The effects of adenoidectomy on the smell perception of children.

BACKGROUND: In this study, we employed a novel children's olfactory test in order to more accurately assess the relationship between nasopharyngeal obstruction and odor identification ability. We quantified the impact of adenoidectomy on olfactory function, established whether the influences of the operation were related to the preoperative amount of nasopharyngeal obstruction, and determined whether sex influenced the olfactory measures. METHODS: Fifty-three boys and 23 girls were administered a standardized children's olfactory test, the Pediatric Smell Wheel™, before and 45 days after adenoidectomy. They ranged in age from 5 to 12 years and exhibited varying degrees of adenotonsillar hypertrophy and histories of recurrent adenotonsillitis. Radiographs of the nasopharynx were used to grade the degree of nasopharyngeal obstruction. RESULTS: Significant postoperative improvement in smell function occurred more frequently in children with >50% preoperative obstruction of the nasopharynx. In this group, average function improved 50.8% after surgery (95% confidence interval [CI], 39.1% to 64%). Improvement on 9 of the 11 odors was present, with significant differences occurring for the odors of bubble gum, baby powder, mint, and cinnamon. No sex differences were evident. CONCLUSION: Olfactory dysfunction occurs primarily in children whose nasopharyngeal obstruction is >50%. Removal of the hypertrophied adenoids returned smell function back to normal in these cases. This study suggests that smell loss may be of value in decisions regarding whether or not to perform adenoidectomy in children with nasopharyngeal obstruction.

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.

Cost analysis of tonsillectomy in children using medicaid data.

OBJECTIVE: To evaluate the cost-effectiveness of adenotonsillectomy (T&A) for adenotonsillar hypertrophy and recurrent tonsillitis through the use of Missouri Medicaid data. STUDY DESIGN: Children ages 2-16 years who had a diagnosis of adenotonsillar hypertrophy (based on medical claim codes) in 2006 (n = 4276) were included in this population-based study. The main outcome was direct total costs paid by Medicaid. Costs 2 years before and after T&A were compared in children who underwent surgical intervention with those who did not as well as costs comparison pre- and post-T&A. Wilcoxon rank-sum or Wilcoxon Signed-rank test was used for costs comparisons. RESULTS: Children with adenotonsillar hypertrophy who underwent T&A were significantly less likely to be African American. They had more adenotonsillar infections before undergoing T&A and greater total costs (median costs $2313 vs. $1945; P = .009). The median costs were $1228 pre-T&A, compared with $823 post-T&A (P < .0001). This reduction in costs of $405 (33%) compares with a median cost of the procedure of $1088. The reduction in costs was mostly because of less antibiotic use and outpatient visits. CONCLUSIONS: African American children have fewer T&A procedures for adenotonsillar hypertrophy than white children, which represents an unexplained racial disparity. Children with adenotonsillar hypertrophy who underwent T&A compared with those who did not had more adenotonsillar infections and greater health care costs. T&A leads to a reduction in costs that, after 2 years, is 37% of the costs of the procedure. Future studies should examine the effects of demographics, obesity, and disease severity on health care costs in children with adenotonsillar hypertrophy.

Parental history of adenotonsillectomy is associated with obstructive sleep apnea severity in children with snoring.

OBJECTIVE: To test the hypothesis that history of adenoidectomy and/or tonsillectomy (AT) in at least 1 of the parents during childhood, is a risk factor for moderate-to-severe obstructive sleep apnea (OSA) (apnea-hypopnea index [AHI] >5 episodes/hour) in the offspring with snoring. STUDY DESIGN: Data of children with snoring who were referred for polysomnography over 12 years by primary care physicians were reviewed. RESULTS: Data of 798 children without history of prior AT, neuromuscular, or genetic disorders or craniofacial abnormalities were analyzed. Of these children, 69.3% had tonsillar hypertrophy, 25.8% were obese, 26.8% had at least 1 parent with history of AT, and 22.1% had AHI >5 episodes/hour. Parental history of AT was significantly associated with moderate-to-severe OSA (logit model including sex, tonsillar hypertrophy, obesity, and physician-diagnosed wheezing; OR [95% CI], 1.70 [1.18-2.46]; P < .01). When significant variables from the logit model (tonsillar hypertrophy, obesity, parental history of AT) were considered independently or in combination, tonsillar hypertrophy combined with history of AT in at least 1 of the parents had high specificity (84.4%) and the highest positive likelihood ratio (1.78) for identifying children with AHI >5 episodes/hour. CONCLUSIONS: Among children with snoring who are referred for polysomnography by primary care physicians, those with tonsillar hypertrophy and parental history of AT have increased risk of moderate-to-severe OSA and represent 1 of the subgroups that should be prioritized for a sleep study in settings with limited resources.

Changes in vertical dentofacial morphology after adeno-/tonsillectomy during deciduous and mixed dentitions mouth breathing children--1 year follow-up study.

OBJECTIVE: The aim of this 1 year follow-up study was to investigate, in mouth breathing children, the impact of respiration normalization on vertical dentofacial growth during two stages of dental development after adeno-/tonsillectomy. METHOD: Linear and angular cephalometric measurements, as well as tracing superimposition of serial lateral cephalograms of 39 patients in the treatment group were compared with those of 31 untreated mouth breathing controls. Cephalometric records in the treatment group comprised registrations made at baseline before surgery (T(0)), and then at approximately 1 year post-operatively (T(1)). Corresponding registrations were available for the control group, with a baseline cephalometric radiograph taken approximately 1 year before the second one (T(0) and T(1), respectively). Treatment and untreated groups were divided into deciduous and mixed dentition groups to aid the identification of an optimum timing for normalizing the respiration after T&A, under a vertical dentofacial perspective. RESULTS: After 1 year of follow up, no statistically significant difference on vertical dentofacial growth was observed in deciduous or mixed dentitions treatment groups compared to the same occlusal developmental stage of untreated control groups. CONCLUSION: The results indicate that regarding the vertical dentofacial growth pattern normalization of the mode of respiration after T&A in young children (deciduous dentition) is not more effective than in older children (mixed dentition).

Adeno-tonsillectomy surgery in a joint aid effort: a feasible solution?

UNLABELLED: 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.

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

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 por cento (5/339), não diferindo estatisticamente do grupo controle, 1,37 por cento (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 percent(5/339), which did not differ statistically from the case-control group (1.37 percent - 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.

[Endoscopic adenoidectomy; use or abuse of the technology?]. / Adenoidectomía endoscópica, uso o abuso de la tecnología?

OBJECTIVE: To evaluate efficacy of the conventional technique of adenoidectomy by means of transoperative endoscopic revision of the nasopharynx and to evaluate the need for including telescopes as part of usual instruments used in adenoidectomy. MATERIAL AND METHODS: Prospective, open, comparative, and transversal study. We included the first 150 patients with absolute indication for adenoidectomy. We did 150 adenoidectomy procedures by conventional technique using Beckman adenotomes, and La Force adenotomes, using a laryngeal mirror to observe condition of nasopharynx once the surgeon thought the procedure was completed, we did a revision of adenoid area with Hopkins telescopes of 0 and 30; if we founded residues of adenoids, these were eliminated with Guggenheim forceps, adenotomes, or curved 40 degrees microdebrider tip, all after endoscopic viewing, which also helped in control of area bleeding. MEASURED PARAMETERS: Presence or absence of adenoids residue location, and presence or absence of active bleeding. RESULTS: Total removal of adenoids was carried in 43 patients, our finding adenoid residues in 107 of cases. Of these, 45.3% were occluding pharyngeal part of Eustachian tubes. CONCLUSIONS: Conventional technique for adenoidectomy was effective in < 30%; therefore, it is imperative to use endoscopic revision in each case.

Efficacy of ceftibuten for pediatric patients undergoing adenotonsillectomy.

A survey between Otolaryngologist Head and Neck Surgeons in Puerto Rico and a prospective study was done, to evaluate the efficacy of ceftibuten in pediatric patients undergoing adenotonsillectomy. Surgery of the tonsils and adenoids is the most common operation performed in the pediatric age by the Otolaryngologist Head and Neck Surgeons in Puerto Rico. Over 70% are performed in a ambulatory setting and almost all of the patients are given antibiotics after surgery. Ceftibuten was given to 112 pediatrics patients after surgery. Adenotonsillectomy is a painful operation and children do not take medication well after surgery. One of the benefits of this third generation cephalosporin, is that is given once a day. Twenty events were reported taking the medication, but only seven patients had to discontinue its use. Ceftibuten had a tolerance rate of 94%. Ceftibuten seems to be a safe antibiotic to use in pediatric patients undergoing adenotonsillectomy and has the convenience of being given once a day.

Tubos timpánicos, adenoidectomía y amigdalectomía. ¿patrones imitativos en una sociedad de consumo terapeútico? / Tympanic ventilation tubes, adenoidectomy and tonsillectomy. an imitative pattern in a theraphy consumer society?

El trabajo analiza las indicaciones y las limitantes terapéuticas de tres procedimientos quirúrgicos comunes en la infancia, la aplicación de tubos de ventilalción timpánica, la adenoidectomía, y la amigdalectomía. Analiza la posibilidad de que se practiquen por razones no médicas y concluye estableciendo las indicaciones terapéuticas en cada procedimiento. Considera que no es probable que ninguna de esas cirugías se practiquen por presiones de la familia ni por conceptos rituales. Las veces que son innecesarias es simplemente por mala indicación, y el responsable es el médico

Evaluación de amigdalectomias y adenoidectomias realizadas en el Hospital Regional Honorio Delgado de Arequipa entre 1975 a 1994

Se realiza el presente trabajo de investigación para determinar la tendencia de este tipo de intervenciones quirúrgicas en nuestro medio, comparandolas con las obtenidas en otros lugares, ademas sus indicaciones, técnicas quirúrgicas, epidemiología y complicaciones. Se seleccionaron a todos los pacientes sometidos a amigdalectomía, adenoidectomía y adenoamigdalectomía en el Servicio de Otorrinolaringología del H.R.H.D.A entre los años 1975 a 1994. El presente trabajo de investigación es un estudio de corte transversal, descriptivo y retrospectivo. El grupo etáreo que fue intervenido quirúrgicamente con mayor frecuencia está comprendido entre 10 a 19 años(37.50 por ciento), la mayoría amigdalectomizados(42.55 por ciento), seguido del de 0 a 9 años(29.69 por ciento), la mayor parte adenoamigdalectomizados(70 por ciento); del total de operados el sexo femenino fue el más prevalente(54.69 por ciento). Los sintomas más comunes en amigdalectomizados correspondió a la odinofagía(63.15 por ciento), disfagia(35.08 por ciento), sensación febril(36.84 por ciento), artralgiamialgia(31.57 por ciento), rinorrea(29.82 por ciento), halitosis(17.54 por ciento) y eliminación de caseum(14.03 por ciento); en adenoidectomizados: dificultad respiratoria nasal(70.58 por ciento), respiración bucal(70.58 por ciento) y rinorrea(64.70 por ciento). Los signos clínicos más frecuentemente encontrados en amigdalectomizados son la hipertrofia amigdalina(80.70 por ciento), congestión de amígdalas(47.37 por ciento), caseum(42.10 por ciento), congestión de pilares(38.59 por ciento) y adenopatía(35.08 por ciento); en adenoidectomizados: masa adenoidea(70.58 por ciento), adenopatía(41.17 por ciento) y rinitis(41.17 por ciento). Las indicaciones quirúrgicas prevalentes fueron en amigdalectomias: amigdalitis recurrente(47.36 por ciento), amigdalitis crónica(14.03 por ciento), obstrucción respiratoria o alteración de la deglución(5.26 por ciento); en adenoidectomías: obstrucción nasal crónica por adenoides(88.24 por ciento). La técnica quirúrgica más empleada en amigdalectomías es la disección extracapsular y lazo(91.23 por ciento) y en adenoidectomías la exéresis con adenótomo(52.94 por ciento). El total de complicaciones postoperatorias fue de 14.06 por ciento. En amigdalectomía la hemorragia(6.38 por ciento) e inflamación del paladar blando y úvula(4.26 por ciento), en adenoidectomías la fiebre(14.29 por ciento) y en la mixta la inflamación del paladar blando(10 por ciento)

Repercusión de la amigdalectomía o adenoamigdalectomía en las alergias / Repercussion of tonsyllectomy or adenotonsyllectomy on allergies

Se realizó un estudio retrospectivo y prospectivo longitudinal, randomizado en el cual se valoraron 30 pacientes con rinitis alérgica que fueron sometidos a adenoamigdalectomía o amigdalectomía. El estudio fue realizado en el Departamento de Otorrinolaringología del Hospital de Especialidades del Centro Médico Nacional de Occidente, en la Unidad de Otorrinolaringología S.C. y en el Hospital General Regional Número 45, de octubre de 1990 a septiembre de 1992. Se solicitó a los pacientes pre y postquirúrgicamente inmunoglobulinas séricas IgE, IgA y valoración de signos y síntomas, y número y frecuencia de cuadros de la rinitis. Los resultados de la IgE prequirúrgica fueron de 4 990.68 UI/10 ml ñ 809.20 y la postquirúrgica de 3 149.06 ñ 745.92 (p< 0.01), lgG prequirúrgica 1 044.68 mg/100 ml ñ 143.97 y la postquirúrgica 1 216.33 mg/100 ml ñ 137.89 (p< 0.1). La IgA prequirúrgica 115.13 mg/100 ml ñ 43.22 y postquirúrgica 139.46 mg/100 ml ñ 33.63 (p< 0.1). Los signos y síntomas de rinitis alérgica disminuyeron en todos los casos. Los resultados obtenidos avalan el que al eliminar las infecciones en un paciente con rinitis alérgica aumentaran la IgA e IgG compitiendo así con el antígeno y mejorando los cuadros alérgicos

Changing trends in adenotonsillectomy at San Pablo Hospital 1983 vs. 1993

The purpose of this paper is to review the changing trends in Adenotonsillectomies performed in San Pablo Medical Center during the last ten years. We have reviewed using a 25 variable questionnaire all patients undergoing this surgical procedure during the first six months in 1983 and compared the information with the patients having this procedure during the first six months of 1993. We conclude that the number of interventions, the indications, prior medical history and cost effects have changed substantially. Our data supports the accuracy of some of the trends being reported in the literature regarding this surgical intervention

Changing trends in adenotonsillectomy at San Pablo Hospital 1983 vs. 1993.

The purpose of this paper is to review the changing trends in Adenotonsillectomies performed in San Pablo Medical Center during the last ten years. We have reviewed using a 25 variable questionnaire all patients undergoing this surgical procedure during the first six months in 1983 and compared the information with the patients having this procedure during the first six months of 1993. We conclude that the number of interventions, the indications, prior medical history and cost effects have changed substantially. Our data supports the accuracy of some of the trends being reported in the literature regarding this surgical intervention.

La adenoamigdalectomía como un procedimiento ambulatorio / Adenotonsillectomy as an ambulatory procedure

El objetivo del presente trabajo es demostrar que la cirugía adenoamigdalina, en ciertas condiciones, puede ser realizada en forma ambulatoria, sin aumentar los riesgos del paciente. Para ello se revisaron las adenoamigdalectomías realizadas en el Servicio de Otorrinolaringología del Hospital Clínico de la Universidad de Chile, Dr. José J. Aguirre, desde enero de 1987 a junio de 1991, obteniéndose un total de 857 fichas clínicas. De éstas, 352 (41 por ciento ) pertenecen al grupo ambulatorio y 505 al con hospitalización. Se considera ambulatorio el paciente que permanece 8 horas hospitalizado después del acto quirúrgico. Se analizaron las complicaciones de la muestra total observándose 17 (2 por ciento ) hemorragias y 2 (0,2 por ciento ) hiperemesis. Ninguna de estas fueron observadas en el grupo que, seleccionado previamente, fue sometido a cirugía operatoria. Se concluye que la adenoamigdalectomía puede ser un procedimiento ambulatorio, siempre que tenga en consideracion los requisitos establecidos, sin aumentar los riesgos al paciente, observándose beneficios tanto para el niño como para sus padres