Indication For Adenotonsillectomy Research Articles

Predictors of Dehydration Following Adenotonsillectomy in Jordanian Pediatric Cases

Background: Dehydration is a well-established complication of adenotonsillectomy. This study aims to measure the prevalence of dehydration among pediatric adenotonsillectomy patients in a tertiary hospital in Amman and to identify the risk factors that could be associated with it. Methods: This is an observational single-center study. Data were collected by reviewing the health records of patients who underwent adenotonsillectomy between January 2015 and June 2020 at Ibn Al-Haytham Hospital. Inclusion criteria were any patient between 1 and 12 years old that has undergone routine adenotonsillectomy. Exclusion criteria were any adenotonsillectomy for neoplasm purposes, patients with reported developmental delay, and patients who underwent adenoidectomy or tonsillectomy alone. Collected data included patients' demographics, indication for adenotonsillectomy, type of surgical technique, and history of dehydration in the following two weeks post adenotonsillectomy. The data were then imported into an SPSS statistical spreadsheet and analyzed. Descriptive statistics analysis of the demographic characteristics of the cases was prepared. Numerical data were expressed as percentages or means ± standard deviation (SD). Results: Three hundred and eighty-four patients met the inclusion criteria of this study. 234 patients (62.2%) were male, and the majority of the cases (223 patients) were between 5 and 6 years old, accounting for 58.8% of the population. The prevalence of post-adenotonsillectomy dehydration was 5.7%. Point estimation with a 95% confidence interval falls between 5.17 and 5.63. Dehydration was more prevalent in children aged under three years old. Dependence-type Multivariate analysis revealed that age and gender remained significantly associated with dehydration with P values > 0.001 and 0.004, respectively, after adjusting for the other variables. Conclusion: Dehydration is a serious yet rare complication post adenotonsillectomy. Screening for dehydration pre- and post-discharge is highly recommended. There is a need for further multi-center and population-based studies to examine the full extent of dehydration complications. It is in the best interest of surgeons and all caregivers to provide the best quality of care for adenotonsillectomy cases. Avoiding dehydration and all other surgical complications would be part of the standards of high-quality health care.

Nocturnal oximetry parameters as predictors of sleep apnea severity in resource-limited settings.

Nocturnal oximetry is an alternative modality for evaluating obstructive sleep apnea syndrome (OSAS) severity when polysomnography is not available. The Oxygen Desaturation (≥3%) Index (ODI3) and McGill Oximetry Score (MOS) are used as predictors of moderate-to-severe OSAS (apnea-hypopnea index-AHI >5 episodes/h), an indication for adenotonsillectomy. We hypothesised that ODI3 is a better predictive parameter for AHI >5 episodes/h than the MOS. All polysomnograms performed in otherwise healthy, snoring children with tonsillar hypertrophy in a tertiary hospital (November 2014 to May 2019) were analysed. The ODI3 and MOS were derived from the oximetry channel of each polysomnogram. Logistic regression was applied to assess associations of ODI3 or MOS (predictors) with an AHI >5 episodes/h (primary outcome). Receiver operating characteristic (ROC) curves and areas under ROC curves were used to compare the ODI3 and MOS as predictors of moderate-to-severe OSAS. The optimal cut-off value for each oximetry parameter was determined using Youden's index. Polysomnograms of 112 children (median [interquartile range] age 6.1[3.9-9.1]years; 35.7% overweight) were analysed. Moderate-to-severe OSAS prevalence was 49.1%. The ODI3 and MOS were significant predictors of moderate-to-severe OSAS after adjustment for overweight, sex, and age (odds ratio [OR] 1.34, 95% confidence interval [CI] 1.19-1.51); and OR 4.10, 95% CI 2.06-8.15, respectively; p < 0.001 for both). Area under the ROC curve was higher for the ODI3 than for MOS (0.903 [95% CI 0.842-0.964] versus 0.745 [95% CI 0.668-0.821]; p < 0.001). Optimal cut-off values for the ODI3 and MOS were ≥4.3 episodes/h and ≥2, respectively. The ODI3 emerges as preferable or at least a complementary oximetry parameter to MOS for detecting moderate-to-severe OSAS in snoring children when polysomnography is not available.

Pediatric obstructive sleep-disordered breathing is associated with arterial stiffness.

The association between obstructive sleep-disordered breathing (oSDB) and arterial stiffness, an independent predictor of cardiovascular outcomes, is not well established in children. This study compared cardiovascular parameters between healthy and oSDB children and aimed to identify predictors of arterial stiffness indices in children with oSDB. Cross-sectional study realized in a tertiary hospital from June 2018 to January 2020. Forty-eight children (3 to 10years old) with clinical diagnosis of oSDB and indication for adenotonsillectomy and 24 controls were evaluated. Cardiovascular parameters were measured non-invasively by brachial artery oscillometry with a portable device. The main arterial stiffness indices assessed were augmentation index and pulse wave velocity, both derived from the aortic pulse wave. In the oSDB group, the questionnaires Obstructive Sleep Apnea-18 (OSA-18)and Pediatric Quality of Life Inventory version 4.0 (PedsQL 4.0)were applied. The oSDB group had higher values of reflection coefficient (p = 0.044) and augmentation index (p = 0.003) than the control group. Stepwise multiple regression analysis revealed that age, female sex, reflection coefficient, and systolic volume were independent predictors of augmentation index. Higher pulse wave velocity values were associated with worse quality of life assessed by PedsQL 4.0questionnaire. There was no association with OSA-18. The vascular and hemodynamic parameters were similar in both groups.Conclusion: Children with oSDB have increased augmentation index, an independent predictor of cardiovascular outcomes. The early identification of subclinical cardiovascular changes reinforces the importance of treating the disease, as well as changing lifestyle habits, to prevent complications in adulthood. What is Known: • The association between oSDB and cardiovascular risk in adults is well described in the literature. • Children with oSDB, regardless of their weight or sex, have higher PWV values when compared to non-snoring children. What is New: • Children with oSDB have augmented arterial stiffness, evidenced by the increase in AIx@75, measured non-invasively by brachial artery oscillometry with a portable device. • Low quality of life and therefore a high disease burden in children with oSDB may be a risk factor for arterial stiffness.

Update on the safety of anesthesia in young children presenting for adenotonsillectomy.

Tonsillectomy with and without adenoidectomy is a frequently performed surgical procedure in children. Although a common procedure, it is not without significant risk. It is critical for anesthesiologists to consider preoperative, intraoperative, and postoperative patient factors and events to optimize safety, especially in young children. In the majority of cases, the indication for adenotonsillectomy in young children is obstructive breathing. Preoperative evaluation for patient comorbidities, especially obstructive sleep apnea, risk factors for a difficult airway, and history of recent illness are crucial to prepare the patient for surgery and develop an anesthetic plan. Communication and collaboration with the otolaryngologist is key to prevent and treat intraoperative events such as airway fires or hemorrhage. Postoperative analgesia planning is critical for safe pain control especially for those patients with a history of obstructive sleep apnea and opioid sensitivity. In young children, it is important to also consider the impact of anesthetic medications on the developing brain. This is an area of continuing research but needs to be weighed when planning for surgical treatment and when discussing risks and benefits with patients’ families.

Impact of Adenotonsillectomy on Weight Gain in Children

Introduction&#x0D; ‘Failure to thrive’ is considered to be an indication for adenotonsillectomy in children. There is contrasting evidence regarding weight gain in children following adenotonsillectomy. The objective of this study is to evaluate weight change post adenotonsillectomy.&#x0D; Materials and Methods &#x0D; A prospective study conducted on 45 children of age between 5 to 15 years, who underwent adenotonsillectomy in our hospital. Weight is calculated at three different period i.e. preoperative, postoperatively at 3 and 6 months and compared with standard Indian Academy of Paediatrics (IAP) weight for age.&#x0D; Results &#x0D; Out of 45 children 62.2% were less than 10 years of age with a male preponderance of 60%. 55.6% had normal birth weight. Preoperatively the average weight of the participants was 25.69 kg when compared to IAP normal weight for age which was 29.67 kg. Postoperatively at 6 months it was 28.19 kg as opposed to the expected weight of 31.88 kg.&#x0D; Conclusion&#x0D; The weight gain post adeno-tonsillectomy failed to meet the expected IAP value and was below the expected value. Hence there was no significant weight change following adenotonsillectomy.&#x0D;

Socioeconomic variables as a predictor of indication for pediatric adenotonsillectomy

ObjectivesAdenotonsillectomy (AT) is a common pediatric procedure performed for sleep disordered breathing (SDB) or chronic/recurrent tonsillitis. A better understanding of factors associated with clinical indications for AT would positively contribute to patient-centered care of these conditions. Our objective is to assess the relationships between race, ethnicity, and socioeconomic status (SES) and indications for adenotonsillectomy in pediatric patients. MethodsA retrospective chart review was conducted for pediatric patients between the ages 0–18 years who underwent adenotonsillectomy between October 2012 and October 2017 at Boston Medical Center. Indication for surgery was categorized as sleep disordered breathing (SDB), tonsillitis, or other. Age, race, ethnicity, gender, language, distance to hospital and insurance type were collected as demographic variables. 9-Digit patient zip codes were matched to a corresponding area deprivation index (ADI) which combines 17 neighborhood level socioeconomic markers. Logistic regression analysis was performed to assess for association between demographic variables and indication for adenotonsillectomy. Results1315 children were included in this study (mean age = 6.4 years, 0–18 years). African American (OR = 3.90, p-value <0.0001), Latino (OR = 2.602, p-value < 0.0001), and Asian American (OR = 4.439, p-value = 0.0146) patients were more likely to have SDB as an indication than Caucasian patients. Among children undergoing AT for SDB, patients who received pre-operative polysomnogram were more likely to be under 2 years old, African American, Asian American, or of Hispanic ethnicity and have higher BMI than patients who were diagnosed clinically prior to surgery. There was no statistically significant association between indications for adenotonsillectomy and ADI, distance to hospital, insurance status or language. Males were more likely have to have SDB as an indication than females (OR = 1.67, p-value = 0.0014). Younger patients under two years of age were more likely to have SDB as an indication for surgery when compared to older patients. ConclusionWe found significant relationships between indications for adenotonsillectomy and race and ethnicity as well as gender and age. Additionally, our study showed that indication for AT was not associated with either ADI or insurance status. This suggests that race and ethnicity are predictors of indication independent of SES. Knowledge of predictive factors of adenotonsillectomy indications may help to improve patient centered care.

Is the Trend in Indications for Tonsillectomy and Adenotonsillectomy Really Changing?

Objectives: Infection and obstruction are the most common indications for performing tonsillectomy and adenotonsillectomy. In the past, infection was the main indication for these procedures; however, in the last few decades, obstruction is said to be more prominent as an indication when compared to infection. This study evaluates the changing trend in indications for tonsillectomy and adenotonsillectomies. Methods: This is a 2 year retrospective analysis of case records of patients aged 0-18 years who have had tonsillectomy or adenoidectomy and tonsillectomy performed in Aminu Kano Teaching Hospital. IBM SPSS (for Windows, version 19) software was used to analyze these data. Results: A total of 115 patient case records were reviewed. 33.9% were children under 3 years old, 60.0% were between 4-10 years, and 6.1% were between 11-18 years. Obstruction accounted for a total of 68.7% while infection accounted for only 31.3% of the indications for these procedures. There was a significant association between age groups and indications for adenotonsillectomies ( P = 0001, Phi and Cramer’s V = 0.363, respectively). Conclusions: Obstruction as an indication is proportionally higher in younger children, while infection is proportionally higher in older children.

Nez bouché et bouche ouverte : le point de vue de l’ORL

Obstructive diseases of children's upper airways are frequent, mostly caused by tonsils and adenoids hypertrophy. A nasal septum deviation or a lower turbinate hypertrophy may also cause a significant obstruction. Tonsillectomy and adenoidectomy must be performed in case of clinical obstruction, sometimes documented by a sleep study. A tonsils' hypertrophy without significant obstruction and clinical symptoms is not an indication of adenotonsillectomy, even in case of snoring or if an orthodontic treatment is planned.

The prevelance of psichiatric symptoms in preschool children with adenotonsillar hypertrophy

ObjectivesThe aim of this study was to determine the prevalence of psychiatric disorders and symptoms in preschool-age children who are indicated for operation due to adenotonsillar hypertrophy. Materials and methodsForty-eight patients between the ages of three and five years with indication for adenotonsillectomy were included in the study, as well as 40 control patients. Cases underwent routine ear nose throat (ENT) examination, flexible nasopharyngoscopy and tympanometry. The Early Childhood Inventory-4 (ECI-4) parent form and Strengths and Difficulties Questionnaire (SDQ) parent form were completed by the parent caring for the child. The SPSS for Windows 16.0 program was used for statistical analysis. ResultsGroups were compared according to they received at least one psychiatric diagnosis measured by ECI-4, the group of adenotonsillar hypertrophy was diagnosed more than the control group. Attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and sleep disorders were detected at a higher rate in patients with adenotonsillar hypertrophy. It also was established that in the comparison of the severity of psychiatric symptoms determined by ECI-4, symptom severity of ADHD, ODD, anxiety disorders, and sleep disorders was higher in the adenotonsillar hypertrophy group than in the control group. In the evaluation of the SDQ parent form, it was determined that attention deficit, hyperactivity, behavioral, and peer relations problems occurred more frequently in the adenotonsillar hypertrophy group. ConclusionsIn addition to oral respiration, snoring, and disordered breathing during sleep, adenotonsillar hypertrophy may also associated with psychiatric disorders and symptoms.

Nonsteroidal Anti-inflammatory Drugs and Postoperative Bleeding Following Adenotonsillectomy in Pediatric Patients

To assess the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on bleeding for pediatric adenotonsillectomy in a retrospective study, based on the common practices at 2 different tertiary care facilities. A retrospective study. Two different tertiary care facilities. Children up to 16 years of age, who underwent elective adenotonsillectomy or tonsillectomy, were included in the study. All indications for adenotonsillectomy, and all surgical techniques were included. Children with a bleeding tendency, and those with contraindications to the use of NSAIDs (eg, because of allergy), were excluded from the study. Nonsteroidal anti-inflammatory drugs. Postoperative bleeding in patients. A total of 1160 patients were selected who met the criteria: 673 patients underwent an adenotonsillectomy or tonsillectomy and did not receive any preoperative and postoperative ibuprofen, and 487 patients underwent routine adenotonsillectomy or tonsillectomy and were given postoperative ibuprofen. We noted a 0.7% postoperative bleeding rate in patients who were not allowed to take ibuprofen perioperatively. There was a 1.0% postoperative bleeding rate in patients who were allowed to take ibuprofen perioperatively (P = .75). Ibuprofen is not a contraindication to adenotonsillectomy or tonsillectomy and should be used in the control of postoperative pain if it is indicated in the patient.

Hipertensão pulmonar em pacientes com hipertrofia adenoamigdaliana

Apesar de a hipertrofia adenoamigdaliana ser uma moléstia reconhecida desde os primórdios, foi somente descrita como causadora de hipertensão pulmonar e cor pulmonale em 1965 por Menashe e Farrehi. Ainda são poucos os casos apresentados na literatura analisando a existência de hipertensão pulmonar em crianças com aumento do tecido adenoamigdaliano. OBJETIVO: Avaliar a prevalência de hipertensão pulmonar em crianças com hipertrofia adenoamigdaliana. FORMA DE ESTUDO: Coorte transversal. MATERIAL E MÉTODO: Foram avaliados 14 pacientes, com idade inferior a 15 anos, de ambos os sexos, com indicação formal para adenoamigdalectomia por hipertrofia adenoamigdaliana. Todos os pacientes foram submetidos à avaliação pré-operatória contendo: questionário, avaliação clínica otorrinolaringológica, Rx simples de cavum, vídeo-nasofibroscopia e ecocardiograma. RESULTADOS: Dos 14 pacientes analisados, um (7,14%) apresentou hipertensão pulmonar. CONCLUSÃO: Com base em nosso estudo, concluímos que a hipertrofia adenoamigdaliana está relacionada com o desenvolvimento de hipertensão pulmonar, sendo o ecocardiograma um exame bastante útil na determinação desta condição clínica. A remoção cirúrgica do tecido adenoamigdaliano pode reverter o quadro de hipertensão pulmonar decorrente do processo obstrutivo crônico.

Sleep disordered breathing: Effects of adenotonsillectomy on behaviour and psychological functioning: Ali N.J.; Pitson D.; Stradling J.R.Eur. J. Pediatr. (GBR) (1996) 155/1 (56–62)

Adenotonsillectomy (AT) is a common pediatric procedure performed for sleep disordered breathing (SDB) or chronic/recurrent tonsillitis. A better understanding of factors associated with clinical indications for AT would positively contribute to patient-centered care of these conditions. Our objective is to assess the relationships between race, ethnicity, and socioeconomic status (SES) and indications for adenotonsillectomy in pediatric patients.A retrospective chart review was conducted for pediatric patients between the ages 0–18 years who underwent adenotonsillectomy between October 2012 and October 2017 at Boston Medical Center. Indication for surgery was categorized as sleep disordered breathing (SDB), tonsillitis, or other. Age, race, ethnicity, gender, language, distance to hospital and insurance type were collected as demographic variables. 9-Digit patient zip codes were matched to a corresponding area deprivation index (ADI) which combines 17 neighborhood level socioeconomic markers. Logistic regression analysis was performed to assess for association between demographic variables and indication for adenotonsillectomy.1315 children were included in this study (mean age = 6.4 years, 0–18 years). African American (OR = 3.90, p-value <0.0001), Latino (OR = 2.602, p-value < 0.0001), and Asian American (OR = 4.439, p-value = 0.0146) patients were more likely to have SDB as an indication than Caucasian patients. Among children undergoing AT for SDB, patients who received pre-operative polysomnogram were more likely to be under 2 years old, African American, Asian American, or of Hispanic ethnicity and have higher BMI than patients who were diagnosed clinically prior to surgery. There was no statistically significant association between indications for adenotonsillectomy and ADI, distance to hospital, insurance status or language. Males were more likely have to have SDB as an indication than females (OR = 1.67, p-value = 0.0014). Younger patients under two years of age were more likely to have SDB as an indication for surgery when compared to older patients.We found significant relationships between indications for adenotonsillectomy and race and ethnicity as well as gender and age. Additionally, our study showed that indication for AT was not associated with either ADI or insurance status. This suggests that race and ethnicity are predictors of indication independent of SES. Knowledge of predictive factors of adenotonsillectomy indications may help to improve patient centered care.

Adenotonsillectomy

<i>To the Editor</i>.—The commentary, "Indications for Adenotonsillectomy," by Gates and Folbre,¹in the May 1986 issue of theArchives, has a number of important flaws or inaccuracies. First, the authors state that a prominent textbook of pediatrics²fails to mention recurrent infection as an indication for adenotonsillectomy. In fact, on the very pages referenced in that textbook, it is clearly stated that tonsillectomy should be considered in children with four or more episodes of tonsillitis in a year. Second, the authors state that "current evidence has demonstrated the efficacy of T &amp; A for severely recurrent sore throat." In fact, whereas the study referenced³showed a shortterm benefit of tonsillectomy in treating the recurrent tonsillitis, no advantage was demonstrated by adding an adenoidectomy to the procedure. Finally, in support of their statement that "current evidence has demonstrated the efficacy of... adenoidectomy for chronic otitis media with

Adenotonsillectomy

<i>To the Editor</i>.—I would like to compliment Gates and Folbre¹on their very timely commentary on adenotonsillectomy in the May 1986 issue of theArchives. It fills a definite need for a current establishment on indications for these procedures. I would, however, like to have seen more elaboration on chronic upper airway obstruction as an indication for adenotonsillectomy. Each year we see a number of children between the ages of 4 and 9 years with symptoms of loud snoring at night and oral breathing. The parents will often state that the child is also somewhat irritable and has a short attention span. On physical examination, these children are often pale, rather small for their age, and thin. They are usually oral breathers; their tonsils approach the midline; and some have high-arched palates and elongated faces. Adenotonsillectomy in these patients is one of the most gratifying procedures we have

Sleep apneic episodes as indications for adenotonsillectomy.

Fourteen children with adenoid and tonsillar hyperplasia were studied for one night in the sleep laboratory. Six of the children had at least 40 apneic episodes per night, mostly central or obstructive. The largest number of episodes was found in rapid eye movement sleep. Mixed episodes were the longest and central episodes the shortest. Adenotonsillectomy was performed on children with at least 40 episodes and on children with predominantly obstructive episodes. In two of these children, preoperative and postoperative recordings were taken, revealing a reduction in the total number of apneic episodes and a complete disappearance of obstructive episodes. These results suggest that polysomnographic recordings can provide useful information regarding the necessity of adenotonsillectomy.