Indication For Tonsillectomy In Children Research Articles

Quality of the Italian Websites for Parental Guidance on the Indications for Tonsillectomy in Children.

Introduction The quality of information on websites about tonsillectomy regarding the knowledge level may be low. Tonsillectomy is a surgical procedure to hypertrophy of the palatine and pharyngeal tonsils. So, it is an invasive procedure with possible complications, which creates insecurity in parents. Significantly, Internet searches have been increased to address possible health concerns, questioning the quality of websites about tonsillectomy. Objective To evaluate the readability, reliability, and comprehensiveness of the Italian websites dedicated to parental guidance regarding the indications for tonsillectomy in children. Methods The search engine google.it was used to search the websites. The Gulpease index, which is a widely used readability formula ranging from 0 (difficult) to 100 (easy readability), was employed to evaluate these websites. The Health on the Net Code of Conduct (HONcode) was used to assess the quality of information, by taking ethical principles into account, with values ranging from 0 to 13. The content comprehensiveness of the web pages was assessed by assigning points ranging from 1 (very insufficient) to 5 (very satisfying) to each page. A final comparison with previous studies on tonsillectomy published on websites from other countries was performed. Results Fourteen Italian websites were selected, and the Gulpease index showed a mean average of 40.77 ± 8.45. The mean of the HONcode analysis was 6.00 ± 1.92, in which the principles with the poorest scores were Attribution and Update . As far as the comprehensiveness of the websites is concerned, the resulting mean was 2.57 ± 0.77, in which Indications was the topic with the highest mean, whereas Benefits was the one with the lowest. Conclusion The Italian websites were characterized by a lower readability level, a middle position regarding ethical principles, and the same (insufficient) comprehensiveness of tonsillectomy when compared with websites from different countries.

Post-tonsillectomy respiratory complications in children with sleep disordered breathing

ObjectiveA common indication for tonsillectomy in children is clinically diagnosed sleep disordered breathing (SDB) without confirmation of obstructive sleep apnea (OSA) by polysomnography (PSG). Our goal was to review rates of post-tonsillectomy respiratory complications in children with SDB without prior PSG in order to develop recommendations for postoperative monitoring and safe hospital discharge in this population. MethodsFollowing Institutional Review Board (IRB) approval at Penn State Milton S. Hershey Medical Center, a database query using Current Procedural Terminology (CPT) codes for tonsillectomy with or without adenoidectomy (42820, 42821, 42825, 42826) between January 1, 2012 and December 31, 2017 was performed. International Classification of Diseases (ICD) codes for sleep disordered breathing (G47.30), snoring (R06.83), and obstructive sleep apnea (G47.33) were applied for further selection. Charts were individually reviewed to confirm the inclusion criteria of pediatric patients (≤18 years) who underwent tonsillectomy without prior PSG and were monitored overnight. Demographic, operative, and relevant postoperative hospital course data (including desaturations, supplemental oxygen requirements, and upgraded level of care) were collected. ResultsA total of 1874 unique patient encounters were identified by our database search and 364 children met inclusion criteria. The average age of the patient population was 6.5 ± 3.1 years and 52.2% of children were female. Mean z-score for the population was 0.6. The rate of overnight oxygen desaturation events (<95%) was 2.2%, with no severe complications found in this population. Children with desaturation events were supplemented with oxygen and resolved prior to hospital discharge. Only race was found to be significantly related to risk of mild overnight desaturations (P = 0.023). ConclusionA lack of significant postoperative respiratory complications or alterations in the clinical management of children with SDB without prior PSG supports the idea that such patients may safely be discharged from the hospital following tonsillectomy without overnight oxygen monitoring.

Tonsillitis and sore throat in children.

Tonsillitis and sore throat in children.

Erkrankungen der Gaumenmandeln im Kindesalter

Die Operation an den Gaumenmandeln ist im Kindesalter eine der haufigsten, und oftmals ist es der erste chirurgische Eingriff bei einem kleinen Patienten. Seit der medienwirksamen Haufung an Todesfallen von Kindern nach Tonsillektomie in Osterreich 2006 kommt es langsam zu einem Paradigmenwechsel in Deutschland. Da jedoch klare Leitlinien fehlen, werden Eingriffe an den Tonsillen je nach Landkreis und Vorlieben sehr inhomogen gehandhabt. In einigen Kreisen werden 8-mal so vielen Kindern die Gaumenmandeln entfernt wie in anderen. Kinder unter 6 Jahren sollten nur noch bei andauernden bakteriellen Mandelentzundungen komplett tonsillektomiert werden. Die Teilentfernung der hyperplastischen Mandeln, die Tonsillotomie, ist wesentlich risikoarmer und der Tonsillektomie vorzuziehen. Die Blutungsgefahr und die postoperativen Schmerzen sind bei der Tonsillotomie deutlich geringer als bei der Tonsillektomie. Die Tonsillotomie kann mit dem Laser, Radiofrequenzgerat, Shaver, Coblation, bipolarer Schere oder monopolarer Nadel durchgefuhrt werden. Entscheidend ist, dass die Krypten offen bleiben und lymphatisch aktives Gewebe in der Fossa tonsillaris zuruck bleibt. Die Indikation zur Tonsillektomie besteht weiterhin bei rezidivierenden bakteriellen Infekten, Antibiotikaallergie, PFAPA Syndrom (periodisches Fieber, Apthen, Pharyngitis, Adenitis) und Peritonsillarabszess (einseitig). Bei den rezidivierenden Tonsillitiden kommt es auf die Schwere und die Haufigkeit an. Bei Kindern bis zum Alter von 16 Jahren sollte man sich an die Paradise Kriterien halten: Eine Indikation zur klassischen, kompletten Tonsillektomie besteht bei 5 oder mehr Tonsillitiden in mindestens 2 aufeinander folgenden Jahren oder bei 7 oder mehr Tonsillitiden innerhalb eines Jahres. Die Diagnose Tonsillitis kann klinisch gestellt werden. Sie besteht bei Schmerzen, tonsillarem Exsudat und Fieber>38,3°C. Wandernder Schmerz, niedrigeres Fieber und Husten lassen eher an eine Viruspharyngitis denken. Im Zweifel sollte ein Abstrich oder Antigentest angelegt werden. Beim Abstrich oder Antigen-Schnelltest muss aber berucksichtigt werden, dass Viren, Bakterien und Pilze zur transienten Mundflora gehoren und 10% aller Kinder klinisch inapparente, nicht behandlungsbedurftige Dauerausscheider von Streptokokken sind. Screeningtests mittels Antistreptolysintiter, Abstrichen oder Schnelltests (wie von manchen Kindertagesstatten gefordert) sind daher sinnlos und rechtfertigen keine Antibiotikatherapie. Die akute, bakterielle Tonsillitis sollte mit nicht steroidalen Antirheumatika (z. B. Ibuprofensaft), Betalactamantibiotika (z. b. Penicillin oder Cefuroxim) und bei Kindern und Jugendlichen auch oralem Steroid (z. B. Dexamethason) behandelt werden. Hinsichtlich der Verkurzung des Krankheitsverlaufes und der Reduktion der Symptome ist die Kurzzeittherapie mit Azithromycin (20mg/kg KG) fur 3 Tage oder Clarithromycin und einem Cephalosporin fur 5 Tage der Langzeit Penicillintherapie ebenburtig. Auch das fruhzeitige Absetzen der Penicilline nach 5 Tagen zeigte keine Nachteile im Krankheitsverlauf, der Rezidivrate oder der Resistenzbildung. Aber nur die empfohlene 10 Tage Antibiotikatherapie senkt die Inzidenz des rheumatischen Fiebers (derzeit 0,5 Falle pro 100 000 Kinder in Europa) und der Glomerulonephritis signifikant. Hauptproblem bei der Tonsillektomie ist, neben dem Schmerz, die gefurchtete Spatnachblutung. Diese kann bis zum kompletten Abheilen der Wunde (i. d. R. nach drei Wochen) auftreten und lebensbedrohlich sein. Grosere Massenblutungen kundigen sich oft durch kleinere, spontan sistierende Blutungen an. Daher muss jede Nachblutung ernst genommen und der betroffene Patient stationar aufgenommen werden. Die Patienten und die Eltern sind uber das korrekte Vorgehen bei Nachblutung idealerweise vor der Operation, aber spatestens bei Entlassung, schriftlich zu informieren. Das Informationsblatt sollte Adressen, Notruftelefonnummern und Ansprechpartner enthalten. Schwere oder letale Verlaufe entstehen meist durch falsches Management der Nachblutung. Eine besondere Lebensgefahrdung besteht bei Kleinkindern, die ein geringes Blutvolumen haben und relativ viel Blut unbemerkt schlucken konnen, bzw. aspirieren. Fur den Notarzt stellt die Intubation einer massiven Nachblutung nach Tonsillektomie eine extreme Herausforderung dar, welche oft nur mit einem geeigneten starren Tonsillensauger bewerkstelligt werden kann. Alle Operationstechniken haben ein Risiko der Nachblutung und selbst der erfahrenste Operateur ist nicht davor gefeit. Jedoch zeigte die „Kalte Dissektion“ mit Ligatur oder Umstechungen die geringsten Nachblutungsraten. Nach Laser-, Coblations-, mono- oder bipolaren Techniken kommt es signifikant haufiger zu schweren Nachblutungen. Kinder mit Gerinnungsstorungen bluten haufiger nach und konnen praoperativ unentdeckt bleiben. Eine standardisierte Blutungsanamnese (17 Punkte Checkliste), wie von den Fachgesellschaften fur Padiatrie, Anasthesie und HNO empfohlen, ist sensitiver und einfacher als das Screening mittels Gerinnungsparametern. In der Realitat zeigt sich jedoch, dass in Deutschland sehr viele der operativ-tatigen HNO Arzte weiterhin harte Laborwerte wie INR und PTT bevorzugen, obwohl diese den haufigen Von-Willebrand-Faktormangel nicht detektieren ­konnen.

The role of tonsils and clinical indications for tonsillectomy in children

The role of tonsils and clinical indications for tonsillectomy in children

Differential Expression of Cysteinyl Leukotriene Receptors 1 and 2 in Tonsils of Children With Obstructive Sleep Apnea Syndrome or Recurrent Infection

Recurrent tonsillitis and sleep apnea are the major indications for tonsillectomy in children. We hypothesized that the recurrent vibration in the upper airway of snoring children would promote inflammatory changes in the tonsillar tissue and would lead to the up-regulation of cysteinyl leukotriene (LT) receptors (Rs). To assess the expression patterns of the human LT-Rs in children undergoing tonsillectomy, and compare those patterns in children having recurrent throat infections (RIs) and children with obstructive sleep apnea syndrome (SA). Tonsillar tissue from 17 children with SA and 13 with RIs was subjected to quantitative polymerase chain reaction using specific primers for LT1-R and LT2-R, and to immunohistochemistry and Western blotting for protein expression of LT1-R and LT2-R. Messenger RNA encoding for the expression of LT1-R and LT2-R was detected in the tonsils of all children. Immunoblots revealed significantly higher expressions of LT1-R and LT2-R in the tonsils of children with SA. The topographic pattern of both receptors differed among the tonsils of children with SA and RI. LT1-R and LT2-R are expressed in pediatric tonsillar tissue, are more abundant in SA patients, and demonstrate a specific topographic pattern of expression. These findings suggest that an inflammatory process involving LT expression and regulation occurs in children with SA.

The effect of recurrent tonsillitis and tonsillectomy on growth in childhood

The aim of this study was to determine if children with recurrent tonsillitis are smaller than expected before tonsillectomy and if they have an altered height or weight gain 1 year post-operatively. All (204) children attending the hospital for tonsillectomy with or without adenoidectomy had their height and weight measured pre-operatively and 1 year after operation. The results of 2204 children in local schools were used as a control population. Analysis was by comparison of each population with the Tanner charts. This study suggests that our population of children listed for tonsillectomy were not lighter or smaller than expected before operation but that one year after tonsillectomy, there was an increase in their weight gain. The height gain was no different than expected after operation. Overweight seems to be a medium term complication of tonsillectomy. It may be necessary to redefine the indications for tonsillectomy in children who are already obese.

The indication for tonsillectomy in children following peritonsillar abscess

The clinical course of 19 consecutive children treated for peritonsillar abscess (PTA), in the Chaim Sheba Medical Center, between 1988–1992 was retrospectively reviewed. The abscess was drained through an incision (12 children) and by needle aspiration (7 children), under local (11 children) or general (8 children) anesthesia. One child suffered from recurrent bouts of tonsillitis after the abscess resolved and eventually underwent tonsillectomy. Two others, with a pre-PTA history of recurrent tonsillitis (T+) underwent interval tonsillectomy. Recurrent PTA did not develop in any of the 16 non-operated children. The involvement of mainly older children can explain both the low rate of the pre-PTA history of T+ and the number of children whose abscess could be drained under local anesthesia. Tonsillectomy should be indicated in cases of recurrent PTA or in children with a pre-PTA history of T+. The need for general anesthesia for draining the abscess in young children does not seem, in itself, to warrant a routine hot tonsillectomy.

Acute upper respiratory tract infections and indications for tonsillectomy in children. I. Immunoglobulin synthesis in the palatine tonsil tissue

Current viewpoints and practice concerning indications for tonsillectomy are presented. The annual specific risk for upper respiratory infection in children aged up to 15 is 1.1. The risk is higher in the youngest age group, in whom it rises to 1.8, decreasing with age and being lowest among children aged 12–15 years (0.5). The proportion of tonsillitis among acute upper respiratory tract infections is highest in the age group up to 3 years (36.9%); at the age of 4–5 years it is 37.1%, and is lowest among children aged 12–15 years (21.9%). The risk of tonsillitis caused by streptococci is highest among children aged up to 5 years. Statistical significance of differences in the synthesis of immunoglobulins (G, M, A and sA) and lysozymes in the palatine tonsil tissue of tonsillectomized children and healthy volunteers was tested by non-parametric tests for independent samples. Significant differences of the above mentioned syntheses were found in all entities studied. Any contribution to the documentation on the nature and cause of each tonsillitis in childhood is of great clinical value, because it is the only basis for rational consideration of indications for tonsillectomy.

INDICATIONS FOR TONSILLECTOMY IN CHILDREN

Medical Journal of AustraliaVolume 1, Issue 10 p. 261-265 Original Article INDICATIONS FOR TONSILLECTOMY IN CHILDREN† Rupert M. Downes C.M.G., M.D., M.S., Rupert M. Downes C.M.G., M.D., M.S. Out-Patient and Temporary In-Patient Surgeon Children's Hospital, MelbourneSearch for more papers by this author Rupert M. Downes C.M.G., M.D., M.S., Rupert M. Downes C.M.G., M.D., M.S. Out-Patient and Temporary In-Patient Surgeon Children's Hospital, MelbourneSearch for more papers by this author First published: 01 March 1922 https://doi.org/10.5694/j.1326-5377.1922.tb60978.x †Read at a meeting of the Melbourne Pædiatric Society on April 13, 1921. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume1, Issue10March 1922Pages 261-265 RelatedInformation