Query: adenoidectomy history,  Currette

title: Adenoidectomy: Inpatient criteria study.
abstract: Current practices for admission for overnight observation after an adenoidectomy alone vary from hospital to hospital, as there are currently no studies that provide evidence for overnight observation criteria. The objective of this study is to determine any relationships between risk factors and postoperative complications or interventions in patients under 2 years old who undergo adenoidectomy and use this data to form a set of guidelines that may be used to stratify patients for inpatient observation.  Consecutive pediatric adenoidectomy without tonsillectomy cases in children younger than 2 years old with subsequent inpatient observation from January 2014 to October 2018 were reviewed at a single tertiary children's institution using electronic medical records. Patient demographics, surgical data, and comorbidities were analyzed for correlations with postoperative complications or interventions.  Out of the 76 patients with sleep disordered breathing (SDB) examined, one patient (1.3% required readmission for postoperative dehydration and seven patients (9.2% required intervention. The presence of at least one major comorbidity was significantly associated with increased incidence of complication or intervention compared to patients with no major comorbidities (18.9% vs. 2.6% p 0.03) Specifically, O2 nadir <80% (p 0.01) craniofacial syndrome (p 0.01) and seizure history (p 0.007) were significant factors of complication or intervention.  Otherwise healthy children >18 month old) with SDB may be considered for discharge the same day of surgery. Children younger than 2 years old with =1 major comorbidities may benefit from overnight inpatient observation. Otherwise healthy children younger than 18 months old or children with a history of RAD or CLD should be managed on a case by case basis.

title: Is Adenoidectomy and/or Tonsillectomy a Risk Factor for Allergic Diseases and Asthma in Adulthood?
abstract: To determine the relationship between adenoidectomy and/or tonsillectomy in childhood and allergic diseases in adulthood.  A survey investigating the history of adenoidectomy and/or tonsillectomy was administered to patients that were followed up by our department between January and June 2014 with the diagnosis of asthma, allergic rhinitis, urticaria angioedema, drug allergy, food allergy, and venom allergy; patients willing to participate were included in the study. The relationship and risk ratios were analyzed.  Totally, 510 (female/male: 379/131) patients were included in the study: 248 with asthma, 205 with rhinitis, 82 with drug allergy, 73 with urticaria, 24 with food allergy, and 14 with venom allergy. Of these, 65 (12.7% had undergone adenoidectomy and/or tonsillectomy. Of these 65 patients, 41 had asthma, 33 had allergic rhinitis, and 28 had other allergic diseases. No relation between the history of atopy and adenoidectomy and/or tonsillectomy (p=0.129) was detected; however, there was a positive correlation between asthma and patients aged <15 years having a history of tonsillectomy and/or adenoidectomy (p=0.020) The risk of asthma was determined to be increased by 1.96 fold among the patients, provided the patient had undergone adenoidectomy and/or tonsillectomy (confidence interval [CI]:1.14 3.36) No connection was observed between atopic and non atopic asthmatic patients in relation to adenoidectomy and/or tonsillectomy (p=0.46) No relationship was observed between allergic rhinitis and adenoidectomy and/or tonsillectomy.  Adenoidectomy and/or tonsillectomy in childhood increase the risk of asthma in adulthood, whereas it does not increase the risk of atopy. This result signifies the criticality of adenoidectomy or tonsillectomy in the pathogenesis of asthma.

title: Factors affecting the outcome of adenoidectomy in children treated for chronic otitis media with effusion.
abstract: The aim of this cohort was to determine potential risk factors, concerning the effectiveness of adenoidectomy in the treatment of chronic otitis media with effusion in children.  Ninety six children with chronic otitis media with effusion treated with adenoidectomy were enrolled in this study. A thorough medical history was taken, including family history of otologic disease, parental smoking habits and breast feeding history. Radiographic palatal airway size was measured preoperatively, whereas the presence of allergy was also investigated. All patients were, postoperatively, followed up for a period of two years, in three month intervals. Disease course was classified as "complete remission" "improvement" or "consistence" in every postoperative evaluation, according to strictly established criteria.  Children's age proved to be a significant factor in the postoperative outcome of adenoidectomy, as a treatment of chronic otitis media with effusion, especially when comparing patients being over and under the fifth year of age. Also, the presence of allergy, family history of otologic disease and palatal airway size, all proved to influence postoperative outcome in a statistical significant way (p<0.05) On the other hand, child's sex, passive smoking, breast feeding and previous acute otitis media infections did not seem to alter the efficacy of adenoidectomy.  Adenoidectomy remains a cornerstone in the treatment of chronic otitis media with effusion in children. Results document that young age, presence of allergy predisposition, otologic family history and small palatal airway can be important drawbacks and should be intensively sought for and taken into account, during treatment planning.

title: Comparative study between radiofrequency coblation and traditional adenoidectomy
abstract: Adenoid hypertrophy is known to be the most common cause of nasal obstruction in children; thus, adenoidectomy with or without tonsillectomy is one of the most commonly performed surgical procedures in the pediatric population. The widely used conventional curette adenoidectomy was first described. Dissatisfaction with this technique led to the use of other methods, including powered shaver adenoidectomy, bipolar electrocautery, coblation, and LASER.  This study aimed to compare the endoscopic assisted coblation adenoidectomy to conventional adenoidectomy (by cold instruments) in terms of safety, efficacy, results, and complications.  Eighty patients were diagnosed depending on history, clinical examination, and radiology. The patients were operated on by either conventional or coblation adenoidectomy and divided into two groups: the patients in group A underwent conventional adenoidectomy, whereas the patients in group B underwent coblation adenoidectomy. The intraoperative parameters studied were operative time, intraoperative bleeding, and completeness of removal of adenoid. Postoperative parameters included assessment of postoperative pain, resolution time, and complications.  It was found that although coblation has a longer operative time, it is a safe and effective alternative to curette adenoidectomy, it is more complete and accurate, there is less intraoperative blood loss, less postoperative pain, and fast resolution time, and fewer complications.  Coblation adenoidectomy proved to be safe and effective; however, reducing the cost is mandatory before considering it as the modality of choice for adenoidectomy.

title: A clinical study to determine the effects of adenoidectomy in cases of secretory otitis media in school going children
abstract: Secretory otitis media (SOM) is common otological symptom in children. If left untreated it leads to hearing and speech impairment. Surgical management is effective in serious cases. The present study was done with the objective to assess the effect of adenoidectomy by pure tone and impedance audiometry in cases of SOM with hypertrophied adenoids.  This study comprised 50 cases, who were aged 5 12 years and diagnosed as SOM with adenoid hypertrophy. It was carried out for a period one and half years from December 2015 to July 2017 at Mamata Medical College and Research Hospital, Khammam, Telangana. After detailed history and clinical examination, investigations such as pure tone audiogram, impedance audiometry, X ray nasopharynx and diagnostic nasal endoscopy were carried out to confirm the diagnosis. All patients were posted for adenoidectomy and when indication was present tonsillectomy was also done. They were followed up at 1st, 3rd and 6th month for pure tone audiometry and impedance was done at 6th month of surgery.  In this study, maximum number (60% of cases belonged to 5 7 years age group, with slight male preponderance (56% On pure tone audiometry 68% had 16 25 dB and 32% had 26 40 dB hearing loss and average being 24.95 dB. On impedance only 14% had peak preoperatively. Postoperatively, no peak/peak conversion was seen in 33% of cases and mean A B gap improvement at 1st, 3rd and 6th month was 13 dB, 13.2 dB and 12.7 dB respectively (p value is 0.0001,<5% when compared to preoperative findings.  Adenoidectomy is effective in the management of middle ear infection in children having hypertrophied adenoids.

title: Persistent sleep disordered breathing after adenoidectomy and/or tonsillectomy: a long term survey in a tertiary pediatric hospital
abstract: PurposeTo determine the long term prevalence of persistent sleep disordered breathing (SDB) in children, after adenoidectomy, tonsillectomy or adenotonsillectomy, and to assess the relationship between baseline characteristics and persistent nocturnal symptoms.MethodsThe clinical charts of children operated for adenoidectomy and/or tonsillectomy in a tertiary hospital, between January 2000 and March 2016, were retrospectively reviewed. All patients who had signs of SDB prior to surgery received a six question validated pediatric questionnaire, the Hierarchic Severity Clinical Scale (HSCS).ResultsA total of 4000 children showing SDB prior to surgery were selected out of 5809 (68.9% 1176 parents returned the questionnaire (29.4% with a mean age at surgery of 4.3 2.2 and age at survey of 9.6 3.6. Complete resolution of SDB was subjectively reported in 798 patients (67.9% and mild SDB was suspected in 301 children (25.6% HSCS 0 with chronic snoring) while 77 (6.5% had a HSCS 2.72, suggesting persistent obstructive sleep apnea. In non syndromic children, male sex, history of sole adenoidectomy, or sole tonsillectomy, and early age of surgery 2 years old) were associated with higher HSCS scores (p 0.05) Moreover, symptoms had a tendency to decrease from 1 to 6 years, re occur at age 7 8, and also after 13, with boys reporting more severe symptoms, at a younger age.ConclusionsSurgical excision of lymphoid tissue to treat SDB in childhood seems to be effective in the long term in two thirds of subjects, while partial surgeries, specific age groups and early surgery are more likely to have persistent or recurrent symptoms.

title: Is Routine Histopathologic Examination Necessary Following Tonsillectomy and/or Adenoidectomy Procedures in Pediatric Patients?
abstract: Tonsillectomy and/or adenoidectomy is the most common surgical procedure in ENT practice and the malignancy rate of tonsillar tissue is very rare. The purpose of the present study is to investigate the necessity of routine histopathologic examinations following tonsillectomy and/or adenoidectomy surgeries. A total of 385 patients between the age of 5 and 16 years who were admitted to our ENT clinic and underwent adenoidectomy and/or tonsillectomy between October 2008 and July 2015 participated in the study. Patient data such as age, sex, indication for surgery, and histopathologic findings were recorded prospectively. Histopathologic findings were analyzed for hyperplastic lymphoid parenchyma and malignancy. No malignancies were detected in the studied patients and all had hyperplastic lymphoid parenchyma. Unilateral tonsillar swelling, significant lesions on the tonsil or adenoid tissue, malignancy history in the head and neck region, or a mass in the neck region with weight loss must be examined histopathologically; however, we conclude that there is no need to perform histopathologic examination for patients for whom there is no clinical suspicion. A meta analysis is needed in this regard.

title: Surgical management of the tonsillectomy and adenoidectomy patient
abstract: tp:/dx.doi.org/10.1016/j.wjorl.20 95 8811/Copyright a 2017 Chinese d.  pharyngotonsillitis and its feared complication rheumatic heart disease. During that era, many children underwent tonsillectomy and adenoidectomy that was not indicated due to a negative history of streptococcal infection, but became surgical candidates because another family member suffered frequent streptococcal disease or worse rheumatic heart disease. Development of potent antibiotics, specifically penicillin, altered the treatment of recurrent streptococcal disease, and decreased the incidence of rheumatic fever and heart disease. Along with a decrease in the incidence of

title: Implementation of a perioperative surgical home protocol for pediatric patients presenting for adenoidectomy.
abstract: The perioperative surgical home (PSH) is a patient centered model designed to improve health, streamline the delivery of health care, and reduce the cost of care. Following the national introduction of PSH in 2014 by the ASA, adult hospitals have reported success with this model, with studies validating the benefits of PSH including reducing length of stay, lowering costs, and improving patient satisfaction.  Eligible patients, ranging in age from 16 35 months of age, were identified by the pre admission testing (PAT) registered nurses (RNs) and faculty anesthesiologists upon review of the patient history. Participation in Pediatric PSH (PPSH) was introduced to the families by the pediatric otolaryngologists. Either the patient's family or physician team could elect to decline participation in the PPSH model. On the day of surgery, the PPSH protocol included a paper checklist to ensure that all patients met eligibility standards. A standardized order set was implemented in the electronic medical record (EMR) for pre operative and post operative nursing instructions and eligible medications. Patients received at least 3 hours of postoperative monitoring prior to discharge home to address postoperative issues. Prior to discharge, caregivers watched a standard teaching video, available on YouTube, which was developed in conjunction with the hospital educational and technical support staff. An attending anesthesiologist made a postoperative followup phone call on the evening of surgery to ensure no untoward events were experienced by the patient as well as elicit caregiver feedback concerning the discharge process. The protocol was discontinued if at any time family members, physicians, or nurses were uncomfortable with completing the protocol or felt that the patient did not meet discharge criteria.  One hundred sixty six patients were evaluated for PPSH inclusion. Forty patients were excluded (23 did not meet inclusion criteria, 5 had viral upper respiratory infections, and 10 for other non specified reasons such as tonsillectomy added, sibling with surgery, and incorrect documentation) Therefore, a total of 126 were eligible for PPSH (male/female 69/57; age 22 4 months) The comparison group included 1,029 children (male/female 645/384; age 22 7 months of age) undergoing adenoidectomy who were not evaluated for PPSH inclusion. Of the 126 PPSH participants included in the analysis, 27 were excluded at some point during the pathway. Nine cases experienced oxygen desaturation, laryngospasm, or required supplemental oxygen. Noncompliance with the protocol was noted in 5 cases, parental concerns were noted in 17 cases, and there were concerns from the pediatric anesthesiologist or otolaryngologist in 5 cases. In the comparison group, hospital length of stay was significantly longer than in the PSH group (p<0.001) with 524 (51% patients discharged on the day of service compared to 99 (79% in the PSH group. No major morbidity or mortality occurred. There was no difference between the two groups in return to the emergency department (ED) visits within 30 days (PSH: 7/126, 6% control: 59/1,029, 6% p=0.935) Within 14 days of the procedure, 4 PPSH patients visited urgent care or a primary care physician; 4 visited the ED; and 1 was readmitted to the hospital. Twenty families contacted the otorhinolaryngology triage phone line primarily related to pain and fever.  We present our experience and success in developing a PPSH for patients, ranging in age from 16 to 35 months of age, undergoing adenoidectomy either alone or with tympanostomy tube insertion by protocolizing care, collaborating among care providers, and educating families. With this process in place, a significant percentage of these patients who were previously admitted were discharged home the same day of surgery.

title: Letter to the Editor regarding "Revision adenoidectomy in children: a population based cohort study in Taiwan"
abstract: Second, although authors proved that tonsillectomy was not statistically associated with revision adenoidectomy, tonsil size or tonsillectomy may be another factor that affects the regrowth of adenoid. The previous studies show that compensatory lymphatic tissue hyperplasia may occur after excessive removal of Waldeyer's ring lymphatic tissue [4] Therefore, if authors separate the population according to the tonsil size or tonsillectomy history and perform statistical analysis once more, it may reveal different results compared to the current findings. Furthermore, if authors can provide the reasons for revision adenoidectomy, it would be extremely helpful to many ENT doctors.