Preliminary experience of surgical treatment for torus tubarius hypertrophy in children / 中华耳鼻咽喉头颈外科杂志

Objective: To assess the incidence of symptomatic torus tubarius hypertrophy (TTH) in recurred OSA in children, and to explore the preliminary experience of partial resection of TTH assisted with radiofrequency ablation. Methods: From January 2004 to February 2020, 4 922 children, who diagnosed as OSA and received adenotonsillectomy at the Department of Otolaryngology, The 4th Medical Center of the PLA General Hospital, were retrospectively reviewed. There were 3 266 males and 1 656 females, the age ranged from 1 to 14 years old(median age of 5.0 years). Twenty-two cases were identified with recurrence of OSA syndrome, and the clinical data, including sex, age of primary operation, age of recurrence and presentation, and opertation methods were analyzed. Follow-up was carried out by outpatient visit or telephone. Graphpad prism 5.0 software was used for statistical analysis. Results: Twenty-two cases were identified as recurred OSA and received revised surgery in 4 922 cases. Among these 22 cases, 11 cases were diagnosed as TTH resulting in an incidence of 2.23‰(11/4 922), 1 case was cicatricial adhesion on tubal torus (0.20‰, 1/4 922), 10 cases were residual adenoid combined with tubal tonsil hypertrophy (2.03‰, 10/4 922). Median age of primary operation was 3.0 years (range:2.4 to 6.0 years) in 11 TTH cases. Recurrent interval varied from 2 months to 5.5 years (2.4±1.9 years) after first operation. Age of revised partial resection of TTH was 7.0±2.7 years (range: 4.0 to 12.0 years). Average time interval between primary operation and revised operation was 3.5±2.1 years (range: 0.5 to 6.0 years). Individualized treatments were carried out based on partial resection of TTH assisted with radiofrequency ablation. All of 11 cases received satisfied therapeutic results without nasopharyngeal stenosis occured. Twenty-two cases were followed up for 1.6 to 13 years (median follow-up time was 6.2 years). Conclusions: TTH contributed to recurred OSA in child. TTH might be misdiagnosed as tubal tonsil hypertrophy. Partial resection of TTH assisted with radiofrequency ablation was a safty and effective treatment.

Recomendaciones para el manejo clínico del niño en el posoperatorio de adenoamigdalectomía / Recommendations for the clinical management of the child in the postoperative adenoamygdalectomy

El síndrome de apneas e hipoapneas obstructivas del sueño se asocia con una disminución de la calidad de vida, bajo rendimiento escolar y, hasta en el 40% de los niños, trastornos de conducta como hiperactividad, enuresis, ansiedad y depresión. Varios estudios demostraron que la adenoamigdalectomía es efectiva para mejorar o resolver los trastornos respiratorios del sueño. Si bien esta cirugía tiene resultados beneficiosos, no está exenta de riesgos. El dolor y el sangrado posoperatorio son las dos causas principales de morbilidad. Otras complicaciones de la cirugía son las náuseas y los vómitos posoperatorios, el retraso en la alimentación, la deshidratación, la otalgia referida, los cambios en la voz y, raras veces, la muerte.En este artículo se realizan recomendaciones sobre el cuidado posoperatorio de los niños con adenoamigdalectomía

Obstructive sleep apnea and hypopnea syndrome is associated with decreased quality of life, poor school performance and, in up to 40% of children, behavioral problems such as hyperactivity, enuresis, anxiety and depression. Several studies have shown that adenoamygdalectomy is effective in improving or resolving sleep-disordered breathing. While this surgery has beneficial results, it is not without risks. Postoperative pain and bleeding are the two main causes of morbidity. Other complications of surgery include postoperative nausea and vomiting, delayed feeding, dehydration, referred earache, voice changes, and, rarely, death. Recommendations on postoperative care for children undergoing adenoamygdalectomy are mentioned in this article.

Study on changes of voice characteristics after adenotonsillectomy or adenoidectomy in children / 中华耳鼻咽喉头颈外科杂志

Objective: To study voice changes in children after adenotonsillectomy or adenoidectomy and the relationship with the vocal tract structure. Methods: Fifty patients were recruited in this study prospectively, aged from 4 to 12 years old with the median age of 6. They were underwent adenotonsillectomy or adenoidectomy in Beijing Tongren Hospital, Capital Medical University from July 2019 to August 2020. In the cases, there are 31 males and 19 females. Thirty-six patients underwent adenotonsillectomy and 14 patients underwent adenoidectomy alone. Twenty-two children (13 males, 9 females) with Ⅰ degree of bilateral tonsils without adenoid hypertrophy and no snoring were selected as normal controls. Adenoid and tonsil sizes were evaluated. Subjective changes of voice were recorded after surgery. Moreover, voice data including fundamental frequency(F0), jitter, shimmer, noise to harmonic ratio(NHR), maximum phonation time(MPT), formant frequencies(F1-F5) and bandwidths(B1-B5) of vowel/a/and/i/were analyzed before, 3 days and 1 month after surgery respectively.SPSS 23.0 was used for statistical analysis. Results: Thirty-six patients(72.0%,36/50) complained of postoperative voice changes. The incidence was inversely correlated with age. In children aged 4-6, 7-9, and 10-12, the incidence was 83.3%(25/30), 63.6%(7/11) and 44.4%(4/9) respectively. Voice changes appeared more common in children underwent adenotonsillectomy(77.8%,28/36) than in those underwent adenoidectomy alone(57.1%,8/14), but there was no statistical difference. After operation, for vowel/a/, MPT(Z=2.18,P=0.041) and F2(t=2.13,P=0.040) increased, B2(Z=2.04,P=0.041) and B4(Z=2.00,P=0.046) decreased. For vowel/i/, F2(t=2.035,P=0.050) and F4(t=4.44,P=0.0001) increased, B2(Z=2.36,P=0.019) decreased. Other acoustic parameters were not significantly different from those before surgery. The F2(r=-0.392, P =0.032) of vowel/a/and F2(r=-0.279, P=0.048) and F4 (r=-0.401, P =0.028) of vowel/i/after adenotonsillectomy were significantly higher than those of adenoidectomy alone. Half of patients with postopertive voice changes can recover spontaneously 1 month after surgery. Conclusions: Voice changes in children underwent adenotonsillectomy or adenoidectomy might be related to their changes in formants and bandwidths. The effect of adenotonsillectomy on voice was more significant compared with that of adenoidectomy alone. The acoustic parameters did not change significantly after surgery except MPT.

Evaluación del impacto de la apnea obstructiva del sueño (OSA) Gestión de la calidad de vida (QoL) en pacientes pediátricos: un estudio transversal / Assessing the Impact of Obstructive Sleep Apnea (OSA) Management on Quality of Life (QoL) in Pediatric Patients: A Cross-Sectional Study

Objective: The study aims to assess the impact of obstructive sleep apnea on quality of life in pediatric patients along with their management approaches. Methodology: The study has applied a cross-sectional design to recruit children, visiting ENT clinics with the suggestion of obstructive sleep apnea. History and OSA assessment were collected for these children from the hospital. Besides this, OSA-18 questionnaire was used to collect the data, translated into Arabic language for respondents' feasibility. Results: A total of 24 patients (40%) were able to cure with medical treatment, whereas 36 patients (60%) were provided with surgical treatment. There were significant association between medical management and parental smoking (p-value=0.011), OSA score (p-value-0.003) and the size of adenoid (p-value=0.008). A significant association was also shown between size of adenoid and severity of OSA18 (p-value=0.031). No significant difference was shown between parental smoking, allergic rhinitis and severity of OSA. Conclusion: Although the surgical management is still the main modality in treating OSA, medical treatment plays an important role especially in cases with mild OSA, small adenoids and indoor smoking.

Características posoperatorias de la faringoplastia combinada con amigdalectomía en comparación con la amigdalectomía en niños con síndrome obstructivo de apnea del sueño / Postoperative characteristics of combined pharyngoplasty and tonsillectomy versus tonsillectomy in children with obstructive sleep apnea syndrome

Objetivo. Identificar las ventajas posoperatorias de la amigdalectomía en conjunto con la faringoplastia en comparación con la amigdalectomía sola en niños con apnea obstructiva del sueño. Métodos. En un estudio prospectivo observacional, los pacientes que cumplían con los criterios del estudio fueron asignados aleatoriamente a dos grupos: el grupo de amigdalectomía y faringoplastia, y el grupo de solo amigdalectomía. En ambos grupos, también se practicó adenoidectomía a los pacientes con vegetaciones. Se compararon los procesos de cicatrización en la herida faríngea y las proporciones hemorrágicas. Además, se evaluó la función velofaríngea posoperatoria. Resultados. La faringoplastia junto con la amigdalectomía se practicó en 328 niños con apnea obstructiva del sueño debido a hipertrofia amigdalina, y la amigdalectomía sola, en 275 niños. Estas cohortes no mostraban diferencias demográficas significativas. Por otro lado, se encontró que la pérdida de sangre fue significativamente menor en el grupo que recibió amigdalectomía y faringoplastia (p < 0,01), y el proceso de cicatrización fue notablemente más breve. La función velofaríngea posoperatoria no resultó afectada. Conclusiones. En comparación con la amigdalectomía, la amigdalectomía junto con la faringoplastia redujeron la duración del proceso de cicatrización y la pérdida de sangre; no obstante, las complicaciones posoperatorias no aumentaron. En nuestra opinión, la combinación de faringoplastia y amigdalectomía reúne un gran potencial en el tratamiento de los niños con apnea obstructiva del sueño.

Purpose. The study aims to identify the postoperative advantages of tonsillectomy in conjunction with pharyngoplasty and tonsillectomy alone in children with obstructive sleep apneas. Methods. In a prospective observational study, patients who met the study criteria were randomly divided into two groups: tonsillectomy and pharyngoplasty group, and tonsillectomy alone group. In both groups, adenoidectomy was also performed in patients with adenoid hypertrophy. Differences in their healing processes in the pharyngeal wound and their hemorrhage proportions were compared. Furthermore, postoperative velopharyngeal function was also assessed. Results. Pharyngoplasty together with tonsillectomy was performed in 328 children with obstructive sleep apnea from tonsillar hypertrophy, and tonsillectomy was performed in 275 children. These cohorts did not reveal any significant demographic differences between groups. Furthermore, blood loss was found to be significantly decreased in the tonsillectomy and pharyngoplasty group (P <0.01), and the healing process was markedly shorter. Postoperative velopharyngeal function was not affected. Conclusions. Tonsillectomy in conjunction with pharyngoplasty reduced the duration of the healing process and blood loss, compared with tonsillectomy alone; however, postoperative complications did not increase. We consider pharyngoplasty in conjunction with tonsillectomy has great potential in the treatment of children with obstructive sleep apnea.

Amigdalo adenoidectomía en pacientes con comobilidades / Adenotonsillectomy in patients with comorbidities

La adenoamigdalectomía es una de las cirugías más frecuentemente realizadas en los pacientes menores de 15 años. Es considerada una cirugía de mediana complejidad. No está exenta de riesgos y sus indicaciones deben ser muy bien evaluadas: la obstrucción de la vía aérea superior causada por hiperplasia y las infecciones bacterianas recurrentes son las indicaciones más frecuentes de amigdalectomía, y adenoidectomía. Objetivo: Describir las características clínico-epidemiológicas de la población a quien se le practica adeno-amigdalectomía portadores de hipertrofia amigdalina y vegetaciones adenoideas (HAVA) en el Hospital J.P Garrahan, sus complicaciones y el tiempo de estadía hospitalaria. Materiales y métodos: estudio descriptivo, observacional, retrospectivo y transversal, con revisión de Historias clínicas de los pacientes adeno-amigdalectomizados entre Enero 2015 a Marzo 2016. Resultados: Se realizó amigdalectomía y/o adenoidectomía en 68 pacientes. 36 masculinos, 32 femeninos. 93% (63/68) presentaban comorbilidades. El 7% (5/68) eran niños previamente sanos. Promedio de edad: 12,5 años (rango 1-16 años), mediana de edad 6 años. Tipos de comorbilidades: síndromes genéticos 18/63, antecedente de transplantes sólidos o alogénicos de médula ósea 12/63, obesidad 6/68, patología de base con compromiso muscular 4/63, patologías hematológicas 2/63, pacientes neurológicos 12/63, otros 9/63. Presentó sangrado en el postoperatorio inmediato 1/68. El tiempo de internación promedio fue de 3 días (AU)

Adenotonsillectomy is one of the most frequently performed surgeries in patients under 15 years of age. It is considered an intermediate surgery that is not devoid of risks and its indications should be well evaluated. Upper airway obstruction caused by hyperplasia and recurrent bacterial infections are the most common indications for tonsillectomy and adenoidectomy. Objective: To describe the clinical and epidemiological features of a series of patients who underwent adenotonsillectomy at Hospital J. P. Garrahan because of tonsillar hypertrophy and adenoid vegetation (THAV) assessing complications and the time of hospital stay. Material and methods: A descriptive, observational, retrospective and cross-sectional study was conducted consisting of a review of the clinical charts of patients who underwent adenotonsillectomy between January 2015 and March 2016. Results: Tonsillectomy and/or adenoidectomy was performed in 68 patients. 36 male, 32 female. Overall, 93% (63/68) presented with comorbidities; 7% (5/68) were previously healthy children. Mean age: 12.5 years (range, 1-16 years), median age: 6 years. Type of comorbidity: genetic syndromes 18/63, history of solid organ or allogeneic bone marrow transplantation 12/63, obesity 6/68, underlying muscular disorder 4/63, hematological disorders 2/63, neurological disorders 12/63, others 9/63. One patient had a hemorrhage in the immediate postoperative period 1/68. Mean hospital stay was 3 days (AU)

Efficacy of minimally invasive tonsil surgery for treatment of obstructive sleep apnea-hypopnea syndrome in children

This study aimed to investigate the efficacy of minimally invasive tonsil surgery for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) in children. Tonsil ablation or turbinate reduction was performed on 49 pediatric patients with OSAHS by minimally invasive tonsil surgery. In order to evaluate the efficacy of surgery, a comparison was conducted between pre-operation and post-operation data in terms of the symptoms, signs and polysomnography test. Total effectiveness rate of the surgery was 83.7%. Subgroup analysis was also performed based on the severity of their conditions: mild, moderate, and severe groups had an effectiveness rate of 90.0, 88.9, and 66.7%, respectively (Hc=6.665, P<0.05). Postoperatively, the apnea-hypopnea index, the minimum oxygen saturation (SaO2), and corresponding symptoms improved compared to pre-operation conditions (P<0.05). Minimally invasive tonsil surgery was a safe and effective method for treating OSAHS in children.

Adenoamigdalitis hemorrágica espontánea, revisión de la literatura y presentación de tres casos / Spontaneous hemorrhagic adenotonsillitis, literature revision and presentation of three cases

La amigdalitis hemorrágica espontánea define al sangrado no iatrogénico de las amígdalas. Es una patología generalmente secundaria a infecciones locales comunes como la amigdalitis, siendo una consecuencia de una erosión de vasos de pequeño calibre localizados en el órgano sangrante y que ha logrado su control en la actualidad gracias al advenimiento de la antibioticoterapia precoz. Se presenta constantemente dentro de las indicaciones de amigdalectomía, pero, en su mayoría, se asume como entidad teórica dada esta baja incidencia y prevalencia. Es importante para su manejo adecuado, mantener la indicación y procurar que ésta no sea olvidada por parte de los especialistas. En esta revisión, presentamos tres casos clínicos de adenoamigdalitis hemorrágica espontánea, revisión de la literatura, destacando un paciente con sangrado exclusivo del adenoides, entidad no descrita previamente en la literatura.

Spontaneous hemorrhagic tonsillitis defines non iatrogenic bleeding of the tonsils. It is a clinical entity generally secondary to common local infections like tonsillitis, being a consequence of an erosion of the small peripheral vessels, and that has been controlled in present time thanks to the advent of early antibiotic therapy. It is constantly presented amongst the indications for tonsillectomy, but, it is mostly assumed as a theoretic entity given its low incidence and prevalence. It is important, for its correct management, to maintain the indication and to seek for it not to be forgotten by the area s specialists. In this article, we present three clinical cases of hemorrhagic adenotonsillitis, detailing one where exclusive bleeding of the adenoids, an entity not yet described in the literature, is present.

Reoperaciones posadenoidectomía por hiperplasia adenoidea obstructiva / Post-adenoidectomy reoperations due to obstructive adenoid hyperplasia

Introducción: La incidencia de reoperación posadenoidectomía, ya sea una segunda adenoidectomía o una amigdalectomía, no es conocida en nuestro medio. Publicaciones extranjeras muestran 2% de readenoidectomías y 8% de amigdalectomías posteriores. Objetivo: Describir las adenoidectomías efectuadas en nuestro centro, evaluar la prevalencia de reoperaciones y buscar posibles factores asociados a éstas. Material y método: Estudio retrospectivo descriptivo y analítico. Se revisaron fichas de pacientes adenoidectomizados por roncopatía con pausas respiratorias entre enero de 1999 y diciembre 2010. Se registraron datos demográficos, controles y nasofaringolaringoscopías (NFL). Se consignaron las reoperaciones (readenoidectomías y amigdalectomías). Resultados: Se revisaron 106 fichas. Un 55,7% de los pacientes eran hombres. A la NFL, 42% de los pacientes tenían adenoides grado 3y 58% grado 4 de Parikh. Un 5,6% de los pacientes fueron reoperados (1 adenoidectomía y 5 adenoamigdalectomías). Se observó diferencia significativa en edad (p =0,04) y tamaño amigdalino (p =0,004) entre los reoperados y lo no reoperados. No hubo asociación por sexo (p =0,45), asma (p =0,31) ni rinitis (p =0,18). Sin embargo, a la regresión logística multivariada, ninguna variable se asoció significativamente de manera independiente con la necesidad de reoperación. Conclusión: La prevalencia de reoperaciones fue similar a la publicada, no encontrándose asociación con otros factores.

Introduction: The incidence of post-adenoidectomy reoperation, be it a second adenoidectomy or a tonsillectomy, is unknown within our environment. Foreign publications show a 2% of re-adenoidectomies and an 8% of ulterior tonsillectomies. Aim: To describe the adenoidectomies performed at our center, to assess the prevalence of reoperations, and to seek possible associated factors to the latter. Material y method: Descriptive and analytical retrospective assessment. A review was performed of records for patients that between January of 1999 and December of 2010 underwent adenoidectomy on account of snoring pathology. Demographics, controls, nasopharyngolaryngoscopies and reoperations (re-adenoidectomies and tonsillectomies) were recorded. Results: The review entailed checking 106 records. 55,7% of patients were men. 42% of patients had Parikh?s Grade III adenoids and 58% showed Grade IV ones. 5,6% of patients underwent reoperation. A significant difference could be observed in age (p=0,04) and tonsillar size (p=0,004) between those that had and had not undergone reoperation. There was no gender association (p=0,45), neither for asthma (p=0,31) or rhinitis (p=0,18). Yet, by multivariate logistic regression, no variable was significantly associated by itself to the need for reoperation. Conclusion: Reoperation prevalence was similar to that published, and no association to other factors was discovered.

Poliposis linfangiomatosa de amígdalas palatinas y adenoides: reporte de un caso / Lymphangiomatous polyps of adenoids and palatine tonsils: one case report

Los pólipos linfangiomatosos son malformaciones congénitas de tipo hamartomatosas caracterizados histológicamente por una proliferación linfática vascular con distintos grados de componente fibroso, adiposo y linfático, cubiertos por un epitelio escamoso. Dado a que se conocen por distintos nombres en la literatura, sólo se han descrito alrededor de 30 casos de pólipos linfagiomatosos como tal. De etiopatogenia desconocida, se presentan como una masa polipoidea o papilomatosa en las amígdalas palatinas, con sintomatología variable. Su diagnóstico definitivo es histológico tras una resección completa. No se han reportado casos de malignización ni recurrencia. En el presente trabajo se reporta el caso de un paciente de 5 años con historia de crecimiento amigdalino bilateral de dos años de evolución. La biopsia definitiva demuestra una poliposis linfangiomatosa de amígdalas palatinas y adenoides.

Lymphangiomatous polyps are hamartomatous congenital malformations. They are histologically characterized by a vascular lymphatic proliferation associated with fibrous, adipose and lymphatic components covered by squamous epithelium. There are only 30 cases described in the literature by the name of lymphangiomatous polyp, since it has multiple denominations. Even though their etiopathogenesis is unknown, their clinical presentation is described as a polypoid mass in the palatine tonsils, which may have multiple manifestations. The diagnosis is made histologically after complete resection. There have not been reports of malignant transformation nor recurrence. We present a case of a five year old patient with history of bilateral palatine tonsil growth. Final biopsy described lymphangiomatous polyps of adenoids and palatine tonsils.

Repercussão da adenotonsilectomia sobre o sistema imune a curto e longo prazo / Short and long term impact of adenotonsillectomy on the immune system

As tonsilas palatinas e faríngea são órgãos linfoides imunologicamente reativos, que manifestam anticorpos específicos e atividade de células B e T em resposta a uma variedade de antígenos, desempenhando funções de imunidade humoral e celular. Os possíveis efeitos imunológicos da adenotonsilectomia ainda permanecem controversos. OBJETIVO: O propósito desse estudo foi investigar o impacto da tonsilectomia na imunidade celular e humoral em crianças a curto e longo prazo. MÉTODO: Desenho do estudo: longitudinal prospectivo. Foram incluídas 29 crianças com indicação de adenotonsilectomia por hipertrofia adenoamigdaliana. IgA, IgM e IgG séricas e contagem de linfócitos foram analisados em 3 períodos: antes, 1 a 2 meses (curto prazo) e 12 a 14 meses (longo prazo) após o procedimento cirúrgico. RESULTADOS: Houve aumento estatisticamente significante de linfócitos TCD4+ a curto prazo após adenotonsilectomia. Os valores de IgA e IgG apresentaram diminuição significante a longo prazo, mas permaneceram dentro dos parâmetros de normalidade para a faixa etária. CONCLUSÃO: Os resultados do presente estudo indicam que a adenotonsilectomia, tanto a curto como a longo prazo, não apresenta repercussão negativa sobre a imunidade celular e humoral das crianças submetidas a este procedimento.

Palatine and pharyngeal tonsils are immune reactive lymphoid organs that manifest specific antibodies and B/T-cell activity to respond to a variety of antigens. They perform humoral and cellular immune functions. The possible effects of adenotonsillectomy upon the immune system remain controversial. OBJECTIVE: To study the short and long-term impacts of tonsillectomy upon the cellular and humoral immunity of children. METHOD: This longitudinal prospective study included 29 children referred to adenotonsillectomy for adenotonsillar hypertrophy. Serum IgA, IgM, and IgG and lymphocyte counts were analyzed at three points in time: before surgery, 1-2 months after surgery (short term), and 12-14 months after surgery (long term). RESULTS: TCD4+ cell counts were significantly increased shortly after surgery. IgA and IgG values were significantly reduced in the long run, but were within normal ranges for this age group. CONCLUSION: This study indicated that adenotonsillectomy does not pose negative short or long term impacts upon the cellular and humoral immunity of children submitted to the procedure.

Assimetria de tonsilas palatinas: experiência de 10 anos do serviço de otorrinolaringologia do Hospital de Clínicas da Universidade Federal do Paraná / Palatine tonsils asymmetry: 10 years experience of the otorhinolaryngology service of the Clinical Hospital of the Federal University of Paraná

Introdução: Poucos pacientes com amígdalas palatinas assimétricas apresentam linfoma, entretanto a maioria dos linfomas em amígdalas palatinas cursam com assimetria amigdaliana. Objetivo: Relatar o perfil dos pacientes e das alterações histopatológicas em pacientes submetidos a adenoamigdalectomia/amigdalectomia com amígdalas palatinas desproporcionais. Método: Estudo retrospectivo, baseado na análise de dados do Banco de Dados do Serviço de Anatomia Patológica e na revisão dos prontuários de pacientes submetidos a adenoamigdalectomias e amigdalectomias com assimetria de amígdalas palatinas durante o período de outubro de 1999 a outubro de 2009 no Hospital de Clínicas (HC) da Universidade Federal do Paraná (UFPR). Resultados: Foram incluídos 50 pacientes, com idade entre 3 a 53 anos, idade média de 14,05 anos. O exame anatomopatológico evidenciou 48 pacientes (96%) com hiperplasia linfoide e 2 casos de linfoma (4%). Estes eram homens de 40 e 53 anos com queixa de aumento unilateral da amígdala, um deles apresentava outros sintomas (astenia e emagrecimento). Ao exame físico: desproporção amigdaliana, sem envolvimento de outros órgãos ou linfonodos. Conclusões: Nosso estudo concorda com a literatura quanto aos linfomas serem mais comuns em homens, o paciente ser o primeiro a notificar o aumento de volume e a assimetria ser maior que 2 graus entre as amígdalas palatinas em casos de linfoma. Embora raro, mesmo na presença de disparidades, há chances da assimetria cursar com um quadro maligno. A necessidade de avaliação anatomopatológica de uma peça deve ser considerada juntamente a outros dados clínicos que sugiram um quadro maligno em vigência.

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.

Técnicas quirúrgicas actuales en adenoamigdalectomía / Adenotonosillectomy current surgical techniques

Las indicaciones de la amigdalectomía y la adenoidectomía no han variado significativamente en las últimas décadas. En la actualidad, una gran variedad de métodos quirúrgicos están disponibles para realizar estos procedimientos, todos los cuales son esencialmente seguros y efectivos. La posibilidad de visualizar el campo operatorio rinofaríngeo a través de una cámara adosada a un endoscopio ha permitido reducir las recurrencias sintomáticas y las complicaciones post-operatorias. Respecto a la amigdalectomía, cobran cada día más importancia nuevas técnicas como son la ablación por radiofrecuencia o las resecciones intracapsulares que permiten disminuir las tasas de hemorragia y el dolor post-operatorio. La decisión de optar por una técnica en particular dependerá de una serie de factores: indicación de la cirugía (infección vs. obstrucción), disponibilidad de equipamiento en pabellón, posibilidad de asumir costos adicionales y preferencias del cirujano.

The indications for adenotonsillectomy have not been changed significlantly in the last decades. Currently, a great variety of surgical procedures are available and are all essentially safe and effective. Regarding tonsillectomy, everyday new techniques are becoming more popular, such as coblation, radiofrecuency, or intracapsular resection that allows a decrease in the incidente of post operative hemorrhage and pain. The use of an endoscope and camera to visualize the rhino pharynx has reduced the recurrence of adenoids and decreased post operative complications. The decision for one particular surgical technique will vary depending of several factors, such as infection versus obstruction, availability of equipment, the possibility of assuming extra cost, and the preference of each surgeon.

Avaliação do impacto da adenotonsilectomia sobre a qualidade de vida em crianças com hipertrofia das tonsilas palatinas e faríngeas / Assessing the impact adenotonsilectomy has on the lives of children with hypertrophy of palatine and pharyngeal tonsils

A hipertrofia das tonsilas palatinas e faríngeas é extremamente comum na infância, sendo um dos problemas mais freqüentes do consultório do otorrinolaringologista, podendo prejudicar a qualidade de vida das crianças. OBJETIVO: Avaliar o impacto da adenotonsilectomia sobre a qualidade de vida das crianças que apresentam aumento do volume das tonsilas. MATERIAL E MÉTODOS: Estudo de coorte contemporâneo longitudinal. Foi aplicado a setenta e cinco pais ou responsáveis por crianças submetidas a adenotonsilectomia um questionário específico para a avaliação da qualidade de vida, OSD-6, antes do procedimento cirúrgico e trinta dias após. RESULTADOS: A adenotonsilectomia proporcionou significativa diminuição na pontuação obtida no questionário. DISCUSSÃO: Ronco e a obstrução nasal foram os sintomas responsáveis pelas maiores pontuações nos questionários. Existe grande preocupação dos pais com o ronco das crianças e pobre correlação estatística entre o grau de obstrução e a pior qualidade de vida. CONCLUSÃO: A adenotonsilectomia apresenta impacto relevante na qualidade de vida das crianças com hipertrofia das tonsilas.

The hypertrophy of the palatine and pharyngeal tonsils is extremely common in children, being one of the most frequent causes of visits to otolaryngologists and such problem can impair the child's quality of life. AIM: to evaluate the impact of adenotonsillectomy on the lives of children with hypertrophied tonsils. MATERIALS AND METHODS: Contemporary longitudinal cohort study. A specific questionnaire used to evaluate the quality of life - OSD-6, was given to seventy five parents or guardians of children previously submitted to adenotonsillectomy, before the surgery and thirty days afterwards. RESULTS: The adenotonsillectomy provided a significant reduction in the questionnaire score. DISCUSSION: Snoring and nasal obstruction were the symptoms with the highest scores. There is a great concern from the parents with the snoring of the children and a poor statistic correlation between the degree of obstruction degree and a worse quality of life. CONCLUSION: Adenotonsillectomy causes a relevant impact in the quality of life of children with tonsil hypertrophy.

Estudo das medidas pôndero-estaturais em crianças adenotonsilectomizadas / Study of weight and height development in children after adenotonsillectomy

A observação clínica diária do retardo de crescimento pôndero-estatural em crianças portadoras de hipertrofia obstrutiva das tonsilas faríngeas e palatinas é prática rotineira na otorrinolaringologia pediátrica e a correção cirúrgica dessa condição, em tempo hábil, através da adenotonsilectomia permite a retomada desse crescimento ("catch up growth"). OBJETIVO: Investigar o real ganho pôndero-estatural presente nessa população quando tratadas cirurgicamente. MATERIAL E MÉTODO: Através de um estudo clínico prospectivo, acompanhou-se durante 6 (seis) meses dois grupos de crianças portadoras de hipertrofia tonsilar faringopalatina, sendo o grupo 1 submetido à intervenção cirúrgica e o grupo 2, não. Todos os pacientes passaram pela aferição das medidas antropométricas (peso e altura), incluindo seus percentis para idade, no início e ao fim dos 6 (seis) meses. RESULTADOS: Enquanto o grupo 1 aumentou sua média final de altura em relação à média inicial em 6,66cm, o grupo controle aumentou sua média em 1,9cm (p=0,0004). Em relação ao peso, o grupo 1 aumentou em média 2150g, sendo que o grupo 2 apresentou aumento médio de 690g (p=0,0010). CONCLUSÃO: As crianças submetidas à adenotonsilectomia adquirem um maior potencial de crescimento pôndero-estatural em relação às crianças que não foram tratadas cirurgicamente.

The daily clinical observation of weight-height growth delays in children with obstructive hypertrophy of the pharyngeal and palatine tonsils is a workaday practice in pediatric otorhinolaryngology, and the surgical correction of this condition, when properly done in time, through adenotonsillectomy, can lead to a "catch up growth". AIM: To investigate the real weight-height gain present in this population when they are surgically treated. MATERIALS AND METHODS: Through a clinical prospective study, two groups of children carrying pharyngopalatine hypertrophy were followed up: group 1 was submitted to surgical intervention, and group 2 was not. All patients underwent standardization of anthropometrical measurements (weight and height), including their age-related percentiles, in the beginning and at the end of 06 (six) months. RESULTS: While group 1 increased its height average in relation to the initial average in 6.66cm, the control group increased its average in 1.9cm (p=0.0004). In relation to weight, group 1 increased 2150g in average, while group 2 presented an average increase of 690g (p=0.0010). CONCLUSIONS: The children that underwent adenotonsillectomy acquired a higher weight-height growth potential in relation to those children who were not operated.

Impacto na qualidade de vida nos pacientes adenoamigdalectomizados / Adenotonsillectomy impact on children´s quality of life

Introdução: Adenoamigdalectomia é o procedimento cirúrgico mais realizado na faixa etária pediátrica, entretanto ainda sofre certo descrédito pelos profissionais da área médica com relação a seus resultados pósoperatórios. Objetivo: Este estudo compara os sinais e sintomas pré e pós-operatórios demonstrando os efeitos da adenoamigdalectomia sobre a qualidade de vida desses pacientes. Método: Foram avaliados 100 pacientes (47 mulheres e 53 homens) entre 1 e 16 anos com queixa de sintomas obstrutivos e outros sintomas relacionados à hipertrofia das tonsilas palatina e faríngea. Esses pacientes foram submetidos à adenoamigdalectomia. Um questionário foi aplicado aos pais ou responsáveis dos pacientes previamente à cirurgia e no seguimento de 5 meses de pós-operatório. Foram avaliados: sofrimento físico, distúrbios do sono, problemas de fala e deglutição, desconforto emocional, limitações de atividade, incômodo e/ou preocupação dos pais com o ronco das crianças. Resultado: Como resultado obtemos significativa melhora na qualidade de vida dos pacientes submetidos à adenoamigdalectomia, comprovada através de validação estatística (p < 0,05) pelo teste T-Student.

Introduction: Adenotonsillectomy is the most common surgical procedure in pediatric patients; however, there is some concern about its postoperative results. Objective: This study compares the pre- and postoperative signs and symptoms, by showing the adenotonsillectomy effects on patients' quality of life. Method: One hundred patients, aging from 1-16 years (47 females and 53 males), with obstructive symptoms and other adenoids and tonsils hypertrophy related symptoms, were studied. These patients were submitted to tonsillectomy. A questionnaire was applied to parents or tutors before surgery and in the 5-month-postoperative follow-up. Physical distress, sleep disorders, speech and deglutition disorders, psychological stress, activity limitation, parents' concern about children's snore were evaluated. Result: There was a significant improvement on the quality of life of the adenotonsillectomized patients, which was confirmed through statistical validation (p<0,05) in T-student test.

Perfil de pacientes submetidos à adenoidectomia, amigdalectomia e adenoamigdalectomia pela Disciplina de Otorrinolaringologia da UNISA / Profile of patients submitted to adenoidectomy, tonsillectomy and adenoidectomy with tonsillectomy in the UNISA

Introdução: Apesar da evolução na prevenção e tratamento medicamentoso das infecções das tonsilas faríngeas e palatinas, em algumas situações o tratamento operatório está indicado e pode estar sujeito a algumas intercorrências ou complicações. Objetivo: O estudo visou à análise do perfil dos pacientes submetidos a tratamento operatório das adenóides e amígdalas, atendidos na Disciplina de Otorrinolaringologia UNISA no período de janeiro/2002 a janeiro/2003 e janeiro/2006 à Agosto/2006. Método: Foi realizado um estudo retrospectivo dos prontuários onde foram investigados: idade, sexo, indicação operatória, tipo e duração do tratamento operatório e complicações pós-operatórias. Resultado: Os dados levantados mostraram que houve uma maior freqüência no sexo masculino (54,66%) sobre o sexo feminino (45,33%). As principais indicações operatórias foram para os casos de respirador oral (70,93%), otites média secretora (16,8%) e amigdalite de repetição ou abscesso periamigdaliano (8,0%). Predominou a faixa etária de 6 a 10 anos (41,86%), seguida da idade de 1 a 5 anos (40,53%). A operação de adenoamigdalectomia foi realizada em 75,73% dos casos, sendo a adenoidectomia em 17,86% e a amigdalectomia em 6,4%. A ocorrência de sangramento foi a única complicação pós-operatória referida em 0,8% do total de casos analisados. Conclusão: A análise dos resultados permitiu concluir que os dados encontrados condizem com literatura pertinente exceto pela faixa etária dos pacientes de 1 a 5 anos que se mostrou elevada comparada a encontrada na literatura, provavelmente pelas condições sociais da população atendida.

Introduction: In spite of the evolution in the prevention and treatment of the infections of the pharyngeal and palatine tonsils, in some situations the operative treatment is suitable and it can be subject the some intercurrence or complications. Objective: The study sought the analysis of the patients' profile submitted to operative treatment of the adenoid ones and amygdale, assisted in the Discipline of Otorhinolaryngology UNISA in the january/2002 period to the january/2003 and January/2006 period to the August/2006. Method: Took place a retrospective study of the handbook where were investigated: age, sex, operative indication, type and duration of the operative treatment and postoperative complications. Results: The lifted up data showed that a small prevalence male existed (54,66%) on the feminine sex (45,33%). The main operative indications went to the cases of oral respirator (70,93%), otitis media with effusion (16,8%) and repetition amygdalitis or peritonsillar abscess (8,0%). The age group prevailed from 6 to 10 years (41,86%) following by the age from 1 to 5 years (40,53%). The adenoidectomy with tonsillectomy operation was accomplished in 75,73% of the cases, and the adenoidectomy in 17,86% and the tonsillectomy in 6,4%. The bleeding occurrence was the only postoperative complication referred in 0.8% of the total of analyzed cases. Conclusion: The analysis of the results allowed concluding that the found data are suitable with the one of pertinent literature, except that the patient's percentage in the age group from 1 to 5 years was higher, due to the socioeconomic profile of the population assisted.

Hipertrofia adenoamigdaliana como causa de hipertensão pulmonar / Adenotonsillar hypertrophy as cause of pulmunari hypertension

A hipertrofia adenoamigdaliana figura como uma das principais causas de hipertensão pulmonar na infância, mas poucos são seus relatos na literatura, possivelmente devido a pouca investigação e a remissão do quadro após a adenoidectomia...

The hypertrophy adenotonsilar figure as one of the most important causes of pulmonary hypertension in infancy but there are few records in literature had too link inquiry and the remission after the adenotonsillectomy...

Management dilemma of otitis media with effusion [OME]

The aim of this study was to propose a management protocol for OME and to assess the role of different treatment modalities cited in the literatures. Our hypothesis was that presence of adenoid enlargement in cases of OME usually necessitates surgical treatment in the form of adenoidectomy with or without ventilation tubes insertion. Retrospective study that included 175 patients complaining of OME, between 1996 and 2004 with a minimum follow up of 6 months. Patients were divided into 2 groups according to presence or absence of adenoid enlargement; data concerning management and follow up were gathered and statistically analyzed

Análise histopatológica de produtos de adenotonsilectomia de janeiro de 2001 a maio de 2003 / Histological analysis of tonsillectomy and adenoidectomy specimens - January 2001 to May 2003

As tonsilas palatinas e faríngeas são agregados encapsulados incompletos de nódulos linfóides em contato direto com o epitélio de revestimento do trato aerodigestivo. TIPO DE ESTUDO: Estudo retrospectivo baseado na revisão de prontuários dos pacientes submetidos a adenotonsilectomias no Hospital de Clínicas da Faculdade de Medicina de Marília durante o período de janeiro de 2001 a maio de 2003. OBJETIVO: Relatar o perfil dos pacientes e as principais alteracões histopatológicas em 250 pacientes com hipertrofia de tonsilas palatinas e faríngea, infeccões de repeticão ou ambos. MATERIAL E MÉTODOS: Análise histopatológica de 250 pacientes submetidos a adenotonsilectomia ou tonsilectomia entre adultos e criancas. RESULTADOS: Dos 250 pacientes, 117 (46,8 por cento) são do sexo feminino e 133 (53,2 por cento) masculino. A idade média foi de 7,3 anos e variou de 2 a 34 anos. A principal indicacão cirúrgica foi a concomitância de infeccões de repeticão e hipertrofia de tonsilas palatinas e faríngea, sendo que em 160 (64 por cento) foram classificadas em 3+/4+. Em 205 (82 por cento) pacientes foi encontrada hiperplasia linfóide ou linfóide folicular. 45 (18 por cento) também apresentaram inflamacão aguda supurativa focal. Dentre estes, 2 pacientes tiveram cistos de inclusão epidermóide, outros 2 com colônias de Actinomyces sp e 1 paciente com lesão compatível com Doenca da Arranhadura de Gato. DISCUSSAO: Os dados apresentados neste trabalho nos mostram uma possível relacão das tonsilites de repeticão com as hipertrofias tonsilas palatinas e faríngea. CONCLUSAO: O exame anatomopatológico de rotina das tonsilectomias apresenta uma relacão custo/benefício negativa, no entanto, por problemas de ordem legal, ético, fica o médico sujeito à solicitacão desse exame.