Pediatric Tonsil Research Articles

YouTube: A good source of information on pediatric tonsillectomy?

ObjectiveTo investigate YouTube as a patient information source on pediatric tonsillectomy. MethodsYouTube was searched on July 31, 2012 for the search terms pediatric tonsillectomy (PT), tonsillectomy (T) and tonsil surgery (TS). Non-English videos were excluded. Two physician reviewers independently assessed the videos for characteristics, usefulness, and information source. Usefulness was assessed according to a checklist developed by the authors. Any discrepancies were resolved by consensuses. Data were analyzed with SPSS software. ResultsOne hundred fifty-six videos were included in the analysis. Forty videos were classified as very or moderately useful (25.6%). Sources of the videos were as follows: patient experience, 103 videos (66%); physician, 30 (19%); surgical technique, 14 (9%); and news report, 9 (6%). Physician sourced information was generally at least moderately useful (58%) and patient experience videos were the predominant source of videos categorized as not useful or misleading (50%). Physician sourced information (coefficient=0.61; 95% CI: .21 to 1.00, p=0.003) and PT search term (coefficient=0.26; 95% CI: 0.05 to .47, p=0.017) were the most useful videos after adjusting for mean duration, days online, number of views and page search. ConclusionYouTube has a large number of videos on pediatric tonsillectomy with a variety of content ranging from very useful to not useful, and misleading. Health care professionals must recognize the potential influence that these video Web sites may have on patient attitudes.

YouTube as a Source of Pediatric Tonsillectomy Information

Objective: Tonsillectomy is a common surgery performed on pediatric patients. Patients and their caregivers may search the Internet for information related to this procedure, and YouTube is a popular Web site that they may consult. We investigated YouTube as an information source on pediatric tonsillectomy. Method: YouTube was searched on February 17, 2012, for videos containing relevant information about tonsillectomies in pediatric patients using the keywords pediatric tonsillectomy, tonsillectomy and tonsil surgery. Non-English videos were excluded. Two physician reviewers watched each video and assessed for content (useful, misleading, personal experience). The StatsDirect software will analyze measures. Results: The search for each keyword identified over 2555 videos (pediatric tonsillectomy = 91, tonsillectomy = about 1800, tonsil surgery = 664). The first 200 videos were screened for each keyword on the assumption that most users would not go beyond the first 10 pages. Therefore, 491 videos were screened for inclusion and exclusion criteria, and duplicates were removed. At the time of abstract submission, final data analysis was not yet available. Outcomes included content assessment and characteristics, and video total viewership, number of days since upload, total duration, viewer rating, and source of upload. Reviewer degree of agreement and relevant statistical analysis will be reported. Conclusion: YouTube has a substantial number of videos on pediatric tonsillectomy with a variety of content ranging from useful to misleading. Health care professionals must recognize the potential influence that these user-generated video Web sites may have on the attitudes of patients and their caregivers.

Laryngeal mask airway versus endotracheal tube in pediatric adenotonsillectomy

Evaluation of safety and postoperative outcomes of the laryngeal mask airway (LMA) during pediatric tonsil surgery compared to use of the endotracheal tube (ETT). Randomized controlled trial. A population-based sample of 117 patients ages 2 to 18 years requiring adenotonsillectomy, adenoidectomy, or tonsillectomy was studied. Evaluation forms covering 36 safety, surgery duration, and patient comfort variables were given to the surgeon, anesthesiologist, and phase I and phase II recovery nurses to collect data on the intra- and postoperative course. A phone survey was conducted 24 hours after surgery. At the α level following Bonferroni correction, LMA showed less coughing or gagging during the anesthesia phase for all surgeries combined (48% for ETT vs. 20% for LMA; χ(2) = 10.153, P = .002), and for ETT nontonsillectomy vs. LMA nontonsillectomy (48% for ETT vs. 3% for LMA; χ(2) = 15.196, P = .000), spontaneous ventilation was used more often in the LMA group when comparing all surgeries (χ(2) = 19.493, P = .000), and when comparing ETT tonsillectomy and LMA tonsillectomy (χ(2) = 11.131, P = .000). Use of the LMA during pediatric tonsil surgery does not appear to have any major disadvantages compared to use of the ETT. In fact, analysis of safety, comfort, complications, and postoperative problems suggests that LMA may be superior for some outcome variables such as coughing and gagging. Use of spontaneous ventilation is more common among LMA patients, although the significance of this finding is uncertain.

The Otologic Microbiome<subtitle>A Study of the Bacterial Microbiota in a Pediatric Patient With Chronic Serous Otitis Media Using <emph type="ital">16SrRNA</emph> Gene-Based Pyrosequencing</subtitle>

To characterize bacterial microbiota in middle ear, adenoid, and tonsil specimens using 16SrRNA gene-based pyrosequencing analysis. Cross-sectional study of bacterial microbiota in middle ear, adenoid, and tonsil specimens from a pediatric patient with chronic serous otitis media. Middle ear, adenoid, and tonsil specimens from a pediatric patient were collected and underwent cell lysis and DNA isolation. Pyrosequencing was performed on the 454 Life Sciences GS FLX platform (Roche Diagnostics Corp, Branford, Connecticut). Pyrosequencing data were processed, quality-checked, and taxonomically classified to generate an abundance-based matrix. Ecological analyses were performed. Academic, tertiary referral center. Comparative microbiome analysis. We detected a total of 17 unique bacterial families, with 9, 9, and 12 bacterial families from the middle ear, tonsil, and adenoid specimens, respectively. Pseudomonadaceae dominated the middle ear microbiota at 82.7% relative abundance, whereas Streptococcaceae dominated the tonsil microbiota at 69.2%. Multiple bacteria, including Pseudomonadaceae, Streptococcaceae, Fusobacteriaceae, and Pasteurellaceae, dominated the adenoid microbiota. Overlap between the middle ear and the tonsil microbiota was minimal. In contrast, the adenoid microbiota encompassed bacteria detected from middle ear and tonsil. Bacterial community analysis using pyrosequencing analysis revealed diverse, previously unknown bacterial communities in a set of pediatric middle ear, tonsil, and adenoid specimens. Our findings suggest that the adenoid may be a source site for both the middle ear and tonsil microbiota. An ecological framework is appropriate in comparative analysis of microbiota from nonsterile body sites.

Systematic Review of Pediatric Tonsil Size and Polysomnogram‐Measured Obstructive Sleep Apnea Severity

Systematically review the biomedical literature for data comparing clinical, subjective tonsil size (0-4+ scale) to objectively measured obstructive sleep apnea syndrome (OSAS) using polysomnography (PSG). PubMed database. A comprehensive PubMed MeSH search was conducted to identify articles comparing subjective tonsil size to objectively measured OSAS. Inclusion criteria included pediatric patients only, sample size greater than 5, and sufficient data to extract for analysis. Exclusion criteria included patients with obesity or craniofacial syndromes. Twenty articles were included in the final data set. The mean sample size was 161 (range, 32-700) and grand mean age was 6.7 (range, 2.7-11.7). Case series (evidence based medicine [EBM] level 4) was the predominant study design (16 studies). Eleven of 20 studies concluded there was an association between subjective tonsil size and objective OSAS, whereas 9 did not. Varying statistical techniques were used including simple diagnostic tables (k = 8), linear or logistic regression (k = 19), correlation (k = 5), and analysis of variance (k = 2). A customized quality assessment of each study was performed. Studies showing no association between tonsil size and OSAS had a higher quality score than studies showing an association (3.22 vs 2.36, P = .0317). The association between subjective pediatric tonsil size using 0-4+ scale and objective OSAS severity is weak at best. High-quality studies suggest no association. Providers must recognize the limitations of using tonsil size in clinical decision making.

Anesthetic management of the pediatric bleeding tonsil

Anesthetic management of the child with post-tonsillectomy hemorrhage is challenging and fraught with hazards such as anemia, hypovolemia, and risk of difficult airway. The aim of this retrospective cohort study was to determine the incidence and further define the anesthetic complications in this population. Retrospective cohort study of all children who underwent operative intervention for post-tonsillectomy hemorrhage (with or without adenoidectomy) from 1998 to 2005 at The Children's Hospital of Philadelphia. Anesthetic records were examined for independent (anesthetic techniques and patient characteristics) and dependent variables (ventilatory and hemodynamic complications). Four hundred and seventy-five patients required surgery for exploration of post-tonsillectomy hemorrhage (incidence 2.9%). Intravenous rapid sequence induction was used in 401 (84.4%) patients. Succinylcholine was used in 420 (88%) patients. The most common adverse event (9.9%) was hypoxemia; most episodes occurred during emergence or extubation. Bradycardia during anesthetic induction occurred in 20 (4.2%) patients, and hypotension was noted in 12 (2.5%) patients. Thirteen (2.7%) patients were noted to be difficult to intubate, none of whom were difficult to intubate during the initial tonsillectomy. We determined our incidence of ventilatory and hemodynamic complications in a relatively large cohort of children with post-tonsillectomy hemorrhage. Transient hypoxemia was the most common complication and was not related to difficult intubation.

Systematic Review of Pediatric Tonsil Size and OSA Severity

Free accessAbstractFirst published online August 2010Systematic Review of Pediatric Tonsil Size and OSA SeverityJennifer Nolan, MD, presenterView all authors and affiliationsVolume 143, Issue 2_supplhttps://doi.org/10.1016/j.otohns.2010.06.226

Utility of Gross Analysis of Pediatric Tonsil Specimens

Utility of Gross Analysis of Pediatric Tonsil Specimens

Child behavior and quality of life before and after tonsillotomy versus tonsillectomy

Objectives Compare two techniques for pediatric tonsil surgery with respect to postoperative pain and morbidity and changes in sleep behavior, health related quality of life (HRQL) and benefits due to surgery. Methods 67 children (4.5–5.5 years) with tonsillar hypertrophy and obstructive sleep-disordered breathing with or without recurrent tonsillitis were randomized to either regular tonsillectomy (TE) ( n = 32) or intracapsular tonsillectomy/tonsillotomy (TT) ( n = 35) with Radiofrequency surgical technique (ellman Int.). Before TT/TE, the parents completed a validated Quality of Life survey of pediatric obstructive sleep apnea, the OSA-18 (Obstructive Sleep Apnea-18) and a standardized assessment of their children's behavior with the Child Behavior Checklist (CBCL). Six months after surgery, the parents repeated these measurements, and assessed the health related benefits of the surgery using the Glasgow Children's Benefit Inventory (GCBI). Results In the TT group, the children recorded less pain from the first day after surgery onwards, used fewer doses of painkillers and were pain-free 3 days earlier than the children in the TE group. Six months after surgery, there were no significant difference between TT and TE with regard to snoring and ENT-infections. The differences in the total scores and in all the individual domains between the initial OSA-18 and post-surgery scores were all significant ( P < 0.0001). The improvement in the total problem score measured with CBCL was also significant ( P < 0.01) and there was no difference between the TT and TE children. The improvements in all subscores of the GCBI indicated a significant health benefit of both TT and TE. Conclusions TT with RF-surgery causes less pain and postoperative morbidity than regular TE and has an equal effect on snoring and recurrent infections. Pre-school children with tonsillar hypertrophy and obstructive sleep-disordered breathing all show an impact on HRQL and behavior before surgery and improve dramatically just as much after TT as after TE. Therefore TT would be considered for treatment of small children.

Pediatric tonsil size: Objective vs subjective measurements correlated to overnight polysomnogram

Objective To compare subjective and objective tonsil size measurements (weight, volume, intertonsillar distance) along with simple pharyngeal measurements in the prediction of pediatric obstructive sleep apnea hypopnea syndrome (OSAHS) severity. Study Design Prospective case series. Subjects and Methods Tonsil size (0-4+) and Mallampati/Friedman palate position were subjectively measured. During adenotonsillectomy, tonsil size was objectively measured along with simple pharyngeal dimensions. Spearman rank correlation coefficients were calculated and forward and reverse stepwise multivariate regression modeling was used to assess the prediction of preoperative OSAHS severity as determined by polysomnogram (PSG). Evaluation of possible outlier influence was also performed. Results Thirty-four pediatric patients (median age, 4; range, 2-9) were included. Objective tonsil weight (Spearman's ρ = 0.6143, P = 0.0002), tonsil volume (ρ = 0.4960, P = 0.0039), and intertonsillar distance (ρ = −0.7559, P < 0.0001) were strongly correlated with subjective tonsil size but not with age, body mass index (BMI), or preoperative apnea-hypopnea index (AHI). Regression modeling demonstrated that only measured tonsil weight (β = 1.43, P = 0.003), age (β = −3.21, P = 0.001), and hard palate length (β = 0.979, P = 0.003) were significant predictors of the preoperative AHI (R 2 = 0.5358). Evaluation of possible outliers indicated tonsil weight was the most robust predictor of preoperative AHI. Conclusion Subjective tonsil size measurements correlate well with objective tonsil volume measurements. However, only objective tonsil measurements were significantly predictive of objective PSG-measured OSAHS severity.

Histologic analysis of pediatric tonsil and adenoid specimens: Is it really necessary?

To evaluate the incidence of unexpected histologic findings in routine tonsillectomy and adenoidectomy specimens. A retrospective medical record review was performed at a tertiary care children's hospital. The pathology records of 2062 children who underwent tonsil or adenoid surgery were analyzed and the final histologic diagnosis was recorded. Four unexpected histologic findings were found on routine tonsil and adenoid specimens. None were clinically significant. A review of the literature shows a very low rate (0.015%) of unexpected clinically significant diagnoses in pediatric adenotonsillectomy specimens. Given rarity of unexpected clinically significant diagnoses in pediatric adenotonsillectomy specimens, the cost and effort of analyzing each specimen histologically is difficult to justify.

R126: Pediatric Tonsil Size: Objective vs. Subjective Measurements

R126: Pediatric Tonsil Size: Objective vs. Subjective Measurements

Does topical lidocaine with adrenaline have an effect on morbidity in pediatric tonsillectomy?

To evaluate the efficacy of lidocaine with adrenaline on post-operative morbidity in pediatric patients after tonsillectomy. A double blind prospective randomized controlled clinical study. The study is consisting of two groups of pediatric patients following tonsillectomy performed in a university hospital. One group received lidocaine with adrenaline soaked swabs packed in their tonsillar fossae while the control group received saline-soaked swabs. Chi-square and two-tailed unpaired Student's t-tests were used to compare the two independent groups. p<0.05 was accepted as statistically significant. No significant pain-relieving effect was seen in the lidocaine with adrenaline group (p>0.05) and also the other post-operative parameters such as nausea, fever, vomiting, odor, bleeding, otalgia and trismus were not statistically different between the two groups based on chi-square analysis (p>0.05). There were no complications associated with lidocaine and adrenaline. We suggest that application of topical lidocaine with adrenaline seems to be a safe and easy medication for local anesthetic use. However, in our study, lidocaine with adrenaline offered no advantage over placebo in the control of post-operative pain and other morbidity related factors following pediatric tonsillectomy. We therefore do not recommend topical application of lidocaine with adrenaline for reducing morbidity in pediatric tonsil surgery.

Long-term effects of intracapsular partial tonsillectomy (tonsillotomy) compared with full tonsillectomy

To compare the long-term effects (six years after surgery) of two techniques for pediatric tonsil surgery with respect to snoring, apneas, eating difficulties, infections and general health. The two methods were intracapsular partial tonsillectomy (tonsillotomy, "TT") using CO(2)-laser technique and traditional (total) blunt dissection tonsillectomy (TE). A questionnaire distributed by mail to the parents of children, who, in 1998, were included in a prospective clinical randomized study in one tertiary care ENT clinic. A 10 question survey follow-up of 41 children, between 9 and 15 years of age, who originally, six years earlier had been randomized to either TT with CO(2)-laser (n=21) or TE (n=20). The main indication for the surgery was a history of sleep related breathing distress (SRBD). Before the present study, all of the children had participated in earlier follow-ups at six months and one year after surgery. All the children in both groups answered the questionnaire. There were no significant differences between the answers from the two groups in any respects: the effect on snoring and apneas was equally stable for both groups. The number of children who remained free from snoring decreased from 40 after the first year to 25 after six years (11 TT, 14 TE). Snoring in the recurrent cases was not rated to be as frequent or as loud as before the surgery. Infections of the upper respiratory tract (URI) that had been treated with antibiotics occurred to the same extent in both groups. None had eating difficulties. The patients' satisfaction with the results of the surgery was high or very high in 18/21 TT and 20 TE cases, and the vast majority of the parents rated their children's present health status as improved compared with the preoperative condition. Tonsillotomy with CO(2)-laser seems to be a reliable method for tonsil surgery with substantially less primary morbidity than conventional tonsillectomy and with the same positive long-term effects after six years.

Intracapsular tonsillectomy with RF surgery versus regular tonsillectomy: One-year results

Problem: To compare 2 techniques for pediatric tonsil surgery with respect to postoperative pain and morbidity and the long-term (that is, 1 year) effects on snoring and recurrent tonsillitis. Methods: Ninety-two children with a history of snoring and (few to several of them) tonsillitis, were randomized to either regular tonsillectomy (T)(n = 43) or intracapsular tonsillectomy (TT) using the radio-frequency (RF) surgical technique (n = 49). Surgitrone™ (Ellman int) 1.7 MHz was used with specially made sling electrodes. Results: In the TT group, the children recorded less pain from the second hour after surgery onward and were back in school and pain-free 3 days earlier than children in the T group. The TT children used fewer doses of painkillers and did not lose weight postoperatively compared to the T-group children who lost a mean of 660 g in 10 days. One year after surgery, both groups were satisfied and in good health. The T-group children remembered their pain as a trauma. The positive effect on snoring was the same in both groups and recurrence of infections had not occurred in a significant higher degree in the TT group. Conclusion: Intracapsular tonsillectomy with RF surgery is a safe method; it causes less pain and morbidity than regular tonsillectomy and has the same effect on snoring and recurrence of infections. Significance: A surgical technique that results in less suffering and a shorter length of time the child and a parent have to stay at home postoperatively is a health gain, as well as a socioeconomic one. Is it defendable to continue performing traditional tonsillectomy? Support: Financial support from the Research Council of South East Sweden (FORSS). Technical support from Ellman int.inc, NY, USA, which has provided with specially made electrodes.

Quality of life and health status in pediatric tonsil and adenoid disease.

To assess the baseline global health status and quality of life (QOL) in children with tonsil and adenoid disease. Cross-sectional multicenter survey series. A tertiary academic pediatric specialty hospital and a tertiary academic hospital in 2 different cities. Consecutive series of 55 parents of children who were seen for tonsil and adenoid disease. INTERVENTION AND METHOD: Cross-sectional survey of the health status of affected children to assess their QOL and its relationship to tonsil and adenoid disease. Quality-of-life subscale scores of affected children on the Child Health Questionnaire version PF28 (CHQ-PF28); comparisons of population data from healthy normal children and children with asthma and juvenile rheumatoid arthritis. The overall health status and QOL of children with tonsil and adenoid disease is significantly worse than those of healthy normal children, as demonstrated by lower mean scores on several CHQ-PF28 subscales, including general health, physical functioning, behavior, bodily pain, and parental impact (emotional). In addition, the general health perception of children with tonsil and adenoid disease is similar to the perceptions of children with asthma and juvenile rheumatoid arthritis, but several aspects of health status, as measured by CHQ-PF28 subscale scores, were significantly worse in children with tonsil and adenoid disease. The health status impact of tonsil and adenoid disease appears to be quite significant, particularly in aspects related to the parental impact of the child's disease.