Search

The aim of this study was to measure tonsils and adenoid vegetations, investigate the modified Mallampati score, determine BMI according to body mass and corresponding percentile, and compare these data with the results of the Pediatric Sleep Questionnaire (PSQ). The subjects were children aged 2 to 18 who were indicated for adenotonsillectomy at the Clinic for Otorhinolaryngology and Head and Neck Surgery. A doctor specialist conducted the clinical examinations. According to the PSQ, 75 subjects were divided into two groups: those at high risk and those at low risk for developing obstructive sleep apnea (OSA). The PSQ results showed that 45 subjects (60 %) were at high risk for OSA, and these subjects had significantly lower weight and BMI. Although a higher number of subjects had grade 4 tonsils and grade 3 and 4 adenoids, this distribution was not statistically significant. There was no statistically significant difference in the distribution of the modified Mallampati score when compared with the PSQ results. Lower body mass and BMI were statistically significant risk factors for OSA, while the size of the tonsils and adenoids, as well as the modified Mallampati score, did not show any statistically significant difference in comparison with the PSQ results., Competing Interests: Declaration of competing interest None. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have no funding, financial relationships, or conflicts of interest to disclose. Study was approved for display by the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Centre Osijek, Croatia, and by ethics committees of Clinical Hospital Centre Osijek and Medical School Osijek, University Josip Juraj Strossmayer in Osijek after the patients' parents/guardians have given their consent to publish the data., (Copyright © 2024 Elsevier B.V. All rights reserved.)

In pediatrics, obstructive sleep apnea syndrome (OSAS) is a disorder associated with multiple consequences at the cognitive and behavioral level. The main associated risk factor is the presence of tonsillar hypertrophy and adenoids. An adenotonsillectomy is the first-line treatment. The incidence of persistent OSAS varies from 15% to 75%, depending on comorbidities. This is a challenge in terms of management; it requires a comprehensive approach for an adequate diagnosis and treatment. The objective of this bibliographic review is to propose a diagnostic and therapeutic approach for persistent OSAS., (Sociedad Argentina de Pediatría.)

A common site of lymphoid hyperplasia in post-transplant lymphoproliferative disorders (PTLD) is the palatine tonsils. However, tonsillar hypertrophy is extremely common in children, which hinders the suspicion of PTLD. A case series of transplanted patients undergoing tonsillectomy for suspected PTLD was conducted at a tertiary care children's hospital in Argentina between January 2014 and December 2021. The objective of this study is to expose the clinical characteristics of transplanted patients who underwent a tonsillectomy to diagnose PTLD., (Sociedad Argentina de Pediatría.)

Background: The clinical value of tonsillectomy continues to cause much debate, despite tonsil disease representing a significant burden to patients, caregivers and healthcare systems. This study assessed the long-term effect of adenotonsillectomy or tonsillectomy on the Paediatric Throat Disorders Outcome Test ('T-14'), a validated tool used to objectively assess obstructive and infective symptoms in paediatric throat disorders., Methods: Patients aged under 16 years undergoing adenotonsillectomy or tonsillectomy were recruited consecutively from 2018 into our prospective observational study. The Paediatric Throat Disorders Outcome Test questionnaire was completed by the children's caregivers pre-operatively ( n = 80), and at 21 days ( n = 68) and 2 years ( n = 66) post-operatively., Results: Significant reductions were noted in mean total Paediatric Throat Disorders Outcome Test scores at 21 days and 2 years post-operatively ( p ≤ 0.003)., Conclusion: Our results provide supporting evidence that paediatric adenotonsillectomy or tonsillectomy significantly improves quality of life up to two years post-operatively, and therefore remains a valuable use of healthcare resources.

Objective: This paper serves to review the historical progression of clinical, epidemiological and immunological evidence on the relationship between tonsillectomy and poliomyelitis and its influence on clinical medicine., Methods: A literature review was conducted using terms relating to poliomyelitis, tonsillectomy, and immunology. Primary sources published between 1900 and 2000 were reviewed, analyzed and evaluated based on their historical, clinical, epidemiological, scientific and immunological pertinence towards the relationship between tonsillectomy, and poliomyelitis during epidemics., Results: The first study proposing a relationship between poliomyelitis and tonsillectomy was a case report published in 1910 by Phillip Sheppard. In response, other physicians began conducting clinical and epidemiological studies investigating the relationship between recent tonsillectomy and poliomyelitis in children. While the results of many of these studies demonstrated an increased morbidity and mortality rate associated with poliomyelitis in children who underwent recent tonsillectomy, other studies claimed there was no connection. Opposing study results and diverging physician views on this relationship left the medical community divided on whether to recommend against elective tonsillectomies during poliomyelitis outbreaks. The relationship between tonsillectomy and poliomyelitis was established after many years of clinical and epidemiological studies. Further scientific and immunological investigations revealed the causal nature of this relationship., Competing Interests: Declaration of competing interest There are no declarations of financial support or conflict of interests to disclose., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: Post-tonsillectomy haemorrhage remains a significant complication despite modifications of technique and instrumentation. Intracapsular tonsillectomy spares the capsule as a protective barrier for underlying blood vessels and musculature. Its efficacy in children with sleep-disordered breathing has been established, along with lowered rates of haemorrhage and pain, but research pertaining to adults and for recurrent infections has been limited., Method: This retrospective study, encompassing 730 patients, compared post-operative haemorrhage rates between extracapsular ( n = 379) and intracapsular tonsillectomy ( n = 351) across all ages and indications using Coblation TM technology., Results: A significant difference in post-operative haemorrhage rate was observed between extracapsular and intracapsular tonsillectomy techniques (2.1 vs 0.3 per cent; p = 0.025). In addition, an age of 18 years or older was also found to be an independent risk factor for post-operative haemorrhage ( p = 0.01)., Conclusion: Coblation TM intracapsular tonsillectomy was shown to be safe and effective across all ages and indications, with a low risk of bleeding and revision surgery.

Objective: To investigate the effects of high-flow nasal oxygen (HFNO) combined with early extubation on the incidence of respiratory adverse events (RAE) during emergence from general anesthesia in children undergoing adenoid-tonsillectomy. Methods: From December 2021 to January 2022, 40 pediatric patients [21 males, 19 females, with a median age of 4 (4, 5) years] undergoing tonsillectomy and/or adenoidectomy in Eye & ENT Hospital of Fudan University were randomly divided into two groups: HFNO-assisted early extubation group (Group H, n =20) and conventional extubation group (Group C, n =20) by using a random number table. After entering the post-anesthesia care unit (PACU), the patients in group H received humidified and heated oxygen (flow rate: 25 L/min) through a nasal cannula until their consciousness regained. After patient's spontaneous breathing resumed for 10 min, the oral endotracheal tube was removed. Patients in group C did not receive HFNO. The oral endotracheal tube was removed after the patient's spontaneous breathing resumed for at least 10 min with signs of tube intolerance, or 20 min without signs of tube intolerance. During the PACU stay, the incidence of RAE, the incidence of cough, the application rate of intensive care strategy, the time to extubation, the duration of PACU stay, and vital signs at spontaneous breathing resuming and extubation in each group were recorded. Results: In Group H, the total incidence of RAE [30% (6/20) vs 65% (13/20), P =0.027], the incidence of cough [10% (2/10) vs 45% (9/20), P =0.031] and the application rate of intensive care strategy [20% (4/20) vs 55% (11/20), P =0.048] during PACU stay was significantly lower, compared with those of Group C. Likewise, the time to extubation was significantly shorter [(33.4±4.5) min vs (42.7±5.3) min, P <0.001]. However, there was no statistically significant difference in the duration of PACU stay, the vital signs at the time of spontaneous breathing resuming and extubation between the two groups ( P >0.05), except that the end-tidal carbon dioxide partial pressure (P ET CO 2 ) at the time of extubation in group H was significantly higher than group C [(52.9±9.4) mmHg vs (48.9±3.1) mmHg (1 mmHg=0.133 kPa), P <0.001]. Conclusion: HFNO combined with early extubation can significantly reduce the incidence of RAE in children undergoing adenoid-tonsillectomy during the emergence from general anesthesia.

Tonsillectomy and adenoidectomy are among the most commonly performed major pediatric operations in the United States, with more than 500,000 procedures performed annually. This procedure can be performed with or without adenoidectomy. These procedures were traditionally performed for recurrent tonsillitis; however, the vast majority of tonsillectomies are currently performed for obstructive symptoms. When performed for appropriate indications, tonsillectomy and adenoidectomy can greatly improve a child's quality of life and general health. Given the prevalence of these conditions and subsequent surgical procedures, evidence-based recommendations are regularly evaluated and updated. As such, familiarity with these guidelines is necessary for pediatric practitioners. This review summarizes the indications, complications, and outcomes for tonsillectomy and adenoidectomy, as well as provides a brief overview of operative techniques., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: To summarize the results of a study of the clinical and polygrapic features of sleep in children with pathologic conditions of the tonsillar ring and obstructive sleep apnea. Tonsillar hypertrophy is the most common cause of obstructive sleep apnea in children. Using the data of overnight polysomnographic study and/or nocturnal pulse oximetry, groups of patients were distinguished depending on the presence and severity of their sleep breathing disorders. The effectiveness of adenotomy, adenotonsillotomy and/or adenotonsillectomy in children is demonstrated, depending on the severity of obstructive sleep apnea syndrome. Evaluation of breathing in sleeping children by polygraphic methods is necessary for early detection of obstructive sleep apnea syndrome and monitoring the effectiveness of surgical treatment.

Tonsillar surgery was, from the 19th century, the reference treatment for apneic patients. Adapting to the technical limitations of the time, surgeons devised ingenious procedures. The purpose of this historical note is to travel back to that time and rediscover one of the techniques favored by Chassaignac: "simultaneous enucleation" of the tonsils., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Obstructive sleep apnea（OSA） is a common disease in otolaryngology in children, and its incidence rate is increasing gradually, which seriously endangers children's growth and development, behavior cognition and so on. There are many etiologies of OSA in children. Besides tonsil hypertrophy and/or adenoid hypertrophy, the most common one, there are many different levels of airway obstruction caused by inflammation, dysplasia, obesity and other reasons. Different individualized treatment plan should be taken according to different etiology. This paper summarizes the different treatment methods of children OSA., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Background: In 2017, the Federal Joint Committee determined tonsillectomy and hysterectomy in non-oncologic diseases as well as tonsillotomy for second opinion procedure. We discuss the suitability of tonsillectomy and tonsillotomy for the second opinion procedure on its quantitative and qualitative characteristics., Materials and Methods: Data from the Federal Statistical Office concerning numbers of cases were evaluated. Numbers and regional distribution of ENT-specialists providing second opinion were analyzed by websites of Associations of SHI Physicians., Results: Between 2005 and 2018a significant decrease in tonsillectomy cases from 119 808 to 42 548 is observable that is by far not compensated by increasing tonsillotomy numbers from 4659 (2007) to 18 369. At the same time, surgical procedure rates at regional levels remain volatile. 218 ENT-specialists in 142 towns provide second opinion. On basic of case numbers in 2018a relationship of 1(ENT-specialist): 280 (tonsillectomy/tonsillotomy patients) results (range from 1:90 to 1:800)., Conclusions: On the background of decreasing surgical rates tonsil surgery does not comply with the requirements of second opinion procedure. Reachability of second opinion providers is difficult in many regions, such compromising a compensation of different levels of surgery. As a result of our investigation we recommend scientific supervision of currently second opinion procedures and a survey of actual demand from the patient's viewpoint., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Otolaryngologic surgery is one of the most frequent operative interventions performed in children. Tonsil surgery with or without adenoidectomy due to hyperplasia of the tonsils and adenoids with obstruction of the upper airways with or without tympanic ventilation disorder is the most common of these procedures. Children with a history of sleep apnoea (OSA) suffer from a significantly increased risk of perioperative respiratory complications. Cases of death and severe permanent neurologic damage have been reported due to apnoea and increased opioid sensitivity. The current guideline represents a pragmatic risk-adjusted approach. Patients with confirmed or suspected OSA should be treated perioperatively according to their individual risks and requirements, in order to avoid severe permanent damage.

This paper reviews current indications for otolaryngology consultation for tonsillectomy and adenoidectomy (T&A). Despite often being performed concurrently, these procedures should be considered separate surgeries done for different indications. The American Academy of Otolaryngology - Head and Neck Surgery published tonsillectomy guidelines for children in 2019. These recommendations are often extrapolated to adults in clinical practice despite less robust literature support for this age group. T&A should be recommended for pediatric obstructive sleep apnea. Specific frequencies of tonsillitis have been identified that indicate benefit from tonsillectomy in normal children; certain modifying health factors warrant consideration of surgery with fewer infections. The guidelines include consideration of tonsillectomy for poorly validated indications such as halitosis, febrile seizure, dental malocclusion, dysphagia, dysphonia, and psoriasis., Competing Interests: Conflict of interest: None., (© Copyright 2020 by the American Board of Family Medicine.)

What is right? Tonsillotomy or tonsillectomy? Moreover, when and what has to be preferred? Is the discussion never ending? No, and this is good. Tonsil surgery is and will remain a frequent surgical procedure for the otolaryngologist. Especially, because many children are operated, and because - also rare - significant complications can occur, a quality-controlled benefit-risk-analysis is important. Part of this is systematic analysis of the evidence of the benefits and risks of tonsillotomy and tonsillectomy, as it was performed recently by the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG) by order of the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA). One result was the implementation of the tonsillotomy as a regular service paid by the insurance companies. Nevertheless, the discussion is not yet concluded. Actually, a randomized controlled trial is in preparation sponsored by the G-BA to proof the non-inferiority of tonsillotomy against tonsillectomy for the treatment of patients with recurrent acute tonsillitis. The present article on ENT specialist knowledge should put the reader, especially ENT residents, in a position to advice patients and their relatives on the pros and cons of tonsil surgery., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

The number of operations for tonsillectomy have been significantly decreasing for many years in Germany. In children the number of adenotonsillectomies has decreased by two thirds within a decade. This phenomenon is mirrored by a significant increase in the number of annually performed tonsillotomies, a surgical procedure which is preferably performed for volume reduction in cases of tonsillar hypertrophy. The aim of this article is to elucidate the different interventional procedures, their typical indications and risks.

Background: A second-opinion procedure was introduced for (adeno)tonsillectomy and tonsillotomy in 2018 by the Federal Joint Committee, due to the assumed high prevalence of both procedures. This study was conducted to quantify and analyze both types of tonsil surgery in Germany., Methods: Data from the Federal Office of Statistics on the number of procedures and population size were used to calculate annual intervention rates between 2005 and 2017. Percentual changes in intervention rates compared to the previous year were calculated for Germany, for the total number of ENT specialists, for the ENT specialists of the federal states, and for four age groups (≤10; ≤20; ≤40; >40 years)., Results: Regression analysis revealed a significant decrease in (adeno)tonsillectomy and a significant increase in tonsillotomy in each investigated year (p < 0.001; exception: 2006 for adenotonsillectomy). Surgical rates of tonsillectomy and tonsillotomy decreased significantly with age (p < 0.001). There was no clear relationship between the density of ENT specialists in the different federal states and the number of surgical procedures., Conclusion: There was no clear association between the surgical prevalence and the density of ENT specialists. The significant decrease in rates of (adeno)tonsillectomy began in 2005 and the tonsillotomy rates have been increasing since 2007, albeit without a compensatory effect. Both procedures are on the list of the 50 most frequently performed operations. The decreasing total number of both surgical procedures questions the value of a second-opinion procedure as suggested by the Federal Joint Committee. Tonsil surgery is significantly associated with young age (<10 years) and discussions on surgery rates must consider the age structure of the investigated population, since this is the most important influencing factor in tonsil surgery.

Background: Tonsillectomy remains a common procedure in Germany. However, demographic changes, the advent of tonsillotomy, and current guidelines may have an impact on the overall incidence., Objective: To longitudinally evaluate the number of tonsillectomies, with (ATE) or without adenoidectomy (TE), and tonsillotomies (TT) performed annually in Germany., Materials and Methods: Based on comprehensive data from the Federal Office for Statistics, the number of patients undergoing the above-stated surgical procedures on an inpatient basis was retrospectively assessed in terms of year and federal state, without restriction by age or gender. Annual rates of ATE, TE, and TT were calculated based on population statistics. Regression analysis was performed to compare different federal states, years, and age groups. The variables were compared using the Pearson correlation coefficient., Results: Between 2005 and 2017, 1,313,449 tonsil surgeries were registered. There was a considerable decrease in the overall incidence rate (per 100,000) of TE (92 to 43), which was even more pronounced for ATE (51 to 15). In contrast, an increased TT rate (6 to 22) was observed. Correlation analysis revealed a strong positive correlation (r = 0.986)., Conclusion: The change of trends in tonsil surgery started long before relevant national guidelines were published. The national trend was associated with considerably less surgical activity overall, a significant decrease in ATE/TE, and a significant increase in TT. Regional differences to the national trend were identified and found to be significant in at least in 7 of 16 federal states.

Adenoidectomy, paracentesis, and tonsillar interventions are the most common operations in childhood. Hypertrophy of the lymphatic tissue of Waldeyer's ring can lead to individually distinct, acute, and chronic symptoms as well as anatomical and functional changes. When presented with affected children in otolaryngologic practice, the combination of parental interview, questionnaire-based screening for obstructive sleep apnea syndrome, and physical examination including ear microscopy, inspection of the oropharynx and, if necessary, the nasopharynx, has proven its worth. Audiometric diagnosis for detection of tympanic effusion should be mandatory. The treatment of choice is adenoidectomy, if necessary plus tonsillotomy and paracentesis with a tympanic tube insert. However, the indication remains controversial, as the effectiveness of the interventions seems to depend on the preoperative severity of symptoms. With a correct indication, effective symptom reduction, improvement in quality of life, and high parent satisfaction can be expected.

Background: Tonsils are first-line host defence organs against pathogenic agents and participate in local and systemic immunity. Persistent increases in systemic inflammatory responses may contribute to associated morbidity. The aim of this study was to verify the short- and long-term impact of adenotonsillectomy on the evolution of inflammatory markers in 3- to 9-year-old children., Methods: A prospective and longitudinal study was conducted over 1 year in 29 children who underwent tonsillectomy due to either chronic tonsillitis or adenotonsillar hypertrophy. Measurements of high-sensitivity C-reactive protein (hs-CRP) levels were taken. Levels of Th1-type cytokines [interleukin-1, interferon-γ, and tumor necrosis factor-α (TNF-α)] and anti-inflammatory Th2-type cytokines [interleukin-4, -5, -6, -10 and -13] were measured. Levels of transforming growth factor-beta (TGF-β) and intercellular adhesion molecule-1 (ICAM-1) were also determined. The results were compared to those of 29 control children., Results: At baseline, children with surgery indications presented with higher levels of hs-CRP, interleukin-1 and -10, interferon-γ, TNF-α and ICAM-1, whereas values of interleukin-4 were significantly lower than in control children. Children with severe tonsillar obstruction had higher values of interleukin-1, -4, and -5 and lower values of interleukin-10 compared with children with recurrent tonsillitis. One year after surgery, the levels except IL-4 did not show a significant difference from those obtained in the control group. The levels of hs-CRP and TNF-α decreased significantly in the first month., Conclusion: Children with chronic tonsillitis and/or adenotonsillar hypertrophy have significantly elevated levels of proinflammatory cytokines. Adenotonsillectomy restores the normal values of these parameters 1 year after surgery., (© 2019 John Wiley & Sons Ltd.)

Background: The frequency of tonsil surgery in Brandenburg (BB) during the period from 2013 to 2017 is analyzed. Causes and possible consequences of the trends are discussed., Materials and Methods: An OPS code-based survey is carried out in the 10 ENT hospitals in BB and using the data from the federal states (Federal Statistical Office). In addition, the respective heads of ENT departments are interviewed concerning the indication for tonsillectomy (TE). The average number of operations in 2013/2014 is compared to that in 2017 (BB) and 2016 (federal states)., Results: In 9/10 participating hospitals in BB, 10,302 operations were performed, thereof 58.4% as TE, 19.0% as tonsillotomy (TT), 13.7% as abscess tonsillectomy (abscess TE), and 8.9% other. In BB in 2017 in comparison to 2013/2014, because of the decrease in TE by 45.6%, a total of 21.1% less operations were performed, while TT and abscess TE increased by 32% and 18%, respectively. The average age at surgery was 28.1, 38.1, and 5.9 years for TE, abscess TE, and TT, respectively. The entire trend for Germany until 2016 on the basis of 395,674 cases reflects a decrease in TE (30.7%) and abscess TE (14%), while TT was performed 27.5% more often, resulting in a total decrease of 21.3%. The interviewed persons follow the "justifiable operation indications" of the German guideline from 2015 and adapted their previous practice., Conclusion: Our survey and results indicate that the massive decrease of TE in BB is associated with the "justifiable operation indications" of the 2015 German guidelines on inflammatory diseases of the tonsils. TE is mainly performed in adults. Therefore, research concerning conservative versus surgical treatment for recurrent tonsillitis is urgently needed for this age profile.

Objective: In this study, symptoms associated with adenoids and hyperplasic palatine tonsils and parental expectation of surgical outcome were recorded, to provide realistic parental information prior to adenoidectomy (AT) ± tonsillotomy (ATT)., Material and Methods: In total n = 111 children (3-6 years, ♂ 65 % ♀ 35 %) were recruited, who received AT (66 %) or ATT (34 %) at ENT University Hospital Ulm. By questionnaire-based survey, the most common symptoms and the main reason for the operation were reported from parent's perspective (operation day, follow-up: 3.5 months). Results were visualized in bar charts for total collective and AT and ATT surgical groups (significance level α = 5 %)., Results: Most commonly, parents observed signs of respiratory problems (mouth breathing 87 %, nasal obstruction 86 %, snoring 78 %), hearing loss (68 %) and infection of upper airways (66 %). Nasal obstruction (77.5 %) and hearing loss (53.2 %) were the main reasons for operation. In children with pharyngeal tonsil hyperplasia only, hearing problems dominated, while in additional tonsillotomy, nocturnal apneas were the most frequently reported reason for surgery. For all symptoms, a significant postoperatively improvement was achieved., Conclusions: With a differentiated indication for surgery, it is possible to inform the parents about a very good and realistic and effective reduction of symptom after AT and ATT., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: To remove the immune function of children with obstructive sleep apnea hypopnea syndrome by resection of adenoids and tonsillar. Method: The fasting peripheral venous blood of children with OSAHS and healthy children were collected. The lymphocyte subsets, NK cells and immunoglobulin levels were compared between the two groups. The fasting blood samples of OSAHS children were collected again after 2d, 30d, 60d and 90d after operation. The changes of lymphocyte subsets, NK cells and immunoglobulin levels were observed after operation. Result: Before operation, at the 0.05 test level, it was not yet clear that the levels of IgG, IgM, IgA, NK, CD3+, CD4+ and CD8+ in OSAHS children were significantly different from those in the control group. The levels of IgA, CD3+ and CD4+ decreased significantly in children at 2d and OSAHS after operation, and IgG, IgM, IgA, NK, CD3+ and IgA continued to rise after 60d until ninetieth day after operation. Conclusion: There is no statistical disorder of immune level in children with OSAHS compared with healthy children. The implementation of adenoidectomy and tonsillectomy in children with OSAHS, the level of immunity in 90 days can be restored to the preoperative level.

Objectives: Describe the patterns of obstruction in persistent pediatric OSA and their relationship with patient weight., Study Design: Retrospective review., Methods: All pediatric DISE procedures performed at a tertiary care hospital between October 2010 and October 2015 were reviewed. Patients had polysomnography after adenotonsillectomy that confirmed persistent obstructive sleep apnea (OSA). Variables included age, gender, co-morbidities, and AHI. DISE findings focused on inferior turbinates, adenoid, tongue base, epiglottis, aryepiglottic (AE) folds, arytenoids, lingual tonsil and their contributions to obstruction., Results: 34 patients were included with mean age of 7.85 (2-16) years, mean BMI of 23.15 (13.6-44.8) and mean AHI of 6.34 (1.5-25.2) events per hour. Obstruction occurred at the level of the epiglottis in 97%, with retropositioning by tongue base (73.6%) or lingual tonsil enlargement (70.5%). Obstruction occurred at the inferior turbinates in 76.5%, the adenoid in 64.7% and the palate in 58.8%. Shortened AE folds were less often identified (15%). Multiple sites of partial or complete obstruction were found in 97% of patients. Overweight or obese patients had a mean of 3 sites of complete obstruction and 4.69 sites of partial or complete obstruction as compared to 2.33 and 4.52 in underweight or normal weight children. Overweight or obese children were more likely to have obstruction at the lingual tonsil or adenoid than normal/underweight children., Conclusion: Multiple sites of obstruction in persistent pediatric OSA were found. Children with higher BMIs had slightly different findings, suggesting that attention to adenoid regrowth and lingual tonsil hypertrophy is important., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Article Title and Bibliographic Information: Impact of adenotonsillectomy on the dentofacial development of obstructed children: a systematic review and meta-analysis. Becking BE, Verweij JP, Kalf-Scholte SM, Valkenburg C, Bakker EWP, van Merkesteyn JPR. Eur J Orthod 2017; 39(5):509-18., Source of Funding: The review received no funding TYPE OF STUDY/DESIGN: Systematic review., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objectives: Intracapsular tonsillectomy (tonsillotomy) has been used internationally, mainly in the management of obstructive sleep apnoea, rather than recurrent tonsillitis, with few published data evaluating its use for this latter indication. We present long-term prospective data from 500 paediatric cases undergoing Coblation ® intracapsular tonsillectomy, for both obstructive and infective indications., Design: Prospective case series, March 2013-January 2016, all with completed follow-up., Setting: Tertiary paediatric otolaryngological practice., Participants: A total of 500 consecutive patients (6 months to 18 years, mean 5.1 years) undergoing Coblation ® intracapsular tonsillectomy (with or without adenoidectomy), for obstructive and/ or infective indications, almost exclusively under the care of the senior author (DJT)., Main Outcome Measures: Validated parent-reported T-14 tonsil symptom questionnaires were used in all cases pre- and postoperatively, including in the long term. Parents also recorded duration of analgesia, time to return to school, any complications and whether they would recommend the procedure., Results: With a mean follow-up 7.4 months, symptom control has been excellent (mean total T-14 score (/70) 31.01 preoperatively, 2.68 postoperatively, P<.0000001), with similar trends for obstructive and infective domains. Two small secondary haemorrhages required readmission and observation only (0.4%); otherwise, no complications, delayed discharges or readmissions occurred; 12/500 (2.4%) have since undergone revision tonsil surgery, 10 for obstructive and 2 for infective symptoms, the majority in very young children, with revision adenoidectomy at the same time. More than 99% of parents would recommend the surgery., Conclusions: Our experience of this technique has been very positive, with excellent control of both obstructive and infective symptoms, and exceptionally low rates of complications. Further work will be required to allow conclusive demonstration of its advantages over extracapsular tonsillectomy., (© 2017 John Wiley & Sons Ltd.)

Objective: To analyze the complications of adenotonsilectomy assisted with coblation in children. Method: Complications of 2 089 cases of children with adenoid and tonsil surgery assisted with coblation, in our hospital nearly 10 years, were analyzed by epidemiological methods through the method of retrospective analysis. Result: ①the sex ratio of male to female was 2.08：1, average age (5.87±3.12) years old, and most of 2 089 cases 76.35% (1 595/2 089) were 3-7 years old; ②all cases underwent adenoidectomy. Different surgery methods of tonsil consisted of three groups as partial resection associated with ablation was 69.17% (1 445/2 089), ablation (channeling) alone was 22.26% (465/2 089) and total resection was 8.57% (179/208). The amount of bleeding in operation was (8.52±3.18)ml, average operation time was (30.15±8.26) minutes, the postoperative pain score was (3.77±1.61); ③The incidence of postoperative complications: postoperative bleeding (all were secondary bleeding cases) rate was 0.24% (5/2 089), recurrence rate was 0.14% (3/2 089), prevertebral lymphadenitis was 0.96% (20/2 089), the other was 0.29% (torus hyperplasia in 2 cases, dyspnea in 2 cases, 1 cases of angle of mouth burned, nasopharyngeal adhesion in 1 cases). Postoperative fever rate was 9.81% (205/2 089). Conclusion: coblation technique is a good method for the treatment of children's adenoids and tonsil diseases with high efficiency and low complications. But improving the operation procedure proficiency level and skills of operation is an important link to reduce complications., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To assess cardiac functions in adenotonsillar or tonsillar hypertrophy., Methods: A prospective, interventional, academic centre based study was conducted on 25 children with adenotonsillar or tonsillar hypertrophy. All patients underwent pulsed 2-dimensional Doppler echocardiography, pulse oximetry and 12-lead electrocardiography. These assessments were repeated three months later to determine the impact of adenotonsillectomy., Results: There were significant differences in mean arterial oxygen saturation, pulmonary flow acceleration time and mean pulmonary artery pressure post-operatively. Adenotonsillectomy led to significant improvements in pulmonary flow acceleration time and pulmonary flow velocity time index, while tonsillectomy resulted in right ventricular early and late diastolic velocity index improvement., Conclusion: Upper airway obstruction in children affects cardiac functioning and this can subsequently lead to morbidity and delayed growth. Hence, revision of surgical indications is advocated in adenotonsillar hypertrophy to avoid irreversible damage to cardiopulmonary functions.

To determine if there was a difference in the inflammatory reaction after tonsil surgery with "traditional" techniques (tonsillectomy and adenoidectomy or TA) compared to partial intracapsular tonsillectomy and adenoidectomy (PITA)., Design: Randomized, double-blind study., Setting: tertiary care academic hospital. Children under the age of 16 years with a diagnosis of obstructive sleep disordered breathing were randomly allocated into three study groups: TA with electrocautery (n = 34), PITA with CO 2 laser (n = 30) and PITA with debrider (n = 28). All of the children underwent adenoidectomy with a current at the same surgical procedure., Main Outcome Measure: c-reactive protein level (CRP) was the primary endpoint. In addition, the following were assessed: white blood cells (WBC), neutrophils (NEU), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α). Pre- and post-procedure measurements were compared between the groups. Parents filled out a questionnaire daily during the first postoperative week assessing pain, swallowing and snoring. CRP levels ascended higher in the PITA groups after surgery (p = 0.023), WBC and NEU showed the same pattern, IL-6 levels were higher in PITA group and there was no difference in TNF-alpha levels between the two types of procedures. Postoperative pain and postoperative hemorrhage were significantly lower in the PITA groups as compared to the TA group (p = 0.01 and 0.048). PITA in comparison to TA is associated with lower morbidity; however, the inflammatory response does not differ significantly in the first 24 h after surgery. Additional long-term studies assessing efficacy of PITA are warranted., Level of Evidence: Level 1, prospective randomized controlled trial.

Objective: To measure the maxillary dentoskeletal and soft tissue changes of severely obstructed mouth breathing (MB) young children who had their mode of breathing normalized after adenotonsillectomy (T&A), in comparison with a matched group of severely obstructed untreated MB children (CG)., Methods: Seventy patients who had an Ear, Nose, and Throat examination (ENT), including flexible nasal endoscopy, to confirm the severe obstruction of the upper airways and the indication of T&A composed the sample. Cephalograms and dental casts were available from the patient's orthodontic records. Treatment group (TG) and CG included 35 children each. Groups were matched by gender (24 males and 11 females in each group), age (TG, 6.7 ± 1.8 years; CG, 6.9 ± 2.3 years), tooth development (TG, 13 primary dentition, 22 mixed dentition; CG, 14 primary dentition, 21 mixed dentition), and skeletal maturation status. Records were taken at baseline (T0) and 1-year after T&A (T1) for TG; while CG records were taken with a 1-year interval. Dentoskeletal measurements were performed in the lateral cephalograms, and dental casts were used to assess the palatal volume and occlusal changes., Results: TG showed a significant increase (503.3 mm(3), P < 0.001) in the palatal volume (10% of change), while CG palatal volume was stable. No dimensional occlusal changes were detected between T0 and T1 in both groups. Significant downward (point A, 2.1 mm; ANS, 2.1 mm) and forward displacements (point A, 0.7 mm; ANS, 1 mm) of the anterior region of the maxilla were observed in the TG, but CG presented only significant downward displacement (point A, 1.8 mm; ANS, 1.4 mm). The maxillary posterior region (PNS, PTM, and Molar) displaced downward in both groups (P < 0.05), however no sagittal change was found. The palatal plane inclination was stable in both groups., Conclusions: TG presented significant increase in the palatal volume and in the forward displacement of the maxilla. No other significant maxillary dentoskeletal changes were found., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Tonsillectomy rates vary considerably among different states, regions and times. This study was undertaken to identify the prevalence of "chronic" tonsillitis, peritonsillar abscess, hyperplasia of the tonsils with and without adenoids in absolute and relative numbers in an 80m people nation. Moreover, the number and rates of different surgical procedures to resolve either "chronic" tonsillitis, peritonsillar abscess or upper airway obstruction due to (adeno)tonsillar hyperplasia over several years was evaluated in this study (tonsillectomy, adenotonsillectomy, tonsillotomy , abscess tonsillectomy, transoral incision and drainage). Finally, the post-tonsillectomy hemorrhage rate was determined and analyzed in relation to age and gender.., Material and Methods: Calculations were based on data as published by the Federal Institute of Statistics or on request, if needed. The latest data were provided for 2013.., Results: The total number of the aforementioned diseases (stratified by ICD-10) decreased from 142.574 (in 2000) to 87.624 in 2013 (38.5 %). Tonsillectomy, with or without adenoidectomy, was performed in a total of 833.896 patients between 2006 and 2013 in Germany. The yearly number decreased continually from 120.993 in 2006 to 84.332 procedures in 2013 (30.3 %). The most significant decrease was registered in patients younger than 20 years of age for this time period: 70.92 per 10.000 in 2010 to 58.68 per 10.000 in 2013. If all age groups were included, the rate decreased from 13.34 per 10.000 to 10.90 per 10.000. In contrast, an increasing number of tonsillotomies was performed between 2007 (4.659 procedures) and 2013 (11.493). The cumulated number of procedures was 59.049. A constant number of 15.000 cases with peritonsillar abscess were diagnosed per year in Germany (19 patients per 100.000). The prevalence increased significantly at an age of 15 years and there was a preponderance of female patients below that age. Compared to transoral incision and drainage, a 2.8-fold greater number of abscess tonsillectomies were performed annually. Post-tonsillectomy hemorrhage was experienced by 5.98% of all patients after 245.721 procedures in 2010 and 2013 (all indications, except tonsillotomy). Bleeding complications had occurred less frequently in female patients (5.06 % vs. 7.02 %). Finally, a considerable increase of post-tonsillectomy hemorrhage in patients older than 10 years of age was registered in male patients only., Conclusions: chronic tonsillitis was less frequently diagnosed and surgically treated in terms of tonsillectomy (with or without adenoidectomy), particularly in female patients. In contrast, the number of tonsillotomies increased continullay, particularly in male patients. Peritonsillar abscess was diagnosed and surgically treated in a constant number of patients in the yearly comparison. Most of these patients were scheduled for abscess tonsillectomy, and only a 2.8-fold smaller number for transoral incision and drainage. Independent from the indication for surgery, post-tonsillectomy hemorrhage was clearly associated with male gender and age (>10 years). The study reveals a dramatic change mandating further surveillance by insurance companies and authorities in the national health system of an 80m people nation.., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: Many clinicians are concerned about possible airway or respiratory complications following adenotonsillectomy for sleep related breathing disorder (SRBD), and routinely admit such patients for overnight monitoring. However, published guidelines suggest this is unnecessary in some cases. This study firstly aimed to establish current UK practice, and secondly to investigate whether children with mild/moderate SRBD experience respiratory problems during the first post-operative night., Methods: To establish current UK practice, we carried out a telephone survey asking if the procedure was carried out as a day-case, and admission criteria. For the second aim, a prospective study of children admitted following adenotonsillectomy for mild/moderate SRBD was carried out to investigate occurrence of respiratory complications on first post-operative night., Results: Forty-two UK ENT doctors responded to the telephone survey, 50% routinely admitted patients having adenotonsillectomy for SRBD. Discharge criteria included stable observations and eating and drinking (14 hospitals), no bleeding (1), stable oxygen saturations (1) and age above 5 years (1); four had no specific criteria. Of 51 children admitted following adenotonsillectomy for mild/moderate SRBD, 11 (21.6%) experienced oxygen desaturations overnight. Of these, nine were under 4 years old, and two older children had asthma. Irrespective of comorbidities, 9/27 (33.2%) children under 4 years old experienced desaturations. The only children aged more than 4 years that had desaturations were ones that had additional comorbidities., Conclusion: Half of surveyed doctors admit all children following surgery for SRBD. The number of admissions could be reduced, because same-day discharge for otherwise-healthy children over 4 years old having adenotonsillectomy for mild/moderate SRBD appears to be safe., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objectives: We modified and abbreviated a pre-existing research questionnaire, the Tonsil and Adenoid Health Status Instrument, to make it suitable for rapid completion as a disease-specific, health-related quality of life research tool for children with tonsil and adenoid disease in the UK. We determined the main psychometric properties of the resulting 14-item Paediatric Throat Disorders Outcome Test., Design, Setting and Participants: Pre- and post-operative questionnaires were completed by the parents of children with throat disorders referred to two large hospitals. We included children with recurrent tonsillitis and with obstructive sleep apnoea. A separate cohort of healthy children of comparable age range was also studied., Main Outcome Measures: The test's internal consistency and responsiveness were analysed and its construct validity documented via known-group differences., Results: A total of 126 completed questionnaires were received from the hospital referral group. The children's mean age was 6.5 years (range one to 16). The 40 unaffected children were well matched in age to the study population (mean 6.1 years, range two to 15). Cronbach's alpha coefficient for the pre-operative assessment total score was 0.84. The test-retest reliability coefficient for the total score was 0.98, indicating very high reproducibility. The 14-item Paediatric Throat Disorders Outcome Test discriminated well between children known to suffer with throat problems and a group of healthy controls (p < 0.0001; t = 24.016). Six months after surgical intervention, parentally reported questionnaire scores had improved (i.e. were lower) (p < 0.0001; t = 7.01). The standard effect size (i.e. change in mean divided by baseline standard deviation) for children for whom post-operative questionnaires were completed was 1.53; this is very large., Conclusions: The 14-item Paediatric Throat Disorders Outcome Test is an appropriate, disease-specific, parent-reported outcome measure for children with throat disorders, for which we have demonstrated internal consistency, reliability, responsiveness to change and two forms of construct validity.

Objectives and Methods: Aim of the study was to describe frequency, causes, regional variations, setting and risk of mortality of tonsillectomy and adenoidectomy in Italy. The study is based on hospital discharge data for the years 1998-2000 provided by the Ministry of Health., Results: During the year 2000, 61.280 tonsillectomy with or without adenoidectomy and 32.655 adenoidectomy alone were performed in Italy. ICD-9-CM codes reported on discharge abstracts indicated that the most frequent causes of tonsillectomy were chronic tonsillitis (45%) and hypertrophy of tonsils and adenoids (43%). The total tonsillectomy rate was 10.6 x 10.000 (CI 10.5-10.7) in 2000, and it was stable throughout the study period. We observed a wide geographical variability of regional tonsillectomy rates, standardised by age and sex. They ranged from 3.5 x 10.000 (CI 3.1-4.0) in Basilicata to 19.0 (CI 18.6-19.5) in Piemonte. We found an inverse correlation (r = -0.50) between regional tonsillectomy rates for tonsillitis and minimum temperatures recorded in capitals of the regions. Most operations were performed in the acute setting with a hospital stay longer than one day. The mortality risk associated to surgery was estimated to be at least of one case over 95.000 operations., Conclusions: The observed variability of regional tonsillectomy rates, only partly explained by weather differences, may be ascribed to disagreement among physicians. Inappropriate variations and setting were the two main reasons conducive to the development of the guidelines "Clinical and organisational appropriateness of tonsillectomy and/or adenoidectomy in Italy", in the frame of LINCO project and of the Italian National Program for Guidelines.

Objective: To review the effectiveness of a perioperative management protocol and our experience with a large population of patients with von Willebrand disease (vWD) who require adenotonsillar surgery (T&A)., Design: A retrospective review of the medical records of all patients having the diagnosis of vWD who underwent T&A between January 1, 1992, and July 31, 1996., Setting: A tertiary care, university-based children's hospital., Interventions: Patients having a preoperative diagnosis of vWD received a single intravenous dose of desmopressin acetate, 0.3 pg/kg, approximately 20 minutes before the induction of anesthesia. Beginning January 15, 1994, a standard management protocol involving the postoperative administration of fluids and electrolytes was followed., Main Outcome Measures: Operative blood loss and the incidence of postoperative bleeding and of hyponatremia., Results: Of approximately 4800 patients who underwent T&A during the study period, 69 patients had a diagnosis of vWD. All 67 patients identified preoperatively received desmopressin; 2 were identified by postoperative workup as a result of excessive surgical bleeding. Minimal immediate postoperative bleeding was noted in 7 patients (10%), but none required intervention. Delayed bleeding occurred in 9 patients (13%); all were readmitted to the hospital for observation, 4 (6%) requiring operative cauterization. Substantial postoperative hyponatremia occurred in 3 patients, and 1 patient had seizure activity. Symptomatic hyponatremia has been avoided since a protocol of fluid and electrolyte administration was instituted., Conclusions: Although T&A can be performed safely in patients with vWD, it is not without an increased risk of postoperative hemorrhage. The administration of desmopressin has been reported to reduce the risk of bleeding, but it is not without risk. A protocol for fluid and electrolyte management is recommended.

Eighty-one children undergoing tonsillectomies and adenoidectomies (T and A) were compared with a control group of 88 hospital patients. A significantly higher incidence of prior T and A was found to have been performed on the siblings and parents of the T and A group than the controls. Environmental, genetic or attitudinal factors could be responsible for this familial clustering.

A statistical survey was made of all the cases of poliomyelitis occurring in all of Los Angeles County during the three years of 1949, 1950 and 1951 in an attempt to determine the effect of operations on the nose and throat on the incidence of poliomyelitis. Tonsillectomy and adenoidectomy were the only operations noted with any degree of frequency. Yet, in the total of 3,601 cases of poliomyelitis that occurred in this three-year period there were only 20 (0.55 per cent) in which the patient had had recent tonsillectomy and adenoidectomy. The incidence of this disease in patients who had had tonsillectomy and adenoidectomy was compared with the "expected" incidence as determined from the incidence in other patients, in the same age group. There was no significant difference between actual and expected incidence even during the summer months when most cases of poliomyelitis occurred. The same was true with regard to recently tonsillectomized patients in the epidemic months of July through October. In a separate survey of 675 patients with poliomyelitis, it was noted that only 30 per cent ever had had tonsillectomy or adenoidectomy. Inasmuch as it is estimated that one of every three persons in the general young population nowadays has had tonsillectomy and adenoidectomy, this figure is no more or less than could be expected.