Audit of Adenotonsillar surgeries in a Tertiary Facility in Uyo, South-south Nigeria

Background:Adenoid and tonsils are lymphoid tissues that occupy the nasopharynx and tonsillar fossae and serve as the initial site of immunological contact for inhaled and ingested antigens. Adenoidectomy, tonsillectomy or adenotonsillectomy is a lifesaving surgical procedure and remains a leading reason of surgical admission in general otorhinolaryngological practice both in developed and developing countries.The study aims to audit adenotonsillar surgeries in the Department of Ear, Nose and Throat in University of Uyo Teaching Hospital, and compare findings with similar studies.Method:This is a retrospective study of patients who had adenoidectomy, tonsillectomy, or adenotonsillectomy over 5 years from January 2015 to December 2019 at the Department of Ear, Nose, and Throat, University of Uyo Teaching Hospital, Uyo, Akwa Ibom state, south-south Nigeria.Results:Atotal of 526 patients were recruited, and this accounted for 38.7% of the total ENTsurgeries performed within the study period. Ages ranged from 6 months to 72 years, with a mean age of 11.89+1.03. The majority of the patients were aged between 1-5 years and the commonest presenting symptom was snoring and mouth breathing (79.5%). Sleep-disordered breathing (55.7%) was the main indication for the surgeries. Adenotonsillectomy (61.0%) was the commonest surgery performed. About 1.0% of the patients had recurrent adenoids. Conclusion: The surgeries were of immense necessity to the patients as all presenting complaints and pre-operative diagnoses became completely resolved.

Audit of perioperative pain management in paediatric patients following tonsillectomy at a tertiary hospital in Johannesburg

Background: Adenotonsillectomy remains one of the most frequently performed surgical procedures in children. Despite improvements in anaesthetic and surgical techniques, severe pain is reported in as many as 25­50% of children. Pain assessment and knowledge of drug pharmacodynamics and pharmacokinetics in the paediatric patient, is a prerequisite for optimal care. Much has been written on perioperative pain management following tonsillectomy. However, no consensus has been reached on what the ideal analgesic regimen should be. This audit is a review of current practice at Chris Hani Baragwanath Academic Hospital. It aims to identify problems and develop possible solutions to improve anaesthetic practice. Methods: A prospective, contextual, descriptive study design using a data collection sheet was used on paediatric patients presenting for tonsillectomy. Results: Eighty-five patients aged three to 12 years of age, with ASA grading I or II, were enrolled in the study. The choice of anaesthetic was variable with a combination of simple analgesics, opioids and adjuvants. This affected postoperative pain scores. Snare dissection and monopolar cautery haemostasis, was the standard surgical technique. Surgical seniority influenced the duration of tonsillectomy, with an effect on postoperative pain scores. Conclusions: Audits are necessary to evaluate what resources are needed to optimise care. The occurrence of pain after tonsillectomy continues to be poorly managed. Appropriate premedication and fasting of clear fluids for no more than two hours, needs to be introduced. Where possible surgical technique should involve bipolar cautery and be limited to less than 45 minutes. A preemptive, multimodal, opioid-sparing anaesthetic should be routinely practised

Pediatric adenotonsillectomy in a low resource setting: Lessons and implications

Objectives: To examine the practices related paediatric adenotonsillectomy in our setting especially in relation to blood request and transfusion, routine investigations, post-operative analgesic practice and complications. Methods: We reviewed the record of paediatric patients who had adenotonsillectomy in our facility over a 5-year period to obtain relevant information to our study. Results: There were 33 males and 19 females with mean age of 3.27 ± 2.76 years. Sinus tachycardia was found in 11(21.2 %) of the subjects and T wave anomaly in 1(1.9%) of the subject. Thirty-five (67.3%) patient had adenotonsillectomy, 13(25.0 %) adenoidectomy only and 4(7.7%) tonsillectomy only. Majority of the patients (24, 46.2%) were classified as ASA physical status I. Pre-operative blood request rate was high (49, 94.3%) though the transfusion rate was 1.9 % (1 patient). Acetaminophen combined with other analgesics was used for post-operative analgesia for most of the patients. There was significant weight gain post-operatively among patient Conclusions: Cold steel adenotonsillectomy is safe and effective in our environment. We believe that there is no justification for routine pre-operative blood request as a preconditions for surgery. We also like to suggest that post-operative pain management be streamlined taking into consideration the available analgesics in our setting

L'amygdalectomie et l'adénoïdectomie à l'hôpital pour enfants de Diamniadio au Sénégal : une évaluation de 3 ans

INTRODUCTION. Les indications de l'amygdalectomie et l'adénoïdectomie sont un sujet de controverse. Notre objectif était de discuter nos indications opératoires en les confrontant à la littérature tout en précisant notre particularité dans la prise en charge des patients dans un hôpital pédiatrique sénégalais. METHODES. Etude rétrospective descriptive au service d'Oto-rhino-laryngologie de l'hôpital pour Enfants de Diamniadio du 1er janvier 2013 au 31 décembre 2015 incluant tous les patients de moins de 15 ans opérés d'une adénoïdectomie, d'une amygdalectomie ou d'une adéno-amygdalectomie. Les variables étudiées étaient l'âge, le sexe, l'indication opératoire, le type de chirurgie et la morbidité. RESULTATS. 522 patients ont été inclus. L'âge moyen était de 4 ans 9 mois avec des extrêmes de 4 mois et 15 ans. L'obstruction respiratoire chronique était la première indication opératoire (63%). Elle était dominée par le syndrome d'apnée obstructive du sommeil retrouvée chez 264 patients (50,6%). Avant l'âge de 10 ans, les indications opératoires étaient dominées par l'obstruction respiratoire chronique (68,2%). Après 10 ans, les infections prédominaient (81,5%). L'adéno-amygdalectomie était le geste chirurgical le plus réalisé (43,7%). La morbidité était de 0,6%, représentée exclusivement par un cas d'hémorragie postopératoire immédiate et deux cas d'hémorragie secondaire.CONCLUSION. L'obstruction respiratoire chronique est la principale indication opératoire particulièrement avant l'âge de 10 ans. Les complications postopératoires sont rares

Tonsillectomy Rates in the South Africa Private Healthcare Sector

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 or regional morbidity. Objectives. To describe the adeno-/tonsillectomy rate in the South African (SA) private healthcare sector and regional variations thereof. To compare local rates with international rates and assess trends in adeno-/tonsillectomy practice. Methods. Analysis of 2012 and 2013 adeno-/tonsillectomy data provided by the largest SA private healthcare funder; accounting for 30% of the medical scheme market. Rates are expressed per 100 000 people =19 years of age. Results. The tonsillectomy rate in the SA private healthcare sector was 1 888/100 000 people =19 years of age in 2012. In 2013; the rate dropped significantly (p0.001) to 1 755/100 000. This is more than double the highest national tonsillectomy rate reported in the literature. There was also considerable regional variation in this rate within SA. Discussion. The SA tonsillectomy rate is very high when compared with international trends and varies regionally within the country. The literature does not support an increased burden of disease as the reason behind this. Rather; it is differences in training and clinical practice of clinicians; as well as social and family factors; that have been implicated.Conclusion. The adeno-/tonsillectomy rate in the SA private healthcare sector is substantially higher than international norms. The reasons for this discrepancy require further consideration

Indications d'amygdalectomie à Lubumbashi : profil clinique

A l'ère où les indications d'amygdalectomie sont constamment discutées et face à l'absence des données dans notre milieu, nous avons mené cette première étude descriptive transversale multicentrique à Lubumbashi du 1er juillet 2013 au 31 décembre 2014, afin déterminer le profil clinique de l'amygdalectomie dans notre milieu. L'analyse statistique et le traitement des données ont été effectués à l'aide des logiciels Excel version 2010 et Epi info 7 version 7.1.1.14 de 2013.Sur 84 patients opérés durant la période de la présente étude, 68 cas d'amygdalectomie ou tonsillectomie ont été colligés, ce qui a représenté 81% des activités chirurgicales oto-rhino-laryngologiques (ORL). Le sexe féminin était plus représenté (53%) avec un sex-ratio H/F de 1:1,1 (0,9). L'âge médian était de 5 [1-37] ans (âge moyen 8,5 ans) et la majorité des opérés avait un âge ≤ 5 ans. Les principaux symptômes étaient dominés par la respiration bouche ouverte pendant le sommeil, la dysphagie et le ronflement pendant le sommeil. L'hypertrophie amygdalienne dans le cadre du syndrome d'apnée obstructive du sommeil et l'amygdalite récurrente étaient les indications les plus représentées avec respectivement 53% (n = 36) et 37% (n = 25). L'amygdalectomie a été couplée à l'adénoïdectomie dans 65% des cas (n = 44). L'hémorragie primaire a été la seule complication objectivée, chez un patient (1,5%). L'amygdalectomie a été réalisée en ambulatoire dans 49% des cas.L'hypertrophie amygdalienne dans le cadre du SOAS et l'amygdalite récurrente ont constitué les indications les plus fréquentes. La maîtrise de ces indications nous éviterait les interventions superfétatoires

Indications actuelles de l'adenoidectomie; de l'amygdalectomie et de l'adenoamygdalectomie a l'Hopital General de Douala

"Sur une serie de patients operes dans le service ORL de l'Hopital General de Douala; evaluer les indications de la chirurgie des vegetations adenoidiennes et de l'amygdale en fonction des criteres de l' "" Evidence Based Medecine "". MATeRIELS ET MeTHODES etude retrospective colligeant les cas d'amygdalectomie; d'adenoidectomie et d'adenoamygdalectomie sur une periode de six ans a ete entreprise. Ont ete inclus les enfants de 0 a 15 ans. Les indications operatoires ont ete repertoriees. Pour l'analyse l'utilisation de la grille standardisee d'evaluation selon les criteres de l' "" Evidence Based Medecine "" en quatre niveaux de preuve suivant le type d'etude effectue pour la pertinence des indications. ReSULTATS 100 dossiers ont ete colliges repartis en 43 adenoidectomies; 40 adenoamygdalectomies et 17 amygdalectomies. L'age moyen des adenoidectomies etait de 3;5 ans ; 5;4 ans pour l'adenoamygdalectomie et 9 ans pour l'amygdalectomie. Pour l'adenoidectomie 3 indications ont ete relevees; le syndrome d'apnee du sommeil (SAS) dans 48;8 des cas; les rhinopharyngites a repetition dans 34;8 des cas et l'otite des cas. L'adenoamygdalectomie a concerne dans 80 seromuqueuse dans 16;2 des cas le SAS et dans 20 une notion d'angine a repetition. L'amygdalectomie isolee etait plus rare que les deux autres interventions et a ete principalement realisee pour les angines a repetition. CONCLUSION Suivant les criteres de l'EBM le SAS; les rhinopharyngites a repetition et l'otite seromuqueuse sont des indications majeures des adenoamygdalectomies. Les angines a repetition sont en regression."

Tonsillectomy: vasoconstrictive hydrolytic cold dissection method

"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 some authorities are reverting back to the conventional methods. We wish to introduce the ""Vasoconstrictive hydrolytic cold dissection"" (VHCD) method. Patients and Methods: The VHCD method was described; and the outcome measures in one hundred and thirty-five patients who had the procedures were presented in . Data entrance was done with SPSS 14. Results: A total 135 patients comprising of 107 children aged 1-12 years and 28 adolescents/adults aged 14-52 years were operated upon using the VHCD between March 2009 and July 2012 by the same teams of Surgeons and Anaesthetists. The average surgical time and blood volume losses were 15 minutes and 5 mls for children and 12 mins and 10 mls for adults/adolescents; respectively. There was a single case (0.7) of post-tonsillar bleed (reactionary haemorrhage). The rest (99.3) recorded nil haemorrhage within and beyond first 2 weeks post-surgery. Conclusions: Surgeons used to other techniques of tonsillectomies may not revert to the cold steel; however; those practicing CSM will benefit from VHCD. We hereby recommend this simple; cost-effective modification of the cold steel tonsillectomy; which appears to have made dissection easier and also minimizes haemorrhage; a common complication of tonsillectomy surgery. It is timely in the advent of increased advocacy towards reversal to the conventional method of tonsillectomy. A randomized control trial is required for further evaluation of this method."

Day case adenotonsiletomy: experience of two private clinics in Nigeria

Background: adenoidectomy and tonsillectomy are among the common surgeries perform in children in otorhinoryngological practice. It was the aim of this study to evaluate the post operative mobility in patients undergoing day-case adenoidedtomy/tonsillectomy or adenotonsillectomy. Methodology: All pediatrics cases requiring adenoidectomy; tonsillectomy or both who presented at HANSA clinics Enugu (January 1990 to June 2004) and GENIKS specialist clinics Ibadan (January 2000 to June 2004) were counseled for day case surgery. The inclusion criteria were: Patients certified fit for surgery- ASA grade I or II for general Anaesthesia and had no intercurrent CVS disease or bleeding diathesis among others. Results: A total number of 144 patients requiring adenoidectomy; Tonsillectomy or both were seen at the study centers with only sixty six (45.8) meeting the inclusion criteria. Adenoidectomy constituted 47of the surgeries with over 80 of the patient age less than 7 years reactionary haemorrhage was noted in 3 (4.5) of the patient. the other complications Were non-persistent vomiting 13 (19.7); low grade fever 5 (7.6) and pain at time of discharge 23 (34.8). There were no fatalities. Conclusion: The complication rates were low. Day-case Adenoidectomy/tonsillectomy or denotonsillectomy is safe and the presence or closeness of the family members contributed greatly to patients/ post recovery as this as this had a soothing/calming effect on the patient/s

Adult tonsillectomy - are long waiting lists putting patients at risk? : otolaryngology

There is a paucity of data on morbidity associated with long waiting lists for adult tonsillectomy. The aim of this study was to assess the morbidity associated with long waiting lists for adult tonsillectomy in a developing world setting. Of 350 patients on the waiting list at Groote Schuur Hospital for 18 months or more; only 55 were contactable. This low yield (15.7) from the telephonic survey highlighted the difficulty of managing long waiting lists efficiently in a developing world setting. As only 1/55 patients on the waiting list had a complication (quinsy); it appears to be safe to delay tonsillectomy in adult patients. Only half of patients ultimately required tonsillectomy because of a natural reduction in the number of episodes of tonsillitis with time. In order to avoid unnecessary tonsillectomy we need to find better prognosticators to identify the subgroup of adult patients likely to have continued recurrent tonsillitis