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Journal of the American Board of Family... 2020This paper reviews current indications for otolaryngology consultation for tonsillectomy and adenoidectomy (T&A). Despite often being performed concurrently, these... (Review)
Review
This paper reviews current indications for otolaryngology consultation for tonsillectomy and adenoidectomy (T&A). Despite often being performed concurrently, these procedures should be considered separate surgeries done for different indications. The American Academy of Otolaryngology - Head and Neck Surgery published tonsillectomy guidelines for children in 2019. These recommendations are often extrapolated to adults in clinical practice despite less robust literature support for this age group. T&A should be recommended for pediatric obstructive sleep apnea. Specific frequencies of tonsillitis have been identified that indicate benefit from tonsillectomy in normal children; certain modifying health factors warrant consideration of surgery with fewer infections. The guidelines include consideration of tonsillectomy for poorly validated indications such as halitosis, febrile seizure, dental malocclusion, dysphagia, dysphonia, and psoriasis.
Topics: Adenoidectomy; Adult; Child; Humans; Sleep Apnea, Obstructive; Tonsillectomy; Tonsillitis
PubMed: 33219085
DOI: 10.3122/jabfm.2020.06.200038 -
BMJ Clinical Evidence Jul 2014The definition of severe recurrent throat infections is arbitrary, but recent criteria have defined severe tonsillitis as: five or more episodes of true tonsillitis a... (Review)
Review
INTRODUCTION
The definition of severe recurrent throat infections is arbitrary, but recent criteria have defined severe tonsillitis as: five or more episodes of true tonsillitis a year; symptoms for at least 1 year; and episodes that are disabling and prevent normal functioning. Diagnosis of acute tonsillitis is clinical, and it can be difficult to distinguish viral from bacterial infections. Rapid antigen testing has a very low sensitivity in the diagnosis of bacterial tonsillitis, but more accurate tests take longer to deliver results. Bacteria are cultured from few people with tonsillitis. Other causes include infectious mononucleosis from Epstein-Barr virus infection, cytomegalovirus, toxoplasmosis, HIV, hepatitis A, and rubella.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of tonsillectomy in children and adults with acute recurrent or chronic throat infections? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 15 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: cold-steel tonsillectomy and diathermy tonsillectomy.
Topics: Electrocoagulation; Humans; Tonsillectomy; Tonsillitis
PubMed: 25051184
DOI: No ID Found -
JAMA Network Open Aug 2022Perioperative respiratory adverse events (PRAEs) are the most common complication during pediatric anesthesia, and they may be affected by the administration of... (Randomized Controlled Trial)
Randomized Controlled Trial
Effect of Intranasal Dexmedetomidine or Midazolam for Premedication on the Occurrence of Respiratory Adverse Events in Children Undergoing Tonsillectomy and Adenoidectomy: A Randomized Clinical Trial.
IMPORTANCE
Perioperative respiratory adverse events (PRAEs) are the most common complication during pediatric anesthesia, and they may be affected by the administration of preoperative sedatives.
OBJECTIVE
To investigate the effect of intranasal dexmedetomidine or midazolam used for premedication on the occurrence of PRAEs.
DESIGN, SETTING, AND PARTICIPANTS
This single-center, double-blind, randomized clinical trial was conducted among children aged 0 to 12 years undergoing elective tonsillectomy and adenoidectomy from October 2020 to June 2021 at Children's Hospital of Xuzhou Medical University, Xuzhou, China. Data analysis was performed from June to October 2021.
INTERVENTIONS
Children were randomly assigned to 3 groups: the midazolam group received intranasal midazolam (0.1 mg/kg), and the dexmedetomidine group received intranasal dexmedetomidine (2.0 μg/kg) for premedication. The normal saline group received intranasal 0.9% saline for control.
MAIN OUTCOMES AND MEASURES
The primary outcome was the difference in the incidence of PRAEs among the 3 groups. The secondary outcomes were the frequency of the individual PRAEs, including the incidence of such events during the induction and recovery periods, postoperative emergence delirium, postoperative pain score, sedation success rate, and heart rate values.
RESULTS
A total of 384 children (median [IQR] age, 7 [5-10] years; 227 boys [59.1%]) were enrolled and randomized; 373 data sets were available for intention-to-treat analysis (124 children in the midazolam group, 124 children in the dexmedetomidine group, and 125 children in the normal saline group). After the data were adjusted for age, sex, American Society of Anesthesiologists physical status, body mass index, obstructive sleep apnea, upper respiratory tract infection, and passive smoking, children in the midazolam group were more likely to experience PRAEs than those in the normal saline group (70 of 124 children [56.5%] vs 51 of 125 children [40.8%]; adjusted odds ratio [aOR], 1.99; 95% CI, 1.18-3.35), whereas the dexmedetomidine group had a significantly lower PRAEs incidence than the normal saline group (30 of 124 children [24.2%] vs 51 of 125 children [40.8%]; aOR, 0.45; 95% CI, 0.26-0.78). Compared with the dexmedetomidine group, the midazolam group had a higher risk of PRAEs (aOR, 4.44; 95% CI, 2.54-7.76), but no other serious clinical adverse events were observed.
CONCLUSIONS AND RELEVANCE
In this randomized clinical trial, intranasal midazolam used for premedication was associated with increased incidence of PRAEs, whereas premedication with intranasal dexmedetomidine was associated with reduced incidence of PRAEs. Where clinically appropriate, anesthesiologists should consider using intranasal dexmedetomidine for sedation in children undergoing tonsillectomy and adenoidectomy.
TRIAL REGISTRATION
Chinese Clinical Trial Register Identifier: ChiCTR2000038359.
Topics: Adenoidectomy; Child; Child, Preschool; Dexmedetomidine; Humans; Male; Midazolam; Premedication; Prospective Studies; Saline Solution; Tonsillectomy
PubMed: 35943745
DOI: 10.1001/jamanetworkopen.2022.25473 -
Otolaryngology--head and Neck Surgery :... Feb 2023To develop an expert consensus statement regarding persistent pediatric obstructive sleep apnea (OSA) focused on quality improvement and clarification of controversies....
OBJECTIVE
To develop an expert consensus statement regarding persistent pediatric obstructive sleep apnea (OSA) focused on quality improvement and clarification of controversies. Persistent OSA was defined as OSA after adenotonsillectomy or OSA after tonsillectomy when adenoids are not enlarged.
METHODS
An expert panel of clinicians, nominated by stakeholder organizations, used the published consensus statement methodology from the American Academy of Otolaryngology-Head and Neck Surgery to develop statements for a target population of children aged 2-18 years. A medical librarian systematically searched the literature used as a basis for the clinical statements. A modified Delphi method was used to distill expert opinion and compose statements that met a standardized definition of consensus. Duplicate statements were combined prior to the final Delphi survey.
RESULTS
After 3 iterative Delphi surveys, 34 statements met the criteria for consensus, while 18 statements did not. The clinical statements were grouped into 7 categories: general, patient assessment, management of patients with obesity, medical management, drug-induced sleep endoscopy, surgical management, and postoperative care.
CONCLUSION
The panel reached a consensus for 34 statements related to the assessment, management and postoperative care of children with persistent OSA. These statements can be used to establish care algorithms, improve clinical care, and identify areas that would benefit from future research.
Topics: Child; Humans; Adenoidectomy; Endoscopy; Postoperative Care; Sleep Apnea, Obstructive; Tonsillectomy
PubMed: 36757810
DOI: 10.1002/ohn.159 -
Drug Design, Development and Therapy 2022To identify the effectiveness of remimazolam at the end of tonsillectomy and adenoidectomy for preventing emergence delirium in children under sevoflurane anesthesia. (Clinical Trial)
Clinical Trial Randomized Controlled Trial
PURPOSE
To identify the effectiveness of remimazolam at the end of tonsillectomy and adenoidectomy for preventing emergence delirium in children under sevoflurane anesthesia.
PATIENTS AND METHODS
One hundred and four patients aged 3-7 years scheduled for tonsillectomy and adenoidectomy under sevoflurane anesthesia were recruited. Patients were randomly assigned to receive either remimazolam 0.2 mg kg (intervention, n=52) or 0.9% normal saline (control, n=52) at the end of the procedure. The primary outcome was the incidence of emergence delirium, defined as a Pediatric Anesthesia Emergence Delirium (PAED) score ≥10. Secondary outcomes were peak PAED score, emergence time, postoperative pain intensity, length of postanesthesia care unit (PACU) stay, parental satisfaction, and postoperative behavior changes three days postoperatively.
RESULTS
Emergence delirium occurred in 6 of 51 (12%) patients receiving remimazolam versus 22 of 50 (44%) patients receiving saline (risk difference 32% [95% confidence interval, 16% to 49%], relative risk 0.27 [95% confidence interval, 0.12 to 0.60]; <0.001). The peak PAED scores (median [interquartile range]) were lower in the remimazolam group than in the saline group (7 [6-8] versus 9 [8-11], <0.001). Likewise, parental satisfaction was improved in the remimazolam group compared with the saline group (9 [8-10] versus 8 [7-8], <0.001). There was no difference between groups concerning postoperative pain scores, length of PACU stay, or postoperative behavior changes.
CONCLUSION
In children undergoing tonsillectomy and adenoidectomy, administration of remimazolam 0.2 mg kg at the end of the surgery, compared with 0.9% saline, resulted in a significantly lower likelihood of emergence delirium after sevoflurane anesthesia.
Topics: Adenoidectomy; Anesthesia; Anesthesia Recovery Period; Benzodiazepines; Child; Double-Blind Method; Emergence Delirium; Humans; Methyl Ethers; Pain, Postoperative; Saline Solution; Sevoflurane; Tonsillectomy
PubMed: 36203819
DOI: 10.2147/DDDT.S381611 -
Lancet (London, England) Jun 2023Tonsillectomy is regularly performed in adults with acute tonsillitis, but with scarce evidence. A reduction in tonsillectomies has coincided with an increase in acute... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Tonsillectomy is regularly performed in adults with acute tonsillitis, but with scarce evidence. A reduction in tonsillectomies has coincided with an increase in acute adult hospitalisation for tonsillitis complications. We aimed to assess the clinical effectiveness and cost-effectiveness of conservative management versus tonsillectomy in patients with recurrent acute tonsillitis.
METHODS
This pragmatic multicentre, open-label, randomised controlled trial was conducted in 27 hospitals in the UK. Participants were adults aged 16 years or older who were newly referred to secondary care otolaryngology clinics with recurrent acute tonsillitis. Patients were randomly assigned (1:1) to receive tonsillectomy or conservative management using random permuted blocks of variable length. Stratification by recruiting centre and baseline symptom severity was assessed using the Tonsil Outcome Inventory-14 score (categories defined as mild 0-35, moderate 36-48, or severe 49-70). Participants in the tonsillectomy group received elective surgery to dissect the palatine tonsils within 8 weeks after random assignment and those in the conservative management group received standard non-surgical care during 24 months. The primary outcome was the number of sore throat days collected during 24 months after random assignment, reported once per week with a text message. The primary analysis was done in the intention-to-treat (ITT) population. This study is registered with the ISRCTN registry, 55284102.
FINDINGS
Between May 11, 2015, and April 30, 2018, 4165 participants with recurrent acute tonsillitis were assessed for eligibility and 3712 were excluded. 453 eligible participants were randomly assigned (233 in the immediate tonsillectomy group vs 220 in the conservative management group). 429 (95%) patients were included in the primary ITT analysis (224 vs 205). The median age of participants was 23 years (IQR 19-30), with 355 (78%) females and 97 (21%) males. Most participants were White (407 [90%]). Participants in the immediate tonsillectomy group had fewer days of sore throat during 24 months than those in the conservative management group (median 23 days [IQR 11-46] vs 30 days [14-65]). After adjustment for site and baseline severity, the incident rate ratio of total sore throat days in the immediate tonsillectomy group (n=224) compared with the conservative management group (n=205) was 0·53 (95% CI 0·43 to 0·65; <0·0001). 191 adverse events in 90 (39%) of 231 participants were deemed related to tonsillectomy. The most common adverse event was bleeding (54 events in 44 [19%] participants). No deaths occurred during the study.
INTERPRETATION
Compared with conservative management, immediate tonsillectomy is clinically effective and cost-effective in adults with recurrent acute tonsillitis.
FUNDING
National Institute for Health Research.
Topics: Male; Female; Humans; Adult; Young Adult; Tonsillectomy; Conservative Treatment; Tonsillitis; Pharyngitis; Respiration Disorders; Pain; United Kingdom
PubMed: 37209706
DOI: 10.1016/S0140-6736(23)00519-6 -
Fertility and Sterility Oct 2016
Topics: Appendectomy; Case-Control Studies; Fertilization; Humans; Risk Factors; Tonsillectomy
PubMed: 27473354
DOI: 10.1016/j.fertnstert.2016.07.001 -
Australian Family Physician May 2016Despite written and verbal education, many post-tonsillectomy patients have a lack of understanding of common postoperative symptoms. Combined with a significant decline... (Review)
Review
BACKGROUND
Despite written and verbal education, many post-tonsillectomy patients have a lack of understanding of common postoperative symptoms. Combined with a significant decline in the length of hospital stay, this has resulted in many presentations to the general practitioner (GP). Prior research has found there was often difficulty with diagnosing postoperative infection, compared with normal postoperative symptoms, which has ultimately led to an over-prescription of antibiotics. Previously, GPs have requested a framework to manage these patients.
OBJECTIVE
This article aims to address many of the common reasons for presentation to a general practice post-tonsillectomy, and provide a guideline for managing these common presenting complaints.
DISCUSSION
Many of the signs and symptoms that have previously prompted antibiotic prescription for suspected infection are part of the normal postoperative course. However, if there is high clinical suspicion of infection then a course of antibiotics would be reasonable.
Topics: General Practice; Humans; Postoperative Care; Postoperative Complications; Tonsillectomy
PubMed: 27166463
DOI: No ID Found -
Journal of the Royal Society of Medicine Feb 1978
Topics: England; Humans; Tonsillectomy; Tonsillitis
PubMed: 633267
DOI: 10.1177/014107687807100203 -
Immunologic Research Dec 2021A potential connection between tonsillectomy and the development of various cancer types has repeatedly been reported in the scientific literature, but many studies have... (Review)
Review
A potential connection between tonsillectomy and the development of various cancer types has repeatedly been reported in the scientific literature, but many studies have contradicted these observations. Thus, we have no clear evidence, neither to firmly support nor to refute the above-mentioned connection. Here, I suggest that the main reason for the lack of clearer evidence is that the investigations have so far mainly used incorrect sample groups. I propose that individual differences in the tonsils' involvement in immune reactions should be taken into account to solve this long-standing puzzle.
Topics: Humans; Incidence; Neoplasms; Palatine Tonsil; Tonsillectomy
PubMed: 34523058
DOI: 10.1007/s12026-021-09230-3