂停低通气综合征术后免疫功能的影响%Tonsillectomy and adenoidectomy in children with obstructive sleep apnea hypopnea syndrome postoperative immune function influence

    Institute of Scientific and Technical Information of China (English)

    陈芳; 李晓艳

    2012-01-01

    儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)是一种在儿童中较为常见的呼吸道阻塞性疾病,常常会影响儿童的智力以及体格发育.对于伴有扁桃体反复发炎以及夜间睡眠呼吸暂停的OSAHS患儿,扁桃体和腺样体切除术是最有效的治疗方法.%Sleep apnea hypopnea syndrome is a common respiratory tract obstructive disease in children, which often affects children's mental and physical development. For repeated tonsil inflammation and nocturnal sleep apnea in children with OSAHS, tonsillectomy and adenoidectomy is the most effective treatment. But children s postoperative immune function remain in dispute, this review focuses on immunologic function change and influence in the OSAHS children after tonsillectomy and adenoidectomy, according to the existing research results can be confirmed. The immune parameters in OSAHS children who had tonsillectomy and adenoidectomy will vary differently after a short period of several, considering these manifestations are the stress response after operation, and its long-term immune parameters can recover to the normal level. Thus, the postoperative immune function of OSAHS with tonsillitis in children after the adenoid and tonsil resection has no negative effects, providing theory basis for clinicians treatment for clinicians to parents of children with answers to questions provide ihe theory basis.

  16. Clinical observation of low-temperature coblation tonsillectomy and/or adenoidectomy in 146 children with obstructive sleep apnea syndrome%低温等离子治疗146例儿童阻塞性睡眠呼吸暂停综合征临床观察

    Institute of Scientific and Technical Information of China (English)

    顾建华; 宋柏龙; 李艳芬

    2012-01-01

    目的 对比传统方法,探讨低温等离子射频扁桃体、腺样体切除术对于治疗儿童阻塞性睡眠呼吸暂停综合征(OSAS)的可行性并观察疗效.方法 回顾性分析2010年3月~2011年7月在我院手术治疗的262例OSAHS患儿的临床资料.其中,实验组146例,应用低温等离子射频行扁桃体切除术、腺样体消融术治疗;对照组116例,采用扁桃体电刀切除术、经鼻内镜下腺样体电动吸切术.随访2~16个月.结果 相对于对照组,采用低温等离子射频治疗的实验组在出血量、手术时间长短、术后疼痛评分和住院时间方面的改善都有统计学意义.结论 对比与传统的手术方法,低温等离子射频治疗儿童OSAS具有微创、安全、有效等优势,是一种较好的儿童OSAS治疗方法.%Objective To investigate the feasibility and therapeutic effect of low-temperature coblation tonsillectomy and/or adenoidectomy for obstructive sleep apnea syndrome (OSAS) in children. Method Retrospective studies were carried out in 262 clinical records of OSAS children who were cured in our department between March 2010 and July 2011. All of these 262 cases were divided into two groups. 146 cases of the experimental group were treated with low-temperature coblation tonsillectomy and/or adenoidectomy; while the other 116 cases of the control group were treated with tonsillectomy and/or adenoidectomy with electrotome. The follow up time of all cases varied from 2 to 16 months. Result Comparing to the control group, the experimental group had statistical advantages in intraoperative bleeding, operation time, postoperative pain and hospitalization time. Conclusion Low-temperature coblation tonsillectomy and/or adenoidectomy was better than the traditional method in curing children's OSAS with much more minimal invasiveness, safety and efficacy.

  17. Comparative study on dynamical system cutterbar via nasal endoscope for adenoidectomy and rout curettage of adenoids%鼻内镜下动力系统切割器行腺样体切除术与常规腺样体刮除术的疗效比较研究

    Institute of Scientific and Technical Information of China (English)

    黄映红; 张建国; 黄敏齐; 严小玲; 翟锦明; 马钊恩

    2009-01-01

    目的 比较鼻内镜下经口动力系统切割器行腺样体切除术与常规腺样体刮除术的疗效.方法 腺样体肥大患儿136例,其中69例接受鼻内镜下动力系统切割器行腺样体切除术,67例接受常规腺样体刮除术,比较两种术式的疗效.结果 常规腺样体刮除术治疗组中有5例存在腺样体残留,有2例存在并发症(出血及咽鼓管咽口损伤),而鼻内镜下动力系统切割器行腺样体切除术无1例腺样体残留及并发症.结论 鼻内镜下动力系统切割器经口腺样体切除术是治疗腺样体肥大的最好手术方式.%Objective The aim of this study was to compare the effectiveness of dynamical system cutterbar via nasal endoscope for adenoidectomy by mouth and rout curet-tage of adenoids. Methods 136 cases with adenoid hypertrophy, 69 cases underwent dynamical system cutterbar via nasal endoscope for adenoidectomy by mouth while 67 cases were performed by rout curettage of adenoids. Then compared the curative effect with two groups. Results 8 cases had adenoid residual ,3 cases had complication(bleeding or the impairment of ostium tubae anditive) in the rout curettage of adenoids group. No adenoid residual or other complication had been noted in dynamical system cutterbar via nasal endoscope for adenoidectomy by mouth group. Conclusion Dynamical system cutterbar via nasal endoscope for adenoidectomy by mouth is the best way to cure adenoid hypertrophy in present time.

  18. 儿童分泌性中耳炎腺样体切除术后听力变化的临床分析%Clinical analysis on hearing changes after adenoidectomy in children with secretary otitis media

    Institute of Scientific and Technical Information of China (English)

    刘强; 佘万东; 戴艳红; 刘收厚; 李佩忠

    2012-01-01

    目的 分析手术切除儿童肥大腺样体后对分泌性中耳炎致听力下降疗效的影响.方法 对本院住院的腺样体肥大并发分泌性中耳炎的30例(49耳)患儿经鼻内镜行腺样体切除术,回顾性分析对患儿听力的治疗效果.结果 在0.25~8kHz的气导阈值,术后与手术前有显著性差异(P<0.05),术后各频率骨导阈值与手术前无显著性差异(t=1.022,P>0.05).结论 对于伴有腺样体肥大的分泌性中耳炎患儿,手术切除其肥大的腺样体可明显改善患儿的听力.%Objective To analyze the effectiveness of surgical removal of hypertrophic adenoids on hearing loss caused by secretory otitis media in children. Method 30 children in hospital with hypertrophic adenoids accompanied with secretary otitis media (49 ears) were perfomed with adenoidectomy via nasal endoscopy, and with retrospective analysis on the treatment effect of children with hearing. Results Air conduction thresholds were significantly imporved In the 0.25 - 8kHz (P0.05 ) . Conclusion In patients with secretory otitis media caused by adenoid hypertrophy, surgical excision of hypertrophic adenoids can significantly improve the children's hearing.

  19. 腺样体切除联合鼓膜置管术治疗儿童分泌性中耳炎临床研究%Adenoidectomy combined treatment of children with tympanic catheter clinical study of secretory otitis media

    Institute of Scientific and Technical Information of China (English)

    刘飞; 史保轩

    2012-01-01

    OBJECTIVE To investigate the adenoidectomy combined grommet insertion of secretory otitis media treatment of children in clinical efficacy. METHODS 68 patients were divided into two groups, 35 children underwent adenoidectomy combined tympanic catheter (study group); 33 children underwent a simple line of grommet insertion technique (control group). We compared the clinical efficacy, recurrence and postoperative infection of the two groups. RESULTS The total effective rate was 91.43%, which was significantly higher than 78.79%. There was significant difference between the two groups (P < 0.05). All patients were followed up for 3 months to 1 year. The recurrence of the observe the group showed in 2 cases, infection in 2 cases. The the relapse rate and infection rates were both 5.71 %; In the control group, recurrence showed in 6 cases, infection in 4 cases, and the recurrence rate and infection rate was 18.18% and 12.12%, respectively. We compared the relapse rate and infection rate of the two groups, and there was significant difference between the two groups (P< 0.05). CONCLUSION Adenoidectomy combined catheter eardrum otitis media with effusion showed a good clinical efficacy, low relapse rate and infection rate, which is an effective method in treatment of secretory otitis media children, has a significant effect on hearing improvement, and is worthy of promotion and application.%目的 探讨腺样体切除联合鼓膜置管术治疗儿童分泌性中耳炎的临床疗效.方法 68例患儿分为两组,35例患儿行腺样体切除联合鼓膜置管术(观察组);33例患儿单纯行鼓膜置管术(对照组).比较两组患儿的临床疗效、复发情况和术后感染情况.结果 观察组总有效率为91.43%,明显高于对照组的78.79%,两组比较差异有统计学意义(P<0.05).所有患者术后随访3个月~1年,观察组复发2例,感染2例,复发率和感染率均为5.71%;对照组复发6例,感染4例,复发率为18.18

  20. Clinical study of post-operative pain following coblation tonsillectomy and/or adenoidectomy in children with sleep-disordered breathing%睡眠呼吸障碍儿童扁桃体和(或)腺样体低温等离子术后疼痛的研究

    Institute of Scientific and Technical Information of China (English)

    黄振云; 刘大波; 钟建文; 刘少锋; 仇书要; 魏玮; 许家健; 邵建波; 钟洁

    2013-01-01

    目的:探讨睡眠呼吸障碍(SDB)儿童扁桃体和(或)腺样体低温等离子术后疼痛的临床特点,并进一步研究术后疼痛水平与年龄及手术持续时间之间的关系.方法:①经多导睡眠监测确诊SDB儿童113例,根据手术方式的不同,所有儿童分为两组:接受扁桃体+腺样体手术的患儿纳入研究组1,单纯进行腺样体消融术的患儿纳入研究组2,根据有无慢性扁桃体炎的病史,研究组1再分为两组:有慢性扁桃体炎病史者为慢扁组,反之为非慢扁组.②患儿术后第1、2、3、7天疼痛水平的评估由患儿家长进行,采用视觉模拟评分进行评估(0~10分,0分为无痛,10分为最痛),在患儿晨起未进食及服止痛药时进行测量.③按以上两种方法进行分组的两组之间术后不同时间点疼痛程度的对比,所有患儿进行术后第1天疼痛水平与年龄及手术持续时间之间的相关性分析.结果:①研究组1与研究组2术后疼痛程度的差异在4个时间点上均有统计学意义(P<0.05).②慢扁组儿童术后第1天、第2天及第7天与非慢扁组疼痛程度的差异有统计学意义(z=-2.004,-2.059,-2.334,P<0.05),但第3天的疼痛差异无显著性(P>0.05).③术后第1天疼痛水平与患儿年龄(r=0.273,P<0.01)及手术持续时间(r=0.423,P<0.01)之间有显著性相关.结论:SDB儿童扁桃体和(或)腺样体等离子手术术后疼痛程度与患儿年龄及手术持续时间有关,伴有慢性扁桃体炎的患儿术后疼痛程度较不伴者更重.%Objective:To explore the characteristics of post-operative pain following coblation tonsillectomy and/or adenoidectomy in children with sleep-disordered breathing(SDB)and explore the correlation between the first day post-operative pain scores and age and operating time.Method:①A total of 113 SDB children scheduled to undergo coblation tonsillectomy and/or adenoidectomy were recruited.113 children were divided into two groups according

  1. Improved temperature-controled radiofrequency-assisted endoscopic tonsilectomy and adenoidectomy in children with obstructive sleep apnea-hypopnea syndrome%改良低温等离子刀头扁桃体切除及鼻内镜直视下腺样体切除治疗儿童阻塞性睡眠呼吸暂停低通气综合征

    Institute of Scientific and Technical Information of China (English)

    李芳; 谢军

    2016-01-01

    目的探讨低温等离子刀切除扁桃体及鼻内镜直视下切除腺样体治疗儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的可行性及临床疗效。方法60例扁桃体肥大伴腺样体肥大的患儿采用改良低温等离子刀头切除扁桃体及鼻内镜直视下切除腺样体。结果改良低温等离子刀头用于鼻内镜直视下腺样体切除术,手术方法简便易行,手术切除干净,术中出血0.5~1 ml,无原发及继发性出血,术后疼痛轻微。随访6个月,48例患儿睡眠打鼾及张口呼吸症状消失,12例在变应性鼻炎发作时张口呼吸但无打鼾,术后无残留,无扁桃体再生及反复炎症发作。结论应用改良低温等离子刀头切除扁桃体及鼻内镜直视下切除腺样体治疗儿童OSAHS术野清晰,切除精确,腺样体残留少,出血少,手术时间短,周围组织无损伤,适用于各年龄段的OSAHS患儿,是一种较好的儿童OSAHS治疗方法。%ObjectiveTo investigate the feasibil-ity and clinical value of improved temperature-controlled radiofrequency-assisted endoscopic tonsillectomy and ade-noidectomy in children with obstructive sleep apnea hypo-pnea syndrome(OSAHS).Methods60 children with hypertrophy of both tonsils and adenoid were treated with improved temperature-controlled radiofrequency-assisted en-doscopic tonsillectomy and adenoidectomy.ResultsAd-enoids were removed completely,intraoperative bleeding volumes were about 0.5~1 ml,and there were no primary and delayed hemorrhage happened and no postoperative pain. All of 60 children had been followed-up for 6 months. Among them,48 children had no symptoms of snoring and mouth breathing,12 children had no tonsil regeneration and repeated inflammatory episode.ConclusionThe operation with improved temperature-controlled radiofre-quency-assisted endoscopic tonsillectomy and adenoidec-tomy in children with OSAHS had advantages of direct and clear view of surgical

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

    OpenAIRE

    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...

  3. Hemorrhage following coblation-assisted tonsillectomy and adenoidectomy in children%儿童扁桃体、腺样体低温等离子切除术后出血的临床研究

    Institute of Scientific and Technical Information of China (English)

    侯瑾; 王波涛; 闫静; 任晓勇; 康全清; 许珉

    2013-01-01

    目的 探讨应用低温等离子手术或者传统手术方式行儿童扁桃体、腺样体切除术在术后出血方面存在的差异.方法 回顾性分析1 597例接受手术治疗的儿童慢性扁桃体炎、腺样体肥大的患者资料,行等离子射频辅助的扁桃体和(或)腺样体切除术者793例(等离子组),行传统扁桃体切除和(或)腺样体者804例(传统组).比较两组原发性及继发性出血的发生率、出血程度和出血部位的差异.结果 等离子组发生术后出血25例(3.2%),传统组出血19例(2.4%),两组间差异无统计学意义(x2=3.34,P>0.05);其中等离子组原发性出血9例(1.1%),继发性出血16例(2.0%);传统组原发性出血11例(1.4%),继发性出血8例(1.0%),两者比较差异有统计学意义(x2 =9.45,P<0.01).两组术后的出血部位经卡方检验,出血程度经Wilcoxon秩和检验,P值均>0.05,差异均无统计学意义.结论 低温等离子辅助行儿童扁桃体、腺样体切除术,在术后出血的发生率、程度、部位三个方面相对于传统的手术方法治疗,二者差异无统计学意义.

  4. Submucous cleft palate and the general practitioner

    Science.gov (United States)

    Lowry, R. B.; Courtemanche, A. D.; MacDonald, C.

    1973-01-01

    Submucous cleft palate refers to a situation where the soft palate is largely composed of mucosa with little or no muscle. The defect is often not obvious on inspection of the mouth and pharynx. There is considerable clinical variation, with speech ranging from normal or minimal nasality to severe nasality and defective articulation. Many patients who have latent submucous cleft palate have the condition unmasked by an adenoidectomy because the adenoid pad had served as a compensatory factor in effecting palatopharyngeal closure. All physicians who perform tonsillectomy and adenoidectomy should be aware of the signs and symptoms which may suggest the diagnosis. ImagesFIG. 2 PMID:4758872

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

    NARCIS (Netherlands)

    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

  6. [Adenotonsillectomy in children only under exceptional circumstances

    NARCIS (Netherlands)

    Bosch, W.J.H.M. van den; Lisdonk, E.H. van de

    2005-01-01

    More and more evidence is becoming available that throws doubt on the value of adenotonsillectomy in children with frequent throat infections or hypertrophic tonsils and adenoids. Tonsillectomy and adenoidectomy have a limited range of indications. Objective symptoms such as the size of the tonsils

  7. Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis

    NARCIS (Netherlands)

    Burton, M.J.; Glasziou, P.P.; Chong, L.Y.; Venekamp, R.P.

    2014-01-01

    Background Surgical removal of the tonsils, with or without adenoidectomy (adeno-/tonsillectomy), is a common ENT operation, but th e indicationsfor surgery are controversial. This is an update of a Cochrane re view first published in The Cochrane Library in Issue 3, 1999 andpreviously updated in 200

  8. Coblation: improving outcomes for children following adenotonsillectomy.

    Science.gov (United States)

    Benninger, Michael; Walner, David

    2007-01-01

    Tonsillectomy and adenoidectomy, 2 of the most common childhood surgeries, are performed for a number of indications, the most common being airway obstruction caused by adenotonsillar hypertrophy. Other indications for tonsillectomy include recurrent pharyngotonsillitis, streptococcal carriage, recurrent peritonsillar abscess, halitosis, and presumed neoplasia. Although adenotonsillar surgery is a safe and effective technique for treating disease and obstruction, parents remain concerned about postoperative morbidity, for which the potential is much greater after tonsillectomy than adenoidectomy. Postoperative pain and hemorrhage are 2 unpleasant side effects that can prolong postoperative recovery. Surgeons use a variety of surgical techniques to remove the tonsils and adenoids. When compared with older techniques, such as cold steel dissection and monopolar electrocautery, a new technique named Coblation that uses lower temperatures than electrocautery to remove tonsil tissue and achieve hemostasis, has been shown to reduce pain and decrease postoperative narcotic use, leading to shorter recovery times and a quicker return to normal in children.

  9. Relationship of opioid analgesic protocols to assessed pain and length of stay in the pediatric postanesthesia unit following tonsillectomy.

    Science.gov (United States)

    Smith, Jana; Newcomb, Patricia; Sundberg, Erin; Shaffer, Paul

    2009-04-01

    After tonsillectomy and adenoidectomy in children, postoperative pain management is an essential, yet often challenging, task. In addition to discomfort, lack of pain management can lead to delays in oral intake of patients, resulting in extended stays and increased costs. At one North Texas pediatric facility, postoperative coblation tonsillectomy and adenoidectomy pain management orders include the as-needed use of both intravenous fentanyl and intravenous morphine. Both drugs are effective and both have potential side effects that might prolong the recovery period. Nurses in the postanesthesia care unit retrospectively compared a fentanyl and morphine regimen with a morphine-only regimen to determine whether either protocol made a difference in length-of-stay or pain relief. Analysis of available data revealed no statistically significant differences in length of stay between the groups and trivial differences thought to be clinically irrelevant on other variables.

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

    OpenAIRE

    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...

  11. 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

    OpenAIRE

    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...

  12. [Nasal obstruction and mouth breathing: the ENT's point of view].

    Science.gov (United States)

    Leboulanger, Nicolas

    2013-06-01

    Obstructive diseases of children's upper airways are frequent, mostly caused by tonsils and adenoids hypertrophy. A nasal septum deviation or a lower turbinate hypertrophy may also cause a significant obstruction. Tonsillectomy and adenoidectomy must be performed in case of clinical obstruction, sometimes documented by a sleep study. A tonsils' hypertrophy without significant obstruction and clinical symptoms is not an indication of adenotonsillectomy, even in case of snoring or if an orthodontic treatment is planned.

  13. [Giant tonsillolith in a child].

    Science.gov (United States)

    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

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

    OpenAIRE

    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...

  15. Helicobacterpylori in middle ear of children with otitis media with effusion

    Institute of Scientific and Technical Information of China (English)

    PARK Chul-won; CHUNG Jae-ho; MIN Hyun-jung; KIM Kyung-rae; TAE Kyung; CHO Seok-hyun; LEE Seung-hwan

    2011-01-01

    Background Otitis media with effusion (OME) is a common pediatric disease,but its pathogenesis remains uncertain.The relationship between OME and Helicobacter pylori (HP) is currently being studied,and a relationship has not yet been confirmed.The purpose of this study was to show that a relationship does exist between HP and OME.Methods The study consisted of 60 patients who were diagnosed with OME and had ventilation tube insertions with or without an adenoidectomy.This study included an additional 30 patients who had only received an adenoidectomy without being diagnosed with OME.The effusion samples were analyzed with polymerase chain reaction (PCR) and the campylobacter-like organism (CLO) test.The adenoid tissue samples were analyzed with the CLO test.Results Eighteen patients among the 60 patients (30%) tested positive for HP.In the cases with adenoids,15.6% of the OME patients and 13.3% of the adenoidectomy only patients were positive for HP.There were no differences between the prevalence of HP in the adenoids of OME patients and the patients without OME.Conclusion HP can be considered one of the causes of OME.

  16. 儿童睡眠呼吸暂停综合症诊治体会%Clinical Experience in Treatment of Children with Sleep Apnea Syndrome

    Institute of Scientific and Technical Information of China (English)

    李彩霞; 张彩兰; 李长文

    2014-01-01

    Objective To explorethe ef ective of the dif erent trentment method to sleep apnea syndrome in children.Methods Take adenoidectomy tonsil excision combined resection and conservative treatment, and compare the efficacy of treatment,according to different causes.Results Take surgical treatment effect is superior to conservative treatment,by the statistical test ( <0.05),With adenoidectomy surgical treatment ef ect is better than that of tonsil ectomy and adenoidectomy tonsil combined resection surgery,by the statistical test ( <0.05).Conclusion Treating children sleep breathing suspending syndrome, Surgical treatment effect is superior to conservative treatment.%目的探讨儿童睡眠呼吸暂停综合症不同治疗方法的效果。方法针对不同病因,采取腺样体切除、扁桃体切除、联合切除及保守治疗,对比不同治疗效果。结果采取手术治疗效果明显优于保守治疗,经统计学检验(<0.05),其中腺样体切除手术治疗效果优于扁桃体切除及腺样体、扁桃体联合切除手术,经统计学检验(<0.05),有显著差别。结论治疗儿童呼吸睡眠暂停综合症,手术治疗效果明显优于保守治疗。

  17. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  18. 腺样体肥大手术切除与分泌性中耳炎

    Institute of Scientific and Technical Information of China (English)

    鞠宏霜; 巩玲

    2012-01-01

    Objective To evaluate the relationships between the adenoidectomy and secretory otitis media in children. Methods A total of 328 children who underwent the surgical treatment of adenoidal hypertrophy were enrolled for retrospective analysis. The functional diagrams of tympanum were evaluated for secretory otitis media before and after adenoidectomy. Results The majority cases who suffered from secretory otitis media had be treated effectively, with 177ears being cured, 37 ears being improved, recurrence or no significant improvement in 15 ears and among them, 12 cases had recurred chronic otitis media more than 2 years. Conclusion Recovery of secretory otitis media in children is closely related with the severity and duration of adenoidal hypertrophy. Adenoidectomy is effective to the recovery of eustachian tube function.%目的探讨手术治疗儿童腺样体肥大对分泌性中耳炎的影响。方法回顾分析手术治疗的腺样体肥大患儿328例,其中并发分泌性中耳炎156例229耳,观察手术治疗前后鼓室功能图的变化。结果疗,其中治愈177耳;好转37耳;复发或无明显改善15耳,慢性中耳炎反复发作12耳,持续病程超过2年。结论分泌性中耳炎的转归与腺样体肥大的程度及临床病程的持续时间有关,腺样体切除术有利于咽鼓管功能的恢复。

  19. Are Histologic Studies of Adenotonsillectomy Really Necessary?

    Directory of Open Access Journals (Sweden)

    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.

  20. Clinico-audio-radiological and operative evaluation of otitis media with effusion

    Directory of Open Access Journals (Sweden)

    Karan Sharma

    2015-01-01

    Full Text Available Aims: Otitis media with effusion (OME is a common cause of hearing and speech impairment in children. The correlation of the clinical, audiological, radiological, and intraoperative findings was carried out so as to make a protocol for early diagnosis and management of OME. It will help prevent the more serious sequelae of OME such as tympanosclerosis, chronic adhesive otitis media, and even chronic suppurative otitis media. Methods: 300 clinically diagnosed patients of OME were studied prospectively. Thereafter, patients underwent impedance audiometry, pure tone audiometry, and X-ray soft tissue nasopharynx for adenoids. The patients were given adequate medical treatment for 3 to 6 months, and the patients who did not respond to the treatment were subjected to adenoidectomy with ear examination under magnification and myringotomy with or without grommet insertion. Results: The mean age at presentation was 5.96 years. Only 32% patients gave a history of hearing loss. About 90% patients had mouth breathing, followed by snoring (84%. About 79% ears had abnormal tympanic membrane appearance and mobility; 65.5% had an abnormality on impedance audiometry; and 69.75% had an air condition threshold level of >20 dB. About 78% patients had either Grade III or Grade IV Adenoid hypertrophy. Adenoidectomy was done in all 300 patients with myringotomy in 472 ears. Grommets were inserted in 365 ears. There was a significant reduction in mean air conduction threshold with an improvement of 8.0 dB and 7.5 dB in right and left ears, respectively at 2 months postoperatively. At 6 th month postoperative, the average improvement from baseline dropped to 6.0 dB in right ear and 5.5 dB in the left ear. Conclusion: OME is the most frequent causes of silent hearing impairment in young children which needs a close vigil. All suspected children (on clinical and otoscopic findings must be subjected to impedance audiometry and X-ray soft tissue nasopharynx for adenoids

  1. 儿童腺样体肥大3种切除方式疗效分析%Retrospective Analysis on Three operative method for Curettage of Adenoids in Children

    Institute of Scientific and Technical Information of China (English)

    杜英; 孔巧; 郭筠芳

    2009-01-01

    目的:比较传统经口腔腺样体刮除术、鼻内镜下经鼻腔腺样体切除术及鼻内镜下经口鼻腔双径路腺样体切除术的疗效.方法:回顾性分析202例接受腺样体肥大手术患儿的临床资料,比较3种术式术后患儿夜间打鼾、鼻塞、鼻漏及听力等症状的恢复和腺样体残留等情况.结果:传统经口腔腺样体刮除术后6例患儿存在腺样体残留,其他2种术式术后无腺样体残留.鼻内镜下经口鼻腔双径路腺样体切除术后患儿打鼾、鼻塞症状改善明显.结论:腺样体肥大的理想手术方法为鼻内镜下经口鼻腔双径路腺样体切除术.%Objective:To compare the three different approaches in the curettage of adenoid hypertrophy, the traditional curettage of adenoids through mouth (group A), the adenoidectomy through nose under nasal endoscope (group B) ,the adenoidectomy through both mouth and nose under nasal endoscope (group C). Method:Clinical data of adenoid hypertrophy patients who had accepted the surgery therapy, were retrospectively analyzed;Symptoms of night snore, nasal obstruction, rhinorrhea, acouesthesia and the adenoid residue among the patients who had got three different surgerys.were compared among them. Result: Adenoid residue were found in six cases of group A. No adenoid residue were found in group B and C . Recovery of nasal obstruction and night snore in group C were much better than that in group A and B(P<0. 01,<0. 05). Conclusion:The ideal way to cure adenoidal hypertrophy is the adenoidectomy done through mouth and nose under nasal endoscope.

  2. Demystifying Septoplasty in Children

    Science.gov (United States)

    Martins, Mariane Barreto Brandão; Lima, Rosa Grazielle de; Lima, Francis Vinícius Fontes de; Barreto, Valéria Maria Prado; Santos, Arlete Cristina Granizo; Júnior, Ronaldo Carvalho Santos

    2013-01-01

    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. PMID:25992064

  3. Clinical observation on the therapeneic effect of Radiofraquency ablation on children OSAS 190 cases%等离子消融术治疗儿童OSAS190例临床观察

    Institute of Scientific and Technical Information of China (English)

    姚昆; 胡伟

    2012-01-01

    目的 探讨儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)行内镜下低温等离子切除扁桃体及腺样体后效果欠佳的原因、术后出血的原因及改进的方法.方法 回顾性分析2007年6月-2011-6月年为190例实行内镜下低温等离子切除扁桃体及腺样体治疗儿童阻塞性睡眠呼吸暂停低通气综合征的临床资料.结果 疗效评定:治愈152例(80%),显效27例(14.21%),有效9例(4.74%),无效2例,总有效率98.94%.显效及有效的36例中有15例为合并慢性鼻-鼻窦炎患者,有望通过鼻部治疗而治愈;6例出现咽腔出血,其中1例是腺样体出血,5例是扁桃体窝出血.结论 低温等离子切除扁桃体及腺样体治疗儿童阻塞性睡眠呼吸暂停综合征效果肯定,术后疗效欠佳的原因是单一切除扁桃体或者腺样体、手术适应症未选择好,鼻部疾患未治愈,术后出血是创面未彻底止血,可以通过腺样体创面彻底止血、缝合扁桃体窝而避免.%Objective To discuss the reasons for the ineffectiveness of children with obstructive sleep apnea syndrome (OSAS) and for postoperative bleeding by endoscopic coblative tonsillectomy and adenoidectomy. Methods We retrospectively reviewed the clinical data of 190 children with OSAS who were treated by endoscpic coblative tonsillectomy and adenoidectomy. Results 152 cases were totally cured (80%), and 27 cases presented remarkably response (14.21%), and 9 cases showed effective (4.74%). The total effective rate were 98.94%, while there were still 2 cases turned to be ineffective. 15 cases were combined with chronic rhinosinusitis among the 36 cases who presented remarkably response and effective. A totally cure could be expected after hopefully totally cured by nasal treatment 6 cases of postoperative bleeding were recognized, including I case of adenoid bleeding and 5 cases of tonsil nest bleeding. Conclusion It was effective to treat children with OSAS by endoscopic

  4. Demystifying Septoplasty in Children

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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

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

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    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.

  7. 儿童腺样体肥大的术式探讨%Comparison of three surgical techniques in the treatment of pediatric adenoid hypertrophy

    Institute of Scientific and Technical Information of China (English)

    李琰; 孙昌志; 周丽枫; 曾清香

    2016-01-01

    目的:比较间接鼻咽镜下低温等离子射频消融术、鼻内镜辅助经口低温等离子消融术及鼻内镜经口电动吸引切割术治疗儿童腺样体肥大的临床疗效。方法选择行腺样体切除术180例患儿,随机分为 A、B、C 共3组,每组60例患儿。A 组采用间接鼻咽镜下低温等离子射频消融术、B 组采用鼻内镜辅助经口低温等离子消融术、C 组采用鼻内镜经口电动吸引切割术。比较3组术前准备时间、手术时间、术中出血量、术后疼痛时间及并发症等情况。结果 A 组术前准备时间最短,与其他2组比较差异均有统计学意义(P 均<0.01);A、B 组手术时间均短于 C 组(P 均<0.01)、术中出血量亦少于 C 组(P 均<0.01);3组术后疼痛比较差异无统计学意义(P >0.05)。结论与鼻内镜辅助经口低温等离子消融术及鼻内镜经口电动吸引切割术比较,间接鼻咽镜下低温等离子消融术治疗儿童腺样体肥大,具有术前准备简单、手术时间短、出血量少、不增加术后疼痛等优点。%Objective To compare the clinical efficacy among indirect nasopharyngoscope-guided ra-diofrequency coblation,transoral endoscopy-guided radiofrequency coblation and transoral power-assisted endo-scopic adenoidectomy in treating the pediatric adenoid hypertrophy.Methods A total of 1 80 children diag-nosed with adenoidal hypertrophy were enrolled and divided into groups A,B and C (n =60 for each group). In group A,patients underwent indirect nasopharyngoscope-guided radiofrequency coblation,transoral endosco-py-guided radiofrequency coblation in group B and transoral power-assisted endoscopic adenoidectomy in group C.Preoperative preparation time,operation time,intraoperative hemorrhage volume,postoperative pain dura-tion and postoperative complications were statistically compared among three groups.Results Preoperative preparation time in group A was

  8. 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

    Institute of Scientific and Technical Information of China (English)

    邹新博; 梅栩彬; 赵立民; 邹慧中; 陈正岗; 刘文君

    2015-01-01

    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.%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。

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

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    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

  10. Role of adenoid biofilm in chronic otitis media with effusion in children.

    Science.gov (United States)

    Saafan, Magdy Eisa; Ibrahim, Wesam Salah; Tomoum, Mohamed Osama

    2013-09-01

    To study the extent of surface adenoid biofilm and to evaluate its role in the pathogenesis of chronic otitis media with effusion (COME) in children. The study was carried out on 100 children between 3 and 14 years of age, who were divided into two groups. The first group (50 children) had otitis media with effusion associated with adenoid hypertrophy, whereas the second group (50 children) had adenoid hypertrophy without middle ear effusion. Adenoidectomy with ventilation tube insertion was done for group 1 cases, whereas, only Adenoidectomy was done for group 2 cases. Microbiological study, Scanning electron microscope and multiplex- PCR were done for suspected adenoid biofilms and specimens from middle ear effusion. Adenoids removed from children with COME had higher grade biofilm formation (74 %) than the second group (42 %). No correlation was found between adenoid size and biofilm formation. Culture of adenoid tissue in group 1 patients was positive in 52 % of cases compared to 96 % by PCR, while in group 2 culture of adenoid tissue was positive in 38 % compared to 48 % by PCR. Culture of middle ear fluid was positive in 32 % of cases only compared to 80 % by PCR. A positive correlation was found between results of bacterial biofilm visualized by SEM and bacteria detected and identified by PCR technique. On the other hand, no correlation was found between results of bacterial biofilm visualized by SEM and bacteria detected by culture. The size of the adenoid is not the main determinant factor in OME pathogenesis but the degree of bacterial colonization is much more important. Adenoids in COME may act as a reservoir of chronic infection rather than causing mechanical Eustachian obstruction. Higher grade biofilm formation was found in cases with middle ear effusion than those with adenoid hypertrophy only. These findings support the hypothesis that there would be an association between adenoidal biofilm formation and COME. This study focused on the value of PCR

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

    Institute of Scientific and Technical Information of China (English)

    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.

  12. 阻塞性睡眠呼吸暂停低通气综合征患儿手术前后听力及中耳功能变化的临床探讨

    Institute of Scientific and Technical Information of China (English)

    杨森; 黄红星; 余文兴; 杨立; 税磊

    2013-01-01

    目的:探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apneahypopnea syndrome OSAHS)患儿术前、术后听力及中耳功能的变化。方法选择病因是扁桃体及腺样体肥大的OSAHS患儿48例,术前做纯音测听、声导抗检查,了解患儿听力状态。全麻下切除双侧扁桃体,同期在鼻内镜下用切吸器切除腺样体;术后抗生素预防感染、静脉激素抗炎、雾化吸入等治疗,术后门诊随访。结果所有患者随访6-12月,复查听力学检查,听力下降患儿39例听力及中耳功能明显改善。结论对OSAHS患儿应常规行术前、术后听力学检查、并作对比,分析扁桃体及腺样体切除术前后患儿的中耳功能及听力改善情况,取得患儿家属的认可,具有良好的社会效益。%Objective To study the change of the heannig in children with obstructive sleep apnea hypopnea syndrome at before and after the surgery of tonsillecto-my and adenoidectomy.Methods A total of 48 children with OSAHS because of the hypertrophy of adenoid and tonsil were included in this study .Pure tone audiometry and acoustic immittance measurement were taken before and after operation to understanding of children with hearing status .Under the general anesthesia,first resection of bilateral amygdala,and then cut the adenoid under nasal endoscope.Postoperative antibiotics to prevent infection,intravenous steroid anti-inflammatory and inhalation therapy,etc.Outpatient follow-up review audiological examination 6 to 12 months,39 cases of hearing and middle ear function improved significantly .Results Children with OSAHS should be routine audiological examination ,to analysing the hearing and middle ear function who with hearing loss in children with OSAHS before and after the tonsillectomy and adenoidectomy,has made with family recognition and favorable social benefit.

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

    Directory of Open Access Journals (Sweden)

    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

  14. 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

    Institute of Scientific and Technical Information of China (English)

    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.

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

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    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.

  16. Impact of passive smoke and/or atopy on adenoid immunoglobulin production in children.

    Science.gov (United States)

    Tagliacarne, Sara Carlotta; Valsecchi, Chiara; Castellazzi, Anna Maria; Licari, Amelia; Klersy, Catherine; Montagna, Lorenza; Castagnoli, Riccardo; Benazzo, Marco; Ciprandi, Giorgio; Marseglia, Gian Luigi

    2015-06-01

    The adenoids are exposed to a wide number and variety of microbes, environmental pollutants, and food antigens. Atopy and passive smoke may significantly affect immune responses, mainly in children. The aim of the present study was to investigate whether passive exposure to tobacco smoke and/or atopy could affect immunoglobulin production by adenoidal lymphocytes in a cohort of children presenting with adenoid hypertrophy. A total of 277 children (151 males and 126 females; median age 5.5 years), with adenoidal hypertrophy requiring adenoidectomy and or adeno-tonsillectomy, were consecutively enrolled in the study. Adenoid mononuclear cells were in vitro stimulated with LPS or CpG. When considering both the presence of smoke exposure and atopy, we observed that the CpG-induced decrease in IgA and IgM production was significantly associated with this combination of risk factors. In the T-independent immunoglobulin production assay we found a positive association between the two risk factors and IgA and IgM production. In particular, the presence of both risk factors, showed a significant increase in IgA and IgM production after stimulation. In conclusion, this is the first study that investigated the in vitro adenoidal B cell response after different stimuli in children, also evaluating possible exposure to passive smoke and/or an atopic condition.

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

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    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.

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

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    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.

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

    Science.gov (United States)

    Oulis, C J; Vadiakas, G P; Ekonomides, J; Dratsa, J

    1994-01-01

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

  20. Atypical streptococcal infection of gingiva associated with chronic mouth breathing.

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    Haytac, M Cenk; Oz, I Attila

    2007-01-01

    Streptococcal infections of oral tissues are mainly seen in young children who experience a variety of upper respiratory tract infections. The disease is characterized by fever, lymphadenopathy, and ulcers on the gingiva, lips, and tonsils. This case report presents an atypical streptococcal infection of the gingiva in an 18-year-old man. The patient was referred to the periodontology department complaining of a 2-month history of gingival enlargement. He had persistent fever (39.5 degrees C) and general malaise for 2 weeks. Intraoral examination revealed extremely inflamed and enlarged gingiva with spontaneous bleeding and suppuration. Based on the otolaryngologic consultation and the hematologic, immunologic, and microbiologic tests, the final diagnosis was an atypical streptococcal gingivitis with chronic adenoid-related mouth breathing and oral hygiene neglect as contributing factors. Treatment consisted of a broad-spectrum antibiotic regimen, supragingival and subgingival debridement, adenoidectomy, and scaling and root planing. A good response to nonsurgical therapy was achieved despite poor patient compliance, and no recurrence of gingival enlargement was observed after 1 year. Streptococcal gingivitis should be included in the differential diagnosis of suppurative gingival enlargements. Furthermore, chronic mouth breathing may initiate and/or contribute to this disease.

  1. Acetaminophen injection: a review of clinical information.

    Science.gov (United States)

    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

  2. Perioperative tranexamic acid in day-case paediatric tonsillectomy

    Science.gov (United States)

    Thorning, G

    2014-01-01

    Introduction Tranexamic acid has been used for many years to minimise blood loss during surgery and, more recently, to reduce morbidity after major trauma. While small studies have confirmed reduction in blood loss during tonsillectomy with its use, the rate of primary haemorrhage following tonsillectomy has not been reported. In the UK, less than 50% of children having a tonsillectomy are managed as day cases, partly because of concerns about bleeding during the initial 24 hours following surgery. Methods A retrospective review of clinical records between January 2007 and January 2013 produced 476 children between the ages of 3 and 16 years who underwent Coblation™ tonsillectomy, with or without adenoidectomy and/or insertion of ventilation tubes. All children were ASA (American Society of Anesthesiologists) grade 1 or 2 and anaesthetised using a standard day surgery protocol. Following induction of anaesthesia, all received intravenous tranexamic acid at a dose of 10–15mg/kg. Results Two children (0.4%) had minor bleeding within two hours of surgery. Both returned to theatre for haemostasis and were discharged home later the same day with no further complications. The expected rate for primary haemorrhage in the UK using this technique for tonsillectomy is 1%. Conclusions Perioperative tranexamic acid in a single, parenteral dose might reduce the incidence of primary haemorrhage following paediatric tonsillectomy, facilitating discharge on the day of surgery. The results from this observational study indicate a potential benefit and need for a large, prospective, multicentre, randomised controlled trial. PMID:24780670

  3. 等离子手术治疗儿童鼾症的围手术期护理%Perioperative nursing of pediatric snoring patients with radiofrequency coblation

    Institute of Scientific and Technical Information of China (English)

    夏震

    2011-01-01

    目的 探讨低温等离子治疗儿童鼾症的术前及术后的护理.方法 对收治的51例鼾症患儿,均在全麻下根据情况行低温等离子扁桃体摘除术、鼻内镜下腺样体摘除术、耳内镜下鼓膜切开置管术.结果51例均痊愈出院,未发生并发症.结论等离子手术是一种损伤小,出血少,不良反应小的手术方法,而良好的围手术期护理是手术成功的保证.%Objective To investigate preoperative and postoperative nursing of pediatric snoring patients with radiofrequency coblation. Methods Fifty - one patients with OSHAS were subjected to the operation of radiofrequency coblation tonsillectomy, endoscopic adenoidectomy, oto-scopic myringotomy with grommet insertion under the condition of general anesthesia. Results All fifty-one patients were free of complications. Conclusion Radiofrequency coblation is minimally invasive and bloodless. It has fewer side effects. Good perioperative nursing plays an important role in a successful operation.

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

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    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.

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

    Science.gov (United States)

    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

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

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    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.

  7. Microbiological Profile of Adenoid Hypertrophy Correlates to Clinical Diagnosis in Children

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    Anita Szalmás

    2013-01-01

    Full Text Available Objective. Adenoid hypertrophy is a common condition in childhood, which may be associated with recurring acute otitis media (RAOM, otitis media with effusion (OME, and obstructive sleep apnea syndrome (OSAS. These different clinical characteristics have some clinical overlap; however, they might be explained by distinct immunologic and infectious profiles and result in various histopathologic findings of adenoid specimens. Methods. A total of 59 children with adenoid hypertrophy undergoing adenoidectomy were studied. Three series of identical adenoid specimens were processed to hematoxylin-eosin (H.E. and Gram staining and to respiratory virus specific real-time PCR, respectively. Results. According to the clinical characteristics, patients were recruited into three groups: RAOM (. Bacterial biofilms were detected in 21 cases, while at least one of the studied respiratory viruses was detected in 52 specimens. RAOM cases were significantly associated with biofilm existence (. In contrast, OME group was characterized by the absence of bacterial biofilm and by normal mucosa. Showing a statistically significant correlation, all OME cases were positive for human bocavirus (HBoV, . Conclusions. Bacterial biofilms might contribute to the damage of respiratory epithelium and recurring acute infections resulting in RAOM. In OME cases persisting respiratory viruses, mainly HBoV, can cause subsequent lymphoid hyperplasia leading to ventilation disorders and impaired immunoreactivity of the middle ear cleft.

  8. Clinical implications of antibiotic resistance for management of acute otitis media.

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    Klein, J O

    1998-11-01

    Antibiotic resistance to available antimicrobial agents has been constant since the introduction of the sulfonamides in the 1930s. Multidrug-resistant Streptococcus pneumoniae and beta-lactamase-producing Haemophilus influenzae are a concern now because of the importance of these pathogens in infections of the respiratory tract in infants and children. Amoxicillin remains the drug of choice for initial episodes of acute otitis media (AOM) although increase of the dosage schedule to 80 mg/kg/day has been recommended by some investigators. There are 15 additional antimicrobial agents approved by the Food and Drug Administration for the indication of AOM. All approved drugs are clinically effective but some have been suggested to have priority for patients who fail amoxicillin: amoxicillin-clavulanate; an oral cephalosporin such as cefuroxime axetil; and intramuscular ceftriaxone. Management of the child with severe and recurrent disease should include antibiotic prophylaxis but the increased incidence of resistance requires selective use. Prevention of infection may be achieved by innovative techniques for interference with attachment of bacteria to the nasal mucosa such as administration of oligosaccharides in a nasal spray. The currently available polysaccharide pneumococcal vaccines have limited immunogenicity in infants, but the vaccine is useful in children 2 years of age and older who still have recurrent AOM. Children with frequent AOM during the prior respiratory season are candidates also for influenza virus vaccine. If medical management fails to prevent new episodes of AOM in children with severe and recurrent disease, placement of tympanostomy tubes and possible adenoidectomy should be considered.

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

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    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.

  10. 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

    Institute of Scientific and Technical Information of China (English)

    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

  11. 不同方法治疗儿童不同程度分泌性中耳炎的疗效观察%Observation Effect of Different Treatments on Different Degree of Secretory Media Otitis in Children

    Institute of Scientific and Technical Information of China (English)

    刘巧花

    2014-01-01

    目的:分析采用不同方法治疗儿童不同程度分泌性中耳炎的临床疗效,为临床治疗儿童不同程度的分泌性中耳炎提供参考依据。方法不伴腺样体肥大儿童患者20例为A组,伴腺样体肥大且单纯声导抗测试异常40例为B组,伴腺样体肥大且声导抗测试异常且伴有听力损失患儿20例为C组。 A组患儿采用鼓膜置管术治疗,B组采用腺样体切除术治疗,C组患儿采用腺样体切除术和鼓膜置管术联合治疗。术后3个月内所有患者服用抗生素预防感染,6个月后观察治疗效果。结果3组患儿经手术后症状均好转,与术前比较各频率气导听阈明显下降( P<0.05);C组患儿术后并发症高于A、B两组。结论采用不同方法治疗儿童不同程度的分泌性中耳炎有助于提高治疗效果,医生要注意使用不同手术方法,减少术后并发症。%Objective To analyze the clinical curative effect of using different methods in treatment of different degrees of secretory media otitis in children , to provide the reference for the clinical treatment of different degrees of secretory media otitis in children .Methods 20 children without adenoidal hypertrophy were in group A , 40 patients with adenoid hypertrophy and simple acoustic immittancetest ab-normal were in group B , 20 children of adenoid hypertrophy and acoustic immittance testabnormalities with hearing loss were in the C group ;group A were treated with grommet insertiontherapy , group B with adenoidectomy treatment , group C with grommet insertiontherapy , com-bined with adenoidectomy .All patients were treated with antibiotics after operation in 3 months with observation of the therapeutic effect af-ter 6 months.Results 3 patients were relieved after operation , and the frequency of gas comparison of preoperative conduction threshold significantly decreased (P<0.05);complications in patients in group C were higher than A and B two groups

  12. 小儿慢性鼻-鼻窦炎的细菌培养及药物敏感观察%Bacterial culture and drug susceptibility observation of children with chronic rhinosinusitis in Chongqing city

    Institute of Scientific and Technical Information of China (English)

    汪武; 姚红兵

    2014-01-01

    Objective To investigate the distribution of pathogenic bacteria in children with chronic rhinosinusitis (CRS) and their susceptibility to commonly used antibacterial drugs .Methods 95 cases of CRS complicating adenoidal hypertrophy were per-formed adenoidectomy .The secretion of maxillary sinus ostium and posterior ethmoid sinus ostium was collected during endoscopic adenoidectomy by the disinfected cotton swab for conducting the bacterial culture and the drug sensitivity test .Results 89 speci-mens showed the bacterial growth ,the positive rate of bacterial culture in all culture specimens was 93 .7% ,86 strains of aerobic bacteria ,28 strains of anaerobic bacteria .Among 95 patients ,81 cases of aerobic infection ,52 cases of anaerobic infection ,44 cases of mixed infection .The drugs susceptibility test in vitro displayed that amoxicillin and clavulanate potassium had the higher antibacte-rial activity to aerobic bacteria and metronidazole had the higher antibacterial activity to anaerobic bacteria .Conclusion Children CRS is dominated by the aerobic bacterial infection .The bacterial infection plays a larger role in children CRS .Antibacterial drugs have better effect for treating CRS .%目的:研究小儿慢性鼻-鼻窦炎的病原微生物分布及其药物敏感试验情况。方法95例慢性鼻-鼻窦炎伴腺样体肥大的小儿行腺样体切除术,术中在鼻窦内窥镜下用消毒棉拭子取上颌窦口和后组筛窦口的分泌物,分别进行细菌的培养及药物敏感实验。结果89份标本有细菌生长,所有标本中细菌培养阳性率为93.7%,其中需氧菌86株,厌氧菌28株。95例患儿需氧菌感染81例,厌氧菌感染52例,混合感染44例。药物敏感试验显示,对需氧菌抗菌活性较高的是阿莫西林克拉维酸;对厌氧菌抗菌活性较高的是甲硝唑。结论儿童慢性鼻-鼻窦炎以需氧菌感染为主,细菌感染在儿童慢性鼻窦炎中的作用较大,对于儿

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

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    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

  14. Relationship between Nasopharyngeal Lateral Film and Adenoid Hypertrophy%鼻咽部X线侧位片A/N值与儿童腺样体肥大的关系

    Institute of Scientific and Technical Information of China (English)

    杨景泓

    2014-01-01

    目的:分析鼻咽部X线侧位片A/N值与儿童腺样体肥大的关系,探讨其在儿童腺样体肥大诊断中的应用价值。方法:回顾性分析105例怀疑腺样体肥大儿童的鼻咽部侧位片等临床资料,测量腺样体厚度、鼻咽腔宽度及后气道宽度(PAS),并计算腺样体指数,分析A/N值与儿童腺样体肥大的关系。结果:A/N≤0.6者20例,0.6adenoidectomy index,analysis of the A/N value and the relationship between adenoid hypertrophy in children.Result:The ratios of A/N≤0.6 were found in 20 cases,0.6adenoidectomy index (A/N) children with adenoid hypertrophy are positively correlated,observation and diagnosis of adenoid hypertrophy in children is simple and accurate method.

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

    Science.gov (United States)

    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

  16. Effects of guidelines on adeno-tonsillar surgery on the clinical behaviour of otorhinolaryngologists in Italy

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    Motta Giovanni

    2013-01-01

    Full Text Available Abstract Background Several guidelines on adeno-tonsillar disease have been proposed in recent years and some discrepancies in relation both to clinical manifestations and indications for surgical treatment have emerged. The aim of the study was to verify what influence (adeno-tonsillectomy guidelines have had on the clinical behaviour of ENT specialists in Italy. Our study is a retrospective and multi-centre case series with chart review. Methods The survey involved 14,770 children, aged between the ages of 2 and 11, who had undergone adeno-tonsillar surgery between 2002 and 2008 in fourteen Italian tertiary and secondary referral centres. Anova test was used for the statistical analysis, assuming p Results The frequency of adeno-tonsillar surgeries did not change significantly (p>0.05 during the study period and following the Italian policy document publication. Overall, adeno-tonsillectomy was the most frequent intervention (64.1%, followed by adenoidectomy (31.1% and tonsillectomy (4.8%. The indications for surgery did not change significantly for each of the operations (p>0.05, with the exception of adeno-tonsillectomy in case of feverish episodes due to acute recurrent tonsillitis ≥ 5 without nasal obstruction (decreased p= 0.010 , even when the feverish episodes due to acute recurrent tonsillitis were Conclusions The recommendations first developed in Italy in a 2003 policy document and then resumed in guidelines in 2008, were not implemented by ENT units involved in the survey. The study highlights the fact that the indications for adeno-tonsillar operations are based on the overall clinical presentation (comorbidity rather than on a single symptom. Guidelines are necessary to give coherent recommendations based on both the findings obtained through randomized controlled trials and the data collected from observational studies.

  17. Prevalence of Panton-Valentine leucocidin and phenotypic and genotypic characterization of biofilm formation among Staphylococcus aureus strains isolated from children with adenoid hypertrophy.

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    Emaneini, Mohammad; Khoramrooz, Seyed Sajjad; Shahsavan, Shadi; Dabiri, Hossein; Jabalameli, Fereshteh

    2015-12-01

    Adenoids as a first line of host defense against respiratory microbes play an important role in majority of upper airway infectious and noninfectious illnesses. Bacterial pathogen can colonize on the adenoid tissue and probably act as a reservoir for them. To determine phenotypic and genotypic characterization of biofilm forming capacity of Staphylococcus aureus isolates from children with adenoid hypertrophy and prevalence of Panton-Valentine leukocidin (PVL) gene we collected 17 consecutive, clinically significant S. aureus isolates from children with adenoid hypertrophy undergoing adenoidectomy with one or more of the upper airway obstruction symptoms, nasal obstruction, mouth breathing, snoring, or sleep apnea. Biofilm formation was evaluated by colorimetric microtiter plate's assay. Gene encoding PVL and adhesion- or biofilm formation-encoding genes were targeted by polymerase chain reaction (PCR) assay. According to the results, all strains produced biofilm. Seven (41.2%) isolates produced strong biofilm whereas 7 (41.2%) isolates produced week and 3 (17.6%) isolates produced medium biofilm. Regarding the adhesion- or biofilm formation-encoding genes, 16 (94.1%) isolates were positive for the gene eno, 13(76.4%) for icaA, 13 (76.4%) for icaD, 10 (58.8%) for fib, 10 (58.8%) for fnbB, 4(23.5%) for can, and 1(5.8%) for fnbA. The high prevalence of genes encoding biofilms and adhesins and phenotypic ability to form a biofilm by S. aureus strains emphasizes the pathogenic character of strains isolated from children with adenoid hypertrophy.

  18. Drug induced sleep endoscopy in the decision-making process of children with obstructive sleep apnea.

    Science.gov (United States)

    Galluzzi, Francesca; Pignataro, Lorenzo; Gaini, Renato Maria; Garavello, Werner

    2015-03-01

    Tonsillectomy and adenoidectomy (T&A) is currently recommended in children with Obstructive Sleep Apnea (OSA). However, the condition persists after surgery in about one third of cases. It has been suggested that Drug Induced Sleep Endoscopy (DISE) may be of help for planning a more targeted and effective surgical treatment but evidence is yet weak. The aim of this review is to draw recommendation on the use of DISE in children with OSA. More specifically, we aimed at determine the proportion of cases whose treatment may be influenced by DISE findings. A comprehensive search of articles published from February 1983 to January 2014 listed in the PubMed/MEDLINE databases was performed. The search terms used were: "endoscopy" or "nasoendoscopy" or "DISE" and "obstructive sleep apnea" and "children" or "child" or "pediatric." The main outcome was the rate of naive children with hypertrophic tonsils and/or adenoids. The assumptions are that clinical diagnosis of hypertrophic tonsils and/or adenoids is reliable and does not require DISE, and that exclusive T&A may solve OSA in the vast majority of cases even in the presence of other concomitant sites of obstruction. Five studies were ultimately selected and all were case series. The median (range) number of studied children was 39 (15-82). Mean age varied from 3.2 to 7.8 years. The combined estimate rate of OSA consequent to hypertrophic tonsils and/or adenoids was 71% (95%CI: 64-77%). In children with Down Syndrome, the combined estimated rate of hypertrophic tonsils and/or adenoids was 62% (95%CI: 44-79%). Our findings show that DISE may be of benefit in a minority of children with OSA since up to two thirds of naive cases presents with hypertrophic tonsils and/or adenoids. Its use should be limited to those whose clinical evaluation is unremarkable or when OSA persists after T&A.

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

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    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.

  20. Post-tonsillectomy hemorrhage in children: a single surgeon's experience with coblation compared to diathermy.

    Science.gov (United States)

    Kim, Jeong-Whun; Mun, Sue Jean; Lee, Woo-Hyun; Mo, Ji-Hun

    2013-01-01

    The aim of this study was to compare coblation and diathermy techniques with respect to secondary post-tonsillectomy hemorrhage (PTH). A total of 1,397 children underwent tonsillectomies with or without adenoidectomy by a single surgeon in a single center from June 2005 through December 2011. A diathermy tonsillectomy was performed on 315 patients for the first 2 years, while a coblation tonsillectomy was performed on 1,082 for the next 5 years. All patients were followed-up within 28 days of surgery by the same surgeon. The characteristics of primary and secondary PTH were analyzed with a retrospective chart review. Primary PTH did not occur in both surgical technique groups. Secondary PTH occurred in 9 patients (2.9 %) in the diathermy group and in 30 patients (2.8 %) in the coblation group. The secondary PTH rates were 1.2, 2.5, 3.8, 3.1 and 4.5 % in the first, second, third, fourth and fifth years after employment of the coblation tonsillectomy, respectively (P = 0.243). Sex, age, tonsil size and severity of tonsillar embedding were not significant factors for PTH. The coblation technique was associated more with late secondary PTH than diathermy technique (odds ratio 9.14, P = 0.049). Analysis of the time of onset of PTH showed that secondary PTH occurred most commonly between 6 p.m. and 6 a.m. In summary, coblation technique has similar secondary PTH rate with diathermy technique although it has increased late secondary PTH rate in children. Coblation technique can be a good alternative to the diathermy technique.

  1. 心理干预对咽部手术患儿合作程度的影响%Impact of Psychological Interventions on Children's Degrees of Cooperation During the Surgery of Laryngopharynx

    Institute of Scientific and Technical Information of China (English)

    何玉凤; 张丽娟; 刘立新

    2012-01-01

    Objective To study the impact of psychological interventions on the degrees of cooperation and the restlessness in anesthesia recovery period in children with laryngopharynx surgery. Methods Eighty children who underwent elective combined tonsillectomy and adenoidectomy in general anesthesia were randomly divided into two groups. Intervention group was given comprehensive psychological care interventions during the operation period, while control group was received routine nursing. The degree of cooperation and the restlessness in anesthesia recovery period in children of the two groups were observed. Results The score of degree of cooperation and the status of restlessness of intervention group were both lower than those of control group (P<0.05). Conclusions After psychological care interventions, children's degree of cooperation in laryngopharynx surgery is increased and the occurrence of the restlessness in anesthesia recovery period is decreased.%目的 探讨心理干预对咽部手术患儿的配合程度及麻醉苏醒期躁动的影响. 方法 80例全麻下择期扁桃体和腺样体联合切除的小儿随机分为2组,干预组在手术期进行全方位的护理干预,对照组只进行常规的护理,观察两组患儿在手术的配合程度和麻醉苏醒期躁动的情况. 结果 干预组在手术的配合程度和躁动评分上均低于对照组(P<0.05). 结论 通过心理护理干预,提高了小儿对手术的配合程度,降低了苏醒期躁动的发生.

  2. Evaluation of Children with Chronic Rhinosinusitis after Adenotonsillectomy

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    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.

  3. Molecular Epidemiology of Streptococcus pneumoniae Isolates from Children with Recurrent Upper Respiratory Tract Infections.

    Science.gov (United States)

    Korona-Glowniak, Izabela; Maj, Maciej; Siwiec, Radosław; Niedzielski, Artur; Malm, Anna

    2016-01-01

    A total of 125 isolates were recovered from adenoids and/or nasopharynx of 170 children aged 2 to 5 from south-east Poland; they had undergone adenoidectomy for recurrent and/or persistent symptoms of upper respiratory tract infections. Pneumococcal isolates were analyzed by phenotyping (serotyping and antimicrobial resistance tests) and genotyping together with the clonality of the pneumococcal isolates based on resistance determinants, transposon distribution and multilocus sequence typing (MLST). Serotypes 19F, 6B and 23F constituted 44.8% of the isolates. Among all of the strains, 44.8% showed decreased susceptibility to penicillin and resistance to co-trimoxazole (52.8%), tetracycline (38.4%), erythromycin (53.6%), clindamycin (52.8%) and chloramphenicol (27.2%) was observed. Tn6002 was found in 34.8% of erythromycin-resistant isolates while composite Tn2010-in 16.7% of erm(B)-carrying isolates that harboured also mef(E) gene. Tn3872-related elements were detected in 27.3% of erythromycin-resistant strains. In the majority of chloramphenicol-resistant catpC194-carrying isolates (79.4%), ICESp23FST81-family elements were detected. The genotyping showed that pneumococcal population was very heterogeneous; 82 sequence types (STs) were identified, and the most frequent contributed to not more than 8% of the isolates. Nearly 44% STs were novel, each of them was recovered only from one child. Four STs belonged to one of the 43 worldwide spread resistant pneumococcal clones currently accepted by Pneumococcal Molecular Epidemiology Network (PMEN), i.e. Spain 9V-3, Spain 23F-1, Norway NT-42 and Poland 6B-20, accounting for 12 (16.7%) of the 75 nonususceptible isolates, and five STs were single-locus variants of PMEN resistant clones (England 14-9, Spain 9V-3, Spain 23F-1, Greece 21-30, Denmark 14-32), accounting 9 (12%) of nonsusceptible isolates. A few MDR clones belonging to 6B and 19F serotypes found among preschool children emphasizes rather the role of clonal

  4. Investigation of life quality in children with obstructive sleep disorders before and after adenotonsillectomy%睡眠呼吸障碍患儿手术前后生活质量分析

    Institute of Scientific and Technical Information of China (English)

    刘丹

    2013-01-01

    [目的]探讨儿童睡眠呼吸障碍行腺样体和/或扁桃体切除术前后生活质量的改善情况. [方法]采用前瞻性对照研究的方法,以儿童睡眠呼吸障碍疾病特异性生活质量调查表(OSA-18)(disease-specific quality of life for children with obstructive sleep apnea 18 items survey,OSA-18)为工具,对经多导睡眠监测确诊的61例阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患儿手术前后生活质量进行调查. [结果]OSA-18调查显示,经手术治疗后患儿术后3~6个月的生活质量均得到明显提高(P<0.01),新增睡眠问题5个项目也得到明显提高(P<0.01). [结论]OSAHS儿童行手术治疗后临床症状、生活质量均得到明显改善.OSA-18调查量表可用作OSAHS患儿临床诊断及术后随访的辅助工具.%[Objective] To evaluate the improvement in quality of life(QOL)for children before and after adenoidectomy and tonsillectomy.[Method] In a prospective controlled trial,questionnaire of disease-specific quality of life for children with obstructive sleep apnea 18 items survey(OSA-18) was used to evaluate QOL in 61 children with obstructive sleep apnea hypoprea syndrome (OSAHS) diagnosed by polysomnography (PSG) before and after surgical operation.[Result] OSA-18 investigation showed,the 18 items and 5 items in additional sleep problem had been markedly improved within 3~6 months after surgery.[Conclusions] The clinical symptoms of children with OSAHS diagnosed by PSG within 3~6months after surgery have been evidently improved,also quality of life markedly improved.Adenotonsillectomy can greatly improve the quality of life of children with OSAHS.OSA-18 can be valuable assessment tool in clinical diagnosis and treatment follow up.

  5. Clinical analysis on the therapeutic effect of adenoid plasma ablation under nasal endoscope on children with snoring condition%鼻内镜下等离子切除腺样体治疗小儿鼾症的临床分析

    Institute of Scientific and Technical Information of China (English)

    陈登胜

    2014-01-01

    Objective To observe the therapeutic effect of adenoid plasma ablation under nasal endoscope on children with snoring condition based on a clinical trial. Methods A retrospective analysis was made among 80 children cases with snoring condition, treated in our Hospital from January 2010 to December 2013 by plasma ablation to remove their hypertrophied adenoid, with their clinical data carefully analyzed to sum up our clinical experience with such a condition. Results All these patients were recovered well, with such symptoms disappeared among them as snoring and mouth breathing and without obvious complications happened. The averaged staying period in hospital was 5.5 days after the operation. As shown by the end of followed up period lasted for 2 to 6 months, nasopharyngeal mucosa was recovered well in an appearance of smooth, with no adhesion and no residual adenoidal tissue present among all these cases. Conclusions Nasal endoscope guided adenoidectomy with plasma ablation can created a much clearer operating field, with such advantages as less bleeding during operation, safer and better therapeutic effect as compared with the conventional procedures.%目的:观察鼻内镜下低温等离子切除腺样体治疗小儿鼾症的临床疗效。方法回顾性分析分析我科2010年1月至2013年12月在鼻内镜下应用等离子刀切除肥大腺样体治疗小儿鼾症80例的临床资料,总结临床经验与体会。结果全部病例术后恢复良好,睡眠打鼾和张口呼吸症状均消失,无明显并发症,平均住院5.5天。术后随访2~6个月,全部病例鼻咽黏膜光滑无粘连,无腺样体残留。结论鼻内镜引导下行腺样体等离子切除术术野清晰,出血少,安全性高,效果良好。

  6. Surgical treatment of children with adenoidal hypertrophy combined with obstructive sleep apnea%儿童腺样体肥大合并阻塞性睡眠呼吸暂停综合征的手术治疗

    Institute of Scientific and Technical Information of China (English)

    何植洲; 罗天飞; 李卫红; 李金奇; 李小娇; 谢志雄

    2013-01-01

      目的探讨儿童腺样体肥大合并阻塞性睡眠呼吸暂停综合征(OSAS)的治疗方法及临床疗效。方法对2011年4月~2012年9月我院耳鼻喉科收治的36例阻塞性睡眠呼吸暂停综合征患儿资料进行回顾分析,术后回访6~12个月。结果36例患儿均治愈,其中12例术后睡眠鼾声基本消失,无张口呼吸,憋醒及呼吸暂停等表现,24例憋醒,张口呼吸,呼吸暂停及睡眠打鼾等症状完全消失。术后回访6~12个月,无一例并发症且无一例复发。结论对于儿童腺样体肥大合并阻塞性睡眠呼吸暂停综合征患儿,鼻内镜下腺样体切除术治疗,临床疗效确切,值得进一步推广。%Objective To explore the treatment method and clinical effect of adenoidal hypertrophy in children with obstructive sleep apnea syndrome (OSAS). Methods 36 cases of children with obstructive sleep apnea were analyzed retrospectively by interview 6 -12 months after surgery,from April 2011 to September 2012 in ENT department of our hospital. Results 36 cases of patients were cured,12 cases of postoperative sleep snoring disappeared,no mouth breathing,arousal and apnea. 24 cases had arousal,mouth breathing,and sleep apnea and snoring and other symptoms disappeared completely. There was no case of complication and recurrence. Conclusion Endoscopic adenoidectomy treatment for the adenoidal hypertrophy with obstructive sleep apnea syndrome,is worthy of further promotion,and the effect is exact.

  7. Prognostic factors of successful tympanoplasty in pediatric patients: a cohort study

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    Boronat-Echeverría Nuria

    2012-06-01

    Full Text Available Abstract Background Tympanoplasty in children is a current and controversial theme. The success of tympanoplasty traditionally has been measured only by the post-operative integrity of the graft. Yet, there are other variables that may be used to determine success. The objectives of the present work were to analyze which factors are predictive of successful tympanoplasty in pediatric patients and to construct and validate a prognostic index that could be used as a tool to predict the success of tympanoplasty in children. Methods Setting. Department of Pediatric Otorhinolaryngology, tertiary-care hospital, Mexico City. Patients. Forty-eight patients, who were older that five years of age, had persistent perforation of the tympanic membrane, and had undergone tympanoplasty (January 2005–June 2008, were followed for a year. Main Outcome Measures. The factors tested for their value as predictors were the following: age at time of surgery, state of contralateral ear, previous adenoidectomy, cause of perforation, size of perforation, infection at the time of surgery, state of mucosa, age at first occurrence of perforation, presence of craniofacial dysmorphia, and surgical technique. These factors were compared with the criterion, success, which was defined as attaining three positive outcomes: 1 integrity of the implant or membrane; 2 minimum of 10-dB gain in the auditory threshold or, in the case of normal hearing, conservation of same; and 3 air-filled space in the middle ear. The best model was obtained through logistic regression analysis; the model was validated. Results The most balanced prediction model was that in which the three success criteria were included, with age, surgical technique, and infection at surgery being excluded as variables. The additional 12 pediatric cases used in the validation had a probability of success >0.425 (best cut-off level; two patients (17% had poor evolution. Conclusions This is the first study that

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

    Science.gov (United States)

    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

  9. Molecular Epidemiology of Streptococcus pneumoniae Isolates from Children with Recurrent Upper Respiratory Tract Infections.

    Science.gov (United States)

    Korona-Glowniak, Izabela; Maj, Maciej; Siwiec, Radosław; Niedzielski, Artur; Malm, Anna

    2016-01-01

    A total of 125 isolates were recovered from adenoids and/or nasopharynx of 170 children aged 2 to 5 from south-east Poland; they had undergone adenoidectomy for recurrent and/or persistent symptoms of upper respiratory tract infections. Pneumococcal isolates were analyzed by phenotyping (serotyping and antimicrobial resistance tests) and genotyping together with the clonality of the pneumococcal isolates based on resistance determinants, transposon distribution and multilocus sequence typing (MLST). Serotypes 19F, 6B and 23F constituted 44.8% of the isolates. Among all of the strains, 44.8% showed decreased susceptibility to penicillin and resistance to co-trimoxazole (52.8%), tetracycline (38.4%), erythromycin (53.6%), clindamycin (52.8%) and chloramphenicol (27.2%) was observed. Tn6002 was found in 34.8% of erythromycin-resistant isolates while composite Tn2010-in 16.7% of erm(B)-carrying isolates that harboured also mef(E) gene. Tn3872-related elements were detected in 27.3% of erythromycin-resistant strains. In the majority of chloramphenicol-resistant catpC194-carrying isolates (79.4%), ICESp23FST81-family elements were detected. The genotyping showed that pneumococcal population was very heterogeneous; 82 sequence types (STs) were identified, and the most frequent contributed to not more than 8% of the isolates. Nearly 44% STs were novel, each of them was recovered only from one child. Four STs belonged to one of the 43 worldwide spread resistant pneumococcal clones currently accepted by Pneumococcal Molecular Epidemiology Network (PMEN), i.e. Spain 9V-3, Spain 23F-1, Norway NT-42 and Poland 6B-20, accounting for 12 (16.7%) of the 75 nonususceptible isolates, and five STs were single-locus variants of PMEN resistant clones (England 14-9, Spain 9V-3, Spain 23F-1, Greece 21-30, Denmark 14-32), accounting 9 (12%) of nonsusceptible isolates. A few MDR clones belonging to 6B and 19F serotypes found among preschool children emphasizes rather the role of clonal

  10. Rinosseptoplastia em crianças Septorhinoplasty in children

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    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

  11. Clinical Analysis of the Treatment of Adenoid Hypertrophy in Children with Semiconductor Laser%半导体激光经鼻治疗小儿腺样体肥大疗效观察

    Institute of Scientific and Technical Information of China (English)

    李丽丽

    2015-01-01

    目的研究半导体激光经鼻治疗小儿腺样体肥大的疗效,探索物理治疗在小儿腺样体肥大治疗中的效果。方法每次每侧鼻腔半导体激光经鼻照射治疗20min,1次/d,连续7d为1疗程。结果64例小儿腺样体肥大患儿,年龄3~8岁。治疗前均用前鼻镜检查,其中经前鼻镜目视发现腺样体肥大患儿39例,其余鼻腔分泌物堵塞,不能直视腺样体者用CT检查示腺样体肥大,堵塞鼻咽腔70%以上且睡眠时打鼾症状明显、不伴有副鼻窦炎者均给予单纯半导体激光经鼻治疗。结论半导体激光经鼻治疗小儿腺样体肥大疗效确切。%Objective To study the semiconductor laser nasal treatment the curative ef ect of infantile adenoid hypertrophy,explore the physical therapy in the treatment of infantile adenoid hypertrophy. Methods 64 cases of children with infantile adenoid hypertrophy,aged 3 to 8.Treatment are made before the nasal endoscopy,of which the former rhinoscope visual found that children with adenoid hypertrophy were 39 cases,the rest of the nasal secretions,who can't look straight into adenoidectomy with CT examination in adenoid hypertrophy,jam,more than 70%of the nasopharyngeal cavity and sleep snoring symptoms,without vice sinusitis were given your nasal passages of semiconductor laser therapy alone.Methods Each side nasal cavity semiconductor laser ir adiation nasal treatment for 20 minutes,once a day,seven days for a course of treatment.Conclusion Your nasal passages of semiconductor laser treatment curative ef ect is infantile adenoid hypertrophy.

  12. Mouth breathing children have cephalometric patterns similar to those of adult patients with obstructive sleep apnea syndrome Crianças respiradoras bucais apresentam padrão cefalométrico semelhante àquele observado em pacientes adultos com síndrome da apnéia obstrutiva do sono

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    Maria Ligia Juliano

    2009-09-01

    Full Text Available OBJECTIVE: To determine whether mouth breathing children present the same cephalometric patterns as patients with obstructive sleep apnea syndrome (OSAS. METHOD: Cephalometric variables were traced and measured on vertical lateral cephalometric radiographs. The cephalometric measurements of 52 mouth and 90 nose breathing children were compared with apneic patients. The children had not undergone adenoidectomy or tonsillectomy and had not had or were not receiving orthodontic or orthopedic treatment. RESULTS: Mouth breathing children showed same cephalometric pattern observed in patients with OSAS: a tendency to have a retruded mandible (p=0.05, along with greater inclination of the mandibular and occlusal planes (pOBJETIVO: Determinar se crianças respiradoras bucais apresentam o mesmo padrão cefalométrico que os pacientes que tem síndrome da apnéia obstrutiva do sono (SAOS. MÉTODO: Foram traçadas radiografias laterais verticais da cabeça para a mensuração das variáveis cefalométricas. As medidas cefalométricas de 52 crianças respiradoras bucais e de 90 crianças respiradoras nasais foram comparadas à de pacientes com apnéia. Foram excluídas as crianças que haviam sido submetidas à cirurgia de remoção de amídalas ou adenóides, ou que haviam recebido tratamento ortodôntico prévio ou em andamento. RESULTADOS: As crianças respiradoras bucais apresentaram o mesmo padrão cefalométrico observado em pacientes com SAOS: tendência a ter retrusão de mandíbula (p=0,05, assim como uma maior inclinação dos planos mandibular e oclusal (p<0,01 e tendência a ter maior inclinação dos incisivos superiores (p=0,08. O espaço da nasofaringe e o espaço aéreo posterior se apresentaram muito diminuídos nas crianças respiradoras bucais, como é observado em pacientes com SAOS (p<0,01. CONCLUSÃO: Crianças respiradoras bucais apresentam padrão cefalométrico alterado e sua morfologia craniofacial é semelhante àquela observada

  13. Expression of Innate Immunity Genes in Epithelial Cells of Hypertrophic Adenoids with and without Pediatric Chronic Rhinosinusitis: A Preliminary Report

    Institute of Scientific and Technical Information of China (English)

    Xiao-Peng Qu; Zhen-Xiao Huang; Yan Sun; Ting Ye; Shun-Jiu Cui; Qian Huang; Li-Jing Ma

    2015-01-01

    Background:Adenoid hypertrophy (AH) is associated with pediatric chronic rhinosinusitis (pCRS),but its role in the inflammatory process of pCRS is unclear.It is thought that innate immunity gene expression is disrupted in the epithelium of patients with chronic rhinosinusitis (CRS),including antimicrobial peptides and pattern recognition receptors (PRRs).The aim of this preliminary study was to detect the expression of innate immunity genes in epithelial cells of hypertrophic adenoids with and without pCRS to better understand their role in pCRS.Methods:Nine pCRS patients and nine simple AH patients undergoing adenoidectomy were recruited for the study.Adenoidal epithelium was isolated,and real-time quantitative polymerase chain reaction (RT-qPCR) was employed to measure relative expression levels of the following messenger RNAs in hypertrophic adenoid epithelial cells of pediatric patients with and without CRS:Human β-defensin (HBD) 2 and 3,surfactant protein (SP)-A and D,toll-like receptors 1-10,nucleotide-binding oligomerization domain (NOD)-like receptors NOD 1,NOD 2,and NACHT,LRR and PYD domains-containing protein 3,retinoic acid-induced gene 1,melanoma differentiation-associated gene 5,and nuclear factor-KB (NF-κB).RT-qPCR data from two groups were analyzed by independent sample t-tests and Mann-Whitney U-tests.Results:The relative expression of SP-D in adenoidal epithelium of pCRS group was significantly lower than that in AH group (pCRS 0.73 ± 0.10 vs.AH 1.21 ± 0.15;P =0.0173,t =2.654).The relative expression levels of all tested PRRs and NF-κB,as well as HBD-2,HBD-3,and SP-A,showed no statistically significant differences in isolated adenoidal epithelium between pCRS group and AH group.Conclusions:Down-regulated SP-D levels in adenoidal epithelium may contribute to the development of pCRS.PRRs,however,are unlikely to play a significant role in the inflammatory process of pCRS.

  14. 咪达唑仑对术后小儿苏醒期躁动及苏醒时间的影响%The Effect of Midazolam on Prevention of Emergence Agitation and Emergence Time in Children

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    郑小艳; 冯昌栋; 胡晓清

    2014-01-01

    Objective To compare the effects of 0.02 mg/kg and 0.05 mg/kg midazolam on prevention of emergence agitation and emergence time in children. Methods Forty-five children undergoing elective tonsillectomy and/or adenoidectomy were randomly divided into three groups (group M1, group M2 and group C) with fifteen cases each. Anesthesia was induced with fentanyl (2μg/kg), etomidate (0.3 mg/kg), cisatracurium (0.1 mg/kg). After tracheal intubation sevoflurane was used for the maintenance of anesthesia. 0.02 mg/kg of midazolam, 0.05 mg/kg of midazolam, or saline was given independently before the end of surgery. Preoperative anxiety, emergence time, postoperative adverse events were recorded, emergence agitation was valuated by the Pediatric Anesthesia Emergence Delirium Scale (PAED), pain was valuated by faces pain scale (FPS). Results The incidence of emergence agitation was lower in patients given 0.02 mg/kg of midazolam and patients given 0.05 mg/kg of midazolam compared with that in patients given saline. The emergence time was longer in patients given 0.05 mg/kg of midazolam compared with that in patients given 0.02 mg/kg of midazolam or saline. Conclusion Intravenous administration of 0.02 mg/kg of midazolam just before the end of surgery may reduce emergence agitation without delaying the emergence time in children having tonsillectomy and/or adenoidectomy surgery with sevoflurane anesthesia.%目的:对比研究0.02 mg/kg和0.05 mg/kg咪达唑仑对小儿术后苏醒期躁动及苏醒时间的影响。方法择期行扁桃体和/或腺样体切除术患儿45例,年龄为3~8岁,ASA分级为Ⅰ~Ⅱ级,随机分为3组:咪达唑仑1组(M1组,n=15),咪达唑仑2组(M2组,n=15),对照组(C组,n=15),3组患儿均经芬太尼2μg/kg,依托咪酯0.3 mg/kg,顺式阿曲库铵0.1 mg/kg麻醉诱导,气管插管后吸入七氟醚维持麻醉。手术结束前M1组静脉推注咪达唑仑0.02 mg/kg,M2组静脉推注咪达唑仑0

  15. 儿童扁桃体腺样体低温等离子手术迟发性出血的初步研究%A prelminary study of the secondary postoperative haemorrhage in pediatric coblation adenotonsillectomy

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    刘大波; 谭宗瑜; 钟建文; 邵剑波; 仇书要; 周婧

    2010-01-01

    Objective To compare secondary postoperative haemorrhage rate of coblation with the conventional pediatric adenotonsillectomy. And to analyze possible reasons which cause the secondary bleeding after coblation adenotonsillectomy. Methods A retrospective study was applied to compare the secondary postoperative haemorrhage rate and the bleeding moment between two groups in which 1-14 years old children from April 2005 to September 2009 in Guangzhou Children's Hospital were included. Group A was pediatric patients who had conventional adenoidectomy and/or tonsillectomy ( dissection, without heat damage to the tissue) from April 2005 to July 2006 in Department of Otorhinolaryngology. Group B was pediatric patients who had eoblation adenoidectomy and/or tonsillectomy from April 2008 to September 2009 in Department of Otorhinolaryngology. Results Two of 484 cases in group A had secondary postoperative bleeding, the rate was 0. 4%. One happened 2 days after operation, another after 3 days. Eleven of 502 cases in group B had secondary postoperative bleeding, the rate was 2. 2%. Secondary bleeding happened 2 to 12 days after surgery, median 6.0 days. The secondary postoperative haemorrhage rate of operating by the freshman was 2.6% (10/385), and it was 0.9% (1/117) by the senior. The rate of secondary bleeding was higher in group B than group A (χ2 = 5. 987, P 0.05). Six of 13 cases who had secondary bleeding suffered wound or upper respiratory tract infection. Three of 13 ate inappropriately after the operation. Conclusions Pediatric eoblation adenotonsillectomy is a new method. The most possible reasons of secondary bleeding are poor surgery skills and ill experience. And, infection,inappropriate eating after the operation may be the other reasons of secondary bleeding.%目的 比较低温等离子手术与常规手术方式在儿童扁桃体、腺样体手术后迟发性出血(手术24 h后)率及出血时间点的情况,初步探讨导致低温等离子手术迟发

  16. 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

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    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

  17. 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

    Institute of Scientific and Technical Information of China (English)

    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

  18. 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

    Directory of Open Access Journals (Sweden)

    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

  19. The Research of the Clinical Actual Efficacy of Ear Endoscopic Tympanostomy Tube Surgery in the Treatment of Secretory Otitis Media in Children%耳内镜下鼓膜置管术治疗儿童分泌性中耳炎的疗效研究

    Institute of Scientific and Technical Information of China (English)

    黄志强; 黄兰芳

    2013-01-01

    significant difference .Conclusion:In the clinical treatment of secretory otitis media in children ,the clinical effects of ear tympanostomy tube surgery com-bined with endoscopic adenoidectomy treatment significantly is a safe and reliable choice for the treatment of secretory otitis media in children .

  20. 内镜技术在儿童分泌性中耳炎的手术治疗中的应用%Endoscopy in surgical treatment for children with chronic non-suppurative otitis media

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    欧阳顺林; 褚玉敏; 郭明明; 汪博; 张建国

    2011-01-01

    [ Objectives ] To investigate the surgical treatment methods and effects on non-supparative otitis media in children. [Methods] 74 children (112 ears) suffering from chronic non-suppurative otitis media were conducted adenoidectomy and myringotomy or myringotomy with tube insertion under endoscopy,they were follow-up more than half year, and the results were evaluated. [ Results ] The hearing and middle ear function in children had significant improvement post-operative, the total effective rate was 93.8% (102/112); Air conduction hearing threshold of speech frequency average were (13.5±5.1) dB, air-bone gap were (7.5 ±4.9) dB, they also had significant difference compared with preoperative (P <0.05); the effective rate was 92.7% (51/55) in myringotomy group, and it was 94.7% (54/57) in myringotomy with tube insertion group,there was no significant difference between the two groups (P >0.05). [ Conclusion ] To practice effective surgical treatment on children with chronic non-suppurative otitis media is conducive to the protection of children's hearing and middle ear function, and to prevent the occurrence of otitis media sequelae.%目的 探讨儿童分泌性中耳炎手术治疗方法和效果.方法 对74例(112耳)患有分泌性中耳炎的儿童在内镜下行腺样体切除术和鼓膜切开或置管术,随访半年以上并评价其治疗效果.结果 术后患儿的听力和中耳功能明显好转,总有效率为93.8%(102/112);53耳语言频率气导平均听阈为(13.5±5.1)dB,气骨导差为(7.5±4.9)dB,两者和术前相比较差异有显著性(P<0.05);行鼓膜切开术组有效率为92.7%(51/55);加鼓膜置管组有效率为94.7%(54/57),两组之间相比较差异无显著性(P>0.05).结论 对患有分泌性中耳炎的儿童进行有效的手术治疗,有利于保护儿童的听力和中耳功能,防止中耳炎后遗症的发生.

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  3. 鼻内镜下吸切器治疗小儿腺样体肥大的疗效观察%Observation on the Efficacy of Nasal Endoscopy-assisted Treatment of Adenoidal Hypertrophy in Children

    Institute of Scientific and Technical Information of China (English)

    邵鑫; 张维天; 吴涛; 陈瑶

    2012-01-01

    Objective To discuss the efficacy and safety of nasal endoscopy-assisted treatment of adenoidal hypertrophy in children. Methods 63 patients aged 4 to 12 years old, diagnosed with adenoidal hypertrophy in children were treated by nasal endoscopy-assisted sucking and cutting. All cases' nasopharyngeal cavity diameters were greater than or equal to 0.71. Fiber endoscope checking the nostril degree after adenoid obstruction: Ⅲ°52 cases, Ⅳ°11 cases. Among these cases,nasal obstruction,rhinorrhea were first diagnosed in 15 cases. Sleep snoring,mouth breathing,breath occurred in 39 cases and hearing loss in 9 cases. 11 patients with Ⅲ° hypertrophy of the tonsils, their tonsil were removed. At the same time,3 patients with middle ear effusion were operated by grommet insertion. Results 9 patients with secretory otitis media review of a-coustic immittance tympanometry function curves were type A, their speech frequency hearing recovered to premorbid levels. 12 patients' nasal ventilation were in normal status,3 cases were improved significantly. Sleep snoring and mouth breathing symptoms disappeared in 37 cases, 2 cases were improved. All patients had no symptoms such as postoperative bleeding,nasopharyngeal adherence or injury. Conclusion Operation is a good method to treat clinical symptoms of adenoidal hypertrophy. Compared with the traditional method,nasal endoscopy-assisted adenoidectomy resection has many advantages such as clear vision, small wound,less bleeding,rare residue,good treatment effect and so on,which can be promoted.%目的 探讨鼻内镜下吸切器治疗小儿腺样体肥大的疗效和安全性.方法 对63例4 ~12岁腺样体肥大的患儿行鼻内镜下吸切器吸切治疗,所有病例鼻咽侧位片示腺样体厚度/鼻咽腔前后径≥0.71,纤维鼻咽镜检查腺样体阻塞后鼻孔的程度Ⅲ°52例;Ⅳ°11例.其中以鼻塞、流涕首诊15例,睡眠打鼾、憋气、张口呼吸39例,听力下降9例.11例并发扁桃

  4. The clinical application of coblation-assisted adenotonsillectomy for treatment of the infant with sleep-disordered breathing%低温等离子在婴幼儿睡眠呼吸障碍疾病中的临床应用

    Institute of Scientific and Technical Information of China (English)

    易新华; 刘大波; 黄振云; 钟建文

    2014-01-01

    目的:探讨低温等离子技术治疗婴幼儿睡眠呼吸障碍疾病的临床应用。方法:回顾2008年1月至2012年6月间在我院行低温等离子技术切除扁桃体和(或)腺样体的161例婴幼儿临床资料。161例患儿包括76例原发性鼾症(primary snoring, PS),85例阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome, OSAHS),评价并发症的发生及疗效情况。结果:术中出血均少于10 mL,2例继发性出血,术后疼痛轻微,2013年1月随访截止,成功随访了161例(sleep disordered breathing, SDB)患儿,术后1年疗效评价,治愈141例(87.6%),显效15例(9.3%),有效3例(1.9%),无效2例(1.2%),总有效率98.8%。结论:等离子技术治疗婴幼儿睡眠呼吸障碍疾病,微创,安全,有效。%Objective To investigate the clinical application of the coblation in the treatment of the infant with sleep-disordered breathing. Methods The clinical data were reviewed from 161 infants, who had the cobtilaon tonsillectomy and/or adenoidectomy sugeries in our hospital from January , 2008 to June, 2012. Among the 161 SDB cases, there were 85 obstructive sleep apnea hypopnea syndrom cases and 76 primary snoring cases. After 12 months, the follow-up visit is cut off in January, 2013. Successful follow-ups had been done to 161 infant with SDB. And the clinical efficacy and the occurrence of the complications were investigated. Results the intra-operative blood loss was 10 mL or less. 2(1.24%) were delayed hemorrhage with less pain afteroperation. One year after the surgery, there were 141 cured (87.6%), 15 with apparent effects (9.3%), 3 with effective results (1.9%), 2 with no effect(1.2%)and the total effective rate is 98.8%. Conclusion It is minimally invasive, safe and effective to use coblation to remove tonsil and adenoid in the treatment of infants with sleep-disordered breathing.

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

    Directory of Open Access Journals (Sweden)

    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

  6. Tonsillectomy in Maine: regulation versus education as modulators of medical care.

    Science.gov (United States)

    Moore, F D; Pratt, L W

    1981-08-01

    The reduction in the rate of tonsillectomy, using the state of Maine as an example, and the causes thereof are addressed. Are federal and state regulations required to change the behavior of physicians and the public, or is education of greater importance? A study of tonsillectomy in the state of Maine was based on data covering a period of approximately 30 years. The data were based on direct contact with hospitals, in which we achieved the cooperation of virtually all of the hospitals of Maine, encompassing 98% of the hospital beds. These data were placed in context by information provided by the Maine Health Data Service, and by information for the northeastern United States, for the eastern United States, and for the entire United States, from the Department of Health, Education and Welfare. The operation of tonsillectomy and its variants, including adenoidectomy, has declined remarkably in the past 30 years, most drastically in the past eight years. It now occupies only 4.5% of the total operative admissions for the State, where it formerly was 17%. It now has a populational incidence for the State of 3.3 operations per thousand population per year, whereas it formerly was at a level of about 10.0. From this study, as well as from physicians in Maine, to whom an informal questionnaire was sent, it is clear that this reduction has come about largely because of education of physicians and the public. Increased awareness by the public, pediatricians and general practitioners of the limitations of this operation has been significant. In addition, there is a general sense of improved general health of young people in Maine, with fewer chronic respiratory infections. Some negative opinions were expressed, including the possibility that peritonsillar abcesses may be more frequent in the future and that some pediatricians and general practitioners overuse antibiotics. Federal regulations, state regulations, Medicare, Medicaid, Blue Cross or Blue Shield regulations

  7. 鼻内镜下电动切割器治疗腺样体肥大36例%Endoscopic electric cutters in the treatment of 36 cases of adenoidal hypertrophy

    Institute of Scientific and Technical Information of China (English)

    王静; 吴加亮; 尹霞

    2014-01-01

    目的:探讨鼻内镜下电动切割器治疗腺样体肥大的临床疗效。方法将36例接受腺样体切除术治疗腺样体肥大的患者根据随机数字表法分为观察组与对照组,观察组采用鼻内镜下电动切割器治疗,对照组则采用传统腺样切除术治疗,比较两组治疗效果。结果观察组彻底切除腺样体所需时间为(10.65±2.38)min,术中出血量(28.82±0.98)mL,并发症发生率为0.00%,与对照组比较差异均有统计学意义(t=25.93、31.79,χ2=3.92,均P<0.05);观察组重度疼痛1例,低于对照组的9例(χ2=8.86,P<0.05);观察组总有效率为94.45%,显著高于对照组的55.55%(χ2=7.26,P<0.05)。结论相比于传统腺样体切除术治疗,采用鼻内镜下电动切割器治疗腺样体肥大能在显著减小术中出血量及并发症发生率的同时改善患者疼痛感,提高临床疗效,值得在临床上进一步推广。%Objective To explore the efficacy of endoscopic electric cutters in the treatment of adenoidal hypertrophy .Methods 36 patients who underwent adenoidectomy treatment of adenoid hypertrophy were divided into the observation group and control group according to the random number table .The observation group was taken endo-scopic electric cutters treatment , the control group was taken traditional adenoid removal treatment .The therapeutic effect of the two groups was compared .Results In the observation group,the total time required for removal of the adenoids was (10.65 ±2.38)min,blood loss was (28.82 ±0.98)mL,compared with the control group,there were significant differences(t=25.93,31.79,χ2 =3.92,all P<0.05).In the observation group,there was 1 case had severe pain,but in the control group,there were 9 cases,the difference was significant (χ2 =8.86,P<0.05).In the observation group,the total effective rate was 94.45%,which was significantly higher than 55.55% in

  8. Expression of CysLTR-1 and CysLTR-2 in adenoid tissues from children with adenoid hypertrophy%CysLTR-1和CysLTR-2在腺样体肥大儿童腺样体组织中的表达

    Institute of Scientific and Technical Information of China (English)

    朱美华; 梁敏; 王志坚; 沈雁; 温红艳; 翟锦明; 杨晓彬

    2015-01-01

    Objective To examine the expression of cysteinyl leukotriene receptor-1 (CysLTR-1) and cysteinyl leukotriene receptor-2 (CysLTR-2) in the adenoid tissues from children with adenoid hypertrophy (AH) and to explore the role of leukotrienes in the pathogenesis of AH. Methods Sixty children with AH who were treated by adenoidectomy and/or tonsillectomy were classified into two groups: simple AH and AH plus allergic rhinitis (n=30 each). Twenty children who underwent tonsillectomy due to recurrent purulent tonsillitis were selected as the control group. The expression of CysLTR-1 and CysLTR-2 in the excised tonsil and/or adenoid tissues was determined by immunolfuorescence histochemical labeling and integrated optical density measurement. Results The expression of CysLTR-1 and CysLTR-2 in the adenoid and tonsil tissues increased signiifcantly in both the simple AH group and AH plus allergic rhinitis group compared with the control group (P<0.01). The expression of CysLTR-1 and CysLTR-2 in the AH plus allergic rhinitis group increased more signiifcantly compared with the simple AH group (P<0.01). Conclusions CysLTR-1 and CysLTR-2 are highly expressed in the adenoid tissues from children with AH, suggesting that leukotrienes are involved in the pathogenesis of AH.%目的:检测腺样体肥大(adenoid hypertrophy, AH)患儿腺样体组织中半胱氨酸白三烯受体1(CysLTR-1)和半胱氨酸白三烯受体2(CysLTR-2)的表达,探讨白三烯在AH发病中的作用。方法将60例行腺样体/扁桃体切除的AH患儿分为单纯AH组与伴变态反应性鼻炎AH组(每组30例),以反复化脓性扁桃体炎行扁桃体切除的20例患儿作为对照组。通过免疫荧光组织化学标记法及累积光密度(IOD)测量方法观察各组患儿术后扁桃体/腺样体组织中CysLTR-1和CysLTR-2的表达。结果在两个AH组的腺样体组织和扁桃体组织中,CysLTR-1和CysLTR-2的表达强度均明显高于对照组(P

  9. 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

    Institute of Scientific and Technical Information of China (English)

    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

  10. 伴高危因素儿童阻塞性睡眠呼吸暂停低通气综合征的手术治疗%Diagnosis and treatment of obstructive sleep apnea hypopnea syndrome in children with risk factors

    Institute of Scientific and Technical Information of China (English)

    刘大波; 仇书要; 钟建文; 黄振云; 陈倩; 谭宗瑜

    2008-01-01

    syndrome(OSAHS),accompanying with risk factors.Methods The clinic data of 19 patients treated in the Department of Otorhinolaryngology of Guangzhou Children's Hospital between January 2005 to January 2008 were investigated retrospectively.Among them,5 were<2 years old,6 with craniofacial deformity:small mandible and(or)mandibular retrusion(5 cases),transverse facial cleft(1 case),Down's syndrome(2 cases),cerebral palsy(2 cases),chronic bronchitis(3 cases)and mucopolysaccharidoses(1 case).Nineteen patients with symptoms of snoring, mouth breathing,were diagnosised as OSAHS by polysemnography(PSG)and treated by tonsillectomy and(or)adenoidectomy in hospital.All patients were closely followed-up.Results Fourteen patients underwent PSG 6 months to 1 year after operation,11 patients recovered,the median [percentiles 25;percentiles 75]apnea-hypopnea index(AHI)decreased from the pre-operative 22.5[16.5;24.3]times/h to 2.0[1.5;4.3]times/h,and the lowest oxygen saturation(LSaO2)before operation was 0.63,and was higher than 0.92 after operation,1 case accompanying with chronic bronchitis,the pulmonary hypertension was improved after operation.One case with Down's syndrome wag not significantly impmved,preoperative AHI and LSaO2 was 22.4 times/h and 0.67,and after operation was 14.2 and 0.84;2 cases accepted adenoidectomy only,snoring,mouth breathing reappeared 3 mornths after operation.pre-operative PSG results showed AHI 24.6 times/h and 26.6 times/h,LSaO2 was 0.69 and 0.73,after operation the AHI was 10.6 times/h and 8.5 times/h,LSaO2 was 0.90 and 0.88,the symptoms disappeared after adenotonsillectomy.Five cases did not have PSG because they lived far away in the other cities,their pre-operative PSG showed AHI 16.4 to 26.2 times/h,LSaO2 was 0.65 to 0.76.One year after operation,these patients were followed-up by telephone,4 children were significantly improved,1 case with mandibular symptoms showed no improvement.Conclusions For OSAHS children accompanying with risk factors

  11. 儿童肺动脉高压64例临床分析%CLINICAL ANALYSIS OF PULMONARY ARTERIAL HYPERTENSION IN 64 CHILDREN

    Institute of Scientific and Technical Information of China (English)

    杨芳; 林志; 钟日荣

    2011-01-01

    Pa vs( 6.68 ±2.49 )kPa,t =2. 800 1 ,P <0.05 ]. Except that 2 cases died,the other 47 cases 'PAP were normal in 6 months to 1 year follow up after the operation. Complex CHDPAH comprised 8 cases, their postoperative PAP were lower than preoperative PAP[ ( 5.36± 1.53 )kPa vs ( 8.77 ±2.61 )kPa,t = -3. 564 3 ,P <0.05 ]. ②Two( 2/64,3.13% )cases were adenoid hypertrophyassociated PAH, PAP was respectively 16.08kPa and 16.91kPa. After adenoidectomy, 1 case's PAP was normal, the other's PAP was lower than preoperative PAP( 10.67kPa ), but higher than normal. (③)Two( 2/64,3.13% )cases were connective tissue disease- associated PAH( CTD -PAH ), 1 case was systemic lupus erythematosus, the other was juvenile rheumatoid arthritis, PAP was respectively 16. 8kPa and 14.4kPa,2 cases all died. (④Three( 3/64,4. 68% )cases were idiopathic PAH( IPAH ), PAP was respectively 14.67 kPa,8.88 kPa and 10.67 kPa, they left hospital voluntarily. Conclusion Pediatric PAH can be caused by various diseases, etiopathogenisis must be found out. If treating earlier, the prognosis can be improved.

  12. 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

    Institute of Scientific and Technical Information of China (English)

    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

  13. 变应性鼻炎伴腺样体肥大患儿应用丙酸氟替卡松喷剂治疗的临床对照研究%Controlled Clinical Studies on Fluticasone Propionate Spray for Allergic Rhinitis Children Suffering with Adenoidal Hypertrophy

    Institute of Scientific and Technical Information of China (English)

    吴莉; 姜妍; 沈莹

    2016-01-01

    Objective:To research the efficacy and safety of fluticasone propionate spray for allergic rhinitis children suffering with adenoidal hypertrophy. Methods:Totally 160 allergic rhinitis with adenoids growth children were in the observation group, in which 109 cases were diagnosed as adenoidal hypertrophy. Totally 157 adenoids growth children were in the control group, in which 114 cases were diagnosed as adenoidal hypertrophy. The two groups both received fluticasone propionate spray treatment for 3 months, and then the nasal endoscopic adenoidectomy volume, symptom score and adverse reactions were observed and analyzed. Results:Allergic rhi-nitis children suffering with adenoidal hypertrophy were mainly in the 3-6-year-old children. After the treatment, adenoids was shrinked in 88 patients (80. 73%) in the observation group, which was significantly higher than that in the control group [67(58. 77%), P<0. 01]. Adenoidal hypertrophy was still in 44 patients (35. 03%) of the observation group after the treatment, which was lower than that of the control group [55(68. 13%), P <0. 05]. In addition, the integral differences of nasal congestion, snoring and mouth breathing in the observation group after the treatment were higher than those in the control group, and the differences were statistically significant (P<0. 05). Conclusion:The efficacy of fluticasone propionate spray used in allergic rhinitis children suffering with adenoi-dal hypertrophy is more obvious than that in adenoid hypertrophy children, which can more significantly improve the symptoms of nasal congestion, snoring and mouth breathing.%目的::研究变应性鼻炎伴腺样体肥大患儿应用丙酸氟替卡松喷剂治疗的有效性和安全性。方法:选择变应性鼻炎伴腺样体生长的患儿160例做为观察组,其中腺样体肥大者109例;选择同期单纯腺样体生长的患儿157例做为对照组,其中腺样体肥大者114例。两组患儿均接受

  14. Tonsillitis and sore throat in children

    Directory of Open Access Journals (Sweden)

    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. Tonsillitis and sore throat in children

    Science.gov (United States)

    Stelter, Klaus

    2014-01-01

    and the danger of 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. PMID:25587367

  16. 血清食欲素A对儿童阻塞性睡眠呼吸暂停低通气综合征的诊断价值%Diagnostic values of serum orexin-A levels in children with obstructive sleep apnea-hypopnea syndrome

    Institute of Scientific and Technical Information of China (English)

    阿布来提·阿布都哈尔; 徐佩茹; 多力坤

    2008-01-01

    diagnostic predictor to screen patients with OSAHS in children.Methods Serum orexin-A concentration was measured with enzyme immunoassay(EIA)kit in 60 patient with snoring before performing polysomnography(PSG).Subsequently all the subjects underwent PSG test.Forty subjects were diagnosed as having OSAHS,and twenty subjects had no OSAHS.These 20 non-OSAHS subjects served as controls.Compared with the PSG results the clinical usefulness of the measurement of orexin-A concentration in serum was assessed as a diagnostic predictor to screen patients with OSAHS.Correlation between orexin-A levels and apnea hypoventilation index(AHI),micro-arousal index(MAI)and lowest SaO2(LSaO2)were analyzed.Resuits The serum orexin-A levels in the OSAHS group[(0.49±0.10)μg/L]was significantly higher than that of the control group[(0.28±0.11)μg/L,P0.05).The serum orexin-A levels in the OSAHS children after who under wend tosiletomy and adenoidectomy significantly decreased(P<0.05)3 months after surgery as compared with pre-operation level.Condusion These findings suggest that the serum level of orexin-A could be used as a predictor in screening for OSAHS children and a biological marker of the severity of OSAHS children.

  17. 儿童反复发作型中耳炎与腺样体肥大的相关性研究%The correlation sstudies between recurrent otitis media and adenoid hypertrophy in children

    Institute of Scientific and Technical Information of China (English)

    刘卫卫; 张淑君; 张宇丽; 岳卓立; 尹桂茹

    2013-01-01

    0.15,respecticvely) (P<0.01) ; the difference of the expression of PCNA,BCL-2,CD4+,CD8+ and CD4+/CD8+ between the latter two groups was not significant.Differences of the gender or the size were not significant(P>0.05).In group of simple adnoid hypertrophy,PCNA in the subgroup of the age 3 to 6 was significantly higher than those in the other groups(P<0.05).Conclusion:In adenoid tissues of recurrent SOM patients,the activities of T-lymphocyte subsets cells in hypertrophic status increase,the adenoids enlarge and local immunity enhances.The age and gender have nothing to do with the SOM,but low age is one of the influencing factors of adenoid hypertrophy.Therefore,adenoidectomy for recurrent SOM patients with adenoid hypertrophy should be carried out as early as possible.

  18. 低温等离子腺样体射频消融术治疗儿童腺样体肥大的研究%Study of low-temperature plasma radiofrequency ablation for treatingthe children with adenoid hypertrophy

    Institute of Scientific and Technical Information of China (English)

    邢海涛; 李玉梅; 王侠

    2012-01-01

    [Objective] To investigate the clinical efficacy of nasal endoscopic assisted by-mouth low-temperature plasma radiofrequency ablation for treating the children with adenoid hypertrophy.[Methods] Seventy patients with adenoid hypertrophy were divided by random digits table method into treatment group and control group with 35 cases each.The patients in control group underwent traditional by-mouth adenoidectomy,while the patients in treatment group were treated with nasal endoscopic assisted by-mouth low-temperature plasma radiofrequency ablation.The operative time and intraoperative blood loss in two groups were calculated.The children were followed up for 6-12 months and the clinical efficacy of snoring,nasal obstruction and hearing and the postoperative complications were observed.[Results]The intrsoperative blood loss in treatment group was significantly lower than that in control group[(2.23±0.74)ml vs.(24.58±8.19)ml](t=19.733,P < 0.01).The total efficiency of snoring,nasal obstruction and hearing in treatment group was 91.4%(32/35),82.9%(29/35)and 77.1%(27/35),respectively,and which was significantly higher than that in control group[68.6%(24/35),62.9%(22/35)and 57.1%(20/35)](x2 =5.354,5.293,5.421,P<0.01).There,was no residual adenoid and adenoidal hypertrophy recurrence in treatment group,while the postoperative residual adenoid rate in control group was 91.4%(32/35),the adenoidal hypertrophy recurrence rate was 20.0%(7/35).There was significant difference in postoperative complication incidence between two groups(x2 =9.391,P < 0.01).[Conclusions] Nasal endoscopic assisted by-mouth low-temperature plasma radiofrequency ablation for treating the children with adenoid hypertrophy has better clinical efficacy,less intraoperative blood loss,no postoperative residual and other complications.It is an ideal method for treating the children with adenoid hypertrophy and worthy of clinical application.%目的 探讨鼻内镜辅助经口低温等