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Sample records for adenoidectomy

  1. Coblation adenoidectomy our experience

    Balasubramanian Thiagarajan

    2014-03-01

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

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

    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.

  3. Role of endoscopic guided partial adenoidectomy in avoiding open nasality

    Eman Mostafa

    2016-11-01

    Conclusion: There is necessity to screen potential candidates for adenoidectomy in order to prevent postoperative velopharyngeal dysfunction. Nasoendoscopy and lateral videofluroscopy have been useful to examine the palatal mobility, palatal length, depth of the pharynx and to exclude possible occult cleft palate. Partial adenoidectomy should be taken into consideration for risky patients. Satisfactory results were obtained as regards relieving nasal symptoms and maintaining velopharyngeal competence but didn’t improve quite fully the closed nasality.

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

    2015-01-01

    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 m...

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

    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?

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

    Casserly, Paula

    2010-08-01

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

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

    Sudhir M Naik

    2015-12-01

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

  9. Craniofacial characteristics and velopharyngeal function in cleft lip/palate children with and without adenoidectomy.

    Pulkkinen, Joonas; Ranta, Reijo; Heliövaara, Arja; Haapanen, Marja-Leena

    2002-02-01

    The association between velopharyngeal function, craniofacial morphology and adenoidectomy was investigated using 27 craniofacial and nasopharyngeal variables taken from lateral cephalograms. The sample consisted of 96 boys with cleft palates with or without cleft lips. They were examined at 6 years of age when cephalograms were obtained and perceptual speech assessments were performed. The subjects were divided into three groups: (1) velopharyngeal competence (VPC, n = 45); (2) mild incompetence not requiring velopharyngoplasty (VPI, n = 36); and (3) previous incompetence operated on with velopharyngoplasty ad modum Hoenig (VPP, n = 15) before the 6-year examination. The groups were further divided into two subgroups according to previous adenoidectomy (Ad+, Ad-). The cranial base, size and interrelationship of the maxilla and mandible and their relationship to the cranial base or the bony nasopharynx did not differ among the VPC, VPI and VPP groups. The sagittal depth of the nasopharyngeal airway (Pm-ad1, Pm-ad2, Pm-ad3) was significantly wider in the VPP group than in the the VPC and VPI groups. The previous adenoidectomy decreased the thickness of the posterior pharyngeal wall (ad1-Ba, ad2-so) and thus increased airway size. The length of the velum did not differ between the three groups or their subgroups with and without adenoidectomy. The results showed that adenoidectomy is a risk to velopharyngeal function by widening the nasal airway, but velopharyngeal incompetence cannot definitely be attributed to adenoidectomy.

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

    Avinash

    2014-06-01

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

  11. Trans-oral endoscopic partial adenoidectomy does not worsen the speech after cleft palate repair

    Mosaad Abdel-Aziz

    Full Text Available ABSTRACT INTRODUCTION: Adenoid hypertrophy may play a role in velopharyngeal closure especially in patients with palatal abnormality; adenoidectomy may lead to velopharyngeal insufficiency and hyper nasal speech. Patients with cleft palate even after repair should not undergo adenoidectomy unless absolutely needed, and in such situations, conservative or partial adenoidectomy is performed to avoid the occurrence of velopharyngeal insufficiency. Trans-oral endoscopic adenoidectomy enables the surgeon to inspect the velopharyngeal valve during the procedure. OBJECTIVE: The aim of this study was to assess the effect of transoral endoscopic partial adenoidectomy on the speech of children with repaired cleft palate. METHODS: Twenty children with repaired cleft palate underwent transoral endoscopic partial adenoidectomy to relieve their airway obstruction. The procedure was completely visualized with the use of a 70° 4 mm nasal endoscope; the upper part of the adenoid was removed using adenoid curette and St. Claire Thompson forceps, while the lower part was retained to maintain the velopharyngeal competence. Preoperative and postoperative evaluation of speech was performed, subjectively by auditory perceptual assessment, and objectively by nasometric assessment. RESULTS: Speech was not adversely affected after surgery. The difference between preoperative and postoperative auditory perceptual assessment and nasalance scores for nasal and oral sentences was insignificant (p = 0.231, 0.442, 0.118 respectively. CONCLUSIONS: Transoral endoscopic partial adenoidectomy is a safe method; it does not worsen the speech of repaired cleft palate patients. It enables the surgeon to strictly inspect the velopharyngeal valve during the procedure with better determination of the adenoidal part that may contribute in velopharyngeal closure.

  12. Indications of Tonsillectomy and Adenoidectomy in Dr. Hasan Sadikin General Hospital Bandung

    Dini Atiyah

    2015-03-01

    Full Text Available Background: Tonsillectomy is the intervention to take out the palatine tonsils either whole or sub capsular, while adenoidectomy is the intervention of extraction of the adenoid gland which is commonly done with curettage method. Both interventions are done to eliminate repeated infections and also obstructions due to inflammation and hypertrophy of the tonsils and adenoids. This study was conducted to examine the indications of tonsillectomy and adenoidectomy in the Departement of Otorhinolaryngology and Head Neck Surgery Dr. Hasan Sadikin General Hospital Bandung in the period of January 2009–December 2011. Methods: A cross-sectional descriptive study was conducted in October–November of 2012 using 207 medical records of patients who had tonsillectomy and adenoidectomy executed in the Department of Otorhinolaryngology and Head Neck Surgery Dr. Hasan Sadikin General Hospital, Bandung in the period of January 2009–December 2011. Data collected were age, gender, main complaint, tonsil size, history of repeated infections, history of snoring as well as of Obstructive Sleep Apnea Syndrome (OSAS. The indication for tonsillectomy and adenoidectomy such as infection, obstruction and neoplasia was selected. Results: The indications of tonsillectomy and adenoidectomy were infection at 106 (51.2% patients, obstruction at 100 (48.3% patients, and neoplasia at 1 (0.05% patient. Conclusions: The most numerous indications for tonsillectomy and tonsilloadenoidectomy in the Department of Otorhinolaryngology and Head Neck Surgery Dr. Hasan Sadikin General Hospital were infection.

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

    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.

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

    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.

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

    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

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

    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

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

    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.

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

    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.

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

    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

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

    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.

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

    Meng-meng LI

    2014-10-01

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

  2. Comparisons of thyroid hormone, intelligence, attention, and quality of life in children with obstructive sleep apnea hypopnea syndrome before and after endoscopic adenoidectomy.

    Feng, Hui-Wei; Jiang, Tao; Zhang, Hong-Ping; Wang, Zhe; Zhang, Hai-Ling; Zhang, Hui; Chen, Xue-Mei; Fan, Xian-Liang; Tian, Yu-Dong; Jia, Tao

    2015-01-01

    Objective. The aim of this study was to compare the differences in thyroid hormone, intelligence, attention, and quality of life (QoL) of children with obstructive sleep apnea hypopnea syndrome (OSAHS) before and after endoscopic adenoidectomy. Method. A total of 35 OSAHS children (21 males and 14 females with a mean age of 6.81 ± 1.08 years) were included in this study for analyzing the levels of thyroid hormone, intelligence, attention, and QoL. There were 22 children underwent endoscopic adenoidectomy with bilateral tonsillectomy (BT), while the other 13 children who underwent endoscopic adenoidectomy without bilateral tonsillectomy without BT. Results. Our results revealed no significant difference in serum free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) levels in OSAHS children before and after endoscopic adenoidectomy (all P > 0.05). However, there were significant differences in full-scale intelligence quotient (FIQ) (92.45 ± 5.88 versus 106.23 ± 7.39, P intelligence quotient (VIQ) (94.17 ± 15.01 versus 103.91 ± 9.74, P = 0.006), and performance intelligence quotient (PIQ) (94.12 ± 11.04 versus 104.31 ± 10.05, P = 0.001), attention (98.48 ± 8.74 versus 106.87 ± 8.58, P intelligence, attention, and QoL of OSAHS children may be significantly improved after endoscopic adenoidectomy.

  3. Detection of Respiratory Viruses in Nasopharyngeal Swab and Adenoid Tissue from Children Submitted to Adenoidectomy: Pre- and Postoperative Analysis

    Biill Primo, Osvaldo Vinícius

    2014-01-01

    Full Text Available Introduction The presence of respiratory viruses in lymphoid tissues of the nasopharynx and oropharynx and its impact on recurrent infections and hypertrophy of these tissues are not yet fully understood. Objective To identify and determine the prevalence of major respiratory viruses in nasopharyngeal secretions and adenoid tissue pre- and postoperatively of children undergoing adenoidectomy. Methods A prospective observational study was conducted in 36 patients under 12 years of age with upper airway lymphoid hypertrophy who were undergoing adenoidectomy, in which various respiratory viruses were investigated using real-time polymerase chain reaction in adenoid tissue and nasopharyngeal secretions collected preoperatively and 30 days postoperatively. Results At least 1 viral agent was isolated in any of the samples collected in 58.3% of children and 25.9% of total samples. Respiratory viruses were identified in 33.8% of preoperative nasopharyngeal specimens and in 19.8% of postoperative secretion. Of the 21 patients with positive results for any respiratory virus, 6 (28.6% had more than 1 virus. Considering all 36 respiratory viruses found, the main agent isolated was rhinovirus (27.8%, followed by bocavirus (22.2%. Conclusion The virus found more frequently in all samples was rhinovirus. After removal of adenoid tissue, there was a decrease in the prevalence of the virus contained in nasopharyngeal secretion 30 days after surgery.

  4. Postobstructive Pulmonary Edema following Tonsillectomy/Adenoidectomy in a 2-Year-Old with Poland-Moebius Syndrome

    Tanisha Powell

    2016-01-01

    Full Text Available A 2-year-old male with Poland-Moebius syndrome was transferred from a local hospital to the Pediatric ICU at Children’s Hospital of Georgia for suspected postobstructive pulmonary edema (POPE after tonsillectomy/adenoidectomy (T&A. The patient’s respiratory status ultimately declined and he developed respiratory failure. Imaging suggested pulmonary edema as well as a left-sided pneumonia. Echocardiogram showed pulmonary hypertension and airway exam via direct fiberoptic bronchoscopy revealed tracheomalacia and bronchomalacia. He developed acute respiratory distress syndrome (ARDS and remained intubated for ten days. This case highlights the association between congenital upper body abnormalities with cranial nerve dysfunction and the development of POPE with delayed resolution of symptoms. Patients with upper body abnormalities as above are at great risk of postoperative complications and should therefore be managed in a tertiary-care facility.

  5. Postobstructive Pulmonary Edema following Tonsillectomy/Adenoidectomy in a 2-Year-Old with Poland-Moebius Syndrome

    Powell, Tanisha; Sharma, Nirupma; McKie, Kathleen T.

    2016-01-01

    A 2-year-old male with Poland-Moebius syndrome was transferred from a local hospital to the Pediatric ICU at Children's Hospital of Georgia for suspected postobstructive pulmonary edema (POPE) after tonsillectomy/adenoidectomy (T&A). The patient's respiratory status ultimately declined and he developed respiratory failure. Imaging suggested pulmonary edema as well as a left-sided pneumonia. Echocardiogram showed pulmonary hypertension and airway exam via direct fiberoptic bronchoscopy revealed tracheomalacia and bronchomalacia. He developed acute respiratory distress syndrome (ARDS) and remained intubated for ten days. This case highlights the association between congenital upper body abnormalities with cranial nerve dysfunction and the development of POPE with delayed resolution of symptoms. Patients with upper body abnormalities as above are at great risk of postoperative complications and should therefore be managed in a tertiary-care facility. PMID:26942029

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

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

    2015-05-01

    Haemophili are pathogenic or opportunistic bacteria often colonizing the upper respiratory tract mucosa. The prevalence of Haemophilus influenzae (with serotypes distribution), and H. parainfluenzae in the nasopharynx and/or the adenoid core in children with recurrent pharyngotonsillitis undergoing adenoidectomy was assessed. Haemophili isolates were investigated for their ability to biofilm production.Nasopharyngeal swabs and the adenoid core were collected from 164 children who underwent adenoidectomy (2-5 years old). Bacteria were identified by the standard methods. Serotyping of H. influenzae was performed using polyclonal and monoclonal antisera. Biofilm formation was detected spectrophotometrically using 96-well microplates and 0.1% crystal violet.Ninety seven percent (159/164) children who underwent adenoidectomy were colonized by Haemophilus spp. The adenoid core was colonized in 99.4% (158/159) children, whereas the nasopharynx in 47.2% (75/159) children (P influenzae were identified, in 22.6% (36/159) children only (nonencapsulated) H. influenzae NTHi (nonencapsulated) isolates were present, whereas 7.5% (12/159) children were colonized by both types. 14.5% (23/159) children were colonized by untypeable (rough) H. influenzae. In 22% (35/159) children H. influenzae serotype d was isolated. Totally, 192 isolates of H. influenzae, 96 isolates of H. parainfluenzae and 14 isolates of other Haemophilus spp. were selected. In 20.1% (32/159) children 2 or 3 phenotypically different isolates of the same species (H. influenzae or H. parainfluenzae) or serotypes (H. influenzae) were identified in 1 child. 67.2% (129/192) isolates of H. influenzae, 56.3% (54/96) isolates of H. parainfluenzae and 85.7% (12/14) isolates of other Haemophilus spp. were positive for biofilm production. Statistically significant differences (P = 0.0029) among H. parainfluenzae biofilm producers and nonproducers in the adenoid core and the nasopharynx were detected.H. influenzae and H

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

    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.

  8. Effect of adenoidectomy on pediatric chronic rhinosinusitis%腺样体切除术治疗儿童慢性鼻窦炎的疗效

    李欣; 张国芳

    2014-01-01

    Objective To investigate the curative effect of adenoidectomy on pediatric chronic rhinosinusitis (CRS).Methods One hundred and twenty-eight children with CRS were divided into two groups,drug treatment group (n =64) and operation treatment group (n =64).The children in drug treatment group were given systemic medication.The patients in operation treatment group were treated with regulary drug and adenoidectomy by nasal endoscope.All patients were followed up for half a year.Results In drug treatment group,36 patients were cured,12 patients got better,16 patients were invalid,the effective rate was 75.00%.In operation treatment group,46 patients were cured,13 patients got better,5 patients were invalid,the effective rate was 92.19%.Conclusions Regular drug treatment is effective for children with CRS.But the curative effect of adenoidectomy combined with regular drug treatment is better than regular drug treatment alone.%目的 探讨腺样体切除术治疗儿童慢性鼻窦炎(CRS)的疗效.方法 将128例CRS患儿分成药物治疗组(n=64)和手术治疗组(n=64).药物治疗组给予系统的药物治疗,手术治疗组在系统的药物治疗的同时,选择最佳手术时机行鼻内镜下行腺样体切除术.所有患者随访半年.结果 药物治疗组治愈36例,好转12例,无效16例,有效率为75.00%;手术治疗组治愈46例,好转13例,无效5例,有效率为92.19%.结论 系统规范的药物治疗有效,但系统、规范的药物治疗同时配合腺样体切除术疗效明显优于药物治疗组.

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

    J. C. Andreu Ballester

    2005-03-01

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

  10. 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

    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.

  11. 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

    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

  12. 腺样体切除术对儿童慢性鼻-鼻窦炎治疗效果的研究%The Effect of Nasal Endoscopy Assisted Adenoidectomy on Chronic Rhinosinusitis in Pediatric Patients

    郑天其; 郭朝先; 刘晓海

    2014-01-01

    目的:观察鼻内镜下腺样体切除术对儿童慢性鼻窦炎的治疗效果。方法对120例腺样体肥大伴慢性鼻窦炎的患儿进行分组治疗,手术治疗组64例,药物治疗组56例,随访观察3个月,比较两组治疗效果。结果手术治疗组的病情完全控制率和总有效率明显高于药物治疗组,差异有统计学意义( P<0.05)。结论腺样体切除术对儿童慢性鼻窦炎有显著的治疗效果。%Objective To explore the effect of nasal endoscopy assisted adenoidectomy with debrider on chronic rhinosi-nusitis in children. Methods 120 pediatric patients with adenoid hypertropy and chronic rhinosinusitis were randomly allocated into two groups, the surgical group with 64 cases who were underwent nasal endoscopy assisted adenoidectomy with debrider and the control group with 56 cases who ere treated with medicines. Results Afer three months follow-up from treatment, the com-plete control rate and total effective rate in operation group were remarkably higher than those in control group, which were of sig-nificant differences statistically ( P<0. 05 ) . Conclusion Nasal endoscopy assisted adenoidectomy is of great effect on chronic rhinusitis in pediatric patients.

  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

    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. Analysis of Adenoidectomy in the Treatment of Children with Chronic Rhinosinusitis%探析腺样体切除术治疗儿童慢性鼻-鼻窦炎

    冯云

    2015-01-01

    目的:探讨腺样体切除术治疗儿童慢性鼻窦炎的治疗效果。方法:选取80例慢性鼻-鼻窦炎儿童患者作为研究对象,经同意将患儿平均分为对照组与治疗组,对照组采用单纯药物控制,治疗组在对照组的基础上执行腺样体切除术,对比两组患儿的治疗有效率。结果:治疗组的总有效率(100%)明显大于对照组(65%),组间差距具有统计学意义(P<0.05);且在复发率、总治疗时间、总治疗花费上,治疗组数据明显小于对照组,组间差异具有统计学意义(P<0.05)。结论:腺样体切除术对治疗儿童慢性鼻-鼻窦炎疾病具有非常好的疗效,值得在临床中推广使用。%Objective: To investigate the therapeutic effect of adenoidectomy in the treatment of children with chronic sinusitis. Methods: 80 patients with chronic rhinosinusitis in children patients as the research object, upon the consent of patients were divided into the control group and treatment group, the control group using a simple drug control, the treatment group performed adenoidectomy on the basis of the control group, treatment of two groups were compared the effective rate. Results: the total efficiency of the treatment group(100%)is obviously higher than that of control group(65%), statistically signiifcant difference(P<0.05); and the recurrence rate, total treatment time, the total cost of treatment, the treatment group data was signiifcantly less than the control group, with statistically signiifcant difference between groups(P<0.05). Conclusion: Adenoidectomy has very good curative effect on the treatment of children with chronic rhinosinusitis and disease, it is worth promoting in clinical use.

  15. 腺样体切除术对分泌性中耳炎转归的影响%The Effect of Adenoidectomy on the Prognosis of Secretory Otitis Media

    廖敏

    2013-01-01

    Objective: To investigate the ef ect of adenoidectomy on the prognosis of secretory otitis media. Methods:120 cases with secretory otitis media treated in our hospital from October 2010-October 2012. Al patients were given nasal endoscopic adenoidectomy in the treatment of ef ect of adenoidectomy on the prognosis of secretory otitis media. Results:110 cases recovered in al patients,7 cases were improved,3 cases inef ective,the total ef iciency of 97.50%. Moderate hypertrophy and secretory otitis media in patients with 24 cases,accounting for 20%;37 cases of pathological hypertrophy complicated with secretory otitis media patients,accounted for 30.83%. The dif erence between the two groups was statistical y significant (P<0.05). Dif erent degrees of uvula and soft palate edema in patients after operation, recovered after symptomatic treatment,1 patients without operation complication. Conclusion:Transnasal endoscopic adenoidectomy is ef ective in the treatment of secretory otitis media,prognosis,the prognosis for disease is safe and reliable,worthy of clinical application.%目的探讨腺样体切除术对分泌性中耳炎转归的影响。方法收集2010年10月~2012年10月于我院接受治疗的分泌性中耳炎患者120例,均给予经鼻内镜下行腺样体切除术治疗。分析腺样体切除术对分泌性中耳炎转归的影响。结果所有患者中痊愈110例,好转7例,无效3例,总有效率97.50%。中度肥大合并分泌性中耳炎患者24例,占20.00%;病理性肥大合并分泌性中耳炎患者37例,占30.83%;两组比较差异具有统计学意义(P<0.05)。患者手术后出现不同程度的悬雍垂以及软腭水肿,对症治疗后痊愈,无1例患者出现手术并发症。结论经鼻内镜下行腺样体切除术可有效治疗分泌性中耳炎,利于疾病的预后转归,值得临床推广。

  16. Experience with adenoidectomy under nasal endoscope for children's snoring diseases%鼻内镜下腺样体切除术治疗儿童鼾症的体会

    刘建国; 李建瑞

    2009-01-01

    目的 总结鼻内镜下电动吸切器切除腺样体的技术优势.方法 在鼻内镜下行经鼻腔、口腔径路吸割腺样体20例,治疗由腺样体肥大引起的儿童鼾症.结果 术后腺样体切除彻底,无残留,鼻咽部结构显示良好,无出血、无咽鼓管损伤等并发症发生.随访6~12个月,患者睡眠打鼾、鼻阻塞、流脓涕及听力障碍等症状均消失或明显缓解.结论该法避免了操作的盲目性,增加了手术的安全性和准确性,提高了疗效,减少了手术并发症.%Objective To sum up the experience with adenoidectomy for children's snoring diseases at electrical cutter with suction under nasal endoscopes. Methods 20 cases with children chronic sinusitis, sleep respiratory disorder, heating loss caused by adenoid hypertrophy were operated through nose and month route un-der nasal endoscope in adenoidectomy, with the one year follow-up. Results The adenoid gland was removed completely without of destroying the normal anatomic character. Conclusion The application of double-route nasal endoscope provides a direct and clear view that allows the surgeon to remove adenoid tissue more accurate-ly and effectively with less complications.

  17. 鼻内镜下腺样体切除术治疗摩洛哥儿童慢性鼻-鼻窦炎临床研究%Clinical Study on Nasal Endoscopy-assisted Adenoidectomy in Treatment of Pediatric Chronic Rhinosinusitis in Morocco

    火英明

    2014-01-01

    To observe the clinical effect of adenoidectomy in treatment of children with chronic rhinosinusitis associated with adenoid hypertrophy in Morocco.To investigate the therapeutic effect of surgical procedures on cases with adenoidal hypertrophy performed either by endoscope-assisted adenoidectomy or by classic trans-oral surgery.Methods:128 children cases with chronic rhinosinusitis associated with adenoid hypertrophy,were randomized divided into three groups.The treatment group (44 cases) were operated by endoscope-assisted adenoidectomy,the control group (44 cases) were operated by classic trans-oral surgery,the medication group(40 cases) were given Amoxicillin orally and fluticasone nasal spray,the three groups were followed up for 3 months.Results:After adenoidectomy treatment,the effective rate of the treatment group was 93.18%(41/44),the control group was 86.36%(38/44),the medication group was 72.50%(29/40).the children'clinical effect of adenoidectomy 89.77%(79/88)were higher than those medicamentosus 72.50%(29/40),the difference were statistically significant(P<0.05).Compared with classic trans-oral surgery,endoscope-assisted adenoidectomy had the advantages of security and less bleeding.Conclusion:By the endoscopy adenoidectomy,the surgical field is clearly;the extent of resection is precisely,and the operative method is easy to master.Adenoidectomy are of positive effects for the prognosis of children with chronic rhinosinusitis associated with adenoid hypertrophy.%目的:观察鼻内镜下腺样体切除术对伴有腺样体肥大的慢性鼻-鼻窦炎患儿的治疗疗效,比较鼻内镜下腺样体切除术与传统腺样体刮除术的疗效。方法:128例腺样体肥大的慢性鼻-鼻窦炎患儿,随机分成三组,治疗组44例儿童鼻窦炎患者行鼻内镜下腺样体切除,对照组44例采用传统腺样体刮除术,药物治疗组40例,按照年龄或体重,予口服阿莫西林并鼻腔内应用氟替卡松喷剂,均

  18. 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

    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

  19. Clinical study on adenoidectomy in the treatment of chronic rhinosinusitis in children%腺样体切除术治疗儿童慢性鼻-鼻窦炎的临床研究

    蔡建良; 官树雄; 王继群

    2014-01-01

    Objective To observe the clinical effect of adenoidectomy in the treatment of children with chronic rhinosinusitis ,to discuss its postoperative complications and postoperative rehabilitation .Methods Chose 100 children with chronic rhinosinusitis from February 2011 to April 2013 treated in our hospital as observation objects ,the cases were randomly divided into experimental group and control group ,with 50 cases in each group ,patients in experimental group was given drug and adenoidectomy treatment ;patients in control group was given drug orally external treatment only .Observed the postoperative complications and postoperative recovery ,then compared treatment effect of two groups .Results The total efficiency of experimental group was 96% ,control group was 60% ,the difference was statistically significant (P<0 .05);compared with those before operation ,there were significant differ-ence in experiment group in postoperative snoring ,purulence stuff ,sinus patency ,etc(P<0 .05) .Moreover ,experimental group and control group had difference in hospitalization days .The control group not only had high cost and long hospital stay but also had relatively high recurrence rate (P<0 .05) .Conclusion The curative effect of adenoidectomy combined with drugs in the treatment of children with chronic rhinosinusitis was much better than drug treatment only .%目的:观察腺样体切除术治疗儿童慢性鼻-鼻窦炎(C RS )的临床疗效,探讨其术后并发症和术后康复情况。方法选取2011年2月至2013年4月来东莞市厚街医院耳鼻咽喉外科住院治疗的C RS患儿100例,分为实验组和对照组,每组各50例。实验组给予药物联合腺样体切除术治疗,对照组给予单纯药物内服加外服治疗。观察两组术后并发症及术后恢复情况,对比两组治疗效果。结果总有效率实验组为96%,对照组为60%,两者差异有统计学意义( P<0.05);与术前比较,实验组术

  20. 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

    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.

  1. 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

    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.

  2. 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

    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.

  3. The application for oxycodone in pediatric tonsillectomy,adenoidectomy children%羟考酮在小儿扁桃体、腺样体切除术中的应用

    山淇; 王宏宇; 李春晖; 蔡巍

    2016-01-01

    Objective The experiment was designed to investigate the influence of general anesthesia intravenous oxyc-odone different programs for children. Methods Elective tonsillectomy,adenoidectomy surgical cases was 120. There were children and 3-6 years old, divided into four groups of 30 children randomly. Group A induction was given oxycodone 0. 1mg/kg;Group B induction received oxycodone 0. 2mg Group C administered during the induction was oxycodone 0. 3mg/kg;Group D induction received fentanyl 5μg/kg;If severing was intubation,added fentanyl 0. 1μg/kg. IV induction:propofol 3mg/kg,cisatracurium besilate 0. 1mg/kg. Insert an endotracheal tube for mechanical ventilation. Record the children bur-glary quiet after 5min(T0),intubation(T1) of MAP,HR;extubation time and after SpO2,and RR for extubation. Record ag-itation score after extubation,one hour after the state of consciousness alertness/sedation( OAA/S) rating,nausea,vomiting incidence and extent of bleeding after tonsillectomy. Results A group,MAP and HR for T1 to T0 was increased significant-ly(P0. 01) . Compared with group D,group C extubation time was significantly longer(P0. 01 ) . After extubation, SpO2 and RR four groups was no significant difference ( P >0. 01). Restlessness score after extubation,group A,B and C was significantly lower than that in group D(P0.01)。与D组相比,C组拔管时间明显延长(P0.01)。四组拔管后的SpO2、RR没有明显差异(P>0.01)。拔管后躁动评分,A组、B组、C组明显低于D组(P<0.01)。 D组拔管后恶心、呕吐发生率明显高于A、B两组(P<0.01),与C组无明显差异。结论对于3~6岁接受扁桃体腺样体切除术的患儿,在诱导时给予0.2mg/kg的羟考酮是比较理想的注射方案。

  4. Curative efficacy of drug treatments in combination with adenoidectomy in children with chronic rhinosinusitis and its effects on life quality%药物联合腺样体切除术治疗儿童慢性鼻-鼻窦炎疗效及对患儿生活质量的影响

    马新明

    2015-01-01

    目的探讨药物联合腺样体切除术治疗儿童慢性鼻-鼻窦炎(CRS)疗效及对患儿生活质量的影响。方法92例符合纳入标准的儿童 CRS 患者按治疗方案分为药物组(n =34)和药物联合手术组(n =58)。药物组给予抗生素、糖皮质激素及鼻腔冲洗等治疗,药物联合手术组在上述药物治疗基础上给予腺样体切除术。观察比较两组患者治疗前后视觉模拟量表(VAS)症状评分、鼻内镜评分、鼻窦 CT 评分及生活质量评分。结果治疗后,与药物组相比,药物联合手术组流涕、鼻塞、面颊部疼痛或胀痛、头痛及嗅觉减退的 VAS 评分、鼻内镜评分及鼻窦 CT 评分显著下降( P 均0.05)。结论药物联合腺样体切除术治疗儿童 CRS 疗效可靠,能够显著缓解临床症状,改善鼻-鼻窦黏膜病变,并能明显提高患儿生活质量。对具有腺样体切除术指征的儿童患者应采用药物联合手术方式治疗。%Objective To investigate the clinical effect of drug treatments in combination with adenoidectomy in children with chronic rhi-nosinusitis(CRS)and its effects on life quality. Methods 92 cases of children with CRS meeting the inclusion criteria were divided into the drug group(n = 34)and the drug combined with surgery group(n = 58)according to therapeutic schemes. The patients of drug group were given anti-biotics,glucocorticoid and nasal cavity irrigation. Vesides that,the drug combined with surgery group was given concurrent adenoidectomy. Then, scores of visual analogue scale(VAS)reflecting clinical symptoms,nasal endoscopy and assessment of sinus with CT examination were compared. Results In comparison with the drug group after the treatment,VAS scores of nasal discharge,nasal obstruction,cheek pain,headache,hypos-mia,score of endoscopy and score of assessment of sinus with CT examination was respectively statistically lower in the drug combined with surgery group(all P 0. 05

  5. 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

    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

  6. 曲马多用于儿童鼻内窥镜下腺手术30例的超前镇痛效应研究%Preemptive Analgesic Effect of Tramadol in Pediatric Adenoidectomy by Nasal Endoscopy in 30 Cases

    程惠平; 吴城; 路建

    2013-01-01

    Objective To investigate the effect of preemptive analgesia of tramadol by intravenous injection in pediatric adenoidectomy by nasal endoscopy.Methods 60 children patients with adenoidal hypertrophy undergoing elective adenoidectomy by nasal endoscopy under general anesthesia were selected and divided into the preemptive analgesia group(T) and the control group(P) randomly and equally.The group T was intravenously dripped with tramadol 2 mg/kg before anesthetic induction,while the group P with 0.9% sodium chloride solution 5 mL before anesthetic induction.The two groups were performed the operation by the target controlled infusion(TCI) of remifentanil hydrochloride combined low concentration isoflurane inhalation anesthesia.All children patients were sent into PACU after extubation and from this time point the visual analog scale (VAS) scores,Ramsay sedation score,postoperative nausea and vomiting (PONV),and adverse reactions at the timepoints of 0,2,4,6,12,24 h were recorded.Results The VAS and Ramsay sedation scores at the timepoints of 0-6 h in the group T were superior to those in the group P (P < 0.05).There were no significant differences in the VAS and Ramsay sedation scores at the timepoints of 12-24 h between the two groups(P>0.05).No severe adverse reactions were found in both the two groups.Conclusion Tramadol can provide effective and safe preemptive analgesia in pediatric adenoidectomy by nasal endoscopy.%目的 观察麻醉前静脉注射曲马多在儿童鼻内窥镜下腺样体切除术的超前镇痛效果.方法 选择60例腺样体肥大患儿择期行鼻内窥镜下腺样体切除术,随机均分成曲马多超前镇痛组(T组)与对照组(P组).于麻醉诱导前T组静脉注射曲马多2 mg/kg,P组静脉注射0.9%氯化纳注射液5 mL,两组患儿均在靶控输注(TCI)盐酸瑞芬太尼复合低浓度异氟烷吸入麻醉下手术.患儿拔除气管导管后送入麻醉后恢复室(PACU),记录此时点起0,2,4,6,12,24 h患儿的

  7. 曲马多用于儿童鼻内窥镜下腺手术30例的超前镇痛效应研究%Preemptive Analgesic Effect of Tramadol in Pediatric Adenoidectomy by Nasal Endoscopy in 30 Cases

    程惠平; 吴城; 路建

    2014-01-01

    目的:观察麻醉前静脉注射曲马多在儿童鼻内窥镜下腺样体切除术的超前镇痛效果。方法选择60例腺样体肥大患儿择期行鼻内窥镜下腺样体切除术,随机均分成曲马多超前镇痛组(T组)与对照组(P组)。于麻醉诱导前T组静脉注射曲马多2 mg/kg,P组静脉注射0.9%氯化纳注射液5 mL,两组患儿均在靶控输注(TCI)盐酸瑞芬太尼复合低浓度异氟烷吸入麻醉下手术。患儿拔除气管导管后送入麻醉后恢复室(PACU),记录此时点起0,2,4,6,12,24 h患儿的疼痛视觉模拟评分(VAS)、Ramsay镇静评分,以及术后恶心呕吐(PONV)发生情况以及药物副作用等。结果0~6 h各时点内T组的VAS评分及Ramsay镇静评分均优于P组( P0.05)。两组均未见严重药品不良反应。结论曲马多可为儿童鼻内窥镜下腺样体切除术提供有效、安全的超前镇痛。%Objective To investigate the effect of PreemPtive analgesia of tramadol by intravenous injection in Pediatric adenoidectomy by nasal endoscoPy. Methods 60 children Patients with adenoidal hyPertroPhy undergoing elective adenoidectomy by nasal endoscoPy under general anesthesia were selected and divided into the PreemPtive analgesia grouP ( T ) and the control grouP ( P ) randomly and e-qually. The grouP T was intravenously driPPed with tramadol 2 mg/kg before anesthetic induction, while the grouP P with 0. 9% sodium chloride solution 5mL before anesthetic induction. The two grouPs were Performed the oPeration by the target controlled infusion ( TCI ) of remifentanil hydrochloride combined low concentration isoflurane inhalation anesthesia. All children Patients were sent into PACU after extubation and from this time Point the visual analog scale ( VAS ) scores, Ramsay sedation score, PostoPerative nausea and vomiting ( PONV ) , and adverse reactions at the timePoints of 0, 2, 4, 6, 12, 24 h were recorded. Results The VAS and Ramsay

  8. 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

    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

  9. 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

    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

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

    Ilana Fukuchi

    2005-08-01

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

  11. Parental smoking related to adenoidectomy and tonsillectomy in children.

    Said, G; Zalokar, J; Lellouch, J; Patois, E

    1978-06-01

    Histories of adenoïdectomy and tonsillectomy were ascertained, as well as smoking habits of both parents, using questionnaires answered by 3920 schoolchildren aged 10 to 20. Adenoïdectomy and/or tonsillectomy, considered as an index of repeated upper respiratory tract disease in early childhood, was very significantly related to the amount of smoking by each parent. This relationship persisted when age, sex, day nursery attendance, sibship size, and history of appendicectomy were controlled.

  12. Application of double route nasal endoscope in adenoidectomy%鼻内镜双径路吸割术治疗腺样体肥大

    刘贤; 李鹏; 叶进; 王涛; 杨钦泰

    2006-01-01

    目的探讨将鼻内镜技术用于双径路腺样体刮除术的可行性.方法在鼻内镜下行经鼻腔、经口腔双径路腺样体吸割术60例,治疗由腺样体肥大引起的儿童慢性鼻窦炎、睡眠呼吸障碍和咽鼓管功能障碍,并进行随访.结果术后腺样体切除彻底,无残留,鼻咽部结构显示良好,无出血、无咽鼓管损伤等并发症发生,随访6~12个月,患者睡眠打鼾、鼻阻塞、流脓涕及听力障碍等症状均消失或明显缓解.结论该法避免了操作的盲目性,增加了手术的安全性和准确性,提高了疗效,减少了手术并发症.

  13. 鼻内镜下等离子小儿腺样体切除临床观察%Endoscopy-assisted Plasm Radiofrequency Adenoidectomy in Children

    许建峰; 王英; 吴建华; 王会河; 贾玉芬; 王建华

    2008-01-01

    Objective To observe the effects of plasm radiofrequency therapy in the treatment of adenoid hypertrophy under endoscope.Methods Sixty-one children of hypertrophied adenoid with otitis media with effusion,OSAHS and pediatric chronic rhinosinusitis were treated under endoscopy-assisted plagm radiofrequency therapy.Results All children had been followed for 6~18 months,20 children(40ears)with otitis media with effusion cured,one uncured;25 children with OSAHS and 15 with pediatric chronic rhinosinusitis cured.No adenoid wag residual and no complication occurred.Conclusion Utilizing plagm radiofrequency in the treatment of adenoid hypertrophy under endoscope had the advantages of direct and clear view of surgical area that allows the surgeons to remove adenoids accurately and avoid damage of normal nasopharyngeal structures,obvious curative effect,easy to operate and high safety,mini invagive and with few complication.%目的 探讨鼻内镜下应用等离子技术切除肥大腺样体的疗效.方法 对61例腺样体肥大合并分泌性中耳炎、OSAHS和慢性鼻-鼻窦炎的患儿在鼻内镜直视下行等离子性等离子腺样体切除术,并辅以鼓膜穿刺、扁桃体切除、上颌窦穿刺等治疗,观察术后疗效.结果 术后随访6~18个月,21例(41耳)分泌性中耳炎患儿中20例痊愈,1例未愈;25例OSAHS和15例慢性鼻-鼻窦炎患儿均痊愈.结论 鼻内镜下应用等离子技术切除腺样体具有视野清楚、创伤小、定位准确、安全性高,是一种较先进的治疗方法.

  14. Tuberous Sclerosis Complex National Database

    2006-10-01

    Unknown If yes, what treatment was performed (choose all that apply): Treatment Number of times treatment was performed Laser ...intervention (e.g., adenoidectomy, tonsillectom Surgical intervention (e.g., adenoidectomy, tonsillectomy , y

  15. Curative Effect Contrast of Nasal Endoscopic Caliber Road Adenoidectomy with Nasal Path Adenoidectomy%鼻内镜下经口径路腺样体切除术与经鼻径路腺样体切除术的疗效对比

    王守玺

    2015-01-01

    Objective To explore the endoscopic trans caliber road adenoidectomy with nasal path adenoidectomy clinical therapeutic effect. Methods Retrospective analysis from April 2009 to April 2013 year in the hospital treated 113 cases of adenoid hypertrophy in patients with clinical data, were randomly divided into nasal endoscopic caliber road adenoidectomy group and endoscopic transnasal approach adenoidectomy group, compared two groups of patients during the treatment of bleeding volume, operation after the healing time, adverse reactions and complications. Results Nasal endoscopic caliber road adenoidectomy group the amount of intraoperative bleeding was 9-12 mL, average bleeding volume was (11.3±0.1)mL, endoscopic transnasal approach adenoidectomy group, amount of bleeding was 13-15 mL, average bleeding volume was (14.1±0.09)mL, two groups had signiifcant difference (P<0.05); patients two in the group were not injured torus and pharyngeal ostium of eustachian tube phenomenon, but the nasal route adenoidectomy group had 2 cases of nasal adhesion. The day after, second days late transnasal endoscopic adenoidectomy breath caliber road, snoring, sleep in the patients symptoms were relieved or disappeared, and the nasal endoscopic path adenoidectomy were improved signiifcantly (P<0.05). Conclusion Nasal endoscopic caliber road adenoidectomy with nasal path adenoidectomy with little trauma, less complications, the treatment effect is more precise, is a reliable method for the clinical treatment of adenoidal hypertrophy, is worthy to be popularized.%目的:探究鼻内镜下经口径路腺样体切除术与经鼻径路腺样体切除术的临床治疗效果。方法回顾性分析2009年4月至2013年4月本院收治113例的腺样体肥大患者临床资料,患者随机分成鼻内镜下经口径路腺样体切除术组和鼻内镜下经鼻径路腺样体切除术组,比较两组患者治疗过程中出血量、术后愈合时间、不良反应及并发症情况。结果鼻内镜下经口径路腺样体切除术组术中出血量为9~12mL,平均出血量(11.3±0.1)mL,鼻内镜下经鼻径路腺样体切除术组出血量为13~15mL,平均出血量为(14.1±0.09)mL,两组差异显著(P<0.05);两组患者术中均未发生损伤圆枕及咽鼓管咽口的现象,但经鼻径路腺样体切除术组有2例患儿出现鼻腔粘连。术后当天、最迟第2天鼻内镜下经口径路腺样体切除术组患者睡眠中憋气、打鼾等症状减轻甚至消失,与鼻内镜下经鼻径路腺样体切除术组相比差异显著(P<0.05)。结论鼻内镜下经口径路腺样体切除术较经鼻径路腺样体切除术创伤小、并发症少,治疗效果更加确切,是临床上治疗腺样体肥大的可靠方法,值得推广使用。

  16. An Analysis of the Surgery Scheduling Process at Madigan Army Medical Center, Tacoma, Washington

    1986-07-29

    38500 Retroperitoneal Lymphadenectomy 38780 Dentoalveolar Structures 41899 Tonsillectomy /Adenoidectomy, 42820 Under 12 Tonsillectomy /Adenoidectomy...42821 12 or over Tonsillectomy , Under 12 42825 Tonsillectomy , 12 & Over 42826 Adenoidectomy, Under 12 42830 Excision Submandibular Gland 42440...CASE CODE Laser Destruction Vulva 56507 Anterior Colporrhaphy 57240 Cerclage of Utrine Cervix 57700 Biopsy of Cervix 57520 Dilation and Curettage

  17. Paediatric refractory rhinosinusitis secondary to hypertrophied adenoids: management and review of literature.

    Gautham MK

    2014-06-01

    Full Text Available Background /Objectives: Hypertrophied adenoids are the most common cause of refractory sinusitis in paediatric age. We study 42 cases of patients of chronic adenoiditis with adenoid facies and refractory chronic rhinosinusitis managed by endoscopic assisted adenoidectomy (EAA and conventional adenoidectomy (CA. Materials and method: 42 cases of chronic refractory sinusitis with adenoid facies secondary to hypertrophied adenoids were randomized into 2 groups during the study period of 12 months from August 2012 to July 2013. Group A (n=21 underwent endoscope assisted adenoidectomy and Group B(n=21 underwent conventional adenoidectomy. 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.

  18. 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

    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.

  19. ANALYSIS OF THE THERAPEUTIC EFFECT OF ADENOIDECTOMY WITH NASAL ENDOSCOPE IN THE TREATMENT OF PEDIATRIC RHINOSINUSITIS%鼻内窥镜下腺样体切除对小儿慢性鼻窦炎的疗效分析

    刘定荣

    2008-01-01

    [目的]探讨小儿慢性鼻窦炎伴腺样体肥大采用腺样体切除的价值.[方法]选择86例鼻窦炎患儿无鼻中隔偏曲及鼻息肉,伴腺样体肥大,随机分成手术组和对照组.手术组行鼻内窥镜下腺样体切除木,对照组给予药物治疗.[结果]6月后,手术组有效率83.72%,对照组有效率39.53%,两者差异有统计学意义(P<0.01).[结论]选择合适的病例,鼻内窥镜腺样体切除对小儿慢性鼻窦炎疗效满意.

  20. An Ambulatory Surgery Service Feasibility Study at Madigan Army Medical Center, Tacoma, Washington

    1978-08-01

    and the security clalsifation of the title enclosed in parentheses. A have a potential for becomine accepted terms. ’ Laser " and report with a...Rhinoplasty Tonsillectomy Adenoidectomy Tonsillectomy with Adenoidectomy (T&A) Abdominal Surgery Repair inguinal hernia Repair umbilical hernia... Tonsillectomies , Adenoidectomies 30 or T&A Total procedures 476 Under the present Capitation Budgeting Demonstration system being utilized by MAMC20 savings can

  1. Ambulatory Care Data Base (ACDB) Data Dictionary Sequential Files of Phase 1

    1989-11-01

    CRYOTHERAPY (CO2, L. TQUID N) 17381 LASER THERAPY, EXCISION 17382 LASER THERAPY, VASCULAR 17383 LASER THERAPY, VERRUCA 17385 LASER THERAPY, OTHER 19000...31545 LARYNGOSCOPY, DIRECT, OPERATIVE W/ LASER 31575 LARYNGOSCOPY, FLEXIBLE FIBEROPTIC, DIAGNOSTIC 31600 TRACHEOSTOMY (INDEP PROC) 31605 TRACHEOSTOMY... TONSILLECTOMY & ADENOIDECTOMY (T&A) 42832 ADENOIDECTOMY, PRIMARY 43200 ESOPHAGOSCOPY, D-AGNOSTIC 43202 ESOPHAGOSCOPY, W/BIOPSY 43204 ESOPHAGOSCOPY, W

  2. Adult adenoid hypertrophy, is it persistent childhood adenoid hypertrophy?

    Shama Shetty

    2016-01-01

    Full Text Available Objectives: Adult adenoid hypertrophy is not common. More number of cases of adult adenoid hypertrophy is detected in recent years due to the free availability of endoscopes. The aim of this study is to know the etiopathology of adenoid hypertrophy in adults. Materials and Methods: Twenty-five cases of adult adenoid hypertrophy who underwent adenoidectomy were studied in our institution over a period of 5 years from 2008 to 2013. All the patients underwent diagnostic nasal endoscopy, and associated sinus and nasal pathology were studied. Results: Of 25 cases, 12 were males and 13 were females. In our study adult adenoid hypertrophy was more common in second and third decade. Nasal obstruction was main symptom in 80% of our cases. Allergic symptoms were seen in 28%, headache in 24%, and repeated throat infection in 20%. Adenoidectomy with tonsillectomy was done in 5 cases, adenoidectomy with septoplasty in 5 cases, septoplasty with turbinectomy along with adenoidectomy in 7 cases, functional endoscopic sinus surgery with adenoidectomy in 3 cases, adenoidectomy with tympanoplasty in 2 cases, myringotomy with grommet insertion in 2 patients, and isolated adenoidectomy in 1 patient. Conclusion: Since highest number of cases in our study is in early adulthood, we believe that adenoid hypertrophy is persistence of childhood hypertrophy.

  3. 77 FR 24716 - Scientific Information Request on Medical Devices To Treat Otitis Media With Effusion

    2012-04-25

    ... groups d. Patients with comorbidities such as craniofacial abnormalities (e.g., cleft palate), Down... tubes b. Adenoidectomy with or without myringotomy c. Myringotomy d. Oral or topical nasal steroids...

  4. Tonsillectomy - series (image)

    ... period, or upper airway obstruction due to tonsillar hypertrophy recurrent tonsillar abscess Tonsillectomy is advised if the tonsils are enlarged and obstructing access to the adenoid during an adenoidectomy operation, or the physician suspects ...

  5. A Study to Determine the Feasibility of Establishing an Ambulatory Surgery Program at Keller Army Community Hospital, West Point, New York

    1987-05-01

    procedures that could have been performed as ambulatory surgery. For example, if a procedure ( Tonsillectomy with Adenoidectomy) was performed and 17 the...technique) 11. Frenotomy 12. Excision aural polyp 13. Adenoidectomy 14. Tonsillectomy 15. Biopsy of tongue Plastic 1. Augmentation mammoplasty 2...cryotherapy 14.53 Repair of retinal detachment with xenon arc photocoagulation 14.54 Repair of retinal detachment with laser photocoagulation 14.55 Repair

  6. Translation of the Department of Defense Disease and Injury Codes to the Eighth Revision International Classification of Diseases for use by the Military Services.

    1976-06-01

    Example: DDDIC ICDA-8 NHRC Code Ntmuber Code Number Code Number Disease Entity Desivnator 5000 08-467-01 Hypertrophy of tonsils and adenoids ...Unspecified with regard to surgical treatment 5100 08-467-02 Hypertrophy of tonsils and adenoids / Without mention of tonsillectomy or adenoidectomy 5101 08-467...03 Hypertrophy of tonsils and adenoids / With tonsillectomy or adenoidectomy 5110 5010 08-468-01 Peritonsillar abscess/All types 5120 5020 08-469-01

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

    Gabriela KOPACHEVA

    2004-12-01

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

  8. Submucous cleft palate and the general practitioner

    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

  9. Life-Threatening Obstructive Sleep Apnea Caused by Adenoid Hypertrophy in an Infant with Noonan Syndrome

    Sonia Khirani

    2012-01-01

    Full Text Available Adenoidectomy is a commonly performed surgery in children, even though its effectiveness is still under investigation. However, in children with risk factors such as age under 3 years old, associated comorbidities, or severe obstructive sleep apneas, a high postoperative respiratory morbidity is possible. We report the case of a 15-month-old boy with Noonan syndrome and a complex clinical history, who presented with a life-threatening obstructive sleep apnea due to hypertrophy of the adenoids which resolved completely after adenoidectomy.

  10. [Adenotonsillectomy in children only under exceptional circumstances

    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

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

    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

  12. Hearing 25 years after surgical treatment of otitis media with effusion in early childhood

    Khodaverdi, Mojgan; Jørgensen, Gita; Lange, Theis;

    2013-01-01

    consecutive children (91 girls and 133 boys) with chronic bilateral OME were enrolled and treated by adenoidectomy, bilateral myringotomy and insertion of a ventilation tube on the right side only. In 2002, a follow-up examination included otomicroscopy and audiometry. Hearing thresholds were compared...

  13. Ambulatory Care Data Base (ACDB) Data Dictionary Sequential Files of Phase 2.

    1992-04-01

    17341 CRYOTHERAPY >10 17342 CRYOTHERAPY ᝺ 17381 LASER THERAPY, EXCISION 17382 LASER THERAPY, VASCULAR 17383 LASER THERAPY, VERRUCA -177- 17385 LASER ...DIRECT, OPERATIVE W/BIOPSY 31545 LARYNGOSCOPY, DIRECT, OPERATIVE W/ LASER 31575 LARYNGOSCOPY, FLEXIBLE FIBEROPTIC, DIAGNOSTIC 31600 TRACHEOSTOMY (INDEP...42700 I&D PERITONSILLAR ABSCESS 42800 BIOPSY, OROPHARYNX 42804 BIOPSY, NASOPHARYNX, VISIBLE LESION, SIMPLE 42822 TONSILLECTOMY & ADENOIDECTOMY (T&A) 42832

  14. A Study to Determine the Feasibility of Implementing Same-Day Surgery at Brooke Army Medical Center

    1989-02-01

    This number will steadily rise as additional changes in technology, such as improved anesthesia methods and new procedures (e.g., with lasers ) are...Q LASER LARYNGOSCOPY VOCAL CORD INJECTION z ESOPHAGOSCOPY-DIAGNOSTIC ESOPHAGOSCOPY WITH FOREIGH BODY REMOVAL z -4ESOPHAGOSCOPY WITH STRICTURE DILATION...PROCEDURES) ADENOIDECTOMY TONSILLECTOMY T & A UVULOPALATOPHARYNGOPLASTY NASAL POLYPECTOMY SUBMUCOUS RESECTION OF SEPTUM NASAL SEPTOPLASTY TURBINECTOMY

  15. Medical Services: Medical Record Administration and Health Care Documentation

    2013-01-31

    liter lab laboratory lac laceration lap laparotomy laser ; LASER light amplification by stimulated emission of radiation lat lateral lb pound L/B live...Social Work Service sx signs; symptoms sys system T temperature T&A tonsillectomy and adenoidectomy tab tablet TAH total abdominal hysterectomy TB

  16. Coblation: improving outcomes for children following adenotonsillectomy.

    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.

  17. HYPERTROPHICALUM ADENOIDIS IN RE-LATIUM CUM SECRETUM OTTITIS IN MEDIAM

    Lidija DUBROVSKA-MILETIC

    1999-11-01

    Full Text Available In this study we presented the treatment of 20 children with secretory otitis media (SOM. The treatment was surgical and it considened-ventilaton tube insertion and adenoidectomy in case of enlarged adenoid. In this clinical investigation was enroll 15 boys and 5 girls in age 5 to 10 were divided in two main groups:1. 9 children without enlarged adenoid2. 11 children with confirmed enlarged adenoidClinical material was analyzed according to hearing level, middle ear condition estimated by pure toneaudiiometry and tympanometry before and after the treatment. The result showed that adenoidectomy in combination with ventilation tube insertion facilitate secretory otitis media. That’s enable timely improving of hearing function us a important on development of speech, social, emotional and academic development in the early childhood.

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

    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.

  19. Prevalence of Streptococcus Pneumoniae, Haemophilus Influenzae and Moraxella Catarrhalis in Adenoid Tissues of Children with Adenoid Hypertrophy

    SS Khoramrooz

    2012-08-01

    Full Text Available Background & aim: Chronic infection of the adenoid tissue is one of the causes of hypertrophy. Adenoids are considered to be as reservoirs of pathogenic bacteria such as Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae. The aim of this study was to determine the prevalence of mentioned bacteria in children with adenoid hypertrophy. Methods: A total of 113 children with adenoid hypertrophy who underwent adenoidectomy were included in this study. Subsequently, adenoidectomy was performed under general anesthesia. All of the adenoid samples were evaluated for bacterial infection by culture and PCR methods. Results: Streptococcus. pneumoniae was the most common (33.6% bacteria isolated by culture followed by H. influenzae (22.9% and M. catarrhalis (9.7%. PCR method detected S. pneumoniae, H. influenzae and M. catarrhalis in 31%, 29.2% and 9.7% of samples respectively. Conclusion: Streptococcus. Pneumonia, H. influenzae and M. catarrhalis are isolated with different frequency in patients with adenoid hypertrophy.

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

    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.

  1. A Study to Determine the Feasibility of Establishing a Same-Day Surgery Program at General Leonard Wood Army Community Hospital, Fort Leonard Wood, Missouri

    1989-05-23

    grows stronger every year as advancing technology allows more procedures to be performed safely in this modality. For example, lasers and faster...diagnostic laparoscopy - laser - cone biopsy - laparoscopic surgery 0 0 c C) m 0 0 m z APPENDIX H m z .I, TOP 30 SUGGESTED SAME-DAY SURGERIES -Dm z BY HIGHEST...OTHER BIOPSY OF BREAST 75 Z 3 2830 TONSILLECTOMY WITH ADENOIDECTOMY 67 4 5421 LAPAROSCOPY 64 5 1359 OTHER EXTRACAPSULAR EXTRACTION OF LENS 54 6 5300

  2. Prevalence of Streptococcus Pneumoniae, Haemophilus Influenzae and Moraxella Catarrhalis in Adenoid Tissues of Children with Adenoid Hypertrophy

    SS Khoramrooz; A. Mirsalehian; Emaneini, M.; A Sharifi; S A Khosravani; Jabalameli, F.; M.Aligholi; D Darban-Sarokhalil; M Mirzaii; A Bazargani

    2012-01-01

    Background & aim: Chronic infection of the adenoid tissue is one of the causes of hypertrophy. Adenoids are considered to be as reservoirs of pathogenic bacteria such as Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae. The aim of this study was to determine the prevalence of mentioned bacteria in children with adenoid hypertrophy. Methods: A total of 113 children with adenoid hypertrophy who underwent adenoidectomy were included in this study. Subsequently, ad...

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

    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.

  4. 腺样体鼻内窥镜切除手术配合与护理

    周生敏; 高翔

    2012-01-01

      Objective To sum up the methods of cooperation and nursing in adenoidectomy by endoscope. Methods 62 cases with adenoidal hypertrophy from September,2008 to September,2011 in our hospital were reviewed who were treated with adenoidectomy by endoscope. Results All cases were successfully operated, out of hospital 4~7 days after operation, no one of complication.62 cases were followed-up for 3~6 months, the nasal mucosa were smoothed, no case of hyperplasia. Conclusion It is the key that the cooperation and nursing make sure of adenoidectomy by endoscope successfully.%  目的总结经鼻内窥镜射频消融结合Medtronic动力系统切除腺样体的手术配合要点与护理方法。方法回顾分析2008年9月~2011年9月四川省达州市中心医院经鼻内窥镜射频消融治疗的62例腺样体肥大患者临床资料。结果62例患者均顺利完成腺样体切除,且术后4~7d全部治愈出院,无1例发生继发性出血等并发症。术后随访3~6个月,患者鼻咽部黏膜平滑光亮、无软组织增生。结论做好手术配合及护理是确保鼻内窥镜下腺样体切除手术顺利进行并减少并发症的关键。

  5. 腺样体肥大手术切除与分泌性中耳炎

    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。

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

    吕怀庆; 陈彦林; 王永强

    2011-01-01

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

  7. Surgical treatment of pediatric rhinosinusitis.

    Isaacson, G

    2015-08-01

    Pediatric rhinosinusitis is a common sequela of upper respiratory infections in children. It is usually a self-limited disease, sometimes requiring antibiotic therapy. Surgery may be indicated in children who suffer complication of acute rhinosinusitis, severe recurrent acute rhinosinusitis, rhinosinusitis in cystic fibrosis with or without polyposis, chronic rhinosinusitis refractory to maximal medical management, allergic fungal sinusitis, and paranasal sinus mucoceles. Surgical options include, adenoidectomy, sinus puncture and lavage, open surgical approaches, endoscopic sinus surgery, balloon sinuplasty, and turbinectomy or turbinate reduction. This paper reviews the anatomy and physiology of rhinosinusitis in children and current knowledge of the indications and best methods of surgical treatment.

  8. Are Histologic Studies of Adenotonsillectomy Really Necessary?

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

    2013-01-01

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

  9. [Current techniques in tonsil surgery].

    Coromina Isern, Jordi; Esteller Moré, Eduard

    2010-12-01

    In recent years, consolidation of tonsillar hypertrophy as the principal surgical procedure has led to the emergence of new techniques. Most aim to reduce volume (tonsillectomy or tonsil reduction). These techniques have considerably decreased intra- and postoperative hemorrhages and pain intensity. The present article describes the mechanisms and the advantages and disadvantages of the various techniques, including electro-dissection using electrical scalpels, reduction using a microdebrider, ultrasonic scalpel, radiofrequency (with its different variations) and CO(2) laser. When techniques that reduce tonsil volume are used, the possibility of recurrence of the tonsillar hypertrophy is high if less than 85% of the tonsil is removed. There is also a considerable possibility of infection of the remaining tonsils, whichever technique is used, and therefore these techniques are not valid in the case of repetitive tonsillitis. Recently, alternatives to classical adenoidectomy using adenoid curette have also appeared. Bleeding can be minimized by using a microdebrider, radiofrequency or a blood coagulator. We also discuss the concept of partial adenoidectomy, which is preferred in patients at risk of velopharyngeal insufficiency.

  10. [Not Available].

    Geißler, K; Guntinas-Lichius, O

    2016-02-01

    Surgery in the pharynx belongs to the most frequent otorhinolaryngological procedures. Adenoidectomy and tonsillectomy are amongst the most frequent surgeries at all and belong to the first procedures which are performed by otorhinolaryngology residents during their specialist training. Therefore, it is essential to study early during the specialist training the most frequent pharyngeal procedures, surgical techniques, complications and outcome. A series of excellent clinical trials and meta-analyses have been published in the recent year demonstrating that adenoidectomy is an important therapy element in pediatric otorhinolaryngology. In particular due to the developments in the field of laser surgery, tonsillotomy could experience a revival in the recent years. The indication spectrum is still widening. There are many fields where clinical trials are needed to proof if tonsillotomy is as effective as tonsillectomy but with the advantage of lower morbidity. There are manifold pharyngeal surgical procedures to treat patients with obstructive sleep apnea. These surgical techniques have proved valuable especially as alternative to conservative therapy and in case of treatment failure under airway pressure therapy. As the obstruction during this type of sleep-related respiratory disorder is often not located at one anatomical site, an individual combination of several pharyngeal and other surgeries are needed for an effective treatment of the patient. The present article gives an overview of the most important pharyngeal surgeries for future otorhinolaryngologists under specialist training.

  11. Are histologic studies of adenotonsillectomy really necessary?

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

    2013-10-01

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

  12. Are Histologic Studies of Adenotonsillectomy Really Necessary?

    Rebechi, Giseli

    2013-09-01

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

  13. Mean platelet volume levels in children with adenoid hypertrophy.

    Kucur, Cuneyt; Kulekci, Semra; Zorlu, Aylin; Savran, Bircan; Oghan, Fatih; Yildirim, Nadir

    2014-01-01

    Adenoid hypertrophy (AH) is a common disorder in children, resulting in chronic nasal congestion. This chronic congestion should be evaluated carefully because it can lead to chronic upper airway obstruction. Many authors have suggested that increased nasal resistance to respiration may cause disturbances in the pulmonary ventilation and carry the risk of cardiopulmonary diseases. Mean platelet volume (MPV) is a marker of platelet function and is positively associated with indicators of platelet activity. Mean platelet volume is an indicator of larger and more reactive platelets and has been shown to be increased in patients with vascular disease, including peripheral, pulmonary, and coronary artery disease. Recently, MPV levels have also been shown to be increased in patients with severe obstructive sleep apnea, and marked nasal septal deviation. Moreover, increased MPV has also been shown to have a prognostic role in cardiovascular disease. We investigated whether MPV is higher in patients with AH and whether higher MPV levels can be reduced by adenoidectomy. To the best of our knowledge, this is the first study to investigate MPV in patients with AH. Our results suggest that MPV, a determinant of platelet activation, is elevated in patients with AH and adenoidectomy is an effective therapeutic measure in such patients. Increased platelet activation may be related to an increase of cardiopulmonary risk in patients with AH.

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

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

    2015-11-01

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

  15. The Role of Adenoid Mast Cells in the Pathogenesis of Secretory Otitis Media

    M. Faruk Oktay

    2007-01-01

    Full Text Available To investigate the possible role of adenoid mast cells in the etiology of secretory otitis media. Between 2001-2002, 25 patients with chronic adenoitis and chronic secretory otitis media and 25 patients with isolated adenoid hypertrophy were included to the study. Adenoidectomy performed to the all patients under general anesthesia. Adenoidectomy specimens were evaluated under the light microscopy and the number of mast cells were calculated for each patient. The number of mast cells were compared between two groups. The number of mast cells were between 4-84 in the otitis media with effusion and adenoid hypertrophy group (median:52, however it was between 2-63 (median: 23 in the isolated adenoid hypertrophy group. When comparing the two groups using Mann-Withney U test, the number of mast cells found to be significantly higher in the chronic secretory otitis media group (p<0.001.Based on our findings there is a relationship between increased adenoid mast cells and otitis media with effusion and these cells may have a possible role in the etiology of chronic secretory otitis media.

  16. Validity of acoustic rhinometry in the evaluation of patients with adenoid hypertrophy.

    Uyar, Melek; Tekat, Atilla; Koyuncu, Mehmet; Ünal, Recep; Şeşen, Teoman; Tanyeri, Yücel

    2014-07-01

    Reliability of acoustic rhinometry (AR) for preoperative diagnosis and decision of surgery in children with adenoid hypertrophy were investigated in this study. Fifty-five children who cannot tolerate nasal endoscopic examination were included. The AR was performed preoperatively and postoperatively 1 month later. The volume of distance between the 6th and 10th centimeters in rhinogram curve was calculated for evaluating the adenoid notch (AN) region. The volume of AN region was compared with each patient's volume of the adenoid tissue removed with adenoidectomy. Whereas the median adenoid specimen volume was 2.0 (1.0-2.0) cm3 in 23 patients with complaint of nasal obstruction, median AN volumes in the rhinogram curve was 2.3 (0.8-5.2) cm3. All children whose preoperative nasopharyngeal volume was 4.2 cm3 or less had increased volume in the area representing the nasopharynx on rhinogram. We found a statistically significant relationship between the AN and the adenoid specimen volume (P = 0.000, r = 0.797). The sensitivity and specificity were found as 61.2% and 95.8%, respectively. We concluded that the children whose preoperative nasopharyngeal volumes were measured as 4.2 cm3 or less by AR could benefit more from adenoidectomy.

  17. Combined Power System and Adenoid Suction Cutting Operation in the Treatment of 96 Cases of Adenoidal Hypertrophy%鼻口联合动力系统腺样体吸割术治疗腺样体肥大96例

    曾刚

    2013-01-01

    Objective:To study the endoscopic and combined power system of adenoidectomy in the treatment of adenoid hypertrophy and clinical application value.Methods:192patients with adenoidal hypertrophy were randomly divided into the observation group and the control group with 96 cases in each group, the observation group was treated with nasal endoscopic combined power system and adenoidectomy, the control group using conventional curettage of adenoids. Results:the total effective rate in the observation group and 93.75%in control group, the total efficiency of 81.25%(P<0.01), during the follow-up period, there were no complications were observed, while in the control group 10 cases with adenoid tissue residue (P<0.01).Conclusion:nasal endoscopic and combined power system adenoidectomy avoids the blindness of operation, clear surgical field, was resected completely,reduce the occurrence of postoperative complications.%  目的:探讨鼻内窥镜下鼻口联合动力系统腺样体切除术在腺样体肥大治疗中的临床应用价值。方法:将192例腺样体肥大患者随机分为观察组和对照组各96例,观察组采用鼻内窥镜下鼻口联合动力系统腺样体切除术,对照组采用常规腺样体刮除术。结果:观察组总有效率93.75%,对照组总有效率81.25%(P<0.01),随访期间,观察组未见并发症发生病例,对照组有10例患者出现腺样体组织残留(P<0.01)。结论:鼻内窥镜下鼻口联合动力系统腺样体切除术避免了常规操作的盲目性,术野清晰、切除完全、减少了术后并发症的发生。

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

    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

  19. 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

    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.

  20. Otitis media with effusion: benefits and harms of strategies in use for treatment and prevention.

    Principi, Nicola; Marchisio, Paola; Esposito, Susanna

    2016-01-01

    Otitis media with effusion (OME) is a common clinical condition that is associated with hearing loss. It can be diagnosed at least once in approximately 80% of preschool children: 30-40% of them have recurrent episodes, and 5-10% have chronic disease. OME, in recurrent and persistent cases, might significantly delay or impair communication skills, resulting in behavioral and educational difficulties. Several therapeutic approaches have been used to avoid these problems. Most, however, have not been adequately studied, and no definitive conclusions can be drawn. Official guidelines do not recommend the use of decongestants, antihistamines, steroids, or antibiotics. The data are too scanty to assess other interventions, although autoinflation, because it incurs neither cost nor adverse events, deserves attention. Surgical procedures (i.e., tympanostomy tube insertion and adenoidectomy as an adjuvant) can be useful in some cases. This review evaluates all the current OME treatments and preventive measures, including their possible adverse events.

  1. 三种不同手术治疗腺样体肥大对照研究%Comparative Study of Treating Adenoid Hypertrophy by Three Kinds of Surgical Modes

    庞长安

    2015-01-01

    Objective To compare the effect between transnasal endoscopic adenoidectomy(TEA), endoscopic-assisted tran-soral adenoidectomy(ETA) and transoral curette adenoidectomy(TCA) on adenoid hypertrophy so as to provide reference for the treatment of adenoid hypertrophy. Methods 148 patients with adenoid hypertrophy underwent surgery in Department of ENT of our hospital from December 2010 to October 2013 were collected, and divided into TEA group(n=28), ETA group(n=34) and TCA group(n=86) in accordance with the surgical method. TEA group were treated by TEA, ETA group were treated by ETA, TCA group were treated by TCA. The improvement of clinical symptoms of the three groups was observed. And the clinical curative effect was compared among three groups. Results The cure rate of TEA group, ETA group, TCA group was respectively 60.7%, 61.8%, 34.9%, which showed that the cure rate of TEA group and ETA group was much higher than that of TCA group(P<0.05). The response rate of TEA group, ETA group, TCA group was respectively 32.1%, 29.4%, 22.1%, the response rate of TEA group and ETA group was much higher than that of TCA group (P<0.05). Conclusion Both TEA and ETA have higher overall cure rate and response rate than TCA, but ETA is better than TEA in the improvement of some clinical symptoms, therefore ETA may be the best surgical mode of adenoidectomy, and it is also suitable for those accompanied by nasal and paranasal sinus diseases.%目的:比较口腔鼻内镜腺样体切除术(TEA)、内镜辅助经口腔腺样体切除术(ETA)、经口腔腺样体刮除术(TCA)治疗腺样体肥大的疗效,为腺样体肥大的治疗提供参考。方法整群收集2010年12月—2013年10月在该院耳鼻喉科行手术治疗的腺样体肥大患者148例,根据手术方式分为TEA组(n=28)、ETA组(n=34)、TCA 组(n=86)。 TEA组采用TEA治疗,ETA组采用ETA治疗,TCA组采用TCA治疗,观察3组的临床症状改善情况,比较3组的临床疗效。结果TEA组

  2. 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

    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

  3. A painful stiff neck following an ear, nose, and throat surgical procedure: case report.

    Pavlidis, Elena; Copioli, Cristiana; Spagnoli, Carlotta; Mazzotta, Silvia; Ormitti, Francesca; Crisi, Girolamo; Pisani, Francesco

    2015-02-01

    Grisel syndrome is a rare, nontraumatic atlantoaxial subluxation, typical of developmental ages and characterized by head flexion/rotation and painful fixation. Neurological symptoms may occur. It is secondary to head/neck infections and ear, nose, and throat surgery (adenoidectomy, tonsillectomy, and mastoidectomy). Here, we report the case of a child who presented a painful stiff neck following an adenotonsillectomy, with imaging evidencing an atlantoaxial subluxation. The child showed improvement in his condition following a conservative treatment with antibiotics, anti-inflammatory, and analgesic therapy and cervical collar. We believe it is of great significance for clinicians taking into account this peculiar condition in the differential diagnosis of a stiff neck in pediatric patients, thus avoiding misdiagnosis and delays. Indeed, its diagnosis is mainly based on a focused anamnesis associated with the detection of the typical neuroradiological findings.

  4. [Laser myringotomy].

    Hassmann-Poznańska, Elzbieta; Skotnicka, Bozena

    2002-01-01

    The aim of the study was assessment of the qualities of laser-assisted myringotomy (LAM) as a treatment for acute and secretory otitis media. Laser-assisted myringotomy was performed on 65 children (113 ears) mean age 6.2 years diagnosed with secretory otitis media (80%), recurrent secretory otitis media (11%) and acute otitis media (9%). Myringotomy was performed under general anesthesia using the OtoLAM device (ESC/Sharplan, Israel). In 64 ears pressure equalisation tubes were inserted after fenestration of the tympanic membrane with laser. Adenoidectomy alone or with tonsillectomy was performed at the same time in 51 cases. Laser tympanostomies remained patent for 7-32 days. All tympanostomies healed with no noticeable scarring. LAM appears to be a safe, and easy to performed, alternative technique in the treatment of otitis media.

  5. A New Clinical Scoring System for Adenoid Hypertrophy in Children

    Shervin Sharifkashani

    2015-01-01

    Full Text Available Introduction: Chronic nasal obstruction due to adenoid hypertrophy is a very common disorder. Although the clinical assessment of adenoid hypertrophy is essential, its real value in young children is difficult to evaluate. The purpose of this prospective study was to validate a simple clinical score to predict the severity of adenoid obstruction and to evaluate the relationship between this method of clinical scoring with radiography and nasopharyngeal endoscopy.   Materials and Methods: Ninety symptomatic children were enrolled into this study. The clinical score included difficulty of breathing during sleep, apnea, and snoring. We investigated the relationship between clinical scoring, nasal endoscopy, and radiographic findings.   Results: The clinical score correlated very well with endoscopic findings (P0.05 and endoscopic findings and imaging (P>0.05 was weak.    Conclusion:  Clinical findings could be used to select children for adenoidectomy, especially when endoscopic examination is not available or cannot be performed.

  6. Clinical effect of endoscopic low-temperature plasma radiofrequency in the treatment of 43 cases of adenoid hypertrophy%鼻内镜下低温等离子消融术治疗腺样体肥大43例临床分析

    黄辉; 钟晓燕; 廖艳萍

    2015-01-01

    Objective To observe the clinical effect of the low-temperature plasma endoscopic adenoidec-tomy in the treatment of adenoid hypertrophy. Methods Eighty-six patients with adenoid hypertrophy were ran-domly divided into control group and observation group, with 43 cases in each group. The control group adopted the nasal endoscopic adenoidectomy, while the observation group used low-temperature plasma endoscopic adenoidecto-my. The situation of surgery, therapeutic effect, follow-up recurrence and complications of the two groups were ob-served. Results The length of hospital stay and intraoperative blood loss in the observation group were significantly less than those in the control group, (6.0±1.2) d vs (9.5±1.3) d and (57.2±3.1) ml vs (72.4±3.4) ml, P0.05. The recurrence rate of adenoid hypertrophy and the rate of postoperative residual ade-noid body were 0%and 2.3%in the observation group, 2.3%and 4.7%in the control group, with no statistically signif-icant difference between the two groups (P>0.05). Conclusion Low-temperature plasma endoscopic adenoidectomy in the treatment of adenoid hypertrophy results in good clinical effect and fewer complications, which is worthy of clinical popularization and application.%目的:观察鼻内镜下低温等离子消融术治疗腺样体肥大的临床效果。方法选择我院收治的86例腺样体肥大患者为研究对象,随机将其分为对照组和观察组,每组各43例。对照组采用鼻内镜下腺样体吸切术治疗,观察组采用鼻内镜下低温等离子消融术治疗。比较两组患者的手术情况、治疗效果、随访复发和并发症发生情况。结果观察组患者的住院时间(6.0±1.2) d、术中出血量(57.2±3.1) ml,均明显少于对照组的(9.5±1.3) d和(72.4±3.4) ml,差异均有统计学意义(P0.05);观察组患者腺样体肥大复发率为0,腺样体术后残留率为2.3%,对照组腺样体肥大复发率为2.3%,腺样体术后残留率为4.7%,

  7. Expression of Th17 and Treg lymphocyte subsets in hypertrophied adenoids of children and its clinical significance.

    Sade, Kobi; Fishman, Gadi; Kivity, Shmuel; DeRowe, Ari; Langier, Sheila

    2011-01-01

    Adenoid hypertrophy is the most common cause of upper airway obstruction and sleep-disordered breathing in children, yet its pathogenesis remains unclear. The identification of the novel helper T cell subsets, Th17 cells and regulatory T cells (Tregs) could provide new insight into our understanding of the mechanisms involved in the development of this condition. The purpose of this study is to evaluate the adenoidal lymphocyte subsets to describe the percentage of various lymphocyte subsets in hypertrophied adenoids and correlate them with symptom severity. Twenty consecutive children undergoing adenoidectomy were included, and lymphocytes were isolated from their adenoids. T cell subpopulations were detected by flow cytometry using a fluoresceinated monoclonal antibody directed against a number of cell markers (CD4+, CD8+, CD25+, FOXP3 IL17+, and others). We found a significant negative linear correlation between the Th17/Treg ratio and the patients' clinical scores (R = -0.71 p adenoid hypertrophy.

  8. Clincal Observation on Chronic Sinusitis and Adenoidal Hypertrophy in Children Treated with Bi-yuan-shu Oral Liquid%鼻渊舒口服液治疗儿童慢性鼻窦炎伴腺样体肥大的临床研究

    李瑾

    2012-01-01

    Objective: To explore the relation between chronic sinusitis and adenoidal hypertrophy and the effect of adenoidec-tomy with debrider on the development of chronic sinusitis in children. Methods: Eighty cases pediatric chronic sinusitis with adenoidal hypertrophy were performed transoral adenoidectomy with nasal endoscopy, Xomed power system and video monitoring under general anesthesia, meanwhile general therapy was applied for them. Results: All surgeries were successful and all cases were recovered without bleeding and complications. After adenoidectomy the clinical symptom improved obviously. The disease was cured in 72 patients, progressive in 6, and not improved in 2. The response rate was 97.5%. Follow up for 6 ~ 12 months found no recurrence and complications. Conclusion: There are some relation between adenoidal hypertrophy and chronic sinusitis in children. Therefore nasal endos-copy-assisted adenoidectomy with debrider was an minamally invasive and more effective treatment for chronic sinusitis with adenoidal hypertrophy in children. It was an effective method that the treatment of chronic sinusitis with adenoidal hypertrophy in children%目的:探讨中成药制剂鼻渊舒口服液治疗儿童慢性鼻窦炎伴腺样体肥大以及腺样体吸割术对儿童慢性鼻窦炎疗效的影响.方法:对80例慢性鼻窦炎经非手术治疗无效且伴腺样体肥大的儿童,采用XPS动力吸割系统及鼻内镜,在电视显示系统监视下行腺样体吸割术,术后辅以中成药鼻渊舒口服液治疗,观察其疗效.结果:80例患儿手术经过顺利,术后无出血及并发症发生,慢性鼻窦炎及腺样体肥大所引起的相关临床症状改善明显.术后慢性鼻窦炎经药物治疗后治愈72例,好转6例,无效2例,有效率97.5%.随访6-12个月,无复发及远期并发症.结论:儿童慢性鼻窦炎与腺样体肥大之间有一定的相关性,术后应用中成药鼻渊舒口服液具有良好的治疗效果,可作为儿

  9. Reasons of postoperative recurrence After Resection of OSAHS in Children Adenoids%小儿腺样体切除术后 OSAHS 复发原因探讨

    周雪; 邵文叶

    2016-01-01

    腺样体肥大伴 OSAHS 是儿童常见疾病,手术治疗已成为主要治疗方法,但手术后 OSAHS 复发的案例不在少数,现根据各文献报导,分析腺样体肥大术后 OSAHS 复发的原因主要为:传统腺样体刮除术等手术未完全切除腺样体,合并分泌性中耳炎、鼻-鼻窦炎等临近器官疾病,扁桃体等淋巴组织代偿增生,肥胖等。积极治疗原发疾病,控制炎症发生是避免腺样体切除术后 OSAHS 复发的有效途径。%Adenoidal hypertrophy with OSAHS is a common childhood illness,surgery has become the main treat-ment,but recurrence after surgery OSAHS a few cases,on the basis of each reported in the literature,analyze the reasons of postoperative recurrence after resection of OSAHS in children adenoids mainly:Traditional adenoidectomy,such as sur-gery are not completely resection,combined secretory otitis media,rhinitis-sinusitis and other adjacent organs diseases, tonsils and other lymphoid tissue compensatory hyperplasia,obesity.Aggressive treatment of primary disease,control of inflammation is an effective way to avoid the recurrence of OSAHS after adenoidectomy.

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

    Katarina Šakić

    2009-02-01

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

  11. Bacteriology of symptomatic adenoids in children

    Aroor Rajeshwary

    2013-01-01

    Full Text Available Background: Children with adenoid hypertrophy have been shown to harbor pathogenic bacteria in the nasopharynx despite antibiotics. Removal of the adenoid is associated with a reduction in the bacterial count. Aims: The study was done to determine the bacteriology of the adenoid tissue in chronic adenotonsillitis and adenoid hypertrophy, and determine the antibiotic sensitivity of potential pathogens. Materials and Methods : This is a descriptive study conducted on 100 patients aged between three and twelve years who underwent adenotonsillectomy/adenoidectomy. After adenoidectomy, the specimen along with the swab taken from the surface of the adenoid was sent for microbiological examination. After 48 and 96 hours, the microbial growth was identified and the antibiotic-sensitivity pattern of the isolate was studied. Results: Aerobic organisms grew in 93% of the specimens and anaerobic organisms in 68%, whereas 7% had no growth. The surface was predominated by commensals and the pathogens were mainly found in the core. The predominant pathogens were Staphylococcus aureus, Streptococcus pneumoniae, and Enterococcus species. The organisms were resistant to penicillin but showed sensitivity to co-amoxiclav and ciprofloxacin. Co-amoxiclav and ciprofloxacin should be considered as the first line of medical treatment for adenotonsillar diseases. Conclusions: Infection is the main cause of adenoid hypertrophy. Amoxicillin with potassium clavulanate and ciprofloxacin should be considered as the drugs of choice for all adenotonsillar diseases.Early and prompt treatment of adenoid hypertrophy with appropriate antibiotics will avoid unnecessary exposure to repeated antimicrobial therapy, thereby maintaining the beneficial effects of the normal adenoid flora.

  12. Clinical analysis of secretory otitis media(SOM) in children%儿童分泌性中耳炎临床治疗分析

    赵巍

    2015-01-01

    Objective :To investigate therapeutic effect of secretory otitis media(SOM ) in children .Meth‐ods18 children cases of adenoid hypertrophy with SOM treated by adenoidectomy combined with surgery were retro‐spectively analyzed .ResultsAll the cases of OME were followed up at least 6 months after operation .The effects of 7 ears with puncture of tympanum were 70% ,but the effects were 92% in 25 ears with tympanostomy tubes .A child was suffered from adenoid hypertrophy again after surgery .Conclusions :The therapeutic effect of transnasal en‐doscopic adenoidectomy combined with tympanostomy tubes is the best on adenoid hypertrophy with SOM .%目的:探讨腺样体肥大引起分泌性中耳炎的原因及手术疗效。方法:总结分析18例儿童腺样体肥大伴分泌性中耳炎患儿临床资料,观察手术治疗后效果情况。结果:所有病例随访半年以上,单纯鼓膜穿刺治疗7耳,有效率70%。鼓膜置管25耳治疗有效率92%。腺样体肥大术后复发1例。结论:内窥镜下腺样体吸切同时行鼓膜置管术对儿童分泌性中耳炎治疗效果最佳。

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

    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

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

    邹新博; 梅栩彬; 赵立民; 邹慧中; 陈正岗; 刘文君

    2015-01-01

    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。

  15. Behavior research of allergic rhinitis with adenoid hypertrophy in children%变应性鼻炎伴腺样体肥大儿童行为调查研究

    敬云龙; 胡彬雅; 黄晶; 赵斯君; 陶礼华; 彭湘粤

    2012-01-01

    目的:探讨变应性鼻炎伴腺样体肥大患儿手术治疗对其行为方面的影响.方法:117例变应性鼻炎伴腺样体肥大患儿随机分成研究组和对照组,其中对照组42例,局部使用类固醇喷鼻剂,连续使用2~3个月,同时给予口服抗组胺药治疗;研究组75例,给予内镜下腺样体切除术,同时使用药物治疗,治疗方法同对照组.3个月后对所有患儿进行行为调查比较,内容包括睡眠、性格、记忆等方面.结果:治疗前两组患儿在腺样体肥大、鼻部症状以及临床问卷分值方面无显著差异,具有可比性.研究组经治疗后在“响鼾”、“不安宁的睡眠或频繁醒觉”、“鼻阻塞而张口呼吸”以及“频繁的上呼吸道感染”4个症状较对照组的改善差异有统计学意义(P<0.05).结论:变应性鼻炎伴腺样体肥大患儿宜采用手术治疗,腺样体切除利于行为症状的改善.%Objective;To investigate the behavior difference of allergic rhinitis with adenoid hypertrophy between study group and control group. Method: One hundred and seventeen children diagnosed as allergic rhinitis with adenoid hypertrophy were enrolled in our study were divided into study group and control group. Forty-two children treated with local steroid nasal spray for two to three months and antihistamine were control group. Seventy-five children treated with endoscopic adenoidectomy and drug treatment were study group; All children' parents were inquired for their clinical presentation. Result; No distinctive differences were found between the two groups(P>0. 05 Jin adenoid hypertrophy, accompanying nasal problems and clinical questionnaire scoring. Significant sratistical distinction were found(P<0. 05)in snoring, sleep disturbance and frequent arousal, nasal obstructive moth-breathing, and recurrent respiratory tract infection between the two groups after three-month follow up. Conclusion: Endoscopic adenoidectomy should be taken into

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

    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

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

    Lucky Onotai

    2013-01-01

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

  18. 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

    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.

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

    REN Dong-dong; WANG Wu-qing

    2012-01-01

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

  20. 鼻镜下经口动力系统与传统手术治疗儿童OSAHS的对比研究%Comparative Study of Obstructive Sleep Apnoea Syndrome Breathing in Children Treated with Dynamical Cutterbar via Nasal Endoscope and Rout Curettage of Adenoids

    谷彬; 王东海

    2011-01-01

    目的 比较鼻内镜监视下经口动力系统和传统手术方式治疗儿童阻塞性呼吸睡眠暂停综合征的临床疗效及对心理行为的改善情况.方法 将370例患者随机分为传统手术组160例(A组),鼻内镜监视下经口动力系统组210例(B组),对经两种手术方法治疗的患儿术后的临床症状和心理行为异常等情况进行分析和比较.结果 A组术后平均随访14个月,B组平均随访16个月.两组手术后对患儿临床症状均有改善.B组在睡眠打鼾、鼻塞、鼻漏、听力、上课注意力不集中、多动等症状改善方面明显优于A组(P<0.05).结论 鼻内镜下经口动力系统腺样体切除及扁桃体部分切除术对儿童阻塞性呼吸睡眠暂停综合征的治疗效果明显优于传统手术方法.%Objective The aim of this study was to compare the clinical effectiveness and the improvement of the mentality and behavior of obstructive sleep apnoea syndrome breathing( OSAHS )in children of dynamical system cutterbar via nasal endoscope for adenoidectomy and part of tonsillectomy ( group B 210cases ) and rout curettage of adenoids( group A 160cases ). Methods Clinical date of 370 patients who had accepted the surgery therapy in two ways,were retrospectively analyzed. To compare their clinical symptoms and the improvement of the mentality and behavior of OSAHS in children. Results The post-operation patients of two groups have significantly different in the symptomatic improvement. It showed that group B had significantly greater improvements in aspects of Sleep snoring, nasal obstruction, rhinorrhea, hearing, inattention in class,and restlessness than that in group A. Conclusion Dynamical system cutterbar via nasal endoscope for adenoidectomy and part of tonsillectomy by mouth is the best way to cure OSAHS in children in present time.

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

    Martin Formánek

    2015-01-01

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

  2. Drug-induced sedation endoscopy in children <2 years with obstructive sleep apnea syndrome: upper airway findings and treatment outcomes.

    Boudewyns, A; Van de Heyning, P; Verhulst, S

    2017-02-20

    Few data are available about the pattern of upper airway (UA) obstruction in children DISE) in young OSAS children to investigate the pattern of UA obstruction and the value of DISE in therapeutic decision making. Retrospective analysis of ≤2-year-old children undergoing DISE-directed UA surgery. OSAS severity and the treatment outcomes were documented by polysomnography. Data are available for 28 patients, age 1.5 years (1.3-1.8), BMI-z score 0.5 (-0.7 to 1.3) with severe OSAS, obstructive apnea/hypopnea index (oAHI) 13.8/hr (7.5-28.3). All but 3 had (>50%) obstruction at the level of the adenoids, and all but 5 had (>50%) tonsillar obstruction. DISE-directed treatment consisted of adenoidectomy (n = 4), tonsillectomy (n = 1), and AT (n = 23). There was a significant improvement in respiratory parameters. Twenty children (71.4%) had a postoperative oAHI DISE showed a collapse of the epiglottis in 6 and late-onset laryngomalacia in 4. These findings did not affect surgical outcome. Adenotonsillar hypertrophy is the major cause of UA obstruction, and DISE-directed UA surgery was curative in 71,4% of children ≤2 years. We suggest that DISE may be helpful in surgical decision making. Circumferential UA narrowing may result in less favorable surgical outcomes.

  3. Perioperative tranexamic acid in day-case paediatric tonsillectomy

    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

  4. 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

    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.

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

    Yoko Nishimura

    2015-01-01

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

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

    周建偉; 吳國强; 郭嘉莉; 张美盈

    2004-01-01

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

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

    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.

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

    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.

  9. Comparison of Helicobacter pylori colonization on the tonsillar surface versus tonsillar core tissue as determined by the CLO test.

    Khademi, Bijan; Niknejad, Nika; Gandomi, Behrooz; Yeganeh, Firoozeh

    2007-08-01

    We conducted a prospective study to determine the correlation between the presence or absence of Helicobacter pylori on the tonsillar surface and in the tonsillar core as determined by the Campylobacter-like organism (CLO) rapid urease enzyme test. Our study population was made up of 55 patients who underwent adenoidectomy, tonsillectomy, or both from December 2002 through April 2003 at Khalili Hospital in Shiraz, Iran. Of these 55 patients, 45 (82%) were positive and 10 (18%) were negative for H pylori colonization as determined by CLO testing. Analysis of samples obtained from individual patients revealed differences in H pylori colonization between tonsillar surface samples and the core tissue samples. Of 106 tonsils obtained from 53 patients who underwent adenotonsillectomy or tonsillectomy, H pylori was found on 56 tonsillar surface samples (53%) and 24 tonsillar core samples (23%); only 13 tonsils (12%) contained H pylori both on the surface and in the core. We conclude that a surface swab is neither specific nor sensitive as an indicator of the presence or absence of H. pylori colonization in tonsillar core tissue.

  10. EVALUATION OF EFFECTIVENESS OF MYRINGOTOMY AND MYRINGOTOMY WITH VENTILATION TUBE INSERTION AS TREATMENT OF OTITISMEDIA WITH EFFUSION IN CHILDREN

    Sujatha

    2015-04-01

    Full Text Available BACKGROUND: Considerable uncertainty and controversies exists regarding the surgical treatment options of Otitis media with effusion (OME. As untreated or improperly treated longstanding OME causes problems in social and intellectual behavior in children, it is of great public health importance. OBJECTIVES: To compare the effectiveness of myringotomy with that of myringotomy with venti lation tube (VT insertion as treatment of OME and to find out long - term sequlae of VT insertion. METHODS AND MATERIALS: Tertiary care hospital level prospective follow - up study was conducted in 50 children of 3 to 10 years of age with history of OME and a denoid hypertrophy. They were randomly divided into two groups. All children had adenoidectomy and along with that one group had myringotomy and other group underwent myringotomy and ventilation tube insertion. The patients’ characteristics were prospectively recorded during the study period of one year starting from January 2013. Results were analyzed. There is significant improvement in hearing in myringotomised children than those with ventilation tube insertion. (Student t test, p<0. 05 and t ympanic membrane appear more towards normalcy (Fisher’s exact test, p<0. 05 in those children after one year. CONCLUSION: The insertion of ventilation tube after myringotomy has not much beneficial effects on hearing in long - term. Ventilation tubes also c ause pathological changes in the tympanic membrane such as tympanosclerosis and perforation.

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

    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.

  12. A case of transient cortical blindness associated with hypercapnia as a result of extremely enlarged adenoid tissue.

    Malbora, Baris; Malbora, Nihan; Avci, Zekai; Olgac, Asburce; Erkan, Alper Nabi

    2015-01-01

    Adenotonsillar hypertrophy is common among children, but it can lead to serious complications if left untreated. Among the well-known complications are obstructive sleep apnea syndrome, growth failure, cor pulmonale, and hypertension. One complication of adenotonsillar hypertrophy that has not been previously reported in the English-language literature is transient cortical blindness. We describe such a case, which occurred in a 6-year-old boy who presented with a sudden loss of vision and subsequent unconsciousness. He had experienced hypercapnia and was resuscitated via endotracheal tube ventilation. Laboratory and radiologic assessments found no pathology except for extremely enlarged adenoid tissue. Once the patient was stabilized, an urgent adenotonsillectomy was performed. The patient recovered well, and his vision and respiratory symptoms resolved. Severe hypertrophy of the adenoid tissue can cause hypercapnia and acidosis secondary to upper airway obstruction. The possibility of adenoid hypertrophy and hypercapnia should be kept in mind in cases of transient cortical blindness. Aggressive treatment, including early intubation and adenoidectomy, may lead to a rapid resolution of symptoms.

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

    Dipti Shastri

    2015-01-01

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

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

    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.

  15. Radiographic adenoid evaluation - suggestion of referral parameters

    Murilo F.N. Feres

    2014-06-01

    Full Text Available OBJECTIVE: this study aimed to evaluate the usefulness of current radiographic measurements, which were originally conceived to evaluate adenoid hypertrophy, as potential referral parameters. METHODS: children aged from 4 to 14 years, of both genders, who presented nasal obstruction complaints, were subjected to cavum radiography. Radiographic examinations (n = 120 were evaluated according to categorical and quantitative parameters, and data were compared to gold-standard videonasopharyngoscopic examination, regarding accuracy (sensitivity, negative predictive value, specificity, and positive predictive value. RESULTS: radiographic grading systems presented low sensitivity for the identification of patients with two-thirds choanal space obstruction. However, some of these parameters presented relatively high specificity rates when three-quarters adenoid obstruction was the threshold of interest. Amongst the quantitative variables, a mathematical model was found to be more suitable for identifying patients with more than two-thirds obstruction. CONCLUSION: this model was shown to be potentially useful as a screening tool to include patients with, at least, two-thirds adenoid obstruction. Moreover, one of the categorical parameters was demonstrated to be relatively more useful, as well as a potentially safer assessment tool to exclude patients with less than three-quarters obstruction, to be indicated for adenoidectomy.

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

    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.

  17. The clinical use of Dexmedetomidine during extubation period on pediatric tonsillectomy%右美托咪定在儿童扁桃体手术围拔管期的应用

    林树勇; 程碧珍; 庄少惠; 程明华

    2012-01-01

    Objective To observe the analgesia and sedative effects of Dexmedetomidine after pediatric tonsillectomy and adenoidectomy during the exlubation period of general anesthesia. Methods 60 patients undergoing the general anesthesia were selected, and divided into two groups randomly: group A (general sedation group,n=30), group B (dexmedetomidine group,n =30). Two groups were induced and maintained with Propofol and Remifentanil by target-controlled infusion (TCI) and 2 mg/kg Tramadol was administrated intravenously after surgery. 0.5 μg/kg Dexmedetomidine was administrated in addition in group B within 10 minutes. The hemodynamics during the extubation period, vital signs, waking time, extubation time, dysphoria, upper respiratory tract obstruction and vomiting were observed. Results There were obviously lower on MAP and HR in the group B than in group A during the extubation period and awaken period(P0.05) between two groups about upper respiratory tract obstruction rate and postoperative nausea and vomiting rate. The dysphoria rate of Group B was 10.0% which was significantly lower than Group A's 30%(P<0.05). Conclusion Dexmedetomidine can prevent the reaction during the extubalion period on the pediatric tonsillectomy and adenoidectomy, and make the general anesthesia to be safe and better recovery.%目的 观察右美托咪定在小儿扁桃体、腺样体切除手术术后围拔管期的镇静作用.方法 选择择期进行扁桃体、腺样体切除手术的患儿60例,随机分为常规组(A组)和右美托咪定组(B组)各30例;两组均以丙泊酚和瑞芬太尼靶控输注诱导及维持,手术结束时停药,并静注曲马多2 mg/kg.B组手术结束前10 min静脉注射右美托咪定0.5 μg/kg,输注时间10 min.两组均等待患儿自然清醒拔管,观察两组生命体征变化、术后睁眼时间、拔管时间以及苏醒期躁动、上呼吸道梗阻、术后恶心呕吐等情况.结果 B组拔管时和术后清醒时平均动脉压(MAP)

  18. 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

    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

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

    段宗瑾; 朱明

    2010-01-01

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

  20. 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

    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

  1. 腺样体肥大对儿童听力的影响%The pathological effect of adenoid hypertrophy on auditory function of children with such a condition

    季超; 高刚; 钱茂华

    2011-01-01

    Objective To investigate the pathological effect of adenoid hypertrophy on auditory function of children with this kind of lesion and the rehabilitation effect of surgical therapy on their hearing level based on a clinical trial. Methods Included in this retrospective study were 140 children cases with adenoid hypertrophy, treated by adenoidectomy and grommet insertion. Auditory function of these children was tested by pure tone audiometry and tympanometry before the operation and one week after fee surgery respectively. Then, careful analysis was done on these data to evaluate the effects of adenoid hypertrophy and relative therapies on auditory function of these children. Results Among these children, 93 cases complained hearing decrease, with 20 (21.51%) showing sensorineural hearing loss at various levels in its nature as seen from audiometry. In this part of cases, tympanometry showed that 88 (165 ears) were B type of tympanogram and 5 (9 ears) were C type of this kind of curve figure. In the other part of children (47 cases) complaining no obvious feeling of auditory acuity decreasing, 25 (53.19%) were seen with hearing loss in one or both ears at various levels and in different nature as revealed from pure tone audiometry, with 30 cases (63.83%) having an abnormal tympanogram, among whom 22 showed a B type of tympanogram 8 showed a C type of curve figure. After adenoid surgery and grommet insertion, all these children were seen with their hearing improved obviously, with very significant statistical significance when compared with those data obtained preoperatively. Conclusions Adenoid hypertrophy usually cause conductive hearing loss in children, but may show sensorineural hearing loss at various levels in its nature in a part of cases. The therapy combined adenoidectomy with grommet insertion can recover their hearing effectively.%目的 观察腺样体肥大对儿童听力的影响及手术后儿童听力的恢复情况.方法 回顾性研究手术

  2. 鼻内镜下两种不同手术方式治疗儿童腺样体肥大78例疗效比较%Comparison of curative effect of two different operation ways under nasal endoscopy in the treatment of 78 children with adenoidal hypertrophy

    赵九洲; 林曾萍; 邱书奇

    2014-01-01

    目的:探讨鼻内镜下两种不同手术方式治疗儿童腺样体肥大的临床效果。方法将我院2011年3月~2013年3月收治的78例儿童腺样体肥大的患者随机分为两组,A组采用鼻内镜下电动切割器行腺样体切除术,B组采用鼻内镜下等离子ENT射频消融系统对腺样体行低温射频消融切除术。比较两组患儿术后发热、出血、鼻腔恢复正常通气时间以及并发症发生情况。结果两组患儿经治疗后临床症状完全缓解,B组在术后发热、出血、鼻腔恢复正常通气时间以及并发症等方面均优于A组,差异有统计学意义(P<0.05)。结论鼻内镜下儿童腺样体肥大的患者行低温等离子射频消融切除术较行电动切割器腺样体切除术损伤小、出血少、预后好,值得临床上广泛应用。%Objective To explore the clinical effect of two different operation ways under nasal endoscopy in the treatment of children with adenoidal hypertrophy. Methods 78 children with adenoidal hypertrophy were collected in our hospital during March 2011 to March 2013, and randomly divided into the two groups, the group A was treated with the adenoidectomy by electric cutter under nasal endoscopy, the group B was treated with the adenoidal low-temperature radiofrequency ablation excision by ENT plasma radiofrequency ablation system under nasal endoscopy. The postoperative fever, bleeding, nasal normal ventilation time and incidence of complications of children in the two groups were compared. Results The clinical symptoms of children in the two groups were completely relieved after treatment, the postoperative fever, bleeding, nasal normal ventilation time and complications in the group B were better than those in the group A, there were statistically significant differences(P<0.05). Conclusion Compared with adenoidectomy by electric cutter, the low-temperature plasma radiofrequency ablation excision for children with adenoidal

  3. 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

    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.

  4. Hemorragia pós-operatória em 397 adenotonsilectomias realizadas nos Hospitais Geral de Pirajussara (HGP e Hospital Estadual de Diadema (HED / UNIFESP-EPM Postoperative hemorrhage in 397 adenotonsillectomies performed at Hospital Geral de Pirajussara (HGP and Hospital Estadual de Diadema (HED / Federal University of São Paulo (UNIFESP-EPM

    Gabriel Cesar Dib

    2004-12-01

    METHOD: We analyzed 397 patients who underwent adenoidectomy, tonsillectomy and adenotonsillectomy. Adenotonsillectomy represented 91.7% of all surgeries. Patients were aged 2 to 39 years. Preoperative tests were conducted in all patients, with weekly follow-up up to the first month after surgery. RESULTS: 397 surgeries were performed in the hospitals (HGP and HED, 364 adenotonsillectomies (91.7%, 16 tonsillectomies (4.03% and 17 adenoidectomies (4.28%. There were 5 cases of postoperative bleeding, 3 of which occurred in the early postoperative period and 2 in the middle postoperative period. There were no reports of bleeding in late postoperative period. The incidence of hemorrhage was 1.37% (5 out of 364 cases. CONCLUSION: Postoperative hemorrhage possibly results from poor surgical technique and blood clotting disorder in some patients.

  5. Clinical effect of two different types of surgical procedures under nasal endoscope in the treatment of pediatric adenoidal hypertrophy%鼻内镜下两种不同手术方式治疗儿童腺样体肥大的临床效果

    韦一; 曾莉

    2015-01-01

    目的:比较鼻内镜下两种不同手术方式治疗儿童腺样体肥大的临床效果。方法选取本院2012年6月~2014年9月收治的74例腺样体肥大患儿作为研究对象,随机分成实验组和对照组,各37例。对照组给予鼻内镜下腺样体切除术,实验组给予鼻内镜下低温射频消融切除术,比较两组的临床效果。结果实验组的总有效率为97.30豫,显著高于对照组的81.08豫,差异有显著统计学意义(P<0.05)。实验组的手术时间、鼻腔恢复至正常通气时间显著短于对照组,差异有统计学意义(P<0.05)。实验组的出血量显著少与对照组,差异有统计学意义(P<0.05)。实验组的并发症发生率显著低于对照组,差异有统计学意义(P<0.05)。结论鼻内镜下低温射频消融切除术治疗儿童腺样体肥大的临床效果优于电动切割器行腺样体切除术,值得临床推广应用。%Objective To compare the clinical effect of two different types of surgical procedures under nasal endo-scope in the treatment of pediatric adenoidal hypertrophy. Methods 74 children patients with adenoidal hypertrophy in our hospital from June 2012 to September 2014 were selected and randomly divided into the control group and the ex-periment group,37 cases in each group.The control group was given adenoidectomy under nasal endoscope,the experi-ment group was given low-temperature radiofrequency ablation and resection under nasal endoscope.The clinical effect of two groups was compared. Results The total effective rate in the experiment group was 97.30%,which was higher than 81.08%in the control group,with significant difference(P<0.05).The operation time,the time of nasal cavity ventila-tion recovery to normal in the experimental group was shorter than that in the control group,with significant difference (P<0.05).The amount of bleeding in the experiment group was less than that in the control group,with significant differ-ence(P<0

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

    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.

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

    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.

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

    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.

  9. Effects of nasal saline lavage on pediatric sinusitis symptoms and disease-specific quality of life: a case series of 10 patients.

    Lin, Sandra Y; Baugher, Katherine M; Brown, David J; Ishman, Stacey L

    2015-02-01

    We conducted a prospective study to assess (1) the effects of daily nasal irrigation in children with chronic sinonasal symptoms and (2) the impact that treatment had on disease-specific quality of life as assessed by a validated instrument, the five-item Sinus and Nasal Quality of Life Survey (SN-5), and by an overall nasal quality-of-life (NQL) score based on a 10-point faces scale. Our patient population was made up of 10 children-7 girls and 3 boys, aged 3 to 9 years (mean: 6.1)-who had presented with symptoms of chronic rhinosinusitis for more than 3 months and who had not responded to previous medical management. Patients were administered nasal saline lavage daily for 1 month. These patients and/or their caregivers completed an SN-5 questionnaire upon entry into the study and at the completion of treatment. At study's end, a comparison of pre- and post-treatment scores with paired Student t tests showed that the mean total SN-5 score improved significantly over baseline, falling 45% from 21.4 to 11.7 (p = 0.0002). Moreover, significant overall improvement was seen in each of the five subcategories of the SN-5 survey (p = 0.0009 to 0.038). The NQL scores also improved significantly from 4.7 to 7.7 (p = 0.0034). Compliance with nasal lavage was generally good among the 10 patients, as 8 of them used at least 75% of the recommended quantity of saline at least once a day. During a follow-up period that ranged from 2 to 23 months (mean: 10.4), only 1 patient required an adenoidectomy for symptom control. The results of this pilot study suggest that nasal saline lavage may significantly alleviate chronic sinonasal symptoms and improve disease-specific quality of life in children with symptoms of chronic rhinosinusitis.

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

    Fathollah Behnoud

    2010-10-01

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

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

    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.

  12. Assessing palatal mobility in post-tonsillectomy patients

    Eman Mostafa

    2016-07-01

    Full Text Available Objectives: To assess palatal mobility in post-tonsillectomy patients. Material and methods: This study was conducted in one year duration in Sohag University Hospital and consisted of 100 patients with ages ranging from 4 to 21 years. Inclusion criteria: history with previous tonsillectomy at least since 6 months or more. Exclusion criteria: any neurological deficit, muscular disorder or structural defects of the palate such as cleft palate or submucous cleft palate. All patients had undergone ear, nose and throat examination. Palatal mobility was assessed through oral examination. Further assessing palatal mobility by endoscopic examination and videofluoroscopy was done for those who have poor palatal mobility detected by intraoral examination. Result: Forty patients (23 males, 17 females had poor palatal mobility on oral examination. Fourteen patients (8 males, 6 females had definite poor palatal mobility on endoscopic examination. On Auditory Perceptual Assessment, 12 patients had closed nasality and 2 patients had mixed nasality. On endoscopic examination, 14 patients had a large adenoid. In 12 patients, the velopharyngeal orifice closure was veloadenoidal closure while in the other 2 patients there was slight velopharyngeal incompetence (coronal closure. Conclusion: Poor palatal mobility may be caused by malpractice of tonsillectomy or it may be a sign that was present and missed by the otolaryngologist. Pre-tonsillectomy evaluation of palatal mobility should be done by nasofiberoptic endoscope and/or videofluoroscopy. Also post-tonsillectomy evaluation of palatal mobility should be taken in consideration if adenoidectomy is needed to prevent possible postoperative open nasality.

  13. 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

    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.

  14. Asymptomatic cardiopulmonary changes caused by adenoid hypertrophy.

    Abdel-Aziz, Mosaad

    2011-07-01

    Adenoid hypertrophy is the most common cause of pediatric upper airway obstruction, and it can lead to cardiopulmonary complications such as pulmonary hypertension, cor pulmonale, and even heart failure. The aim of this study was to detect the asymptomatic cardiopulmonary changes that could happen in children with adenoid hypertrophy.Eighty children with adenoid hypertrophy were included in this study. Chest x-ray was used to assess the cardiothoracic ratio, whereas echocardiography was used for measuring the pulmonary arterial pressures, right ventricular diastolic filling parameters, and right ventricular end-diastolic diameters. All patients underwent adenoidectomy with or without tonsillectomy, and they were subjected again to echocardiographic assessment 6 months after the operation. No patient showed an increase in the cardiothoracic ratio on x-ray. Preoperative echocardiography showed an increase in pulmonary artery pressure (22.7 [SD, 3.8] mm Hg), a decrease in right ventricular diastolic filling parameters (E/A = 1.03 [SD, 0.17]), and an increase in right ventricular end-diastolic diameters (1.89 [SD, 0.19] cm). Postoperatively, pulmonary artery pressure decreased to 17.2 [SD, 2.1] mm Hg, right ventricular diastolic filling (E/A) increased to 1.25 [SD, 0.11], and right ventricular end-diastolic diameters decreased to 1.68 [SD, 0.12] cm. The comparison between preoperative and postoperative results for each individual parameter was statistically significant. Clinically asymptomatic cardiopulmonary changes due to adenoid hypertrophy are not rare. Early diagnosis and treatment of upper airway obstruction can prevent these serious complications. Echocardiographic examination should be recommended for these patients as a part of preoperative preparation to avoid anesthetic complications.

  15. Nasal endoscopic plasma treatment in 90 cases of adenoid hypertrophy in children%鼻内镜下等离子治疗腺样体肥大90例

    王丽鸣

    2013-01-01

    objective:to observe the nasal endoscopic plasma radiofrequency treatment at low temperature of adenoid hypertrophy in children of efficacy and safety. Methods:a retrospective analysis of the fiber nasopharyngeal endoscopy diagnosed as children of adenoid hypertrophy in 90 cases of patients, the endotracheal intubation and vein compound general anesthesia, in diameter 4 mm nasal endoscopic down low temperature plasma ablation therapy. Results:al cases adenoidectomy clean, no bleeding and eustachian tube damage, and other complications. Were fol owed up for 6 months without recurrence. Conclusion:nasal endoscopic treatment of low temperature plasma ablation of adenoid hypertrophy in children is a safe, simple and effective method.%目的:观察鼻内镜下低温等离子消融术治疗儿童腺样体肥大的疗效和安全性。方法:回顾性分析经纤维鼻咽镜检查确诊为儿童腺样体肥大患者90例,采用气管插管加静脉复合全身麻醉,在直径4mm鼻内镜下行低温等离子消融治疗。结果:全部病例腺样体切除干净,无出血及咽鼓管损伤等并发症。随访6个月无复发。结论:鼻内镜下等离子低温消融治疗儿童腺样体肥大是一种安全、简捷、有效的方法。

  16. PFAPA syndrome (Periodic Fever, Aphthous stomatitis, Pharyngitis, Adenitis).

    Lee, W I; Yang, M H; Lee, K F; Chen, L C; Lin, S J; Yeh, K W; Huang, J L

    1999-01-01

    This paper aims to remind paediatric clinicians to suspect and confirm 'PFAPA' syndrome (Periodic Fever, Aphthous stomatitis, Pharyngitis and cervical Adenitis syndrome). We report two cases of PFAPA syndrome: a 3-year-old healthy boy with atopic rhinitis and a boy aged 8 years 5 months who simultaneously had lymphocytic vasculitis syndrome treated with immunosuppressive drugs. Both met Marshall's criteria. The literature regarding PFAPA syndrome was complied using a Medline search for articles published between 1963 and 1998 and we then reviewed the reference lists of the articles. The Medline search revealed 28 cases with available clinical manifestations, management and prognosis. Our study describes two additional cases. We divided the cases into typical (28 cases) and atypical (two cases) PFAPA syndrome. In typical PFAPA, the age of onset was less than 5 years in most cases and the patients presented 4.9 +/- 1.4 days of fever (100%), pharyngitis (89.3%), cervical adenitis (72.1%), stomatitis (71.4%), malaise (64.3%), headache (60.7%), abdominal pain (53.6%) and nausea/vomiting (17.9%). Afebrile intervals were 3.2 +/- 2.4 months and increased with age. The time from initial onset to final episode was 3 years 7 months +/- 3 years 6 months. The total number of episodes was 8.3 +/- 2.5 (range 6-14). Effective treatment included steroids, tonsillectomy/adenoidectomy and cimetidine. The general outcome was good. In atypical PFAPF, the clinical manifestations were similar to those of typical PFAPA except that the age of onset was more than 5 years, and life-threatening intestinal perforation happened once in a patient with underlying Fanconi's anaemia. It was concluded that typical PFAPA syndrome is benign and can be diagnosed by detailed history-taking and from physical findings during repeated febrile episodes with tests to rule out other periodic fever syndromes. A review of the literatures since the first report in 1987 has shown that typical PFAPA syndrome is

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

    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

  18. 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

    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。

  19. 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

    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.

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

    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

  1. The influence of snoring, mouth breathing and apnoea on facial morphology in late childhood: a three-dimensional study

    Al Ali, Ala; Richmond, Stephen; Popat, Hashmat; Playle, Rebecca; Pickles, Timothy; Zhurov, Alexei I; Marshall, David; Rosin, Paul L; Henderson, John; Bonuck, Karen

    2015-01-01

    Objective To explore the relationship between the prevalence of sleep disordered breathing (SDB) and face shape morphology in a large cohort of 15-year-old children. Design Observational longitudinal cohort study Setting Avon Longitudinal Study of Parents and Children (ALSPAC), South West of England. Participants Three-dimensional surface laser scans were taken for 4784 white British children from the ALSPAC during a follow-up clinic. A total of 1724 children with sleep disordered breathing (SDB) and 1862 healthy children were identified via parents’ report of sleep disordered symptoms for their children. We excluded from the original cohort all children identified as having congenital abnormalities, diagnoses associated with poor growth and children with adenoidectomy and/or tonsillectomy. Main outcome measures Parents in the ALSPAC reported sleep disordered symptoms (snoring, mouth breathing and apnoea) for their children at 6, 18, 30, 42, 57, 69 and 81 months. Average facial shells were created for children with and without SDB in order to explore surface differences. Results Differences in facial measurements were found between the children with and without SDB throughout early childhood. The mean differences included an increase in face height in SDB children of 0.3 mm (95% CI −0.52 to −0.05); a decrease in mandibular prominence of 0.9° (95% CI −1.30 to −0.42) in SDB children; and a decrease in nose prominence and width of 0.12 mm (95% CI 0.00 to 0.24) and 0.72 mm (95% CI −0.10 to −0.25), respectively, in SDB children. The odds of children exhibiting symptoms of SDB increased significantly with respect to increased face height and mandible angle, but reduced with increased nose width and prominence. Conclusions The combination of a long face, reduced nose prominence and width, and a retrognathic mandible may be diagnostic facial features of SBD that may warrant a referral to specialists for the evaluation of other clinical symptoms of

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

    Rosenbloom, Arlan L

    2009-01-01

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

  3. 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

    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

  4. 鼻内镜下两种不同手术方式切除腺样体的比较%A comparison of temperature-controlled radiofrequency and powered microdebrider in resection of adenoid hypertrophy

    赵新; 肖大江; 袁渊; 朱国臣; 张永胜

    2012-01-01

    Objective To compare the clinical outcomes of temperature-controlled radiofrequency and powered microdebrider in the surgical treatment of adenoid hypertrophy. Methods A total of 78 cases with adenoid hypertrophy underwent adenoidectomy was equally divided into two groups of A (surgery with temperature-controlled radiofrequency) and B(surgery with powered microdebrider). The operative time, blood lose, complications and effectiveness rate were compared between two groups. Results The surgeries were performed smoothly without any severe complications in both groups. The operative time was shorter and blood lose was less in group A than those in group B[(18. 3±2.4) min vs. (37. 9±5. 5) min and (9. 4±3.1) ml vs. (61. 4±7. 8) ml] (P<0.05). Conclusion Compared to powered microdebrider. surgical resection of adenoid hypertrophy with temperature-controlled radiofrequency is with shorter operative time and less blood lose.%目的 比较鼻内镜下分别使用低温等离子系统和电动切割器切除腺样体的优越性.方法 腺样体切除手术的患儿78例均分为两组:A组使用低温等离子手术系统;B组使用电动切割器.比较两组的手术时间、术中出血量、术后并发症及有效率.结果 两组患儿手术顺利,术后效果好,无严重并发症发生.A组手术时间较B缩短[(18.3±2.4) min vs.(37.9±5.5)min] (P<0.05);A组出血量较B组减少[(9.4±3.1) ml vs.(61.4±7.8)ml](P<0.05).结论 与应用电动切割器比较,使用低温等离子手术系统实施腺样体切除术具有手术时间短、出血少的优势.

  5. 儿童腺样体肥大切除术的临床疗效%Clinical Effect of Adenoid Resection in Children with Adenoid Hypertrophy

    黄芳辉; 曾友根

    2016-01-01

    Objective:To investigate the adenoid hypertrophy in children’s relationship with related complications,strive for early diagnosis,early treatment and reduce the occurrence of complications. Method: 36 children with adenoid hypertrophy in our hospital were selected from February 2014 to February 2016, the age, gender, complications, treatment and curative effect were analyzed.Result:36 patients with adenoid hypertrophy,31 cases with merge and sleep apnea,22 cases with secretory otitis media,8 cases with sinusitis. Postoperative follow-up of 1 month, snoring, improve hearing, stuffy nose, nasal drip efficient was 96.8%, 86.4%, 87.5% and 75.0% respectively.Conclusion:Adenoid hypertrophy in children with sleep apnea,secretory otitis media and sinusitis.Definite diagnosis as soon as possible,take timely adenoidectomy,reduce complications,can obtain satisfactory curative effect, avoid affect children’s growth and development.%目的:探讨儿童腺样体肥大与相关并发症的关系,争取早诊断,早治疗,减少并发症的发生。方法:选择2014年2月-2016年2月在本院住院儿童腺样体肥大患者36例,对其年龄、性别、并发症、诊治和疗效进行分析。结果:36例腺样体肥大患者,合并鼾症31例,合并分泌性中耳炎22例,合并鼻窦炎8例。及时采取腺样体切除术后随访1个月,打鼾、听力改善、鼻塞、鼻漏有效率分别为96.8%、86.4%、87.5%、75.0%。结论:儿童腺样体肥大可并发鼾症、分泌性中耳炎、鼻窦炎。尽早明确诊断,及时采取腺样体切除术,减少并发症产生,可获得满意疗效,避免影响儿童生长发育。

  6. 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

    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.

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

    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.

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

    Xiao-Peng Qu

    2015-01-01

    Full Text Available 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-κB (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.

  9. Clear Lung Fights Soup Treatment Curative Effect Observation of Children with Adenoid Hypertrophy%清肺散结汤治疗小儿腺样体肥大的疗效探讨

    王艳玲

    2015-01-01

    Objective To explore the clear lung fights soup clinical curative effect for the treatment of infantile adenoid hypertro-phy. Methods Select our hospital of 60 cases of children with adenoid hypertrophy were randomly divided into control group (30 patients receiving treatment: rhinitis tablet) and observation group (30 cases, treated with clear lung fights soup) in the two groups, to compare the treatment effect in two groups of children. Results The observation group and control group total effective rate was 93.3%and 93.3%respectively, in patients with significant difference between groups(P<0.05);After treatment, the clinical symp-toms and adenoidectomy volume integral, the observation group was significantly lower than(P<0.05).Conclusion Clear lung fights soup cure infantile adenoid hypertrophy curative effect, clinical symptoms improved significantly.%目的:探讨清肺散结汤治疗小儿腺样体肥大的临床疗效。方法随机选择该院收治的60例腺样体肥大患儿,随机分为对照组(30例,接受通窍鼻炎片治疗)和观察组(30例,接受清肺散结汤治疗),比较两组患儿治疗效果。结果观察组和对照组患者总有效率分别为93.3%和70.0%,组间差异有统计学意义(P<0.05);治疗后,在临床症状积分和腺样体体积积分方面,观察组显著低于(P<0.05)。结论清肺散结汤治疗小儿腺样体肥大的疗效确切,患儿临床症状改善明显。

  10. 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

    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

  11. 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

    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

  12. The clinical research on the treatment of the low temperature plasma radiofrequency ablation through the mouth under endoscope in adenoid hypertrophy of children%鼻内镜下低温等离子射频消融治疗儿童腺样体肥大的临床研究

    毛贺娟; 蒋蓉; 陈艳辉; 赵倩; 颜光堂; 程奇; 王建洪; 肖世强

    2014-01-01

    radiofrequency ablation under endoscope, the control group given conventional adenoidectomy curettage, and analysis and comparison of two groups of children with operation time, intraoperative blood loss and length of hospital stay, and followed up for 1 year, compared to observe the patient's clinical symptoms such as nasal congestion, snoring and hearing, and postoperative residue, recurrence and complications. Results Compared with control group, experimental intraoperatie blood loss is lower than the control group significantly, and the difference was statistically significant (P < 0.05); Patients postoperative nasal congestion, snoring and hearing the clinical total effective rate was 86.0%(43/50), 80.0%(40/50), 76.0%(38/50), significantly higher than the control group 68.8%(33/48), 60.4%(29/48), 54.2%(26/48), the difference was statistically significant (P<0.05);Patients postoperative only 1 (2.0%) cases of adenoid residual body, and no recurrence of adenoid hypertrophy, the control group after adenoidectomy residual rate is 58.3%(28/48), recurrent adenoid hypertrophy were 16.7%(8/48), is similar between the two groups have statistical significance (P<0.05), and two groups there were no serious postoperative complications. In addition, the two groups were no recurrence rate analysis and Log-rank test, there were significant differences (P<0.05). Conclusion Nasal endoscopic low-temperature plasma radiofrequency ablation in the treatment of adenoid hypertrophy in children good clinical curative effect, less intraoperative blood loss, postoperative recurrence and other complications, can be used as a surgical preferred method for the treatment of adenoid hypertrophy in children.

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

    Aysu Inan Kocum

    2013-02-01

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

  14. 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

    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.

  15. Indications for tonsillectomy stratified by the level of evidence

    Windfuhr, Jochen P.

    2016-01-01

    , or with a significant history of tonsillitis. In particular, interval-tonsillectomy is not justified as a routine. 4) TE, with or without adenoidectomy, is efficacious to resolve sleep-related breathing disorders resulting from (adeno)tonsillar hypertrophy in children. However, the benefit is reduced by co-morbidities, such as obesity, and further research is required to identify prognostic factors for this subgroup of patients. Further research is indicated to clarify selection criteria not only for this subpopulation that may benefit from less invasive procedures such as tonsillotomy in the long-term. 5) Further trials are also indicated to evaluate the efficacy of TE on the clinical course in children with psoriasis guttata as well as on psoriasis vulgaris in adults, not responding to first-line therapy. 6) Conflicting results were reported concerning the role of TE in the concert to treat Ig-A nephropathy, mandating further clinical research. 7) Most importantly, randomized-controlled clinical trials with an adequate long-term follow-up are desirable to clarify the benefit of TE in patients with recurrent episodes of tonsillitis, with or without pharyngitis. Factors like age, spontaneous healing rate and postoperative quality of life have to be included when comparing TE with antibiotic therapy. PMID:28025609

  16. 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

    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 .

  17. 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

    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.

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

    Otávio Bejzman Piltcher

    2005-10-01

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

  19. 去氨加压素致儿童低血钠性癫痫发作8例分析%Analysis of 8 Cases of Pediatric Hyponatremia Epilepsy Caused by Desmopressin

    王璐; 邹湘; 盛光耀

    2012-01-01

    目的:提示临床重视去氨加压素致儿童低血钠性癫痫发作.方法:回顾性分析8例患儿使用去氨加压素后导致低血钠性癫痫发作的病历,记录其年龄、性别、癫痫既往史、诊断、给药方式、发作时间、发作形式、血钠水平、处理措施.结果:8例患儿年龄2~7岁;男性5例,女性3例;既往均无癫痫病史;尿崩症1例,轻型血友病甲1例,扁桃体切除术后2例,腺样体切除术后3例,眼外伤术后1例;均为静脉输注给药,按0.3μg·kg-1给药6例,超出0.3μg·kg12例;均发作在给药2~4d;均表现为癫痫大发作;血钠水平为119~125mmol·L-1.采取停用去氨加压素、地西泮止抽、呋塞米利尿、高张盐水输注纠正低钠血症后缓解.结论:去氨加压素可致儿童低血钠性癫痫发作,临床应用时应严格掌握适应证并严密监测血钠水平.%OBJECTIVE: To report and analyze the adverse drug reaction induced by desmopressin which caused hyponatremia epilepsy, and to promote rational drug use in the clinic. METHODS: Medical records of 8 cases of hyponatremia epilepsy induced by desmopressin were analyzed retrospectively to record age, gender, epilepsy history, diagnosis, route of administration, time and form of epilepsy, serum sodium concentration and therapy. RESULTS: The age of these 8 cases were from 2 to 7 years old. There were 5 male and 3 female. All cases had no epilepsy history. 1 case was diabetes insipidus, 1 case was hemophilia A, 2 cases were post-tonsillectomy, 3 cases were post-adenoidectomy, 1 cases was post-ocular trauma operation. The routes of administration were all intravenous injection. The dosage were 0.3 μg·kg-1 among 6 cases and >0.3 μg·kg-1 among 2 cases. Epilepsy happened 2 to 4 days after medication and manifested as grand mal. Serum sodium concentration was 119—125 mmol·L-1. All cases were given diazepam, ftirosemide and hypertonic sodium chloride, and stopped taking desmopressin when

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

    陈伟南; 覃兴龙; 邓丽芳

    2014-01-01

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

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

    贺飞龙; 施开德

    2013-01-01

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

  2. Change and Significance of Mean Platelet Volume in Children with Chronic Tonsillitis and Adenoid Hypertrophy%慢性扁桃体炎和腺样体肥大儿童外周血平均血小板体积变化及意义

    郑海明

    2016-01-01

    Objective Chronic tonsillitis (CT)and adenoid hypertrophy (AH)is the most common cause of ob-structive sleep apnea hyponea syndrome(OSAHS).In the present study,we evaluated the relationship between mean platelet volume (MPV)and CT and AH which is the most frequent cause leading OSA in children.Methods A total of 40 children aged between 4 and 16,who underwent adenoidectomy or adenotonsillectomy with a diagnosis of AH and/or CT were recruited as operation group.38 healthy controls aged between 4 and 16 were employed as control group.Mean platelet volume (MPV)values,platelet count (PLT),white blood cell count (WBC)and hemoglobin (Hb)levels were recorded individually.Results It was found that MPV values in operation group were significantly lower than control group(P<0.001),whereas PLT in operation group was significantly higher than control group(P<0.001).There were no significant differences in WBC and HB values among groups.Conclusion OSAHS caused by CT-AH is associ-ated with low MPV values in childhood aged 4 to 1 6 .%目的:慢性扁桃体炎(CT)和腺样体肥大(AH)是引起阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的最常见原因。本研究探讨扁桃体和(或)腺样体切除后外周血平均血小板体积(MPV)变化及其意义。方法40例被诊断为腺样体肥大和(或)慢性扁桃体炎患儿全麻下行腺样体和(或)扁桃体切除术,设为手术组,年龄4到16岁。38例4到16健康岁儿童设为对照组。分别检测外周血平均血小板体积(MPV),血小板计数(PLT),白细胞计数(WBC)和血红蛋白(HB)水平。结果手术组 MPV水平明显低于对照组(P<0.001),手术组PLT明显高于对照组(P<0.001);手术组 WBC和 HB水平与对照组相比无统计学意义。结论4到16岁儿童由慢性扁桃体炎(CT)和腺样体肥大(AH)引起的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与外周血低水平血小板平均体积(MPV)有关。

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

    Beatriz de Souza Vilella

    2006-03-01

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

  4. 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

    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

  5. 阻塞性睡眠呼吸暂停低通气综合征对儿童身高体重的影响%Study on the height and weight in children with obstructive sleep apnea hypopnea syndrome

    曾勇; 王跃建; 陈伟雄; 于青青; 何发尧; 张剑利

    2013-01-01

    Objective:To investigate the influence of obstructive sleep apnea hypopnea syndrome(OSAHS) on children's growth. Method:Fifty-three children diagnosed as OSAHS were included in the treatment group and underwent tonsillectomy or adenoidectomy. and 51 normal children were employed as the control group. Main data monitered by PSG and growth hormone(GH) in children of the treatment group were recorded before and after surgery, in addition, growth hormone, height and weight of children in the treatment group and control group were respectively recorded and compared. Result: Height and weight of children with OSAHS before treatment were lower than that of the normal children and the difference was significant (P<0. 05). Compared with the data before surgery, oxygen saturation of blood in children of treatment group recorded by PSG increased(P<0. 05).while value of other data decreased(P<0. 05). Growth hormone in children of the treatment group was lower than that of the control group and the difference between two group was significant ( P<C0. 05). while the content of growth hormone in children of the treatment group elevated after 3 months postoperatively and at this time no difference was found between the two groups. Conclusion:Children with OSAHS present the symptom of upper airway obstruction, which badly affects sleep quality and results in decreased secretion of growth hormone and finally the height and weight of children is got involved. Timely surgery is necessary to alleviate the symptom.%目的:探讨儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对儿童生长发育的影响.方法:选择符合OSAHS诊断标准的53例儿童作为治疗组,进行扁桃体切除术和(或)腺样体切除术治疗,同时选择51例正常儿童作为对照组.观察治疗组手术前后PSG的主要指标,测定治疗组患儿手术前后血浆中生长激素(GH)的含量及对照组儿童血浆中GH的含量,准确记录治疗组患儿的身高和体重,并

  6. 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

    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

  7. Plasma Radiofrequency Treatment at Low Temperature Under Endoscope Clinical Research of Adenoid Hypertrophy in Children%鼻内镜下低温等离子消融术治疗儿童腺样体肥大的临床研究

    杨国勇; 李亶; 温太佩

    2015-01-01

    目的研究分析采用鼻内镜下低温等离子消融术治疗儿童腺样体肥大的临床效果以及不良反应情况。方法采用回顾性分析的方法,分析了我院在2012年3月~2014年3月收治的108例儿童腺样体肥大患者的临床资料,根据治疗方法的不同,将本组患者随机分成对照组和实验组,每组各54例,对照组患者采用经口咽刮除腺样体的传统手术方法治疗,实验组患者则采用鼻内镜下低温等离子消融术治疗。分析比较两组患者的临床治疗效果。结果研究结果表明采用鼻内镜下低温等离子消融术治疗儿童腺样体肥大有效率明显高于传统的手术方法。结论对于儿童腺样体肥大,采用鼻内镜下低温等离子消融术治疗效果好,能够明显提高患者的临床治疗有效率,且不良反应少,安全可靠。%Objective To analyze the clinical ef ects and adverse reactions for adenoid hypertrophy in children using plasma radiofrequency treatment at low temperature under endoscope.Methods We analyzed the clinical data of 108 cases of adenoid hypertrophy children in our hospital from March 2012 to March 2012.According to the dif erent method of treatment,this group of patients were randomly divided into control group and experimental group,each group with 54 cases.The control group were treated with traditional surgery method by the oropharynx shaving adenoidectomy,while the experimental group patients used plasma radiofrequency treatment at low temperature under endoscope.Analyze and compare the clinical treatment ef ect of two groups of patients.Results The results indicate that using plasma radiofrequency treatment at low temperature under endoscope in children adenoid hypertrophy were significantly higher than the ef icient traditional surgical method. Conclusion The ef ect of using plasma radiofrequency treatment at low temperature under endoscope adenoid hypertrophy in children is good,it can

  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

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

    Aracy Pereira Silveira Balbani

    2005-04-01

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

  10. 腺样体、扁桃体肥大患儿肺功能的改变及手术对其影响%Pulmonary function in children with adenoid and tonsil hypertrophy

    庞冲; 刘传合; 谷庆隆; 李硕; 黄春雷; 高帆; 陆颖霞

    2012-01-01

    Objective Explore the pulmonary function in children with adenoid and tonsil hypertrophy and it changes by operation . Method 130 children with adenoid and tonsil hypertrophy were enrolled in the study. MS-IOS pulmonary function testing was performed preoperatively for each patient, and repeated postoperatively for 50 patients with abnormalities in preoperative one. Respiratory impedance ( Zr), resonance frequency (Rf), viscous resistance of R5, R20, X5, X35 elastic resistance, central airway resistance (Re), peripheral airway resistance (Rp) and other parameters were evaluated. The influence of different hypertrophic degree of adenoid and tonsil, and of operative intervention were also inverstigated. Results Adenoid and tonsil hypertrophy resulted in a significant high value in Z5, R5, R20, X5, Re and Rp, However, hypertropic degrees showed unclear affection ( P > 0.05 ). Surgical intervention presented an obviously improvement in Z5, R5 and R20 ( P < 0.05 ). Conclusion Airway obstruction existed in children with adenoid and tonsil hypertrophy was reduced by adenoidectomy and tonsillectomy. Early surgical intervention is necessary in order to eliminate the impairment on ventilation function in these children.%目的 探讨腺样体、扁桃体肥大患儿肺功能的改变及手术对其影响.方法 选择因腺样体,扁桃体肥大住院手术患儿130例,采用MS-IOS肺功能仪检测其肺功能,并对术前肺功能异常的50例患儿术后随诊并再次行肺功能检测.采用呼吸阻抗(Zr)、共振频率(Rf),黏性阻力R5、R20,弹性阻力X5、X35,中心气道阻力(Rc)、外周气道阻力(Rp)等参数,分析不同程度腺样体、扁桃体肥大患儿以上参数的改变及手术前后的差异.结果 腺样体、扁桃体肥大患儿多数存在气道阻塞,Z5、R5、R20、X5、Rc、Rp等值偏高;但不同程度腺样体、扁桃体肥大患儿肺功能水平未见统计学差异(P>0.05);与术前比较,患儿手术

  11. 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

    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

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

    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.

  13. Tonsillitis and sore throat in children

    Stelter, Klaus

    2014-12-01

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

  14. Tonsillitis and sore throat in children

    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

  15. Tonsillitis and sore throat in children.

    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.

  16. [Tonsillitis and sore throat in childhood].

    Stelter, K

    2014-03-01

    danger of aspiration with asphyxia. A massive hemorrhage is an extreme challenge for every paramedic or emergency doctor because of the difficult airway management. Intubation is only possible with appropriate unflexible suction tubes. All different surgical techniques have the risk of hemorrhage and even the best surgeon will experience a postoperative hemorrhage. The lowest risk of hemorrhage 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 hemorrhage. Children with a hereditary coagulopathy have a higher risk of hemorrhage. 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-points-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 test are inappropiate and incapable of detecting the von Willebrand disease, which is the most often 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.

  17. 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

    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

  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

    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

  19. 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

    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.

  20. 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

    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.

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

    Aldo José Peixoto

    2002-06-01

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