Adenoidectomy In Children Research Articles

Clinical practice guidelines for standardized low-temperature plasma radiofrequency ablation tonsillectomy and adenoidectomy in children

Clinical practice guidelines for standardized low-temperature plasma radiofrequency ablation tonsillectomy and adenoidectomy in children

A comparative study of conventional curettage adenoidectomy versus endoscopic microdebrider-assisted adenoidectomy in children

Introduction: Adenoid hypertrophy or chronic adenoiditis may cause significant problems requiring adenoidectomy. Patients with chronic adenoid hypertrophy causing craniofacial morphology problems, excessive snoring, or possibly quality of life issues are candidates for adenoidectomy. The aim of this study is to compare the advantages of endoscopic-assisted microdebrider adenoidectomy in comparison with conventional curettage adenoidectomy. Materials and Methods:A prospective study of patients undergoing adenoidectomy was performed in the Department of ENT, Head and Neck Surgery at Tertiary center from January 2018 to October 2019. Results: Fifty patients of adenoid hypertrophy underwent adenoidectomy (25 patients in Group I and 25 patients in Group II). The groups were almost similar in age and sex. The mean operative time was 15 min 60 s in Group I and 12 min 56 s in Group II. The average blood loss was 31 ml in Group I and 28.60 ml in Group II. The residual adenoid tissue and complications were present in eight and three patients in Group I, respectively. Conclusion: The endoscopic-assisted adenoidectomy is minimally invasive. Intraoperative bleeding, duration of surgery, and complication were less in endoscopic-assisted adenoidectomy as comparison to conventional curettage method.

A clinical study to determine the effects of adenoidectomy in cases of secretory otitis media in school going children

Introduction: Secretory Otitis media (SOM) is the leading cause of hearing loss in children. Despitenumerous studies on the prevention and treatment of SOM during the past decades, itsmanagement remains challenging and controversial. A study was conducted to find the effect ofadenoidectomy in cases of SOM with hypertrophied adenoids and to determine the effect ofadenoidectomy on hearing as assessed by the pure tone and impedance audiometry. Material andMethods: Children aged 5 – 12 years, diagnosed as SOM with adenoid hypertrophy were included.The study was conducted from April 2019 to May 2020, in the department of ENT, GSL MedicalCollege. A detailed history and clinical examination were done. Investigations such as pure toneaudiogram, impedance audiometry, X-ray nasopharynx, and diagnostic nasal endoscopy were carriedout to confirm the diagnosis. Results: Out of the 50 participants, a maximum (60%) belonged tothe 5 – 7 years age group, the male-female ratio was 1.2. Hard of hearing was a common symptomin 66%, tonsillitis, and sinusitis in 36% and 18% respectively. On pure tone audiometry, the averagehearing loss was 24.95dB. Conclusion: Adenoidectomy in children having hypertrophied adenoidswith SOM, not only relieves Eustachian tube obstruction but also removes the source of infection.This leads to clearance of middle ear effusion and improvement in hearing postoperatively.

Role of Peak Nasal Inspiratory Flow for Measuring the Effectiveness of Surgery in Children with Adenoidal Hypertrophy.

ObjectiveNasal airway obstruction in children is a frequent problem in otolaryngology practice. Adenoidal hypertrophy (AH) is the most common pathology in childhood that requires surgery. Nasal patency can be evaluated by subjective and objective methods. Unlike other methods, peak nasal inspiratory flow (PNIF) is portable and easy to perform. The need for patient compliance is the most important disadvantage of this method. We aimed to analyze the significance of PNIF for measuring the effectiveness of adenoidectomy as well as to compare PNIF with other subjective methods.MethodsTwo-hundred forty-five (245) patients aged between six and 11 years were evaluated. Seventy-seven (77) of them formed the study group and 168 formed the control group. Pre and post-surgery PNIF measurements, adenoid scores, and simple visual analog scale (sVAS) were recorded.ResultsThe average PNIF value has significantly increased to 70.65 L/min from 33.02 L/min after adenoidectomy (p<0.01). The average PNIF value was 71.66 L/min in control subjects. High PNIF values were significantly correlated with low sVAS and adenoid scores postoperatively in the study group as compared with those of preoperative data (p<0.01).ConclusionsPNIF has a satisfying correlation with nasal examination findings and other subjective methods to evaluate nasal obstruction and may provide unique and complementary information helpful for evaluating and improving the effects of adenoidectomy in children.

Changes in healthcare utilisation for paediatric tonsillectomy and adenoidectomy in the Netherlands: a population-based study.

ObjectivesTonsillectomy and adenoidectomy in children are controversial subjects with large regional variation in surgical rates, partly explained by cultural differences and lack of high‐quality evidence on indications for surgery. A quality of care cycle was executed on this topic in the Netherlands. The objective of this study was to estimate changes in healthcare utilisation for paediatric tonsil surgery in the Netherlands.MethodsPopulation‐based data on tonsillectomies and adenoidectomies in children up to age 10 were retrieved retrospectively from Dutch administrative databases between 2005 and 2018. A change point analysis was performed to detect the most pivotal change point in surgical rates. We performed univariate analyses to compare surgical patients’ characteristics before and after the pivotalpoint . Impact on healthcare budget and societal costs were estimated using current prices and data from cost‐effectiveness analyses.ResultsThe annual number of adenotonsillectomies reduced by 10 952 procedures (−39%; from 129 per 10 000 children to 87 per 10 000 children) between 2005 and 2018, and the number of adenoidectomies by 14 757 procedures (−49%; from 138 per 10 000 children to 78 per 10 000 children). The most pivotal change point was observed around 2012, accompanied by small changes in patient selection for surgery before and after 2012. An estimated €5.3 million per year was saved on the healthcare budget and €10.4 million per year on societal costs.ConclusionThe quality of care cycle resulted in fewer operations, with a concomitant reduction of costs. We suggest that part of these savings be invested in new research to maintain the quality of care cycle.

Study on the ultrastructural pathological change of nostril mucosa after adenoidectomy in children with temperature-controlled coblation

Objective:To explore the characteristics of ultrastructural pathological changes of the choanal mucosa after adenoidectomy in children with temperature-controlled coblation. So as to provide evidence to avoid surgical injury in choana. Method:50 choanal mucosa samples were collected from children with adenoidectomy using temperature-controlled coblation; another 10 samples from patients 0.5-2 years after surgery were taken into account as control. All specimens were examined by transmission electron microscopy （TEM）. The ultrastructural characteristics of the immediate injury and healing mucosa of the choanal mucosa were determined according to the results of the TEM. Result:The ultrastructural damage of mucosa were obvious in the immediate injury; the healed mucosa was covers with pseudostratified ciliated columnar epithelium. Due to the incomplete formation of "9 + 2" bodies in the cilia, the ciliary function is weakened. Conclusion:The application of temperature-controlled coblation in adenoidectomy of children has excessively damaged the nostril mucosa, which will affect the function of the nasal mucus blanket.〓.

Opioid-Sparing Anesthetic Technique for Pediatric Patients Undergoing Adenoidectomy: A Pilot Study.

IntroductionAn opioid-sparing anesthetic involves a multi-modal technique with non-opioid medications targeting different analgesic pathways. Such techniques may decrease adverse effects related to opioids. These techniques may be considered in patients at higher risk for opioid-related adverse effects including obstructive sleep apnea or sleep disordered breathing.MethodsA prospective, pilot study was performed in 10 patients (3–8 years of age), presenting for adenoidectomy. The perioperative regimen included oral dextromethorphan (1 mg/kg) and acetaminophen (15 mg/kg) plus single boluses of intraoperative dexmedetomidine (0.5 μg/kg) and ketamine (0.5 mg/kg). Pain scores were assessed in the post anesthesia care unit (PACU) using the FLACC (Face, Legs, Activity, Cry, Consolability) scale. Patients with a pain score >4 received fentanyl as needed. PACU time, pain scores, and parent satisfaction were recorded. Postoperatively, patients were instructed to use oral acetaminophen or ibuprofen every 6 hours as needed for pain.ResultsThe study cohort included 10 patients, 3–8 years of age. All patients had opioid-free anesthetic care. PACU time ranged from 24 to 102 minutes (median: 56 minutes). FLACC pain scores were 0 for all PACU assessments. Nine patients were discharged home and 1 patient had a planned overnight admission. Following hospital discharge, the pain scores were satisfactory during the 72-hour study period and 90% of the patients’ guardians were satisfied or highly satisfied with their child’s pain control.ConclusionThis opioid-sparing approach provided safe and effective pain control as well as parental satisfaction following adenoidectomy in children. Additional prospective studies are needed to determine whether this regimen is effective in a larger cohort of patients with and for other otolaryngology procedures.

The Effect of Ice Cream Intake on Pain Relief for Patients After Tonsillectomy.

IntroductionThe post-tonsillectomy pain can lead to a decrease in fluid and food intake, followed by dehydration, which can slow down the repair process and make pain control harder. Different groups of analgesics have their own side effects. Therefore, the consideration of non-pharmacological ways to control pain can be of great value such as ice cream and other cold drinks.AimThe purpose behind this study is to assess whether the use of ice cream after tonsillectomy with or without adenoidectomy in children reduces pain in the immediate postoperative period, as well as to compare the effect of ice cream and diet at room temperature on post-tonsillectomy pain in children.Materials and methodsEach patient’s post-operative pain was evaluated and assessed by nursing staff prior to discharge using two reliable pain scale: FLACC scale (F: Face, L: Legs, A: Activity, C: Cry, C: Consolability) for patient less than seven years and Wong Baker pain scale (Face 0, very happy because he doesn’t hurt, Face 1, hurts a little bit, Face 2, hurts a little more, Face 3, hurts even more, Face 4, hurts a whole lot, Face 5, hurts as much as you can imagine, although you do not have to be crying to fell this bad) for patient more than seven years.ResultsThe ice cream intake is significantly associated with having no pain (p-value 0.014). In univariate regression, compared to preschool, school-aged children have significant effect with the ice cream intake postoperatively (OR = 0.286, p-value 0.039) while sex and instrument used to assess pain score were having no significant effect with the ice cream intake postoperatively.ConclusionFurther research is needed in order to validate the effectivity of ice cream intakes after tonsillectomy in our region.

The effects of adenoidectomy of serum insulin-like growth factor-1 (IGF-1) and ghrelin in hypertrophied adenoids in children with otitis media with effusion.

&lt;b&gt;Aim:&lt;/b&gt; The aim of the current study was to assess the serum levels of insulin-like growth factor-1 (IGF-1) and ghrelin in hypertrophied adenoids in children suffering with or without otitis media with effusion before and after adenoidectomy. &lt;br&gt;&lt;b&gt;Material and methods:&lt;/b&gt; Serum IGF-1 and ghrelin concentrations were measured with specific enzyme-linked immunoassay (ELISA) methods. The study was carried out in 20 children with otitis media with effusion. The reference group comprised 24 children with hypertrophied adenoid, while control group included 19 children. &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; This mean values of IGF-1 in children with otitis media with effusion and children with hypertrophied adenoid before adenoidectomy were significantly lower than those found in healthy children. Serum levels of IGF-1 were higher after adenoidectomy. There was a significant difference of serum ghrelin levels between both examined groups and the control group. &lt;br&gt;&lt;b&gt;Conclusion:&lt;/b&gt; Our results suggest that adenoidectomy in children with hypertrophied adenoids and in children with otitis media with effusion significantly increases the level of IGF-1 in serum compared to before surgery through the effect of the GH-IGF-1 axis, which could contribute to children's growth.

No impact on the incidence rate of adenoidectomy 1998-2014 on a national level in Denmark by the use of nasal steroid and the introduction of pneumococcal vaccines.

To describe trends in incidence rates of adenoidectomy in children in Denmark from 1998-2014 and to look for possible explanatory factors such as intranasal steroids and pneumococcal vaccination. A nationwide, population-based, retrospective, interrupted time-series analysis, using data from Danish registries. Hospitals and private Ear, Nose and Throat clinics. Children who underwent adenoidectomy from 1998 to 2014 in Denmark. Adenoidectomy. The National Patient Register and the National Health insurance Service Register were used to identify all adenoidectomies performed in children. The National Prescription Register supplied data on intranasal steroids. A total of 174,557 adenoidectomies were identified, distributed among 153022 children. The annual incidence rate was stable at around 11 per 1000 person-years from 1998 to 2004. A decrease was seen from 2004 reaching 7.9 in 2009, followed by an increase to 9.1 in 2014. The highest age-specific incidence rates were seen at 2-3years of age. An estimated 14% of children born in 2014 will have had adenoidectomy performed before turning 16years old. The proportion of adenoidectomies performed in private clinics compared with hospitals was 90%. From 1998 to 2004 the incidence rate of adenoidectomy in children in Denmark was among the highest in the world with around 11 per 1000 person-years. A decrease to 7.9 was seen from 2004 to 2009. We found no inverse correlation on a national level between the incidence rates of adenoidectomy and intranasal steroid, nor the introduction of the pneumococcal vaccine. The amount of intranasal steroids used in children in Denmark was negligible compared with adenoidectomy.

A Comparative Study on Surgical Outcome of Conventional Adenoidectomy and Endoscopic Adenoidectomy in Children with Adenoid Hypertrophy

A Comparative Study on Surgical Outcome of Conventional Adenoidectomy and Endoscopic Adenoidectomy in Children with Adenoid Hypertrophy

Swallowing outcomes after pediatric epiglottopexy.

Persistent sleep apnea following tonsillectomy and adenoidectomy in children requires additional evaluation. One of the common areas of persistent upper airway obstruction in these children is the base of the tongue and lingual tonsils as well as epiglottic prolapse. Depending on the site of obstruction on sleep endoscopy or a cine MRI, surgical procedures include base of tongue reduction and lingual tonsillectomy with or without epiglottopexy. To assess the swallowing outcomes in children undergoing epiglottopexy with lingual tonsillectomy. A retrospective case series review of children undergoing epiglottopexy with or without lingual tonsillectomy. All patients underwent an epiglottopexy with lingual tonsillectomy using coblation. A detailed evaluation including a sleep study, sleep endoscopy, and thorough swallowing assessment preoperatively as well as postoperatively was performed. Five children underwent epiglottopexy with lingual tonsillectomy for obstructive sleep apnea. Epiglottopexy improved sleep apnea with Apnea Hypopnea Index (AHI) falling significantly from 4.6 to 0.5 (p < 0.05). All patients had a normal swallowing assessment postoperatively with functional endoscopic evaluation of swallowing (FEES) revealing no evidence of aspiration and penetration. In our case series epiglottopexy with lingual tonsillectomy is a safe and effective technique, which improves sleep apnea in pediatric patients. It does not affect the swallowing mechanism, and the epiglottis still retains the laryngeal protective role.

Revision adenoidectomy in children: a meta-analysis.

To estimate the rate of revision surgery after previous adenoidectomy in children and to compare the rate of revision adenoidectomy in children with different conditions and by using different surgical techniques. The study protocol was registered on PROSPERO (CRD42018107877). Two authors independently searched databases, specifically PubMed, MEDLINE, EMBASE, and the Cochrane Review database. The keywords used were "adenoids","adenoidectomy","reoperation","revision"and "regrowth". The revision rate was pooled using a random-effect model. Subgroup analyses were conducted for children based on different settings, countries, risks of bias, and surgical techniques. A total 16 studies with 95 727 children were analyzed (mean age: 4.69 (1.62) years; 60% boys; sample size: 5983 patients). Five studies had a low risk of bias, 10 studies had a moderate risk of bias, and one study had a high risk of bias. The rate of revision adenoidectomy was 1.9%. Ages at initial surgery and follow-up were not significantly associated with revision surgeries. The revision rate was not significantly different in children receiving surgeries in different settings (single center vs multicenter vs population-based, country (non-United States vs United States, and risk of bias. Moreover, surgical techniques, such as curettage, suction cautery, microdebridement, and coblation did not significantly affect revision rates in children who received adenoidectomy. Revision surgery was undertaken with a frequency of 1.9% in children who underwent adenoidectomy. A lack of strong evidence exists to correlate surgical techniques with revision rate in pediatric adenoidectomy.

Comparison of desflurane and sevoflurane on postoperative recovery quality after tonsillectomy and adenoidectomy in children.

Comparison of desflurane and sevoflurane on the postoperative recovery quality after tonsillectomy and adenoidectomy in children was carried out. A retrospective analysis was performed on the medical records of 165 children who underwent tonsil and adenoid radiofrequency ablation under low-temperature plasma and were admitted to the Xuzhou Children's Hospital, Xuzhou Medical University from February 2014 to May 2017. In total, 79 children with sevoflurane anesthesia were in the sevoflurane group, and 86 children with desflurane anesthesia in the desflurane group. The non-invasive blood pressure (NIBP), heart rate (HR) and oxygen saturation (SpO2) level, the postoperative sedation (Ramsay) scores, the modified objective pain score (MOPS) of children were recorded. The pediatric anesthesia emergence delirium (PAED) scores of children were recorded. Children in the sevoflurane group had longer operation time, anesthesia time, extubation time and coincidence time than those in the desflurane group (P<0.05). At the beginning of operation (t1), 10 min after operation (t2), at the time of entering anesthesia recovery room (t3), at the time of tracheal catheter extubated (t4), 10 min after extubation (t5), and at the time of leaving the anesthesia recovery room (t6), children in the sevoflurane had higher NISBP and NIDBP, lower HR than those in the desflurane group (P<0.05). At the time of the tracheal catheter extubation (c2), 10 min after extubation (c3), 30 min after extubation (c4), children in the sevoflurane group had lower Ramsay scores and higher PAED scores than those in the desflurane group (P<0.05). More suitable as an anesthetic maintenance drug for tonsillectomy and adenoidectomy in children, desflurane has a better anesthetic effect and is safer. In addition, children with desflurane anesthesia have high postoperative recovery quality and quick recovery in the short term, with better sedative and analgesic effects. Therefore, it is worthy of promotion in clinic practice.

Curettage adenoidectomy versus endoscopic microdebrider adenoidectomy in children: A randomized controlled trial

IntroductionAdenoidectomy is one of the most frequently performed surgical procedures with different techniques and technologies. Although curettage adenoidectomy (CA) has been practiced conventionally for many years, endoscopic microdebrider adenoidectomy (EMA) has emerged as an innovative surgical method. Comparing physiological effects, efficacy and safety of the endoscopic microdebrider adenoidectomy (EMA) and curettage adenoidectomy (CA) in pediatric population is aimed with this prospective, single-blind, randomized, controlled trial. MethodsSixty pediatric patients with type-A tympanogram according to Jerger classification in both ears before surgery were randomly assigned to receive the CA (n = 30) and the EMA (n = 30). Tympanometry evaluation for each ear was performed the day before surgery firstly and was repeated on days 1, 7 and 14 after surgery. Intraoperative time, complications during and after the operation were recorded. Postoperative pain was also evaluated for 10 days postoperatively. ResultsTympanometric evaluation revealed significantly reduced middle ear peak pressure levels with the EMA than with the CA for each ear on day 1 after surgery and for only left ear on day 7 after surgery (P < 0.05). In addition, statistically significant reduced pain scores in postoperative first 3 days were related to the EMA (P < 0.05). There was no significant difference between the methods in terms of duration of surgery and complications. ConclusionAccording to findings from this study, the EMA procedure may be as safe and rapid as the CA. Furthermore, the EMA may be more controlled and less invasive to the surrounding tissues. Further studies are advised to support these data.

Does treatment with sub-lingual allergen-specific immunotherapy reduce adenoid size and improve quality of life among Egyptian children?

IntroductionAdenoidal hypertrophy is a paediatric problem. Adenoidectomy contributes to post-operative complications. Allergic rhinitis is a major health problem. Its prevalence in Egypt and the Middle East is up to 9%. The aim of the present study was to evaluate the effect of sub-lingual immunotherapy on adenoid size and/or quality of life among children suffering from adenoid hypertrophy with allergic rhinitis in Suez Canal University Hospital.Material and methodsForty-six children suffering from adenoid hypertrophy and allergic rhinitis were recruited for this purpose. Skin prick test was administered to identify the causative allergen. All patients received sub-lingual immunotherapy. Lateral X-ray, serum total immunoglobulin E, symptoms, and sign score were recorded for all patients before and after the treatment.ResultsThe nasal symptoms and adenoidal size of the examined patients were significantly decreased after immunotherapy was applied, and thus there was an improvement in the quality of life among those patients.ConclusionsIt was concluded that sub-lingual immunotherapy was an alternative treatment of adenoidectomy in children with moderate adenoid hypertrophy with allergic rhinitis. Surgical treatment for children who suffer from severe adenoid hypertrophy with allergic rhinitis could not be considered as obligatory because medical treatment has no effect on the size of adenoids nor on quality of life.

Techniques for evaluation and management of tongue-base obstruction in pediatric obstructive sleep apnea.

Tongue-base obstruction (TBO) is a common cause of persistent obstructive sleep apnea (OSA) after tonsillectomy and adenoidectomy in children. This review discusses available diagnostic modalities and surgical treatment options for the management of TBO. Recently, a systematic review that included nine studies using drug-induced sleep endoscopy (DISE) in the evaluation of children with persistent OSA after tonsillectomy and adenoidectomy identified the tongue-base as the most common site of obstruction. TBO is a common and correctable cause of persistent OSA in children. Diagnostic modalities include awake flexible laryngoscopy, plain neck films, DISE, and cine MRI. Because DISE and cine MRI are performed in a sleep-like state, they are fairly reliable in identifying the site of obstruction. As continuous positive airway pressure is often poorly tolerated in the pediatric population, there is considerable interest in surgical options for TBO. Depending on the location and the severity of the obstruction, interventions such as lingual tonsillectomy, posterior midline glossectomy, tongue suspension suture, epiglottopexy, hypoglossal nerve stimulation, tongue-lip adhesion, and hyoid suspension may play a role in management.

Impact of Non-Hospital Owned Ambulatory Surgery Centers on Rates of Tonsillectomy and Adenoidectomy in Children

Cooper, Jennifer N. PhD; Onwuka, Amanda J. MPH, PhD; Elmaraghy, Charles A. MD, FACS Author Information

The effects of adenoidectomy on the smell perception of children.

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. 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. 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. 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.

Adenoid size by drug induced sleep endoscopy compared to nasopharyngeal mirror exam

ObjectiveTo establish how assessment of adenoid size is correlated between drug-induced sleep endoscopy (DISE) with indirect mirror nasopharyngoscopy (IMN). Study DesignRetrospective chart review. SettingTertiary care academic hospital. MethodsOver a 6-year period, 154 pediatric patients underwent DISE for obstructive sleep apnea and had IMN. DISE videos were assessed by one reviewer, blinded to results of mirror exams. IMN findings were taken from operative notes recorded by one attending physician. Demographic data, co-morbidities, and sleep study results were also recorded. ResultsNinety-three (58.5%) males and 66 (41.5%) females were included. Mean age at DISE was 7.34 ± 3.99 years, with an average of 29 days after DISE until nasopharyngeal mirror examination. The mean initial adenoid size based on DISE assessment was 2.62 + 0.99, and on nasopharyngeal mirror assessment was 2.56 + 0.97. DISE and IMN assessment of adenoid size correlated well (Spearman's Rho = 0.82, P < 0.00001; Kendal tau = 0.764, P < 0.00001). ConclusionsDISE has proven to be an excellent tool to assess adenoid size prior to adenoidectomy in children with OSA.