Adult tonsillectomy: postoperative pain depends on indications

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Olaf Zagólski

Full Text Available ABSTRACT INTRODUCTION: Intense pain is one of the most important postoperative complaints after tonsillectomy. It is often described by patients as comparable to the pain that accompanies an acute tonsillitis. Although recurrent tonsillitis is the most frequent indication for surgery, many tonsillectomies are performed due to other indications and these patients may be unfamiliar with such pain. OBJECTIVE: To verify whether individuals with recurrent tonsillitis experience different post-tonsillectomy pain intensity than those with other indications for surgery, with no history of episodes of acute tonsillitis. METHODS: A total of 61 tonsillectomies were performed under general anesthesia, using a potassium titanyl phosphate (KTP laser (to eliminate the potential influence on the study results of forceful dissection of fibrotic tonsils in patients with history of recurrent tonsillitis and multiple ligations of blood vessels within the tonsillar beds. The patients received 37.5 mg Tramadoli hydrochloridum + 325 mg Paracetamol tablets for 10 days. Postoperative variables included the duration of hospital stay, postoperative hemorrhage and readmission rate. The patients reported pain intensity on consecutive days, pain duration, weight loss on postoperative day 10, character, intensity and duration of swallowing difficulties, and the need for additional doses of painkillers. Healing was also assessed. Capsular nerve fibers were histologically examined in the resected tonsils by immunostainings for general and sensory markers. RESULTS: Indications for the surgery were: recurrent acute tonsillitis (34 patients, no history of recurrent tonsillitis: focus tonsil (20 and intense malodour (7. Pain intensity on postoperative days 3-4 and incidence of readmissions due to dehydration were significantly higher in the group with no history of recurrent tonsillitis. No significant differences in relative densities of protein gene product (PGP 9.5- and

Efficacy of sucralfate for the treatment of post-tonsillectomy symptoms.

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Siupsinskiene, Nora; Žekonienė, Jurgita; Padervinskis, Evaldas; Žekonis, Gediminas; Vaitkus, Saulius

2015-02-01

Pain after tonsillectomy remains the main issue of postoperative morbidity and the search for an effective post-tonsillectomy analgesic is of increasing relevance. The aim of this study was to evaluate the effectiveness of topical sucralfate during an early post-tonsillectomy period. Fifty patients of both genders from 6 to 58 years submitted to tonsillectomy or adenotonsillectomy were randomly included into either a sucralfate treatment group (N = 25) or into a control group (N = 25). Patients of the sucralfate group received topical sucralfate four times a day for 7 days. No topical treatment was applied to patients of the control group. A systemic analgesic was standardized. Post-tonsillectomy symptoms, including throat pain, odynophagia and otalgia, were evaluated during the period of seven postoperative days. Secondary outcomes were analgesic use, well being in general, return to regular daily activities, secondary hemorrhage and side effects of sucralfate. This study revealed that during the period of the second to seventh postoperative days average throat pain scores of the sucralfate using patients were significantly lower than those of the control group patients (p < 0.05); the same could be applied to odynophagia scores during the period of all seven postoperative days (p < 0.01) and otalgia scores from the 4th postoperative day (p < 0.05). The sucralfate group patients also had a significantly smaller need for analgesics, better scores of well being in general and early return to regular daily activities with no side effects of the treatment. Topical sucralfate could be recommended for the everyday clinical practice as a safe, adjuvant medicine of treatment during the period of the first post-tonsillectomy week.

Intracapsular tonsillectomy for keratosis pharyngeous: A pilot study of postoperative recovery and surgical efficacy.

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Gaudreau, Philip A; Gessler, Eric M

2017-09-01

Our objective was to perform a pilot study comparing intracapsular radiofrequency ablation tonsillectomy with subcapsular tonsillectomy in adult patients with keratosis pharyngeous. Patients diagnosed with keratosis pharyngeous between December 2010 and February 2013 were randomized to undergo either intracapsular or subcapsular tonsillectomy using radiofrequency ablation. Postoperative pain scores and amount of pain medication taken were recorded for 2 weeks. A 6-month follow-up questionnaire was used to assess efficacy of the procedure. Twenty-two patients completed the initial 2-week questionnaire. Eighteen completed the 6-month follow-up questionnaire. The amount of pain medication consumed on postoperative days 8 (p = 0.0293), 9 (p = 0.0146), and 10 (p = 0.035) was significantly less in the intracapsular group. Risk of recurrence of tonsilloliths was significantly greater at the 6-month follow-up in the intracapsular cohort (p = 0.0291). Based on these findings, in patients undergoing tonsillectomy for keratosis pharyngeous, intracapsular radiofrequency ablation tonsillectomy may result in decreased pain medication consumption compared with subcapsular tonsillectomy. Intracapsular tonsillectomy, however, resulted in a higher rate of recurrence of tonsilloliths. The benefit of decreased pain medication may be offset by the greater likelihood for symptoms to recur. Larger studies are needed to confirm these findings.

Day-case tonsillectomy: practical solution or practical impossibility.

LENUS (Irish Health Repository)

Kharytaniuk, N

2015-01-01

The use of day case surgery is on the rise. In order to improve efficiency and reduce cost, it has been proposed that tonsillectomy could be undertaken as a day-case procedure in Ireland. A retrospective, chart-based study was carried out. The medical and social criteria of all patients who underwent tonsillectomy during a twelve-month period were evaluated. Individual, local and national factors were identified and international comparisons were made. Of 161 patients included, 43 (27%) were considered suitable for day case tonsillectomy (DCT). The distance\\/time criteria from hospital excluded 64% of patients. The diagnosis of obstructive sleep apnoea was the single most common medical reason for exclusion. Support structures were deficient. Local factors must be considered before any policy or targets are developed for DCT. Patient safety is the fundamental tenet. Currently, the infrastructure and the support required for a patient-focused, safe efficient DCT are deficient, and need investment.

Scoping review of pediatric tonsillectomy quality of life assessment instruments.

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Kao, Stephen Shih-Teng; Peters, Micah D J; Dharmawardana, Nuwan; Stew, Benjamin; Ooi, Eng Hooi

2017-10-01

Sleep-disordered breathing or recurrent tonsillitis have detrimental effects on the child's physical health and quality of life. Tonsillectomy is commonly performed to treat these common conditions and improve the child's quality of life. This scoping review aims to present a comprehensive and descriptive analysis of quality of life questionnaires as a resource for clinicians and researchers when deciding which tool to use when assessing the quality of life effects after tonsillectomy. A comprehensive search strategy was undertaken across MEDLINE (PubMed), CINAHL, Embase, and Cochrane CENTRAL. Quality of life questionnaires utilized in studies investigating pediatric patients undergoing tonsillectomy for chronic tonsillitis or sleep-disordered breathing were included. Methodological quality and data extraction were conducted as per Joanna Briggs Institute methodology. Ten questionnaires were identified, consisting of six generic and four disease-specific instruments. The Pediatric Quality of Life Inventory was the most commonly utilized generic questionnaire. The Obstructive Sleep Apnea-18 was the most commonly utilized disease-specific questionnaire. This review identified a range of generic and disease-specific quality of life questionnaires utilized in pediatric patients who have undergone tonsillectomy with or without adenoidectomy for sleep-disordered breathing or chronic tonsillitis. Important aspects of each questionnaire have been summarized to aid researchers and clinicians in choosing the appropriate questionnaire when evaluating the quality of life effects of tonsillectomy. NA Laryngoscope, 127:2399-2406, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Preoperative information needs of children undergoing tonsillectomy.

LENUS (Irish Health Repository)

Buckley, Aoife

2012-02-01

AIMS AND OBJECTIVES: To identify the information needs of children undergoing tonsillectomy with reference to content of information, method of delivery, information providers and timing of information provision. BACKGROUND: Tonsillectomy can be anxiety provoking for children and preoperative preparation programmes are long recognised to reduce anxiety. However, few have been designed from the perspectives of children and to date little is known about how best to prepare children in terms of what to tell them, how to convey information to them, who can best provide information and what is the best timing for information provision. DESIGN: A qualitative descriptive study. METHOD: Data were collected from nine children (aged 6-9) using interviews supported by a write and draw technique. Data were coded and categorised into themes reflecting content, method, providers and timing of information. RESULTS: Children openly communicated their information needs especially on what to tell them to expect when facing a tonsillectomy. Their principal concerns were about operation procedures, experiencing \\'soreness\\' and discomfort postoperatively and parental presence. Mothers were viewed as best situated to provide them with information. Children were uncertain about what method of information and timing would be most helpful to them. CONCLUSION: Preoperative educational interventions need to take account of children\\'s information needs so that they are prepared for surgery in ways that are meaningful and relevant to them. Future research is needed in this area. RELEVANCE TO CLINICAL PRACTICE: Practical steps towards informing children about having a tonsillectomy include asking them what they need to know and addressing their queries accordingly. Child-centred information leaflets using a question and answer format could also be helpful to children.

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

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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.

Six years of evidence-based adult dissection tonsillectomy with ultrasonic scalpel, bipolar electrocautery, bipolar radiofrequency or 'cold steel' dissection.

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Ragab, S M

2012-10-01

To conduct an adequately powered, prospective, randomised, controlled trial comparing adult dissection tonsillectomy using either ultrasonic scalpel, bipolar electrocautery, bipolar radiofrequency or 'cold steel' dissection. Three hundred patients were randomised into four tonsillectomy technique groups. The operative time, intra-operative bleeding, post-operative pain, tonsillar fossa healing, return to full diet, return to work and post-operative complications were recorded. The bipolar radiofrequency group had a shorter mean operative time. The mean intra-operative blood loss during bipolar radiofrequency tonsillectomy was significantly less compared with cold dissection and ultrasonic scalpel tonsillectomy. Pain scores were significantly higher after bipolar electrocautery tonsillectomy. Patients undergoing bipolar electrocautery tonsillectomy required significantly more days to return to full diet and work. The bipolar electrocautery group showed significantly reduced tonsillar fossa healing during the first and second post-operative weeks. In this adult series, bipolar radiofrequency tonsillectomy was superior to ultrasonic, bipolar electrocautery and cold dissection tonsillectomies. This method combines the advantages of 'hot' and 'cold' tonsillectomy.

The effect of tonsillectomy on the immune system: A systematic review and meta-analysis.

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Bitar, Mohamad A; Dowli, Alexander; Mourad, Marc

2015-08-01

The immunological sequelae of tonsillectomy in children have been a source of debate among physicians and a continuous concern for parents. Contradictory pertinent results exist in the literature. To understand the real effect of tonsillectomy on the immune system. MEDLINE, EMBASE and COCHRANE. Articles addressing the effect of tonsillectomy on the immune system, up to Dec 2014. Related keywords and medical subject headings were used during the search. The abstracts were reviewed to determine suitability for inclusion based on a set of criteria. Manual crosscheck of references was performed. We checked the tests results and the conclusion of each study to classify it as supporting or refuting the hypothesis of a negative effect of tonsillectomy on the immune system. We reviewed 35 articles, published between 1971 and 2014, including 1997 patients. Only Four studies (11.4%), including 406 patients (20.3%) found that tonsillectomy negatively affects the immune system. We performed a separate meta-analysis on various reviewed humoral and cellular immunological parameters (e.g. total and specific serum Ig's, SecIgA, cellular immunity, and Ag specific Ig). There is more evidence to suggest that tonsillectomy has no negative clinical or immunological sequalae on the immune system. Study limitations included heterogeneity in the diagnostic tools, timing of testing, indication for tonsillectomy and patients' age. It is reasonable to say that there is enough evidence to conclude that tonsillectomy has no clinically significant negative effect on the immune system. It will be important for future studies to uniformly use both preoperative and control laboratory tests' levels to compare the postoperative levels with, to have short and long term follow-up levels, and to include both humoral and cellular immunity in their measurements. The results should reassure both surgeons and parents that tonsillectomy has no proven clinical sequalae. If more research is to be done in the

Monopolar electrodissection versus cold dissection tonsillectomy among children

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Bukhari, Manal A.; Al-Ammar, Ahmed Y.

2007-01-01

To compare cold dissection to monopolar tonsillectomy in terms of operative time, intraoperative bleeding, post operative bleeding. The study included 100 children who underwent tonsillectomy between January 2002 and January 2004. This study was carried out at King Abdul-Aziz University Hospital, Riyadh, Kingdom of Saudi Arabia. Patients were randomly selected to have either the right or left tonsils removed by either technique (cold dissection or monopolar dissection technique). We compared both techniques in each side on the same patient. There was no significant difference in operative time between both sides by either technique, however, when the patients were grouped into 3 minute groups, the result showed that a greater number of patients were operated up on <-3 minutes by diathermy procedure compared to dissection method (44 versus 67) (p=0.0011). Blood loss was minimal with the diathermy technique, averaging 25.37 ml compared to 88.5 for cold dissection tonsillectomy. There was a significant increase in postoperative pain on the first postoperative day in the diathermy group compared to the cold dissection group (27% versus 12%) (p=0.0151). However, there was no significant difference in pain between both sides in the first 24 hours and from the 2nd to 10th postoperative days. Monopolar dissection tonsillectomy is a safe technique. It significantly reduces the operative time and intraoperative blood loss. However, it causes more pain on the 1st postoperative day, while on the rest of the days until the 10th postoperative day, there was no significant difference in pain between two sides. (author)

Protocol for north of England and Scotland study of tonsillectomy and adeno-tonsillectomy in children (NESSTAC). A pragmatic randomised controlled trial comparing surgical intervention with conventional medical treatment in children with recurrent sore throats.

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Bond, John; Wilson, Janet; Eccles, Martin; Vanoli, Alessandra; Steen, Nick; Clarke, Ray; Zarod, Andrew; Lock, Catherine; Brittain, Katie; Speed, Chris; Rousseau, Nikki

2006-08-09

Uncertainties surrounding the effectiveness and cost-effectiveness of childhood tonsillectomy for recurrent sore throat led the NHS Health Technology Assessment Programme to commission this research to evaluate the effectiveness and cost-effectiveness of tonsillectomy and adeno-tonsillectomy in comparison with standard non-surgical management in children aged under 16 with recurrent throat infections. The aim is to evaluate if tonsillectomy and adeno-tonsillectomy reduces the number of episodes of sore throats among children to a clinically significant extent. A simple prospective pragmatic randomised controlled trial with economic analysis and prospective cohort study of non-trial participants comparing surgical intervention with conventional medical treatment. The treatment arm will receive tonsillectomy and adeno-tonsillectomy while in the control arm non-surgical conventional medical treatment only will be used. The primary outcome measure will be reported number of episodes of sore throat over two years with secondary outcomes measures of reported number of episodes of sore throat, otitis media and upper respiratory tract infection which invoke a GP consultation; reported number of symptom-free days; reported severity of sore throats and surgical and anaesthetic morbidity. The study will take place in five hospitals in the UK. The trial population will be 406 children aged 4-15 on their last birthday with recurrent sore throat referred by primary care to the 5 otolaryngology departments. The duration of the study is seven years (July 2001-July 2008). As with all pragmatic randomised controlled trials it is impossible to control the external environment in which the research is taking place. Since this trial began a number of factors have arisen which could affect the outcome including; a reduction in the incidence of respiratory tract infections, marked socio-economic differences in consultation rates, the results from the National Prospective Tonsillectomy

Protocol for north of England and Scotland study of tonsillectomy and adeno-tonsillectomy in children (NESSTAC. A pragmatic randomised controlled trial comparing surgical intervention with conventional medical treatment in children with recurrent sore throats

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Lock Catherine

2006-08-01

Full Text Available Abstract Background Uncertainties surrounding the effectiveness and cost-effectiveness of childhood tonsillectomy for recurrent sore throat led the NHS Health Technology Assessment Programme to commission this research to evaluate the effectiveness and cost-effectiveness of tonsillectomy and adeno-tonsillectomy in comparison with standard non-surgical management in children aged under 16 with recurrent throat infections. The aim is to evaluate if tonsillectomy and adeno-tonsillectomy reduces the number of episodes of sore throats among children to a clinically significant extent. Methods/design A simple prospective pragmatic randomised controlled trial with economic analysis and prospective cohort study of non-trial participants comparing surgical intervention with conventional medical treatment. The treatment arm will receive tonsillectomy and adeno-tonsillectomy while in the control arm non-surgical conventional medical treatment only will be used. The primary outcome measure will be reported number of episodes of sore throat over two years with secondary outcomes measures of reported number of episodes of sore throat, otitis media and upper respiratory tract infection which invoke a GP consultation; reported number of symptom-free days; reported severity of sore throats and surgical and anaesthetic morbidity. The study will take place in five hospitals in the UK. The trial population will be 406 children aged 4–15 on their last birthday with recurrent sore throat referred by primary care to the 5 otolaryngology departments. The duration of the study is seven years (July 2001- July 2008. Discussion As with all pragmatic randomised controlled trials it is impossible to control the external environment in which the research is taking place. Since this trial began a number of factors have arisen which could affect the outcome including; a reduction in the incidence of respiratory tract infections, marked socio-economic differences in

Tonsillectomy: Vasoconstrictive hydrolytic cold dissection method ...

African Journals Online (AJOL)

Background: Tonsillectomy, a common paediatric otolaryngology procedure, has undergone several evolutionary trends in the surgical techniques aimed at minimizing complications and improving patients' satisfaction. Despite the technological advancements in this respect, search for an ideal method is still ongoing, and ...

Management of pediatric second branchial fistulae: is tonsillectomy necessary?

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Cheng, Jeffrey; Elden, Lisa

2012-11-01

To describe the surgical management of second branchial fistulae that extend to the pharynx, specifically to determine whether tonsillectomy, along with surgical excision of the tract affects the rate of recurrence. Retrospective chart review of pediatric patients (agebranchial anomalies at a tertiary-care children's hospital between January 1, 2006 and September 1, 2011. Sinus tracts that extended to the pharynx were considered to be fistulae. Seventy-four patients were identified who underwent surgical excision of 85 total second branchial anomalies - 20 cysts (23.5%), 29 sinuses (34.1%), and 36 fistulae (42.4%). The 36 fistulae were removed from 32 patients, 23 males and 9 females, with an average age of 43.3 months. There were 16 right, 11 left, and 5 bilateral lesions. In 14 (43.8%) of the fistulae cases, a tonsillectomy was performed. There was only one recurrence (2.8%), which occurred 41 months postoperatively. No statistically significant difference for recurrence (p=1.0) was found between the group of patients that underwent tonsillectomy and those that did not. Pediatric branchial anomalies can present as a cyst, sinus, or fistula. They are developmental failures in the involution of the branchial apparatus during the embryologic period. Management of second branchial anomalies is with surgical excision of the tract and ligation of the terminal attachment to the pharynx. Our results suggest that the recurrence rates are not affected by whether or not an ipsilateral tonsillectomy is performed. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Is bacterial colonisation of the tonsillar fossa a factor in post-tonsillectomy haemorrhage?

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Stephens, J. C.; Georgalas, C.; Kyi, M.; Ghufoor, K.

2008-01-01

OBJECTIVES: To identify if there is a link between bacterial colonisation of the tonsillar fossa and post-tonsillectomy haemorrhage. STUDY DESIGN AND SETTING: Prospective non-interventional study of 105 patients who underwent tonsillectomy during a seven-month period. The study took place in a

Recurring Strep Throat: When Is Tonsillectomy Useful?

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... throat: When is tonsillectomy useful? My 7-year-old daughter has been diagnosed with strep throat four ... of Privacy Practices Notice of Nondiscrimination Manage Cookies Advertising Mayo Clinic is a not-for-profit organization ...

Pain progression, intensity and outcomes following tonsillectomy.

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Warnock, F F; Lander, J

1998-03-01

The objective of this study was to assess outcomes of pediatric day surgery tonsillectomy. A total of 129 children, aged 5-16 years, and their parents were recruited from three urban hospitals which provided pediatric day surgery. Children reported pain on a visual analogue scale (VAS) in day surgery and then daily at home for 7 days. Parents reported outcomes of surgery, including fluid intake, nausea, vomiting and sleep disturbances. They also recorded analgesic administration. Three main results related to extent and duration of pain, quality of management of pain, and effect of pain on utilization of health services. Tonsillectomy caused considerable pain which lasted more than 7 days. Pain followed a trajectory of intense or moderately intense pain for the first 3 days followed by a gradual decline over the next 4 days. In general, post-tonsillectomy pain was poorly managed by health professionals and parents. An unexpected observation was that children who had a bupivacaine infiltration of the tonsil fossa during surgery had significantly more pain in the evening of surgery than children who did not have an infiltration. The increase in postoperative pain experienced by those who had the infiltration was attributed to quality of pain management. Children with persistent pain (those who did not follow the typical trajectory) were likely to be taken to a medical practitioner. One-third of the sample made unscheduled visits to practitioners with most occurring from Day 4 to Day 7 of the follow-up.

Analysis of clinical negligence claims following tonsillectomy in England 1995 to 2010.

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Mathew, Rajeev; Asimacopoulos, Eleni; Walker, David; Gutierrez, Tatiana; Valentine, Peter; Pitkin, Lisa

2012-05-01

We determined the characteristics of medical negligence claims following tonsillectomy. Claims relating to tonsillectomy between 1995 and 2010 were obtained from the National Health Service Litigation Authority database. The number of open and closed claims was determined, and data were analyzed for primary injury claimed, outcome of claim, and associated costs. Over 15 years, there were 40 claims of clinical negligence related to tonsillectomy, representing 7.7% of all claims in otolaryngology. There were 34 closed claims, of which 32 (94%) resulted in payment of damages. Postoperative bleeding was the most common injury, with delayed recognition and treatment of bleeding alleged in most cases. Nasopharyngeal regurgitation as a result of soft palate fistulas or excessive tissue resection was the next-commonest cause of a claim. The other injuries claimed included dentoalveolar injury, bums, tonsillar remnants, and temporomandibular joint dysfunction. Inadequate informed consent was claimed in 5 cases. Clinical negligence claims following tonsillectomy have a high success rate. Although postoperative bleeding is the most common cause of negligence claims, a significant proportion of claims are due to rare complications of surgery. Informed consent should be tailored to the individual patient and should include a discussion of common and serious complications.

Audit of GP Referrals for Tonsillectomy to the ENT Clinic Using Present HIQA Guidelines

LENUS (Irish Health Repository)

2016-10-01

Recurrent sore throat for possible tonsillectomy is the commonest clinical entity referred to the ENT outpatient department. The numbers involved represent a large clinical burden on the service. Not all of these patients require surgical intervention. Patients who fit the criteria for tonsillectomy are faced with two stage obstacles; the long waiting time until assessed by the Otolaryngologist at OPD and the time spent on long operative waiting lists. The aim of this study was to analyze the percentage of referred patients with sore throats requiring tonsillectomy versus those not needing surgery, using the present HIQA guidelines for this operation.

Anaesthesia for tonsillectomy in HIV-infected children with ...

African Journals Online (AJOL)

pulmonary arterial hypertension. Tonsillectomy is a ... tonsillitis, peritonsillar abscess, obstructive ... the high risk for postoperative nausea and vomiting .... The interlinking of factors leading to the development of pulmonary arterial hypertension.

Ambulatory anesthetic care in pediatric tonsillectomy: challenges and risks

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Collins C

2015-11-01

Full Text Available Corey Collins Massachusetts Eye and Ear Infirmary, Department of Anesthesiology, Harvard Medical School, Boston, MA, USA Abstract: Pediatric tonsillectomy is a common surgery around the world. Surgical indications are obstructive sleep apnea and recurrent tonsillitis. Despite the frequency of tonsillectomy in children, most aspects of perioperative care are supported by scant evidence. Recent guidelines provide important recommendations although clinician adherence or awareness of published guidance is variable and inconsistent. Current guidelines establish criteria for screening children for post-tonsillectomy observation, though most are based on low-grade evidence or consensus. Current recommendations for admission are: age <3 years; significant obstructive sleep apnea; obesity; and significant comorbid medical conditions. Recent reports have challenged each criterion and recommend admission criteria that are based on clinically relevant risks or observed clinical events such as adverse respiratory events in the immediate recovery period. Morbidity and mortality are low though serious complications occur regularly and may be amenable to improvements in postoperative monitoring, improved analgesic regimens, and parental education. Careful consideration of risks attributable to individual patients is vital to determine overall suitability for ambulatory discharge. Keywords: adverse airway events, complications, guidelines, mortality, OSA, pediatric anesthesia

[Ischemic stroke in childhood. A complication of tonsillectomy].

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Matilla Álvarez, A; García Serrano, E; González de la Huebra Labrador, T; Morales Martín, A C; Yusta Martín, G; Vaquero Roncero, L M

2016-02-01

Tonsillectomy is one of the most frequently performed otorhinolaryngological procedures on children. The postoperative complications are classified into primary or intermediate, which generally appear within 24h, and as secondary or delayed, after 48 h. We present the case of an ischemic stroke after performing a tonsillectomy on a 3 year-old boy, which was diagnosed in the immediate postoperative period. Using brain echo-doppler and angio-CT, an intraluminal clot was observed in the left internal carotid artery, probably as a result of direct vessel injury during arterial ligature for hemostasis. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Management of pediatric tonsillectomy pain: a review of the literature

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Hansen J

2016-05-01

Full Text Available Jennifer Hansen, Ravi D Shah, Hubert A Benzon Department of Pediatric Anesthesiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Abstract: Tonsillectomy is associated with significant pain and postoperative pain control is often unsatisfactory. We discuss the various strategies that have been investigated to control pain following tonsillectomy. Codeine is a weak analgesic frequently used in children for the treatment of mild-to-moderate pain, however, due to adverse events related to its metabolism, it has been contraindicated for postoperative pain in children since 2013. Intravenous morphine is frequently used for moderate-to-severe pain in children, however, its active metabolite can lead to respiratory depressant and other undesirable side effects. Hydromorphone is a commonly used alternative that has been studied infrequently. Alternatives to narcotic pain strategies have also been studied. Nonsteroidal anti-inflammatory drugs (NSAIDs are effective as analgesics, yet many practitioners avoid their use given the concern for postoperative bleeding. Intraoperative acetaminophen has been shown to improve postoperative pain and decrease recovery room time. Dexamethasone has been shown to improve postoperative pain, vomiting, and decrease airway swelling, and seems to be effective for use during tonsillectomy surgery. Ketamine has been shown to decrease analgesic requirements without adverse affects of hallucinations. Direct injection of local anesthetic into the tonsillar bed has been shown to be effective in improving pain control, however, there is concern that local anesthetic could be erroneously injected into the carotid artery and lead to devastating consequences. Optimal pain control regimens following pediatric tonsillectomy continue to be a challenge for both anesthesiologists and otorhinolaryngologists. Opioids are the most commonly used but are

Blood transfusion in children with sickle cell disease undergoing tonsillectomy.

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Atwood, Carlyn M; Gnagi, Sharon H; Teufel, Ronald J; Nguyen, Shaun A; White, David R

2017-12-01

Tonsillectomy is the second most common surgery in children with sickle cell disease. These children are at an increased risk of perioperative complications due to vaso-occlusive events. Although controversial, preoperative blood transfusions are sometimes given in an effort to prevent such complications. The purpose of this study is to analyze trends in the use of blood transfusion for management of children with sickle cell disease (SCD) undergoing tonsillectomy in a national database. Patients in the 1997-2012 KID with a primary procedure matching the ICD-9 procedure code for tonsillectomy (28.2-28.3) and diagnosis code for SCD (282.60-282.69) were examined. Patients were split into groups by blood transfusion status and compared across variables including complication rate, length of stay (LOS), and hospital charges. Statistical analysis included chi-square test for trend, Mann-Whitney U test, and independent t-test. 1133 patients with SCD underwent tonsillectomy. There was a strong positive correlation between increasing chronologic year and the proportion of patients receiving blood transfusions, 47 (30.1%) in 1997 to 78 (42.5%) in 2012 (r = 0.94, p = 0.005). During this period, there was no significant change in the rate of complications (r = -0.1, p = 0.87). Overall, patients receiving blood transfusion had a longer mean LOS (3.1 ± 2.4 days vs. 2.5 ± 2.2 days, p blood transfusion. The rate of complications in the transfusion group, 18 of 352(5.1%), was not significantly different (p = 0.48) from the group without transfusion, 40 of 626 (6.4%). From 1997 to 2012, there was a significant increase in the proportion of patients with SCD receiving perioperative blood transfusions for tonsillectomy. While the frequency of transfusion rose, those who received a transfusion had similar complication rates with increased charges and length of hospital stays compared to those who did not receive a transfusion. Copyright © 2017 Elsevier B.V. All

Assessment of the effect of tranexamic acid on perioperative bleeding in pediatric patients undergoing tonsillectomy

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Rabie Soliman

2015-10-01

Conclusion: The present study showed no effect of tranexamic acid in decreasing the tonsillectomy-related bleeding and there is no complication related to tranexamic acid. We are recommending other studies to measure the fibrinolytic activity during tonsillectomy and its inhibition by tranexamic acid.

ADENOIDECTOMY/TONSILLECTOMY – Is the Clotting Profile ...

African Journals Online (AJOL)

Dr. Paul Adekunle Onakoya

findings that could suggest bleeding disorders, values of prothrombin/activated partial thromboplastin time and ... history, complete blood count, platelet level and .... References. 1. Hartnick CJ, Ruben RJ. Preoperative coagulation studies prior to tonsillectomy. Arch Otolaryngol. Head Neck Surg 2000; 126: 684 – 688. 2.

[N. glossopharyngeus and tonsillectomy (author's transl)].

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Beck, C

1979-05-01

Due to its course in the pharyngeal space, the trunk of the glossopharyngeal nerve can be damaged during tonsillectomy which results in paralysis of the soft palate and impairment of the sense of taste. These symptoms may recede within two years but permanent damages can be seen as well. They can be treated by logopedia and relaxation therapy.

The comparison of bleeding and pain after tonsillectomy in bipolar electrocautery vs cold dissection.

Science.gov (United States)

Dadgarnia, Mohammad Hossein; Aghaei, Mohammad Ali; Atighechi, Saeid; Behniafard, Nasim; Vahidi, Mohammad Reza; Meybodian, Mojtaba; Zand, Vahid; Vajihinejad, Maryam; Ansari, Abdollah

2016-10-01

Although tonsillectomy is one of the most common surgeries performed in pediatric, it has potential major complications such as pain and bleeding. This study aimed to compare the bleeding and pain after tonsillectomy in bipolar electrocautery tonsillectomy versus cold dissection. This double blind clinical trial was conducted on 70 pediatric patients who were candidate of tonsillectomy. Patients were divided into two groups of including bipolar cautery (BC) and cold dissection (CD). operation time, intraoperative blood loss, and postoperative bleeding and pain were evaluated in the current study. In both of the CD and BC groups, no significant difference was found in terms of sex and age. The average amount of the intraoperative blood loss in BC group was 14.086 ± 5.013 ml and in CD group was 26.14 ± 4.46 ml (p. v = 0.0001). The mean time of operation in BC group was 19 ± 2.89 min and in CD group was 29.31 ± 5.29 min (p. v = 0.0001). patients were evaluated in terms of pain on the first, third, fifth, and seventh days after the operation. No statistically significant difference was found between two groups. Moreover, Compared pain scores in all times across two groups, no significant difference was found. In terms of postoperative bleeding, none of the patients in both groups had bleeding during follow-up. Our study showed that bipolar electrocautery tonsillectomy can significantly reduce the operation time and intraoperative blood loss; however, postoperative pain and blood loss were similar in both techniques. We recommend bipolar electrocautery as the most suitable alternative method for tonsillectomy, especially in children. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Indications for tonsillectomy and adenoidectomy: Our experience

African Journals Online (AJOL)

2013-04-13

Apr 13, 2013 ... relatively ineffective and often an unjustified procedure. An audit was carried out to strengthen the argument that tonsillectomy was a valid treatment, the audit reported that 85% of the patients had all the essential criteria/ indications documented, necessitating these procedures. It then concluded that these ...

INCIDENCE OF POLIOMYELITIS—The Effect of Tonsillectomy and Other Operations on the Nose and Throat

Science.gov (United States)

Miller, Alden H.

1952-01-01

A statistical survey was made of all the cases of poliomyelitis occurring in all of Los Angeles County during the three years of 1949, 1950 and 1951 in an attempt to determine the effect of operations on the nose and throat on the incidence of poliomyelitis. Tonsillectomy and adenoidectomy were the only operations noted with any degree of frequency. Yet, in the total of 3,601 cases of poliomyelitis that occurred in this three-year period there were only 20 (0.55 per cent) in which the patient had had recent tonsillectomy and adenoidectomy. The incidence of this disease in patients who had had tonsillectomy and adenoidectomy was compared with the “expected” incidence as determined from the incidence in other patients, in the same age group. There was no significant difference between actual and expected incidence even during the summer months when most cases of poliomyelitis occurred. The same was true with regard to recently tonsillectomized patients in the epidemic months of July through October. In a separate survey of 675 patients with poliomyelitis, it was noted that only 30 per cent ever had had tonsillectomy or adenoidectomy. Inasmuch as it is estimated that one of every three persons in the general young population nowadays has had tonsillectomy and adenoidectomy, this figure is no more or less than could be expected. PMID:12978882

Detection of human papilloma virus in the tonsils of children undergoing tonsillectomy

Directory of Open Access Journals (Sweden)

Kátia Moreira Xavier Ribeiro

Full Text Available Human papilloma virus (HPV is related to respiratory mucosal diseases, such as recurrent respiratory papillomatosis, as well as to upper-respiratory-tract malignancies. There are few reports concerning the prevalence of HPV in the upper respiratory tract of non-affected individuals. We examined the prevalence of HPV in the tonsils of children of the general population scheduled for tonsillectomy. Samples were taken from the tonsils of 100 children undergoing tonsillectomy and were then tested for HPV with the polymerase chain reaction (PCR technique, utilizing the generic primers MY09 and MY 11. The study excluded children known to have HPV and HIV-related diseases. Parents and legal guardians completed a standardized socio-demographic questionnaire. The questionnaire revealed that 84% of the mothers had at least one risk factor for genital HPV. None of the tonsil samples were positive for HPV. Apparently HPV does not commonly colonize the tonsils of children undergoing routine tonsillectomy.

Clinical utility of PPPM and FPS-R to quantify post-tonsillectomy pain in children.

Science.gov (United States)

de Azevedo, Carolina Brotto; Carenzi, Lucas Rodrigues; de Queiroz, Danielle Leite Cunha; Anselmo-Lima, Wilma T; Valera, Fabiana Cardoso Pereira; Tamashiro, Edwin

2014-02-01

As pain is a subjective and difficult parameter to assess in children, we aimed to evaluate the correspondence of two pain scales - parents' post-operative pain measure (PPPM) and faces pain scale-revised (FPS-R) with analgesic intake in the assessment of post-tonsillectomy pain in a pediatric population. Children aged 4-10 years (n=174) undergoing tonsillectomy with or without adenoidectomy had their pain monitored by PPPM and FPS-R over 7 days following surgery. The amount of analgesic (acetaminophen or dipyrone) intake was also recorded each day. Linear regression and correlation analysis were performed for pain scales and Poisson regression model for analgesic administration. To evaluate influence of gender linear regression and logistic regression with random effects were performed. PPPM and FPS-R presented a significant positive correlation (τ=0.5; R(2)=0.36; pFPS-R also showed a significant correlation with analgesic use over the 7 post-operative days (pFPS-R are equivalent pain scales to quantify post-tonsillectomy pain in children and are useful tools in post-tonsillectomy clinical research. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Demonstration of analgesic effect of intranasal ketamine and intranasal fentanyl for postoperative pain after pediatric tonsillectomy.

Science.gov (United States)

Yenigun, Alper; Yilmaz, Sinan; Dogan, Remzi; Goktas, Seda Sezen; Calim, Muhittin; Ozturan, Orhan

2018-01-01

Tonsillectomy is one of the oldest and most commonly performed surgical procedure in otolaryngology. Postoperative pain management is still an unsolved problem. In this study, our aim is to demonstrate the efficacy of intranasal ketamine and intranasal fentanyl for postoperative pain relief after tonsillectomy in children. This randomized-controlled study was conducted to evaluate the effects of intranasal ketamine and intranasal fentanyl in children undergoing tonsillectomy. Tonsillectomy performed in 63 children were randomized into three groups. Group I received: Intravenous paracetamol (10 mg/kg), Group II received intranasal ketamine (1.5 mg/kg ketamine), Group III received intranasal fentanyl (1.5 mcg/kg). The Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Wilson sedation scale scores were recorded at 15, 30, 60 min, 2 h, 6hr, 12 h and 24 h postoperatively. Patients were interviewed on the day after surgery to assess the postoperative pain, nightmares, hallucinations, nausea, vomiting and bleeding. Intranasal ketamine and intranasal fentanyl provided significantly stronger analgesic affects compared to intravenous paracetamol administration at postoperative 15, 30, 60 min and at 2, 6, 12 and 24 h in CHEOPS (p ketamine administration group. No such sedative effect was seen in the groups that received intranasal fentanyl and intravenous paracetamol in Wilson Sedation Scale (p ketamine and intranasal fentanyl were more effective than paracetamol for postoperative analgesia after pediatric tonsillectomy. Sedative effects were observed in three patients with the group of intranasal ketamine. There was no significant difference in the efficacy of IN Ketamine and IN Fentanyl for post-tonsillectomy pain. Copyright © 2017 Elsevier B.V. All rights reserved.

Post-operative pain following coblation or monopolar electrocautery tonsillectomy in children: a prospective, single-blinded, randomised comparison.

Science.gov (United States)

Parker, N P; Walner, D L

2011-10-01

To compare post-operative pain following tonsillectomy by either coblation or monopolar electrocautery in children. A parallel-designed, prospective, single-blinded, randomised trial. Ambulatory surgical facility. Eighty otherwise healthy paediatric patients undergoing coblation or electrocautery tonsillectomy by a fellowship-trained paediatric otolaryngologist. (i) The number of post-operative days with severe pain based on subjective qualification by the caretaker, (ii) post-operative days with pain rated ≥ 5 on a scale of 1-10, (iii) post-operative days requiring oral paracetamol/acetaminophen with codeine solution and (iv) post-operative days until resumption of a regular diet were assessed and recorded daily using a post-operative pain survey as a form of daily diary that was returned at the 2-week follow-up visit. Patients were consecutively enrolled into two groups of 40 patients. Average ages were 5.2 years for coblation tonsillectomy and 6.0 years for electrocautery tonsillectomy. The average number of post-operative days with severe pain was 4.2 for coblation and 5.9 for electrocautery (P = 0.006), days rating pain ≥ 5 were 3.6 for coblation and 4.8 for electrocautery (P = 0.037), days of codeine use were 2.5 for coblation and 2.9 for electrocautery (P = 0.324), and days until resumption of a regular diet were 5.2 for coblation and 6.2 for electrocautery (0.329). Coblation tonsillectomy may reduce post-operative pain and the time until resumption of a regular diet compared to electrocautery tonsillectomy. © 2011 Blackwell Publishing Ltd.

Comparison of bipolar electrocautry and cold steel dissection methods for tonsillectomy

International Nuclear Information System (INIS)

Ali, M.; Rafique, A.; Dastgir, M.; Rashid, M.; Maqbool, M.; Maqbool, S.; Bashir, S.

2014-01-01

To compare the efficacy and post-operative morbidity of bipolar electrocautry and cold steel dissection methods for tonsillectomy in pediatric population, in terms of operating time, peri-operative blood loss, post-operative pain and frequency of secondary hemorrhage. Study Design: Randomized controlled trial. Place and Duration: This study was conducted at department of ENT, Combined Military Hospital Kharian and Lahore between Jan 2009 to Jan 2012. Patients and Methods: Total 146 patients between age 6 to 12 years were enrolled in this study but only 102 patients who fulfilled the desired criteria and had regular follow up were placed in two groups. They were divided into two equal groups of 51 each labeled as A and B. Patients in group A were operated for tonsillectomy by bipolar electrocautry while group B underwent tonsillectomy by cold steel dissection method. All patients in both groups were assessed for operating time, peri-operative blood loss, secondary hemorrhage and postoperative pain on Visual Analogue Score. Results: In group A there were 27 males and 24 females while group B had 28 females and 23 males. Mean age of patients was 9.4 (SD +- 2.67) years. Patients in groups A had statistically significant lower operative time and blood loss than group B. While initial post-operative pain was not different in two groups. However late onset pain (pain on 7th and 14th day) and frequency of secondary hemorrhage was significantly higher in group A. Conclusion: Bipolar electrocautry dissection method of tonsillectomy is better than cold steel dissection method in terms of operating time and peri-operative blood loss. Although initial post-operative pain was not much significant in two groups but incidence of late onset pain and secondary hemorrhage is higher in bipolar electrocautry group. (author)

Reducing Postoperative Pain from Tonsillectomy Using Monopolar Electrocautery by Cooling the Oropharynx

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Vieira, Lucas

2014-01-01

Full Text Available Objective Evaluate intraoperative cooling of the oropharynx to reduce postoperative pain in tonsillectomy using monopolar electrocautery. Methods Sixty-six patients, age 1 to 12 years, were selected for the study, 33 in the control group and 33 in the experimental group. After randomization, patients underwent subcapsular dissection and hemostasis with monopolar electrocautery. Patients in the experimental group had the oropharynx cooled after tonsil dissection and hemostasis for 10 minutes. The procedure was done through the oral cavity by irrigation with 500 mL of 0.9% saline, in temperatures between 5°C and 10°C, for 5 minutes. The evaluation of postoperative pain was made with the pain visual analog scale (VAS for 10 days. As complementary data on the evaluation of pain, we recorded daily use of ketoprofen for pain relief. Results Pain after tonsillectomy assessed by VAS was significantly lower in the experimental group at days 0, 5, and 6 (p < 0.05. There were no differences in the use of ketoprofen between the groups. Conclusion Cooling of the oropharynx after tonsillectomy promotes clinically significant reduction in postoperative pain, without additional complications.

Risk factors for post-tonsillectomy hemorrhage.

Science.gov (United States)

Ikoma, Ryo; Sakane, Sayaka; Niwa, Kazutomo; Kanetaka, Sayaka; Kawano, Toshiro; Oridate, Nobuhiko

2014-08-01

The aim of the present study was to investigate the rate of post-tonsillectomy hemorrhage (PTH) in a single institution and to evaluate the clinical risk factors for PTH. We reviewed the records of 692 patients who underwent tonsillectomy (TE) at Yokohama Minami Kyosai Hospital in Japan. PTH grades were grouped into three categories according to the severity of the hemorrhagic episode: (I) minimal hemorrhage that stopped after noninvasive treatment, (II) hemorrhage requiring treatment with local anesthesia, and (III) hemorrhage requiring reoperation under general anesthesia in the operating room. Clinical risk factors such as sex, age (adults vs. children), TE indication, surgeon's skill level, operative time, ligature type, and duration of antibiotic administration for PTH were investigated. Among the 692 patients, 80 (11.6%) showed PTH, with primary and secondary hemorrhage accounting for 1.6% and 10.0%, respectively. A category III PTH was observed in 18 patients; thus, the overall risk of reoperation was 2.6%. The PTH episode most frequently occurred on postoperative days 5 and 6. The frequency of PTH was significantly higher in male patients and in adults (Pdefinition of PTH. Clinical risk factors for PTH were adult age and male gender. The surgeon's skill level was an additional risk factor for category III PTH. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Comparative study of the analgesic efficacy of rectal tramadol versus intravenous tramadol for adult tonsillectomy

OpenAIRE

Gadani, Hina N.; Chaudhary, Virendra Pratap

2010-01-01

Background: The optimal method for intra- and post-operative analgesia for adult tonsillectomy is uncertain. Tramadol hydrochloride is an analgesic with mixed mu and nonopioid activities, having less/no respiratory depression. Aim: The aim of our study was to compare the analgesic efficacy and nausea/vomiting produced by tramadol via intravenous and rectal administration during the first 24 h after anesthesia for adult tonsillectomy. Materials and Methods: The study design was prospective, ra...

Tonsillectomy rates in the South African private healthcare sector ...

African Journals Online (AJOL)

Background. Adeno-/tonsillectomy is a commonly performed procedure with internationally standardised and recognised indications. Despite this, there exists considerable international (190 - 850/100 000 people ≤19 years of age) and regional variation in rates. This cannot be accounted for by differences in clinical need ...

The Role of Tonsillectomy in Adults with Tonsillar Hypertrophy and Obstructive Sleep Apnea.

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Smith, Matthew M; Peterson, Ed; Yaremchuk, Kathleen L

2017-08-01

Objective To determine if tonsillectomy alone is an effective treatment in improving obstructive sleep apnea in adult subjects with tonsillar hypertrophy and to evaluate the effect of tonsillectomy on patient-reported quality-of-life indices. Study Design Case series with planned data collection. Setting Academic hospital. Subjects and Methods Thirty-four subjects completed enrollment and intervention from January 2011 to January 2016. Subjects completed pre- and postoperative quality-of-life questionnaires, including the Insomnia Severity Index, Epworth Sleepiness Scale, and the Functional Outcomes of Sleep Questionnaire-10. Surgical response to treatment was defined by a >50% decrease in the Apnea-Hypopnea Index and a decrease in the overall Apnea-Hypopnea Index to Wilcoxon matched-pairs signed-rank tests were used to test each variable to assess for a change from pre- to postintervention. Subjects were then split into 3 BMI subgroups, with results also evaluated by Wilcoxon matched-pairs signed-rank tests. Results There was a significant difference discovered between the mean preoperative Apnea-Hypopnea Index of 31.57 and the mean postoperative value of 8.12 ( P < .001). All patient-reported outcomes improved significantly following tonsillectomy. After stratifying all outcome variables (Apnea-Hypopnea Index, Epworth Sleepiness Scale, Insomnia Severity Index, and Functional Outcomes of Sleep Questionnaire-10) by sex, race, and tonsil size, no statistically significant difference was noted among any of these subgroups. There was a 78% surgical response to treatment. Conclusion Tonsillectomy appears to be an effective treatment for obstructive sleep apnea in a select population of adults with tonsillar hypertrophy.

Tonsillectomy efficacy in children with PFAPA syndrome is comparable to the standard medical treatment: a long-term observational study.

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Vigo, Giulia; Martini, Giorgia; Zoppi, Silvia; Vittadello, Fabio; Zulian, Francesco

2014-01-01

Tonsillectomy has recently been suggested as an effective treatment for PFAPA syndrome but little is known about its long-term efficacy. We compared the clinical features and the long-term outcome of a large cohort of patients with PFAPA syndrome treated with tonsillectomy or with standard medical treatment. We conducted a retrospective study on patients with PFAPA syndrome followed at a tertiary care centre from January 1993 to August 2010. Clinical characteristics and laboratory parameters were evaluated at onset and during the follow-up. Disease outcomes of patients who underwent tonsillectomy and of those treated with medical therapy (NSAIDs, prednisone) were compared. Clinical remission on medication (CRM) was considered the persistence of fever attacks which were well controlled by medical therapy, clinical remission (CR) was defined as the absence of fever attacks, without any treatment, for more than 12 months. 275 patients with PFAPA syndrome, 59.6% males, aged 27.9 months at onset and followed for mean 54.5 months, entered the study. CR was reported in 59.6% of the patients and was significantly less frequent in those with positive family history for PFAPA (46.4% vs. 66.1%, p=0.003). 27/41 patients (65.9%), responded to tonsillectomy and this result was comparable with that observed in those treated with medical therapy (59.1%, p=0.51). Disease duration, age at remission or presence of associated symptoms were not significantly different in both groups. No predictors of tonsillectomy failure were found. In a large cohort of patients with PFAPA syndrome, tonsillectomy efficacy was comparable to the standard medical treatment.

Addressing the Challenges in Tonsillectomy Research to Inform Health Care Policy: A Review.

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Mandavia, Rishi; Schilder, Anne G M; Dimitriadis, Panagiotis A; Mossialos, Elias

2017-09-01

Eighty-five percent of investment in medical research has been wasted, with lack of effect on clinical practice and policy. There is increasing effort to improve the likelihood of research being used to influence clinical practice and policy. Tonsillectomy is one of the most common otorhinolaryngologic surgical procedures, and its frequency, cost, and morbidity create a clear need for evidence-based guidelines and policy. The first systematic review on tonsillectomy was conducted 40 years ago and highlighted the lack of definitive evidence for the procedure. Since that study, the body of evidence has still not been able to sufficiently inform policy. This review provides an overview of the key challenges in research to inform tonsillectomy policy and recommendations to help bridge the evidence-policy gap. The challenges in using research to inform policy can be summarized as 4 main themes: (1) non-policy-focused evidence and lack of available evidence, (2) quality of evidence, (3) communication of research findings, and (4) coordinating time frames. Researchers and decision makers should be aware of the limitations of research designs and conflicts of interest that can undermine policy decisions. Researchers must work with decision makers and patients throughout the research process to identify areas of unmet need and political priority, align research and policy time frames, and disseminate research findings. Incentives for researchers should be reorganized to promote dissemination of findings. It is important to consider why evidence gaps in tonsillectomy research have not been addressed during the past 40 years despite considerable investment in time and resources. These findings and recommendations will help produce research that is more responsive to policy gaps and more likely to result in policy changes.

A prospective study of parents' compliance with their child's prescribed analgesia following tonsillectomy.

LENUS (Irish Health Repository)

Lennon, Paul

2013-03-01

We conducted a prospective study to assess how well parents ensured that their children received their prescribed analgesia following tonsillectomy. Our study was based on 69 cases of tonsillectomy that were carried out at our tertiary pediatric care center. Postoperatively, all patients were prescribed paracetamol (acetaminophen) on the basis of their weight; the standard pediatric dosage of this agent at the time of our study was 60 mg\\/kg\\/day. The parents were telephoned 2 weeks postoperatively to assess their compliance with this regimen. Of the original 69 patients who had been recruited, 66 completed the study-35 girls and 31 boys, aged 2 to 15 years (mean: 7.0; median 5.5). According to the parents, only 15 children (22.7%) received our recommended 60-mg\\/kg\\/day dosage and were thus determined to be fully compliant. Overall, parents reported a wide variation in the amount of drug administered, ranging from 12.5 to 111.0 mg\\/kg\\/day (mean: 44.8), indicating that parents often underdose their children. We recommend that more emphasis be placed on weight-directed, parent-provided analgesia during the post-tonsillectomy period.

Hematology Expert System (HES) For Tonsillectomy/Adenoidectomy Patients

Science.gov (United States)

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

1989-03-01

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

Quality and readability of websites for patient information on tonsillectomy and sleep apnea.

Science.gov (United States)

Chi, Ethan; Jabbour, Noel; Aaronson, Nicole Leigh

2017-07-01

Tonsillectomy is a common treatment for obstructive sleep apnea (OSA). The Internet allows patients direct access to medical information. Since information on the Internet is largely unregulated, quality and readability are variable. This study evaluates the quality and readability of the most likely visited websites presenting information on sleep apnea and tonsillectomy. The three most popular search engines (Google, Bing, Yahoo) were queried with the phrase "sleep apnea AND tonsillectomy." The DISCERN instrument was used to assess quality of information. Readability was evaluated using the Flesch-Kincaid Reading Grade Level (FKGL) and Flesch Reading Ease Score (FRES). Out of the maximum of 80, the average DISCERN quality score for the websites was 55.1 (SD- 12.3, Median- 60.5). The mean score for FRES was 42.3 (SD- 15.9, Median- 45.5), which falls in the range defined as difficult. No website was above the optimal score of 65. The mean score for the FKGL was US grade-level of 10.7 (SD- 1.6, Median- 11.6). Only 4(27%) websites were in the optimal range of 6-8. There was very weak correlation between FRES and DISCERN (r = 0.07) and FKGL and DISCERN (r = 0.21). Tonsillectomy is one of the most common surgeries in the US. However, the internet information readily available to patients varies in quality. Additionally, much of the information is above the recommended grade level for comprehension by the public. By being aware of what information patients are reading online, physicians can better explain treatments and address misunderstandings. Physicians may consider using similar methods to test the readability for their own resources for patient education. Copyright © 2017 Elsevier B.V. All rights reserved.

Effectiveness of hyaluronic acid in post-tonsillectomy pain relief and wound healing: a prospective, double-blind, controlled clinical study.

Science.gov (United States)

Hancı, Deniz; Altun, Huseyin

2015-09-01

To find the effectiveness of hyaluronic acid in post-tonsillectomy pain relief and wound healing. Fifty patients were included in this prospective, double-blind, controlled clinical study (20 males, 30 females mean age of 13.56 years). Hyaluronic acid was applied to one side and the other side was used as a control during tonsillectomy. Therefore, the same patient evaluated and scored the post-tonsillectomy pain, excluding individual bias. Results indicated that patients had significantly lower pain scores for hyaluronic acid treated side (pwound in the hyaluronic acid side was almost completely healed, indicating that the healing was faster with hyaluronic acid compared to control side (pwound healing. Copyright © 2015. Published by Elsevier Ireland Ltd.

A study on the efficacy and safety of combining dental surgery with tonsillectomy in pediatrics

Directory of Open Access Journals (Sweden)

Syed F

2018-03-01

Full Text Available Faizaan Syed,1 Joshua C Uffman,1,2 Dmitry Tumin,1 Catherine M Flaitz,3,4 Joseph D Tobias,1,2 Vidya T Raman1,2 1Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, 2Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, 3Department of Dentistry, Nationwide Children’s Hospital, 4Division of Dentistry, The Ohio State University College of Dentistry, Columbus, OH, USA Purpose: Few data exist on combining pediatric surgical procedures under a single general anesthetic encounter (general anesthesia. We compared perioperative outcomes of combining dental surgical procedures with tonsillectomy during one anesthetic vs separate encounters. Methods: We classified elective tonsillectomy ± adenoidectomy and restorative dentistry as combined (group C or separate (group S. Outcomes included anesthesia time, recovery duration, the need for overnight hospital stay, and postoperative complications. Results: Patients aged 4±1 years underwent tonsillectomy and dental surgery in combination (n=7 or separately (n=27. No differences were noted in total anesthesia time (C: median: 150, interquartile range [IQR]: 99, 165 vs S: median: 109, IQR: 92, 132; 95% CI of difference in median: –58, +10 minutes; P=0.115 and total recovery time (C: median: 54, IQR: 40, 108 vs S: median: 72, IQR: 58, 109; 95% CI of difference in median: –16, +48 minutes; P=0.307. The need for overnight stay (C: 4 of 7, S: 20 of 27; P=0.394 did not differ between the groups. No postoperative complications were noted in either group. Conclusion: These preliminary data support the potential feasibility of combining dental procedures with tonsillectomy during a single anesthetic encounter. Such care may not only reduce costs but also limit parental work absences and increase convenience for patient families. When compared with procedures performed separately, combined procedures did not result in increased morbidity or

Efficacy of pre-incisional peritonsillar infiltration of ketamine for post-tonsillectomy analgesia in children

International Nuclear Information System (INIS)

Siddiqui, A.S.; Raees, U.S.; Siddiqui, S.Z.; Raza, S.A.

2013-01-01

Objective: To assess the efficacy of pre-incisional peritonsillar infiltration of two doses of ketamine on postoperative analgesia compared with peritonsillar normal saline in children undergoing tonsillectomy. Study Design: Double blind, randomized controlled trial. Place and Duration of Study: Department of Anaesthesiology, Surgical Intensive Care and Pain Management, Civil Hospital, Karachi, Dow University of Health Sciences, from August 2008 to January 2009. Methodology: Seventy-five ASA physical status one patients, aged 5 - 12 years scheduled for tonsillectomy were enrolled in this study. Patients were divided into three groups of 25 each. Group-A received normal saline, Group-B, ketamine 0.5 mg/kg while group-C ketamine 1 mg/kg respectively. All medications were 2 ml and were applied 1 ml per tonsil; 3 minutes before tonsillectomy incision. Anaesthesia was induced and maintained with standard technique. All patients were monitored throughout surgery. The Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Wilson sedation scale were used to evaluate pain levels and sedation respectively after operation. Results: Mean duration of analgesia was significantly higher in group-C (17.28 +- 5.33 hours) as compared to group-B (11.36 +- 4.15 hours) and A (3.2 +- 0.71 hours) as well as group-B was also significantly higher than group-A (p < 0.05). Group-A had significantly higher pain scores than group-B and group-C. Both B and C groups had comparable pain scores, which were statistically significant at 6 and 8 hours. Conclusion: Single 0.5 or 1 mg/kg injection of ketamine given before surgical incision by peritonsillar infiltration provides efficient pain relief during postoperative period without significant side-effects in children undergoing tonsillectomy. (author)

Ligasure Vessel sealing system Tonsillectomy versus Cold Knife Tonsillectomy: A study ofefficy and Adverse effcts

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Farahani F

2017-06-01

Full Text Available Introduction: Tonsillectomy is one of the most common procedures performed by otolaryngologists. Intraoperative bleeding is a significant problem, which requires hemostasis and causes prolonged operative time. Several different techniques are used to perform this operation. The Ligasure Vessel Sealing System (LVSST has been widely used in head and neck surgery because of its effectiveness and safety. Methods: This project was conducted at the department of otolaryngology of Besat Hospital, Hamadan, Iran. In this double-blinded clinical trial, 82 subjects, who were candidates for tonsillectomy and qualified in eligible criteria, were randomly assigned to 2 group of 41 subjects. Surgery was performed using Lvsst for one group and cold knife dissection for the other group. Measured outcomes for efficacy and adverse effect were intraoperative blood loss, operation time, post-operative pain in visual analogue scale, and post-operative bleeding for28 days after surgery. The SPSS 16 software was used for data analysis. Results: Method of LVSST was significantly better than CKT in operation time and bleeding on the first day after surgery, yet, postoperative blood loss in the first week after surgery in LVSST group was significantly higher than the CKT group. Severity of sore throat after surgery with Ligasure was higher than CKT the group, however the difference was not significant. Intraoperative bleeding in the LVSST group was significantly lower than that of the CKT group (P = 0.000. Conclusions: The results of this study showed that the prevalence of respiratory symptoms LVSST was better than CKT in intraoperative (not post-operative blood loss and operation time, yet there was no difference regarding postoperative pain. For workers with a history of allergies, this ratio is higher.

Preemptive analgesia by peritonsillar ketamine versus ropivacaine for post-tonsillectomy pain in children

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Manal S. Farmawy

2014-01-01

Conclusion: Perincisional peritonsillar infiltration of both ropivacaine and ketamine was effective in reduction of post-tonsillectomy pain. Ropivacaine was superior to ketamine in reduction of time to first analgesic demand.

Can Red Blood Cell Distribution Width be a Potential Marker in the Decision to Perform Tonsillectomy?

Science.gov (United States)

Sakat, Muhammed Sedat; Kilic, Korhan; Kars, Ayhan; Kara, Mustafa; Gozeler, Mustafa Sitki

2018-02-01

Tonsillectomy is one of the most common surgical procedures performed at ear, nose, and throat clinics. Chronic recurrent tonsillitis, obstructive tonsillitis, and halitosis are among the most common indications for surgery. Determining whether the infection is chronic and the patient's annual number of infections are important in estimating the necessity for surgery to be performed due to infectious causes. Red blood cell distribution width (RDW) is a numerical value present in normal complete blood count that provides information about erythrocytes and their dimensions. Studies in recent years have shown that RDW increases in chronic infections, hypoxia, and oxidative stress. This study investigated the changes in RDW in patients with chronic tonsillitis and the effect tonsillectomy has on this value by comparing RDW between patients scheduled for tonsillectomy and normal population and examining preoperative and postoperative changes in RDW. Sixty-three patients scheduled for tonsillectomy due to recurrent tonsillitis aged 4-14 years were included in the study. The control group consisted of 60 subjects comparable in terms of age and sex. Hemoglobin level and RDW were recorded by collecting 2 mlof blood before surgery and at 4 months postoperatively from all patients. Preoperative RDW was significantly higher in the patient group than in the control group. Comparison of patients' preoperative and postoperative RDW revealed a significant decrease in RDW after surgery. As a biomarker showing chronic infection in patients with tonsillitis, RDW can provide support to the clinician in deciding on surgery. However, this has to be confirmed in further studies with greater participation.

Genome-wide association study identifies variants in HORMAD2 associated with tonsillectomy

DEFF Research Database (Denmark)

Feenstra, Bjarke; Bager, Peter; Liu, Xueping

2017-01-01

BACKGROUND: Inflammation of the tonsils is a normal response to infection, but some individuals experience recurrent, severe tonsillitis and massive hypertrophy of the tonsils in which case surgical removal of the tonsils may be considered. OBJECTIVE: To identify common genetic variants associate...... the molecular mechanisms underlying the genetic association involve general lymphoid hyper-reaction throughout the mucosa-associated lymphoid tissue system.......BACKGROUND: Inflammation of the tonsils is a normal response to infection, but some individuals experience recurrent, severe tonsillitis and massive hypertrophy of the tonsils in which case surgical removal of the tonsils may be considered. OBJECTIVE: To identify common genetic variants associated...... with tonsillectomy. METHODS: We used tonsillectomy information from Danish health registers and carried out a genome-wide association study comprising 1464 patients and 12 019 controls of Northwestern European ancestry, with replication in an independent sample set of 1575 patients and 1367 controls. RESULTS...

Effect of intravenous fluid therapy on postoperative vomiting in children undergoing tonsillectomy.

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Elgueta, M F; Echevarría, G C; De la Fuente, N; Cabrera, F; Valderrama, A; Cabezón, R; Muñoz, H R; Cortinez, L I

2013-04-01

Postoperative vomiting (POV) is one of the most frequent complications of tonsillectomy in children. The aim of this study was to evaluate the antiemetic effect of super-hydration with lactated Ringer's solution in children undergoing elective otorhinolaryngological surgery. One hundred ASA I-II children, aged 1-12 yr, undergoing elective tonsillectomy, with or without adenoidectomy, under general anaesthesia were studied. Induction and maintenance of anaesthesia were standardized with fentanyl, mivacurium, and sevoflurane in N(2)O/O(2). Subjects were assigned to one of the two groups: 10 ml kg(-1) h(-1) lactated Ringer's solution or 30 ml kg(-1) h(-1) lactated Ringer's solution. A multivariable logistic regression was used for assessing the effects of super-hydration on POV (defined as the presence of retching, vomiting, or both). A value of P<0.05 was considered statistically significant. During the first 24 h postoperative, the incidence of POV decreased from 82% to 62% (relative reduction of 24%, P=0.026). In the adjusted logistic regression model, subjects in the 10 ml kg(-1) h(-1) group had an odds ratio of POV that was 2.92 (95% confidence interval: 1.14, 7.51) for POV compared with subjects in the 30 ml kg(-1) h(-1) group. Intraoperative administration of 30 ml kg(-1) h(-1) lactated Ringer's solution significantly reduced the incidence of POV during the first 24 h postoperative. Our results support the use of super-hydration during tonsillectomy, as an alternative way to decrease the risk of POV in children.

Epstein-Barr virus is related with 5-aminosalicylic acid, tonsillectomy, and CD19(+) cells in Crohn's disease.

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Andreu-Ballester, Juan C; Gil-Borrás, Rafael; García-Ballesteros, Carlos; Catalán-Serra, Ignacio; Amigo, Victoria; Fernández-Fígares, Virgina; Cuéllar, Carmen

2015-04-21

To study anti-Epstein-Barr virus (EBV) IgG antibodies in Crohn's disease in relation to treatment, immune cells, and prior tonsillectomy/appendectomy. This study included 36 CD patients and 36 healthy individuals (controls), and evaluated different clinical scenarios (new patient, remission and active disease), previous mucosa-associated lymphoid tissue removal (tonsillectomy and appendectomy) and therapeutic regimens (5-aminosalicylic acid, azathioprine, anti-tumor necrosis factor, antibiotics, and corticosteroids). T and B cells subsets in peripheral blood were analyzed by flow cytometry (markers included: CD45, CD4, CD8, CD3, CD19, CD56, CD2, CD3, TCRαβ and TCRγδ) to relate with the levels of anti-EBV IgG antibodies, determined by enzyme-linked immunosorbent assay. The lowest anti-EBV IgG levels were observed in the group of patients that were not in a specific treatment (95.4 ± 53.9 U/mL vs 131.5 ± 46.2 U/mL, P = 0.038). The patients that were treated with 5-aminosalicylic acid showed the highest anti-EBV IgG values (144.3 U/mL vs 102.6 U/mL, P = 0.045). CD19(+) cells had the largest decrease in the group of CD patients that received treatment (138.6 vs 223.9, P = 0.022). The analysis of anti-EBV IgG with respect to the presence or absence of tonsillectomy showed the highest values in the tonsillectomy group of CD patients (169.2 ± 20.7 U/mL vs 106.1 ± 50.3 U/mL, P = 0.002). However, in the group of healthy controls, no differences were seen between those who had been tonsillectomized and subjects who had not been operated on (134.0 ± 52.5 U/mL vs 127.7 ± 48.1 U/mL, P = 0.523). High anti-EBV IgG levels in CD are associated with 5-aminosalicylic acid treatment, tonsillectomy, and decrease of CD19(+) cells.

Efficacy of Opioid-free Anesthesia in Reducing Postoperative Respiratory Depression in Children Undergoing Tonsillectomy

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2018-05-04

Anesthesia; General Anesthesia; Analgesics, Opioid; Postoperative Complications; Pathologic Processes; Physiologic Effects of Drugs; Narcotics; Analgesics; Sleep Disordered Breathing; Obstructive Sleep Apnea of Child; Tonsillectomy; Respiratory Depression; Dexmedetomidine; Ketamine; Lidocaine; Gabapentin; Pulse Oximetry

Effect of postoperative dexamethasone on pain, emesis and haemorrhage in tonsillectomy by dissection method

International Nuclear Information System (INIS)

Khan, K.A.; Faiz, S.B.

2013-01-01

Objectives: To compare the effect of postoperative intravenous dose of dexamethasone on morbidity in patients undergoing tonsillectomy. Design: Randomized control trial. Place and Duration of Study: This study was conducted in ENT Department Shaikh Khalifa Bin Zayed Al Nahyan Hospital (CMH) Muzaffarabad from 10th Jan 2010 to 15th Feb 2011. Patients and Methods: After getting informed consent, a total of 60 patients who fulfilled the inclusion criteria were selected and tonsillectomy by dissection method was carried out. They were divided into two groups of 30 each using a random numbers table. Group A received 0.25 mg/kg body weight (maximum 20 mg) of Dexamethasone postoperatively intravenously for 03 days while group B (control group) did not receive any steroid. Results: In group A, 80% patients had mild pain, 16.7% had moderate pain and 3.3% had a severe pain while in group B, 30% patients had mild pain, 6.7% had moderate pain and 63.3% had severe pain (p< 0.05). In group A, 76.7% patients had mild emesis while in group B, 86.7% had moderate emesis (p< 0.05). There was an insignificant difference in secondary hemorrhage. Conclusion: Dexamethasone given postoperatively significantly reduces the morbidity that is pain, episodes of emesis thus early recovery to a normal lifestyle with no effect on secondary hemorrhage in patients undergoing Tonsillectomy by dissection method. (author)

[Evaluation of swallowing function with surface electromyography before and after tonsillectomy].

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Gürkan, Emre; Veyseller, Bayram; Açıkalın, Reşit Murat; Elbistanlı, Suphi; Yurtsever, Serveren; Acar, Hürtan

2011-01-01

In this study, we evaluated the swallowing function with surface electromyography before and after tonsillectomy. Twenty patients (12 males, 8 females; mean age 23.8 years; range 17 to 30 years) who had tonsillectomy indication as study group, and 10 healthy individuals (8 males, 2 females; mean age 26 years; range 18 to 35 years) as control group were included in this prospective study between October 2008 and February 2009. Due to their significant role on oral and faringeal phases of swallowing; the surface electromyography prosedure is performed on the masseter muscle, the submental-submandibular muscle group and the infrahyoid muscles to measure their electrical activity and duration of contraction. For this purpose, single swallow and continuous drinking of 100 cc water tests were applied to each patient preoperatively and; in the postoperative 1st week and the 1st month. The preoperative duration of drinking periods were significanly longer in the study group compared to the control group (p<0.05). At the end of the first postoperative week the duration of drinking 100 cc water test was significantly longer than the preoperative mean of the study group (p<0.05). After one month single- swallow durations of study group were significantly shorter then the preoperative mean (p<0.05). The electrical activity of the masseter and infrahyoid muscles were significantly higher in study group compared with control group (p<0.05). The close proximity of the surgical area to the muscles affects swallowing after tonsillectomy. The surface electromyography is a simple, non-invasive and reliable method for postoperative evaluation of the swallowing functions of the throat muscles and thereby allows monitoring of the recovery and functional improvement of these muscles.

Pain experiences and non-pharmacological strategies for pain management after tonsillectomy: a qualitative interview study of children and parents.

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Idvall, Ewa; Holm, Charlotta; Runeson, Ingrid

2005-09-01

Tonsillectomy is one of the most common paediatric surgical procedures. This study aimed to investigate children's experience of pain and the nonpharmacological strategies that they used to manage pain after tonsillectomy. A further aim was to investigate parental views on these same phenomena. Six children (aged seven to 18 years) and their parents (four mothers and two fathers) were interviewed separately on the day after tonsillectomy. The data were analysed using a qualitative approach. Pain experiences were divided into the categories of physiological pain and psychological pain. Children rated their 'worst pain' during the past 24 hours between 6 and 10 (visual analogue scale, 0-10). The non-pharmacological strategies used most frequently to manage pain were thermal regulation (physical method) and distraction (cognitive-behavioural method) according to the framework used. Specific non-pharmacological strategies for pain management relative to different surgical procedures need to be considered.

Evaluation of the effect of aromatherapy with lavender essential oil on post-tonsillectomy pain in pediatric patients: a randomized controlled trial.

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Soltani, Rasool; Soheilipour, Saeed; Hajhashemi, Valiollah; Asghari, Gholamreza; Bagheri, Mahdi; Molavi, Mahdi

2013-09-01

To evaluate the effect of aromatherapy with Lavandula angustifolia essential oil on post-tonsillectomy pain in pediatric patients. This was a randomized controlled prospective clinical trial. In this study, 48 post-tonsillectomy patients aged 6-12 years were randomly assigned to two groups (24 patients in each group). After tonsillectomy surgery, all patients received acetaminophen (10-15 mg/kg/dose, PO) every 6h as necessary to relieve pain. The patients of the case group also inhaled lavender essential oil. The frequencies of daily use of acetaminophen and nocturnal awakening due to pain, and pain intensity (evaluated using visual analog scale [VAS]) were recorded for each patient for 3 days after surgery. Finally, the mean values of variables were compared between two groups separately for each post-operative day. The use of lavender essential oil caused statistically significant reduction in daily use of acetaminophen in all three post-operative days but had not significant effects on pain intensity and frequency of nocturnal awakening. Aromatherapy with lavender essential oil decreases the number of required analgesics following tonsillectomy in pediatric patients. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Post-operative pain control after tonsillectomy: dexametasone vs tramadol.

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Topal, Kubra; Aktan, Bulent; Sakat, Muhammed Sedat; Kilic, Korhan; Gozeler, Mustafa Sitki

2017-06-01

Tramadol was found to be more effective than dexamethasone in post-operative pain control, with long-lasting relief of pain. This study aimed to compare the effects of pre-operative local injections of tramadol and dexamethasone on post-operative pain, nausea and vomiting in patients who underwent tonsillectomy. Sixty patients between 3-13 years of age who were planned for tonsillectomy were included in the study. Patients were divided into three groups. Group 1 was the control group. Patients in Group 2 received 0.3 mg/kg Dexamethasone and Group 3 received 0.1 mg/kg Tramadol injection to the peritonsillary space just before the operation. Patients were evaluated for nausea, vomiting, and pain. When the control and the dexamethasone groups were compared; there were statistically significant differences in pain scores at post-operative 15 and 30 min, whereas there was no statistically significant difference in pain scores at other hours. When the control and tramadol groups were compared, there was a statistically significant difference in pain scores at all intervals. When tramadol and dexamethasone groups were compared, there was no statistically significant difference in pain scores at post-operative 15 and 30 min, 1 and 2 h, whereas there was a statistically significant difference in pain scores at post-operative 6 and 24 h.

Coblation versus other surgical techniques for tonsillectomy.

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Pynnonen, Melissa; Brinkmeier, Jennifer V; Thorne, Marc C; Chong, Lee Yee; Burton, Martin J

2017-08-22

Tonsillectomy is a very common operation and is performed using various surgical methods. Coblation is a popular method because it purportedly causes less pain than other surgical methods. However, the superiority of coblation is unproven. To compare the effects of coblation tonsillectomy for chronic tonsillitis or tonsillar hypertrophy with other surgical techniques, both hot and cold, on intraoperative morbidity, postoperative morbidity and procedural cost. The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2017, Issue 3); PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 20 April 2017. Randomised controlled trials (RCTs) of children and adults undergoing tonsillectomy with coblation compared with any other surgical technique. This review is limited to trials of extracapsular (traditional) tonsillectomy and excludes trials of intracapsular tonsil removal (tonsillotomy). We used the standard Cochrane methods. Our primary outcomes were: patient-reported pain using a validated pain scale at postoperative days 1, 3 and 7; intraoperative blood loss; primary postoperative bleeding (within 24 hours) and secondary postoperative bleeding (more than 24 hours after surgery). Secondary outcomes were: time until resumption of normal diet, time until resumption of normal activity, duration of surgery and adverse effects including blood transfusion and the need for reoperation. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. We included 29 studies, with a total of 2561 participants. All studies had moderate or high risk of bias. Sixteen studies used an adequate randomisation technique, however the inability to mask the surgical teams and/or provide adequate methods to mitigate the risk of bias put nearly all studies at moderate or high risk of

A nationwide registry-based cohort study of incidence of tonsillectomy in Denmark, 1991-2012

DEFF Research Database (Denmark)

Juul, Marie Louise; Rasmussen, Eva Rye; Rasmussen, Stig Hebbelstrup Rye

2018-01-01

OBJECTIVE: To update tonsillectomy incidence rates in Denmark and identify whether the incidence rates vary between geographical areas in the country during the period 1991-2012. DESIGN: This was a retrospective nationwide cohort study using data from the comprehensive Danish patient registries. ...

Time course of subacute pain after transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma versus traditional bilateral tonsillectomy in adults - a case-control study

DEFF Research Database (Denmark)

Scott, Susanne Irene; Madsen, Anne Kathrine Østergaard; Rubek, Niclas

2018-01-01

OBJECTIVE: To examine pain after Transoral Robotic Surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC) versus traditional bilateral tonsillectomy in adults. METHODS: Pain evolvement was assessed in a prospective case-control design of 16 consecutive patients treated with TORS for early...... stage OPSCC versus 12 patients, who underwent bilateral tonsillectomy on suspicion of malignant disease. The TORS group received an optimized analgesia regime of preoperative oral celecoxib and gabapentin, intra- and postoperative high-dose intravenous dexamethasone, and regular postoperative oral...... contalgin, gabapentin, celecoxib, paracetamol and rescue morphine. The tonsillectomy group received the departmental standard analgesia regime with low-dose preoperative oral dexamethasone, celecoxib and paracetamol. Postoperative regular analgesia consisted of oral NSAID and paracetamol with weak opioids...

The Efficacy of Perioperative Antibiotic Therapy in Tonsillectomy Patients.

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Orłowski, Krzysztof; Lisowska, Grażyna; Misiołek, Hanna; Paluch, Zbigniew; Misiołek, Maciej

2016-01-01

While the results of early research suggested that perioperative antibiotic prophylaxis in tonsillectomy patients is associated with many benefits, these data were not confirmed by further studies and meta-analyses. The aim of this study was to investigate the usefulness and efficacy of antibiotic monotherapy in the healing of surgical wounds of patients undergoing bilateral resection of the palatine tonsils, based on an analysis of selected objective and subjective characteristics of wound healing during the postoperative period. The study included 50 men and women who underwent routine resection of the palatine tonsils. The patients were randomized into two groups: Group I, undergoing tonsillectomy with cefuroxime prophylaxis (n = 25), and Group II, who were not given perioperative antibiotic therapy (n = 25). The severity of signs and complaints recorded on postoperative days 1-10 was scored on 3- and 10-item scales. The only significant intergroup differences pertained to problems with swallowing food and fluids on postoperative days 4-6, 8 and 9 (less prevalent in Group II), postoperative use of analgesics on postoperative day 9 (less frequent in Group II), the degree of mucosal swelling in the operated area on postoperative days 3 and 7 (less severe in Group II), and the amount of fibrin covering the tonsillar niches on the third postoperative day (significantly higher in Group I). The administration of antibiotics for prevention or control of infection should be preceded by a comprehensive analysis of the potential benefits and risks. Perioperative use of antibiotics is justified only in selected cases, i.e. in individuals with comorbidities.

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

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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

Preoperative use of granisetron plus dexamethasone and granisetron alone in prevention of post operative nausea and vomiting in tonsillectomy.

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Islam, M R; Haq, M F; Islam, M A; Meftahuzzaman, S M; Sarkar, S C; Rashid, H; Rashid, H U

2011-07-01

This prospective study was done for to see the efficacy of preoperative use of granisetron plus dexamethasone (Group A) & granisetron (Group B) alone for the postoperative prevention of nausea & vomiting after tonsillectomy operation. One hundred patients undergoing tonsillectomy & adenoidectomy operation under general anaesthesia who were admitted in the Mymensingh Medical College Hospital during the period from July 2008 to June 2009 with American Society of Anaesthesiologists (ASA) grade I & II with age 3-40 years, body weight 10-60 kgs, were studied. Observation of this study was analyzed in the light of comparison between the two groups. All results were expressed as mean±SEM. Age in Group A 15.98±1.028 & Group B 17.18±0.961 years; Weight in Group A 38.40±1.492 & Group B 39.76±1.561 kgs and operational duration in Group A 52.60±0.786 & Group B 52.70±0.823 minutes. The studied groups were statistically matched for age, weight, duration of surgery. We observed that the effects of combination of granisetron & dexamthasone are more than granisetron alone in prevention of nausea & vomiting after tonsillectomy operation. The frequency of vomiting was 4% in combination & 16% in single therapy which is statically significant (p<0.05).

ANALGESIC EFFICACY OF TRAMADOL IN PEDIATRIC TONSILLECTOMY WITH ADENOIDECTOMY

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Janez Benedik

2015-05-01

Full Text Available Background: Tonsillectomy is one of the most commonly performed surgical prcedures in childhood. Acute pain after tonsillectomy and adenoidectomy can be treated with non-opioid and opioid analgesics. Our hypothesis stated that tramadol iv after induction of anaesthesia has superior analgesic effect compared to acetaminophen.Methods:  In a prospective, randomised study we compared analgesic efficacy of tramadol (group T: 2 mg/kgBW iv and acetaminophen (group A: elixir 15 mg/kgBW before op. procedure in a group of 108 children (age 3-7 years. Exclusion critheria: allergy, liver or kidney failure, epilepsy, febrile convulsions. A standard anaesthetic technique was used: propofol, alfentanil, vecuronium, positive pressure ventilation with 60% nitrous oxide in oxygen. After the procedure each child received acetaminophen suppositories (10 mg/kgBW/4-6h and combined suppositories. Monitoring: vital signs during and after op. procedure, pain intensity on the ward (facial pain score.    Results: There were no significant differences between the two groups in age distribution (mean age 5,2 years, ASA physical status, body weight, operative procedure, pain scores (VAS 6h after operative procedure; group T: 4,21±1,45; group A: 4,06±1,33, oxygen saturation, pulse frequency and the consumption of acetaminophen suppositories. Significant difference was in the consumption of combined suppositories (group T: 1,85±0,79; group A: 1,43±0,69, p=0,003.   Conclusion: Our study has shown, that tramadol is not a superior analgesic for the relief of posttonsillectomy pain in children compared to acetaminophen. 

A new analgesia regimen after (adeno) tonsillectomy in children: a pilot study.

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Syed, M I; Magos, T A; Singh, J; Montague, M L

2016-12-01

The objective was to ascertain the efficacy of a new analgesic regimen introduced in children undergoing (adeno)tonsillectomy in view of the ban on codeine use in children codeine, albeit one should bear in mind that parental concerns and adverse effects of the drug were seen in a minority of patients (n = 11) and anaesthetists were reluctant to prescribe the drug in cases of severe OSA or associated central apnoeas (n = 7). © 2015 John Wiley & Sons Ltd.

Comparison of the preventive analgesic effect of rectal ketamine and rectal acetaminophen after pediatric tonsillectomy

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S Morteza Heidari

2012-01-01

Full Text Available Objectives: There is a little data about rectal administration of Ketamine as a postoperative analgesic, so we compared the efficacy of rectal ketamine with rectal acetaminophen, which is applied routinely for analgesia after painful surgeries like tonsillectomy. Methods: In this single-blinded comparative trial, we enrolled 70 children undergoing elective tonsillectomy, and divided them randomly in two groups. Patients received rectal ketamine (2 mg / kg or rectal acetaminophen (20 mg / kg at the end of surgery. The children′s Hospital of Eastern Ontario Pain scale was used to estimate pain in children. Also the vital signs, Wilson sedation scale, and side effects in each group were noted and compared for 24 hours. Results: The ketamine group had a lower pain score at 15 minutes and 60 minutes after surgery in Recovery (6.4 ± 0.8, 7.4 ± 1 vs. 7.1 ± 1.2, 7.8 ± 1.2 in the acetaminophen group, P < 0.05 and one hour and two hours in the ward (7.2 ± 0.7, 7 ± 0.5 vs. 7.9 ± 1.2, 7.5 ± 1.2 in the acetaminophen group, P < 0.05, with no significant differences till 24 hours. Dreams and hallucinations were not reported in the ketamine group. Systolic blood pressure was seen to be higher in the ketamine group (104.4 ± 7.9 vs. 99.8 ± 7.7 in the acetaminophen group and nystagmus was reported only in the ketamine group (14.2%. Other side effects were equivalent in both the groups. Conclusions: With low complications, rectal ketamine has analgesic effects, especially in the first hours after surgery in comparison with acetaminophen, and it can be an alternative analgesic with easy administration in children after tonsillectomy.

Treatment of extensive post tonsillectomy oropharyngeal stenosis secondary to fibromatosis.

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Chang, Brian; Ha, Jennifer F; Zopf, David

2018-04-01

Aggressive fibromatosis is an uncommon, benign tumor of fibroblastic origin with high potential for local invasion. Less than a quarter of these lesions are located in the head and neck, and although extremely rare, associations have been demonstrated with physical trauma. We describe a unique case of oropharyngeal fibromatosis with traumaticetiology, managed successfully with surgical excision of the lesion with negative surgical margins. A 5-year old patient was found to have an aggressive fibromatosis causing oropharyngeal stenosis following tonsillectomy. We demonstrate that surgical resection with a clear margin allowed for alleviation of stenosis without recurrences reported since the procedure. Copyright © 2018 Elsevier B.V. All rights reserved.

COMPARISON OF THE EFFECTS OF ORAL VS. PERITONSILLAR INFILTRATION OF KETAMINE IN PAIN REDUCTION AFTER TONSILLECTOMY: A RANDOMIZED CLINICAL TRIAL.

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Norouzi, Afsaneh; Jafari, Abolfazl; Vishteh, Hamid Reza Khoddami; Fateh, Shahin

2015-02-01

Although oral ketamine has been used in some cases to reduce pain in children, the use of this drug to reduce pain after tonsillectomy has not been studied yet. This double-blind clinical trial was conducted in 2009 in 92 children who were aged three to nine years old, met ASA I or II criteria, and were candidate for tonsillectomy. Patients were divided randomly into two groups. Half an hour before general anesthesia, 5 mg/kg ketamine mixed in 2 cc/kg apple juice was given to the children in oral ketamine group and 2 cc/kg of apple juice alone was given to the children in the peritonsillar group. After general anesthesia and three minutes before surgery 1 cc of 0.9% normal saline in the oral group and 1cc of ketamine (0.5 mg/kg) in the peritonsillar group was injected to the tonsil bed of patients. There was no difference between the two groups in terms of sex, age, and weight. Duration of surgery was significantly shorter in the peritonsillar group (P pain in children six hours after surgery according to CHEOPS criteria was significantly lower in the peritonsillar group (0.9 ± 0.8) than in the oral group (2.6 ± 1) (P ketamine, the use of oral ketamine before general anesthesia was less effective in reducing postoperative pain of tonsillectomy in children.

Comparison of topical ropivacaine with and without ketamine on post-surgical pain in children undergoing tonsillectomy: a randomized controlled double-blind study.

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Hong, Boohwi; Lim, Chae Seong; Kim, Yoon-Hee; Lee, Jung Un; Kim, Yong Min; Jung, Choonho; Jo, Yumin

2017-08-01

Tonsillectomy in pediatric patients may cause severe postoperative pain. Topical local anesthetics are an easy and safe way to control post-tonsillectomy pain, but there is no benefit during the early postoperative stage. Topical ketamine shows a good effect on early stage postoperative pain. We compared the effect of topical ropivacaine with and without ketamine on post-tonsillectomy pain. Patients aged 3-7 years undergoing tonsillectomy were selected to participate in the study. Our study was performed in a randomized, placebo-controlled, double-blind manner. Patients were randomly assigned to one of two groups using computer-generated random numbers. The researchers who assessed the pain score, the caregivers, and the patient were blinded to group assignment. One group received topical ropivacaine with saline (RS group) and the other group received topical ropivacaine with 20 mg ketamine (RK group) on the tonsillar bed. Pain scores using the modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) at 15 min and 30 min, and at 1, 2, 4, 8, 16 and 24 h were recorded. Rescue analgesic requirement and complications were also recorded. A total of 66 patients were randomly assigned to the RS group (n = 33) and the RK group (n = 33). The mCHEOPS scores were significantly lower in the RK group at 15 min (P = 0.046). The mCHEOPS scores of the two groups decreased with time, but there was no intergroup interaction. The RS group received more analgesics until 1 h after surgery and the RK group received more analgesics during 1-24 h after surgery. There were no differences in adverse outcomes. Topical ropivacaine with ketamine can reduce immediate postoperative pain and analgesic requirement better than ropivacaine alone.

Efficacy of ketamine in improving pain after tonsillectomy in children: meta-analysis.

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Cho, Hye Kyung; Kim, Kyu Won; Jeong, Yeon Min; Lee, Ho Seok; Lee, Yeon Ji; Hwang, Se Hwan

2014-01-01

The goal of this meta-analysis study was to perform a systematic review of the literature on the effects of ketamine on postoperative pain following tonsillectomy and adverse effects in children. Two authors independently searched three databases (MEDLINE, SCOPUS, Cochrane) from their inception of article collection to February 2014. Studies that compared preoperative ketamine administration (ketamine groups) with no treatment (control group) or opioid administration (opioid group) where the outcomes of interest were postoperative pain intensity, rescue analgesic consumption, or adverse effects (sedation, nausea and vomiting, bad dream, worsening sleep pattern, and hallucination) 0-24 hours after leaving the operation room were included in the analysis. The pain score reported by the physician during first 4 hours and need for analgesics during 24 hours postoperatively was significantly decreased in the ketamine group versus control group and was similar with the opioid group. In addition, there was no significant difference between ketamine and control groups for adverse effects during 24 hours postoperatively. In the subgroup analyses (systemic and local administration) regarding pain related measurements, peritonsillar infiltration of ketamine was more effective in reducing the postoperative pain severity and need for analgesics. Preoperative administration of ketamine systemically or locally could provide pain relief without side-effects in children undergoing tonsillectomy. However, considering the insufficient evaluation of efficacy of ketamine according to the administration methods and high heterogeneity in some parameters, further clinical trials with robust research methodology should be conducted to confirm the results of this study.

Comparing the Efficacy of Peritonsillar Injection of Tramadol With Honey in Controlling Post-Tonsillectomy Pain in Adults.

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Hatami, Maryam; Mirjalili, Mahdieh; Ayatollahi, Vida; Vaziribozorg, Sedighe; Zand, Vahid

2018-06-01

The authors investigated the effect of honey on post-tonsillectomy pain and compare its efficacy with tramadol. This clinical trial was performed on 60 patients with American Society of Anesthesia I and II aged between 18 and 55 years and underwent tonsillectomy. Induction of anesthesia was carried out using 2 mg/kg propofol and 0.5 atracurium following 1.5 μg/kg fentanyl administration. Group B was given tramadol at dose of 2 mg/kg and with volume of 4 mL and Group A was given normal saline with the same volume 2 mL of medications were injected using needle (25) into tonsil bed and anterior old of each tonsil by an anesthesiologist. Three minutes after injection, the surgery was performed by the same ENT residents for all patients. In the recovery room Group B received antibiotics and oral acetaminophen. Group A was given antibiotics, oral acetaminophen, and honey dissolved in 40 mL warm water every 6 hours from when the patient was fully awake. Patients in Group A were told to eat honey 3 times a day 7 days postoperatively. Pain was scored using Numeric Rating Scale at the time points of 2, 6, 12, and 24 hours as well as 3 and 7 days postoperatively. Moreover, the healing status and epithelialization degree of tonsillar bed were considered on 1 and 7 days after the surgery by ENT specialist. The mean of pain score was significantly higher in Group A within 24 hours postoperatively as compared with Group B (P pain score was lower in Group B after 3 and 7 days but this difference was not statistically significant (P > 0.05). Considering restoration status and epithelialization degree of tonsillar bed on the 1st and 7th days, there was no statistically significant difference between 2 groups; however, tonsillar bed healing process was better in Group B on the 7th day. The current investigation confirmed the positive impact of tramadol on post-tonsillectomy pain relief in adults. The authors also found that honey can be used as a complementary treatment along with

Pain treatment after tonsillectomy: advantages of analgesics regularly given compared with analgesics on demand.

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Thorneman, G; Akervall, J

2000-10-01

The aim of the present prospective study was to evaluate pain treatment during the first postoperative 24 h for 40 patients (age over 18) undergoing tonsillectomy. Patients were divided into two groups: group A (n = 20) received analgesics on demand and group B (n = 20) on a regular basis. Basic pain treatment consisted of paracetamol 750 mg x 6 and diclofenac 50 mg x 3. Pain measurement was performed using a visual analogue scale (VAS): a 10 cm line with 0 cm equalling no pain and 10 cm equalling the worst pain ever felt. The following parameters were studied: VAS values, the need for rescue analgesics, intra- and postoperative bleeding, nausea and vomiting, postoperative food intake and hospital time. Only 4 of 20 (20%) patients in group B needed rescue analgesics in the postoperative ward compared with 15 of 20 (75%) in group A (p values were generally rather low in both groups. The mean value for all observed VAS values was less than 4 in both study groups. However, no significant difference in VAS values was observed between the two study groups. Our results suggest that regularly given postoperative pain treatment after tonsillectomy, starting intraoperatively with paracetamol and diclofenac, has significant advantages compared with a regimen in which patients receive analgesics only on demand.

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

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Meng-meng LI

2014-10-01

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

Comparison of post-tonsillectomy pain with two different types of bipolar forceps: low temperature quantum molecular resonance device versus high temperature conventional electrocautery.

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Chang, Hyun; Hah, J Hun

2012-06-01

The low temperature device did not show any advantages over the conventional high temperature electrocautery in terms of the postoperative pain, operation time, and complications in pediatric tonsillectomy. To compare post-tonsillectomy pain following the use of two different instruments with the same bipolar forceps techniques: low temperature quantum molecular resonance (QMR) device versus conventional high temperature electrocautery. Pediatric patients admitted from July 2008 through January 2009 were included. The participants underwent bilateral tonsillectomy; one side by the QMR device and the other by the bipolar electrocautery. The sides for each instrument were counterbalanced by the order of presentation. The postoperative pain was measured using the faces pain rating scale. In all, 33 patients with a mean age of 7.6 years were enrolled. The postoperative pain, operation time, and complications in 33 sides dissected by the electrocautery and 33 sides by the QMR device were compared. The average operation times with each device were not statistically different. The mean ratings of the perception of pain related to each instrument were not different on operation day and postoperative day 1, day 4, and day 7 (p = 0.133, 0.057, 0.625, and 1.0, respectively). There was no postoperative complication in any of the patients.

Evaluation of early postoperative morbidity in pediatric tonsillectomy with the use of sucralfate.

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Sampaio, André L L; Pinheiro, Thaís Gonçalves; Furtado, Paula Lobo; Araújo, Mercedes F S; Olivieira, Carlos A C P

2007-04-01

The objective of this study is to evaluate the efficacy of sucralfate in alleviating posttonsilectomy morbidity in a pediatric group of patients. A prospective, double-blind, randomized, and placebo-controlled study comparing the irrigation of a solution containing either 1g of sucralfate (study group) or 1g of lactulose (control group) was performed on 69 children aged 3-12 years, who underwent tonsillectomy at the University Hospital of Brasilia Medical School. The children were randomly assigned and each one used a solution containing sucralfate or lactulose to swish and swallow four times daily during 7 days. Eleven patients were excluded. The anesthetic was standardized and no premedication was used. Pain magnitude using an "Oucher" scale, nausea, vomiting, bleeding, earache, analgesic drug intake, changes in the interincisor teeth distance, and changes in the weight and temperature were assessed by the surgeon 6, 24h, and 7 days after the surgery. Patients in the study group had significantly lower pain scores in the initial 6 postoperative hours (p<0.05). The difference between the two groups was not statistically significant for the other periods following the procedure or on the evaluation of the other indices. The use of the sucralfate in pediatric patients undergoing tonsillectomy was not effective in reducing the postoperative morbidity according to the parameters used in this study. The surgical technique with careful mucosal dissection associated with postoperative caries could be more important in the reduction of posttonsilectomy morbidity.

Stakeholders' views of recurrent sore throat, tonsillitis and their management: a qualitative interview study for the NAtional Trial of Tonsillectomy IN Adults (NATTINA Part 1).

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McSweeney, L A; Rousseau, N S; Wilson, J A; Wilkes, S; Haighton, C A

2017-04-01

To determine the impact of recurrent sore throats and tonsillitis in adults and stakeholder views of treatment pathways. Qualitative semistructured interview design reporting novel data from a feasibility study for a UK national trial of tonsillectomy in adults. Nine study sites linked to ear, nose and throat departments in National Health Service hospitals located across the United Kingdom. Fifteen patients, 11 general practitioners and 22 ear, nose and throat staff consented to in-depth interviews, which were analysed using a framework analysis approach. Views of stakeholder groups. Recurrent sore throats were reported to severely impact patients' family, work and social life. Ear, nose and throat staff stated that patients faced increasing barriers to secondary care service access. General practitioners were under pressure to reduce 'limited clinical value' surgical procedures. The findings from this study suggest that there is a disconnect between the attitudes of the stakeholders and the reality of recurrent sore throat, tonsillectomy procedures and service provision. More evidence for the role of tonsillectomy is needed from randomised controlled trials to determine whether it should continue to be ranked as a procedure of limited clinical effectiveness. © 2016 John Wiley & Sons Ltd.

Improving postoperative tonsillectomy pain management in children--a double blinded randomised control trial of a patient analgesia information sheet.

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Bailey, Lucas; Sun, Jing; Courtney, Mark; Murphy, Paul

2015-05-01

To evaluate paediatric post-tonsillectomy pain management using oxycodone when a specific analgesia information sheet is included with standard postoperative information. Oxycodone information sheets were randomly allocated to half the study children's post-tonsillectomy information pack. The trial was double-blinded to the surgeon, anaesthetist, nursing and administrative staff. Parents and children completed the pain assessment on day 3, 5 and 7. On day 10 the parents completed a questionnaire. A postoperative analgesia information sheet provides for higher satisfaction and knowledge for parents using oxycodone (psheet, most significantly at day 3 and 7 post operatively (psheets are useful in education and use of postoperative analgesia. The primary objective to explore the efficacy of the information sheet has proved to be successful in this setting. Given risks of opioid analgesia, it is recommended that postoperative information sheets be given to all parents, to provide for improved analgesia control and safe management of children in the postoperative period. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Comparison of peritonsillar infiltration effects of ketamine and tramadol on post tonsillectomy pain: a double-blinded randomized placebo-controlled clinical trial

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Ayatollahi, Vida; Behdad, Shekoufeh; Hatami, Maryam; Moshtaghiun, Hossein; Baghianimoghadam, Behnam

2012-01-01

Aim To assess the effect of peritonsillar infiltration of ketamine and tramadol on post tonsillectomy pain and compare the side effects. Methods The double-blind randomized clinical trial was performed on 126 patients aged 5-12 years who had been scheduled for elective tonsillectomy. The patients were randomly divided into 3 groups to receive either ketamine, tramadol, or placebo. They had American Society of Anesthesiologists physical status class I and II. All patients underwent the same method of anesthesia and surgical procedure. The three groups did not differ according to their age, sex, and duration of anesthesia and surgery. Post operative pain was evaluated using CHEOPS score. Other parameters such as the time to the first request for analgesic, hemodynamic elements, sedation score, nausea, vomiting, and hallucination were also assessed during 12 hours after surgery. Results Tramadol group had significantly lower pain scores (P = 0.005), significantly longer time to the first request for analgesic (P = 0.001), significantly shorter time to the beginning of liquid regimen (P = 0.001), and lower hemodynamic parameters such as blood pressure (P = 0.001) and heart rate (P = 0.001) than other two groups. Ketamine group had significantly greater presence of hallucinations and negative behavior than tramadol and placebo groups. The groups did not differ significantly in the presence of nausea and vomiting. Conclusion Preoperative peritonsillar infiltration of tramadol can decrease post-tonsillectomy pain, analgesic consumption, and the time to recovery without significant side effects. Registration No: IRCT201103255764N2 PMID:22522994

Intra-operative lidocaine in the prevention of vomiting after elective tonsillectomy in children: A randomised controlled trial.

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Echevarría, Ghislaine C; Altermatt, Fernando R; Paredes, Sebastian; Puga, Valentina; Auad, Hernán; Veloso, Ana M; Elgueta, María F

2018-05-01

Postoperative vomiting (POV) is a frequent complication of tonsillectomy in children. In adult patients undergoing abdominal surgeries, the use of intravenous lidocaine infusion can prevent POV. To evaluate the anti-emetic effect of an intravenous lidocaine infusion used as an adjuvant to general anaesthesia, in children undergoing elective ear, nose and throat surgery. Double-blind, randomised, controlled study. Hospital-based, single-centre study in Chile. ASA I-II children, aged 2 to 12 years, scheduled for elective tonsillectomy. We standardised the induction and maintenance of anaesthesia. Patients were randomly allocated to lidocaine (1.5 mg kg intravenous lidocaine over 5 min followed by 2 mg kg h) or 0.9% saline (at the same rate and volume). Infusions were continued until the end of the surgery. Presence of at least one episode of vomiting, retching or both in the first 24 h postoperatively (POV). Plasma concentrations of lidocaine and postoperative pain. Ninety-two children were enrolled. Primary outcome data were available for 91. In the Lidocaine group, 28 of 46 patients (60.8%) experienced POV, compared with 37 of 45 patients (82.2%) in the Saline group [difference in proportions 21.3% (95% confidence interval (CI) 2.8 to 38.8), P = 0.024]. The intention-to-treat analysis showed that when we assumed that the patient in the Saline group lost to follow-up did not have POV, the difference in proportions decreased to 19.6% (95% CI, 0.9 to 37.2), with an unadjusted odds ratio of 0.38 (95% CI, 0.15 to 0.97, P = 0.044). The odds of having POV were 62% less likely in those patients receiving lidocaine compared with patients in the Saline group. The mean lidocaine plasma concentration was 3.91 μg ml (range: 0.87 to 4.88). Using an intravenous lidocaine infusion as an adjuvant to general anaesthesia decreased POV in children undergoing elective tonsillectomy. ClinicalTrials.gov Identifier: NCT01986309.

Self-reported postoperative recovery in children after tonsillectomy compared to tonsillotomy.

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Eriksson, Mats; Nilsson, Ulrica; Bramhagen, Ann-Cathrine; Idvall, Ewa; Ericsson, Elisabeth

2017-05-01

Tonsil surgery is associated with significant morbidity during recovery. Patient-reported outcome measures (PROM) are the golden standard for the planning and follow-up of delivered care, which should also be an axiom for children. The current aims were to describe self-reported postoperative recovery in children after tonsil surgery, and to compare tonsillotomy and tonsillectomy in this respect. In total, 238 children (4-12 years old) with a history of obstructive problems and/or recurrent tonsillitis, and undergoing tonsil surgery were included. Forty-eight per cent were operated with partial tonsil resection/tonsillotomy (TT) and 52% with total tonsillectomy (TE), all in day surgery. Postoperative recovery was assessed on days 1, 4 and 10 using the validated self-rating instrument PRiC, Postoperative Recovery in Children. This includes 23 items covering different aspects of recovery after tonsil surgery. A higher score indicates worse status in the respective items. Daily life activities (sleeping, eating and playing), physical symptoms (e.g., headache, stomach ache, sore throat, otalgia, dizziness, nausea, defecation, urination), and emotional aspects (sadness, frightening dreams) were affected during the recovery period. The TE-girls showed higher scores than the boys regarding stomach ache, defecation and dizziness. Children above 6 years of age reported higher values for the physical comfort variables, while the younger group showed worse emotional states. Postoperative recovery improved from day 1-10 in all surgical groups. The TE-group showed lower recovery compared to the TT-group (p < 0.01-0.001) in most items. The goal of postoperative management is to minimize or eliminate discomfort, facilitating the recovery process and avoiding complications. Children are able to describe their recovery, and thus, PRiC seems to be able to serve as a PROM to obtain patient-centered data after tonsil surgery. The recovery process after TT causes less postoperative

Comparison between consecutive and intermittent steroid pulse therapy combined with tonsillectomy for clinical remission of IgA nephropathy.

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Kamei, Daigo; Moriyama, Takahito; Takei, Takashi; Wakai, Sachiko; Nitta, Kosaku

2014-04-01

In recent years, tonsillectomy and steroid pulse (TSP) therapy have been widely performed in Japan. However, there is no consensus about the treatment protocol and indication. In this retrospective analysis, we compared patients who received tonsillectomy plus intermittent steroid pulse (SP) therapy three times in 6 months (ISP group, n = 44) with patients who received tonsillectomy plus 3 weeks of consecutive SP therapy (CSP group, n = 46) within 1 year after renal biopsy. These two different protocols were performed at two different institutions. We analyzed the clinical and histological background and clinical remission (CR), defined as disappearance of urine abnormalities at 18 months after starting treatment. Before treatment, there was no significant difference in the clinical findings except for sex between the two groups. In ISP group and CSP group, mean estimated glomerular filtration rate was 82.1 ± 20.9 and 85.9 ± 19.1 ml/min/1.73 m(2), median proteinuria was 0.55 and 0.56 g/day, and median urinary red blood cells were 20 (10-20) and 20 (6-30)/high power filed. The histological (H) grade was lower in the CSP than the ISP group (p = 0.022). The remission rate of proteinuria, hematuria, and rate of CR by the Kaplan-Meier method and logrank test were significantly higher in the CSP group than in the ISP group (CSP vs. ISP group; proteinuria: 97.8 vs. 77.3 %, p forced entry), SP protocol and proteinuria before treatment were significantly associated with CR [SP protocol: hazard ratio (HR) 2.50, 95 % confidence interval (CI) 1.46-4.30, p = 0.001, proteinuria: HR 0.81, 95 % CI 0.68-0.96, p = 0.013)]. However H-grade was associated with remission of proteinuria (H-grade: hazard ratio (HR) 0.56, 95 % confidence interval (CI) 0.37-0.85, p = 0.006), and this result meant histological bias affected the remission of proteinuria. The difference of the protocol of TSP therapy may have some effect on the CR of IgAN, though the histological bias was observed in this

Post-tonsillectomy hemorrhagic outcomes in children with bleeding disorders at a single institution.

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Patel, Priyesh N; Arambula, Alexandra M; Wheeler, Allison P; Penn, Edward B

2017-09-01

To report on the post-tonsillectomy bleeding outcomes and factors associated with hemorrhage among children with pre- or post-operatively diagnosed bleeding disorders treated with an institutional protocol. Retrospective cohort study of patients with hematologic disorders who underwent tonsillectomy between 2003 and 2016 and were treated with perioperative desmopressin or factor replacement and/or aminocaproic acid. Postoperative outcomes were compared to controls matched for age, sex, and indication for surgery. Analysis of factors associated with hemorrhage was performed in patients with bleeding disorders using Mann-Whitney U or chi-squared tests. 45 patients with hematologic disorders met inclusion criteria. Platelet dysfunction, including von Willebrand Disease (vWD), was the most common diagnosis (77.8%). Most patients had a preoperative diagnosis of a bleeding disorder and received perioperative hematologic medications (86.7%). Compared to matched controls, patients with hematologic disorders experienced more postoperative bleeding (15.5%; 12 bleeds, 7 patients vs. 1.7%; 1 bleed, 1 patient, p = 0.05) and had longer postoperative stays (1.3 days vs. 0.4 days, p bleed were significantly more likely to have a factor deficiency (e.g. Hemophilia over vWD) and have a postoperative diagnosis (compared to preoperative diagnosis) for which they did not receive perioperative hematologic medication. Of patients with a postoperative bleed, all those diagnosed postoperatively required at least one surgical intervention to control bleeding compared to 33% of patients with a preoperative diagnosis. A history of post-surgical bleeding, male sex, age at surgery, and pharyngitis as surgical indication were not associated with higher hemorrhage rates in this group. This study suggests a clinically important magnitude of increased bleeding risk in patients with hematologic disease. This risk appears to decrease with the use of an institutional protocol consisting of

Effects of intraoperative dexmedetomidine with intravenous anesthesia on postoperative emergence agitation/delirium in pediatric patients undergoing tonsillectomy with or without adenoidectomy: A CONSORT-prospective, randomized, controlled clinical trial.

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Cao, Jun-Li; Pei, Yu-Ping; Wei, Jing-Qiu; Zhang, Yue-Ying

2016-12-01

Postoperative emergence agitation/delirium (POED) is a common complication in pediatric surgery patients, which increases the risk of developing postoperative airway obstruction and respiratory depression. This study aims to investigate the safety and efficacy of intraoperative infusion of dexmedetomidine (DEX) and its effects on POED in pediatric patients undergoing tonsillectomy with or without adenoidectomy.Sixty patients scheduled for tonsillectomy with or without adenoidectomy, aged 2 to 8 years, were randomly allocated into 2 groups (n = 30). Pediatric patients in the group DEX received intravenous (IV) DEX 1 μg/kg over 10 minutes, followed by 0.5 μg/kg/h continuous infusion, and the same volume of 0.9% saline was administrated in the group control. Anesthesia was maintained with target-controlled infusion (TCI) of propofol and remifentanyl. Intraoperative heart rate (HR), noninvasive blood pressure (NIBP), blood oxygen saturation (SPO2), recovery time, and extubation time were recorded. Pain level was evaluated using the objective pain score (OPS), pediatric anesthesia emergence delirium (PAED) scale and Cole 5-point scale (CPS) was used to evaluate POED when patients at 0, 5, 15 minutes, and then at intervals of 15 minutes for 60 minutes after parents arrival at postanesthesia care unit (PACU).The results showed that intraoperative HR was significantly lower in group DEX (P pediatric patients undergoing tonsillectomy with or without adenoidectomy, without adverse hemodynamic effects, though the lower incidence of POED was not observed.

Does Microscope Assistance in Cold Steel Tonsillectomy Reduce the Risk of Postoperative Hemorrhage? Results of a Prospective Cohort Study

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Thomas Wilhelm

2017-01-01

Full Text Available Background. Posttonsillectomy hemorrhage (PTH is the most feared complication. Dissection near the tonsillar capsule under microscopic view (TEmic could be assumed to decrease PTH compared to traditional tonsillectomy (TEtrad. Methods. In this study, patients were evaluated with respect to the need for surgical control (R/N: return/no return to theater (RTT: the day of surgery [0] or thereafter [1]. The findings at resection site and pain were measured. Results. 869 patients were included (183 TEmic; 686 TEtrad. PTH requiring RTT was not seen in the TEmic group on the day of surgery (R0 while PTH requiring RTT subsequently (R1 was seen in 1.1% of the cases. In the TEmic group, hemorrhages without a need for surgical control were observed in 0.6% (N0 and 3.4% (N1, respectively. The corresponding rates for TEtrad were as follows: R0, 0.3%; R1, 1.7%; N0, 0.6%; and N1, 3.6% (p>0.05. Postoperative edema and local infection at resection site were proven to be predictive of PTH (p=0.007. Conclusion. Microscope assistance in tonsillectomy did not statistically have an influence on the PTH even though there was a trend towards lower PTH rate in the TEmic group. Benefit for TEmic was observed in high-volume and long experienced surgeons.

Indications for tonsillectomy stratified by the level of evidence

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Windfuhr, Jochen P.

2016-01-01

Background: One of the most significant clinical trials, demonstrating the efficacy of tonsillectomy (TE) for recurrent throat infection in severely affected children, was published in 1984. This systematic review was undertaken to compile various indications for TE as suggested in the literature after 1984 and to stratify the papers according to the current concept of evidence-based medicine. Material and methods: A systematic Medline research was performed using the key word of “tonsillectomy“ in combination with different filters such as “systematic reviews“, “meta-analysis“, “English“, “German“, and “from 1984/01/01 to 2015/05/31“. Further research was performed in the Cochrane Database of Systematic Reviews, National Guideline Clearinghouse, Guidelines International Network and BMJ Clinical Evidence using the same key word. Finally, data from the “Trip Database” were researched for “tonsillectomy” and “indication“ and “from: 1984 to: 2015“ in combination with either “systematic review“ or “meta-analysis“ or “metaanalysis”. Results: A total of 237 papers were retrieved but only 57 matched our inclusion criteria covering the following topics: peritonsillar abscess (3), guidelines (5), otitis media with effusion (5), psoriasis (3), PFAPA syndrome (6), evidence-based indications (5), renal diseases (7), sleep-related breathing disorders (11), and tonsillitis/pharyngitis (12), respectively. Conclusions: 1) The literature suggests, that TE is not indicated to treat otitis media with effusion. 2) It has been shown, that the PFAPA syndrome is self-limiting and responds well to steroid administration, at least in a considerable amount of children. The indication for TE therefore appears to be imbalanced but further research is required to clarify the value of surgery. 3) Abscesstonsillectomy as a routine is not justified and indicated only for cases not responding to other measures of treatment, evident complications

Effect of carboxyhemoglobin on postoperative complications and pain in pediatric tonsillectomy patients.

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Koyuncu, Onur; Turhanoglu, Selim; Tuzcu, Kasım; Karcıoglu, Murat; Davarcı, Isil; Akbay, Ercan; Cevik, Cengiz; Ozer, Cahit; Sessler, Daniel I; Turan, Alparslan

2015-03-01

Carbon monoxide (CO) is a product of burning solid fuel in stoves and smoking. Exposure to CO may provoke postoperative complications. Furthermore, there appears to be an association between COHb concentrations and pain. We thus tested the primary hypothesis that children with high preoperative carboxyhemoglobin (COHb) concentrations have more postoperative complications and pain after tonsillectomies, and secondarily that high-COHb concentrations are associated with more pain and analgesic use. 100 children scheduled for elective tonsillectomy were divided into low and high carbon monoxide (CO) exposure groups: COHb ≤3 or ≥4 g·dl(-1) . We considered a composite of complications during the 7 days after surgery which included bronchospasm, laryngospasm, persistent coughing, desaturation, re-intubation, hypotension, postoperative bleeding, and reoperation. Pain was evaluated with Wong-Baker Faces pain scales, and supplemental tramadol use recorded for four postoperative hours. There were 36 patients in the low-exposure group COHb [1.8 ± 1.2 g·dl(-1) ], and 64 patients were in the high-exposure group [6.4 ± 2.1 g·dl(-1) ]. Indoor coal-burning stoves were reported more often by families of the high- than low-COHb children (89% vs 72%, P < 0.001). Second-hand cigarette smoke exposure was reported by 54% of the families with children with high COHb, but only by 24% of the families of children with low COHb. Composite complications were more common in patients with high COHb [47% vs 14%, P = 0.0001, OR:7.4 (95% Cl, lower = 2.5-upper = 21.7)], with most occurring in the postanesthesia care unit. Pain scores in postanesthesia care unit and one hour after surgery were statistically significantly lower in the low-exposure group [respectively, P = 0.020 (95%CI, lower = -1.21-upper = -0.80), P = 0.026 (95% CI, lower = -0.03-upper = 0.70)], and tramadol use increased at 4 h (3.5 (interquartile range: 0-8) vs 6 (5-9) mg, P = 0.012) and

Reducing post-tonsillectomy haemorrhage rates through a quality improvement project using a Swedish National quality register: a case study.

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Odhagen, Erik; Sunnergren, Ola; Söderman, Anne-Charlotte Hessén; Thor, Johan; Stalfors, Joacim

2018-03-24

Tonsillectomy (TE) is one of the most frequently performed ENT surgical procedures. Post-tonsillectomy haemorrhage (PTH) is a potentially life-threatening complication of TE. The National Tonsil Surgery Register in Sweden (NTSRS) has revealed wide variations in PTH rates among Swedish ENT centres. In 2013, the steering committee of the NTSRS, therefore, initiated a quality improvement project (QIP) to decrease the PTH incidence. The aim of the present study was to describe and evaluate the multicentre QIP initiated to decrease PTH rates. Six ENT centres, all with PTH rates above the Swedish average, participated in the 7-month quality improvement project. Each centre developed improvement plans describing the intended changes in clinical practice. The project's primary outcome variable was the PTH rate. Process indicators, such as surgical technique, were also documented. Data from the QIP centres were compared with a control group of 15 surgical centres in Sweden with similarly high PTH rates. Data from both groups for the 12 months prior to the start of the QIP were compared with data for the 12 months after the QIP. The QIP centres reduced the PTH rate from 12.7 to 7.1% from pre-QIP to follow-up; in the control group, the PTH rate remained unchanged. The QIP centres also exhibited positive changes in related key process indicators, i.e., increasing the use of cold techniques for dissection and haemostasis. The rates of PTH can be reduced with a QIP. A national quality register can be used not only to identify areas for improvement but also to evaluate the impact of subsequent improvement efforts and thereby guide professional development and enhance patient outcomes.

Comparison of different administration of ketamine and intravenous tramadol hydrochloride for postoperative pain relief and sedation after pediatric tonsillectomy.

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Yenigun, Alper; Et, Tayfun; Aytac, Sirin; Olcay, Betul

2015-01-01

Tonsillectomy is the oldest and most frequently performed surgical procedure practiced by ear, nose, and throat physicians. In this study, our aim was to compare the analgesic effects of peritonsillar, rectal, as well as intravenous infiltration of ketamine and intravenous tramadol hydrochloride infiltration for postoperative pain relief and sedation after tonsillectomy in children. This randomized controlled study evaluated the effects of peritonsillar, intravenous, and rectal infiltration of ketamine in children undergoing adenotonsillectomy. One hundred twenty children who were categorized under American Society of Anesthesiologists classes I to II were randomized to 4 groups of 30 members each. Group 1 received intravenous (IV) ketamine (0.5 mg/kg), group 2 received rectal ketamine (0.5 mg/kg), group 3 received local peritonsillar ketamine (2 mg/kg), and the control group received IV tramadol hydrochloride infiltration (2 mg/kg). Children's Hospital of Eastern Ontario Pain Scale scores and Wilson sedation scale were recorded at minutes 1, 15, 30, 60 as well as hours 2, 12, and 24 postoperatively. The patients were interviewed on the day after the surgery to assess the postoperative pain and sedation. All the routes of infiltration of ketamine were as effective as those of tramadol hydrochloride (P > 0.05). A statistically significant difference was observed between IV infiltrations and all groups during the assessments at hours 6 and 24. The analgesic efficacy of IV ketamine was found especially higher at hours 6 and 24 (P(6) = 0.045, P(24) = 0.011). Perioperative, low-dose IV, rectal, or peritonsillar ketamine infiltration provides efficient pain relief without any adverse effects in children who would undergo adenotonsillectomy.

Does Listening to Music during Tonsillectomy Affect Sevoflurane Consumption?

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Doğan Baki, Elif; Ulu, Şahin; Yüksek, Ahmet; Arıcan, Hüseyin; Sivaci, Remziye

2018-03-12

The aim of this study was to investigate the effect of listening to music on the consumption of an anesthetic agent as well as postoperative recovery and pain in children undergoing elective tonsillectomy. Fifty patients were randomized into those to whom music was played during surgery (Group M) and a control group to whom music was not played (Group C). The depth of anesthesia was provided by entropy levels of 50 ± 5 in both groups. Demographic characteristics and hemodynamic parameters were recorded perioperatively. The duration of surgery sevoflurane consumption, eye opening time, and extubation time were also recorded. A value of p < 0.05 was considered statistically significant. Surgical pleth index values measured intraoperatively were statistically lower in Group M than in Group C. In the post-anesthesia care unit children in the music group felt less pain than those in the control group according to Wong-Baker Faces Pain Rating Scale (p = 0.035). The heart rates of the patients in the music group were statistically lower at 30 minutes intraoperatively and at the end of the procedure compared to the values of the control group (p = 0.015). Consumption of sevoflurane was lower in Group M than in Group C but the difference was not statistically significant. The need for additional fentanyl was significantly lower in Group M than in Group C. In this study, the children exposed to music intraoperatively needed less analgesia during surgery, and reported less pain postoperatively, but there was no difference in sevoflurane requirements. ©2018The Author(s). Published by S. Karger AG, Basel.

Comparing the effects of peritonsillar infiltration of tramadol before and after the surgery on post-tonsillectomy pain.

Science.gov (United States)

Maryam, Hatami; Amin, Jesmani; Sedighe, Vaziribozorg; Vida, Ayatollahi

2017-06-01

The aim of the study was to compare the effects of peritonsillar infiltration of tramadol before and after the surgery on post-tonsillectomy pain. In this double-blinded clinical trial study, 80 children aged 5-12 years old with ASA (American Society of Anesthesiologists) class I or II undergoing tonsillectomy involved. In group A (n = 40), after anesthesia induction and before starting the surgery, tramadol 2 mg/kg diluted in normal saline up to 2 cc total volume was injected into the tensile bed by the anesthesiologist using a 25 gauge needle. Surgery began 3 min later and the tonsils were removed using the sharp dissection method. In children of group B (n = 40), anesthesia induction was performed. When surgery was completed, tramadol 2 mg/kg diluted in normal saline up to 2 cc total volume was injected at the site of removing each tonsil using a 25 gauge needle by the anesthesiologist. Using the CHEOPS (Children's Hospital of Eastern Ontario Pain Scale) Scale, pain recorded at different times. Patient sedation was recorded using the RAMSAY Sedation Scale. All the data were analyzed using SPSS 17 statistical software. Two groups significantly felt different pain intensities at different times following the surgery. At the three times, the mean sedation score in the group receiving tramadol infiltration before surgery was a little higher compared to the other group, but this difference was not significant (p > 0.05). As for the relative frequency of nausea and vomiting, the difference was not significant (p = 0.793). Request for analgesics between the groups was not significant (p = 0.556). The mean time of the first feeding after the surgery was not significant between the groups (p = 0.062). Surgical duration was almost the same for both groups (p > 0.05). Systolic blood pressures (before surgery, before extubation, and after extubation) were statistically the same in both groups (p pain better from 8 h after the surgery

Treating pediatric post-tonsillectomy pain and nausea with complementary and alternative medicine.

Science.gov (United States)

Keefe, Katherine R; Byrne, Kevin J; Levi, Jessica R

2018-05-04

Although tonsillectomy is a common and largely safe procedure, pain management in children remains a controversial topic. In addition to the challenge of choosing appropriate analgesia, there is often low parent and child adherence. This article presents a review, and evaluates the potential role, of a range of complementary and alternative therapies that may be sought out by parents. A literature review of complementary and alternative interventions performed using PubMed, Cochrane Library, and EMBASE, supplemented by searches from Google and hand searches of cross-references of selected articles, yielded 32 studies for qualitative analysis. The studies included for analysis investigated a wide variety of alternative treatment modalities: acupuncture and related therapies, aromatherapy, homeopathy, honey, intravenous fluid, speech therapy, hyaluronic acid, behavioral therapies, ice/cold, hydrogen peroxide rinse, and chewing gum. At this time, stronger conclusions cannot be made about the therapies investigated because there are many methodology limitations of the studies analyzed. However, our results suggest merit for these treatments as adjuvant therapies that can enhance analgesia and decrease requirements of controversial medications. Honey and acupuncture have the greatest amount of evidence for postoperative pain and nausea; however, all interventions examined were cost-effective and safe. We recommend against hydrogen peroxide rinses and chewing gum. Laryngoscope, 2018. © 2018 The American Laryngological, Rhinological and Otological Society, Inc.

Examining the effects of enhanced provider-patient communication on postoperative tonsillectomy pain: protocol of a randomised controlled trial performed by nurses in daily clinical care.

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van Vliet, Liesbeth M; van Dulmen, Sandra; Thiel, Bram; van Deelen, Gerard W; Immerzeel, Stephanie; Godfried, Marc B; Bensing, Jozien M

2017-11-03

Placebo effects (true biopsychological effects not attributable to the active ingredients of medical technical interventions) can be attributed to several mechanisms, such as expectancy manipulation and empathy manipulation elicited by a provider's communication. So far, effects have primarily been shown in laboratory settings. The aim of this study is to determine the separate and combined effects of expectancy manipulation and empathy manipulation during preoperative and postoperative tonsillectomy analgesia care on clinical adult patients' outcomes. Using a two-by-two randomised controlled trial, 128 adult tonsillectomy patients will be randomly assigned to one out of four conditions differing in the level of expectancy manipulation (standard vs enhanced) and empathy manipulation (standard vs enhanced). Day care ward nurses are trained to deliver the intervention, while patients are treated via the standard analgesia protocol and hospital routines. The primary outcome, perceived pain, is measured via hospital routine by a Numeric Rating Scale, and additional prehospitalisation, perihospitalisation and posthospitalisation questionnaires are completed (until day 3, ie, 2 days after the operation). The manipulation is checked using audio recordings of nurse-patient interactions. Although communication is manipulated, the manipulations do not cross norms or values of acceptable behaviour. Standard medical care is provided. The ethical committee of the UMC Utrecht and the local OLVG hospital committee approved the study. Results will be published via (inter)national peer-reviewed journals and a lay publication. NTR5994; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

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

2006-06-15

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

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

International Nuclear Information System (INIS)

Fricke, Bradley L.; Donnelly, Lane F.; Shott, Sally R.; Kalra, Maninder; Poe, Stacy A.; Chini, Barbara A.; Amin, Raouf S.

2006-01-01

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

Information quality and dynamics of patients' interactions on tonsillectomy web resources

Directory of Open Access Journals (Sweden)

Marianne Arsenault

2016-05-01

Full Text Available Information technologies have drastically altered the way patients gather health-related information. By analysing web resources on tonsillectomy, we expose information quality and dynamics of patients' interactions in the online continuum. Readability was assessed using Flesch Reading Ease (FRE, Flesch Kincaid Grade Level (FKGL, Simple Measure of Gobbledygook (SMOG, and Gunning Fog Index (GFI. Comprehensibility and actionability were assessed using the Patient Education Materials Assessment Tool (PEMAT. Metrics of forums included author characteristics (level of disclosure, gender, age, avatar image, etc., posts' motive (community support vs. medical information and content (word count, emoticon use, number of replies, etc.. Analysis of 6 professional medical websites, of 10 health information portals, and of 3 discussion forums totalizing 1369 posts on 358 threads, from January 1, 2007 to December 31, 2014, reveals that online resources exceed understandability recommendations. Women were more present on online health forums (68.2% of authors disclosing their gender and invested themselves more in their avatar. Authors replying were significantly older than authors of original posts (39.7 ± 0.8 years vs. 29.2 ± 0.9 years, p < 0.001. The degree of self-disclosure was inversely proportional to the requests for medical information (p < 0.001. Men and women were equally seeking medical information (men: 74.0%, women: 77.0% and community support (men: 65.7%, women: 70.4%, however women responded more supportively (women 86.2%, men 59.1%, p < 0.001. The dynamics of patients' interactions used to overcome accessibility difficulties encountered is complex. This work outlines the necessity for comprehensible medical information to adequately answer patients' needs.

Adeno-tonsillectomy and rapid maxillary distraction in pre-pubertal children, a pilot study.

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Guilleminault, Christian; Monteyrol, Pierre-Jean; Huynh, Nelly T; Pirelli, Paola; Quo, Stacey; Li, Kasey

2011-05-01

When both narrow maxilla and moderately enlarged tonsils are present in children with obstructive sleep apnea, the decision of which treatment to do first is unclear. A preliminary randomized study was done to perform a power analysis and determine the number of subjects necessary to have an appropriate response. Thirty-one children, 14 boys, diagnosed with OSA based on clinical symptoms and polysomnography (PSG) findings had presence of both narrow maxillary complex and enlarged tonsils. They were scheduled to have both adeno-tonsillectomy and RME for which the order of treatment was randomized: group 1 received surgery followed by orthodontics, while group 2 received orthodontics followed by surgery. Each child was seen by an ENT, an orthodontist, and a sleep medicine specialist. The validated pediatric sleep questionnaire and PSG were done at entry and after each treatment phase at time of PSG. Statistical analyses were ANOVA repeated measures and t tests. The mean age of the children at entry was 6.5 ± 0.2 years (mean ± SEM). Overall, even if children presented improvement of both clinical symptoms and PSG findings, none of the children presented normal results after treatment 1, at the exception of one case. There was no significant difference in the amount of improvement noted independently of the first treatment approach. Thirty children underwent treatment 2, with an overall significant improvement shown for PSG findings compared to baseline and compared to treatment 1, without any group differences. This preliminary study emphasizes the need to have more than subjective clinical scales for determination of sequence of treatments.

Palatine Tonsillar Metastasis of Small-Cell Neuroendocrine Carcinoma from the Lung Detected by FDG-PET/CT After Tonsillectomy: A Case Report

International Nuclear Information System (INIS)

Chen, Xiao-Hong; Bao, Yang-Yang; Zhou, Shui-Hong; Wang, Qin-Ying; Zhao, Kui

2013-01-01

Metastasis from a malignant tumor to the palatine tonsils is rare, accounting for only 0.8% of all tonsillar tumors, with only 100 cases reported in the English-language literature. Various malignant lung carcinomas may metastasize to the tonsils. A few cases of tonsillar metastasis from neuroendocrine lung carcinoma have been reported. A 67-year-old female underwent a right tonsillectomy because of a sore throat and an enlarged right tonsil. The postoperative pathology showed right tonsillar small cell neuroendocrine carcinoma (SCNC). Fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) demonstrated metabolic activity in the lower lobe of the right lung. In addition, hypermetabolic foci were noted in the lymph nodes of the right neck and mediastinum. A needle biopsy of the pulmonary mass showed SCNC. The patient received chemotherapy and died of multiple distant metastases after 6 months. This is the first report using PET/CT to evaluate tonsillar metastasis from lung SCNC

Comparison of benzydamine hydrochloride and Salvia officinalis as an adjuvant local treatment to systemic nonsteroidal anti-inflammatory drug in controlling pain after tonsillectomy, adenoidectomy, or both: an open-label, single-blind, randomized clinical trial

Directory of Open Access Journals (Sweden)

MD Sinisa Lalićević

2004-07-01

Conclusions: In this clinical trial of children and adults who underwent tonsillectomy, adenoidectomy, or both, BNZD, as an adjuvant to an NSAID, was more effective than SO in controlling postoperative pain and infection. The pain-reducing effect of BNZD was of quick onset and persisted for 1 week after surgery. The safety profile of BNZD was comparable to that of SO, with the exception of postoperative infection in adults, for which BNZD was more efficacious. In particular, the use of BNZD was not associated with a high risk for early postoperative hemorrhage.

Estudo comparativo entre duas técnicas de tonsilectomia: bisturi harmônico (Ultracision e dissecção tradicional com bisturi de lâmina fria Comparative study between two tonsillectomy techniques: Ultracision harmonic scalpel and traditional dissection with cold scalpel

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Fernando A. Ramos

2004-06-01

Full Text Available Tonsilectomia é a cirurgia realizada com maior frequência na clínica otorrinolaringológica. As modificações e as evoluções da técnica ocorrem no sentido de simplificar o procedimento e minimizar as complicações. O bisturi harmônico (Ultracision começou a ser utilizado na Otorrinolaringologia em 1999 para tonsilectomia com bons resultados. OBJETIVO: O objetivo deste estudo foi comparar o tempo cirúrgico, sangramento e hemostasia trans-operatórios, dor pós-operatória, aspecto cicatricial da loja tonsilar e intercorrências no trans e pós-operatório em pacientes submetidos a tonsilectomia pela técnica tradicional com lâmina fria e pela técnica utilizando lâmina cirúrgica em ganchos de coagulação Ultracision. FORMA DE ESTUDO: Coorte transversal. CASUÍSTICA E MÉTODO: Vinte e seis pacientes foram submetidos a tonsilectomia: 13 pela técnica tradicional com bisturi de lâmina fria e 13 pela técnica com Ultracision, avaliando os parâmetros previamente estabelecidos através de um protocolo padrão. Os pacientes foram submetidos a uma análise da intensidade da dor através da escala analógica visual horizontal. RESULTADOS: O tempo cirúrgico foi estatisticamente menor na cirurgia realizada pela técnica com o bisturi harmônico comparada com a técnica tradicional. O percentual de pontos dados na loja tonsilar também mostrou-se mais baixo do que pela técnica tradicional. Não houve diferença significativa em relação ao padrão de dor e a evolução pós-operatória do aspecto cicatricial da loja. CONCLUSÃO: O bisturi harmônico mostrou ser um excelente recurso para a realização de cirurgias onde o tempo cirúrgico e o sangramento trans-operatório são de grande importância.Tonsillectomy is the most commom surgical procedure in Otolaringology. The modifications and the technique surgical evolutions aim to simplifly and reduce the complications. The UltacisionÒ harmonic scalpel begin to be used in 1999 in

Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children.

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Venekamp, Roderick P; Hearne, Benjamin J; Chandrasekharan, Deepak; Blackshaw, Helen; Lim, Jerome; Schilder, Anne G M

2015-10-14

Obstructive sleep-disordered breathing (oSDB) is a condition that encompasses breathing problems when asleep, due to an obstruction of the upper airways, ranging in severity from simple snoring to obstructive sleep apnoea syndrome (OSAS). It affects both children and adults. In children, hypertrophy of the tonsils and adenoid tissue is thought to be the commonest cause of oSDB. As such, tonsillectomy - with or without adenoidectomy - is considered an appropriate first-line treatment for most cases of paediatric oSDB. To assess the benefits and harms of tonsillectomy with or without adenoidectomy compared with non-surgical management of children with oSDB. We searched the Cochrane Register of Studies Online, PubMed, EMBASE, CINAHL, Web of Science, Clinicaltrials.gov, ICTRP and additional sources for published and unpublished trials. The date of the search was 5 March 2015. Randomised controlled trials comparing the effectiveness and safety of (adeno)tonsillectomy with non-surgical management in children with oSDB aged 2 to 16 years. We used the standard methodological procedures expected by The Cochrane Collaboration. Three trials (562 children) met our inclusion criteria. Two were at moderate to high risk of bias and one at low risk of bias. We did not pool the results because of substantial clinical heterogeneity. They evaluated three different groups of children: those diagnosed with mild to moderate OSAS by polysomnography (PSG) (453 children aged five to nine years; low risk of bias; CHAT trial), those with a clinical diagnosis of oSDB but with negative PSG recordings (29 children aged two to 14 years; moderate to high risk of bias; Goldstein) and children with Down syndrome or mucopolysaccharidosis (MPS) diagnosed with mild to moderate OSAS by PSG (80 children aged six to 12 years; moderate to high risk of bias; Sudarsan). Moreover, the trials included two different comparisons: adenotonsillectomy versus no surgery (CHAT trial and Goldstein) or versus

Efficacy of peritonsillar infilltration of ketamine, tramadol, and ...

African Journals Online (AJOL)

Backgrounds: Tonsillectomy is one of the most common surgeries in children. Controlling pain after tonsillectomy is still controversial. In this study, the efficacy of peritonsillar injection of lidocaine, tramadol, ketamine,and placebo is compared on post tonsillectomy pain. Methods: In a randomized double-blind clinical trial, ...

Coblation adenotonsillectomy in children.

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Shakeel, Muhammad; Trinidade, Aaron; Al-Adhami, Ahmed; Supriya, Mrinal; Kubba, Haytham

2012-09-01

To determine re-admission rate for post-tonsillectomy pain; the primary and secondary post-tonsillectomy bleeding rate; the percentage requiring control of post-tonsillectomy bleeding in children undergoing coblation tonsillectomy. A descriptive study. Royal Hospital for Sick Children (Yorkhill Hospital) between 2004 and 2006. All patients who underwent tonsillectomy with or without adenoidectomy by coblation technique. Patients were identified from operation theatre log book and electronic data base of theatre activity. The hospital case notes were reviewed retrospectively to collect data, regarding demographics, indication and type of surgery, grade of operating surgeon, duration of hospital stay, re-attendance and re-admission, and management of complications. A total of 106 children; males (n = 53, 50%), females (n = 53, 50%) with a mean age 6.3 years underwent surgery using coblation technique. Thirty-one percent had a tonsillectomy while 69% underwent an adenotonsillectomy. Of these, 48% had history of recurrent tonsillitis, 43% had obstructive sleep apnoea and 9% suffered predominantly from obstructive symptoms. Eighty-two percent of patients were discharged on the first postoperative day. Only one patient had primary bleeding requiring re-operation. After discharge, 7 patients (6.7%) were re-admitted with secondary bleeding, 3 (2.8%) of whom were taken back to theatre to control the bleeding under general anaesthesia. Coblation tonsillectomy is a useful technique in having a low primary and secondary bleeding rates in children undergoing tonsillectomy and adenotonsillectomy.

Variation in practice: an analysis of Scottish Surgical Profiles ENT data.

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Yeo, J C L; Ah-See, K W; Mackenzie, K

2013-02-01

Variation in otolaryngology intervention rates is reported in the Scottish Surgical Profiles Project. Tonsillectomy is one of the selected key indicator procedures. The variation in practice was discussed nationally at the Scottish Otolaryngology Society summer meetings in 2009 and 2010. NHS Grampian had a significantly higher tonsillectomy rate compared with other Scottish NHS boards. To determine the accuracy of NHS Grampian data reported by the Information Service Division (ISD) and to record the appropriateness of listing of patients for tonsillectomy with reference to the Scottish Intercollegiate Guidelines Network (SIGN). Retrospective review of case notes and surgical records of patients who had undergone tonsillectomy between March 2007 and March 2008 in NHS Grampian. Between March 2007 and March 2008, 509 tonsillectomy cases were performed in NHS Grampian. This corresponded to the data received from ISD. 87% of tonsillectomies performed were compliant with SIGN guidelines. The Scottish otolaryngology clinicians have found the reporting of the intervention rates stimulating and challenging. Discussion of the surgical profile project regularly at national specialty meetings resulted in a preliminary detailed targeted audit of those who were persistent outliers for tonsillectomy. This refuted the presumed reasons for this variation, namely inaccurate figures from ISD and inappropriate listings by clinicians.

A retrospective observational study of glucocorticoid-induced diabetes mellitus with IgA nephropathy treated with tonsillectomy plus methylprednisolone pulse therapy.

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Yoshia Miyawaki

Full Text Available To evaluate the incidence of GC-DM among patients with immunoglobulin A nephropathy (IgAN and to confirm the risk factors for the development of GC-DM.The medical records of patients with IgAN newly treated with the protocol of tonsillectomy combined with steroid pulse therapy were reviewed. The primary outcome was the development of GC-DM within the hospitalization period and during one year of follow-up.During hospitalization, 19 of the 95 patients developed GC-DM (20.0%, and the patients with GC-DM were significantly older and had a higher rate of family history of diabetes and higher HbA1c levels. The prevalence of hypertension was higher and the eGFR was numerically lower in patients with GC-DM than in those without. Older age (≥45 years and a family history of diabetes emerged as independent risk factors for the development of GC-DM (odds ratio [OR], 6.3 and 95% confidence interval [CI], 1.6-27.6; OR, 4.4 and 95% CI, 1.2-16.6, respectively. No patients were newly diagnosed with GC-DM during 1-year observation period at out-patient clinic.Among the patients with IgAN, 20% developed GC-DM during the hospitalization period, confirming the family history of diabetes is clinically necessary before starting GC therapy.

A retrospective observational study of glucocorticoid-induced diabetes mellitus with IgA nephropathy treated with tonsillectomy plus methylprednisolone pulse therapy

Science.gov (United States)

Katsuyama, Takayuki; Sada, Ken-Ei; Hiramatsu, Sumie; Ohashi, Keiji; Morishita, Michiko; Katsuyama, Eri; Watanabe, Haruki; Takano-Narazaki, Mariko; Toyota-Tatebe, Noriko; Sunahori-Watanabe, Katsue; Kawabata, Tomoko; Inoue, Tatsuyuki; Kinomura, Masaru; Sugiyama, Hitoshi; Wada, Jun

2017-01-01

Aims To evaluate the incidence of GC-DM among patients with immunoglobulin A nephropathy (IgAN) and to confirm the risk factors for the development of GC-DM. Methods The medical records of patients with IgAN newly treated with the protocol of tonsillectomy combined with steroid pulse therapy were reviewed. The primary outcome was the development of GC-DM within the hospitalization period and during one year of follow-up. Results During hospitalization, 19 of the 95 patients developed GC-DM (20.0%), and the patients with GC-DM were significantly older and had a higher rate of family history of diabetes and higher HbA1c levels. The prevalence of hypertension was higher and the eGFR was numerically lower in patients with GC-DM than in those without. Older age (≥45 years) and a family history of diabetes emerged as independent risk factors for the development of GC-DM (odds ratio [OR], 6.3 and 95% confidence interval [CI], 1.6–27.6; OR, 4.4 and 95% CI, 1.2–16.6, respectively). No patients were newly diagnosed with GC-DM during 1-year observation period at out-patient clinic. Conclusions Among the patients with IgAN, 20% developed GC-DM during the hospitalization period, confirming the family history of diabetes is clinically necessary before starting GC therapy. PMID:28562629

Pulsating Tonsil Due to Medial Displacement of the Internal Carotid Artery.

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Alsini, Albaraa Y; Ibrahim, Alsheikhi

2017-05-06

BACKGROUND The internal carotid artery (ICA) is about 2.5 cm away from the tonsils. It has no branches in the cervical portion. ICA anomalies of the neck zone may result in a massive arterial bleeding during pharynx and neck surgery. Due to these anomalies, the surgeon must be aware of this risk during tonsillectomy, adenoidectomy, and pharyngeal operations.  CASE REPORT A 23-year-old woman who was discovered to have an acute S curling-type anomaly of the ICA in contact with the lateral border of the right tonsil during a work-up for a tonsillectomy. This anomaly was incidentally discovered via computed tomography (CT) with contrast. In re-evaluating the course of treatment, we found a severe S-shape kink on the right side, bringing it close to the right tonsil by approximately 2 mm, and putting it at severe risk of injury during a simple tonsillectomy, possibly exposing the patient to serious bleeding. Partial tonsillectomy was performed for this patient with the aim to preserve and not expose the internal carotid artery. Pulsation of right tonsil was recorded. The patient made an uneventful postoperative recovery. CONCLUSIONS Undetected ICA anomaly variation can lead to fatal bleeding during a simple procedure, like tonsillectomy. We recommend vigilance during tonsillectomy if one is using a hot dissection method versus a cold dissection method, which may allow for detection of a perioperative ICA anomaly. Tonsillectomy performed by a junior resident should be under direct supervision, particularly if the hot dissection method is used.

Tissue welding tonsillectomy provides an enhanced recovery compared to that after monopolar electrocautery technique in adults: a prospective randomized clinical trial.

Science.gov (United States)

Silvola, Juha; Salonen, Aarre; Nieminen, Jouko; Kokki, Hannu

2011-02-01

We have compared tonsillectomy (TE) with tissue welding (TW) technology using a specially designed forceps versus conventional monopolar electrocautery to evaluate whether this new technology may improve recovery after TE. This was a single-blind, randomized clinical trial with two parallel groups. Sixty healthy adult day-surgery patients were allocated into the TW-TE group (n = 31) and the monopolar electrocautery-TE group (n = 29). We recorded intraoperative events and short- and long-term recovery for 2 weeks postoperatively. The patients and study nurses evaluating patients during recovery were blinded to the operation method used. All patients in the TW-TE group completed the study as per protocol, but in the monopolar electrocautery-TE group, there was one drop-out in the hospital and another after discharge. There was no difference in the perioperative parameters and early recovery between the two groups. After discharge, recovery was significantly faster in the TW group than in the monopolar group: (1) the duration of postoperative pain was 2 days shorter, and (2) activities of normal daily living were less affected, and (3) the need for hospital contacts after discharge, and (4) the incidence of postoperative bleeding was less in the TW group than that in the monopolar group. No patients in the TW group developed secondary bleeding versus three patients in the monopolar group requiring electrocautery to control bleeding. In conclusion; our results indicate that, TW technique may provide reduced pain, faster recovery, and fewer complications compared to electrocautery TE.

Anaesthetic management of paediatric adenotonsillectomy

African Journals Online (AJOL)

From a risk-benefit perspective, tonsillectomy is an elective ... Potential problems with adenotonsillectomy can be minimised by .... For many children, pain and functional limitation ... pain after tonsillectomy, and time to resumption of oral intake.

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

Directory of Open Access Journals (Sweden)

Otávio Bejzman Piltcher

2005-10-01

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

Impact of the Korean Diagnosis-Related Groups payment system on the outcomes of adenotonsillectomy: A single center experience.

Science.gov (United States)

Kwak, Sang Hyun; Kim, Ji Hoon; Kim, Da Hee; Kim, Jung Min; Byeon, Hyung Kwon; Kim, Won Shik; Koh, Yoon Woo; Kim, Se-Heon; Choi, Eun Chang

2018-06-01

To report outcomes with regard to clinical aspects and medical costs of adenotonsillectomy and tonsillectomy at a single institution before and after implementation of the Diagnosis-Related Groups (DRG) payment system in Korea. We retrospectively reviewed the records of patients treated with adenotonsillectomy or tonsillectomy between July 2012 and June 2014. The Korean DRG payment system was applied to seven groups of specific diseases and surgeries including adenotonsillectomy and tonsillectomy from July 2013 at all hospitals in Korea. We divided patients into four groups according whether the fee-for-service (FFS) or DRG payment system was implemented and operation type (FFS-adenotonsillectomy (AT), DRG-AT, FFS-tonsillectomy (T), and DRG-T). A total of 1402 patients were included (485 FFS-AT, 490 DRG-AT, 203 FFS-T, and 223 DRG-T). The total medical cost of the DRG-AT group was significantly lower than that of the FFS-AT group (1191±404 vs. 1110±279 USD, PDRG system for adenotonsillectomy and tonsillectomy reduced medical costs and clinical outcomes were not significantly altered by the adoption of the DRG system. 4. Copyright © 2017 Elsevier B.V. All rights reserved.

Safe Day Case Adenotonsillectomy: Experience from a Private ...

African Journals Online (AJOL)

... hypertrophy. Conclusion: Day case tonsillectomies in private hospitals settings are safe with few complications that are often not life threatening. It should be encouraged in our environment in private hospitals where the facilities are available. Key Words Day case tonsillectomy, adenotonsillectomy, otolaryngology ...

Influence of radiofrequency surgery on architecture of the palatine tonsils.

Science.gov (United States)

Plzak, Jan; Macokova, Pavla; Zabrodsky, Michal; Kastner, Jan; Lastuvka, Petr; Astl, Jaromir

2014-01-01

Radiofrequency surgery is a widely used modern technique for submucosal volume reduction of the tonsils. So far there is very limited information on morphologic changes in the human tonsils after radiofrequency surgery. We performed histopathological study of tonsillectomy specimens after previous bipolar radiofrequency induced thermotherapy (RFITT). A total of 83 patients underwent bipolar RFITT for hypertrophy of palatine tonsils. Tonsil volume reduction was measured by 3D ultrasonography. Five patients subsequently underwent tonsillectomy. Profound histopathological examination was performed to determine the effect of RFITT on tonsillar architecture. All tonsillectomy specimens showed the intact epithelium, intact germinal centers, normal vascularization, and no evidence of increased fibrosis. No microscopic morphological changes in tonsillectomy specimens after bipolar RFITT were observed. RFITT is an effective submucosal volume reduction procedure for treatment of hypertrophic palatine tonsils with no destructive effect on microscopic tonsillar architecture and hence most probably no functional adverse effect.

Enfisema subcutâneo pós-amigdalectomia: relato de caso Enfisema subcutáneo después de amigdalectomia: relato del caso Subcutaneous emphysema after tonsillectomy: case report

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Walter Luiz Ferreira Lima

2005-08-01

cirugía, se notó un edema crepitante y depresible en el cuello y en la región parotídea izquierda, característico de enfisema subcutáneo. La tomografía computadorizada mostró la existencia de aire en las regiones malar y cervical (principalmente a la izquierda, alcanzando hasta el mediastino superior. No hubo obstrucción de las vías aéreas y el estado general del paciente permaneció estable. Tuvo alta hospitalario en el día siguiente y fue acompañado en el ambulatorio. El enfisema retrocedió totalmente después de 10 días. CONCLUSIONES: El enfisema subcutáneo es una complicación rara de la amigdalectomia, ocurriendo casi siempre después de disecciones profundas de la mucosa faríngea, cuando se crea interface porosa que proporciona la entrada del aire. El aumento de la presión en las vías aéreas superiores puede contribuir para el problema.BACKGROUND AND OBJECTIVES: Tonsillectomy is considered a relatively safe procedure. This report aimed at describing an uncommon complication of this surgical procedure: subcutaneous emphysema. CASE REPORT: Male patient, 25 years old, admitted for recurrent tonsillitis and hypertrophic nasal turbinates. Tonsillectomy and nasal cauterization were performed under general anesthesia with tracheal intubation. Surgery was uneventful. At post-anesthetic recovery unit (PACU, patient was agitated and performing major physical effort. Four hours after surgery, gross and crepitus swelling of neck and left parotid region, typical of subcutaneous emphysema, was noted. CT scan has revealed free air in the malar and cervical regions (especially to the left, reaching upper mediastinum. There was no airway obstruction and his general condition was stable. Patient was discharged one day after and was followed on ambulatory basis. Emphysema was no longer clinically evident 10 days after. CONCLUSIONS: Subcutaneous emphysema is an uncommon complication of tonsillectomy, appearing almost ever after deeper dissections of the pharyngeal

Woodlands House Nursing Home, Trim Road, Navan, Meath.

LENUS (Irish Health Repository)

2016-10-01

Recurrent sore throat for possible tonsillectomy is the commonest clinical entity referred to the ENT outpatient department. The numbers involved represent a large clinical burden on the service. Not all of these patients require surgical intervention. Patients who fit the criteria for tonsillectomy are faced with two stage obstacles; the long waiting time until assessed by the Otolaryngologist at OPD and the time spent on long operative waiting lists. The aim of this study was to analyze the percentage of referred patients with sore throats requiring tonsillectomy versus those not needing surgery, using the present HIQA guidelines for this operation.

Peritonsillar abscess

DEFF Research Database (Denmark)

Sørensen, J A; Godballe, C; Andersen, N H

1991-01-01

readmitted for surgery of the remaining tonsil during the follow-up period. Ninety-seven per cent of these patients were younger than 30 years of age. Previous investigations have shown increasing frequency by age of pharyngitis after bilateral tonsillectomy. We suggest bilateral tonsillectomy in all cases...

Tonsillectomy and adenoidectomy in children with sleep-related breathing disorders: consensus statement of a UK multidisciplinary working party.

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Robb, P J; Bew, S; Kubba, H; Murphy, N; Primhak, R; Rollin, A-M; Tremlett, M

2009-07-01

During 2008, ENT-UK received a number of professional enquiries from colleagues about the management of children with upper airway obstruction and uncomplicated obstructive sleep apnoea (OSA). These children with sleep-related breathing disorders (SRBDs) are usually referred to paediatricians and ENT surgeons. In some district general hospitals, (DGHs) where paediatric intensive care (PICU) facilities to ventilate children were not available, paediatrician and anaesthetist colleagues were expressing concern about children with a clinical diagnosis of OSA having routine tonsillectomy, with or without adenoidectomy. As BAPO President, I was asked by the ENT-UK President, Professor Richard Ramsden, to investigate the issues and rapidly develop a working consensus statement to support safe but local treatment of these children. The Royal Colleges of Anaesthetists and Paediatrics and Child Health and the Association of Paediatric Anaesthetists nominated expert members from both secondary and tertiary care to contribute and develop a consensus statement based on the limited evidence base available. Our terms of reference were to produce a statement that was brief, with a limited number of references, to inform decision-making at the present time. With patient safety as the first priority, the working party wished to support practice that facilitated referral to a tertiary centre of those children who could be expected, on clinical assessment alone, potentially to require PICU facilities. In contrast, the majority of children who could be safely managed in a secondary care setting should be managed closer to home in a DGH. BAPO, ENT-UK, APA, RCS-CSF and RCoA have endorsed the consensus statement; the RCPCH has no mechanism for endorsing consensus statements, but the RCPCH Clinical Effectiveness Committee reviewed the statement, concluding it was a 'concise, accurate and helpful document'. The consensus statement is an interim working tool, based on level-five evidence. It

Quinsy tonsillectomy or interval tonsillectomy - a prospective ...

African Journals Online (AJOL)

Their personality traits were evaluated clinically. After 5 years, 205 respondents were traced to complete a follow-up questionnaire and, where possible, a personality assessment was completed on clinical grounds. They were also evaluated for brief recurrent depression. Among the men, antisocial, dependent and histrionic.

ISSN 2073 ISSN 2073-9990 East Cent. Afr. J. surg. (Online) 90 East ...

African Journals Online (AJOL)

DELL

Pinder D, Hilton M. Dissection versus diathermy for tonsillectomy. Cochrane Database Syst Rev. 2001;(4):CD002211. 3. Gendy S, O'leary M, Colreavy M, Rowley H, O'Dwyer T, Blayney A. Tonsillectomy- cold dissection versus hot dissection: a prospective study. Ir Med J 2005; 98(10):243-4. 4. Leach J, Manning S, Schaefer ...

The efficiacy of anterior and posterior archs suturation at inferior tonsillar pole for posttonsillectomy pain control.

Science.gov (United States)

Sakallioğlu, Oner; Düzer, Sertaç; Kapusuz, Zeliha

2014-01-01

The aim of our study was to investigate the efficiacy of the suturation technique after completing the tonsillectomy procedure for posttonsillectomy pain control in adult patients. August 2010-February 2011, 44 adult patients, ages ranged from 16 to 41 years old who underwent tonsillectomy at Elaziğ Training and Research Hospital Otorhinolaryngology Clinic were included to the study. After tonsillectomy procedure, anterior and posterior tonsillar archs were sutured each other and so, the area of tonsillectomy lodges which covered with mucosa were increased. Twenty two patients who applied posttonsillectomy suturation were used as study group and remnant 22 patients who did not applied posttonsillectomy suturation were used as control group. The visual analogue score (VAS) was used to evaluate the postoperative pain degree (0 no pain, 10 worst pain). ANOVA test (two ways classification with repeated measures) was used for statistical analysis of VAS values. P < 0.05 was accepted as statistically significant. The effect of time (each post-operative day) on VAS values was significant. The mean VAS values between study and control group on post-operative day 1st, 3rd, 7th, and 10th were statistically significant (P < 0.05). The severity of posttonsillectomy pain was less in study group patients than control group patients. The suturation of anterior and posterior tonsillar archs after tonsillectomy procedure was found effective to alleviate the posttonsillectomy pain in adult patients.

Our experience with pre-operative haemostatic assessment of paediatric patients undergoing adenotonsillectomy at Federal Medical Centre, Makurdi

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Amali Adekwu

2016-01-01

Full Text Available Background: In 2-4% of all patients requiring adenoidectomy, tonsillectomy or adenotonsillectomy, pre-operative screening tests for coagulation disorders are indicated to detect surgical bleeding complications. However, because of cost effect on the patients, the usefulness of these tests is being challenged. We therefore highlight our experience in paediatric patients undergoing adenoidectomy, tonsillectomy or both in our centre. Patients and Methods: This is a 3½-year analysis of the data of 165 paediatric patients who had adenoidectomy, tonsillectomy or both over the study period. The data collected included age, sex, procedure done and detailed clinical bleeding history. Results: A total of 165 children had either adenoidectomy or tonsillectomy, or both. There were 76 males and 89 females giving a male to female ratio of 1:1.2. Their ages ranged from 10 months to 18 years. Eighty-five (51.5% patients had adenotonsillectomy, 48 (29.1% and 32 (19.4% had only tonsillectomies and adenoidectomies, respectively. Only 11 (6.7% families volunteered the history of either prolonged bleeding with minor injury on the skin or occasional slight nose bleeding. Six (3.6% patients including 3 of the children with positive family history had posttonsillectomy bleed, out of which 4 (66.7% were moderate whereas the remaining 2 (33.3% were severe bleeding, which was not statistically significant (P = 0.041. The two cases of severe bleeding had fresh whole blood transfused whereas the rest that had no bleeding issues were discharged home 48 h postoperatively. Conclusion: Our experience in this study suggests that detailed bleeding history is necessary as well as pre-operative haemostatic assessment, if available and affordable for paediatric patients undergoing adenotonsillectomy.

Are Histologic Studies of Adenotonsillectomy Really Necessary?

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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.

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

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Ashraf Arafat Abdelhalim

2013-01-01

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

Oral Flurbiprofen Spray for Posttonsillectomy Pain.

Science.gov (United States)

Muderris, Togay; Gul, Fatih; Yalciner, Gokhan; Babademez, Mehmet Ali; Bercin, Sami; Kiris, Muzaffer

2016-07-01

Tonsillectomy is still one of the most common surgical procedures, but there exists no standard guideline for pain management after tonsillectomy. Our aim is to determine whether oral spray of flurbiprofen reduces pain and has an influence on other morbid outcomes following tonsillectomy. Prospective, double-blind, randomized, placebo controlled. Patients at Ataturk Training and Research Hospital, Ankara, Turkey. This study was performed on 84 patients (45 in flurbiprofen group, 39 in placebo group) who underwent tonsillectomy. The patients were randomly chosen, and each used oral spray of flurbiprofen 3 times daily or placebo solution at the same regimen. Efficacy was assessed by changes in Numeric Pain Rating Scale. Data were collected at postoperative days 1, 3, 5, and 7 for pain, bleeding, and healing. Data for Mallampati scores were also collected. There were no significant difference between groups with respect to the demographic data. The flurbiprofen group had statistically significant lower pain scores at days 1, 3, 5, and 7 (P = .000, P = .002, P = .001, P = .000, respectively). On days 3 and 7, pain scores were significantly different between different Mallampati groups (P = .049, P = .015, respectively). The flurbiprofen group required less analgesic than the placebo group during the study period on days 1, 3, 5, and 7 (P = .001, P = .001, P = .03, P = .001, respectively). Healing and side effects were not significantly different between the groups. In this study, topical use of flurbiprofen may reduce posttonsillectomy pain without any evidence of additional complications. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

The Effect of Ketamine on Posttonsillectomy Pain in Children: A Clinical Trial

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Akbar Pirzadeh

2012-01-01

Full Text Available Introduction: Tonsillectomy is one of the most common surgical operations and has such complications as pain, hemorrhage and laryngospasm. Pain management is of vital importance in order to reduce the suffering and restlessness in children having undergone tonsillectomy. Different studies differ in their findings as to the use of ketamine for postoperative analgesia. The aim of this study was to investigate the effect of peritonsillar injection of ketamine preoperatively on postoperative pain relief.  Materials and Methods: This was a randomized controlled trial (RCT on sixty 3-12-year-old children. Children were randomly assigned to the intervention and control groups. Peritonsillar injection consisted of 1 mg/kg ketamine in the intervention group and of normal saline in the control group. An injection of 1 cc was administered on each side five minutes prior to tonsillectomy. Pain assessment was performed using the self-report Oucher Scale and CHEOPS (Children's Hospital of Eastern Ontario Pain Scale and sedative state assessment was performed using the Wilson Sedation Scale. Pain, medication and complications were studied for 24 hours. Data analysis was performed using chi-squared test and t-test. Results: The ketamine group had a lower pain score compared with the control group (1.40±1.003 compared with 1.53±1.074. The average pain was less in the control group two hours after the surgery. The difference was statistically significant. There was no difference between the two groups in terms of nausea and vomiting incidence.  Conclusion: The peritonsillar injection of ketamine five minutes prior to the surgery reduces the post-tonsillectomy pain without causing any complications.

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

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Motta Giovanni

2013-01-01

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

Anaesthesia for adenotonsillectomy: An update

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Anand Bangera

2017-01-01

Full Text Available Adenotonsillectomy remains one of the most common surgical procedures carried out in children. Though a commonly performed procedure, it poses a great challenge to the surgeon as well as the anaesthesiologist and is associated with a substantially increased risk of morbidity and mortality. In the post-operative period, it poses threats such as post-tonsillectomy bleeding and airway obstruction if not diagnosed and treated promptly. Various recent advances in airway management and early detection of post-operative complications have been made to reduce the sequelae associated with tonsillectomy. In this article, we have reviewed the various techniques, complications and recent advances, which have evolved in the anaesthetic technique related to adenotonsillectomy.

Periodic Fever, Aphthous Stomatitis, Pharyngitis and Cervical Adenitis Syndrome: Current Literature Review with a Case Report

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Mahmut Demirtaş

2018-04-01

Full Text Available Periodic Fever, Aphthous Stomatitis, Pharyngitis and Cervical Adenitis syndrome (PFAPA is a frequently seen, important medical condition, which must be kept in mind in periodic fever etiology. Although its etiology is not clearly understood, autoimmune etiology is suspected due to response to steroids. There is no specific test for the diagnosis of disease. Diagnosis is based on symptoms and physical examination. Although medical treatment is the first choice for the management of the disease, tonsillectomy take over in treatment options for termination of attacks and permanent results. We have presented a patient that was performed tonsillectomy in our clinic for frequent attacks despite recurrent medical therapy with diagnosis of PFAPA with review of current literature.

Tonsillar Surface Micro Flora: Does it Truly Represent Pathological Tonsillar Flora?

Science.gov (United States)

Haq, Syed Nadeem Ul; Ayub, Zeeshan; Ahmed, Azeema

2017-01-01

To determine the best method of identifying core tonsillar flora. Quasi-experimental study. ENT Department, Combined Military Hospital, Lahore, from September 2013 to October 2015. Eighty-seven patients of recurrent tonsillitis undergoing tonsillectomy were included. All the patients, after being anaesthetised, had surface swabs taken from the tonsillar surface followed by tonsillar aspiration with a 5cc syringe. Following tonsillectomy, the tonsils were sent for culture of core flora. All three specimens from each patient were cultured according to established criteria. The patient population had 33 (37%) female and 54 (62%) male patients. Flora of 12 (13.8%) surface swabs and 68 (78.2%) tonsillar aspirates matched the flora cultured from core of the tonsils. Chi-square test showed this difference to be significant (p-value flora as compared to surface swabs.

[2000 year history of tonsillectomy. Images from the history of otorhinolaryngology, highlighted by instruments from the collection of the German Medical History Museum in Ingolstadt].

Science.gov (United States)

Feldmann, H

1997-12-01

The etymology of the anatomical terms and their use in history are elucidated: "Tonsil" (from Latin tonsa = the oar) in use since Celsus (about 40 AD). The Greek terms of that time, "antiádes", "paristhmia", were not adopted in later medical terminology. "Amygdala" (Greek/Latin = the almond) was introduced by Vesalius in 1543. Vesalius was also the first to depict the tonsils in a specimen of the whole human body; Duverney (1761) gives the first exact depiction of the pharyngeal region. Special anatomical and histological studies of the tonsils were carried out in the 19 century. Cornelius Celsus in Rome (about 40 AD) described the blunt removal of the tonsils by use of the finger. This method was favoured anew by numerous laryngologists at the beginning of the 20th century when it had been realised that a gentle enucleation of the entire tonsil including its capsule was advisable against cutting off a slice, but before long this procedure was discarded again for hygienic reasons. Precursors of special instruments for tonsillectomy were instruments designed for shortening the uvula: uvulotomy. Paré (1564) and Scultetus (1655) devised instruments that permitted placing a thread shaped like a snare around the uvula and cutting it off by strangulation. Hildanus (1646), Scultetus (1655) and Heister (1763) presented an instrument of the guillotine-type for uvulotomy. This instrument was modified by P. S. Physick (USA 1828) and used for tonsillotomy. It became the prototype for a number of similar instruments which were to follow: W. M. F. Fahnestock (USA 1832). M. Mackenzie (London 1880), G. Sluder (USA 1911). Besides these guillotines snares were also perfected and used for tonsillotomy, e.g. by W. Brünings (1908). The concentration on tonsillotomy aimed at performing the operation as quickly as possible, especially in children, as it was not yet possible to sustain general anaesthesia for a longer period of time while doing surgery in the pharynx. The operation of

PFAPA (Periodic fever, aphtous stomatitis, pharingitis, cervical adenitis or Marshall’s syndrome in children

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N N Kuzmina

2005-01-01

Full Text Available PFAPA (periodic fever, aphtous stomatitis, pharingitis, cervical adenitis or Marshall’s syndrome is one of the rare periodic fever conditions appearing in children. Its cause is unknown. This syndrome may continue for several years. During interictal period the child is quite well, grows and develops normally. The disease should be differentiated from Behcet’s disease, cyclic neutropenia, familial Mediterranean fever, familial Ireland fever, hyperimmunoglobulinemia D syndrome, systemic juvenile idiopathic arthritis, chronic tonsillitis, some infectious diseases. Many drugs are used for the treatment of PFAPA syndrome: antibiotics, non-steroidal anti-inflammatory drugs, chloroquin, antiviral drugs, glucocorticoids, cimetidin. Tonsillectomy is used quite often. Analysis of the literature data shows that best results may be achieved with tonsillectomy (sometimes in combination with ade- notomy. PFAPA in a child of 2 years age diagnosed for the first time in Russian pediatric rheumatology is described.

Pediatric Adenotonsillectomy in a Low Resource Setting: Lessons ...

African Journals Online (AJOL)

suggest that post-operative pain management be streamlined taking into consideration the available analgesics in our setting. KEYWORDS: Adenoidectomy, analgesia, pediatric, tonsillectomy, transfusion. How to cite this article: Ameye SA, Owojuyigbe AM, Adeyemo A,. Adenekan AT, Ouche S. Pediatric adenotonsillectomy ...

Association Between Ibuprofen Use and Severity of Surgically Managed Posttonsillectomy Hemorrhage.

Science.gov (United States)

Mudd, Pamela A; Thottathil, Princy; Giordano, Terri; Wetmore, Ralph F; Elden, Lisa; Jawad, Abbas F; Ahumada, Luis; Gálvez, Jorge A

2017-07-01

Ibuprofen used in postoperative management of pain after tonsillectomy has not been shown to increase the overall risk for posttonsillectomy hemorrhage (PTH). The severity of bleeding is difficult to quantify but may be a more important outcome to measure. To evaluate the association between ibuprofen use and severity of PTH using transfusion events as a marker of severity. This retrospective cohort study identified 8868 patients who underwent tonsillectomy from January 20, 2011, through June 30, 2014, at the tertiary academic Children's Hospital of Philadelphia. Of these patients, 6710 met the inclusion criteria. Data were collected using electronic database acquisition and query. Multivariate analysis was performed to identify independent prognostic factors for PTH and receipt of transfusion. Of the 6710 patients who met criteria for analysis (3454 male [51.5%] and 3256 female [48.5%]; median age, 5.4 years [interquartile range, 3.7-8.2 years]), 222 (3.3%) presented with PTH that required surgical control (sPTH). A total of 15 of the 8868 patients required transfusion for an overall risk for transfusion after tonsillectomy of 0.2%. Fifteen of 222 patients undergoing sPTH (6.8%) received transfusions. No significant independent increased risk for sPTH was associated with use of ibuprofen (adjusted odds ratio [OR], 0.90; 95% CI, 0.68-1.19). A significant independent association was found in the risk for sPTH in patients 12 years or older (adjusted OR, 2.74; 95% CI, 1.99-3.76) and in patients with a history of recurrent tonsillitis (adjusted OR, 1.52; 95% CI, 1.12-2.06). When using transfusion rates as a surrogate for severity of sPTH, transfusion increased by more than 3-fold among ibuprofen users compared with nonusers (adjusted OR, 3.16; 95% CI, 1.01-9.91), and the upper limit of the 95% CI suggests the difference could be nearly 10 times greater. The risk for sPTH is not increased with use of postoperative ibuprofen but is increased in patients 12 years or older

Second branchial cleft fistulae: patient characteristics and surgical outcome.

Science.gov (United States)

Kajosaari, Lauri; Mäkitie, Antti; Salminen, Päivi; Klockars, Tuomas

2014-09-01

Second branchial cleft anomalies predispose to recurrent infections, and surgical resection is recommended as the treatment of choice. There is no clear consensus regarding the timing or surgical technique in the operative treatment of these anomalies. Our aim was to compare the effect of age and operative techniques to patient characteristics and treatment outcome. A retrospective study of pediatric patients treated for second branchial sinuses or fistulae during 1998-2012 at two departments in our academic tertiary care referral center. Comparison of patient characteristics, preoperative investigations, surgical techniques and postoperative sequelae. Our data is based on 68 patients, the largest series in the literature. One-fourth (24%) of patients had any infectious symptoms prior to operative treatment. Patient demographics, preoperative investigations, use of methylene blue, or tonsillectomy had no effect on the surgical outcome. There were no re-operations due to residual disease. Three complications were observed postoperatively. Our patient series of second branchial cleft sinuses/fistulae is the largest so far and enables analyses of patient characteristics and surgical outcomes more reliably than previously. Preoperative symptoms are infrequent and mild. There was no difference in clinical outcome between the observed departments. Performing ipsilateral tonsillectomy gave no outcome benefits. The operation may be delayed to an age of approximately three years when anesthesiological risks are and possible harms are best avoided. Considering postoperative pain and risk of postoperative hemorrhage a routine tonsillectomy should not be included to the operative treatment of second branchial cleft fistulae. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Transoral robotic surgery for the management of head and neck squamous cell carcinoma of unknown primary

DEFF Research Database (Denmark)

Channir, Hani Ibrahim; Rubek, Niclas; Nielsen, Hans Ulrik

2015-01-01

Scandinavian study could potentially minimize the radiation field to the pharyngeal axis in patients with identified primary tumours. OBJECTIVES: The aim of the study was to investigate whether bilateral lingual tonsillectomy performed with TORS is feasible, and whether it could improve the detection rates...

SAMJ 8207.indd

African Journals Online (AJOL)

Bleeding risk assessment. Has the patient, or a blood relative, ever received medical care for a bleeding tendency, e.g.: Nose bleeds (epistaxis). Excessive bleeding after a dental procedure or extraction. Excessive bleeding after trauma or surgery. Excessive bleeding after tonsillectomy. Excessive bleeding during childbirth ...

Management of guttate psoriasis in patients with associated streptococcal infection

Directory of Open Access Journals (Sweden)

Karabudak Abuaf O

2012-11-01

Full Text Available Özlem Karabudak Abuaf, Bilal DoganDepartment of Dermatology, GATA Haydarpasa Teaching Hospital, Istanbul, TurkeyAbstract: Psoriasis is a T cell-mediated inflammatory skin disease. It can be provoked or exacerbated by environmental factors, particularly medications and infections. Guttate psoriasis is a distinctive acute form of psoriasis that generally occurs in children and young adults. The association between guttate psoriasis and Streptococcus pyogenes is well established in medical literature; however, the exact mechanism can only be theorized. Treatment guidelines are not established, and it is unclear how necessary antibiotics are for acute state guttate psoriasis. Many dermatologists have recommended using antibiotic therapy or tonsillectomy, especially for patients with recurrent streptococcal infections. This paper briefly summarizes the possible mechanisms of pathogenesis and the recent research results on this topic and examines under what conditions a curative treatment of streptococcal infection by tonsillectomy or antibiotic treatment may benefit psoriasis patients.Keywords: guttate, psoriasis, treatment, Streptococcus pyogenes

Impact of Resident Surgeons on Procedure Length based on Common Pediatric Otolaryngology Cases

Science.gov (United States)

Puram, Sidharth V.; Kozin, Elliott D.; Sethi, Rosh; Alkire, Blake; Lee, Daniel J.; Gray, Stacey T.; Shrime, Mark G.; Cohen, Michael

2015-01-01

Background Surgical education remains an important mission of academic medical centers. Financial pressures, however, may favor improved operating room (OR) efficiency at the expense of surgical education. We aim to characterize resident impact on the duration of procedural time using common pediatric otolaryngologic cases which do not necessitate a surgical assistant and assess whether other factors modify the extent to which residents impact OR efficiency. Study Design We retrospectively reviewed resident and attending surgeon total OR and procedural times for isolated tonsillectomy, adenoidectomy, tonsillectomy with adenoidectomy (T&A) and bilateral myringotomy with tube insertion between 2009 and 2013. We included cases supervised or performed by one of four teaching surgeons in children with ASA otolaryngology procedures. While residents may increase operative times, addressing other system-wide issues may decrease impact of time needed for education and added efficiencies of resident participation may exist throughout the perioperative period. Our model is applicable to surgical education across specialties. Level of Evidence 4 PMID:25251257

The functional role of the tonsils in speech.

Science.gov (United States)

Finkelstein, Y; Nachmani, A; Ophir, D

1994-08-01

To present illustrative cases showing various tonsillar influences on speech and to present a clinical method for patient evaluation establishing concepts of management and a rational therapeutic approach. The cases were selected from a group of approximately 1000 patients referred to the clinic because of suspected palatal diseases. Complete velopharyngeal assessment was made, including otolaryngologic, speech, and hearing examinations, polysomnography, nasendoscopy, multiview videofluoroscopy, and cephalometry. New observations further elucidate the intimate relation between the tonsils and the velopharyngeal valve. The potential influence of the tonsils on the velopharyngeal valve mechanism, in hindering or assisting speech, is described. In selected cases, the decision to perform tonsillectomy depends on its potential effect on speech. The combination of nasendoscopic and multiview videofluoroscopic studies of the mechanical properties of the tonsils during speech is required for patients who present with velopharyngeal insufficiency in whom tonsillar hypertrophy is found. These studies are also required in patients with palatal anomalies who are candidates for tonsillectomy.

Pathological Role of Tonsillar B Cells in IgA Nephropathy

Directory of Open Access Journals (Sweden)

Yusuke Suzuki

2011-01-01

Full Text Available Although impaired immune regulation along the mucosa-bone marrow axis has been postulated to play an important role, the pathogenesis of IgA nephropathy (IgAN is unknown; thus, no disease-specific therapy for this disease exists. The therapeutic efficacy of tonsillectomy or tonsillectomy in combination with steroid pulse therapy for IgAN has been discussed. Although randomized control trials for these therapies are ongoing in Japan, the scientific rationale for these therapies remains obscure. It is now widely accepted that abnormally glycosylated IgA1 and its related immune complex (IC are probably key molecules for the pathogenesis, and are thus considered possible noninvasive biomarkers for this disease. Emerging evidence indicates that B cells in mucosal infections, particularly in tonsillitis, may produce the nephritogenic IgA. In this paper, we briefly summarize characteristics of the nephritogenic IgA/IgA IC, responsible B cells, and underlying mechanisms. This clinical and experimental information may provide important clues for a therapeutic rationale.

Peritonsillaer absces. Forekomst af operationskraevende sygdom i tilbageblevne tonsil efter unilateral tonsillektomi à chaud

DEFF Research Database (Denmark)

Godballe, C; Sørensen, J A; Andersen, N H

1991-01-01

.3% of the patients under 30 years of age were readmitted for surgery on the remaining tonsil during the follow up period. Only 0.5% of the patients over 30 years were readmitted. Previous investigations have shown increasing frequency of pharyngitis after bilateral tonsillectomy. The present authors suggest...

67 Ambulatory Surgery: Current Status and Future Trends

African Journals Online (AJOL)

user

selected patients to hospital for a planned, non emergency, surgical procedure, returning home on the same day. Minor outpatient ... Some examples of the procedures of the basket are the following: • Hernia repair,. • Varicose vein surgery,. • Mastectomy,. • Cataract surgery,. • Tonsillectomy,. • Knee arthroscopy and ...

Causes, costs, and risk factors for unplanned return visits after adenotonsillectomy in children.

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Duval, Melanie; Wilkes, Jacob; Korgenski, Kent; Srivastava, Rajendu; Meier, Jeremy

2015-10-01

To review the causes, costs, and risk factors for unplanned return visits and readmissions after pediatric adenotonsillectomy (T&A). Review of administrative database of outpatient adenotonsillectomy performed at any facility within a vertically integrated health care system in the Intermountain West on children age 1-18 years old between 1998 and 2012. Data reviewed included demographic variables, diagnosis associated with return visit and costs associated with return visits. Data from 39,906 children aged 1-18 years old were reviewed. A total of 2499 (6.3%) children had unplanned return visits. The most common reasons for return visits were bleeding (2.3%), dehydration, (2.3%) and throat pain (1.2%). After multivariate analysis, the main risk factors for any type of return visits were Medicaid insurance (OR=1.64 95% CI 1.47-1.84), Hispanic race (OR=1.36 95% CI 1.13-1.64), and increased severity of illness (SOI) (OR=11.29 95% CI 2.69-47.4 for SOI=3). The only factor associated with increased odds of requiring an inpatient admission on return visit was length of time spent in PACU (prelationship was also observed between the child's age and the risk of post-tonsillectomy hemorrhage. Children with increased severity of illness, those insured with Medicaid, and children of Hispanic ethnicity should be targeted with increased education and interventions in order to reduce unplanned visits after T&A. Further studies on post-tonsillectomy complications should include evaluating the effect of surgical technique and post-operative pain management on all complications and not solely post-tonsillectomy hemorrhage. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Effect of topical sucralfate vs clindamycin on posttonsillectomy pain in children aged 6 to 12 years: a triple-blind randomized clinical trial.

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Jahanshahi, Javaneh; Pazira, Sara; Farahani, Farhad; Hashemian, Farnaz; Shokri, Narges; Karkhanei, Behruz; Poorolajal, Jalal

2014-08-01

Postoperative sore throat is one of the most common problems after tonsillectomy. Antibiotics remove the local flora and reduce inflammation and thus may reduce postoperative pain after tonsillectomy. To assess the effect of topical sucralfate and clindamycin on local pain reduction after tonsillectomy in children aged 6 to 12 years. Triple-blind randomized clinical trial of children aged 6 to 12 years with sleep apnea or snoring due to adenotonsillar hypertrophy and chronic airway obstruction or with chronic infections who were candidates for tonsillectomy at Besat Hospital, Hamadan University of Medical Sciences, from May to October 2013. Patients were randomly assigned to receive sucralfate mouthwash, clindamycin mouthwash, or placebo (cellulose). The oral cavity was washed before and immediately after surgery with 10 mL of the prepared solution for 1 minute and then suctioned. Then, 8 hours after surgery, the patients were asked to keep 10 mL of the prepared mouthwash solution in their mouths for 1 minute 3 times a day for 3 days. Postoperative sore throat evaluated daily for 5 days using the Faces Pain Scale-Revised. Of 110 patients enrolled, 101 patients remained for analysis. Patients in the placebo group had significantly higher mean (SD) throat pain scores than did patients in both drug groups on postsurgery days 1 through 4. Day 1 scores were 8.00 (1.84) for placebo and 6.00 (1.84) for sucralfate and 6.79 (1.87) for clindamycin (P = .001). Pain scores were not significantly different on day 5. Acetaminophen use was more common in the placebo group on days 3 and 4 (2.97 and 2.44) vs the sucralfate group (2.24 and 2.15) and the clindamycin group (2.36 and 2.12) (P = .001 and .02, respectively). Bleeding on day 1 was more common in the placebo group (3 of 34) vs none in the drug groups. Food intolerance on day 1 was less common in patients receiving sucralfate (2 of 34) than placebo (9 of 34) or clindamycin (11 of 33) (P = .02). There was no

Author Details

African Journals Online (AJOL)

Mulwafu, W. Vol 44, No 2 (2006) - Articles Adult tonsillectomy - are long waiting lists putting patients at risk? Abstract PDF · Vol 44, No 3 (2006) - Articles Suprahyoid approach to base-of-tongue squamus cell carcinoma. Abstract PDF · Vol 45, No 3 (2007) - Articles Emergency percutaneous tracheostomy. Abstract PDF · Vol ...

Overuse of preoperative laboratory coagulation testing and ABO blood typing: a French national study.

Science.gov (United States)

Beloeil, H; Ruchard, D; Drewniak, N; Molliex, S

2017-12-01

Following publication of guidelines on routine preoperative tests, the French Society of Anaesthesiology and Intensive Care (SFAR), in association with French national public health insurance, conducted a survey to evaluate adherence to guidelines and the economic consequences. Using the French Hospital Discharge Database and National Health Insurance Information system, tests performed during the 30 days before surgery were analysed for two situations: (1) standard laboratory coagulation tests and ABO blood typing in children able to walk and scheduled for tonsillectomy/adenoidectomy; and (2) ABO blood typing in adults before laparoscopic cholecystectomy, thyroidectomy, lumbar discectomy or breast surgery. Guidelines do not recommend any preoperative tests in these settings. Between 2013 and 2015, a coagulation test was performed in 49% of the 241 017 children who underwent tonsillectomy and 39% of the 133 790 children who underwent adenoidectomy. A similar pattern was observed for ABO blood typing although re-operation rates for bleeding on the first postoperative day were very low (0.12-0.31% for tonsillectomy and 0.01-0.02% for adenoidectomy). Between 2012 and 2015, ABO blood typing was performed in 32-45% of the 1 114 082 patients who underwent one of the four selected procedures. The transfusion rate was very low (0.02-0.31%). The mean cost for the four procedures over the 4 yr period was €5 310 000 (sd €325 000). Standard laboratory coagulation tests and ABO blood typing are still routinely prescribed before surgery and anaesthesia despite current guidelines. This over-prescription represents a high and unnecessary cost, and should therefore be addressed. © The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Plasma-mediated ablation for the management of obstructive sleep apnea

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Puchalski, Robert; Shah, Udayan K.

2000-05-01

Plasma-mediated ablation (PMA) removes tissue by developing an electrically induced plasma layer between the instrument and target tissue. Charged particles within the plasma field then accelerate toward the tissue, breaking the molecular bonds within the top layer of tissue. Thermal damage to collateral tissue is minimal, resulting in the moniker, 'cold' ablation, for this method. Recently, instrumentation has been developed to permit application for soft tissue resection in Otolaryngology. Presentation of the theory, as well as the benefits and disadvantages associated with CoblationTM technology will be followed by examples of its use. A brief videotape will demonstrate the application of PMA for UPPP, tonsillectomy and nasal turbinate reduction. Preliminary experience from our institution, including eighteen children treated with tonsillectomy and followed for at least one month post-operatively, has provided an initial cohort for comparing the risks and benefits of the approach. The advantage of CoblationTM technology identified thus far, that of less thermal damage, is balanced against a decreased level of hemostasis (compared to MES) and an increased cost.

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

Science.gov (United States)

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 attention (98.48 ± 8.74 versus 106.87 ± 8.58, P attention, and QoL of OSAHS children may be significantly improved after endoscopic adenoidectomy.

Post-tonsillectomy haemorrhage following traditional uvulectomy in ...

African Journals Online (AJOL)

routinely performed in children due to the traditional belief that an elongated uvula is responsible for all throat problems, including suffocation during sleep in the neonatal period. Occasionally, it is done during ethnic identification ritual practices.2 The commonest complications following this procedure include haemorrhage,.

The Hygiene Hypothesis and Breast Cancer: A Novel Application of an Etiologic Theory for Allergies, Asthma, and Other Immune Disorders

Science.gov (United States)

2009-05-01

splenectomy • Current consumption of fermented or probiotic foods (e.g., yogurt , kim chee) • Lifetime number of insect stings b. Translate...tonsillectomy, appendectomy, or splenectomy; current consumption of yogurt or kimchee; or number of lifetime insect stings. However, suggestively...21 5.56 27 7.14 p value 0.3708 Average number of days/month in last year reported eating yogurt None 108 28.57 109 28.76 1-5

Pathology Observed on Cone Beam Computed Tomographic Scans: A Comparison of Prevalence and Type of Incidental Findings for Child/Adolescents and Adults

Science.gov (United States)

2013-04-13

the radiation passed through the subject. For conventional CT , this value is called a Hounsfield unit (HU), named in the honor of Godfrey Hounsfield ...in the younger population, with the tonsillectomy being the second most common performed procedure among children in the United States (Clayburgh...concretions and tonsilloliths. Otolaryngol Clin North Am. 1987 May;20(2):305-9. 39. Reeves TE, Mah P, McDavid WD. Deriving Hounsfield units using grey

Granistron and dexamethasone provide more improved prevention of postoperative emesis than granisetron alone in children.

Science.gov (United States)

Fujii, Y; Tanaka, H; Toyooka, H

1996-12-01

Dexamethasone decreases chemotherapy-induced emesis when added to antiemetic regimens. This study was designed to compare the effectiveness of granisetron and dexamethasone with granisetron alone in the prevention of post-operative vomiting after strabismus repair, tonsillectomy with or without adenoidectomy in children. In a randomized, double-blind study, 60 healthy children, 4-10 yr of age, received either granisetron 40 micrograms.kg-1 and saline (Group S) or granisetron 40 micrograms.kg-1 and dexamethasone 4 mg (Group D) iv immediately after the induction of anaesthesia. All subjects received anaesthetics consisting of sevoflurane and nitrous oxide in oxygen Postoperative pain was treated with acetaminophen pr or pentazocine iv. Postoperatively, during the first 24 hr after anaesthesia, the frequencies of retching and vomiting, and the incidence of adverse events were recorded by nursing staff. There were no differences between the treatment groups with regard to demographics, surgical procedure, anaesthetic administered or analgesics used for postoperative pain. The frequency of the symptoms was 27% and 7% in Groups S and D, respectively (P < 0.05). The incidence of adverse events was comparable in the two groups. The prophylactic administration of granisetron and dexamethasone was more effective than granisetron alone in the prevention of postoperative vomiting in paediatric subjects undergoing strabismus repair, tonsillectomy and adenoidectomy.

Coblation in otolaryngology

Science.gov (United States)

Woloszko, Jean; Kwende, Martin; Stalder, Kenneth R.

2003-06-01

Coblation is a unique method of delivering radiofrequency energy to soft tissue for applications in Otolaryngology (ENT). Using radiofrequency in a bipolar mode with a conductive solution, such as saline. Coblation energizes the ions in the saline to form a localized plasma near the target tissue. The plasma has enough energy to dissociate water molecules from the saline, as well as ionizing the saline salt species, thus forming chemical conditions leading to the breaking of the tissue's molecular bonds. Energetic electrons in the plasma also possess enough energy to directly dissociate tissue chemical bonds. The overall effect results in tissue ablation and localized removal or reduction of tissue volume. The heat dissipated in the process, aided by continual cooling from the surrounding saline solution, produces tissue temperature raises of approximately 45 - 85°C, significantly lower than traditional radio-frequency techniques. Coblation has been used for Otolaryngological applications such as Uvulopalatopharyngoplasty (UPPP), tonsillectomy, turbinate reduction, palate reduction, base of tongue reduction and various Head and Neck cancer procedures. The decreased thermal effect of Coblation has led to less pain and faster recovery for cases where tissue is excised. Several clinical studies have shown the benefits of using Coblation for both extra and intra-capsular tonsillectomy.

Parents' experiences managing their child's complicated postoperative recovery.

Science.gov (United States)

Purcell, Mary; Longard, Julie; Chorney, Jill; Hong, Paul

2018-03-01

Tonsillectomy is commonly performed as same-day surgery and parents are heavily relied upon for management of children's postoperative recovery. The objective of this study was to provide an in-depth description of the experiences parents face when managing their child's complicated postoperative recoveries at home. An exploratory qualitative study at an academic pediatric hospital in Eastern Canada was performed. Participants included 12 parents of children aged 3-6 years who underwent adeno/tonsillectomy and experienced unexpected outcomes or complications during the postoperative recovery period. Parents participated in semi-structured interviews within 6 months of their child's surgery. Interviews were transcribed verbatim and thematic analysis was used to identify themes in the parents' experiences. Parents described struggling to make the decision to come back to hospital, that adequate information does not prevent emotional difficulties, and feeling somewhat responsible for the unexpected outcome or complicated course of recovery. Communication with healthcare providers was considered very important in helping with the recovery process. This research helps to inform healthcare professionals about how they might better support families during complicated recovery processes. Areas of action may include clear communication, setting expectations, and psychosocial support. Copyright © 2018 Elsevier B.V. All rights reserved.

Diagnostic Value of Histological and Microbiological Screening in Etiopathogenesis of Recurrent and Hypertrophic Tonsillitis

Directory of Open Access Journals (Sweden)

Uldis Viesturs

2006-12-01

Full Text Available Interest in the mechanisms and causes of recurrent tonsillitis is considerable. CD4+CD25+ T-lymphocytes have an important role in the maintenance of immunological tolerance. The aim of our research was to compare the diagnostic value of palatine tonsils histological and microbiological screening in patients with hypertrophic and recurrent tonsillitis. 14 patients with hypertrophic and 10 patients with chronic tonsillitis undergoing tonsillectomy were enrolled in the study. Rapid diagnosis of adenovirus, parainfluenza, influenza A and B, and respiratory syncytial virus infection was made before tonsillectomy by viral antigen detection using the immunofluorescence procedure from tonsils. Herpes simplex and cytomegaloviruses DNA were detected by the polymerase chain reaction. Samples for bacteriological studies were collected using a cotton swab. Immunohistochemical methods were used to evaluate S-100 and TGF-beta1 expression. The obtained results showed that patients with recurrent tonsillitis had less S-100 and TGF-beta1 positive cells in parafollicular regions compared to patients with hypertrophic tonsillitis. In both groups, tonsils were colonized predominantly by gram-positive microorganisms and adenovirus (36% of cases. However, in patients with recurrent tonsillitis, associations of gram-positive, gram-negative bacteria and viruses (40% of cases were observed. To conclude, recurrent tonsillitis is characterized by the breakdown of the immunological tolerance to oral microflora.

Unique migration of a dental needle into the parapharyngeal space: successful removal by an intraoral approach and simulation for tracking visibility in X-ray fluoroscopy.

Science.gov (United States)

Okumura, Yuri; Hidaka, Hiroshi; Seiji, Kazumasa; Nomura, Kazuhiro; Takata, Yusuke; Suzuki, Takahiro; Katori, Yukio

2015-02-01

The first objective was to describe a novel case of migration of a broken dental needle into the parapharyngeal space. The second was to address the importance of simulation elucidating visualization of such a thin needle under X-ray fluoroscopy. Clinical case records (including computed tomography [CT] and surgical approaches) were reviewed, and a simulation experiment using a head phantom was conducted using the same settings applied intraoperatively. A 36-year-old man was referred after failure to locate a broken 31-G dental needle. Computed tomography revealed migration of the needle into the parapharyngeal space. Intraoperative X-ray fluoroscopy failed to identify the needle, so a steel wire was applied as a reference during X-ray to locate the foreign body. The needle was successfully removed using an intraoral approach with tonsillectomy under surgical microscopy. The simulation showed that the dental needle was able to be identified only after applying an appropriate compensating filter, contrasting with the steel wire. Meticulous preoperative simulation regarding visual identification of dental needle foreign bodies is mandatory. Intraoperative radiography and an intraoral approach with tonsillectomy under surgical microscopy offer benefits for accessing the parapharyngeal space, specifically for cases medial to the great vessels. © The Author(s) 2014.

¿Sirven los estudios de variabilidad geográfica de la práctica para informar la desinversión?: Varias cautelas y algunas reflexiones Are studies of geographical variation in medical practice useful in guiding decisions on disinvestmant?: Some pros and cons

Directory of Open Access Journals (Sweden)

Enrique Bernal-Delgado

2013-02-01

technologies deemed of low-value. Studies of geographic variation in medical practice have been suggested to be useful in guiding decisions on disinvestment, as they may identify unwarranted variations in procedure-rates at the population level. This study aimed to determine the utility of these studies. Methods: We performed an ecologic study of variations in standardized rates in four "low-value" interventions: proctologic surgery, arthroplasty revision, incisional hernia repair and tonsillectomy. Variation across 199 healthcare areas within the Spanish national health system between 2002 and 2007 was studied by using the extremal quotient (EQ, the empirical Bayes statistic (EB and the standardized utilization ratio (SUR. Results: A total of 168,363 proctologic interventions, 41,066 arthroplasty revisions, 222,427 incisional hernia repairs, and 72,724 tonsillectomies were studied. The EQ ranged from a 3-fold variation in proctologic surgery to a 6.5-fold variation in tonsillectomy. The EB figures varied from moderate to high systematic variation: 0.12 in hernia repair and proctology, 0.20 in arthroplasty revision, and 0.30 in tonsillectomy. Twenty-five percent of the healthcare areas showed SUR figures above 1.24 in proctologic interventions, 1.25 in arthroplasty revision, 1.32 in hernia repair and 1.35 in tonsillectomy. Conclusions: The interventions studied showed moderate to high systematic variation, supporting the usefulness of variation studies in guiding disinvestment policies. Nevertheless, caution should be exercised when evaluating interventions with an uncertain risk-benefit ratio.

Post-tonsillectomy hemorrhage after bipolar diathermy vs. cold ...

African Journals Online (AJOL)

Material and Methods: This is a cross sectional study done in Alahsa city, eastern province, Saudi Arabia during the period from January 2014 to March 2015,This study reported the postoperative hemorrhage after Bipolar diathermy and Cold dissection surgical techniques to evaluate the incidence of the hemorrhage and to ...

Obstructive sleep apnea syndrome and growth failure.

Science.gov (United States)

Esteller, E; Villatoro, J C; Agüero, A; Lopez, R; Matiñó, E; Argemi, J; Girabent-Farrés, M

2018-05-01

Obstructive sleep apnea syndrome is a common problem among children and is recognized as a cause of significant medical morbidity. Since the 1980s, it has been suggested that obstructive sleep apnea syndrome is a risk factor for growth failure in children. In many cases, it has been shown that growth failure is reversible once the obstructive sleep apnea syndrome is resolved. The objectives of this study were to analyze and compare growth failure prevalence in a Mediterranean population of children with obstructive sleep apnea syndrome and healthy children matched in age and sex, and to assess the effectiveness of tonsillectomy and adenoidectomy in resolving growth retardation. We compared 172 children with obstructive sleep apnea syndrome (apnea-hypopnea index ≥ 3) who had undergone tonsillectomy and adenoidectomy with 172 healthy controls in terms of key anthropometric parameters. Most of the criteria used for growth failure were higher to a statistically significant degree in the study group vs the control group: height-for-age ≤ 3rd percentile (7.56% vs 2.91%; p = 0.044), weight-for-age ≤ 5th percentile (9.30% vs 2.33%; p = 0.005), weight-for-age ≤ 3rd percentile (8.14% vs 2.33%; p = 0.013) and height and/or weight for-age ≤ 5th percentile (13.95% vs 5.81%; p = 0.009). The height-for-age ≤ 5th percentile was almost at the limit of statistical significance (8.72% for the study group vs 4.65% for the control group; p = 0.097). At one-year post-surgery follow-up, 10 of 15 children with height-for-age ≤ 5th percentile had achieved catch-up growth (66.6%), and 14 of 24 children with height- and/or weight-for-age ≤ 5th percentile had normalized growth (58.33%). For children with failure to thrive or who have growth failure, physicians should consider the possibility of obstructive sleep apnea. A significant number of children with obstructive sleep apnea concurrent with growth failure could benefit from

The impact of recurrent throat infection on children and their families.

Science.gov (United States)

Howel, Denise; Webster, Simon; Hayes, Jane; Barton, Andrew; Donaldson, Liam

2002-06-01

Recurrent throat problems in children are common and have an impact on the family. The appropriateness of surgery will depend on both clinical and social factors. The aim of this study was to assess the impact on the whole family when a child is suffering from recurrent throat problems, and investigate related parental attitudes. A total of 1190 parents of children in northern England for whom tonsillectomy or adeno-tonsillectomy was a possible treatment option were sent a questionnaire covering social and clinical issues such as children's symptoms, the impact on family life and parental attitudes. The majority of children had experienced more than four episodes in the previous year, had their sleep affected and time off school. Most parents were worried and reported disruption to the family, including taking time off work and cross-infection. Parental disruption, worry and eagerness for surgery were significantly associated with the duration of episodes of throat problems and the number of episodes in the previous year, but not with duration of tonsillitis. Time off school, or parental time off work was significantly associated with parental worry and disruption, but not with eagerness for surgery. This work highlights the impact of recurrent throat problems and related parental attitudes, and will aid in striking a balance between clinical requirements and the needs and wishes of the family.

Anestesia para amigdalectomia em criança portadora de síndrome de Klippel-Feil associada à síndrome de down: Relato de caso Anestesia para amigdalectomía en niño portador de síndrome de Klippel-Feil asociado al síndrome de down: Relato de caso Anesthesia for tonsillectomy in a child with Klippel-Feil syndrome associated with down syndrome: Case report

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Magda Lourenço Fernandes

2010-06-01

discutir los cuidados para el abordaje de la vía aérea y los riesgos de la manipulación cervical en un paciente portador de síndrome de SKF y SD, sometido a la amigdalectomía. RELATO DEL CASO: Niño de cinco años, con diagnóstico previo de SKF, SD e inestabilidad de la articulación atlantocervical, que fue sometido a la amigdalectomía bajo anestesia general balanceada. La ventilación bajo máscara y la intubación traqueal fueron realizadas con la cabeza en posición neutra. La perfecta visualización de la epiglotis y de las cuerdas vocales, permitió la intubación traqueal con laringoscopia convencional. La cirugía también se hizo sin la extensión cervical, y transcurrió sin intercurrencias. CONCLUSIONES: Aunque el acceso a la vía aérea pueda ser fácil, las alteraciones anatómicas nos avisan que existe una vía aérea difícil en pacientes portadores de SKF y SD. Los cuidados diferenciados y los recursos adecuados son indispensables para evitar las complicaciones durante el abordaje de la vía aérea. La manipulación cervical debe ser evitada en presencia de una inestabilidad de la articulación atlanto-occipital, por el riesgo de lesión neurológica.BACKGROUND AND OBJECTIVES: Craniofacial abnormalities present in Klippel-Feil Syndrome (KFS and Down Syndrome (DS can hinder access to the airways. Oropharyngeal surgeries also require special attention with the airways. The association of both syndromes in a patient scheduled for tonsillectomy is a rare condition that imposes challenges to the anesthetic-surgical treatment. The objective of this report was to discuss the approach of the airways and the risks of cervical manipulation in a patient with KFS and DS undergoing tonsillectomy. CASE REPORT: This is a 5 years old child with diagnosis of KFS and DS and instability of the atlantoaxial joint who underwent tonsillectomy under general balanced anesthesia. Ventilation under face mask and tracheal intubation were done with the neck in the neutral

A Study to Develop a Case Mix Model for the Allocation of Impatient Workload for Silas B. Hays Army Community Hospital Fort Ord, California

Science.gov (United States)

1987-06-26

Development Research Department, World Bank, Washington, D.C. Evans, R.G. and H.D. Walker (1972). Information theory and the analysis of hospital cost...system. Medical Care 14: 185-201. Horn, S.D. and D.N. Schumacher (1979). An analysis of case mix complexity using information theory and diagnosis...REL UGT 459 HA 1 1.0 RETINAL PROCEDURES 0.7101 460 HA 3 1.0 OTHER DISORDERS OF JHE EYE AGE 0-17 0.4018 460 HB 7 2.4 T & A PROC EXCEPT TONSILLECTOMY

Profile ENT surgery in a pediatric hospital in Curitiba

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Mocellin, Marcos

2010-12-01

Full Text Available Introduction: ENT procedures are very common in the pediatric surgery and otolaryngologists have a wide range of surgical procedures, and adenotonsillectomy most performed procedure, followed by otological. The most common complication is bleeding from tonsillectomies. Despite being the most feared complication, only a minority of patients need surgical intervention to stop the bleed. Objective: To evaluate the surgical profile in hospital pediatric otolaryngology Curitiba. Method: Retrospective Study of registered surgeries. Results: A total 2020 procedures performed in the operating room in 2009, 9.26% (187 and tests were 90.74% (1833 surgeries, being 65.14% (1316 performed by the SUS,% 32.47 (656 by covenant and 2.39% (48 individuals. The gender distribution was 1106 boys and 914 girls. Adenoidectomy with or without tonsillectomy corresponded to 62.5% (1146. Of these, only 0.96% (11 underwent revision surgery center. In second place comes the otological surgery, with results of tympanostomy, with or without ventilation tube, the most prevalent. Conclusion: The otolaryngologists are able to perform various types of ENT surgical. A procedure most frequently performed in pediatric hospital in Little Prince is adenotonsillectomy, with revision rate similar to that reported in the literature. Boys are more subjected to procedures than girls. Most ENT procedures performed in this hospital in 2009 were performed by the SUS. This shows the importance of adenotonsillectomy in the daily practice of pediatric ENT, and the weight of this problem among users of SUS is great.

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

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Katarina Šakić

2009-02-01

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

The comparison of preincisional peritonsillar infiltration of ketamine and tramadol for postoperative pain relief on children following adenotonsillectomy.

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Ugur, Kadriye Serife; Karabayirli, Safinaz; Demircioğlu, Rüveyda İrem; Ark, Nebil; Kurtaran, Hanifi; Muslu, Bunyamin; Sert, Hüseyin

2013-11-01

To investigate and compare the effectiveness of preincisional peritonsillar infiltration of ketamine and tramadol for post-operative pain on children following adenotonsillectomy. Prospective randomized double blind controlled study. Seventy-five children aged 3-10 years undergoing adenotonsillectomy were included in study. Patients received injections in peritonsillar fossa of tramadol (2 mg/kg-2 ml), ketamine (0.5 mg/kg-2 ml) or 2 ml serum physiologic. During operation heart rate, oxygen saturation, average mean blood pressures were recorded in every 5 min. Operation, anesthesia and the time that Alderete scores 9-10, patient satisfaction, analgesic requirements were recorded. Postoperatively nausea, vomiting, sedation, dysphagia, bleeding scores were recorded at 0, 10, 30, 60 min and 2, 4, 8, 12, 18, 24h postoperatively. Pain was evaluated using modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) at fixed intervals after the procedure (15 min and 1, 4, 12, 16, and 24h postoperatively). The recordings of heart rate, mean arterial pressure, nausea, vomiting, sedation and bleeding scores were similar in all groups (p>0.05). The mCHEOPS scores at 10 min, 30 min, 1h, 8h were significantly lower in both tramadol and ketamine group when compared with control (p0.05). Preincisional injection of ketamine and tramadol prior to tonsillectomy is safe, effective method and equivalent for post-tonsillectomy pain, patient satisfaction, postoperative nausea, vomiting, dysphagia. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Treatment selection for tonsillar squamous cell carcinoma

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Yao-Yuan Kuo

2013-04-01

Conclusion: Both primary surgery and RT/CRT organ preservation are effective treatments for tonsillar SCC. Single modality treatment, either surgery or RT/CRT, can typically be provided for stage I–II diseases. Although RT/CRT organ preservation is used more frequently for stage III–IV tonsillar SCC in recent years, primary surgery combined with adjuvant therapy still achieves equivalent outcomes. Multidisciplinary pretreatment counseling and the facilities and personnel available are therefore important for decision-making. In addition, if RT/CRT organ preservation is selected as the primary treatment, tumor tonsillectomy is not indicated.

Palatine Tonsils Asymmetry: 10 Years Experience of the Otorhinolaryngology Service of the Clinical Hospital of the Federal University of Paraná

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Ballin, Annelyse Cristine

2011-01-01

Full Text Available Introduction: A few patients with asymmetric palatine tonsils have lymphoma; but most lymphomas in palatine tonsils evolve with tonsillar asymmetry. Objective: To report the profile of patients and histopathological changes in patients submitted to adenotonsillectomy/tonsillectomy with disproportional palatine tonsils. Method: Retrospective study based on data analysis from the Pathologic Anatomy Service Database and in the review of reports of patients submitted to adenotonsillectomy and tonsillectomy with palatine tonsils asymmetry during the period from October 1999 through October 2009 at the Clinical Hospital (HC of the Federal University of Paraná (UFPR. Results: 50 patients took part, aged between 3 to 53 years old, mean age of 14.05 years. The anatomopathological exam confirmed 48 patients (96% with lymphoid hyperplasia and 2 cases of lymphoma (4%. These included men aged from 40 to 53 yeas with complaint of unilateral increase of the tonsil, one of whom had other symptoms (asthenia and weight loss. Upon physical examination: tonsils disproportion without involvement of other organs or lymph nodes. Conclusion: Our study is according to the literature as regards the fact the lymphomas are more common in men, the patient is the first one to notice the increase in volume and the asymmetry is larger than 2 degrees between palatine tonsils in cases of lymphoma. Although it is rare, even in the presence of differences, there are chances for the asymmetry to evolve to a malignant profile. The need for anatomopathological evaluation of a part must be considered along with other clinical data that suggests a malignant profile.

Prevalence of pressure equalization tube placement and hearing loss in children with down syndrome.

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Bernardi, Gisele F; Pires, Carolina T F; Oliveira, Nanci P; Nisihara, Renato

2017-07-01

To determine the prevalence of pressure equalization tube (PET) placement and hearing loss in children with Down syndrome (DS). We evaluated 90 DS children births between 1 and 11 years old and compared to 90 children without DS paired in sex and age. Medical records were analyzed consecutively. Were collected data about proceedings PET placement, age of the patient at each PET, adenoidectomy, tonsillectomy and results for audiometry and tympanometry. Among the 90 patients with DS, 49 (54.4%) were male, median age of 58 months (15-143 months). In this group, 75 PET were placed in 26/90 children (28.9%) mostly between 3 and 5 years old. In 10/26 (38.5%) was necessary PET replaced. When compared to the control group- 6/90 (6.7%)- children with DS presented OR = 13.7 (95% CI 4.0-47.3) times more likely to use PET. Adenoidectomy and tonsillectomy (44.4% and 42.2% respectively) were significantly more frequent in DS group. The prevalence of hearing loss was 32.1% in the right ear and 26.9% in the left ear. Type B timpanometry was found in more than half of the patients with DS. We found a 13-fold higher risk of PET in DS children, especially between the ages of 3-5 years. The high prevalence of hearing loss and PET placement in patients with DS reinforcing the importance of early and regular follow-up for hearing screening in this population, mostly in preschool-aged children. Copyright © 2017. Published by Elsevier B.V.

Topical sucralfate in post-adenotonsillectomy analgesia in children: a double-blind randomized clinical trial.

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Miura, Mauricio Schreiner; Saleh, Catia; de Andrade, Marina; Assmann, Melina; Ayres, Marcio; Lubianca Neto, José Faibes

2009-09-01

Tonsillectomy, with or without adenoidectomy, is one of the most common surgical procedures in pediatric otolaryngology. Despite its relative simplicity, pain is the main cause of morbidity in the postoperative period. We determined the effect of topical sucralfate on reduction of oropharyngeal pain in children submitted to adenotonsillectomy. Secondary outcomes were otalgia, analgesic use, type of diet, secondary bleeding, vomiting, fever, and weight loss. Double-blind, randomized clinical trial. Tertiary hospital. Eighty-two children of both sexes between four and 12 years old submitted to adenotonsillectomy were evaluated. They were allocated to receive topical sucralfate or placebo in intraoperative and postoperative periods four times a day for five days. Pain was measured through faces pain scale. Reduction in oropharyngeal pain was significant with use of sucralfate during five days of evaluation (mean, 95% confidence interval, and P value); day 1: 2.05, 1.53-2.58, P = 0.000; day 2: 2.1, 1.51-2.70, P = 0.001; day 3: 1.44, 0.88-1.99, P = 0.003; day 4: 1.13, 0.58-1.55, P = 0.027; day 5: 0.67, 0.26-1.04, P = 0.021). There was no difference in secondary outcomes. We found beneficial effect of use of sucralfate in reduction of oropharyngeal pain in the postoperative period of adenotonsillectomy. However, topical sucralfate does not have a potent effect to the point of being utilized as a single analgesic treatment. Because it is simple, safe, tolerated, and low-cost, it is an important tool as adjuvant treatment of post-tonsillectomy pain.

A prospective study of blood splatter in ENT.

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Lakhani, Raj; Loh, Yiwen; Zhang, Ting Ting; Kothari, Prasad

2015-07-01

Surgeons face an occupational risk of daily exposure to blood and body fluids. Potential sources of infection include sharps injuries and mucocutaneous contact. The transmission of blood-borne viruses, in particular human immunodeficiency virus (HIV), Hepatitis B and Hepatitis C from the patient to healthcare workers is well documented in the literature. We studied the incidence and degree of blood splash in all otolaryngology (ENT) procedures undertaken in a single unit over a 12 week period. In addition, we investigated which intraoperative factors might predict the degree of splash. We undertook a prospective, non-blinded study of 102 patients undergoing a range of 'routine' elective ENT within one department over 12 weeks. A surgical mask with visor attached was worn in all procedures. Following each procedure, all splatter masks were collected and examined macroscopically and microscopically for blood splash. In addition, the procedure performed, technique used, total blood loss, operating time and grade of surgeon was noted. 54% of procedures resulted in splash mask contamination. The median number of splash spots per mask was 4.7 (range 0-63). Tonsillectomy was the most commonly performed procedure, accounting for over one-third of total procedures investigated. Each mask had an average of 8.2 splash marks. Tonsillectomy had a splash rate of 76.9%. Although the risk of developing HIV is low the operating surgeon has a duty to take all precautions to protect themselves during a procedure and therefore a protective mask and visor or suitable goggles must be worn.

Primary immunization-like response without hepatitis following transfusion of HBeAg-positive blood

DEFF Research Database (Denmark)

Gluud, C; Aldershvile, J; Kryger, P

1983-01-01

An accidental transfusion of hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) positive whole blood was given to a 19-yr-old male, bleeding after tonsillectomy. Serum obtained from the patient before the transfusion revealed no hepatitis B antigens or antibodies. After...... the transfusion the patient became HBsAg-positive, cleared this antigen and developed antibodies to both HBsAg and HBeAg. The transfusion blood was positive for total antibody and IgM antibody to hepatitis B core antigen (HBcAg). The patient's blood became positive for these antibodies after the transfusion...

The Glasgow Benefit Inventory: a systematic review of the use and value of an otorhinolaryngological generic patient-recorded outcome measure

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Hendry, J.; Chin, A.; Swan, I.R.C.; Akeroyd, M.A.; Browning, G.G.

2018-01-01

Background The Glasgow Benefit Inventory (GBI) is a validated, generic patient-recorded outcome measure widely used in otolaryngology to report change in quality of life post-intervention. Objectives of review To date, no systematic review has made (i) a quality assessment of reporting of Glasgow Benefit Inventory outcomes; (ii) a comparison between Glasgow Benefit Inventory outcomes for different interventions and objectives; (iii) an evaluation of subscales in describing the area of benefit; (iv) commented on its value in clinical practice and research. Type of review Systematic review. Search strategy ‘Glasgow Benefit Inventory’ and ‘GBI’ were used as keywords to search for published, unpublished and ongoing trials in PubMed, EMBASE, CINAHL and Google in addition to an ISI citation search for the original validating Glasgow Benefit Inventory paper between 1996 and January 2015. Evaluation method Papers were assessed for study type and quality graded by a predesigned scale, by two authors independently. Papers with sufficient quality Glasgow Benefit Inventory data were identified for statistical comparisons. Papers with 50% and gave sufficient Glasgow Benefit Inventory total and subscales for meta-analysis. For five of the 11 operation categories (vestibular schwannoma, tonsillectomy, cochlear implant, middle ear implant and stapes surgery) that were most likely to have a single clear clinical objective, score data had low-to-moderate heterogeneity. The value in the Glasgow Benefit Inventory having both positive and negative scores was shown by an overall negative score for the management of vestibular schwannoma. The other six operations gave considerable heterogeneity with rhinoplasty and septoplasty giving the greatest percentages (98% and 99%) most likely because of the considerable variations in patient selection. The data from these operations should not be used for comparative purposes. Five papers also reported the number of patients that had no

Pediatric Price Transparency: Still Opaque With Opportunities for Improvement.

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Faherty, Laura J; Wong, Charlene A; Feingold, Jordyn; Li, Joan; Town, Robert; Fieldston, Evan; Werner, Rachel M

2017-10-01

Price transparency is gaining importance as families' portion of health care costs rise. We describe (1) online price transparency data for pediatric care on children's hospital Web sites and state-based price transparency Web sites, and (2) the consumer experience of obtaining an out-of-pocket estimate from children's hospitals for a common procedure. From 2015 to 2016, we audited 45 children's hospital Web sites and 38 state-based price transparency Web sites, describing availability and characteristics of health care prices and personalized cost estimate tools. Using secret shopper methodology, we called children's hospitals and submitted online estimate requests posing as a self-paying family requesting an out-of-pocket estimate for a tonsillectomy-adenoidectomy. Eight children's hospital Web sites (18%) listed prices. Twelve (27%) provided personalized cost estimate tool (online form n = 5 and/or phone number n = 9). All 9 hospitals with a phone number for estimates provided the estimated patient liability for a tonsillectomy-adenoidectomy (mean $6008, range $2622-$9840). Of the remaining 36 hospitals without a dedicated price estimate phone number, 21 (58%) provided estimates (mean $7144, range $1200-$15 360). Two of 4 hospitals with online forms provided estimates. Fifteen (39%) state-based Web sites distinguished between prices for pediatric and adult care. One had a personalized cost estimate tool. Meaningful prices for pediatric care were not widely available online through children's hospital or state-based price transparency Web sites. A phone line or online form for price estimates were effective strategies for hospitals to provide out-of-pocket price information. Opportunities exist to improve pediatric price transparency. Copyright © 2017 by the American Academy of Pediatrics.

Intracellular persisting Staphylococcus aureus is the major pathogen in recurrent tonsillitis.

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Andreas E Zautner

Full Text Available BACKGROUND: The two major indications for tonsillectomy are recurrent tonsillitis (RT and peritonsillar abscess (PTA. Unlike PTAs, which are primarily treated surgically, RT is often cured by tonsillectomy only after a series of failed drug therapy attempts. Although the bacteriological background of RT has been studied, the reason for the lack of success of conservative therapeutic approaches is not well understood. METHODS: In a prospective study, tonsil specimens from 130 RT patients and 124 PTA patients were examined for the presence of extra- and intracellular bacteria using antibiotic protection assays. Staphylococcus aureus isolates from RT patients were characterized by pulsed-field gel electrophoresis (PFGE, spa-typing and MSCRAMM-gene-PCR. Their ability for biofilm formation was tested and their cell invasiveness was confirmed by a flow cytometric invasion assay (FACS, fluorescent in situ hybridization (FISH and immunohistochemistry. FINDINGS: S. aureus was the predominant species (57.7% in RT patients, whereas Streptococcus pyogenes was most prevalent (20.2% in PTA patients. Three different assays (FACS, FISH, antibiotic protection assay showed that nearly all RT-associated S. aureus strains were located inside tonsillar cells. Correspondingly, the results of the MSCRAMM-gene-PCRs confirmed that 87% of these S. aureus isolates were invasive strains and not mere colonizers. Based upon PFGE analyses of genomic DNA and on spa-gene typing the vast majority of the S. aureus isolates belonged to different clonal lineages. CONCLUSIONS: Our results demonstrate that intracellular residing S. aureus is the most common cause of RT and indicate that S. aureus uses this location to survive the effects of antibiotics and the host immune response. A German translation of the Abstract is provided as supplementary material (Abstract S1.

Recurrence and graft loss after renal transplantation in adults with IgA vasculitis.

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Kawabe, Mayuko; Yamamoto, Izumi; Komatsuzaki, Yo; Yamakawa, Takafumi; Katsumata, Haruki; Katsuma, Ai; Mafune, Aki; Nakada, Yasuyuki; Kobayashi, Akimitsu; Tanno, Yudo; Ohkido, Ichiro; Tsuboi, Nobuo; Yokoyama, Keitaro; Horita, Shigeru; Okumi, Masayoshi; Ishida, Hideki; Yamamoto, Hiroyasu; Yokoo, Takashi; Tanabe, Kazunari

2017-08-01

IgA vasculitis, a rare condition resulting in end-stage renal disease, is a small-vessel vasculitis that affects the kidney in 49-83 % of adults. The reported recurrence rate of IgA vasculitis in renal transplant recipients is 11.5-60 %, leading to graft loss in 0-50 % of these patients. However, limited data are available on recurrence and graft loss after renal transplantation. We evaluated renal transplant recipients seen from 1987 to 2015 at the Jikei University School of Medicine and the Department of Urology, Tokyo Women's Medical University. Using a 1:2 match, 21 patients with IgA vasculitis and 42 controls were selected. The mean post-transplant follow-up was 121 ± 69 months for IgA vasculitis and 147 ± 66 months for the controls. The 15-year patient survival was 100 % in IgA vasculitis and 97.6 % in the controls (p = 0.22). The 5-, 10-, and 15-year graft survival rates were 95.2, 90.5, and 81 % in IgA vasculitis and 100, 90.5, and 88.1 % in the controls, respectively (p = 0.63). The recurrence rate was 28.6 % (6 of 21 cases) and half of them (3 of 6 cases) showed histological activity (ISKDC III). We treated them with methylprednisolone pulse therapy and/or tonsillectomy. None of the recurrence cases lost the allograft. The long-term patient and graft survival of IgA vasculitis in renal transplantation were comparable with the previous reports. The recurrence rate was 28.6 %, but none of the recurrent cases showed allograft loss in this study. We speculate that methylprednisolone pulse therapy and/or tonsillectomy prevent the progression of recurrent IgA vasculitis.

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

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Fathollah Behnoud

2010-10-01

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

[The efficacy of tympanopunction in children with OMS].

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Jezewska, Elzbieta; Kukwa, Andrzej; Jabłońska, Joanna; Wozniak, Monika

2008-01-01

Otitis media with effusion is the most frequent cause of conductive hearing impairement (HL) at pediatric age. This entity can be asymptomatic for an important period of time (silent OME). There is a surgical and a nonsurgical approach for OME. In case of failure of conservative treatment of OME the ventilation tube insertion (VT) with adenoidectomy alone or combined with tonsillectomy should be choosed. If the hearing loss is less than 20 dB children are candidates for conservative treatment and myringotomy. From 1999 to 2003, 50 children with bilateral and 9 with unilateral OME underwent the surgical treatment in our ENT Department. Mean age of patient population was 6,8 years. Clinical evaluation of the OME treatment outcome was done in 2004. Surgical procedure involved myringotomy, aspiration of the middle ear effusion, middle ear irrigation with soline solution 0.9 % Sodium Chloride (NaCl) followed by suction of diluted glue. Depo-Medrol (methylprednisolone acetate) was administrated into the middle ear. Our procedure included the management of the upper airways obstruction. Good long-term outcomes after surgical treatment of OME were obtained in 30 patients (79%). In this group of children the upper airways management included adenoidectomy and partial tonsillectomy. 8 children presented poor response to the treatment. In this group the surgical procedure consisted of adenoidectomy and inferior turbinate reduction. Two children presented acute otitis media and improved after conservative treatment. Other children with poor outcome were: a boy who underwent multiple surgical procedures due to laryngotracheal stenosis, a girl who suffered from chondrodysplasia. Remaining two patients presented few months ago aggravation of conductive hearing loss. According to positive familial history they underwent allergical examinations. One boy was planned for readenoidectomy and laser myringotomy, a girl already operated at the age of tree years, was planned for

Lymphangiomatous Polyp of Tonsil: A Case Report.

Science.gov (United States)

Sayar, Hamide; Sayar, Çağdaş; Adamhasan, Fulya; Uğuz, Aysun

2016-01-01

Lymphangiomatous polyps of the palatine tonsils are uncommon hamartomatous proliferations that could be clinically misdiagnosed as malignant neoplasms. These polyps consist of dilated lymphatic vessels located inside fibrous and/or adipose tissue. In this paper, a 27-year-old man who presented to the outpatient clinic with a complaint of dysphagia is presented. On physical examination, the patient had a smooth, polypoid mass extending from the posterior section of the right palatine tonsil into the oropharynx. The patient underwent right tonsillectomy. Histopathological examination of the specimen showed typical features of a lymphangiomatous polyp of the tonsil. The case is reported with the accompanying literature to avoid the possibility of misdiagnosing it as a malignant lesion clinically.

Management of avulsed permanent maxillary central incisors during endotracheal intubation

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Ritesh R Kalaskar

2016-01-01

Full Text Available Avulsion is serious injury that may encounter during endotracheal intubation and its management often presents a challenge. Replantation of the avulsed tooth can restore esthetic appearance and occlusal function shortly after the injury. The present article describes the management of air-dried maxillary permanent incisors that have been avulsed due to direct laryngoscopy during the induction of general anesthesia for tonsillectomy procedure. The replanted maxillary central incisors had maintained its function and esthetic for 1 year after replantation. Children in a mixed dentition phase are high-risk group children for traumatic dental injury during laryngoscopy; therefore, Anesthetic Departments should have local protocols to refer patients for dental treatment postoperatively in the event of trauma.

A radical proposition: the brief but exceptional history of the Seattle school clinic, 1914-21.

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Woolworth, Stephen

2013-04-01

This article examines the history of the Seattle school clinic (1914-21) and the efforts of public school administrators to institutionalize a full-service medical program for poor and working class children. At its height, thirty-six volunteer physicians and thirteen partially paid dentists organized within nine departments performed a range of diagnostic and "corrective" surgical procedures, including tonsillectomies, circumcisions, and eye surgeries. These practices were not funded by other public school systems across the United States, almost all of which delineated between prevention and treatment services. This article explains the exceptional nature of the clinic, examines the institutional tensions instigated by the expression of medical authority within the schools, and considers how clinic technologies influenced state-school-child relations.

Sleep-disordered breathing and its management in children with achondroplasia.

Science.gov (United States)

Tenconi, Rossana; Khirani, Sonia; Amaddeo, Alessandro; Michot, Caroline; Baujat, Geneviève; Couloigner, Vincent; De Sanctis, Livio; James, Syril; Zerah, Michel; Cormier-Daire, Valérie; Fauroux, Brigitte

2017-04-01

Sleep-disordered breathing is a common feature in children with achondroplasia. The aim of our study was to review the poly(somno)graphic (P(S)G) findings and consequent treatments in children with achondroplasia followed in the national reference center for skeletal dysplasia. A retrospective review of the clinical charts and P(S)G of 43 consecutive children (mean age 3.9 ± 3.5 years) with achondroplasia seen over a period of 2 years was performed. Twenty four (59%) children had obstructive sleep apnea (OSA). Thirteen children had an obstructive apnea-hypopnea index (OAHI) achondroplasia. The observation of a reduced prevalence of OSA after (adeno-)tonsillectomy is in favor of this type of surgery when possible. © 2017 Wiley Periodicals, Inc.

Stylocarotid syndrome: A case report

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Petrović Branko

2008-01-01

Full Text Available INTRODUCTION The American otolaryngologist Eagle was the first to describe styloid syndrome in 1937 and the syndrome was named after him (Eagle's syndrome. The original description of two separate syndromes is connected with his name: classical syndrome, which almost constantly occurs after tonsillectomy and carotid artery syndrome, which occurs without tonsillectomy and also in cases when stylohyoid complex compresses the carotid segments and perivascular sympathetic fibers. In the following years, two more syndromes were defined: stylohyoid and pseudostylohyoid, which according to their manifestations, correspond to the genuine classical form. CASE OUTLINE A 40-year old male is presented, with a history of 3-year duration of pains in the upper part of the left side of the neck, in the left eye and its surroundings. Pain occurrences were not regular. Throbbing pains were most often provoked by sudden head movements and neck compression. He was healthy until the onset of these problems. The findings of all examinations were normal. The applied prophylactic therapy, typical for cluster headache, was without any effect. On 64-MSCT (multislice computed tomography, the neck arteries did not show any intraluminal pathology. The styloid processes were of normal length. On the left side, the styloid process tip pressed the internal carotid artery disturbing its longitudinal axis. CONCLUSION In our presentation, the defined lengths of the styloid processes were normal. The medial angulation of the left styloid process was more expressed reaching 63.5 degrees (the right side angulation was normal. Persistent and throbbing pain in the region of the left eye with backward projection suggested compression on the internal carotid artery. Pains were most frequently provoked by head turning and neck compression. 64-MSCT diagnostics enabled us to determine the characteristics of styloid processes and their relation to the internal carotid artery. Improvement

Synovial Sarcoma of the Palatine Tonsil:Report of Two Cases and Review of theLiterature

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Negar Azarpira

2010-07-01

Full Text Available Here, we describe young men with synovial sarcoma in the palatine tonsil, who presented with a 3-4 month history of progressive sore throat, tonsillar ulcerativemass and bleeding. Clinical and radiological examinations revealed that the tumors arose from the palatine tonsil and extended to the parapharyngeal space. Both tumors were too advanced to remove completely; therefore, they underwent surgical debulking during tonsillectomy and partial pharyngectomy. Histopathological and immunohistochem-ical studies confirmed the diagnosis of synovial sarcoma of the palatine tonsil. Despite postoperative radiotherapy and systemic chemotherapy, they relapsed 18 and 22 months later. The first patient died from unresectable local recurrent disease three years after primary diagnosis, and the second patient is alive after 36 months, but suffers from unresectable locoregional recurrent disease and is receiving palliative chemotherapy and supportive care.

Non-Hodgkin lymphoma presenting as bilateral tonsillar hypertrophy: case report.

LENUS (Irish Health Repository)

Khan, Sardar U

2012-02-01

We describe the case of a 57-year-old man who was referred to us with persistent sore throat, dysphagia, and enlarged tonsils. He had not responded to earlier treatment with antibiotic therapy and other routine measures. In view of the persistent nature of the patient\\'s symptoms and the tonsillar hypertrophy, we decided to perform a tonsillectomy and to send the excised specimens for pathologic analysis. Histologic evaluation identified non-Hodgkin lymphoma in both tonsils. The patient was treated with postoperative chemo- and radiotherapy, and he was free of symptoms during 18 months of follow-up. To the best of our knowledge, only 4 cases of bilateral non-Hodgkin lymphoma of the tonsils have been reported in the English-language literature. We also discuss the importance of histologic analysis of excised tonsil tissue in selected cases.

Peritonsillar abscess: clinical aspects of microbiology, risk factors, and the association with parapharyngeal abscess.

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Klug, Tejs Ehlers

2017-03-01

PTA is a collection of pus located between the tonsillar capsule and the pharyngeal constrictor muscle. It is considered a complication of acute tonsillitis and is the most prevalent deep neck infection (approximately 2000 cases annually in Denmark) and cause of acute admission to Danish ENT departments. Teenagers and young adults are most commonly affected and males may predominate over females. However, no studies of age- and gender-stratified incidence rates have previously been published. Furthermore, smoking may be associated with increased risk of peritonsillar abscess (PTA) development, although the magnitude of the association has not been estimated. Complications are relatively rare. They include parapharyngeal abscess (PPA), upper airway obstruction, Lemierre´s syndrome, necrotizing fasciitis, mediastinitis, erosion of the internal carotid artery, brain abscess, and streptococcal toxic shock syndrome. The treatment consists of abscess drainage and antimicrobial therapy. There are three accepted methods of surgical intervension: needle aspiration, incision and drainage (ID), and acute tonsillectomy (á chaud). Internationally, there is a strong trend towards less invasive surgical approach to PTA treatment with avoidance of acute tonsillectomy, needle aspiration instead of ID, and in some cases even antibiotic treatment without surgical drainage. The preferred antibiotic regimen varies greatly between countries and centers. Group A streptococcus (GAS) is the only established pathogen in PTA. However, GAS is only recovered from approximately 20% of PTA patients. The pathogens in the remaining 80% are unknown. Culturing of PTA pus aspirates often yields a polymicrobial mixture of aerobes and anaerobes. As the tonsils of healthy individuals are already heavily and diversely colonized, the identification of significant pathogens is challenging. In addition, when studying PTA microbiology, one must consider diagnostic precision, collection, handling, and

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

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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

Current demand of paediatric otolaryngology input for children with Down's syndrome in a tertiary referral centre.

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Khalid-Raja, M; Tzifa, K

2016-11-01

This study aimed to evaluate the activity of paediatric otolaryngology services required for children with Down's syndrome in a tertiary referral centre. A review of the paediatric otolaryngology input for children with Down's syndrome was performed; data were obtained from the coding department for a two-year period and compared with other surgical specialties. Between June 2011 and May 2013, 106 otolaryngology procedures were performed on children with Down's syndrome. This compared to 87 cardiac and 81 general paediatrics cases. The most common pathologies in children with Down's syndrome were obstructive sleep apnoea, otitis media, hearing loss and cardiac disease. The most common otolaryngology procedures performed were adenoidectomy, tonsillectomy, grommet insertion and bone-anchored hearing aid implant surgery. ENT manifestations of Down's syndrome are common. Greater provisions need to be made to streamline the otolaryngology services for children and improve transition of care to adult services.

Aerobic and Anaerobic Bacterial Isolates on the Surface and Core of Tonsils from Patients with Chronic Tonsillitis

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Meera Niranjan Khadilkar

2017-08-01

Full Text Available Introduction Controversy regarding treatment of tonsillitis based on throat culture report still persists. If surface culture is a determinant of bacteriology of the core, then rational therapy could be aimed at organisms cultured by surface swab. Materials and Methods A Cross-sectional study was conducted on 100 patients of chronic tonsillitis who underwent tonsillectomy. Tonsil surface and core swabs were studied for aerobic and anaerobic growth. Result Eighty seven percent patients had aerobic growth on tonsil surface and ninety percent in tonsil core. Staphylococcus aureus was the commonest aerobic bacteria isolated. Anaerobic growth was present in 47% patients on tonsil surface, and 48% in core. Porphyromonas sp. was the commonest anaerobic bacterium isolated. Discussion There was no statistically significant difference between aerobic and anaerobic bacteria found in tonsil surface and core.  Conclusion Throat swabs adequately represent core pathogen, and are dependable in detecting bacteriology of chronic tonsillitis.

Bilateral Peritonsillar Abscesses: A Case Presentation and Review of the Current Literature with regard to the Controversies in Diagnosis and Treatment

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G. X. Papacharalampous

2011-01-01

Full Text Available Although unilateral peritonsillar abscess is a common complication of acute bacterial tonsillitis, bilateral peritonsillar abscesses are quite rare. The incidence of unsuspected contralateral peritonsillar abscess identified at tonsillectomy has been reported to be between 1.9% and 24%, while the overall incidence of bilateral peritonsillar abscess is reported to reach 4.9%. Diagnosis can be based on clinical criteria or imaging techniques. As far as the treatment is concerned, it is generally accepted that the basic strategy consists of systemic antibiotics and drainage of the pus. We report the case of a 19-year-old girl, treated in the emergency room with a bilateral diagnostic needle aspiration followed by bilateral incision and drainage along with intravenous clindamycin plus anti-inflammatory agents and hydration. Following treatment, the patient progressively experienced a marked alleviation of her odynophagia. She was discharged 48 hours later on a 10-day course of clindamycin.

Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children

NARCIS (Netherlands)

Venekamp, Roderick P; Hearne, Benjamin J; Chandrasekharan, Deepak; Blackshaw, Helen; Lim, Jerome; Schilder, Anne G M

2015-01-01

BACKGROUND: Obstructive sleep-disordered breathing (oSDB) is a condition that encompasses breathing problems when asleep, due to an obstruction of the upper airways, ranging in severity from simple snoring to obstructive sleep apnoea syndrome (OSAS). It affects both children and adults. In children,

What Is PFAPA and Why Does it Matter?

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Dennis J. Baumgardner

2014-11-01

Full Text Available PFAPA, the syndrome of periodic fever, aphthous stomatitis, pharyngitis and cervical lymphadentitis, is an uncommon disease of episodic immune dysregulation that usually begins in early childhood. Symptoms occur at regular, predictable intervals, with healthy periods in between, and generally include the namesake signs and various other constitutional symptoms such as fever and fatigue. The etiology is unknown and there is no definitive diagnostic test or treatment. Uncertainty during the period of searching for a diagnosis may be disconcerting to the family and the clinician. Single-dose prednisone is effective for resolving the fever of PFAPA episodes within just a few hours, but it does not prevent further episodes. Tonsillectomy is an effective surgical option; however, PFAPA often spontaneously resolves or episodes get less intense and less frequent with age. Febrile PFAPA episodes are an area of active research and may involve environmentally triggered inappropriate interleukin-1 and complement activation leading to chemokine release and trapping of activated T-cells in peripheral tissue.

May 2018 imaging case of the month

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Gotway MB

2018-05-01

Full Text Available No abstract available. Article truncated at 150 words. Clinical History: A 79-year-old man with a past medical history significant for mild, intermittent asthma since childhood and mild aortic stenosis presents to the Emergency Room with fevers and chills for 5 days, associated with dry cough and dyspnea on exertion. His past medical history was otherwise relatively unremarkable, with coronary artery disease as evidenced by coronary artery calcium at a calcium scoring CT, hypothyroidism, and dyslipidemia. The patient has allergies to dust and penicillin, and his only medications included thyroid replacement, aspirin, and an albuterol inhaler as needed. He was a 15-pack-year smoker, quitting 30 years ago. His past surgical history was remarkable only for tonsillectomy, inguinal hernia repair, meniscal repair, and sigmoid colon resection for diverticular abscess 14 years earlier. The patient was afebrile, his heart rate was 96 beats / minute and regular, decreased breath sounds at the lung bases was noted, and the white blood cell …

Snippets from the past: the evolution of Wade Hampton Frost's epidemiology as viewed from the American Journal of Hygiene/Epidemiology.

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Morabia, Alfredo

2013-10-01

Wade Hampton Frost, who was a Professor of Epidemiology at Johns Hopkins University from 1919 to 1938, spurred the development of epidemiologic methods. His 6 publications in the American Journal of Hygiene, which later became the American Journal of Epidemiology, comprise a 1928 Cutter lecture on a theory of epidemics, a survey-based study of tonsillectomy and immunity to Corynebacterium diphtheriae (1931), 2 papers from a longitudinal study of the incidence of minor respiratory diseases (1933 and 1935), an attack rate ratio analysis of the decline of diphtheria in Baltimore (1936), and a 1936 lecture on the age, time, and cohort analysis of tuberculosis mortality. These 6 American Journal of Hygiene /American Journal of Epidemiology papers attest that Frost's personal evolution mirrored that of the emerging "early" epidemiology: The scope of epidemiology extended beyond the study of epidemics of acute infectious diseases, and rigorous comparative study designs and their associated quantitative methods came to light.

An unusual cause of mechanical dysphagia: an agglomerate of calculi in a tonsillar residue.

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Cantarella, Giovanna; Pagani, Davide; Biondetti, Pietro

2006-04-01

We report the case of a 68-year-old man affected by severe oropharyngeal dysphagia for solid food, who had undergone tonsillectomy when he was 22 years old. Videolaryngoscopy revealed a smooth-surfaced, elongated overgrowth on the left lateral pharyngeal wall that protruded toward the left pyriform fossa and impeded the transit of solid boli. A computed tomography scan showed that the solid content of the lesion was markedly inhomogeneous and denser than the surrounding soft tissues. The mass was removed by means of direct pharyngoscopy under general anesthesia. It was found that it arose from the inferior pole of the left tonsillar fossa and had a central cavity filled with caseum and multiple calculi. Histopathologic examination showed that its soft tissue component consisted of lymphoid tonsillar tissue. The operation totally resolved the swallowing disturbance. This case report highlights that tonsilloliths in a tonsillar residue should be considered in the differential diagnosis of mechanical oropharyngeal dysphagia, even in tonsillectomized patients.

A retrospective, case-control study on traditional environmental risk factors in inflammatory bowel disease in Vukovar-Srijem County, north-eastern Croatia, 2010.

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Vcev, Aleksandar; Pezerovic, Davorin; Jovanovic, Zeljko; Nakic, Darko; Vcev, Ivan; Majnarić, Ljiljana

2015-05-01

Traditional environmental risk factors in inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohn's disease (CD), were examined as part of the retrospective epidemiologic study conducted in Vukovar-Srijem County, north-eastern Croatia in 2010. The geographical variations in the frequency of IBD in Croatia have been observed, which is also the trend in the Central Eastern European region and Europe as a whole, indicating the influence of environmental and lifestyle factors. However, the data on the spread of environmental IBD risk factors are still limited. The purpose of this study was to analyse the traditional environmental risk factors in IBD on our cohort sample, including measles virus infection and vaccination (MMR vaccine-Mumps, Measles, Rubella), tonsillectomy, appendectomy, current and former cigarette smoking and use of oral contraceptives in women. This retrospective, case-control study was performed as a part of a wider epidemiologic study aimed at assessing the incidence, prevalence and clinical expression of IBD, in Vukovar-Srijem County (population: 204,768; 2001), which is a lesser developed part of the continental Croatia that experienced deep demographic changes in the recent past. IBD patients were identified according to the hospital's patient records. There were 119 UC patients and 31 CD patients of a total of 150 patients in the cohort. A total of 150 individuals, volunteers, not having a diagnosis of IBD, age- and sex-matched, were used as the control group. Information on examined risk factors were obtained from all subjects in a previously conducted interview. Patients were contacted personally or by phone and interviewed by a gastroenterologist. There were no differences in the number of smokers, former smokers and non-smokers, between UC and CD patients and the controls, nor in the duration of smoking (years), in current smokers and ex-smokers. Only marginally significant longer time of non-smoking, in ex-smokers was found in

["Loss of breath" as a cause of postoperative hypoxia and bradycardia in children submitted to tonsillectomy].

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Moro, Eduardo Toshiyuki; Goulart, Alexandre Palmeira

2015-01-01

The "shortness of breath" or "breathing interruption" crisis can be considered a cause of hypoxia in childhood. It is characterized by the presence of a triggering factor followed by weeping and apnea in expiration accompanied by cyanosis or pallor. The sequence of events may include bradycardia, loss of consciousness, abnormal postural toneand even asystole. A review of the literature revealed only two reports of postoperative apneacaused by "shortness of breath". This article describes the case of a child with a history of "shortness of breath" undiagnosed before the adenotonsillectomy, but that represented the cause of episodes of hypoxemia and bradycardia in the postoperative period. the "shortness of breath" crisis should be considered as a possible cause of perioperative hypoxia in children, especially when there is a history suggestive of this problem. As some events may be accompanied by bradycardia, loss of consciousness, abnormal postural tone and even asystole, observation in a hospital setting should be considered. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

"Loss of breath" as a cause of postoperative hypoxia and bradycardia in children submitted to tonsillectomy.

Science.gov (United States)

Moro, Eduardo Toshiyuki; Goulart, Alexandre Palmeira

2015-01-01

the "shortness of breath" or "breathing interruption" crisis can be considered a cause of hypoxia in childhood. It is characterized by the presence of a triggering factor followed by weeping and apnea in expiration accompanied by cyanosis or pallor. The sequence of events may include bradycardia, loss of consciousness, abnormal postural tone and even asystole. A review of the literature revealed only two reports of postoperative apnea caused by "shortness of breath". this article describes the case of a child with a history of "shortness of breath" undiagnosed before the adenotonsillectomy, but that represented the cause of episodes of hypoxemia and bradycardia in the postoperative period. the "shortness of breath" crisis should be considered as a possible cause of perioperative hypoxia in children, especially when there is a history suggestive of this problem. As some events may be accompanied by bradycardia, loss of consciousness, abnormal postural tone and even asystole, observation in a hospital setting should be considered. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Coblation technology: plasma-mediated ablation for otolaryngology applications

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Woloszko, Jean; Gilbride, Charles

2000-05-01

Coblation is a unique method of delivering radio frequency energy to soft tissue for applications in Otolaryngology (ENT). Using radio frequency in a bipolar mode with a conductive solution, such as saline, Coblation energizes the ions in the saline to form a small plasma field. The plasma has enough energy to break the tissue's molecular bonds, creating an ablative path. The thermal effect of this process is approximately 45 - 85 degrees Celsius, significantly lower than traditional radio-frequency techniques. Coblation has been used for Otolaryngological applications such as Uvulopalatopharyngoplasty (UPPP), tonsillectomy, turbinate reduction, palate reduction, base of tongue reduction and various Head and Neck cancer procedures. The decreased thermal effect of Coblation anecdotally has led to less pain and faster recovery for cases where tissue is excised. In cases where Coblation is applied submucosally to reduce tissue volume (inferior turbinate, soft palate), the immediate volume reduction may lead to immediate clinical benefits for the patient. Coblation is currently being tested in various clinical studies to document the benefits for otolaryngological applications.

The quality of information on three common ENT procedures on the Internet.

LENUS (Irish Health Repository)

2012-02-01

BACKGROUND: The Internet hosts a large number of high-quality medical resources and poses seemingly endless opportunities to inform, teach, and connect professionals and patients alike. However, it is difficult for the lay person to distinguish accurate from inaccurate information. AIM: This study was undertaken in an attempt to assess the quality of information on otolaryngology available on the Internet. METHODS: Sixty appropriate websites, using search engines Yahoo and Google, were evaluated for completeness and accuracy using three commonly performed ENT operations: tonsillectomy (T), septoplasty (S), and myringoplasty (M). RESULTS: A total of 60 websites were evaluated (NT = 20, NM = 20, NS = 20). A total of 86.7% targeted lay population and 13.3% targeted the medical professionals. 35% of the sites included all critical information that patients should know prior to undergoing surgery and over 94% of these were found to contain no inaccuracies. Negative bias towards medical profession was detected in 3% of websites. CONCLUSIONS: In the current climate, with informed consent being of profound importance, the Internet represents a useful tool for both patients and surgeons.

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

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Yoko Nishimura

2015-01-01

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

Assessment of adenosine deaminase (ADA) activity and oxidative stress in patients with chronic tonsillitis.

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Garca, Mehmet Fatih; Demir, Halit; Turan, Mahfuz; Bozan, Nazım; Kozan, Ahmet; Belli, Şeyda Bayel; Arslan, Ayşe; Cankaya, Hakan

2014-06-01

To emphasize the effectiveness of adenosine deaminase (ADA) enzyme, which has important roles in the differentiation of lymphoid cells, and oxidative stress in patients with chronic tonsillitis. Serum and tissue samples were obtained from 25 patients who underwent tonsillectomy due to recurrent episodes of acute tonsillitis. In the control group, which also had 25 subjects, only serum samples were taken as obtaining tissue samples would not have been ethically appropriate. ADA enzyme activity, catalase (CAT), carbonic anhydrase (CA), nitric oxide (NO) and malondialdehyde (MDA) were measured in the serum and tissue samples of patients and control group subjects. The serum values of both groups were compared. In addition, the tissue and serum values of patients were compared. Serum ADA activity and the oxidant enzymes MDA and NO values of the patient group were significantly higher than those of the control group (p ADA activity (p > 0.05). Elevated ADA activity may be effective in the pathogenesis of chronic tonsillitis both by impairing tissue structure and contributing to SOR formation.

Common management issues in pediatric patients with mild bleeding disorders.

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O'Brien, Sarah H

2012-10-01

Type 1 von Willebrand disease and mild platelet function defects are among the most common disorders seen by pediatric hematologists. The management and prevention of bleeding in these patients can be challenging, as there are limited published data to guide clinical practice, and a complete lack of randomized clinical trials. Desmopressin (DDAVP) and antifibrinolytics are the mainstays of treatment in these patients, yet the optimal dosing and timing of these agents to prevent or resolve bleeding, while minimizing adverse side effects, is sometimes unclear. DDAVP-induced hyponatremia is a particularly under-recognized complication in children with bleeding disorders who undergo surgery. Clinicians need to be aware of local measures that are equally important in treating problems such as epistaxis and surgical bleeding. This review will discuss the published literature and provide practical suggestions regarding four common management issues in the care of children and adolescents with mild bleeding disorders: epistaxis, heavy menstrual bleeding, dental extractions, and tonsillectomy. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Branchial cleft cyst: An unusual site for the cervical metastasis of nasopharyngeal carcinoma.

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Liao, Yu-Chang; Adel, Mohamad; Lee, Li-Yu; Chang, Kai-Ping

2018-04-01

Cancers found in the resected branchial cleft cyst are rare clinically but usually impose substantive diagnostic and treatment challenges for clinicians. A 31-year-old man presented with a lateral neck mass that was suspected to be an inflammatory branchial cleft cyst. After excision, the pathologic specimen revealed a benign cystic appearance with a focus of undifferentiated carcinoma. Serologic tests for Epstein-Barr virus were negative. A positron emission tomography scan and upper aerodigestive tract endoscopies were negative for any other suspicious lesion. The patient underwent random biopsies of the nasopharynx, tongue base, and hypopharynx and bil tonsillectomy. Pathologic examination of the nasopharyngeal biopsies showed the presence of undifferentiated carcinoma. The cancerous part of the branchial cleft cyst and this nasopharyngeal specimen were positive for the latent membrane protein-1 and EBV-encoded RNAs of Epstein-Barr virus (EBV) and confirmed our diagnosis. This is the first report of a NPC metastasizing to a branchial cleft cyst. Molecular diagnostic techniques facilitate the definite diagnosis that enabled us to refine treatment plans and offered the patient a favorable outcome. Copyright © 2017 Elsevier B.V. All rights reserved.

The effect of obstructive sleep apnea syndrome on growth and development in nonobese children: a parallel study of twins.

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Zhang, Xiao Man; Shi, Jun; Meng, Guo Zhen; Chen, Hong Sai; Zhang, Li Na; Wang, Zhao Yan; Wu, Hao

2015-03-01

To explore the effects of obstructive sleep apnea syndrome (OSAS) on children's growth by the study of identical twins. Seventeen cases of nonobese children with OSAS were included in this study. The control group was their identical twin sibling, who had no signs of OSAS. Data including height, weight, and serum insulin-like growth factor 1 levels were analyzed before tonsillectomy and adenoidectomy (T&A) and at 3, 6, and 12 months after surgery. The mean apnea hyponea index was 3.9 times/hour in patients with OSAS and became normal after surgery. Minimum oxygen saturation gradually increased after T&A. The height and weight of the OSAS group before T&A was lower than the control group. During the follow-up period, height and weight increased but were lower than the control group. Serum insulin-like growth factor 1 levels in the OSAS group before T&A were lower than the control group. The level was significantly increased 3 months after T&A. OSAS impairs growth and development. Significant growth recovery occurs after T&A, and early surgical intervention is an important factor for improvement in growth. Copyright © 2015. Published by Elsevier Inc.

Effect of diathermy on pain and healing in tonsillectomy, compared with other methods of haemostasis: a randomised study

DEFF Research Database (Denmark)

Hahn, C.H.; Rungby, J.A.; Overgaard, T.

2008-01-01

with gauze packs; bipolar diathermy; and local anaesthesia then pack compression. The outcome measures were pain scores (derived from a visual analogue scale), peri-operative bleeding, and post-operative episodes of blood-stained saliva, consultation rate, tonsillar bed healing and days before return...... to regular diet. One hundred and five patients were included.Results:Peri-operative bleeding was significantly reduced in the local anaesthesia group compared with the other two groups. Delayed post-operative tonsillar bed healing was noted in the diathermy group. No other significant differences were found...

Electroacupuncture-Assisted Craniotomy on an Awake Patient

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Amritpal Sidhu

2017-02-01

Full Text Available Although acupuncture has existed for over 2000 years, its application as an anesthetic aid began in the 1950s in China. The first surgical procedure performed under acupuncture anesthesia was a tonsillectomy. Soon thereafter, major and minor surgical procedures took place with electroacupuncture alone providing the anesthesia. The procedures performed were diverse, ranging from cardiothoracic surgery to dental extractions. Usage of acupuncture anesthesia, specifically in neurosurgery, has been well documented in hospitals across China, especially in Beijing, dating back to the 1970s. We present a case of a 65-year-old man who presented with right-sided body weakness. He had a past medical history of uncontrolled diabetes mellitus, hypertension, and obstructive sleep apnea requiring use of a nasal continuous positive airway pressure device during sleep. We performed a computed tomography brain scan, which revealed a left-sided acute on chronic subdural hemorrhage. Due to his multiple comorbidities, we decided to perform the surgical procedure under electroacupuncture anesthesia. The aim of this case report is to describe a craniotomy performed under electroacupuncture on an elderly patient with multiple comorbidities who was awake during the procedure and in whom this procedure, if it had been performed under general anesthesia, would have carried high risk.

Updating the treatment of recurrent tonsillitis in adults. Review

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María Cristina GASCÓN-RUBIO

2016-03-01

Full Text Available Introduction and Objectives: Acute pharyngitis in adults (APA is one of the most frequent reasons for consultation in primary care. The main objective of this review is to update the therapeutic options for the prevention and treatment of APA and to determine which interventions have the greatest impact in reducing morbidity and improving the quality of life of patients, which directly affects the consumption of health resources. Material and Methods: First clinical criteria of the FAA, indications of tonsillectomy and patterns of antibiotic therapy according to clinical guidelines of national and international scientific societies were defined. Subsequently, the literature related to the treatment of the FAA including other therapeutic options not covered in previous clinical guidelines (P. Leucotomos extract, vaccination by the mucosal route, AM3 and beta-glucans, homeopathy and herbal medicine was revised. ClinicalKey bases and PubMed data were used. Results: The comparison of the studies was difficult due to the disparity of criteria for inclusion and diagnostics, sample sizes, time tracking and poor uniformity in the clinical scales measuring variations. Conclusions: Therefore we cannot conclude whether a therapeutic option is more effective than another in the treatment and prevention of adult APA.

Hemophilia Care in the Pediatric Age

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Marta Bertamino

2017-05-01

Full Text Available Hemophilia is the most common of the severe bleeding disorders and if not properly managed since early infancy can lead to chronic disease and lifelong disabilities. However, it enjoys the most efficacious and safe treatment among the most prevalent monogenic disorders. Hemophilia should be considered in the neonatal period in the case of unusual bleeding or in the case of positive family history. Later, hemophilia should be suspected mainly in males because of abnormal bruising/bleeding or unusual bleeding following invasive procedures—for example, tonsillectomy or circumcision. Prophylactic treatment that is started early with clotting-factor concentrates has been shown to prevent hemophilic arthropathy and is, therefore, the gold standard of care for hemophilia A and B in most countries with adequate resources. Central venous access catheters and arterovenous fistulas play an important role in the management of hemophilia children requiring repeated and/or urgent administration of coagulation factor concentrates. During childhood and adolescence, personalized treatment strategies that suit the patient and his lifestyle are essential to ensure optimal outcomes. Physical activity is important and can contribute to better coordination, endurance, flexibility and strength. The present article focuses also on questions frequently posed to pediatric hematologists like vaccinations, day-care/school access and dental care.

The effect of telephone follow-up after ambulatory surgery on pain management for children at home by parents

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Saeedeh Almasi

2016-07-01

Full Text Available Since time was short hospitalization after ambulatory surgery after discharge the duty of care of children at home, and parents are responsible, their familiarity with pharmacological and nonpharmacological methods of pain relief is essential. Therefore, this study aimed to determine the effect of telephone follow-up after ambulatory surgery on pain management for children at home by their parents. In these clinical trial 68 children 6 to 12 years admitted for tonsillectomy operation with careful parent choice and block randomly divided into control and test. For experimental group, including training of pharmacological and nonpharmacological methods of pain relief and telephone follow-up was done in the first three days after discharge. Data were collected log home checklist was completed by parents. Data by SPSS version 16 and chi-square tests, t and analysis of variance with repeated measures were analyzed. The mean pain intensity scores, palliative effects of acetaminophen and the use of pain relief medication and non-drug control between the two groups was statistically significant difference (P <0.05. However, between the two groups was statistically significant difference was observed sedative effects. ambulatory surgery and follow-up training before the telephone after discharge would empower parents with children at home pain management.

Evidence of Bacterial Biofilms among Infected and Hypertrophied Tonsils in Correlation with the Microbiology, Histopathology, and Clinical Symptoms of Tonsillar Diseases

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Saad Musbah Alasil

2013-01-01

Full Text Available Diseases of the tonsils are becoming more resistant to antibiotics due to the persistence of bacteria through the formation of biofilms. Therefore, understanding the microbiology and pathophysiology of such diseases represent an important step in the management of biofilm-related infections. We have isolated the microorganisms, evaluated their antimicrobial susceptibility, and detected the presence of bacterial biofilms in tonsillar specimens in correlation with the clinical manifestations of tonsillar diseases. Therefore, a total of 140 palatine tonsils were collected from 70 patients undergoing tonsillectomy at University Malaya Medical Centre. The most recovered isolate was Staphylococcus aureus (39.65% followed by Haemophilus influenzae (18.53%. There was high susceptibility against all selected antibiotics except for cotrimoxazole. Bacterial biofilms were detected in 60% of patients and a significant percentage of patients demonstrated infection manifestation rather than obstruction. In addition, an association between clinical symptoms like snore, apnea, nasal obstruction, and tonsillar hypertrophy was found to be related to the microbiology of tonsils particularly to the presence of biofilms. In conclusion, evidence of biofilms in tonsils in correlation with the demonstrated clinical symptoms explains the recalcitrant nature of tonsillar diseases and highlights the importance of biofilm’s early detection and prevention towards better therapeutic management of biofilm-related infections.

Electroacupuncture-Assisted Craniotomy on an Awake Patient.

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Sidhu, Amritpal; Murgahayah, Trushna; Narayanan, Vairavan; Chandran, Hari; Waran, Vicknes

2017-01-01

Although acupuncture has existed for over 2000 years, its application as an anesthetic aid began in the 1950s in China. The first surgical procedure performed under acupuncture anesthesia was a tonsillectomy. Soon thereafter, major and minor surgical procedures took place with electroacupuncture alone providing the anesthesia. The procedures performed were diverse, ranging from cardiothoracic surgery to dental extractions. Usage of acupuncture anesthesia, specifically in neurosurgery, has been well documented in hospitals across China, especially in Beijing, dating back to the 1970s. We present a case of a 65-year-old man who presented with right-sided body weakness. He had a past medical history of uncontrolled diabetes mellitus, hypertension, and obstructive sleep apnea requiring use of a nasal continuous positive airway pressure device during sleep. We performed a computed tomography brain scan, which revealed a left-sided acute on chronic subdural hemorrhage. Due to his multiple comorbidities, we decided to perform the surgical procedure under electroacupuncture anesthesia. The aim of this case report is to describe a craniotomy performed under electroacupuncture on an elderly patient with multiple comorbidities who was awake during the procedure and in whom this procedure, if it had been performed under general anesthesia, would have carried high risk. Copyright © 2016 Medical Association of Pharmacopuncture Institute. Published by Elsevier B.V. All rights reserved.

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

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Dipti Shastri

2015-01-01

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

[Long-term follow-up after tympanostomy tube insertion in children with serous otitis media].

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Fekete-Szabó, Gabriella; Kiss, Fekete; Rovó, László

2015-11-15

The authors report about the efficacy of inserted tympanostomy tube in children with serous otitis media. The aim of the authors was to assess the status of eardrum, the function of Eustachian tube and hearing level 10 years after the use of tympanostomy tube. Patients filled out a questionnaire and microscopic examination of tympanic membrane, tympanometry, Eustachian tube function examination, and audiometry tests were performed. In the period of 2003-2004, ventilation tube insertion was performed in 711 patients in the ENT Department of Pediatric Health Center of University of Szeged. In 349 patients adenotomy and tympanostomy tube insertion, in 18 cases tonsillectomy and grommet insertion and in 344 patients only typmanostomy tube insertion were performed. Due to objective difficulties (address change, no phone number) 453 patients were asked for control test and 312 persons accepted the invitation. Normal hearing level was found in 84.6% of patients and normal tympanometry result occurred in 82%. Tympanic ventilation disorder, perforation of tympanic membrane, sensorineural hearing loss and sensorineural hearing loss due to noise exposure were diagnosed. Application of tympanostomy tube is effective in the treatment of serous otitis media resulting from ventilation disorder. The authors draw attention to the importance of tympanometry examination to prevent the adhesive processes and cholesteatoma in chronic ventilation disorder of the middle ear.

Risk of transmission of sporadic Creutzfeldt-Jakob disease by surgical procedures: systematic reviews and quality of evidence.

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López, Fernando J García; Ruiz-Tovar, María; Almazán-Isla, Javier; Alcalde-Cabero, Enrique; Calero, Miguel; de Pedro-Cuesta, Jesús

2017-10-01

Sporadic Creutzfeldt-Jakob disease (sCJD) is potentially transmissible to humans. This study aimed to summarise and rate the quality of the evidence of the association between surgery and sCJD. Firstly, we conducted systematic reviews and meta-analyses of case-control studies with major surgical procedures as exposures under study. To assess quality of evidence, we used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Secondly, we conducted a systematic review of sCJD case reports after sharing neurosurgical instruments. Thirteen case-control studies met the inclusion criteria for the systematic review of case-control studies. sCJD was positively associated with heart surgery, heart and vascular surgery and eye surgery, negatively associated with tonsillectomy and appendectomy, and not associated with neurosurgery or unspecified major surgery. The overall quality of evidence was rated as very low. A single case-control study with a low risk of bias found a strong association between surgery conducted more than 20 years before disease onset and sCJD. Seven cases were described as potentially transmitted by reused neurosurgical instruments. The association between surgery and sCJD remains uncertain. Measures currently recommended for preventing sCJD transmission should be strongly maintained. Future studies should focus on the potential association between sCJD and surgery undergone a long time previously.

Operative time and cost of resident surgical experience: effect of instituting an otolaryngology residency program.

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Pollei, Taylor R; Barrs, David M; Hinni, Michael L; Bansberg, Stephen F; Walter, Logan C

2013-06-01

Describe the procedure length difference between surgeries performed by an attending surgeon alone compared with the resident surgeon supervised by the same attending surgeon. Case series with chart review. Tertiary care center and residency program. Six common otolaryngologic procedures performed between August 1994 and May 2012 were divided into 2 cohorts: attending surgeon alone or resident surgeon. This division coincided with our July 2006 initiation of an otolaryngology-head and neck surgery residency program. Operative duration was compared between cohorts with confounding factors controlled. In addition, the direct result of increased surgical length on operating room cost was calculated and applied to departmental and published resident case log report data. Five of the 6 procedures evaluated showed a statistically significant increase in surgery length with resident involvement. Operative time increased 6.8 minutes for a cricopharyngeal myotomy (P = .0097), 11.3 minutes for a tonsillectomy (P operative time difference. Cost of increased surgical time was calculated per surgery and ranged from $286 (cricopharyngeal myotomy) to $2142 (mastoidectomy). When applied to reported national case log averages for graduating residents, this resulted in a significant increase of direct training-related costs. Resident participation in the operating room results in increased surgical length and additional system cost. Although residency is a necessary part of surgical training, associated costs need to be acknowledged.

[Organic and functional limitations due to milking phenomenon: a clinical case report].

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Gómez-Henry, Juan Carlos; Rodríguez-Pérez, Francisco Antonio

2014-01-01

The incidence of milking phenomenon is between 0.6 and 4 % in angiographic series; however, autopsy studies raise the incidence of myocardial bridges up to 85 %. This malformation goes unnoticed in most cases but can have a big impact on personal and professional level. The objective was to present an example of milking phenomenon with disability and professional consequences. Male, 44 years old, bricklayer and farmhand laborer. He referred tonsillectomy and osteoarthritis and being a smoker of 10 cigarettes per day, drinking 2-3 cups of coffee daily and 2-3 glasses of wine at the weekends. The primary care physician referred him to cardiologist with suspicion of arrhythmia. The cardiology service report mentioned electrocardiogram at sinusal rhythm, 90 beats per minute and incomplete right bundle-branch block. At ergonomics test, in the first stage of Bruce protocol, the patient's development of hypertensive crisis suggested a milking phenomenon. Finally, the diagnosis was established by angiographic studies with left common branch, circumflex coronary artery, right coronary artery and anterior descendent artery, without evidence of pathology but it was seen systolic compression on the medial segment. The case was concluded by the disability assessment team, recognizing a total permanent disability with limitations for activities requiring moderate physical efforts. The milking phenomenon diagnosis that could be related with ischemic heart disease is by angiography. Finally, the patient ended with total permanent disability.

Relationship between Helicobacter pylori Adenotonsillar Colonization and Frequency of Adenotonsillitis in Children

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Oğuz Güçlü

2013-09-01

Full Text Available Background: There are insufficient data in the literature on the presence of Helicobacter pylori in tonsil and adenoid tissue of patients with only airway obstruction. This study examined the presence of H. pylori in surgical cases with airway obstruction or recurrent infection. Aims: To investigate the relationship between H. pylori adenotonsillar colonisation and the frequency of adenotonsillitis and to compare paediatric and adult patients according to H. pylori tonsillar colonisation. Study Design: Prospective clinical trial. Methods: Patients scheduled for adenoidectomy or tonsillectomy were classified into three groups based on indications: paediatric infection (n=29, paediatric obstruction (n=29 and adult infection (n=12. Tissue samples obtained from patients were examined for the presence of H. pylori by culture, rapid urease test and polymerase chain reaction. Results: Forty-nine tonsil tissues were examined. Positive results were found in two specimens with the rapid urease test (4.1% and three with polymerase chain reaction examination (6.1%. Only three positive polymerase chain reaction results (5.8% were identified in 52 adenoid tissue samples. There were no statistically significant differences in the presence of H. pylori between paediatric infection and obstruction groups or between paediatric infection and adult infection groups. Conclusion: In our study, there was a low incidence of H. pylori colonisation in tonsil and adenoid tissues. Regarding H. pylori colonisation, there was no significant difference between paediatric infection and obstruction groups. Also, no significant difference was found between adult and paediatric cases.

Otolaryngology Service Usage in Children With Cleft Palate.

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Whittemore, Kenneth R; Dargie, Jenna M; Dornan, Briana K; Boudreau, Brian

2018-05-01

To determine the usage of otolaryngology services by children with cleft palate at a pediatric tertiary care facility. Retrospective case series. Specialty clinic at a pediatric tertiary care hospital. Children born between January 1, 1999, and December 31, 2002, with the diagnosis of cleft palate or cleft lip and palate. A total of 41 female and 48 male patients were included. Total number of otolaryngology clinic visits and total number of otolaryngologic surgeries (tympanostomy tube placements and other otologic or upper airway procedures). In the first 5 years of life, these children utilized an average of 8.2 otolaryngology clinic visits (SD = 5.0; range: 1-22) and underwent 3.3 tympanostomy tube surgeries (SD = 2.0; range: 0-10). Seventy-three had their first tube placed at the time of palate repair, and 4 at the time of lip repair. Fifty-one (57.3%) required other otologic or upper airway procedures, including tonsillectomy and/or adenoidectomy (27 children), removal of tympanostomy tubes (24 children), tympanomastoidectomy (3 children), and tympanoplasty (14 children). Of the children who underwent other procedures, they underwent a mean of 1.67 (SD = 0.84; range: 1-4) surgeries. Children with cleft palate are at increased risk for eustachian tube dysfunction, frequently utilize otolaryngology care, and typically receive multiple sets of tympanostomy tubes. This study found that children with cleft palate receive on average of approximately 3 sets of tympanostomy tubes, and the majority required another otologic or upper airway surgery.

Targeted Treatment With Radio Frequency Ablation for Lingual Tonsil

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Suvi Renkonen

2018-01-01

Full Text Available Objectives: Benign enlargement of the lingual tonsils due to various causes may cause symptoms that warrant treatment. Conventional lingual tonsillectomy remains a challenging procedure, and there is no established standard procedure. We aimed to review the patients receiving different methods of lingual tonsil surgery for various indications at our institute. Methods: Retrospective clinical data on all patients with an ablative operation of the tongue base during the 8-year period between 2007 and 2014 at the Helsinki University Hospital, Helsinki, Finland, were reviewed. The larger cohort comprised 35 patients, of whom 26 were men (74%. Ten patients had undergone solely lingual tonsil radio frequency ablation (LTRFA. The minimum follow-up time for all patients was 2 years. Results: Of the 10 patients, 5 patients with LTRFA had been operated on because of symptomatic lingual tonsil hypertrophy and 5 because of periodic fever associated with possible lingual tonsil involvement. In 2 of the 5 patients with periodic fever, the fever cycles ended after the operation. Of the 5 patients, 3 patients with symptomatic lingual tonsil hypertrophy have been non-symptomatic after 1 to 3 treatment sessions. The last 2 patients continue to have persistent symptoms. There were no major complications. Conclusions: Development of new approaches for the management of various lingual tonsil conditions is warranted. Lingual tonsil volume reduction by LTRFA seems to be a treatment alternative with low morbidity but with limited curative effect only.

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

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Patrícia Junqueira

2002-08-01

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

Comparison in anesthetic effects of propofol among patients with different ABO blood groups.

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Du, Yiri; Shi, Haixia; Yu, Jianshe

2017-05-01

Our study was aimed to investigate anesthetic effects of propofol in patients with different blood groups.A total of 72 participants were enrolled from patients arranged for surgeries of cholecystectomy, tonsillectomy, and spinal operation. Each blood group (A, B, AB, and O) contained 18 participants. Mean arterial pressure (MAP), heart rate (HR), and bispectral index (BIS) were assayed with Philips monitor. These indexes were observed before propofol anesthesia (T0), and then were recorded when concentration of propofol was 1 μg/mL (T1), 2 μg/mL (T2), 3 μg/mL (T3), and 4 μg/mL (T4). The differences in MAP, HR, and BIS at T0 among groups were compared with the χ test. Multiple comparisons were adopted to calculate the differences in MAP, HR, and BIS between groups at T1, T2, T3, and T4.No significant differences in age, sex, and weight of all groups were found (P > .05). Before propofol anesthesia (T0), all the participants exhibited no differences in MAP, HR, and BIS (P > .05). Subsequently, we found obvious differences in ΔMAP, ΔHR, and ΔBIS between groups. The patients in the B blood group showed highest ΔMAP and ΔHR at each time point (P blood group exhibited highest value at T3 and T4 (P blood group remarkably affects the anesthetic effects of propofol.

Otolaryngologic manifestations of Noonan syndrome.

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Geelan-Hansen, Katie; Anne, Samantha

2015-09-01

Noonan syndrome is an autosomal dominant disorder with associated anomalies that include short stature, congenital heart defects, developmental delay, and characteristic facial features among other abnormalities. Articulation deficiency and language delay are often present and require speech therapy. Otitis media and hearing loss have been reported to be common in these patients. We performed a retrospective chart review of pediatric patients who were diagnosed with Noonan syndrome at our tertiary care center from January 1979 through December 2009. We found 19 such patients. Of these, 8 had received single-specialty care at our hospital; it is not known if they had received otolaryngologic care from an outside provider. These 8 patients were not included in our study. The remaining 11 patients-6 boys and 5 girls, aged 1 to 19 years (mean: 9.2)-had all received multidisciplinary care at our institution; 9 of them had received care from an otolaryngologist at our center. Of this group, 7 had history of feeding difficulty, 6 had experienced speech delay that required speech therapy, 6 had undergone placement of a pressure equalization tube, 4 had undergone adenoidectomy with or without tonsillectomy, and 1 had been treated with endoscopic sinus surgery. Although this study is limited by our small number of patients, our results suggest that early otolaryngologist involvement must be considered in the care of children with Noonan syndrome because many have evidence of eustachian tube dysfunction, hearing loss, and speech delay.

The effects of adenotonsillotomy on nocturnal enuresis in snoring children

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Marta Kostrzewa

2017-12-01

Full Text Available Introduction: Nocturnal enuresis is a common problem in the paediatric population. A number of reports indicate that there is a relationship between sleep-disordered breathing in children with tonsillar hypertrophy and nocturnal enuresis. Restoration of nasopharyngeal patency may eliminate nocturnal enuresis. Aim: The aim of the study was to evaluate the incidence of nocturnal enuresis in children snoring due to nasopharyngeal lymphatic tissue hypertrophy as well as to assess the effects of restored upper respiratory patency by means of adenectomy and tonsillectomy on the resolution of nocturnal enuresis in children. Material and methods: The study included 50 children with sleep-disordered breathing qualified for adenectomy, tonsillotomy or adenotonsillotomy (median age 7 years. The control group consisted of 20 healthy children (median age 8 years. Children in the study group were assessed prior to surgical procedure as well as 3 and 6 months after surgery. The presence of sleep-disordered breathing and nocturnal enuresis was determined based on author’s questionnaire completed by parents. Results: The incidence of nocturnal enuresis in children with nasopharyngeal lymphatic tissue hypertrophy was 18% (M:F 17%:19%; p > 0.05. Nocturnal enuresis was still reported in 6% of children 3 months after tonsillotomy. The disorder resolved in all girls and 97% of boys 6 months after procedure. Conclusions: Sleep-disordered breathing in children with nasopharyngeal lymphatic tissue hypertrophy is associated with nocturnal enuresis. Restoration of nasopharyngeal patency in these patients eliminates nocturnal enuresis. Tonsillar hypertrophy causing obstructive breathing should be included in the differential diagnosis of nocturnal enuresis.

Eagle syndrome surgical treatment with piezosurgery.

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Bertossi, Dario; Albanese, Massimo; Chiarini, Luigi; Corega, Claudia; Mortellaro, Carmen; Nocini, Pierfrancesco

2014-05-01

Eagle syndrome (ES) is an uncommon complication of styloid process elongation with stylohyoideal complex symptomatic calcification. It is an uncommon condition (4% of the population) that is symptomatic in only 4% of the cases. Eagle syndrome is usually an acquired condition that can be related to tonsillectomy or to a neck trauma. A type of ES is the styloid-carotid syndrome, a consequence of the irritation of pericarotid sympathetic fibers and compression on the carotid artery. Clinical manifestations are found most frequently after head turning and neck compression. Although conservative treatment (analgesics, anticonvulsants, antidepressants, local infiltration with steroids, or anesthetic agents) have been used, surgical treatment is often the only effective treatment in symptomatic cases. We present the case of a 55-year-old patient, successfully treated under endotracheal anesthesia. The cranial portion of the calcified styloid process was shortened through an external approach, using a piezoelectric cutting device (Piezosurgery Medical II; Mectron Medical Technology, Carasco, Italy) with MT1-10 insert, pump level 4, vibration level 7. No major postoperative complications such as nerve damage, hematoma, or wound dehiscence occurred. After 6 months, the patient was completely recovered. Two years after the surgery, the patient did not refer any symptoms related to ES. The transcervical surgical approach in patients with ES seems to be safe and effective, despite the remarkable risk for transient marginal mandibular nerve palsy. This risk can be decreased by the use of the piezoelectric device for its distinctive characteristics--such as precision, selective cut action, and bloodless cut.

Selected medical conditions and risk of pancreatic cancer.

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Olson, Sara H

2012-01-01

We review the current evidence for associations of several medical conditions with risk of pancreatic cancer, including allergies, pancreatitis, gall bladder disease, cholecystectomy, ulcers, gastrectomy, appendectomy, and tonsillectomy. There are consistent findings of reduced risk associated with presence of self-reported allergies, particularly hay fever but not asthma; data on other allergies are limited and inconclusive. Several studies provide evidence that patients with pancreatic cancer are more likely than comparison groups to report pancreatitis. Those studies that investigated the time between onset of pancreatitis and diagnosis of pancreatic cancer found that risk estimates declined with longer periods of time; however, increased risks were noted for long-term pancreatitis, indicating that this condition is both a risk factor and a sign of early disease. Increased risk was reported in association with cholelithiasis, but the few studies that considered time before diagnosis of cancer did not find increased risk for cholelithiasis diagnosed in the more distant past. There is weak evidence that cholecystectomy 2 or more years before cancer diagnosis is related to risk, but this is based on only a few studies. There is no consistent association between ulcers and risk, while gastrectomy may increase risk. Overall, study of these conditions, particularly those that are rare, presents methodologic challenges. Time between diagnoses is likely to be important but is not considered in most studies. Lack of adequate control in several studies for risk factors such as smoking and heavy alcohol use also makes it difficult to draw firm conclusions about these results. Copyright © 2011 Wiley Periodicals, Inc.

Remission and incidence of obstructive sleep apnea from middle childhood to late adolescence.

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Spilsbury, James C; Storfer-Isser, Amy; Rosen, Carol L; Redline, Susan

2015-01-01

To study the incidence, remission, and prediction of obstructive sleep apnea (OSA) from middle childhood to late adolescence. Longitudinal analysis. The Cleveland Children's Sleep and Health Study, an ethnically mixed, urban, community-based cohort, followed 8 y. There were 490 participants with overnight polysomnography data available at ages 8-11 and 16-19 y. Baseline participant characteristics and health history were ascertained from parent report and US census data. OSA was defined as an obstructive apnea- hypopnea index ≥ 5 or an obstructive apnea index ≥ 1. OSA prevalence was approximately 4% at each examination, but OSA largely did not persist from middle childhood to late adolescence. Habitual snoring and obesity predicted OSA in cross-sectional analyses at each time point. Residence in a disadvantaged neighborhood, African-American race, and premature birth also predicted OSA in middle childhood, whereas male sex, high body mass index, and history of tonsillectomy or adenoidectomy were risk factors among adolescents. Obesity, but not habitual snoring, in middle childhood predicted adolescent OSA. Because OSA in middle childhood usually remitted by adolescence and most adolescent cases were incident cases, criteria other than concern alone over OSA persistence or incidence should be used when making treatment decisions for pediatric OSA. Moreover, OSA's distinct risk factors at each time point underscore the need for alternative risk-factor assessments across pediatric ages. The greater importance of middle childhood obesity compared to snoring in predicting adolescent OSA provides support for screening, preventing, and treating obesity in childhood. © 2014 Associated Professional Sleep Societies, LLC.

Long-term changes in neurocognition and behavior following treatment of sleep disordered breathing in school-aged children.

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Biggs, Sarah N; Vlahandonis, Anna; Anderson, Vicki; Bourke, Robert; Nixon, Gillian M; Davey, Margot J; Horne, Rosemary S C

2014-01-01

Sleep disordered breathing (SDB) in children is associated with detrimental neurocognitive and behavioral consequences. The long term impact of treatment on these outcomes is unknown. This study examined the long-term effect of treatment of SDB on neurocognition, academic ability, and behavior in a cohort of school-aged children. Four-year longitudinal study. Children originally diagnosed with SDB and healthy non-snoring controls underwent repeat polysomnography and age-standardized neurocognitive and behavioral assessment 4y following initial testing. Melbourne Children's Sleep Centre, Melbourne, Australia. Children 12-16 years of age, originally assessed at 7-12 years, were categorized into Treated (N = 12), Untreated (N = 26), and Control (N = 18) groups. Adenotonsillectomy, Tonsillectomy, Nasal Steroids. Decision to treat was independent of this study. Changes in sleep and respiratory parameters over time were assessed. A decrease in obstructive apnea hypopnea index (OAHI) from Time 1 to Time 2 was seen in 63% and 100% of the Untreated and Treated groups, respectively. The predictive relationship between change in OAHI and standardized neurocognitive, academic, and behavioral scores over time was examined. Improvements in OAHI were predictive of improvements in Performance IQ, but not Verbal IQ or academic measures. Initial group differences in behavioral assessment on the Child Behavior Checklist did not change over time. Children with SDB at baseline continued to exhibit significantly poorer behavior than Controls at follow-up, irrespective of treatment. After four years, improvements in SDB are concomitant with improvements in some areas of neurocognition, but not academic ability or behavior in school-aged children.

New clinical staging for pharyngeal surgery in obstructive sleep apnea patients.

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Vidigal, Tatiana Aguiar; Haddad, Fernanda Louise Martinho; Cabral, Rafael Ferreira Pacheco; Oliveira, Maria Claudia Soares; Cavalcante, Ricardo Rodrigues; Bittencourt, Lia Rita Azeredo; Tufik, Sergio; Gregório, Luis Carlos

2014-01-01

The success of pharyngeal surgery in the treatment of obstructive sleep apnea syndrome depends on the appropriate selection of patients. To propose a new staging for indication of pharyngeal surgery in obstructive sleep apnea syndrome. A total of 54 patients undergoing extended tonsillectomy were retrospectively included, divided into six stages. Stage I: patients with palatine tonsils grade 3/4 and modified Mallampati index 1/2; stage II: palatine tonsils 3/4 and modified Mallampati index 3/4; stage III: palatine tonsils 1/2 and modified Mallampati index 1/2; stage IV: palatine tonsils 1/2 and modified Mallampati index 3/4; stage V: body mass index ≥40 kg/m(2) with palatine tonsils 3/4 and modified Mallampati index 1, 2, 3, or 4. Stage VI: body mass index ≥40 with palatine tonsils 1/2 and modified Mallampati index 1, 2, 3, or 4. The surgical success rates were 88.9%, 75.0%, 35.7%, 38.5%, and 100.0% in stages I-V. The presence of hypertrophic palatine tonsils was the anatomical factor in common in the most successful stages (I, II, and V), regardless of body mass index. Although the modified Mallampati index classes 3 and 4 reduced the success rate of surgery in patients with hypertrophic tonsils (stage II), the presence of modified Mallampati index classes 1 and 2 did not favor surgical success in patients with normal tonsils (stage III). Copyright © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Generation of tidal volume via gentle chest pressure in children over one year old.

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Tsui, Ban C H; Horne, Sara; Tsui, Jenkin; Corry, Gareth N

2015-07-01

In the event of cardiac arrest, cardiopulmonary resuscitation (CPR) is a well-established technique to maintain oxygenation of tissues and organs until medical equipment and staff are available. During CPR, chest compressions help circulate blood and have been shown in animal models to be a means of short-term oxygenation. In this study, we tested whether gentle chest pressure can generate meaningful tidal volume in paediatric subjects. This prospective cohort pilot study recruited children under the age of 17 years and undergoing any surgery requiring general anaesthetic and endotracheal intubation. After induction of general anaesthesia, tidal volumes were obtained before and after intubation by applying a downward force on the chest which was not greater than the patient's weight. Mean tidal volumes were compared for unprotected versus protected airway and for type of surgery. Mean tidal volume generated with an unprotected and protected airway was 2.7 (1.7) and 2.9 (2.3) mL/kg, respectively. Mean tidal volume generated with mechanical ventilation was 13.6 (4.9) mL/kg. No statistical significance was found when comparing tidal volumes generated with an unprotected or protected airway (p = 0.20), type of surgery (tonsillectomy and/or adenoidectomy versus other surgery) (unprotected, p = 0.09; protected, p = 0.37), and when age difference between groups was taken into account (p = 0.34). Using gentle chest pressure, we were able to generate over 20% of the tidal volume achieved with mechanical ventilation. Our results suggest that gentle chest pressure may be a means to support temporary airflow in children. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Reduced Number of CD8+ Cells in Tonsillar Germinal Centres in Children with the Periodic Fever, Aphthous Stomatitis, Pharyngitis and Cervical Adenitis Syndrome.

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Førsvoll, J; Janssen, E A M; Møller, I; Wathne, N; Skaland, I; Klos, J; Kristoffersen, E K; Øymar, K

2015-07-01

The syndrome of periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) is an autoinflammatory disorder of unknown aetiology. Tonsillectomy may cause a prompt resolution of the syndrome. The aim was to study the histologic and immunological aspects of the palatine tonsils in PFAPA, to help understand the pathophysiology of the syndrome. Tonsils from children with PFAPA (n = 11) and children with tonsillar hypertrophy (n = 16) were evaluated histologically after haematoxylin and eosin staining. The number of different cell types was identified immunohistochemically by cluster of differentiation (CD) markers: CD3 (T cells), CD4 (T helper cells), CD8 (cytotoxic T cells), CD15 (neutrophils), CD20 (B cells), CD45 (all leucocytes), CD57 (NK cells) and CD163 (monocytes and macrophages). Tonsils from children with PFAPA showed reactive lymphoid hyperplasia dominated by well-developed germinal centres with many tingible body macrophages. The histologic findings were unspecific, and a similar morphologic appearance was also found in the tonsils from controls. The number of CD8+ cells in germinal centres differed between children with PFAPA [median 9 cells (quartiles: 5, 15)] and controls [18 cells (12, 33) (P = 0.001)] and between children with PFAPA with (median 14 cells; 9, 16) and without (4 cells; 3, 8) aphthous stomatitis (P = 0.015). For the other cell types, no differences in germinal centres were found between children with PFAPA and controls. In conclusion, a lower number of CD8+ cells were found in germinal centres of tonsils in children with PFAPA compared to controls, which may be a feature linked to the aetiology of the syndrome. © 2015 John Wiley & Sons Ltd.

Characterization of the expanded T cell population in infectious mononucleosis: apoptosis, expression of apoptosis-related genes, and Epstein–Barr virus (EBV) status

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Verbeke, C S; Wenthe, U; Bergler, W F; Zentgraf, H

2000-01-01

Infectious mononucleosis (IM), a manifestation of primary infection with EBV, is characterized by a massive expansion of the T cell population. In this study we examined this expanded T cell population regarding its EBV status, its proliferative and apoptotic activity, and its expression of apoptosis-related genes. Whereas previous studies were performed on ex vivo cultures or on peripheral blood, our investigations included in vivo analysis of IM tonsillectomy specimens (14 cases) by in situ hybridization for viral RNA (EBERs) combined with immunohistochemistry (IHC; CD3, CD45RO, CD20, CD79a, Ki-67, Bcl-2, Bax, Fas, FasL) and the TUNEL method. Of the EBER+ cells 50–70% showed expression of the B cell markers CD20/CD79a. The remainder of the EBER+ cells expressed neither B nor T cell antigens. No co-expression of EBERs and T cell antigens was detected in any of the specimens. In accordance with a high rate of apoptosis (up to 2·37%) within the expanded T cell population, Bcl-2 expression was drastically reduced and FasL expression remarkably increased. The levels of Bax and Fas expression showed no or moderate up-regulation. In conclusion, the massive expansion of IM T cells is not caused by EBV infection of these cells but merely represents an intense immune reaction. Through altered expression of Bcl-2/Bax and Fas/FasL, the activated T cells are subject to enhanced apoptosis while residing within the lymphoid tissue, which eventually allows the efficient silencing of this potentially damaging T cell response. PMID:10792379

Prevalence of Dental Occlusal Patterns and Their Association with Obstractive Upper Airway Diseases in Primary School Children, Isfahan, Iran

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SM Sonbolestan

2005-11-01

Full Text Available Background: Teeth, apart from their physiologic function, play an important role in general appearance of indivduals. Therefore any disorder in their growth and evolution, will cause psychologic, social and even economic problems for the person. This observational cross- sectional study aimed to investigate relationship between dental occlusal patterns and obstructive nasal-upper airway- diseases. Methods: This study was perfromed in schools of No.4 Education at district of Isfahan in educational year 1381-82 between 607 students (277 male, 330 female aged 9-12 years old. Results of accurate ENT and dentistry physical examination were registered and analyzed using SPSS software and Chi-square and Mantel - Hanzel test. Results: With increasing age, The frequency of abnormal occlusal patterns increases (from 45.5% to 68.2% in males and 25.8% to 48.5% in females, p=0.015. The increasing in degree of palatal tonsilar hypertrophy was related to higher frequency of abnormal occlusal patterns (36.7% in +1 tonsilar hypertrophy, and 70% in +4 tonsilar hypertrophy, p=0.02. Also, history of frequent common colds, and history of previous nasal fractures were related with abnormal patterns [58.9% (p=0.032, and 83.4% (p= 0.043%, respectively].Five other parameters including sinusitis, hypertrophy of nasal turbinates, rhinitis, nasal polyposis and nasal septal deviation were not associated with abnormal occlusal patterns (p>0.1. Conclusion: Some of obstructive upper airwacy diseases are related with abnormal dental occlusal patterns. These parameters can be simply diagnosed, treated or prevented. Key words: dental occlusion, malocclusion, obstructive nasal disorders, nasal turbinates, adenoid, rhinitis, tonsillectomy, open mouth breathing

Otorhinolaryngological patient injuries in Finland.

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Lehtivuori, Tuuli; Palonen, Reima; Mussalo-Rauhamaa, Helena; Holi, Tarja; Henriksson, Markus; Aaltonen, Leena-Maija

2013-10-01

Otorhinolaryngology (ORL) is considered a specialty associated with few serious patient injuries. Research data that support this belief are, however, scarce. We analyzed claims associated with ORL to determine the number of Finnish cases and the possible common denominators. Register study of ORL cases in the Patient Insurance Centre (PIC), the Regional State Administrative Agencies (RSAA), and the National Supervisory Authority for Welfare and Care (Valvira) during the years 2004 to 2008. These three agencies are the main actors in the field of patient injury in Finland. We analyzed compensated ORL patient injury cases from the PIC and cases associated with the ORL specialty for Valvira and RSAA from 2004 to 2008 and surveyed patient treatment files, statements from specialists, and compensation decisions. Injuries were usually associated with operations; three patients who experienced injuries during these procedures died. Common ORL operations such as tonsillectomy, septoplasty, and paranasal sinus surgery were most often associated with compensated injuries. Serious injuries were few, with a total of 110 out of 422 (26.1%) claims compensated by the PIC. Of the 110 compensated cases, 30 (27.3%) were related to tumor surgery. The most usual compensated case had iatrogenic nerve injury affecting the facial or trigeminal nerves. Of the compensated cases, 79 (71.8%) were treated by specialists, 15 (13.6%) by residents, and the rest by other medical professionals. Patient injuries in ORL are seldom severe and are strongly associated with surgery. A typical compensated injury was one that occurred in a central hospital during working hours. N/A. Copyright © 2013 The American Laryngological, Rhinological, and Otological Society, Inc.

Recurrent Acute Tonsillitis, The 'Core' Issue

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Saikat Samaddar

2016-04-01

Full Text Available Introduction: Today bacteriological and patho-anatomical considerations too are taken into account while treating a case of tonsillitis. Past decade has seen the rise of resistance amongst the common pathogens, as well as rise in the number of unusual offenders. Determination of the true offending organism and prescribing an antibiotic as per the sensitivity pattern is of utmost importance.  Materials and Method: A prospective longitudinal study was conducted in a tertiary care hospital in Kolkata. The study population consisted of patients presenting with recurrent attacks of acute tonsillitis. Determination of throat swab micro flora, ASO titre and core tissue microflora was done and correlated statistically. Result: There was poor correlation between throat swab and core tissue microflora. Positive predictive value of throat swab was 10%. Pseudomonas is the predominant flora harbouring tonsillar core in our study population. Amoxicillin the most commonly prescribed antibiotic stands out to be the most resistant one. No statistical significance could be reached comparing streptococcal tonsillitis with ASO titre. Discussion: The real pathology within the tonsil core is not always reflected in routine throat swab and bacteriology of recurrent tonsillitis may differ in different regions. ASO titre estimation adds up to the economic burden if rheumatic fever is not suspected. Judicious use of antibiotics based on true sensitivity pattern is encouraged. In the era of antibiotics Tonsillectomy still holds an important position in the management of recurrent attacks. Conclusion: Pseudomonas was found to be the most common pathogen in recurrent acute tonsillitis. Core tissue study remains the Gold standard in identifying the pathogenic organism. Oral third generation Cephalosporin was the most efficacious antibiotic for recurrent tonsillitis in our study population.

Nefropatía por Inmunoglobulina A: Guía de práctica clínica Immunoglobulin A nephropathy: Clinical Practice Guidelines

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Alicia Fayad

2011-05-01

tonsilectomía.Immunoglobulin A nephropathy (N.IgA is the world most common glomerular disease; 15-50% of patients develop loss of renal function in 10-20 years, and the rest remission or mild proteinuria/ hematuria. The optimal treatment is uncertain. Our aim was to develop evidence-based recommendations through research in Medline, Embasse, Lilacs and Cochrane Central Register of Controlled Trials. The study-quality was independently assessed by the reviewers following the Cochrane Renal Group checklist: randomization, blinding, intention-to-treat analysis and follow-up period. Levels of evidence and grades of recommendation were assigned according to Center for Evidence-Based Medicine, Oxford. Two approaches were considered: Immunosuppressive therapy (corticosteroids, cytostatics, cyclosporine A, mycophenolate-mofetil: Level I a, grade A. -Combined suppressive therapy in adults. Corticosteroids plus cytotoxics drugs (cyclophosphamide/azathioprine: Level II b, grade B. In children with severe IgA nephropathy: Level II b, grade D. Cyclosporine and mycophenolate- mophetil: Level II b, grade C. Cyclosporine and mycophenolate-mophetil: Level ll b, grade C. -Non immunosuppressive therapy: reninangiotensin converting enzyme inhibitors (ACEI and/or angiotensin II receptor blockers (ARB, fish oil, statins, antiplatelets and tonsillectomy. ACEI and/or ARB, in patients with proteinuria =1 g: Level I a, grade A. In children with moderate proteinuria: ACEI and/or ARB with close monitoring of renal function and serum potassium level: Level II b, grade B. Antiplatelet as supportive treatment: Level I a, grade C. Fish oil in addition to ACEI or ARB in patients with mild histological lesions: Level II b, grade B (Not in children. Statins: no evidence to recommend these drugs in children. In patients > 5 years with nephrotic syndrome and hyper-cholesterolemia, use statins with close monitoring of serum creatine-kinase. There is no evidence to recommend tonsillectomy.

Examining the effects of enhanced provider-patient communication on postoperative tonsillectomy pain: protocol of a randomised controlled trial performed by nurses in daily clinical care

NARCIS (Netherlands)

Vliet, L.M. van; Dulmen, S. van; Thiel, B.; Deelen, G.W. van; Immerzeel, S.; Godfried, M.B.; Bensing, J.M.

2017-01-01

INTRODUCTION: Placebo effects (true biopsychological effects not attributable to the active ingredients of medical technical interventions) can be attributed to several mechanisms, such as expectancy manipulation and empathy manipulation elicited by a provider's communication. So far, effects have

Periodontal disease bacteria specific to tonsil in IgA nephropathy patients predicts the remission by the treatment.

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Yasuyuki Nagasawa

Full Text Available BACKGROUND: Immunoglobulin (IgA nephropathy (IgAN is the most common form of primary glomerulonephritis in the world. Some bacteria were reported to be the candidate of the antigen or the pathogenesis of IgAN, but systematic analysis of bacterial flora in tonsil with IgAN has not been reported. Moreover, these bacteria specific to IgAN might be candidate for the indicator which can predict the remission of IgAN treated by the combination of tonsillectomy and steroid pulse. METHODS AND FINDINGS: We made a comprehensive analysis of tonsil flora in 68 IgAN patients and 28 control patients using Denaturing gradient gel electrophoresis methods. We also analyzed the relationship between several bacteria specific to the IgAN and the prognosis of the IgAN. Treponema sp. were identified in 24% IgAN patients, while in 7% control patients (P = 0.062. Haemophilus segnis were detected in 53% IgAN patients, while in 25% control patients (P = 0.012. Campylobacter rectus were identified in 49% IgAN patients, while in 14% control patients (P = 0.002. Multiple Cox proportional-hazards model revealed that Treponema sp. or Campylobactor rectus are significant for the remission of proteinuria (Hazard ratio 2.35, p = 0.019. There was significant difference in remission rates between IgAN patients with Treponema sp. and those without the bacterium (p = 0.046, and in remission rates between IgAN patients with Campylobacter rectus and those without the bacterium (p = 0.037 by Kaplan-Meier analysis. Those bacteria are well known to be related with the periodontal disease. Periodontal bacteria has known to cause immune reaction and many diseases, and also might cause IgA nephropathy. CONCLUSION: This insight into IgAN might be useful for diagnosis of the IgAN patients and the decision of treatment of IgAN.

Periodontal disease bacteria specific to tonsil in IgA nephropathy patients predicts the remission by the treatment.

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Nagasawa, Yasuyuki; Iio, Kenichiro; Fukuda, Shinji; Date, Yasuhiro; Iwatani, Hirotsugu; Yamamoto, Ryohei; Horii, Arata; Inohara, Hidenori; Imai, Enyu; Nakanishi, Takeshi; Ohno, Hiroshi; Rakugi, Hiromi; Isaka, Yoshitaka

2014-01-01

Immunoglobulin (Ig)A nephropathy (IgAN) is the most common form of primary glomerulonephritis in the world. Some bacteria were reported to be the candidate of the antigen or the pathogenesis of IgAN, but systematic analysis of bacterial flora in tonsil with IgAN has not been reported. Moreover, these bacteria specific to IgAN might be candidate for the indicator which can predict the remission of IgAN treated by the combination of tonsillectomy and steroid pulse. We made a comprehensive analysis of tonsil flora in 68 IgAN patients and 28 control patients using Denaturing gradient gel electrophoresis methods. We also analyzed the relationship between several bacteria specific to the IgAN and the prognosis of the IgAN. Treponema sp. were identified in 24% IgAN patients, while in 7% control patients (P = 0.062). Haemophilus segnis were detected in 53% IgAN patients, while in 25% control patients (P = 0.012). Campylobacter rectus were identified in 49% IgAN patients, while in 14% control patients (P = 0.002). Multiple Cox proportional-hazards model revealed that Treponema sp. or Campylobactor rectus are significant for the remission of proteinuria (Hazard ratio 2.35, p = 0.019). There was significant difference in remission rates between IgAN patients with Treponema sp. and those without the bacterium (p = 0.046), and in remission rates between IgAN patients with Campylobacter rectus and those without the bacterium (p = 0.037) by Kaplan-Meier analysis. Those bacteria are well known to be related with the periodontal disease. Periodontal bacteria has known to cause immune reaction and many diseases, and also might cause IgA nephropathy. This insight into IgAN might be useful for diagnosis of the IgAN patients and the decision of treatment of IgAN.

The Use of Ibuprofen in Posttonsillectomy Analgesia and Its Effect on Posttonsillectomy Hemorrhage Rate.

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Pfaff, Julia A; Hsu, Kevin; Chennupati, Sri Kiran

2016-09-01

To determine the effect of ibuprofen on posttonsillectomy bleeding when compared with codeine in posttonsillectomy analgesia. Case series with chart review. Tertiary care children's hospital, Philadelphia, Pennsylvania. On July 1, 2012, our institution transitioned from acetaminophen with codeine to ibuprofen for posttonsillectomy analgesia. Pediatric patients (0-18 years old) who underwent surgery from July 1, 2010, to June 30, 2012, were placed in the codeine cohort, and those who underwent surgery from July 1, 2012, to June 30, 2014, were placed in the ibuprofen cohort. A total of 6014 patients underwent tonsillectomy between July 1, 2010, and June 30, 2014, and 211 patients presented for posttonsillectomy hemorrhage during the same period. The incidence of readmission for posttonsillectomy hemorrhage was 3.4% and 3.6% (P = .63; odds ratio [OR] = 1.07; 95% confidence interval [95% CI]: 0.811-1.410) for the codeine and ibuprofen groups, respectively, and the incidence of second operation for control of posttonsillectomy bleeding for the codeine and ibuprofen groups was 1.9% and 2.2% (P = .54; OR = 1.117; 95% CI: 0.781-1.600), respectively. Patients aged 11 to 18 years demonstrated a higher incidence of posttonsillectomy bleeding events overall. When age is controlled, multivariate logistic regression demonstrated no statistically significant increase in posttonsillectomy bleeding events among pediatric patients treated with ibuprofen versus patients treated with codeine (readmission: P = .617; OR = 0.932; 95% CI: 0.707-1.228; reoperation: P = .513; OR = 0.887; 95% CI: 0.618-1.272). Age is an independent risk factor for posttonsillectomy bleeding. When age is controlled, there is no statistically significant increase in the incidence of posttonsillectomy bleeding events among patients treated with ibuprofen when compared to patients treated with codeine. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Mutirão de cirurgias de adenotonsilectomias: uma solução viável? Adeno-tonsillectomy surgery in a joint aid effort: a feasible solution ?

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Marcos Luiz Antunes

2007-08-01

Full Text Available Os hospitais públicos sofrem com a demanda reprimida de indicações de cirurgias de adenoidectomia e/ou tonsilectomia, fazendo com que haja uma fila de espera crescente. O otorrinolaringologista se acostumou com as filas de espera, talvez por entender que este é um problema exclusivo do estado. Achamos de fundamental importância a realização de mutirões dessas cirurgias. OBJETIVOS: Padronizar a organização de mutirões, sua eficácia e viabilidade para os hospitais públicos e comparar a hemorragia pós-operatória nos mutirões e em cirurgias de rotina. MATERIAL E MÉTODOS: Estudo clínico-prospectivo tipo coorte. Foram realizados mutirões de adenotonsilectomias no período de setembro de 2004 a junho de 2006, no Hospital Estadual de Diadema, analisando-se a equipe multiprofissional envolvida e comparando a complicação hemorragia no pós-operatório com um grupo controle de cirurgias realizadas na rotina. RESULTADOS: Foram realizados 22 mutirões no período (339 cirurgias, uma média de 15,4 cirurgias por mutirão. O índice de hemorragia pós-operatória que necessitou de revisão foi de 1,48% (5/339, não diferindo estatisticamente do grupo controle, 1,37% (5/364. CONCLUSÃO: Conseguimos padronizar a realização de mutirões de cirurgias de adenotonsilectomias, dentro dos parâmetros que consideramos mais seguros, diminuindo a fila de espera das cirurgias. O índice de hemorragia no pós-operatório entre as cirurgias nos mutirões e na rotina não mostrou diferença estatisticamente significante.Public hospitals in Brazil are under capacity for adenotonsillectomies, resulting in a growing waiting line. Otolaryngologists are used to these lines, since they understand that this problem is under govern responsibility. For this reason we believe that joint aid efforts to carry out adenotonsillectomies are justified. AIM: To standardize the organization of adenotonsillectomies in joint aid efforts, its effectiveness and feasibility for public hospitals, and to compare the incidence of post-operative hemorrhage in joint aid effort surgery with that of regular surgeriy. METHODS: A clinical case-control prospective study of adenotonsillectomies done in joint aid efforts was done from September 2004 to June 2006 at the Diadema State Hospital. An analysis was made of the multiprofessional staff involved in this process, and a comparison was made of the incidence of hemorrhage in joint aid efforts and after regular surgery. RESULTS: 22 joint aid effort events for adenotonsillectomies were done during the period mentioned above (339 surgeries, an average 15.4 surgeries per event. The rate of postoperative hemorrhage requiring surgical revision was 1.48%(5/339, which did not differ statistically from the case-control group (1.37% - 5/364. CONCLUSION: We were able to standardize the results of adenotonsillectomies done in a joint aid effort to the parameters that are considered as safe. This may reduce the waiting line for this procedure. The difference in the incidence of postoperative hemorrhage in the joint aid effort and regular surgery was not statistically significant.

Prevalence and Management of Otitis Media with Effusion Amongst the School Going Children of a Rural Area in Puducherry

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Sharath Babu K

2016-04-01

Full Text Available Background :  Otitis Media with Effusion(OME also known as  Secretory Otitis Media, has been identified as the commonest middle ear condition causing deafness in children in developed countries. Neither the indication for surgical treatment nor the types and number of procedures used are uniform. Possible treatment includes myringotomy with or without insertion of ventilation tube either alone or with adenoidectomy and occasionally tonsillectomy. Aims and Objectives :  To assess the prevalence and the different modes of presentation of Otitis Media with Effusion among the rural school children of Puducherry and to assess the improvement in hearing after 6 months of surgical intervention done on patients with Otitis Media with Effusion. Materials and Methods:  A school screening camp was conducted on 600 children in the age group of 5-12 years in a government middle school near our medical college hospital for identifying children with Otitis Media with Effusion. Students with Otitis Media with Effusion were further classified into 4 groups for various interventional procedures namely adenotonsillectomy with bilateral grommet insertion (Group A, adenoidectomy with bilateral grommet insertion (Group B, bilateral grommet insertion (Group C,  bilateral myringotomy with wide field incision in the antero-inferior quadrant (Group D. Result : The prevalence was almost in equal proportions in the age group between 5-12 years and the overall prevalence of Otitis Media with Effusion among the study population was 13.3%. The adenotonsillectomy with bilateral grommet insertion procedure had shown a significant improvement in hearing, which was measured by using pure tone audiometry by assessing the mean air-bone gap, which was 9.81, 8.27 and 6.73 at the end of 6 weeks, 3 months and 6 months respectively, when compared to the other procedures.   Conclusion : Adenotonsillectomy with bilateral grommet insertion should be considered in a child with Otitis

Relative bioavailability and plasma paracetamol profiles of Panadol suppositories in children.

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Coulthard, K P; Nielson, H W; Schroder, M; Covino, A; Matthews, N T; Murray, R S; Van Der Walt, J H

1998-10-01

To determine the relative bioavailability and plasma paracetamol concentration profiles following administration of a proprietary formulation of paracetamol suppositories to postoperative children. Study A-eight children undergoing minor surgery had blood samples collected following the rectal administration of either a 250 mg or 500 mg paracetamol suppository on one day and an equivalent oral dose on the following day. A mean dose of 13 mg/kg gave a mean Cmax (Tmax) of 7.7 mg/L (1.6 h) and 4.9 mg/L (2.0 h) following oral and rectal administration, respectively. The mean relative rectal bioavailability was 78% (95% confidence interval of 55-101%). Study B-20 children undergoing tonsillectomy and/or adenoidectomy were randomly assigned to receive a postoperative dose of 500 mg of paracetamol either as 2 x 250 mg liquid filled or 1 x 500 mg hard wax Panadol suppository. A mean dose of 25 mg/kg produced mean maximum plasma paracetamol concentrations of 13.2 mg/L and 14.5 mg/L at 2.1 and 1.9 h for the hard and liquid filled suppository, respectively. The absorption rate constants and areas under the curves suggested no difference in the rate or extent of absorption between the two formulations. Absorption of paracetamol following rectal administration of Panadol suppositories to postoperative children is slower and reduced as compared to oral therapy. The hard wax and liquid filled products have similar absorption characteristics. The usually quoted antipyretic therapeutic range for paracetamol is 10-20 mg/L, although 5 mg/L may be effective. A single rectal dose of 25 mg/kg will obtain this lower concentration within 1 h of administration and maintain it for up to 6 h. When given in an appropriate dose for analgesia, maximum plasma paracetamol concentrations would be available in the immediate postoperative period if the rectal dose was given 2 h before the planned end of the procedure.

A case-control study of Drug-Induced Sleep Endoscopy (DISE) in pediatric population: A proposal for indications.

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Collu, Maria Antonietta; Esteller, Eduard; Lipari, Fiorella; Haspert, Raul; Mulas, Demetrio; Diaz, Miguel Angel; Dwivedi, Raghav C

2018-05-01

To evaluate whether and when Drug-Induced Sleep Endoscopy (DISE) changes diagnosis and treatment plan in pediatric Obstructive Sleep Apnoea Syndrome (OSAS) with the aim to identify specific subgroups of patients for whom DISE should be especially considered. A case-control study of DISE in 150 children with OSAS. Pre-operative OSA were assessed through detailed history, Chervin questionnaire, physical examination and overnight polysomnography. The group of study was divided into three subgroups according to clinical and polysomnographyc criteria: conventional OSAS, disproportional OSAS and persistent OSAS. Endoscopic evaluation of the upper airway during DISE was scored using Chan classification. Surgical treatment was tailored individually upon the basis of sleep endoscopy findings: performance of any surgery other than tonsillectomy and adenoidectomy (T&A) was considered as a change of the treatment plan. Cases and controls were compared considering presence and absence of DISE-directed extra surgery, respectively. 150 patients with mean age (SD) 56.09 (23.94) months and mean apnoea-hypopnea index (AHI) of 5.79 (6.52) underwent DISE. The conventional subgroup represented the 58.67% of the sample (n = 88), while the disproportional one counted for the 26.67% (n = 40), and the persistent one for 14.66% (n = 22) of the population. Sleep endoscopy changed the surgical plan in 4.5% of conventional OSAS, 17.5% of disproportional OSAS and 72.7% of persistent OSAS (p < 0.005). Overall, a change of the treatment plan operated by DISE was associated with a non-conventional OSAS status (OR = 6; 95% CI = 1.6-26.4). DISE is a safe procedure in children suffering from OSAS, and, despite being unnecessary in conventional cases of OSA, DISE should be considered not only in syndromic children, as previously demonstrated, but also in the general non-syndromic pediatric population, in the case of non-conventional OSA patients, and in children with persistent

The clinical observation of sucralfate suspension used for the recovery of tonsillectomy%扁桃体摘除术后硫糖铝冷混悬液的疗效

Institute of Scientific and Technical Information of China (English)

李淑洁; 刘金英; 沈桂荣; 赵玉莲; 王洪英; 刘寿芹

2004-01-01

目的:评价硫糖铝在扁桃体摘除术后止痛止血,促进白膜迅速覆盖,减少出血和感染的效果.方法:40例扁桃体摘除术后患者局部含嗽硫糖铝冷混悬液,并与对照组30例对比疗效.结果:治疗组疼痛减轻总有效率为95%,对照组术后24h无咽痛明显减轻病例.扁桃体窝白膜覆盖开始脱落平均为4.8±0.5d,对照组为6.1±0.6d,差异有高度显著性(P＜0.01).结论:硫糖铝冷混悬液服用简便,效果确切,副作用小,是扁桃体摘除术后止痛、止血,促进黏膜恢复的有效方法.

Presidential address: adjusting the art and the science of surgery.

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Traverso, L William

2007-10-01

Why are there so many opinions for surgical treatments? Why do surgeons not agree on the same definitions? To adjust the art and science of surgery, we should understand the reason behind this Tower of Babel and ourselves by grasping the three biological lessons of history. These lessons are instincts of man--our instincts have not changed for as long as there has been recorded history. The lessons were elucidated by Will and Ariel Durant and these are competition, selection, and reproduction. How might they be applied to improving our surgical science? First, competition has always forced individuals or small groups to strengthen themselves with cooperation. Cooperate or not survive. Cooperation increases with social development and technology. Next, we must realize that nature relishes diversity. We are all born unequal and diverse. The second biological lesson is selection; which individual among a diverse group of individuals will succeed (by improving)? Therefore, by nature, man's instincts provide diverse opinions and bias. This creates a myopic view when surgeons try to discern the truth. The results are the trendy bandwagons that divert us, like tonsillectomy. Too much diversity is bad, and a balance is required. Man's third lesson of history is reproduction. Better stated is that nature loves quantity. We naturally give priority to quantity over quality. To obtain quality rather than just quantity, we need the antidotes for competition and diversity--that would be cooperation using the Deming guidelines of leadership, profound knowledge, and technology. One example of this urge for quantity and diversity is our lack of standardized definitions. These three biological lessons can be summarized by viewing competition as an impediment for quality improvement in the complex challenges of modern healthcare. Cooperation (trust) is the antidote to the bandwagon effect of unproven treatments. Cooperation and technology can be joined to establish a successful team

Postoperative analgesia using diclofenac and acetaminophen in children.

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Hannam, Jacqueline A; Anderson, Brian J; Mahadevan, Murali; Holford, Nick H G

2014-09-01

Diclofenac dosing in children for analgesia is currently extrapolated from adult data. Oral diclofenac 1.0 mg·kg(-1) is recommended for children aged 1-12 years. Analgesic effect from combination diclofenac/acetaminophen is unknown. Children (n = 151) undergoing tonsillectomy (c. 1995) were randomized to receive acetaminophen elixir 40 mg·kg(-1) before surgery and 20 mg·kg(-1) rectally at the end of surgery with diclofenac suspension 0.1 mg·kg(-1) , 0.5 mg·kg(-1) , or 2.0 mg·kg(-1) before surgery or placebo. A further 93 children were randomized to receive diclofenac 0.1 mg·kg(-1) , 0.5 mg·kg(-1) , or 2.0 mg·kg(-1) only. Postoperative pain was assessed (visual analogue score, VAS 0-10) at half-hourly intervals from waking until discharge. Data were pooled with those from a further 222 children and 30 adults. One-compartment models with first-order absorption and elimination described the pharmacokinetics of both medicines. Combined drug effects were described using a modified EMAX model with an interaction term. An interval-censored model described the hazard of study dropout. Analgesia onset had an equilibration half-time of 0.496 h for acetaminophen and 0.23 h for diclofenac. The maximum effect (EMAX ) was 4.9. The concentration resulting in 50% of EMAX (C50 ) was 1.23 mg·l(-1) for diclofenac and 13.3 mg·l(-1) for acetaminophen. A peak placebo effect of 6.8 occurred at 4 h. Drug effects were additive. The hazard of dropping out was related to pain (hazard ratio of 1.35 per unit change in pain). Diclofenac 1.0 mg·kg(-1) with acetaminophen 15 mg·kg(-1) achieves equivalent analgesia to acetaminophen 30 mg·kg(-1) . Combination therapy can be used to achieve similar analgesia with lower doses of both drugs. © 2014 John Wiley & Sons Ltd.

Pseudo (Platelet-type von Willebrand disease in pregnancy: a case report

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Grover Neetu

2013-01-01

Full Text Available Abstract Background Pseudo (platelet-type-von Willebrand disease is a rare autosomal dominant bleeding disorder caused by an abnormal function of the glycoprotein lb protein; the receptor for von Willebrand factor. This leads to an increased removal of VWF multimers from the circulation as well as platelets and this results in a bleeding diathesis. Worldwide, less than 50 patients are reported with platelet type von Willebrand disease (PT-VWD. Case presentation We describe the management of platelet type von Willebrand disease in pregnancy of a 26 year old Caucasian primigravida. The initial diagnosis was made earlier following a significant haemorrhage post tonsillectomy several years prior to pregnancy. The patient was managed under a multidisciplinary team which included obstetricians, haematologists, anaesthetists and neonatologists. Care plans were made for the ante- natal, intra-partum and post-partum periods in partnership with the patient. The patient’s platelet count levels dropped significantly during the antenatal period. This necessitated the active exclusion of other causes of thrombocytopenia in pregnancy. A vaginal delivery was desired and plans were made for induction of labour at 38 weeks of gestation with platelet cover in view of the progressive fall of the platelet count. The patient however went into spontaneous labour on the day of induction. She was transfused two units of platelets before delivery. She had an unassisted vaginal delivery of a healthy baby. The successful antenatal counselling has encouraged the diagnosis of the same condition in her mother and sister. We found this to be a particularly interesting case as well as challenging to manage due to its rarity. Psuedo von Willebrand disease in pregnancy can be confused with a number of other differential diagnoses, such as gestational thrombocutopenia, idiopathatic thrombocytopenia, thrombotic thrombocytopenic purpura and pre-eclampsia; all need consideration

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS: An Evolving Concept

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Antonella Macerollo

2013-09-01

Full Text Available Pediatric autoimmune neuropsychiatric disorders associated with streptococcus infections (PANDAS originated from the observational work of Swedo and collaborators, who formalized their definition in 1998 in a set of operational criteria. The application of these criteria, which focuses on tics and obsessive-compulsive symptoms as core symptoms, has encountered difficulties, eventually leading to a high rate of misdiagnosis. In particular, the core feature represented by the association between newly diagnosed infections and neuropsychiatric symptom relapses in youths with this diagnosis could not be demonstrated by longitudinal studies. Exploratory studies aiming to identify clinical or cognitive features that could discriminate PANDAS from other pediatric obsessive-compulsive and tic disorders present methodological limitations, and therefore are not conclusive. Other behavioral features, in addition to obsessive-compulsive symptoms and tics, have been included in pediatric acute-onset neuropsychiatric syndromes (PANS and childhood acute neuropsychiatric syndromes (CANS, two new concepts recently proposed in order to define a much broader clinical spectrum encompassing etiologically diverse entities. Given the uncertainties on the clinical definition of PANDAS, it is not surprising that evidence in support of a post-infectious, immune-mediated pathophysiology is also insufficient. Anti-dopamine receptor antibodies might be relevant to both Sydenham’s chorea (SC—the prototypical post-streptococcal neuropsychiatric disorder—and some rare forms of encephalitis targeting the basal ganglia specifically, but studies exploring their association with children fulfilling Swedo’s criteria for PANDAS have been inconclusive. Moreover, we lack evidence in favor of the efficacy of antibiotic prophylaxis or tonsillectomy in patients fulfilling Swedo’s criteria for PANDAS, whereas a response to immune-mediated treatments like intravenous

Structures of non-cellular tissues of the body and their importance in otorhinolaryngology

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S. N. Shatokhina

2016-01-01

Full Text Available We present  the  results of our studies  in various pathological   conditions   in  otorhinolaryngology performed  with  a diagnostic  technology  of functional morphology  of non-cellular tissue structures  (mouth  fluid, surgical wound  exudation, blood  serum, and  others. With the  use of methods of cuniform and  marginal dehydration of biological fluids, the possibility of developing essentially novel criteria was shown, such as:• prediction  of complicated  course of post-operative wound  healing in subjects with a lamellar morphotype in the  wound  exudation  resulting from cholesterol residues due to massive cell death;• prediction  of a polypous  rhinosinusitis  relapse in subjects with an increase in the proliferation marker, anisotropic  parallels lines in the  dehydrated  serum  obtained from the  blood  taken from the inferior nasal turbinate;• diagnostics   of  the  middle  ear  cholesteatoma in children by combination of cuniform and marginal  dehydration of the  mouth  fluid. The singularity of the  technique  is based  on triple sampling  of the  fluid:  first sample  was  taken immediately  after awakening, the  second  one, after a few minutes  of active swallowing movements  and  the  third one,  after trans-tympanicair pumping.  Detection  of the  structural  signs of congestive effusion and the lamellar morphotype as a destruction marker in the third sample suggested the presence  of cholesteatoma;• assessment  of  treatment  efficacy  in  patients with chronic tonsillitis and of the indications to tonsillectomy in patients  with persisting pathological  characteristics   of  the  exudation   from the palatal tonsil lacunes throughout the whole course of conservative treatment;• determination of the grade of activity / absence of activity of laryngeal cancer by identification of a basic spherolith with various degrees  of anisotropy

Age at Exposure to Surgery and Anesthesia in Children and Association With Mental Disorder Diagnosis.

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Ing, Caleb; Sun, Ming; Olfson, Mark; DiMaggio, Charles J; Sun, Lena S; Wall, Melanie M; Li, Guohua

2017-12-01

Animals exposed to anesthetics during specific age periods of brain development experience neurotoxicity, with neurodevelopmental changes subsequently observed during adulthood. The corresponding vulnerable age in children, however, is unknown. An observational cohort study was performed using a longitudinal dataset constructed by linking individual-level Medicaid claims from Texas and New York from 1999 to 2010. This dataset was evaluated to determine whether the timing of exposure to anesthesia ≤5 years of age for a single common procedure (pyloromyotomy, inguinal hernia, circumcision outside the perinatal period, or tonsillectomy and/or adenoidectomy) is associated with increased subsequent risk of diagnoses for any mental disorder, or specifically developmental delay (DD) such as reading and language disorders, and attention deficit hyperactivity disorder (ADHD). Exposure to anesthesia and surgery was evaluated in 11 separate age at exposure categories: ≤28 days old, >28 days and ≤6 months, >6 months and ≤1 year, and 6-month age intervals between >1 year old and ≤5 years old. For each exposed child, 5 children matched on propensity score calculated using sociodemographic and clinical covariates were selected for comparison. Cox proportional hazards models were used to measure the hazard ratio of a mental disorder diagnosis associated with exposure to surgery and anesthesia. A total of 38,493 children with a single exposure and 192,465 propensity score-matched children unexposed before 5 years of age were included in the analysis. Increased risk of mental disorder diagnosis was observed at all ages at exposure with an overall hazard ratio of 1.26 (95% confidence interval [CI], 1.22-1.30), which did not vary significantly with the timing of exposure. Analysis of DD and ADHD showed similar results, with elevated hazard ratios distributed evenly across all ages, and overall hazard ratios of 1.26 (95% CI, 1.20-1.32) for DD and 1.31 (95% CI, 1.25-1.37) for

Development and Validation of a Risk Scale for Emergence Agitation After General Anesthesia in Children: A Prospective Observational Study.

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Hino, Maai; Mihara, Takahiro; Miyazaki, Saeko; Hijikata, Toshiyuki; Miwa, Takaaki; Goto, Takahisa; Ka, Koui

2017-08-01

Emergence agitation (EA) is a common complication in children after general anesthesia. The goal of this 2-phase study was (1) to develop a predictive model (EA risk scale) for the incidence of EA in children receiving sevoflurane anesthesia by performing a retrospective analysis of data from our previous study (phase 1) and (2) to determine the validity of the EA risk scale in a prospective observational cohort study (phase 2). Using data collected from 120 patients in our previous study, logistic regression analysis was used to predict the incidence of EA in phase 1. The optimal combination of the predictors was determined by a stepwise selection procedure using Akaike information criterion. The β-coefficient for the selected predictors was calculated, and scores for predictors determined. The predictive ability of the EA risk scale was assessed by a receiver operating characteristic (ROC) curve, and the area under the ROC curve (c-index) was calculated with a 95% confidence interval (CI). In phase 2, the validity of the EA risk scale was confirmed using another data set of 100 patients (who underwent minor surgery under general anesthesia). The ROC curve, the c-index, the best cutoff point, and the sensitivity and specificity at the point were calculated. In addition, we calculated the gray zone, which ranges between the two points where sensitivity and specificity, respectively, become 90%. In phase 1, the final model of the multivariable logistic regression analysis included the following 4 predictors: age (logarithm odds ratios [OR], -0.38; 95% CI, -0.81 to 0.00), Pediatric Anesthesia Behavior score (logarithm OR, 0.65; 95% CI, -0.09 to 1.40), anesthesia time (logarithm OR, 0.60; 95% CI, -0.18 to 1.19), and operative procedure (logarithm OR, 2.53; 95% CI, 1.30-3.75 for strabismus surgery and logarithm OR, 2.71; 95% CI, 0.99-4.45 for tonsillectomy). The EA risk scale included these 4 predictors and ranged from 1 to 23 points. In phase 2, the incidence of EA

Comparison of Postoperative Respiratory Monitoring by Acoustic and Transthoracic Impedance Technologies in Pediatric Patients at Risk of Respiratory Depression.

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Patino, Mario; Kalin, Megan; Griffin, Allison; Minhajuddin, Abu; Ding, Lili; Williams, Timothy; Ishman, Stacey; Mahmoud, Mohamed; Kurth, C Dean; Szmuk, Peter

2017-06-01

In children, postoperative respiratory rate (RR) monitoring by transthoracic impedance (TI), capnography, and manual counting has limitations. The rainbow acoustic monitor (RAM) measures continuous RR noninvasively by a different methodology. Our primary aim was to compare the degree of agreement and accuracy of RR measurements as determined by RAM and TI to that of manual counting. Secondary aims include tolerance and analysis of alarm events. Sixty-two children (2-16 years old) were admitted after tonsillectomy or receiving postoperative patient/parental-controlled analgesia. RR was measured at regular intervals by RAM, TI, and manual count. Each TI or RAM alarm resulted in a clinical evaluation to categorize as a true or false alarm. To assess accuracy and degree of agreement of RR measured by RAM or TI compared with manual counting, a Bland-Altman analysis was utilized showing the average difference and the limits of agreement. Sensitivity and specificity of RR alarms by TI and RAM are presented. Fifty-eight posttonsillectomy children and 4 patient/parental-controlled analgesia users aged 6.5 ± 3.4 years and weighting 35.3 ± 22.7 kg (body mass index percentile 76.6 ± 30.8) were included. The average monitoring time per patient was 15.9 ± 4.8 hours. RAM was tolerated 87% of the total monitoring time. The manual RR count was significantly different from TI (P = .007) with an average difference ± SD of 1.39 ± 10.6 but were not significantly different from RAM (P = .81) with an average difference ± SD of 0.17 ± 6.8. The proportion of time when RR measurements differed by ≥4 breaths was 22% by TI and was 11% by RAM. Overall, 276 alarms were detected (mean alarms/patient = 4.5). The mean number of alarms per patient were 1.58 ± 2.49 and 2.87 ± 4.32 for RAM and TI, respectively. The mean number of false alarms was 0.18 ± 0.71 for RAM and 1.00 ± 2.78 for TI. The RAM was found to have 46.6% sensitivity (95% confidence interval [CI], 0.29-0.64), 95

Optimization of postoperative analgesia after adenoidectomy in children

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M. A. Georgiyants

2017-04-01

Full Text Available It is known that pharyngalgia is very common after tonsillectomy. It should be emphasized that the intensity of pain after adenoidectomy in children is not less important than after adenotonsillectomy. Despite the availability of standardized pain assessment scales and existing postoperative analgesia recommendations, unresolved postoperative pain still occurs in children. The research included 117 children with an average age of 7.5 ± 0.4 years, who underwent adenoidectomy at the Department of Anesthesiology and Intensive Care of "Regional Children’s Clinical Hospital" of Kharkov city in 2014. Depending on the method of general anesthesia, patients were divided into 3 groups: group I (n = 41 those who received propofol in combination with fentanyl; group II (n = 40 those who received sevoflurane in combination with fentanyl; group III (n = 36 those who received thiopental sodium combined with fentanyl. We monitored the heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, BIS-index, heart rate variability, respiration rate, and SpO2. We determined the levels of cortisol and insulin in the blood serum, glucose level, the ratio of cortisol/insulin was calculated. Assessment of the efficiency of postoperative analgesia was performed using the Wong-Baker FACES Pain Scale («Faces» and the Oucher Scale. The result of analysis of the intensity of postoperative pain determined that at the 1st hour after the operation by the «Faces» and Oucher scales, it was significantly higher in patients of group II compared with the patients of group I and group III. The morning after the operation there was no significant difference in the pain scales, and the number of scale points showed that children from all groups did not have pain. According to the data of ANOVA it was determined that only the patients in group I with indicator ΔBIS-index «intubation – traumatic moment of operation» experienced postoperative pain

Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children.

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Carvalho, Fernando R; Lentini-Oliveira, Débora A; Prado, Lucila Bf; Prado, Gilmar F; Carvalho, Luciane Bc

2016-10-05

Apnoea is a breathing disorder marked by the absence of airflow at the nose or mouth. In children, risk factors include adenotonsillar hypertrophy, obesity, neuromuscular disorders and craniofacial anomalies. The most common treatment for obstructive sleep apnoea syndrome (OSAS) in childhood is adeno-tonsillectomy. This approach is limited by its surgical risks, mostly in children with comorbidities and, in some patients, by recurrence that can be associated with craniofacial problems. Oral appliances and functional orthopaedic appliances have been used for patients who have OSAS and craniofacial anomalies because they hold the lower jaw (mandible) forwards which potentially enlarges the upper airway and increases the upper airspace, improving the respiratory function. To assess the effects of oral appliances or functional orthopaedic appliances for obstructive sleep apnoea in children. We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 7 April 2016); Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 3) in the Cochrane Library (searched 7 April 2016); MEDLINE Ovid (1946 to 7 April 2016); Embase Ovid (1980 to 7 April 2016); LILACS BIREME (from 1982 to 7 April 2016); BBO BIREME (from 1986 to 7 April 2016) and SciELO Web of Science (from 1997 to 7 April 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials on 7 April 2016. We placed no restrictions on the language or date of publication when searching the electronic databases. All randomised or quasi-randomised controlled trials comparing all types of oral and functional orthopaedic appliances with placebo or no treatment, in children 15 years old or younger. reduction of apnoea to less than one episode per hour. dental and skeletal relationship, sleep parameters improvement, cognitive and phonoaudiological function, behavioural problems, quality of life, side effects

Estudo do efeito de distintos períodos de fixação em formalina e métodos de recuperação antigênica na técnica de imuno-histoquímica Study of the effect of different fixation times in formalin and methods of antigen retrieval in immunohistochemistry

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Maria Teresa de Seixas Alves

2005-02-01

of antibodies anti-PCNA (nuclear proliferation antigen and anti-AE1 and AE3 (citokeratins were studied. Specimens with cross section of 0,5 cm² from five Tonsils from ellective tonsillectomies done at Hospital São Paulo UNIFESP/EPM were fixed for six, 12, 18, 24 and 48 hours and embedded in paraffin for the production of 4mum sections. For HIER was used a steamer, microwave oven and pressure cooker. The level of PCNA expression was assessed by the ratio stained nuclei: total number of nuclei. The staining intensity was assessed by using Corel Photo Paint 9 and UT Morph 2.0 softwares. The present study has shown that: 1 for the detection of anti-PCNA, the use of a microwave oven provided the best results; 2 for the detection of anti-PCNA, longer fixation periods, specially after 24 hours, causes the staining intensity to decrease; 3 for the detection of AE1 and AE3, all procedures used provided equivalent levels of staining.

Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults.

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Aurora, R Nisha; Casey, Kenneth R; Kristo, David; Auerbach, Sanford; Bista, Sabin R; Chowdhuri, Susmita; Karippot, Anoop; Lamm, Carin; Ramar, Kannan; Zak, Rochelle; Morgenthaler, Timothy I

2010-10-01

appliances, which are more often appropriate in mild and moderate OSA patients, have been considered and found ineffective or undesirable (Option). UPPP as a sole procedure, with or without tonsillectomy, does not reliably normalize the AHI when treating moderate to severe obstructive sleep apnea syndrome. Therefore, patients with severe OSA should initially be offered positive airway pressure therapy, while those with moderate OSA should initially be offered either PAP therapy or oral appliances (Option). Use of multi-level or stepwise surgery (MLS), as a combined procedure or as stepwise multiple operations, is acceptable in patients with narrowing of multiple sites in the upper airway, particularly if they have failed UPPP as a sole treatment (Option). LAUP is not routinely recommended as a treatment for obstructive sleep apnea syndrome (Standard). RFA can be considered as a treatment in patients with mild to moderate obstructive sleep apnea who cannot tolerate or who are unwilling to adhere to positive airway pressure therapy, or in whom oral appliances have been considered and found ineffective or undesirable (Option). Palatal implants may be effective in some patients with mild obstructive sleep apnea who cannot tolerate or who are unwilling to adhere to positive airway pressure therapy, or in whom oral appliances have been considered and found ineffective or undesirable (Option). Postoperatively, after an appropriate period of healing, patients should undergo follow-up evaluation including an objective measure of the presence and severity of sleep-disordered breathing and oxygen saturation, as well as clinical assessment for residual symptoms. Additionally, patients should be followed over time to detect the recurrence of disease (Standard). While there has been significant progress made in surgical techniques for the treatment of OSA, there is a lack of rigorous data evaluating surgical modifications of the upper airway. Systematic and methodical investigations are

Family-centred care for hospitalised children aged 0-12 years.

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Shields, Linda; Zhou, Huaqiong; Pratt, Jan; Taylor, Marjory; Hunter, Judith; Pascoe, Elaine

2012-10-17

inclusion from 80% to 50% in this update. We also changed several other selection criteria in this update: eligible study designs are now limited to randomised controlled trials (RCTs) only; single interventions not reflecting a FCC model of care have been excluded; and the selection criterion whereby studies with inadequate or unclear blinding of outcome assessment were excluded from the review has been removed. Two review authors undertook searches, and four authors independently assessed studies against the review criteria, while two were assigned to extract data. We contacted study authors for additional information. Six studies found since 2004 were originally viewed as possible inclusions, but when the family-centred score assessment was tested, only one met the minimum score of family-centredness and was included in this review. This was an unpublished RCT involving 288 children post-tonsillectomy in a care-by-parent unit (CBPU) compared with standard inpatient care.The study used a range of behavioural, economic and physical measures. It showed that children in the CBPU were significantly less likely to receive inadequate care compared with standard inpatient admission, and there were no significant differences for their behavioural outcomes or other physical outcomes. Parents were significantly more satisfied with CBPU care than standard care, assessed both before discharge and at 7 days after discharge. Costs were lower for CPBU care compared with standard inpatient care. No other outcomes were reported. The study was rated as being at low to unclear risk of bias. This update of a review has found limited, moderate-quality evidence that suggests some benefit of a family-centred care intervention for children's clinical care, parental satisfaction, and costs, but this is based on a small dataset and needs confirmation in larger RCTs. There is no evidence of harms. Overall, there continues to be little high-quality quantitative research available about the effects

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

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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

Preoperative blood transfusions for sickle cell disease

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Estcourt, Lise J; Fortin, Patricia M; Trivella, Marialena; Hopewell, Sally

2016-01-01

ongoing trials identified. These trials were conducted between 1988 and 2011. The majority of people included had haemoglobin (Hb) SS SCD. The majority of surgical procedures were considered low or intermediate risk for developing sickle cell-related complications. Aggressive versus simple red blood cell transfusions One trial (551 participants) compared an aggressive transfusion regimen (decreasing sickle haemoglobin to less than 30%) to a simple transfusion regimen (increasing haemoglobin to 100 g/l). This trial re-randomised participants and therefore quantitative analysis was only possible on two subsets of data: participants undergoing cholecystectomy (230 participants); and participants undergoing tonsillectomy or adenoidectomy surgeries (107 participants). Data were not combined as we do not know if any participant received both surgeries. Overall, the quality of the evidence was very low across different outcomes according to GRADE methodology. This was due to the trial being at high risk of bias primarily due to lack of blinding, indirectness and the outcome estimates being imprecise. Cholecystectomy subgroup results are reported in the abstract. Results for both subgroups were similar. There was no difference in all-cause mortality between people receiving aggressive transfusions and those receiving conservative transfusions. No deaths occurred in either subgroup. There were no differences between the aggressive transfusion group and conservative transfusion group in the number of people developing: an acute chest syndrome, risk ratio 0.84 (95% confidence interval 0.38 to 1.84) (one trial, 230 participants, very low quality evidence);vaso-occlusive crisis, risk ratio 0.30 (95% confidence interval 0.09 to 1.04) (one trial, 230 participants, very low quality evidence);serious infection, risk ratio 1.75 (95% confidence interval 0.59 to 5.18) (one trial, 230 participants, very low quality evidence);any perioperative complications, risk ratio 0.75 (95% confidence