Rate Of Tonsillectomy Research Articles

Behçet’s syndrome and micro-organisms

Behçet's syndrome (BS) is a multi-systemic vasculitis of unknown aetiology. More than one mechanism seems to be operative in the pathogenesis of Behçet's syndrome, including genetic and environmental factors, causing different manifestations of the syndrome. There are several clues to the role of environmental factors and especially micro-organisms in the pathogenesis. These include clinical findings such as a decrease in the frequency of a positive pathergy reaction with surgical cleaning of the skin before the procedure, the acne-arthritis association carrying similar features to acne-associated reactive arthritis, a higher rate of tonsillectomy, cold sores, late birth order, higher number of siblings, history of travel to countries with a high incidence of BS and earlier age at first sexual intercourse. Moreover, basic research on both viruses and bacteria suggests that micro-organisms may be playing a role, possibly through heat shock proteins and T-cell hypersensitivity.

A meta-analysis of the clinical remission rate and long-term efficacy of tonsillectomy in patients with IgA nephropathy

We wished to evaluate the clinical remission rate and long-term efficacy of tonsillectomy for patients with IgA nephropathy. We searched a number of databases, including PubMed, CNKI, Wanfang and others, for clinical case-control studies of tonsillectomy in patients with IgA nephropathy. We then performed a meta-analysis of these studies. After evaluating total clinical remission rates, we compared the remission rates for specific treatments: tonsillectomy plus steroid pulse, tonsillectomy plus normal-dose steroid, and general treatment using neither tonsillectomy nor steroids. We also compared the rates of end-stage renal failure (ESRF) at last follow-up to estimate the long-term renal survival rate associated with each treatment. Seven retrospective studies met the inclusion criteria and were included. These included a total of 858 patients, in which 534 underwent tonsillectomy and 324 did not. The total clinical remission rate was higher in the operative group, while the ESRF rate was higher in the non-operative group. The clinical remission rate in patients who underwent tonsillectomy remained higher than in the non-operative group at both 5- and 10-year follow-up. The clinical remission rate in patients who underwent tonsillectomy plus steroid pulse was higher than in those treated with steroid pulse alone, normal-dose steroids or general treatment alone (P < 0.05). However, the clinical remission rate of simple tonsillectomy was not higher than that of general treatment (P > 0.05). Whereas neither tonsillectomy nor steroid treatment alone increased remission rates in patients with IgA nephropathy, tonsillectomy combined with either normal steroid or steroid pulse treatment resulted in higher remission rates with favourable long-term efficacy.

Changes and consistencies in the epidemiology of pediatric adenotonsillar surgery, 1996-2006

ObjectiveDetermine changes in rates for pediatric adenotonsillar procedures over time with attention to infectious indications. Study DesignHistorical cohort study. SettingAcademic medical center. Subjects and MethodsThe National Survey of Ambulatory Surgery and the National Hospital Discharge Survey 1996 and 2006 releases were examined, extracting all cases of pediatric tonsillectomy, adenotonsillectomy, and adenoidectomy. The aggregate numbers and rates of adenotonsillar procedures performed overall and specifically for chronic infectious etiologies were determined. These procedure rates were then compared to determine differences in performance rates between 1996 and 2006. ResultsIn 1996, an estimated 441,870 ± 23,315 children underwent some form of adenotonsillar surgery in the ambulatory and inpatient settings (60,034 ± 6994 tonsillectomies, 255,217 ± 18,960 adenotonsillectomies, and 126,619 ± 11,627 adenoidectomies), while in 2006, the total rose to 695,029 ± 36,979 children (58,111 ± 9645 tonsillectomies, 506,778 ± 32,054 adenotonsillectomies, and 129,540 ± 15,714 adenoidectomies). However, when examined according to infectious indications, a notable decline in the population rate of tonsillectomy from 0.62 per 1000 children in 1996 to 0.53 per 1000 in 2006 was found (P = 0.252). Moreover, the larger decline in the rate of adenotonsillectomy for infectious indications from 2.20 per 1000 to 1.46 per 1000 was significant (P = 0.003). There was no significant change adenoidectomy rates for chronic infectious etiologies (0.25 versus 0.21 per 1000, P = 0.326). ConclusionAlthough there was an overall increase in the rate of performance of adenotonsillar surgery, population adjusted performance rates of these procedures specifically for infectious indications declined from 1996 to 2006.

Dexamethasone Administration and Postoperative Bleeding Risk in Children Undergoing Tonsillectomy

To assess whether administration of dexamethasone during tonsillectomy is associated with a dose-dependent increased rate of postoperative tonsillectomy hemorrhage. Retrospective review of 2788 children and adolescents who underwent tonsillectomy with or without adenoidectomy for sleep-disordered breathing or infectious tonsillitis and received perioperative dexamethasone between January 1, 2002, and March 3, 2009. Patients underwent 1 of 3 methods of tonsillectomy, including extracapsular electrosurgical tonsillectomy, extracapsular radiofrequency ablation tonsillectomy, or intracapsular microdebrider tonsillotomy. Massachusetts Eye and Ear Infirmary. Two thousand seven hundred eighty-eight children and adolescents aged 2 to 18 years (hereinafter referred to as children) who underwent tonsillectomy with or without adenoidectomy. Each child received 1 of 2 distinct intravenous doses of perioperative dexamethasone (0.5 mg/kg or 1.0 mg/kg) based on the protocol of the surgeon who performed the tonsillectomy; other aspects of care, including anesthetic technique, perioperative analgesia, and postoperative care, were equivalent between children. Occurrence of postoperative hemorrhage based on 3 severity stratification levels. Ninety-four of the 2788 children experienced 104 episodes of postoperative hemorrhage. After adjusting for age, sex, primary diagnosis, and surgical technique, the odds ratio of experiencing a postoperative hemorrhage of any severity in children who received the 1.0-mg/kg compared with the 0.5-mg/kg dose was 0.66 (95% confidence interval [CI], 0.42-1.05). Children requiring readmission with or without the need for operative intervention demonstrated an adjusted odds ratio of 0.83 (95% CI, 0.51-1.36). An adjusted odds ratio of 0.71 (95% CI, 0.39-1.28) was seen in children requiring operative intervention. In this observational review of children undergoing tonsillectomy or adenotonsillectomy, perioperative dexamethasone administration is not associated with a dose-dependent elevation of postoperative hemorrhage rates after adjusting for age, sex, primary diagnosis, and surgical technique.

Tonsil size and body mass index are important factors for efficacy of simple tonsillectomy in obstructive sleep apnoea syndrome

To evaluate the efficacy of simple tonsillectomy to treat obstructive sleep apnoea syndrome (OSAS) in adults. Prospective study. Tertiary referral centre. Thirty patients (28 males) underwent simple tonsillectomy under general anaesthesia. The patients' mean age was 33.2 +/- 6.8 years and body mass index was 30.7 +/- 6.0 kg/m2. Seven patients (23%) were classified with grade 4, 16 patients (53%) with grade 3, and seven patients (23%) with grade 2 according to the tonsil size of Friedman's classification. The number of apnoea episodes per hour (apnoea index), the number of apnoea and hypopnoea episodes per hour (apnoea-hypopnoea index), lowest nocturnal oxygen saturation and oxygen desaturation time were measured during overnight polysomnography before and after surgery. A successful tonsillectomy was defined as an apnoea-hypopnoea index improvement ratio of > or =50% and an apnoea-hypopnoea index <20 after operation. Apnoea-hypopnoea index decreased from 69.0 +/- 28.4/h to 30.1 +/- 24.0/h (P < 0.0001). Simple tonsillectomy was successful in all six patients with body mass index <25 kg/m2. Concerning success rate of simple tonsillectomy with tonsil, size 2 was lowest (42.9%). Eight of the 13 patients who used continuous positive airway pressure before simple tonsillectomy did not use continuous positive airway pressure after simple tonsillectomy because of a significant reduction of excessive daytime sleepiness. Continuous positive airway pressure decreased significantly after simple tonsillectomy from 13.6 +/- 2.5 cmH2O preoperatively to 10.6 +/- 1.3 cmH2O postoperatively (P < 0.05). These data suggest that simple tonsillectomy is a beneficial modality to treat OSAS in selected patients (larger tonsil, low body mass index), even in adults.

Meningitis as a complication of tonsillectomy

Adenotonsillar surgery remains among the most commonly-performed pediatric surgical procedures. The complication rate of tonsillectomy is generally considered to be in a range of 1–5%. Bacterial meningitis following adenotonsillectomy is a rarely reported complication. Bacterial meningitis is a potentially fatal acute infectious disease caused by a variety of micro-organisms. Current case fatality rates associated with this entity can be as low as 2% in infants and children and as high as 30% in neonates. The successful management of meningitis depends on early clinical suspicion and diagnosis, with prompt medical treatment using high-dose, broad-spectrum antibiotics that adequately cross the blood-brain barrier. We present a case of meningitis complicating a tonsillectomy procedure, in a 7-year-old girl. The diagnosis and treatment of this rare complication is illustrated, and the possible etiology is discussed.

Variation in selected childhood surgical procedures: the case of tonsillectomy and management of middle ear disease.

We examined rates of the most common ear, nose and throat (ENT) surgical procedures among NSW residents under 15 years of age, against a background of concern for the relevance of differences in clinical practice to cost and quality of health care. We found significant (P < 0.01) increases in the rate of procedures involving myringotomy (from 5.8/1000 to 7.6/1000) or adenoidectomy (from 5.6/1000 to 6.3/1000) between 1986 and 1989/90. Over this period the proportion of ENT procedures which involved myringotomy also increased significantly (P < 0.01) from 53 to 60%. We found significant (P < 0.01) differences in procedural rates between health areas when aggregated into inner and outer metropolitan and rural groups with the mean rate of procedures involving myringotomy highest in the outer metropolitan group in both years. The difference was not due to variation in patient insurance status, per capita hospital bed or staff numbers. We found no evidence that the National Health and Medical Research Council Tonsillectomy and Adenoidectomy Guidelines (first published in 1982) have been effective in influencing clinical practice. The rate of tonsillectomy had been declining in NSW since the late 1970s but has remained stable in recent years. Surgical intervention for middle ear disease is increasing.

Tonsillectomy history in Hodgkin's disease.

Abstract Of 174 patients recently treated for Hodgkin's disease, a history of tonsillectomy was obtained in 52 per cent. Except for a low rate of tonsillectomy in younger patients, statistically significant variations from the overall rate were absent when tonsillectomy was correlated with other features such as sex, extent of disease, presence versus absence of constitutional symptoms, primary site of involvement and histologic subclassification. A comparison of patients and matched siblings did not reveal a difference in tonsillectomy rate although a number of patients with intact tonsils had healthy matched siblings with a history of tonsillectomy. The review failed to demonstrate a relation between tonsillectomy and the clinical features of Hodgkin's disease and did not support the hypothesis that prior tonsillectomy increases susceptibility to this disease by removal of a lymphoid barrier. Also of interest were two sibling pairs without tonsillectomy in whom Hodgkin's disease developed coincidental...

Tonsillectomy in children: Kaiser, A. B.: Jour. Am. Med. Assn., 1926, lxxxvii, 1012

Despite declining rates of Tonsillectomy due to wide spread antibiotic therapy, Tonsillectomy is still the most common surgical procedure performed in the world. Even in highly developed countries such as USA the rate of Tonsillectomy exceeded one to two million cases in recent years. A statistical study of Tonsillectomy and adenoidectomy in three (2 public and 1 private) hospitals in Tehran shows that the maximum rates of Tonsillectomy are performed in July and August, which coincides with the summer vacations of our public schools. In our public hospitals the adults are Tonsillectomized under local anesthesia whereas Tonsillectomy with adenoidectomy is performed under general anesthesia. However, in private hospitals both children and adults are operated under general anesthesia with endotracheal intubation. Although tonsils are still guillotinized by induction anesthesia in many academic centers of the western countries, in our country tonsils are removed by snare dissection. This article reviews the anatomical and physiological aspects of the tonsils and includes a discussion on Tonsillectomy indications based on Pittsburgh pediatric hospital criteria. High-points and pitfalls of traditional Tonsillectomy are also discussed and the most important complications of the procedure, e.g. bleeding which may be hazardous and occasionally fatal, is remained. In addition, the application of modern technology such as cryosurgery and laser surgery is described