Adenotonsillectomy In Children Research Articles

Adenotonsillectomy in Children with Recurrent Acute Tonsillitis: Review and Implications for Practice Adenotonsillectomy in Recurrent Acute Tonsillitis

Adenotonsillectomy in Children with Recurrent Acute Tonsillitis: Review and Implications for Practice Adenotonsillectomy in Recurrent Acute Tonsillitis

Adenotonsillectomy in children with sickle cell disease and obstructive sleep apnea

IntroductionObstructive sleep apnea (OSA) is prevalent and may be more severe in children with Sickle Cell Disease (SCD) compared to the general pediatric population. ObjectivesThe objective of this study was to describe the therapeutic effects and complications of tonsillectomy and adenoidectomy (T&A) for treatment of OSA in children with SCD. MethodsA comprehensive database of pediatric SCD patients was reviewed to identify all patients who underwent T&A between 2010 and 2016. An IRB-approved, retrospective review of laboratory values, perioperative course, pre- and post-T&A hospital utilization, and polysomnography was conducted. ResultsThere were 132 SCD children (108 HbSS) who underwent T&A. Mean age was 7.6 ± 4.6 years. The mean baseline hemoglobin of these patients was 9.3 ± 1.4 g/dL; 72.7% of patients had pre-operative transfusion, such that the mean Hb at time of T&A was 11.4 ± 1.0 g/dL. The average admission length surrounding T&A was 3.5 ± 1.2 days. Complications were documented in 11.4% of operative cases. Polysomnography was available in 104 pre-T&A and 45 post-T&A. The Apnea-Hypopnea Index decreased on post-T&A polysomnogram (7.6 ± 8.7 vs. 1.3 ± 1.9, p = 0.0001). The O2 nadir improved on post-T&A polysomnogram (81.2 ± 10.8 vs. 89.3 ± 7, p = 0.0003). Emergency room visits (mean events per year) decreased post-operatively (2.6 ± 2.8 vs. 1.8 ± 2.2, p = 0.0002). ConclusionsT&A can be a safe and effective option to treat OSA in pediatric patients with SCD and was significantly associated with reduced AHI and fewer ER visits post-operatively.

PIH29 - Benefits of Adenotonsillectomy in Children with Mild Obstructive Sleep Apnea Syndrome

The early treatment of mild obstructive sleep apnea syndrome (OSAS) with adenotonsillectomy (T&A) is controversial. The objectives were to compare changes in validated quality of life (QOL) and symptom measurements among a subset of children with OSAS who were randomized to one of 2 arms, adenotonsillectomy (T&A) or watchful waiting with supportive care (WWSC). Data from the Childhood Adenotonsillectomy Trial, a multicenter, randomized controlled study of adenotonsillectomy for OSAS were used to evaluate changes in quality of life and symptom improvement. Children aged 5 to <10 years with OSAS were randomized to undergo T&A or WWSC. Mild OSAS was defined to be an apnea-hypopnea index (AHI) < 5. Children underwent polysomnography, and parents completed the Peds QOL inventory, Pediatric Sleep Questionnaire (PSQ), the 18-item OSA QOL and the modified Epworth Sleepiness Scale (ESS) at baseline and at 7 months. Changes in the QOL and symptom surveys were assessed in each arm (paired t-tests) and compared between arms (independent samples t-tests). There were 241 children with mild OSAS, half of which (n = 120) received a T&A. There was no difference in treatment group in gender, ethnicity, race, BMI (normal, overweight, obese), tonsil size (0-50% vs 51-100%), and age. T&A patients had a decrease in AHI (p <0.0001), modified ESS (p <0.0001), total OSA QOL (p <0.0001) and total PSQ (p <0.0001). The WWSC patients also saw a change in modified ESS (p = 0.02), total OSA QOL (p = 0.006) and total PSQ (p = 0.04). The changes in the WWSC were not as large as the changes in the T&A group (p<0.001 for all). In children with mild OSA (AHI < 5), adenotonsillectomy, compared to watchful waiting, resulted in improved quality of life and parent reported symptoms.

0753 Polysomnography Outcomes Following Adenotonsillectomy in Children With Down Syndrome: Effects Of Weight And Obstructive Sleep Apnea Severity

0753 Polysomnography Outcomes Following Adenotonsillectomy in Children With Down Syndrome: Effects Of Weight And Obstructive Sleep Apnea Severity

0768 Role of Drug Induced Sleep Endoscopy and Sleep Surgery in Management of Persistent Obstructive Sleep Apnea Following Adenotonsillectomy in Children with Down Syndrome

0768 Role of Drug Induced Sleep Endoscopy and Sleep Surgery in Management of Persistent Obstructive Sleep Apnea Following Adenotonsillectomy in Children with Down Syndrome

The role of tonsillectomy in the Periodic Fever, Aphthous stomatitis, Pharyngitis and cervical Adenitis syndrome; a literature review

BackgroundTonsillectomy (TE) or adenotonsillectomy (ATE) may have a beneficial effect on the clinical course in children with the Periodic Fever, Aphthous stomatitis, Pharyngitis and cervical Adenitis (PFAPA) syndrome. However, an immunological reason for this effect remains unknown. This literature review summarizes the current knowledge of the effect of TE or ATE in the PFAPA syndrome.MethodsA search of PubMed, Medline, EMBASE and Cochrane was conducted for papers written in English dated from 1 January 1987 to 31 December 2016. The search included all studies reporting outcomes after TE or ATE from children aged 0 to 18 years with PFAPA.ResultsTwo randomized controlled trials reported significantly faster resolution of febrile episodes after TE or ATE in children with PFAPA compared to controls (non-surgery groups). We identified 28 case series including 555 children with PFAPA. The diagnosis was set prospectively before surgery in 440 children and retrospectively after surgery in 115 of the children. TE or ATE had a curative effect in 509 of the 555 children with PFAPA (92%), but few studies were of high quality.ConclusionTE or ATE may have a curative effect on children with PFAPA, but the evidence is of moderate quality. Further high-quality randomized controlled studies are still needed.

How Does Adenotonsillectomy Affect the Olfactory Threshold in Children?

Adenotonsillectomy is one of the main operations on the head and neck surgery quality in children. This study aimed to compare the olfactory threshold changes in adenotonsillectomy patients. This comparative study was done on 152 children whom candidate for adenotonsillectomy before and 3weeks after the operation referred to the Dr. Kermanshahi Hospital, Kermanshah, Iran during 2015-2016. The olfactory threshold was determined by olfactory test using phenyl butyl alcohol in propylene glycol. The orthonasal test was done by a strip and the lowest propylene glycol detection used as olfactory threshold. The mean age was 6.81±3.83 of patients were boys and 69 of them were girls. The allergic rhinitis was detected in 83.6% of the patients before the adenotonsillectomy while it was only in 16.4% after adenotonsillectomy. Also, nocturia was higher before the adenotonsillectomy 104 (68.4%) compared to post-adenotonsillectomy 48 (31.6%). In 73 (48%) patients, the sleep quality score was 10 after the surgery while there was a patient with score 10 before the operation. The positive allergic rhinitis was higher in male 70 (84.3%) compared to female 57 (82.6%). Also, no significant difference detected on nocturia (P=0.531). Also, significant difference detected between 2 groups in sleep quality score before and after the adenotonsillectomy (P=0.001). The olfactory threshold significantly improved after surgery compared to previous (P=0.034). These results suggest olfactory threshold improves after adenotonsillectomy in children.

Retraction: Evaluation of gabapentin and dexamethasone alone or in combination for pain control after adenotonsillectomy in children.

[This retracts the article on p. 317 in vol. 8, PMID: 25191179.].

Study of quality of life outcome after adenotonsillectomy in children with sleep disorderd breathing

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;This prospective study was conducted in our department with the objective to study the quality of life outcome after adenotonsillectomy in children with sleep disorderd breathing. Sleep-disordered breathing, can lead to substantial morbidities, affecting the central nervous system (CNS), the cardiovascular and metabolic systems, and somatic growth, ultimately leading to reduced quality of life. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;This prospective study was conducted in 47 patients in the Department of Otorhinolaryngology Head and Neck Surgery, Government Medical College and associated SMHS Hospital Srinagar. The study was included the patients with SDB in pediatric age group, who visited in our OPD.OSA-18 questionnaire was used pre-operatively, at 2 and 6 months after surgery. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Our study groups comprised of total 47 patients with majority of patients with in age group of 5-7 years, males were 29 (61.70%) and females were 18 (38.30%). In our study the OSA 18 scale used pre-operatively showed majority of patients 33 (70.21%) having score &amp;gt;80 score, with mean OSA-18 score of 84.15 showing that there was a major impact on quality of life and there was significant improvement in mean OSA-18 score in postoperative period from 30.49 to 26.85 at 2 and 6 months post- operatively and hence improvement in quality of life. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Based on the observation made in the study we concluded that there was a significant improvement in the disease specific postoperative quality of life after both adenotonsillectomy and tonsillectomy. We also concluded that polysomnography results matched with OSA 18 questionnaire scale score done preoperatively.&lt;/span&gt;&lt;/p&gt;

STUDY OF EFFECT OF ADENOTONSILLECTOMY IN CHILDREN WITH SLEEP DISORDERD BREATHING USING PEDIATRIC SLEEP QUESTIONNAIRE.

10Nov 2017 STUDY OF EFFECT OF ADENOTONSILLECTOMY IN CHILDREN WITH SLEEP DISORDERD BREATHING USING PEDIATRIC SLEEP QUESTIONNAIRE. Arshed Ali , Jasif Nisar , Ihsan Ali , Salma Gull and Prof. Dr Rauf Ahmad. Post-Graduate Resident, Department Of ENT AND HNS, GMC Srinagar. Assistant professor, department of ENT AND HNS, GMC Srinagar. Post-graduate resident, department of PATHOLOGY, SKIMS, SOURA, Srinagar. Head Of Department, ENT AND HNS, GMC Srinagar.

Postoperative bradycardia following adenotonsillectomy in children: Does intraoperative administration of dexmedetomidine play a role?

IntroductionDexmedetomidine is a novel pharmacologic agent that has become a frequently used adjunct during care of pediatric patients with obstructive sleep apnea (OSA) undergoing tonsillectomy. While generally safe and effective, dexmedetomidine is associated with adverse effects of hypotension and bradycardia from its central sympatholytic effects. Due to safety concerns, our institution routinely admits patients with OSA for overnight cardiorespiratory monitoring following tonsillectomy. With such monitoring, we have anecdotally noted bradycardia in our patients and sought to investigate whether this was related to the increased use of intra-operative dexmedetomidine. MethodsWe retrospectively reviewed records over an 11-month period to compare the incidence of postoperative bradycardia following hospital admission for tonsillectomy in patients who received dexmedetomidine versus those who did not. ResultsThe study cohort included 921 patients (371 received dexmedetomidine and 550 did not). Bradycardia was asymptomatically noted in 66 patients (7.2%). No patient required medical intervention for the bradycardia or developed clinical symptoms. There was no association of bradycardia with the intra-operative administration of dexmedetomidine (8.9% of patients who received dexmetomidine vs. 9.4% who did not). In multivariable analysis, bradycardia was more common among older patients, with the administration of topical or injected lidocaine, and with specific associated procedures (inferior turbinate coblation with out-fracture or direct laryngoscopy and bronchoscopy). ConclusionThe increased incidence of asymptomatic bradycardia in our post-adenotonsillectomy patients seemed to relate more to increased utilization of postoperative cardiac telemetry, and did not appear associated with the use of dexmedetomidine use intra-operatively.

Response to “In Reference to ‘The Effect of Montelukast on Mild Persistent OSA after Adenotonsillectomy in Children: A Preliminary Study’”

Response to “In Reference to ‘The Effect of Montelukast on Mild Persistent OSA after Adenotonsillectomy in Children: A Preliminary Study’”

Clinical variables determining the success of adenotonsillectomy in children with Down syndrome

ObjectivesTo evaluate the evolution of polysomnographic parameters of children with Down syndrome and obstructive sleep apnea syndrome submitted to adenotonsillectomy and the interaction of comorbidities on therapeutic outcome. MethodsNinety patients with Down syndrome and habitual snoring were identified between 2005 and 2015 in a Pediatric Otorhinolaryngology Clinic. Parent's complaints were evaluated by the test of equality of two proportions. Wilcoxon test was used to examine pre- and post-operative polysomnographic differences. Mann-Whitney test evaluated the influence of comorbidities. A p < 0.05 was considered significant. ResultsA total of 27 patients met the inclusion criteria (55.6% patients were males; mean (SD) age were 6.7 (3.6) years (range, 1.5–16 years). Significant improvement of parent's complaints (p < 0.001), arousal index (p = 0.045), and minimum oxygen saturation were observed post-adenotonsillectomy (p = 0.034). Adenotonsillectomy was able to resolve obstructive sleep apnea syndrome in 29.6% of children with Down syndrome. Nineteen patients (70.4%) remained with obstructive sleep apnea syndrome and 44.4% showed a reduction of at least 50% of obstructive apnea-hypopnea index. Central apnea index post-adenotonsillectomy was worse in patients with heart disease (p = 0.022). Sleep efficiency (p = 0.031), N1 sleep stage (p = 0.001), apnea-hypopnea index (p = 0.023), and central apnea index (p = 0.008) were worse after surgery in patients with hypothyroidism. Patients with severe OSAS showed significant improvement in polysomnographic parameters after surgery. ConclusionAlthough adenotonsillectomy improved symptoms and objective sleep data in children with Down syndrome, it was not able to resolve obstructive sleep apnea syndrome in most patients. Congenital heart diseases and hypothyroidism may affect the outcome.

Bleeding after tonsillectomy

Oropharyngeal hemorrhage after tonsillectomy is one of the most common postprocedural ENT emergencies that require immediate attention. Management choices depend on the severity of bleeding, underlying platelet or coagulation disorders, and the patient’s maturity and age. Treatment range from simple observation to an emergent need to both secure the airway and stop the hemorrhage. The workup of the hemorrhagic patient will be discussed from the preoperative to postoperative time period. Surgical techniques in response to various acuity will be discussed to fully elucidate options to control the hemorrhage.

Persistent respiratory effort after adenotonsillectomy in children with sleep-disordered breathing.

Adenotonsillectomy (AT) markedly improves but does not necessarily normalize polysomnographic findings in children with adenotonsillar hypertrophy and related sleep-disordered breathing (SDB). Adenotonsillectomy efficacy should be evaluated by follow-up polysomnography (PSG), but this method may underestimate persistent respiratory effort (RE). Mandibular movement (MMas) monitoring is an innovative measurement that readily identifies RE during upper airway obstruction. We hypothesized that MMas indices would decrease in parallel of PSG indices and that children with persistent RE more reliably could be identified with MMas. Twenty-five children (3-12 years of age) with SDB were enrolled in this individual prospective-cohort study. Polysomnography was supplemented with a midsagittal movement magnetic sensor that measured MMas during each respiratory cycle before and > 3 months after AT. Adenotonsillectomy significantly improved PSG indices, except for RE-related arousals (RERA). Mandibular movement index changes after AT significantly were correlated with corresponding decreases in sleep apnea-hypopnea index (AHI) and O2 desaturation index (ODI) (Spearman's rho = 0.978 and 0.922, respectively), whereas changes in MMas duration significantly were associated with both RERA duration (rho = 0.475, P = 0.017) and index (rho = 0.564, P = 0.003). Conditional multivariate analysis showed that both AHI and RERA significantly contributed to the variance of MMas index after AT (P = 0.0003 and 0.0005, respectively), whereas MMas duration consistently was related to the duration of RERA regardless of AT. Adenotonsillectomy significantly reduced AHI. However, persistent RERA were apparent in a significant proportion of children, and this was reflected by the remaining abnormal MMas pattern. Follow-up of children after AT can be recommended and readily achieved by monitoring MMas to identify persistent RE. 4. Laryngoscope, 128:1230-1237, 2018.

Increase of plasma S100B and neuron-specific enolase in children following adenotonsillectomy: a prospective clinical trial.

S100B protein and neuron-specific enolase (NSE) can be considered the markers of cerebral injury. To our knowledge the association of general anesthesia for elective non-cardiac surgery in children with these markers has not been studied before. The goalof this study was to find out whether these markers change after adenotonsillectomy with general anesthesia. The secondary goal was to determine whether different types of anesthesia, gender, age and body mass index are associated with the change of S100B and NSE after adenotonsillectomy with general anesthesia. This study was designed as a prospective clinical trial. We did a simple pre-post experiment with no control group. In 59 children (aged 6-13, ASA I-II) undergoing adenotonsillectomy and randomized to TIVA or inhalational general anesthesia, plasma S100B and NSE were measured during anesthesia before and after the surgery which lasted a median (interquartile range) of 16.5 (13.0-20.0)min. S100B and NSE assays were performed using the electrochemiluminescence immunoassay. Significance of the differences was assessed by two-tailed asymptotic Wilcoxon signed rank test. Main outcome measures were differences in the levels of S100B and NSE before and after the general anesthesia and surgery. There were significant increases in S100B and NSE levels after the surgery. S100B was increased by 38% (P<0.001) and NSE was increased by 10% (P<0.001). Increase of S100B was significantly negatively associated with age (P=0.023). We have not found significant association of S100B and NSE with any other of the monitored variables. The values of neurological biomarkers S100B and NSE were significantly increased after general anesthesia for elective adenotonsillectomy in children.

Assessment of weight gain following adenotonsillectomy in children with Down syndrome

IntroductionAdenotonsillectomy (T&A) has been associated with postoperative weight gain in children. The purpose of this study is to determine whether a similar association exists in children with Down syndrome (DS). MethodsThe medical records of 311 DS patients were reviewed. Subjects were classified into either a control group or surgical group based on whether they had undergone adenotonsillectomy (T&A). Subjects were excluded if they only had one recorded BMI. Cases were analyzed in a pairwise fashion to maximize available data. 113 total patients with DS were identified: 84 (74.3%) in the control group and 29 (25.7%) in the T&A group. Height, weight, BMI, and Z-score data were compared between the control and T&A groups at 6-month intervals over a 24-month period. ResultsChildren with DS who underwent T&A were comparable by demographics to children with DS who did not undergo T&A. Mean weight gain at 24 months for the T&A group was 8.07 ± 5.66 kg compared with 5.76 ± 13.20 kg in controls. The median Z-score at 24 months for the T&A group was 1.11 (0.10–1.88) compared with 1.17 (0.80–1.75) in controls. Children undergoing T&A had a stable median Z-score change of 0.09 at 24 months (p = 0.861, compared to baseline) while children who did not undergo T&A had a significantly increased median Z-score of 0.52 (p = 0.035, compared to baseline). Despite this, there were no significant intergroup differences between weight change, BMI, nor Z-score at any interval (p > 0.05). Conclusions and relevanceChildren with DS did not have an increased rate of weight gain or increased BMI after T&A. BMI Z-scores were shown to stabilize over 24 months in the T&A group and increase in the control group. While this suggests that T&A provides an added benefit of weight control in patients with DS, the results should be interpreted with caution due to the small sample size and the fact that not all patients had complete follow up across a 24-month period.

Adenotonsillectomy outcomes in children with sleep apnea and narcolepsy

ObjectiveTo identify improvements in daytime sleepiness following adenotonsillectomy in children with non-severe obstructive sleep apnea and narcolepsy. Study designCase series with chart review over 15 years. SettingTertiary Children's Hospital. Subjects and methodsChildren between 6 and 17 years of age with narcolepsy that underwent adenotonsillectomy for non-severe obstructive sleep apnea (OSA) were included. Narcolepsy was diagnosed based on clinical assessment and the Multiple Sleep Latency Test (MSLT) results. A standardized instrument, the pediatric Epworth Sleepiness Scale (ESS), was used to assess daytime sleepiness before and after adenotonsillectomy. ResultsNine children with a mean age of 12.1 years were included. The majority of the subjects (78%, n = 7) were African American and six children (66.7%) were obese. Four children (44%) were treated with wake promoting agents during the study. The mean preoperative apnea hypopnea index on polysomnography was 4.89 (SD 1.86), while the mean sleep latency on MSLT was 6.32 min (SD 3.14). The mean preoperative ESS was 16.10 and the postoperative ESS was 10.80 (SD 3.96). There was significant improvement (p = 0.02) in the ESS following adenotonsillectomy with seven children (78%) reporting diminished daytime sleepiness. ConclusionsChildren with non-severe OSA and narcolepsy experience significant improvement in daytime sleepiness following adenotonsillectomy. Future studies are needed to determine the incidence and clinical significance of non-severe OSA in children with narcolepsy.

Discontinuous insurance coverage predicts prolonged hospital stay after pediatric adenotonsillectomy

BackgroundChanges in health insurance coverage have been implicated in limiting access to care and increasing morbidity risk. The consequences of insurance discontinuity for surgical outcomes are unclear. In this study, we explored whether recent insurance discontinuity was associated with prolonged inpatient hospitalization after adenotonsillectomy in children. Materials and methodsWe retrospectively evaluated single-center data on children aged 2-18 y undergoing adenotonsillectomy with overnight stay in 2009-2014. Insurance coverage at surgery and over the preceding year was categorized as (1) continuous private, (2) continuous Medicaid, or (3) discontinuous (changes or gaps in coverage). The association between insurance discontinuity and prolonged hospitalization (≥2 d) was evaluated using multivariable logistic regression. ResultsThe study included 1013 girls and 983 boys (aged 4.5 ± 2.9 y), of whom 205 (10%) required prolonged hospitalization. Insurance was continuous private for 749 patients (38%), continuous Medicaid for 1121 patients (56%), and discontinuous for 126 patients (6%). Prolonged stay was most common with discontinuous insurance (23/126, 18%), followed by continuous Medicaid (117/1,121, 10%), and continuous private insurance (65/749, 9%; P = 0.004). In multivariable analysis, discontinuous insurance remained associated with prolonged hospital stay, compared with continuous private insurance (odds ratio = 1.88; 95% confidence interval: 1.06-3.33; P = 0.031), and compared with continuous Medicaid (odds ratio = 1.86; 95% confidence interval: 1.09-3.19; P = 0.023). ConclusionsThis study demonstrates greater odds of prolonged hospitalization after adenotonsillectomy among children with recent gaps or changes in insurance coverage and illustrates the feasibility of studying influences of health insurance change on surgical outcomes using existing data in hospital electronic records.

Neuropsychological functioning after adenotonsillectomy in children with obstructive sleep apnea: A meta-analysis.

The present study aimed to investigate the efficacy of adenotonsillectomy (AT) for children with obstructive sleep apnea syndrome (OSAS) and the improvement of their cognitive function. Studies on cognitive performance of OSAS children treated with or without AT were identified by searching the Pubmed, EMBASE and Cochrane library. A meta-analysis was conducted to analyze the literature. The random-effects model was used to evaluate 11 eligible studies using an inverse- variance method. The neuropsychological test results of 4 cognitive domains (general intelligence, memory, attention-executive function and verbal ability) were obtained and analyzed. By comparison of cognitive function between OSAS children and healthy controls, the effect sizes of each domain were achieved as follows: general intelligence,-0.5 (P<0.0001); memory,-0.18 (P=0.02); attention-executive function,-0.21 (P=0.002); and verbal ability,-0.48 (P=0.0006). The effect sizes of general intelligence, memory, attention-executive function, and verbal ability after AT compared to baseline level were-0.37 (P=0.008),-0.36 (P=0.0005),-0.02 (P=0.88), and-0.45 (P=0.009), respectively. Comparing the cognitive ability between OSAS children after AT and healthy controls showed that the effect sizes were-0.54 (P=0.0009),-0.24 (P=0.12),-0.17 (P=0.35), and-0.45 (P=0.009) in general intelligence, memory, attention-executive function, and verbal ability, respectively. Our results confirmed that OSAS children performed worse than healthy children in terms of the 4 cognitive domains investigated. After 6-12 months of observation, significant improvement in attention-executive function and verbal ability were found in OSAS children treated with AT compared to their baseline level; restoration of attention-executive function and memory were observed in OSAS children after AT in comparison to healthy controls. Further rigorous randomized controlled trials should be conducted to obtain definitive conclusions.