The study compares the efficacy of adenoidectomy and myringotomy on the treatment of otitis media with effusion (OME) in children depending on the size of adenoids (AV) and age. A total of 509 children with OME lasting at least 3months, who underwent endoscopic adenoidectomy (AT) and myringotomy without the insertion of a ventilation tube in the years 2010-2019 were enrolled in the study. The efficacy of AT and myringotomy on OME was evaluated with regard to the size of the adenoids, their relationship to the tubal tori, the viscosity of middle ear effusion and the age of the child. To evaluate the effect of age, children were divided into two groups-up to 4years and over 4years. The efficacy of AT and myringotomy in OME treatment was demonstrated in both groups. Within the entire group, a significantly greater benefit of AT and myringotomy was found in children with adenoids in contact with the tubal tori (grade B) or compressing them (grade C) (p = 0.039). Other parameters were not statistically significant. Neither the size of the adenoids relative to the choanae, nor the children age, nor the type of middle ear effusion (serous, mucous) had an effect on the treatment. AT and myringotomy is an effective surgical procedure in the treatment of OME not only in children older than 4years, but also in younger children. The effect of the surgery is affected by the contact of adenoids to tubal tori.

Background:Adenoid hypertrophy (AH) and laryngopharyngeal reflux (LPR) are common, pathologically linked pediatric otolaryngological conditions; however, their causal relationship and mechanistic underpinnings are presently unclear. This study aimed to explore the association between AH and LPR in pediatric populations.Methods:Two investigators independently performed literature screening across PubMed, Web of Science, and Cochrane Library databases. Newcastle–Ottawa Scale was employed to assess the methodological quality of cohort studies, as well as Appraisal tool for Cross-Sectional Studies was applied for evaluating cross-sectional investigations. The funnel plot was used to analyze publication bias. A meta-analysis of the extracted data was conducted by using R software platform (version 4.4.2, R Foundation, Vienna, Austria).Results:A total of 18 studies (3 cross-sectional study and 15 cohort studies) were included, including 39,427 participants. Meta-analysis revealed elevated prevalence of LPR among children with AH, with a significantly increased risk of LPR in AH children (odds ratio = 10.53). Meanwhile, children underwent >1 time adenoidectomy (AT) exhibited increased risk of LPR (risk ratio = 9.43). All these data indicated LPR may play a role on AH. However, data from AT studies showed short-term symptoms of LPR could be alleviated (<1 year) after AT, but increased susceptibility to LPR (risk ratio = 2.03) was found with long-term follow-up (>10 years). These results suggested LPR was not only increase the risk of AH but also affected by AH.Conclusion:This study preliminarily validates the close association between AH and LPR. Future studies employing standardized diagnostic criteria are required to further elucidate the reciprocal relationship between AH and LPR, as the marked heterogeneity among earlier studies has primarily stemmed from variations in diagnostic methodologies.

Adenoid hypertrophy has a high prevalence in children, often causing early orofacial muscle dysfunction that worsens facial deformities over time. While adenoidectomy (AT) alleviates airway obstruction, it only partially addresses the condition, leaving persistent neuromuscular habits. Orofacial myofunctional therapy is necessary for post-AT recovery but faces challenges such as poor adherence and ineffective parent-child communication. Dyadic interventions, which actively involve both parents and children, have shown advantages in improving treatment adherence and enhancing orofacial muscle function. Evidence suggests that dyadic intervention addresses both the child's recovery needs and the caregiving capacity of parents, offering a more comprehensive solution for long-term intervention. Therefore, our team developed a parent-child dyadic orofacial myofunctional therapy (PCD-OMT) programme, offering insights into its potential application in paediatric healthcare to support comprehensive family-centred care. This two-arm, parallel-design, randomised controlled trial will recruit 80 dyads whose children performed AT from two hospitals in Qingdao, China. Dyads will be randomly allocated to two arms. Dyads randomly assigned to the intervention group will receive the PCD-OMT programme. Dyads randomly assigned to the control group will receive regular care. The primary outcomes are orofacial myofunction in children and parental care abilities. The secondary outcomes are children's engagement and parental functioning. A feasibility and acceptability process will be employed to evaluate the viability in clinical practice. Outcomes will be collected at three checkpoints: baseline (T0), postintervention (T1) and after a 12-week follow-up phase (T2). This study was approved by the Ethics Committee of Medical College of Qingdao University (QDU-HEC-2023216). The results will be published in peer-reviewed publications and presented in international conferences. ChiCTR2400091466.

ABSTRACTBackground and AimsChildren undergoing tonsillotomy (TT) or adenoidectomy (AT) often suffer from anxiety before and pain or nausea afterward. Greater preoperative anxiety in children and their parents is associated with increased postoperative discomfort. The aim of our study is to test if a preoperative hypnosis intervention reduces perioperative anxiety and thereby alleviates postoperative discomfort.MethodsIn a previous study, we developed a narcosis comic to reduce children's preoperative anxiety. Now, we investigate whether a hypnosis audio intervention further reduces children's perioperative anxiety. Here, a little monkey describes the surgery as an adventurous space journey. We included children 3−6 years old receiving TT or AT. Thirty‐four children prepared for the surgery with the hypnosis audio intervention in addition to the comic (comic+hypnosis group), while 30 children received the comic only (comic group). All children received preoperative sedation via midazolam. We measured children's subjective well‐being before and after surgery, parents' anxiety before surgery, children's anxiety during surgery, and children's postoperative pain.ResultsChildren showed high well‐being before and after surgery in both groups with subjective distress ratings around 2 out of 10. Parents' anxiety was on a moderate level in both groups with anxiety ratings around 42 on the STAI‐S scale from 20 to 80. Children's anxiety was low to moderate in both groups during surgery with mYPAS ratings of 33 on a scale from 20 to 100. In the postoperative telephone interviews, children reported medium pain ratings with maximum pain values around 5 out of 10 in both groups with no significant differences in any postoperative outcome between groups.ConclusionOur study shows that all children participating in our study reported high well‐being and low anxiety. In future studies, it should be assessed if the combination of nonmedical interventions like narcosis comic and hypnosis shows an additive effect in non‐medicated children.

Background: Adenoid hypertrophy is a common condition in childhood, which may be associated with recurring acute otitis media, otitis media with effusion (OME), and obstructive sleep apnoea syndrome. There is close relationship between adenoids and possible middle ear pathology leading to conductive deafness. Objective: To find out the outcome of surgery regarding clinical features and hearing status in children with adenoids. Methods: This hospital based prospective study was conducted at the Department of Otolaryngology&amp; Head-Neck Surgery, Shaheed Suhrawardy Medical College &amp; Hospital, for a period of 6 months following approval from IRB. Patients having enlarged adenoids with or without OME of 3-12 years and both sex group were approached for inclusion of the study. Informed written consent was taken from the guardian. Proper surgical intervention was chosen according to condition of the child. Before and after intervention, data were collected by the researcher himself. Data were recorded into the case record form. Following collection, data were analyzed by the SPSS 26 (SPSS Inc, Chicago, IL, USA). Results: Among 100 patients, 66% were males and 34% were females. Mean age was 7.2±2.34 SD (years). Of all, 60% underwent adenoidectomy (AT), 20% underwent adenoidectomy with myringotomy (AM), and remaining 20% underwent adenoidectomy with myringotomy with grommet insertion (AMG). The PTA findings (baseline) of adenoidectomy, adenoidectomy with myringotomy, and adenoidectomy with myringotomy with grommet insertion group were 15.466±1.395, 37.8±3.349 and 38.2±3.548 db, respectively. Similarly, significant improvement was noticed in all of the three groups as evidenced by PTA value in three groups were 11.91±1.12, 18.65±.933 and 17.45±1.31 db, respectively (p&lt;0.05). Improvements in PTA among different groups also showed significant changes following operation (p&lt;0.05). Conclusion: Clinical improvement are noticed following surgical intervention in both ............

Adenoidectomy (AT) represents one of the first and most common surgeries in childhood. A joint statement of the German Society for Anesthesiology & Intensive Care Medicine as well as Pediatric & Adolescent Medicine and Otolaryngology, Head and Neck Surgery was published in 2006 to prevent of a possibly life-threatening postoperative bleeding after AT in Child age. Routine blood sampling should be avoided during preoperative preparations and instead a standardized coagulation questionnaire (GB) should be performed to clarify a coagulation disorder (GS). If the GB is abnormal, there is an indication for coagulation diagnostics (GD). This unicenter, nonrandomized, retrospective study compared the rate of bleeding after AT and Re-AT without (2011 to early 2014) and with (early 2014 to 2018) the use of a GB. 2633 children aged one to six years, were included in the statistical analysis to assess whether the introduction of GB in early 2014 was able to reduce the rate of bleeding after AT and Re-AT. Of the 2633 children, 1451 had GB and 1182 did not. Without GB, there was a bleeding rate of 0.83% and 2,08% with GB. 174 GB were abnormal and 169 GD were performed, 164 of these were unremarkable, 2 resulted in a confirmed mild type 1 von Willebrand syndrome as well as 2 suspected vWS and 1 suspected factor VII deficiency. The sensitivity of the GB was 16% and the specificity was 87.5%. The positive predictive value was 2.8% and the negative predictive value was 98%. The GB is a tool for detecting possible GS, but is not useful for reducing the rate of postoperative bleeding.

AimTo investigate the impact of adenotonsillectomy (ADT) and adenoidectomy (AD) on child health and evaluated their post‐operative complications.MethodsWe included all children aged <16 years undergoing ADT (tonsillectomy ± adenoidectomy) or AD in New South Wales, Australia, 2008–2017. Health information was obtained from administrative hospitalisation data. Rates of post‐operative complications and reoperation were evaluated using generalised estimating equations and Kaplan–Meier methods, respectively.ResultsOut of 156 500 included children, 112 361 had ADT and 44 139 had AD. Population rates increased during 2008–2017 (ADT: 68–79 per 10 000 children; AD: 25–34 per 10 000), and children were increasingly operated on at a younger age. Overall, 7262 (6.5%) and 1276 (2.9%) children had post‐operative complications (mostly haemorrhage), and 4320 (3.8%) and 5394 (12.2%) required reoperation, following ADT and AD, respectively. Complication rates were highest among children aged 0–1 years, lowest for those 2–5 years and increased with age thereafter. Three‐year reoperation rates for children aged 0–1 years were 9.0% and 25.9% following ADT and AD, respectively, decreasing thereafter to 0.5% and 2.1% in children aged 12–13 years.ConclusionsADT and AD in Australian children have both increased in frequency and are being done at a younger age. Post‐operative complications and reoperation rates highlight surgery is not without risk, especially for children under 2 years old. These findings support a more conservative approach to management of upper respiratory symptoms, with surgery reserved for cases where potential benefits are most likely to outweigh harms.

アデノイド切除術後の合併症として鼻咽腔閉鎖不全を来すことがあるが, 多くは保存的加療で消失する. 今回アデノイド切除術後に重度の開鼻声を生じ改善に外科的治療を要した一症例を経験した.

Glucose-6-phosphate dehydrogenase (G-6-PD) is the major enzyme in the pentose phosphate pathway (PPP). The end products of this pathway are ribose-5-phosphate and nicotinamide adenine dinucleotide phosphate hydrogen (NADPH). G-6-PD deficiency is known to be the most common enzymatic deficiency in red blood cells (RBCs). Genetically, the mode of inheritance is an X-linked recessive disease. The exposure to oxidative stressors will result in hemolytic anemia including fava beans, infections, metabolic conditions such as diabetic ketoacidosis, metabolic acidosis, hyperglycemia, hypoglycemia, and hypothermia. Moreover, surgical stress and certain types of medication are known to lead to hemolytic anemia. Acute hemolytic crisis is a life-threatening situation in patients with G-6-PD deficiency. Therefore, it is extremely important to monitor the patient perioperatively. The authors present this case of successful anesthetic management in a 23-year-old lady with G-6-PD deficiency and a previous history of acute hemolytic anemia undergoing coblation adenoidectomy with septoplasty and turbinectomy. J Med Cases. 2019;10(10):293-295 doi: https://doi.org/10.14740/jmc3371

Objective To explore the clinical effect of mometasone furoate nasal spray combined with montelukast in the treatment of children with obstructive sleep apnea hypopnea syndrome (OSAHS), and to analyze its feasibility and clinical application value. Methods From August 2017 to March 2019, 64 children with OSAHS who were treated in the People's Hospital of Jinhua were selected in the study.According to the random number table method, they were divided into the observation group and the control group, with 32 cases in each group.The observation group was treated with mometasone furoate nasal spray combined with montelukast for 12 weeks.The control group was treated with surgical treatment to remove hypertrophic tonsils and/or adenoids.The clinical symptom scores, polysomnography(PSG) monitoring index, adenoid and tonsil size index, and the efficacy after 12 weeks of treatment were compared between the two groups. Results There were no statistically significant differences in symptom scores and minimum arterial oxygen saturation(LSaO2) between the two groups before treatment(all P>0.05). After treatment, the symptom scores and LSaO2 of the control group were (1.90±0.53)points and (94.74±1.54)%, respectively, which of the observation group were (4.00±1.50)points and (85.34±10.57)%, respectively, the differences between the two groups were statistically significant(t=-7.416, 4.972, all P<0.05). There were statistically significant differences in the apnea hypopnea index(AHI) and obstructive apnea index(OAI) between the two groups(all P<0.05). After treatment, the A/N of the adenoids in the observation group was significantly decreased, and the difference in the tonsil classification was statistically significant(Z=-2.602, P<0.05). The effective rate of the observation group was 56.25%(18/32), which was significantly lower than that of the control group [100.00%(32/32)], the difference was statistically significant(χ2=17.920, P<0.05). Conclusion In summary, non-surgical treatment can alleviate OSAHS-related symptoms, reduce the size of tonsils and adenoids, and achieve the purpose of remission or cure.Non-surgical treatment can be selected when patients' families are reluctant to choose surgical treatment. Key words: Sleep apnea, obstructive; Glucocorticoids; Leukotriene antagonists; Tonsillectomy; Adenoidectomy; Polysomnography; Blood gas monitoring, transcutaneous; Ventilation-perfusion ratio; Children

Objective To investigate the minimum alveolar concentration of sevoflurane for endotracheal intubation in children who underwent tonsillectomy and adenoidectomy under inhalation anesthesia induction without the use of muscle relaxants. Methods A total of sixty-three patients [American Society of Anesthesiologists(ASA) Ⅰ or Ⅱ] undergoing tonsillectomy and adenoidectomy were divided into two groups: a neutral head position group (n=27) and a rotary head position group (n=36) according to the random number table. General anesthesia was induced with 8% sevoflurane. After the loss of the eyelash reflex, the vapourizer was adjusted, so that the end-tidal sevoflurane concentration reached the preset concentration, and maintain for 10 min, followed by endotracheal intubation. The intubation score was assessed using Helbo-Hansen score scale. For each group, the concentration of sevoflurane used for each consecutive patient was increased or decreased using the Dixon′s up-and-down method based on the success or failure to achieve adequate conditions for intubation in the previous patient. The adjacent concentration gradient was 0.5%. Results In the neutral head position group, the minimum alveolar concentration (MAC) of sevoflurane for endotracheal intubation was (4.30±0.44)%, where the median effective dose (ED50) was 4.30%, and the 95% effective dose (ED95) was 4.99%. In the rotary head position group, the MAC of sevoflurane for endotracheal intubation was (3.45±0.54)%, where the ED50 was 3.45%, and the ED95 was 4.62%. Conclusions The head position of rotating 45° was superior to the neutral head position, which can significantly reduce the MAC of sevoflurane for endotracheal intubation in children undergoing tonsillectomy and adenoidectomy. Key words: Children; Sevoflurane; Anesthesia induction; Endotracheal intubation; Minimum alveolar concentration; Tonsillectomy and adenoidectomy

Background: Most children with asthma start to have symptoms in early life; socio-demographic and environmental factors can play an important role in the development and clinical expression of asthma. Objectives: The aim of this study was to determine risk factors in children with asthma from southwestern Iran. Methods: This cross-sectional study included children with asthma, aged five to 15 years, who frequently referred to the allergy outpatient clinics affiliated to Shiraz University of Medical Sciences during year 2016. Information about the participants’ demographic characteristics and social and environmental factors was collected using a questionnaire during year 2016. Results: A total of 737 children (494 males and 243 females) with asthma with mean age of 8.1 ± 2.7 years were recruited. Various factors, including male gender, low birth weight, being the first child, low number of siblings, no vaccination against influenza, adenoidectomy, and young age of mother were found to be associated with an increased risk of asthma during childhood. About 50% of children ate little fish and drank too much cola in a week. Conclusions: The current study showed that influenza vaccination and consumption of fish should be encouraged; also, the rate of adenoidectomy was high in asthmatic patients. The results of this study can help plan strategies for preventing asthma.

In this study, symptoms associated with adenoids and hyperplasic palatine tonsils and parental expectation of surgical outcome were recorded, to provide realistic parental information prior to adenoidectomy (AT) ± tonsillotomy (ATT). In total n = 111 children (3-6 years, ♂ 65 % ♀ 35 %) were recruited, who received AT (66 %) or ATT (34 %) at ENT University Hospital Ulm. By questionnaire-based survey, the most common symptoms and the main reason for the operation were reported from parent's perspective (operation day, follow-up: 3.5 months). Results were visualized in bar charts for total collective and AT and ATT surgical groups (significance level α = 5 %). Most commonly, parents observed signs of respiratory problems (mouth breathing 87 %, nasal obstruction 86 %, snoring 78 %), hearing loss (68 %) and infection of upper airways (66 %). Nasal obstruction (77.5 %) and hearing loss (53.2 %) were the main reasons for operation. In children with pharyngeal tonsil hyperplasia only, hearing problems dominated, while in additional tonsillotomy, nocturnal apneas were the most frequently reported reason for surgery. For all symptoms, a significant postoperatively improvement was achieved. With a differentiated indication for surgery, it is possible to inform the parents about a very good and realistic and effective reduction of symptom after AT and ATT.

Should adenotonsillectomy be routinely offered in children undergoing adenoidectomy?

Objective To explore the application effect of fast track surgery in tonsillectomy or adenoidectomy perioperative nursing. Methods Totally 123 Patients with tonsillectomy or adenoidectomy were selected as study group to receive the nursing care under the guidance of the concept of fast track surgery. 74 patients with the same surgery from early clinical data who were treated by traditional nursing care were selected as control group. Postoperative pain score, length of hospital stay, the incidence of complications and the families of children with satisfaction were compared between the two groups. Results The average hospital stay was (4.56±1.28) d in the study group and (6.32±1.56) d in the control group. The difference was statistically significant (t=2.35, P 0.05), and there were statistically significant differences in the satisfaction of children and their families (χ2=23.05, P<0.01) . Conclusion Application of fast track surgery concept in the perioperative care of pediatric tonsil adenoidectomy can relieve postoperative pain, shorten the length of hospital stay, improve the satisfaction degree of the patients and their families and is worth of being generalized. Key words: Tonsillectomy; Adenoidectomy; Nursing care; Fast track surgery

Objective To explore the application effects of perioperative personalized nursing in pediatric tonsil adenoidectomy surgery, so as to find the optimum clinical nursing method. Methods A total of 180 cases of pediatric patients who underwent tonsil adenoidectomy surgery in Peking University Third Hospital from September 2015 to September 2016 were selected as the research objects, and divided into control group and observation group by random number table method, with 90 cases in each group. The control group was given routine perioperative nursing care, while the observation group was given perioperative personalized nursing care. Operation time, intraoperative blood loss, postoperative hospitalization time, postoperative visual analogue scale (VAS) score, the incidence of postoperative complications and major postoperative clinical symptoms disappearing time were compared between the two groups. Results In the observation group, the hospitalization time was (3.52±1.24) days, and VAS score was (2.89±1.07) , which were both significantly lower than those of the control group (5.63±1.05) days and (4.25±1.13) respectively. The differences were statistically significant (t=5.69, 6.25; P 0.05) . The disappearing time of nasal congestion, runny nose, nasal voice and sleep breathing symptoms of the observation group was shorter than those of the control group, and the difference was statistically significant (P<0.05) . Conclusions The application of perioperative personalized nursing in pediatric tonsil adenoidectomy surgery can shorten the time of postoperative hospitalization and relieve the pain. Key words: Perioperative; Personalized care; Children; Tonsil adenoidectomy surgery

Background Adenoid hypertrophy is known to be the most common cause of nasal obstruction in children; thus, adenoidectomy with or without tonsillectomy is one of the most commonly performed surgical procedures in the pediatric population. The widely used conventional curette adenoidectomy was first described. Dissatisfaction with this technique led to the use of other methods, including powered-shaver adenoidectomy, bipolar electrocautery, coblation, and LASER. Aim This study aimed to compare the endoscopic-assisted coblation adenoidectomy to conventional adenoidectomy (by cold instruments) in terms of safety, efficacy, results, and complications. Patients and methods Eighty patients were diagnosed depending on history, clinical examination, and radiology. The patients were operated on by either conventional or coblation adenoidectomy and divided into two groups: the patients in group A underwent conventional adenoidectomy, whereas the patients in group B underwent coblation adenoidectomy. The intraoperative parameters studied were operative time, intraoperative bleeding, and completeness of removal of adenoid. Postoperative parameters included assessment of postoperative pain, resolution time, and complications. Results It was found that although coblation has a longer operative time, it is a safe and effective alternative to curette adenoidectomy, it is more complete and accurate, there is less intraoperative blood loss, less postoperative pain, and fast resolution time, and fewer complications. Conclusion Coblation adenoidectomy proved to be safe and effective; however, reducing the cost is mandatory before considering it as the modality of choice for adenoidectomy.

Tonsillectomy and Adenoidectomy: Indications, Complications and their Management

Objective To compare the effect of adenoidectomy with adenoidectomy under nasal endoscope in the treatment of adenoid hypertrophy. Methods 120 cases with adenoid hypertrophy were selected as the research subjects.The patients were randomly divided into two groups by random number table, and the control group(n=60) was treated with routine adenoidectomy.The surgical treatment of the observation group(n=60) was performed under nasal endoscope.Surgical treatment, surgery related indicators(operative time, the average amount of bleeding, hospitalization time and the incidence of postoperative complications) were compared between the two groups.Before and after operation, acoustic rhinometry examination of nasopharynx was used to detect the smallest cross-sectional area and compared. Results In the observation group, the operation time, the average amount of bleeding, hospitalization time and incidence rate of postoperative complication were (5.32±2.05)min, (51.05±8.26)mL, (8.50±2.50)d, 15.00%, respectively, which in the control group were (8.56±2.68)min, (78.45±10.15)mL, (12.00±3.50)d, 36.67%, respectively, there were significant differences between the two groups(t=7.44, 15.98, 6.30, χ2=7.35, all P<0.05).12 months after surgery, the nasal minimal cross-sectional area of nasal pharynx in the observation group was (1.99±0.51)cm2, which of the control group was (1.81±0.48)cm2, there was significant difference between the two groups(t=3.99, P<0.05). Conclusion Compared with conventional adenoidectomy, endoscopic adenoidectomy in the treatment of adenoid hypertrophy has good clinical curative effect, less bleeding, shorter operative time and less postoperative complications and other advantages, it is worthy of promotion. Key words: Adenoidal hypertrophy; Adenoidectomy; Endoscopy; Child

Objective To investigate the effects of tonsillectomy and adenoidectomy on the body's immune function of preschool children. Methods Using paired comparison method, 40 preschool children with OSAHS[average age (4.5±1.2)years] were selected.The peripheral venous blood's white blood cells, neutrophils, lymphocytes, monocytes, immune active cells(total T lymphocytes and total B lymphocytes), immunoglobulin(IgA, IgG, IgM) and the content of C3 and C4 levels in the different periods (after 1 month, 3 months ) before and after tonsillectomy and adenoidectomy were detected.And the immune parameters of 20 healthy children with matched age were selected as control group, the analysis comparison was conducted. Results In preoperative and postoperative 1 month, 3 months compared with the control group, the above immune parameters had no statistically significant differences (t=0.332, 0.212, 0.336, 0.415, 0.579, 1.295, 0.874, 1.143, 1.296, 1.058, 1.261, all P>0.05). At postoperative 1 month, the immune active cells(total T lymphocytes and total B lymphocytes), immunoglobulin (IgA, IgG, IgM) and the content of C3 and C4 levels declined slightly compared with preoperation, but within the normal range, back to normal at postoperative 3 months. Conclusion Tonsillectomy and adenoidectomy will not suppress the development of preschool children's immune systems, and the resection is feasible. Key words: Tonsil; Adenoid; Immune function; Child, preschool; Surgical operation