Assessment of the consensus about tonsillectomy and/or adenoidectomy among pediatricians and otolaryngologists.

BACKGROUND: Several recent publications have shown that the current indications for tonsillectomy and/or adenoidectomy (T&A) in children vary considerably between and even within countries. The objective of our study is to present statistically valid information to surgeons and pediatricians, primary care physicians, and family physicians as key referral channels to the operation, whether there is consensus between pediatricians and otolaryngologists regarding the appropriateness of T&A. METHODS: Six academic pediatricians and six otolaryngologists participated in the study. After otolaryngologists visited 200 patients, the cases were referred to a pediatrician who also visited the patients independently on the same day pre-operatively. They ranked the appropriateness of T&A on a numerical Likert scale from 0 (never indicated) to 9 (always indicated) in a questionnaire. RESULTS: Overall, 200 (102 boys and 98 girls) children with a mean age of 6.1+/-5.6 were enrolled in this study. Otolaryngologists and Pediatricians had agreed about the history of tonsillitis attacks in the previous 6 months and previous year. The patients provided them with the same history. The agreement between otolaryngologists and pediatrician's views about T&A was poor. CONCLUSIONS: This study can serve as an initial warning in developing a national community-based working group to prepare a transparent local guideline regarding T&A indications. More attention should focused the role of pediatricians, primary care physicians, and family physicians for more follow up and determining which patients will eventually need T&A.

An epidemiologic study of tongue lesions in 1901 Iranian dental outpatients.

AIM: The aim of this study was to assess the frequency of nine tongue conditions and evaluate their relationship to oral hygiene status and personal habits in a Northern Iranian population. METHODS AND MATERIALS: This descriptive study evaluated 1901 healthy subjects (1142 women, 759 men) >12 years who were referred to the Dental Faculty of Babol University during a period from February 2005 to July 2006. A questionnaire was designed according to the aims of the study. Each subject completed the questionnaire and received a complete dental and oral examination. Statistical analysis was performed using SPSS software and Chi-square and Fisher's exact probability tests. RESULTS: Six hundred seventy-two (35.3%) of 1901 subjects had tongue lesions with a frequency of 38.6% in women and 47.7% in men which was statistically significant (P<0.0001). A strong association was found between tongue lesions and smoking (p<0.0001), black tea drinking (p=0.021), and poor oral hygiene (p<0.0001). Hairy tongue (p<0.0001), coated tongue (p<0.0001), and fissured tongue (p=0.014) conditions were significantly higher in males, while crenation of the tongue was more frequent in women (p<0.0001). CONCLUSION: This epidemiologic survey of adult dental outpatients of Northern Iran assessing tongue conditions and lesions found the frequency of these conditions in 47.7% of males and 38.6% of females in this population. Tongue conditions and lesions were more frequent among smokers, black tea drinkers, and those with poor oral hygiene. The results of this epidemiological survey can only be interpreted for the population studied and as such cannot be generalized to the wider population of Iran, but future studies should be designed to assess the frequency of these conditions on a countrywide basis. CLINICAL SIGNIFICANCE: The results of this study suggest efficient oral hygiene programs and encouraging people to drink less tea and quit smoking may reduce tongue lesions in adult dental outpatients in Northern Iran.