-
Singapore Medical Journal Apr 2020Sleep is an important component in a child's growth and development. Snoring is common in children and often perceived as benign, but habitual snoring may be an...
Sleep is an important component in a child's growth and development. Snoring is common in children and often perceived as benign, but habitual snoring may be an indication of obstructive sleep apnoea (OSA). OSA can have health, developmental and cognitive consequences. The three common risk factors for paediatric OSA are tonsillar and/or adenoidal hypertrophy, obesity and allergic rhinitis. Primary care providers are well-placed to identify children at risk by screening for habitual snoring and associated OSA risk factors during routine consultations. Physician awareness of OSA symptoms/signs facilitates diagnosis, management and referral decisions. A trial of medical treatment may be considered for habitual snoring with mild symptoms/signs before referral. Overnight polysomnography is the gold standard investigation utilised by paediatric sleep specialists to diagnose OSA. Adenotonsillectomy is the first-line management for OSA with adenotonsillar hypertrophy, but residual/recurrent OSA may occur, so follow-up by primary care providers is important after surgery.
Topics: Adenoidectomy; Child; Child, Preschool; Female; Humans; Male; Polysomnography; Risk Factors; Sleep Apnea, Obstructive; Snoring; Tonsillectomy
PubMed: 32500157
DOI: 10.11622/smedj.2020054 -
International Journal of Pediatric... Dec 2022To investigate postoperative morbidity and mortality after paediatric adenoidectomy.
OBJECTIVES
To investigate postoperative morbidity and mortality after paediatric adenoidectomy.
METHODS
This was a retrospective national population-based cohort study of data from the Swedish National Patient Register (NPR) and The Swedish Cause of Death Register (CDR). All patients aged 0-18 years who underwent adenoidectomy from 2007 to 2017 (without concomitant tonsil surgery) were included in this study. To evaluate postoperative morbidity and mortality, all diagnostic and surgical codes registered in the NPR for health care contacts within 30 days of surgery were analysed. The patients retrieved from the NPR were matched with the CDR to identify any deaths occurring within 30 days of the surgery.
RESULTS
A total of 51 746 adenoidectomies were included in this study. No deaths related to adenoidectomy were identified. All types of haemorrhagic complications were rare. Only 0.1% of the surgeries resulted in an outpatient contact due to postoperative haemorrhage and only 0.1% of the adenoidectomies resulted in a readmission due to haemorrhage. The rarest haemorrhagic complication was RTT (return to theatre), with only 4 events (0.01%). Postoperative haemorrhage was most frequent on the first day after surgery. Other complications were rare as well, requiring a total of 922 (2.6%) outpatient visits and 75 (0.2%) readmissions in the adenoidectomy group, with postoperative infection being the most commonly reported.
CONCLUSIONS
Overall, adenoidectomy should be considered a safe surgical procedure associated with few postoperative complications. No deaths related to adenoidectomy were found. Severe complications, such as late postoperative haemorrhage after adenoidectomy, were rare, and haemorrhage resulting in RTT was even rarer. The highest rate of postoperative haemorrhage was observed the first day after surgery, and most haemorrhagic complications occurred within a week. Comparisons with studies on tonsil surgery show that adenoidectomy is associated with substantially lower postoperative morbidity.
Topics: Child; Humans; Adenoidectomy; Tonsillectomy; Retrospective Studies; Cohort Studies; Postoperative Hemorrhage; Postoperative Complications; Morbidity
PubMed: 36265351
DOI: 10.1016/j.ijporl.2022.111335 -
Kulak Burun Bogaz Ihtisas Dergisi : KBB... 2008This study evaluated endoscopic adenoidectomy operations performed in children for hypertrophic adenoid tissue in the nasopharynx.
OBJECTIVES
This study evaluated endoscopic adenoidectomy operations performed in children for hypertrophic adenoid tissue in the nasopharynx.
PATIENTS AND METHODS
A total of 125 patients (67 boys, 58 girls; mean age 4.8+/-2.4 years; range 2 to 15 years) underwent endoscopic adenoidectomy under general anesthesia for one or more of the following complaints: nasal obstruction, mouth breathing, snoring, loss of appetite, slower development than peers, and decreased hearing. Preoperatively, 48 patients were eligible for endoscopic rhinoscopy, which showed an adenoid mass causing total or almost total obstruction of the nasal passage. In the remaining patients, lateral cranial radiographs showed a mass narrowing the air passage in the nasopharynx. Postoperative controls were carried out at one and four weeks by physical examination and an inquiry into the patients' satisfaction. In addition, endoscopic rhinoscopy was performed in the fourth week in eligible patients. Final controls were carried out at the end of the second year.
RESULTS
At the end four weeks, none of the patients had nasal obstruction or related complaints. Postoperative endoscopic rhinoscopy performed in 39 patients showed almost complete removal of adenoid tissues. None of the patients exhibited recurrent adenoid hypertrophy at the end of two years.
CONCLUSION
Hypertrophic adenoid tissue in the nasopharynx, especially those encroaching on the nasal cavity, can be removed completely under direct endoscopic visualization. Endoscopic adenoidectomy is a more satisfactory method than conventional adenoidectomy, because it allows control of how much adenoid tissue is removed.
Topics: Adenoidectomy; Adenoids; Adolescent; Child; Child, Preschool; Endoscopy; Female; Humans; Hypertrophy; Male; Nasal Obstruction; Treatment Outcome
PubMed: 18628638
DOI: No ID Found -
Pediatrics Feb 2017The effectiveness of tonsillectomy or adenotonsillectomy (hereafter, "tonsillectomy") for obstructive sleep-disordered breathing (OSDB) compared with watchful waiting... (Comparative Study)
Comparative Study Meta-Analysis Review
CONTEXT
The effectiveness of tonsillectomy or adenotonsillectomy (hereafter, "tonsillectomy") for obstructive sleep-disordered breathing (OSDB) compared with watchful waiting with supportive care is poorly understood.
OBJECTIVE
To compare sleep, cognitive or behavioral, and health outcomes of tonsillectomy versus watchful waiting with supportive care in children with OSDB.
DATA SOURCES
Medline, Embase, and the Cochrane Library.
STUDY SELECTION
Two investigators independently screened studies against predetermined criteria.
DATA EXTRACTION
Two investigators independently extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. Investigators synthesized data qualitatively and meta-analyzed apnea-hypopnea index (AHI) scores.
RESULTS
We included 11 studies. Relative to watchful waiting, most studies reported better sleep-related outcomes in children who had a tonsillectomy. In 5 studies including children with polysomnography-confirmed OSDB, AHI scores improved more in children receiving tonsillectomy versus surgery. A meta-analysis of 3 studies showed a 4.8-point improvement in the AHI in children who underwent tonsillectomy compared with no surgery. Sleep-related quality of life and negative behaviors (eg, anxiety and emotional lability) also improved more among children who had a tonsillectomy. Changes in executive function were not significantly different. The length of follow-up in studies was generally <12 months.
LIMITATIONS
Few studies fully categorized populations in terms of severity of OSDB; outcome measures were heterogeneous; and the durability of outcomes beyond 12 months is not known.
CONCLUSIONS
Tonsillectomy can produce short-term improvement in sleep outcomes compared with no surgery in children with OSDB. Understanding of longer-term outcomes or effects in subpopulations is lacking.
Topics: Adenoidectomy; Child; Child Behavior; Humans; Polysomnography; Sleep Apnea, Obstructive; Tonsillectomy; Treatment Outcome; Watchful Waiting
PubMed: 28096514
DOI: 10.1542/peds.2016-3491 -
Journal of Otolaryngology - Head & Neck... Mar 2023There is a lack of robust evidence in regards to whether the intra and post-operative safety and efficacy of conventional curettage adenoidectomy is better than those of... (Meta-Analysis)
Meta-Analysis
Comparison of the efficacy and safety of conventional curettage adenoidectomy with those of other adenoidectomy surgical techniques: a systematic review and network meta-analysis.
OBJECTIVES
There is a lack of robust evidence in regards to whether the intra and post-operative safety and efficacy of conventional curettage adenoidectomy is better than those of other available surgical techniques. Therefore, this study was conducted as a systematic review and network meta-analysis of published randomized controlled trials (RCTs) with the aim of comparing the safety and efficacy of conventional curettage adenoidectomy with all other available adenoidectomy techniques.
MATERIALS AND METHODS
A systematic search of published articles was performed in 2021 using databases such as PubMed/Medline, EMBASE, EBSCO, and the Cochrane Library. All RCTs that compared conventional curettage adenoidectomy with other surgical techniques and were published in English between 1965 and 2021 were included. The quality of the included RCTs have been assessed using Cochrane Collaboration Risk of Bias Tool.
RESULTS
After screening 1494 articles, 17 were identified for comparing several adenoidectomy techniques and were eligible for quantitative analysis. Of those, 9 RCTs were analyzed for intraoperative blood loss, and 6 articles were included for post-operative bleeding. Furthermore; 14, 10, and 7 studies were included for surgical time, residual adenoid tissue, and postoperative complications respectively. Endoscopic-assisted microdebrider adenoidectomy yielded a statistically significantly greater estimate of intraoperative blood loss compared with conventional curettage adenoidectomy (mean difference [MD], 92.7; 95% confidence interval [CI] 28.3-157.1), suction diathermy (MD, 117.1; 95% CI 37.2-197.1). Suction diathermy had the highest cumulative probability of being the preferred technique because it was estimated to result in the least intraoperative blood loss. Electronic molecular resonance adenoidectomy was estimated to be more likely to result in the shortest surgical time (mean rank, 2.2). Participants in the intervention group were 97% less likely to have residual adenoid tissue than children in the conventional curettage group (odds ratio 0.03; 95% CI 0.01-0.15); therefore, conventional curettage was not considered an appropriate technique for complete removal of adenoid tissue.
CONCLUSION
There is no single technique that can be considered best for all possible outcomes. Therefore, otolaryngologists should make an appropriate choice after critically reviewing the clinical characteristics of children requiring adenoidectomy. Findings of this systematic review and meta-analysis may guide otolaryngologists when making evidence-based decisions regarding the treatment of enlarged and symptomatic adenoids in children.
Topics: Child; Humans; Adenoidectomy; Blood Loss, Surgical; Network Meta-Analysis; Postoperative Hemorrhage; Postoperative Complications; Randomized Controlled Trials as Topic
PubMed: 36870974
DOI: 10.1186/s40463-023-00634-9 -
HNO May 2023Hyperplasia of the pharyngeal tonsils is to be considered pathologic when nasopharyngeal symptoms of mechanical obstruction and/or chronic inflammation occur. Chronic... (Review)
Review
Hyperplasia of the pharyngeal tonsils is to be considered pathologic when nasopharyngeal symptoms of mechanical obstruction and/or chronic inflammation occur. Chronic Eustachian tube dysfunction can result in various middle ear diseases such as conductive hearing loss, cholesteatoma, and recurrent acute otitis media. During examination, attention should be paid to the presence of adenoid facies (long face syndrome), with a permanently open mouth and visible tip of the tongue. In the case of severe symptoms and/or failure of conservative treatment, adenoidectomy is usually performed on an outpatient basis. Conventional curettage remains the established standard treatment in Germany. Histologic evaluation is indicated for clinical evidence of mucopolysaccharidoses. Due to the risk of hemorrhage, the preoperative bleeding questionnaire, which is obligatory before every pediatric surgery, is referred to. Recurrence of adenoids is possible despite correct adenoidectomy. Before discharge home, otorhinolaryngologic inspection of the nasopharynx for secondary bleeding should be performed and anesthesiologic clearance obtained.
Topics: Child; Humans; Adenoids; Adenoidectomy; Otitis Media; Inflammation; Mouth; Otitis Media with Effusion
PubMed: 37071194
DOI: 10.1007/s00106-023-01298-7 -
The Laryngoscope Jun 2023The survival rate of patients with trisomy 13 and trisomy 18 has increased dramatically over the past two decades. We sought to comprehensively describe the...
OBJECTIVE
The survival rate of patients with trisomy 13 and trisomy 18 has increased dramatically over the past two decades. We sought to comprehensively describe the otolaryngologic clinical characteristics and procedures required for these patients at our institution.
METHODS
We performed algorithmic identification of patients with a diagnosis of trisomy 13 and trisomy 18 for whom the otolaryngology service provided inpatient or outpatient care at our institution between the dates of February 1997 and March 2021.
RESULTS
Of the 47 patients studied, 18 patients had a diagnosis of trisomy 13, and 29 had a diagnosis of trisomy 18. Complete trisomy was present in 44% (8/18) of trisomy 13 patients and 55% (16/29) of trisomy 18 patients. 81% of patients were living at the time of the study. About 94% (44/47) of patients required consultation with another specialty in addition to Otolaryngology. Overall, the most common diagnoses among this cohort were gastroesophageal reflux disease (47%), dysphagia (40%), otitis media (38%), and obstructive sleep apnea (34%). Nearly three-quarters (74%) of patients studied required an otolaryngologic procedure. The most common surgical procedure was tonsillectomy and/or adenoidectomy. Patients with trisomy 18 were significantly more likely to have external auditory canal stenosis and obstructive sleep apnea whereas patients with trisomy 13 were more likely to have cleft lip and palate.
CONCLUSIONS
Patients with a diagnosis of trisomy 13 or 18 often require multidisciplinary management and the range of required care spans the breadth of otolaryngology.
LEVEL OF EVIDENCE
4 Laryngoscope, 133:1501-1506, 2023.
Topics: Child; Humans; Trisomy 13 Syndrome; Trisomy 18 Syndrome; Cleft Lip; Cleft Palate; Tonsillectomy; Adenoidectomy; Sleep Apnea, Obstructive; Otolaryngology; Retrospective Studies
PubMed: 37158261
DOI: 10.1002/lary.30350 -
BMJ (Clinical Research Ed.) May 1989
Topics: Adenoidectomy; Airway Obstruction; Child; Humans; Hypoxia; Mouth Breathing
PubMed: 2502290
DOI: 10.1136/bmj.298.6685.1451-a -
Advances in Oto-rhino-laryngology 2017Pediatric obstructive sleep apnea (OSA) was initially described in 1976. In 1981, Dr. Guilleminault emphasized that pediatric OSA was different from the clinical... (Review)
Review
Pediatric obstructive sleep apnea (OSA) was initially described in 1976. In 1981, Dr. Guilleminault emphasized that pediatric OSA was different from the clinical presentation reported in adults. It was characterized by more disturbed nocturnal sleep than excessive daytime sleepiness, and presented more behavioral problems, particularly school problems, hyperactivity, nocturnal enuresis, sleep terrors, depression, insomnia, and psychiatric problems. The underlying causes of pediatric OSA are complex. Such factors as adenotonsillar hypertrophy, obesity, anatomical and neuromuscular factors, and hypotonic neuromuscular disease are also involved. Adenotonsillectomy (T&A) has been the recommended treatment for pediatric OSA, but in the recent past this practice has been placed very much in question. Therefore, we will discuss the mechanism of pediatric OSA and investigate obese and nonobese pediatric sleep-disordered breathing. Moreover, the important concept that dysfunction leads to the dysmorphism that impacts on the size of the upper airway has been advanced recently. Finally, the treatments of pediatric OSA, such as T&A, medication, the orthodontic approaches (rapid maxillary expansion, or mandibular advancement with functional appliances), positive airway pressure, and noninvasive treatment, such as myofunctional therapy (MFT), will be investigated. A "passive MFT" has been tried recently, but very few results exist. In conclusion, we have made progress in our understanding of pediatric OSA, and we can even recognize factors leading to its development or worsening. However, pediatricians and pediatric subspecialists are often unaware of the advances and the remedies available.
Topics: Adenoidectomy; Adenoids; Child; Humans; Hypertrophy; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Tonsillectomy
PubMed: 28738322
DOI: 10.1159/000470885 -
Canadian Medical Association Journal Dec 1963
Topics: Accident Prevention; Adenoidectomy; Humans; Tonsillectomy
PubMed: 14101456
DOI: No ID Found