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Nicholls A, Gupta E, Bew S, Bliss A. A service evaluation of the impact of parental information provision on analgesia administration at home post tonsillectomy. Paediatr Anaesth 2023; 33:691-698. [PMID: 37528615 DOI: 10.1111/pan.14693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION Tonsillectomy and adenotonsillectomy are together the most common pediatric surgical procedure and are increasingly performed as day cases. Postoperative pain is commonly severe for 1-2 weeks, but parental analgesia concerns lead to poor analgesia prescription compliance and under administration. This service evaluation assessed parental compliance with analgesia, elicited parental concerns, and obtained parental suggestions for improving the current written advice. METHODS Telephone questionnaires were completed on postoperative Days 3/4 and 7 with 42 parents of pediatric (adeno)-tonsillectomy patients over a 6-month period, peri-pandemic. The questionnaire collected categorical data on: analgesia prescribed and administered, the child's symptoms, and healthcare resource use. Qualitative data on barriers to analgesia administration and suggestions for written advice improvement were grouped thematically. RESULTS Sore throats were reported by 93.3% parents between discharge and Day 3/4 but only 43.3% parents had 100% compliance with regular paracetamol and ibuprofen in the same time period. Parents frequently avoided morphine administration, expressing concerns about side effects, addiction, and previous experience. Parents were also concerned about using ibuprofen, discrepancies between weight-based and bottle instruction doses, and the length of the analgesia course. Parents would like further written information and reassurance on these topics as well as guidance on tapering or stopping analgesics and whether to wake their child at night. CONCLUSION The breadth of unmet information needs identified in this service evaluation, alongside parental suggestions, will be used to improve the current written advice with the aim to improve the postoperative pain experience at home. These include information on length of analgesic course, safety of ibuprofen and paracetamol coadministration for analgesia, and details about morphine administration, including safety, side effects, and indication.
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Virgilio E, Bonfili D, Bettoni S, Vona L, Mercuri J, D'Agostino F, Baldinu M, Salvemini C, Montali F, Costi R. Tonsillectomy as Prevention of Tonsil and Base of Tongue Cancer: Systematic Review and Meta-analysis on the Immuno-Oncological Effect of One Among the Most Common Surgeries in the World. Anticancer Res 2023; 43:3881-3889. [PMID: 37648322 DOI: 10.21873/anticanres.16575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 09/01/2023]
Abstract
Otorhinolaryngology tradition is that tonsillectomy (TE) is conducted among children and adolescents for obstructive sleep apnea secondary to adenotonsillar hypertrophy and in adults for chronic disease of the tonsils and adenoids (recurrent tonsillitis). Nevertheless, over the last 50 years, we have observed a decline in TE worldwide. As a result, there is an emerging concern of a correlated possible increased risk of tonsil cancer (TC) and other subtypes of oropharyngeal squamous cell carcinoma. Since the available data on such topics are limited and controversial, our aim was to elucidate the impact of TE on the incidence mainly of TC through a systematic review of the literature and a meta-analysis of the studies. After a thorough search, 7 retrospective studies were considered eligible for review and meta-analysis (MA). At MA, patients with a history of TE seem to show a reduced risk of TC but a higher predisposition for base of tongue (BOT) cancer (p<0.001): however, the elevated heterogeneity of the studies hampers drawing firm and convincing conclusions (statistical inconsistency >95%). In future, randomized control trials will be welcome to elucidate the prophylactic role of TE against TC and its real impact on BOT cancer.
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Affiliation(s)
- Edoardo Virgilio
- Department of Medicine and Surgery, University of Parma, Parma, Italy;
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
| | - Deborah Bonfili
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Stefania Bettoni
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Lorenzo Vona
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Jacopo Mercuri
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Manuel Baldinu
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Carlo Salvemini
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
| | - Filippo Montali
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
| | - Renato Costi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
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Friedman NR, Nguyen T, McLeod L. In Reference to " Tonsillectomy for Obstructive Sleep-Disordered Breathing: Should They Stay, or Could They Go?". Laryngoscope 2023; 133:E55-E56. [PMID: 36912387 DOI: 10.1002/lary.30650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 03/14/2023]
Affiliation(s)
- Norman R Friedman
- Department of Otolaryngology, University of Colorado School of Medicine; Division of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Thanh Nguyen
- Department of Anesthesiology, University of Colorado School of Medicine; Children's Hospital Colorado, Aurora, Colorado, USA
| | - Lisa McLeod
- Pediatric Center of Excellence, Global Product Development (L.M.), Pfizer, Inc., New York, New York, USA
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Cramer JD, Anne S, Brenner MJ. Updated Centers for Disease Control and Prevention Guidelines on Opioid Prescribing: What Should Surgeons Know? Otolaryngol Head Neck Surg 2023; 169:441-443. [PMID: 36939524 DOI: 10.1002/ohn.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 12/09/2022] [Accepted: 12/26/2022] [Indexed: 01/31/2023]
Abstract
The Centers for Disease Control and Prevention (CDC) recently published a 2022 guideline on opioid prescribing for acute, subacute, and chronic pain. This information is relevant to surgeons because many patients receive their first opioid prescription after surgery. When prescribing opioids, surgeons walk the line between benefit and harm. Many of the CDC recommendations mirror the AAO-HNS Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations. For example, opioids are not recommended as first-line therapy for acute pain from otolaryngology-head, and neck surgery procedures. New insights include safeguards and strategies to mitigate the risk of complications in patients with chronic pain undergoing surgical procedures. Consultation with a pain specialist should be considered for patients transitioning from acute to chronic pain, cognizant of the risks of abrupt discontinuation of opioids in patients with opioid use disorder. This article summarizes key considerations for providing individualized, evidence-based perioperative pain management.
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Affiliation(s)
- John D Cramer
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Samantha Anne
- Section of Pediatric Otolaryngology, Head & Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Shayan A, Berjis N, Hashemi SM. Effect of Oral Prednisolone on Pain after Tonsillectomy with Sutures: A Randomized Clinical Trial. Adv Biomed Res 2023; 12:202. [PMID: 37694239 PMCID: PMC10492605 DOI: 10.4103/abr.abr_410_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 09/12/2023] Open
Abstract
Background Tonsillectomy, one of the most common otolaryngology surgeries, often results in postoperative complications such as pain and bleeding. Currently, there is no consensus on postoperative pain management. This study aimed to determine the efficacy of oral prednisolone on postoperative pain after tonsillectomy with sutures. Materials and Methods This pilot, double-blind, randomized clinical trial was conducted at two tertiary care centers affiliated with Isfahan University of Medical Sciences. Patients who underwent tonsillectomy with sutures were included. Participants were randomly divided into experimental and control groups. In the experimental group, patients received oral prednisolone in addition to acetaminophen; in the control group, patients received acetaminophen and a placebo. Post-operative pain was evaluated by a visual analog scale daily for ten days. Results Initially, 60 patients were enrolled in the study; however, four were excluded due to non-attendance at follow-up visits. The groups were similar in terms of age and sex (both P values >0.05). In the study, postoperative pain from 1st day to the 10th day was lower in the experimental group than in the control group (P value <0.05). Conclusion Numerous studies have been conducted on the effect of intravenous corticosteroids on this pain. However, there is no consensus on the analgesic role of oral corticosteroids for post-tonsillectomy pain. The present study showed that oral prednisolone is effective on post-operative pain compared to a placebo.
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Affiliation(s)
- Amin Shayan
- Department of Otolaryngology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nezammedin Berjis
- Department of Otolaryngology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sayed Mostafa Hashemi
- Department of Otolaryngology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Masoudifar M, Rezaeian A, Mosharaf S. The Effect of Half Percent Oxymetazoline Nasal Drops on Post- Tonsillectomy Cough, Sore Throat and Bleeding in Children; A Double-Blind Randomized Clinical Trial. Adv Biomed Res 2023; 12:193. [PMID: 37694249 PMCID: PMC10492611 DOI: 10.4103/abr.abr_247_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 09/12/2023] Open
Abstract
Background Considering the high prevalence of tonsillectomy in children and concerns of postoperative management, this study was conducted with the aim of evaluating the effects of oxymetazoline on bleeding, cough, and sore throat in children undergoing tonsillectomy. Materials and Methods The current double-blind clinical trial study was conducted on 88 tonsillectomy candidate patients. These patients were randomly divided into two groups. In the first group, oxymetazoline 0.05% nasal spray (OXY group) and in the second group, distilled water spray (Control group) was prescribed as one puff in each nostril immediately after anesthesia induction., the nasal spray was prescribed again in both nostrils at 12 h after tonsillectomy. Then the hemodynamic parameters, post-tonsillectomy hemorrhage (PTH) and sore throat were evaluated. Results The mean of the sore throat of children was not significantly different between the two groups in any of the follow-up times (P value >0.05). PTH in recovery and in the ward in the OXY group with the mean of 57.60 ± 71.82 ml and 22.11 ± 22.50 ml, respectively, was significantly lower than the control group (83.50 ± 113.64 ml and 27.52 ± 35.11 ml) (P value < 0.05). Also, the frequency of cough in the ward in the OXY group with 27.3% was significantly lower than the control group with 56.8% (P value = 0.005). Conclusion Regarding the results of the present study, sore throat and hemodynamic parameters did not change significantly with the administration of oxymetazoline. But this drug has played a significant role in reducing PTH and cough in children.
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Affiliation(s)
- Mehrdad Masoudifar
- Department of Anesthesiology, School of Medicine, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Rezaeian
- Department of Otolaryngology, School of Medicine, Isfahan University of Medical Sciences Isfahan, Iran
| | - Sheida Mosharaf
- Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Solarz P, Zwierz A, Wierzchowska M, Burduk P. Transient Facial Nerve Palsy as a Complication of Local Anesthesia After Tonsillectomy. Ear Nose Throat J 2023:1455613231185021. [PMID: 37464789 DOI: 10.1177/01455613231185021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Chronic tonsillitis is a common otolaryngological disease worldwide. The treatment of choice is tonsillectomy, which is one of the most frequently performed procedures in Ear, Nose and Throat Departments. As with any surgical procedure, there are possible complications. Among them, rarely encountered and reported mainly in the pediatric population, is a short-term, transient facial nerve palsy resulting from local anesthetic administration. Here, we present a rare case of a 20-year-old woman with recurrent angina, who developed short-term, fully transient peripheral facial nerve palsy immediately after tonsillectomy under local anesthesia.
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Affiliation(s)
- Paweł Solarz
- Department of Otolaryngology, Laryngological Oncology and Maxillofacial Surgery, Bydgoszcz, Poland
| | - Aleksander Zwierz
- Department of Otolaryngology, Laryngological Oncology and Maxillofacial Surgery, Bydgoszcz, Poland
- Department of Otolaryngology, Phoniatrics and Audiology, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland
| | - Małgorzata Wierzchowska
- Department of Otolaryngology, Laryngological Oncology and Maxillofacial Surgery, Bydgoszcz, Poland
- Department of Otolaryngology, Phoniatrics and Audiology, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland
| | - Paweł Burduk
- Department of Otolaryngology, Laryngological Oncology and Maxillofacial Surgery, Bydgoszcz, Poland
- Department of Otolaryngology, Phoniatrics and Audiology, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland
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Qian Q, Liu HX, Li YQ. Effect of esketamine nasal drops on pain in children after tonsillectomy using low temperature plasma ablation. Front Pediatr 2023; 11:1110632. [PMID: 37528873 PMCID: PMC10390061 DOI: 10.3389/fped.2023.1110632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/12/2023] [Indexed: 08/03/2023] Open
Abstract
Objective To explore the effect of esketamine nasal drops on pain in children after tonsillectomy using low-temperature plasma ablation. Methods 76 children who underwent tonsillectomy between May 2020 and July 2021, were randomly divided into two groups of 38 cases each. Patients in the control group were treated with conventional medication, while those in the study group were treated with esketamine nasal drops, along with the routine drug treatment. Pain levels of children in the two groups were compared within 1-3 days post-surgery, and the pseudomembrane formation and shedding-off time and recovery time were statistically analyzed. Results The pain level of children in the study group was lower than that of the control group 1-3 days post-surgery. The pseudomembrane formation and shedding-off time and recovery time in the study group were shorter than in the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups, and there were no serious adverse reactions in the two groups (P > 0.05). Conclusion It is safe to use esketamine nasal drops in children after tonsillectomy using low temperature plasma ablation, and this is found to reduce pain and shorten the recovery time.
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Affiliation(s)
- Qiu Qian
- Department of Anesthesiology, Suzhou Wujiang District Children’s Hospital, Suzhou, China
| | - Hua Xian Liu
- Department of Anesthesiology, Children’s Hospital of Soochow University, Suzhou, China
| | - Yue Qing Li
- Department of Anesthesiology, Children’s Hospital of Soochow University, Suzhou, China
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Cash E, Albert C, Potts K, Chandran S, Horrell R. Near-Field LED Illumination Strategies for Tonsillectomy and Adenoid Surgery. Ear Nose Throat J 2023:1455613231183568. [PMID: 37365826 DOI: 10.1177/01455613231183568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Objective: Perform a pilot feasibility study to demonstrate viability, quality, and safety advantages of light-emitting diode (LED) illumination when performing tonsillectomy. Study Design: Prospective cohort. Setting: Children's Hospital and Community Multispecialty Hospital. Methods: We tested a commercially available LED light, held in position with a minimally modified mouth gag, for off-label use in a "cavernous wound." We assessed surgeons', residents', and nurses' perceptions of function, safety, as well as preferences compared to headlights. Results: The light was used in 30 cases. Noted advantages over traditional lighting methods included superior brightness, stability and consistency of illumination, and the ability for others to assist more quickly. The inability to adjust brightness and/or the angle of light was an observed disadvantage. A small oral cavity or large tonsillar pillars creating a shadow required the temporary addition of a headlight. However, LED light use was not discontinued. Surgeons and residents reported a preference for not wearing a headlight, and nurses expressed concerns about headlight cleanliness. Conclusion: LED lighting technology demonstrated utility for teaching surgeons, residents, and nurses, and was perceived as safe. Additional specifications may make the light applicable to a wider variety of cases and could potentially mitigate headlight use during procedures of the oral cavity and oropharynx.Level of Evidence: 4.
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Affiliation(s)
- Elizabeth Cash
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, KY, USA
| | - Christina Albert
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, KY, USA
| | - Kevin Potts
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, KY, USA
| | - Swapna Chandran
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, KY, USA
| | - Robin Horrell
- Department of Otolaryngology, Billings Clinic, Billings, MT, USA
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Samara P, Athanasopoulos M, Athanasopoulos I. Unveiling the Enigmatic Adenoids and Tonsils: Exploring Immunology, Physiology, Microbiome Dynamics, and the Transformative Power of Surgery. Microorganisms 2023; 11:1624. [PMID: 37512798 PMCID: PMC10383913 DOI: 10.3390/microorganisms11071624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/18/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
Within the intricate realm of the mucosal immune system resides a captivating duo: the adenoids (or pharyngeal tonsils) and the tonsils (including palatine, tubal, and lingual variations), which harmoniously form the Waldeyer's ring. As they are strategically positioned at the crossroads of the respiratory and gastrointestinal systems, these exceptional structures fulfill a vital purpose. They function as formidable "gatekeepers" by screening microorganisms-both bacteria and viruses-with the mission to vanquish local pathogens via antibody production. However, under specific circumstances, their function can take an unsettling turn, inadvertently transforming them into reservoirs for pathogen incubation. In this review, we embark on a fascinating journey to illuminate the distinctive role of these entities, focusing on the local immune system inside their tissues. We delve into their behavior during inflammation processes, meticulously scrutinize the indications for surgical intervention, and investigate the metamorphosis of their microbiota in healthy and diseased states. We explore the alterations that occur prior to and following procedures like adenoidectomy, tonsillectomy, or their combined counterparts, particularly in pediatric patients. By comprehending a wealth of data, we may unlock the key to the enhanced management of patients with otorhinolaryngological disorders. Empowered with this knowledge, we can embrace improved therapeutic approaches and targeted interventions/surgeries guided by evidence-based guidelines and indications.
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Affiliation(s)
- Pinelopi Samara
- Children's Oncology Unit "Marianna V. Vardinoyannis-ELPIDA", Aghia Sophia Children's Hospital, 11527 Athens, Greece
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Lis A, Zając H, Lachowski K, Zatoński T, Olchowy A, Dąbrowski P, Domagała Z, Olchowy C. Distance of the cervical part of the internal carotid artery from the selected anatomical structures in the parapharyngeal space and its relation to patient characteristics. Folia Morphol (Warsz) 2023:VM/OJS/J/94038. [PMID: 37285085 DOI: 10.5603/fm.a2023.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/03/2023] [Accepted: 05/09/2023] [Indexed: 06/08/2023]
Abstract
Anomalies of the internal carotid artery (ICA) can increase the risk of haemorrhage during common surgical procedures. The aim of this literature review was to summarize the current state of knowledge on the course of the internal carotid artery in the parapharyngeal space, including the impact of the patient characteristics on the distances between the artery and other anatomical structures, as well as symptoms accompanying the aberrations. Pathologies related to the course of ICA in the parapharyngeal space are common (10%-60% in the general population and up to 84.4% in the elderly). In women, the distances in the oropharynx area are shorter than in men. Although the number of morphological studies is growing, providing more information on this topic, the identified studies differ in the methods and results. Knowledge on the variability in the course of ICA can help identify patients at high risk for the ICA trauma during pharyngeal procedures.
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Affiliation(s)
- Agnieszka Lis
- Radiology Department, Greater Poland Cancer Centre, Poznan, Poland
| | - Hanna Zając
- Department of Ophthalmology, University Clinical Hospital in Wroclaw, Poland
| | - Krzysztof Lachowski
- Centre of Orthopaedics and Trauma Surgery, University Hospital Brandenburg, Brandenburg University of Medicine Theodor Fontane, Brandenburg an der Havel, Germany
| | - Tomasz Zatoński
- Department of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Olchowy
- Department of Experimental Dentistry, Wroclaw Medical University, Wroclaw, Poland
| | - Paweł Dąbrowski
- Division of Normal Anatomy, Department of Human Morphology and Embryology, Wroclaw Medical University, Wroclaw, Poland
| | - Zygmunt Domagała
- Division of Normal Anatomy, Department of Human Morphology and Embryology, Wroclaw Medical University, Wroclaw, Poland
| | - Cyprian Olchowy
- Department of Radiology, POLMED Diagnostyka, Legnica, Poland.
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Mesolella M, Allosso S, Coronella V, Massimilla EA, Mansi N, Motta G, Salerno G, Motta G. Extracapsular Tonsillectomy versus Intracapsular Tonsillotomy in Paediatric Patients with OSAS. J Pers Med 2023; 13:jpm13050806. [PMID: 37240976 DOI: 10.3390/jpm13050806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/30/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE The objective of our study was to compare our experience of intracapsular tonsillotomy performed with the help of a microdebrider usually used for adenoidectomy with results obtained from extracapsular surgery through dissection and from adenoidectomy in cases of people affected with OSAS, linked to adeno-tonsil hypertrophy, observed and treated in the last 5 years. METHODS 3127 children with adenotonsillar hyperplasia and OSAS-related clinical symptoms (aged between 3 and 12 years) underwent tonsillectomy and/or adenoidectomy. A total of 1069 patients (Group A) underwent intracapsular tonsillotomy, while 2058 patients (Group B) underwent extracapsular tonsillectomy, from January 2014 to June 2018. The parameters considered in order to evaluate the effectiveness of the two different surgery techniques taken into consideration were as follows: the presence of possible postoperative complications, represented mainly by pain and perioperative bleeding; the level of postoperative respiratory obstruction compared with the original obstruction through night pulse oximetry, performed 6 months before and after the surgery; tonsillar hypertrophy relapse in Group A and/or the presence of residues in Group B with clinical evaluation performed 1 month, 6 months, and 1 year after the surgery; and postoperative life quality, evaluated through submitting to parents the same survey proposed before the surgery 1 month, 6 months, and 1 year after the surgery. RESULTS Regardless of the technique used (extracapsular tonsillectomy or intracapsular tonsillotomy), there was a clear improvement in both the obstructive respiratory symptomatology and quality of life in both patient groups, as highlighted by the pulse oximetry and the OSA-18 survey submitted later. CONCLUSIONS Intracapsular tonsillotomy surgery has improved in terms of a reduction in postoperative bleeding cases and pain reduction, with an earlier return to patients' usual lifestyle. Lastly, using a microdebrider with the intracapsular technique seems to be particularly effective in removing most of the tonsillar lymphatic tissue, leaving only a thin border of pericapsular lymphoid tissue and preventing lymphoid tissue regrowth during one year of follow-up.
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Affiliation(s)
- Massimo Mesolella
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, 80138 Napoli, Italy
| | - Salvatore Allosso
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, 80138 Napoli, Italy
| | - Valentina Coronella
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, 80138 Napoli, Italy
| | | | - Nicola Mansi
- Otorhinolaryngology Unit, AORN Santobono-Pausilipon, 80112 Naples, Italy
| | - Giovanni Motta
- Unit of Otorhinolaryngology, University Luigi Vanvitelli, 80138 Napoli, Italy
| | - Grazia Salerno
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, 80138 Napoli, Italy
| | - Gaetano Motta
- Unit of Otorhinolaryngology, University Luigi Vanvitelli, 80138 Napoli, Italy
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Mao B, Woods CM, Athanasiadis T, MacFarlane P, Boase S, Joshi H, Wood J, Ooi EH. BiZact™ tonsillectomy: Predictive factors for post-tonsillectomy haemorrhage from a 1717 case series. Clin Otolaryngol 2023. [PMID: 37129013 DOI: 10.1111/coa.14068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/27/2023] [Accepted: 04/09/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To determine primary and secondary post-tonsillectomy haemorrhage (PTH) rates and identify predictive factors in a cohort of consecutive adult and paediatric BiZact™ tonsillectomy cases. SETTING Retrospective cohort study. Patients from Flinders Medical Centre, Noarlunga Hospital and private otolaryngology practices who underwent BiZact™ tonsillectomy from 2017 to 2020. DATA COLLECTED patient age, indication for tonsillectomy, surgeon experience, time and severity of PTH, including return to theatre. Each secondary PTH was graded using the Stammberger classification. Logistic regression was utilised to identify predictors of secondary PTH. RESULTS One thousand seven hundred and seventeen patient medical records were assessed (658 adults and 1059 children). The primary PTH rate was 0.1%, and secondary PTH rate was 5.9%. The majority of secondary PTH cases were Stammberger grade A (80/102, 78.4%) requiring observation only. Few secondary PTH required medical intervention (grade B; 9/102, 8.8%), return to theatre (grade C; 12/102, 11.8%), or blood transfusion (grade D; 1/102, 1.0%), with no death reported (grade E; 0/102, 0.0%). Recurrent secondary PTH occurred in 8 patients (0.5%). Predictive factors of secondary PTH in children were surgeon experience with trainees having greater chance of PTH (OR 2.502, 95% CI 1.345-4.654; p = .004) and age of child (OR 1.095, 95% CI 1.025-1.170; p = .007). Surgeon experience was a predictive factor for adults (OR 3.804, 95% CI 2.139-6.674; p < .001). CONCLUSIONS BiZact™ tonsillectomy has a low primary PTH rate, with a secondary PTH rate comparable to other 'hot tonsillectomy' techniques. The majority of PTH events were minor and self-reported. There appears to be a learning curve for trainee surgeons.
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Affiliation(s)
- Boyuan Mao
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Charmaine M Woods
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Theodore Athanasiadis
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Adelaide and Hills ENT, Adelaide, South Australia, Australia
| | - Patricia MacFarlane
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Adelaide and Hills ENT, Adelaide, South Australia, Australia
- Adelaide ENT Surgery, Flinders Private Hospital, Bedford Park, South Australia, Australia
| | - Samuel Boase
- Adelaide and Hills ENT, Adelaide, South Australia, Australia
| | - Himani Joshi
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Adelaide ENT Surgery, Flinders Private Hospital, Bedford Park, South Australia, Australia
| | - John Wood
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Adelaide and Hills ENT, Adelaide, South Australia, Australia
| | - Eng H Ooi
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Adelaide ENT Surgery, Flinders Private Hospital, Bedford Park, South Australia, Australia
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Iokura D, Kojima T, Okanoue Y, Otsuki S. Hemostasis for a Post- tonsillectomy Hemorrhage in a Patient With Coronavirus Disease. Cureus 2023; 15:e39432. [PMID: 37378122 PMCID: PMC10292131 DOI: 10.7759/cureus.39432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, otolaryngologists should be careful when performing upper airway surgery because of the risk of aerosol generation. This paper describes the case of a 23-year-old male who was diagnosed with COVID-19 four days after undergoing tonsillectomy. COVID-19 was complicated by pulmonary thromboembolism, and anticoagulation was administered, which caused postoperative hemorrhage. The patient had to undergo another surgery for the control of hemorrhage, during the infective period of COVID-19. COVID-19 is sometimes associated with venous embolism, and for postoperative patients, treatment should be carefully considered because of the risk of bleeding. The administration of heparin as an anticoagulant would be preferable because heparin allows for dosage adjustment by measuring activated partial thromboplastin time and also allows the rapid cessation of the anticoagulant effect when the administration is discontinued together with antagonization by protamine administration, even if bleeding occurs. When performing surgery for patients with COVID-19, special care is necessary in order not to spread the infection. Even if the preoperative polymerase chain reaction (PCR) test is negative, the patient may be in the incubation period of COVID-19; therefore, caution should be exercised when performing upper respiratory tract surgery such as tonsillectomy.
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Affiliation(s)
- Daisuke Iokura
- Department of Otolaryngology, Tenri Hospital, Tenri, JPN
| | - Tsuyoshi Kojima
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, JPN
| | - Yusuke Okanoue
- Department of Otolaryngology, Tenri Hospital, Tenri, JPN
| | - Shuya Otsuki
- Department of Otolaryngology, Tenri Hospital, Tenri, JPN
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Jamshaid W, Jamshaid M, Coulson C, Sharma N, Muzaffar J, Nieto H. A systematic review on the efficacy of tranexamic acid in head and neck surgery. Clin Otolaryngol 2023. [PMID: 37042081 DOI: 10.1111/coa.14059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/08/2023] [Accepted: 02/19/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Intraoperative and postoperative blood loss is a major risk in head and neck (H&N) surgery. Recently the use of tranexamic acid (TXA) has been investigated by multiple studies for reducing intraoperative and postoperative bleeding, however reported results are variable. OBJECTIVES To determine the safety and efficacy of TXA use in H&N surgery. METHODS Systematic review of MEDLINE, EMBASE, CINAHL, Cochrane Library, PubMed, ClinicalKey, and Clinicaltrials.gov according to the PRISMA guidelines. Studies were included if they reported on intraoperative bleeding, volume or duration of postoperative drain or return to theatre rate for postoperative haemorrhage in adult populations following use of TXA. Risk of bias assessment with Cochrane Risk of Bias (RoB2) tool for randomised controlled trials and Newcastle-Ottawa Scale tool for non-randomised studies. RESULTS Sixteen studies were identified (114 407 patients). Eight studies evaluated TXA in major H&N surgery and eight studies in tonsillectomy. Primary outcomes were reduction in intraoperative or postoperative bleeding. Secondary outcomes included the duration of postoperative drain placement and return to theatre rate. No adverse events were reported in any patients. TXA is effective in reducing intraoperative blood loss in tonsillectomy. However, the effect on posttonsillectomy haemorrhage was unclear. Insufficient evidence exists of benefit of TXA on intraoperative bleeding in major H&N procedures. Postoperative drainage volumes were significantly reduced in most major H&N studies. The duration of drain placement and risk of blood transfusion was unchanged in most cases. CONCLUSION TXA use is safe in H&N patients. Whilst sufficient evidence exists to support the use of TXA in tonsillectomy, insufficient evidence exists to recommend use in major H&N surgery.
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Affiliation(s)
- Warda Jamshaid
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | - Chris Coulson
- Department of Ear, Nose and Throat Surgery, University Hospitals Birmingham NHS Foundation, UK
| | - Neil Sharma
- Department of Ear, Nose and Throat Surgery, University Hospitals Birmingham NHS Foundation, UK
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - Jameel Muzaffar
- Department of Clinical Neurosciences, University of Cambridge Trust, Cambridge, UK
| | - Hannah Nieto
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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Qarbal J, Le Treut-Gay C, Allali L, Rossi ME, Nicollas R, Moreddu E. Drug-Induced sleep endoscopy in children: NAVOTEL scoring system development. Pediatr Pulmonol 2023. [PMID: 37036166 DOI: 10.1002/ppul.26408] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/01/2023] [Accepted: 03/25/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVES Pediatric drug-induced sleep endoscopy (DISE) lacks a universal and easy-to-use scoring system. The velum, oropharynx, tongue, epiglottis (VOTE) scoring system is widely used but needs to be completed in pediatrics. The main objective of this study was to investigate the distribution of obstructive sites in DISE and to propose an appropriate pediatric scoring system. The secondary objective was to evaluate the changes in surgical management induced by the proposed scoring system. METHODS A single-center prospective 5-year study was conducted from March 2016 to December 2021, including 99 children with a mean age of 7.2 years (±3.7), with pathological preoperative sleep recordings and undergoing DISE. The distribution of all upper airway obstructive sites was studied. RESULTS Adenoids (A) were the most frequent obstructive site (63% of patients), and the nasal cavities (N) and the larynx (L) were other frequent obstructive sites. These sites are not explored by the VOTE scoring system, leading to the creation of the nose, adenoids, velum, oropharynx, tongue, epiglottis, larynx (NAVOTEL) scoring system. NAVOTEL was significantly correlated with the severity of obstructive sleep apnea-hypopnea syndrome (OSAS) (ρ = 0.2; p = 0.04) and highlighted obstructive sites in 6/9 patients with VOTE = 0. Of these patients, 4 had a complete obstructive site, and 3 had a multisite obstruction. VOTE indicated 8 additional surgical actions; NAVOTEL indicated 50 other actions compared to clinical examination. The NAVOTEL scoring system was exhaustive regarding surgical indications for OSAS. CONCLUSIONS The NAVOTEL scoring system is exhaustive in pediatric DISE and correlated to OSAS severity. It should be preferred in pediatric DISE.
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Affiliation(s)
- Jawad Qarbal
- Department of Pediatric Otorhinolaryngology-Head & Neck Surgery, La Timone Children's Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Claire Le Treut-Gay
- Department of Pediatric Otorhinolaryngology-Head & Neck Surgery, La Timone Children's Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Laure Allali
- Department of Pediatric Otorhinolaryngology-Head & Neck Surgery, La Timone Children's Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Marie-Eva Rossi
- Department of Pediatric Otorhinolaryngology-Head & Neck Surgery, La Timone Children's Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Richard Nicollas
- Department of Pediatric Otorhinolaryngology-Head & Neck Surgery, La Timone Children's Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Eric Moreddu
- Department of Pediatric Otorhinolaryngology-Head & Neck Surgery, La Timone Children's Hospital, Aix-Marseille University, APHM, Marseille, France
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Stramiello JA, Ortega B, Brigger M, Nation JJ. Effect of Local Anesthetic Injections on Subjective Pain Scales in Pediatric Tonsillectomies: A Meta-analysis. Otolaryngol Head Neck Surg 2023; 168:619-627. [PMID: 35471955 DOI: 10.1177/01945998221094228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/25/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the effect of local anesthetic injection on subjective pain scores for pediatric tonsillectomies on postoperative days (PODs) 0 and 1. DATA SOURCES A comprehensive literature search was conducted with the PubMed, Embase, Web of Science, and Scopus databases. REVIEW METHODS A 2-researcher team following the PRISMA guidelines performed a systematic review and meta-analysis. Studies with original data and a saline injection control arm were selected. Corresponding authors were contacted for missing data. The collated data were analyzed with RevMan version 5.4 (Review Manager; Cochrane Collaboration). Random effects modeling and standard mean difference were utilized to control for heterogeneity. Surgical technique subgroup analysis was performed. RESULTS A total of 319 publications were identified, and 8 articles with 13 experimental arms (627 participants) were selected for meta-analysis. Local anesthetic injection was compared with placebo with saline injection. The standard mean difference for POD 0 pain was -0.81 (95% CI, -1.16 to -0.46; P < .00001) in favor of local anesthetic. The standard mean difference for POD 1 was -1.13 (95% CI, -1.48 to -0.78; P < .00001) in favor of local anesthetic. Subgroup analysis by surgical technique showed a less robust effect for cautery excision (-1.01 [95% CI, -1.37 to -0.66]) vs cold excisional technique (-1.19 [95% CI, -1.64 to -0.74]), with or without cautery-based hemostasis. CONCLUSIONS A local anesthetic injection during a pediatric tonsillectomy reduces postoperative pain on POD 0 and 1. Further analysis on total narcotic use and postoperative complications would benefit surgeon decision making.
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Affiliation(s)
- Joshua A Stramiello
- Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, California, USA
| | - Briana Ortega
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Matthew Brigger
- Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, California, USA
- Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, San Diego, California, USA
| | - Javan Jonathon Nation
- Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, California, USA
- Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, San Diego, California, USA
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68
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Bharat N, Sandelski M, Cerasiello S, Hurtuk A. TikTok Influence on Rates of Tonsillectomies for Tonsil Stones. Cureus 2023; 15:e37957. [PMID: 37223167 PMCID: PMC10200686 DOI: 10.7759/cureus.37957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Tonsillectomy is one of the most common otolaryngologic surgeries and is increasingly being performed for the management of tonsil stones or tonsilloliths. Incidentally, over the years, tonsilloliths have become a popular topic on the social media platform TikTok (ByteDance, Beijing, China) and we propose that this may be influencing the trends of tonsillectomies for tonsil stones. Objectives: We aim to assess rates of outpatient visits and tonsillectomies for tonsil stones at our institution as well as analyze videos on TikTok regarding tonsil stones. METHODS A retrospective chart query was performed. Data including the number of patient encounters per month with a diagnosis code of tonsilloliths were collected from July 2016 to December 2021. The number of TikTok videos under the search result "tonsil stones" and the content of these videos were reviewed. RESULTS There were 126 patients seeking evaluation for tonsil stones with an average age of 33.4 years, and 76% were females. The number of patients who underwent a tonsillectomy for tonsil stones increased from two in the first full year of collection in 2017 to 13 in 2021. Similarly, the average number of patients presenting for tonsil stone evaluation per month increased steadily from 1.0 in 2017 to 3.3 in 2021. TikTok video content under the search result "tonsil stones" varied and the number of videos on this topic has increased in recent years. CONCLUSION Rates of patients seeking tonsillectomy for tonsil stones increased from 2016 to 2021 in conjunction with the rising popularity of TikTok. Given the numerous TikTok videos featuring tonsil stones, we believe that this social media platform may be influencing the number of patients seeking evaluation for tonsil stones. This data may be used to understand future influence patterns of social media posts on healthcare consumer behavior and patient care practices.
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Affiliation(s)
- Nisha Bharat
- Otolaryngology, Loyola University Chicago Stritch School of Medicine, Maywood, USA
| | | | | | - Agnes Hurtuk
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
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69
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García Arteaga JP, Cardozo MS, Pastore CS, Khouri M, Sommerfleck PA. Indication for tonsillectomy in pediatric patients with suspected post-transplant lymphoproliferative disorder. ARCH ARGENT PEDIATR 2023; 121:e202202694. [PMID: 36573798 DOI: 10.5546/aap.2022-02694.eng] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Juan P García Arteaga
- Department of Ear, Nose and Throat, Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - María S Cardozo
- Department of Ear, Nose and Throat, Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Cecilia S Pastore
- Department of Ear, Nose and Throat, Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Mercedes Khouri
- Department of Ear, Nose and Throat, Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Patricia A Sommerfleck
- Department of Ear, Nose and Throat, Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
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McCoul ED, Megwalu UC, Joe S, Gray R, O'Brien DC, Ference EH, Lee VS, Patel PS, Figueroa-Morales MA, Shin JJ, Brenner MJ. Systemic Steroids for Otolaryngology-Head and Neck Surgery Disorders: An Evidence-Based Primer for Clinicians. Otolaryngol Head Neck Surg 2023; 168:643-657. [PMID: 35349383 DOI: 10.1177/01945998221087664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/26/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To offer pragmatic, evidence-informed guidance on the use of systemic corticosteroids (SCS) for common otolaryngologic disorders. DATA SOURCES PubMed, Cochrane Library, and American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guidelines. REVIEW METHODS A comprehensive search of published literature through November 2021 was conducted on the efficacy of SCS, alone or in combination with other treatments, for managing disorders in otolaryngology and the subdisciplines. Clinical practice guidelines, systematic reviews, and randomized controlled trials, when available, were preferentially retrieved. Interventions and outcomes of SCS use were compiled to generate summary tables and narrative synthesis of findings. CONCLUSIONS Evidence on the effectiveness of SCS varies widely across otolaryngology disorders. High-level evidence supports SCS use for Bell's palsy, sinonasal polyposis, and lower airway disease. Conversely, evidence is weak or absent for upper respiratory tract infection, eustachian tube dysfunction, benign paroxysmal positional vertigo, adenotonsillar hypertrophy, or nonallergic rhinitis. Evidence is indeterminate for acute laryngitis, acute pharyngitis, acute sinusitis, angioedema, chronic rhinosinusitis without polyps, Ménière's disease, postviral olfactory loss, postoperative nerve paresis/paralysis, facial pain, and sudden sensorineural hearing loss. IMPLICATIONS FOR PRACTICE Clinicians should bring an evidence-informed lens to SCS prescribing to best counsel patients regarding the risks, anticipated benefits, and limited data on long-term effects. Alternate routes of corticosteroid administration-such as sprays, drops, inhalers, and intralesional injections-may be preferable for many disorders, particularly those that are self-limited or require a prolonged duration of therapy. Prudent use of SCS reduces the risk of medication-related adverse effects. Clinicians who are conversant with high-level evidence can achieve optimal outcomes and stewardship when prescribing SCS.
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Affiliation(s)
- Edward D McCoul
- Department of Otorhinolaryngology, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Uchechukwu C Megwalu
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California
| | - Stephanie Joe
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Raluca Gray
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel C O'Brien
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Canada
| | - Elisabeth H Ference
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Victoria S Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Prayag S Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Marco A Figueroa-Morales
- Department of Otolaryngology-Head and Neck Surgery, Mexican Social Security Institute, Mexico City, Mexico
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Mothersole K, Ulualp SO, Szmuk P, Liu C. The Effect of Tonsillectomy and Adenoidectomy on Upper Airway Obstruction Patterns in Children with Obstructive Sleep Apnea. Int Arch Otorhinolaryngol 2023; 27:e211-e217. [PMID: 37125372 PMCID: PMC10147455 DOI: 10.1055/s-0043-1768207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/24/2021] [Indexed: 05/02/2023] Open
Abstract
Introduction Alterations in upper airway flow dynamics and sites of airway obstruction immediately after tonsillectomy and adenoidectomy (TA) have not been assessed. Identification of the changes in airway obstruction patterns after TA potentially improves the surgical management of children with obstructive sleep apnea (OSA). Objective To evaluate the effect of TA on upper airway obstruction patterns detected with drug-induced sleep endoscopy (DISE). Methods The medical records of patients who underwent pre-TA DISE during the induction of anesthesia and post-TA DISE at the end of TA were reviewed. Data pertaining to polysomnography and DISE findings were analyzed. Results Twenty-seven patients (15 male and 12 females aged between 2 and 18 years old) were identified. All patients had obstruction at multiple sites of the upper airway. Prior to TA, airway obstruction was at the level of the velum in 27 patients, of the oropharynx/lateral walls in 27, of the tongue in 7, and of the epiglottis in 4. After TA, airway obstruction was at the level of the velum in 24 patients, of the oropharynx/lateral walls in 16, of the tongue in 6, and of the epiglottis in 4. The degree of obstruction at the levels of the velum and oropharynx/lateral walls after TA was significantly decreased. Conclusions Drug-induced sleep endoscopy performed prior to TA revealed that most of the sites of airway obstruction persisted after TA in OSA children with multiple sites of airway obstruction. Further studies in larger group of children with OSA are needed to establish the value of DISE findings in predicting residual OSA after TA, surgical planning, determining the need for post TA sleep study, and counseling caregivers.
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Affiliation(s)
- Kelsey Mothersole
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Seckin Omer Ulualp
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Divisions of Pediatric Otolaryngology, Department of Anesthesiology and Pain Management, University of Texas Southwestern, Dallas, TX, United States
- Address for correspondence Seckin Omer Ulualp, MD Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center5323 Harry Hines Blvd, Dallas, TX 75390-9035United States
| | - Peter Szmuk
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Department of Anesthesiology, Children's Health Medical Center, Dallas, TX, United States
- Outcome Research Consortium, Cleveland, OH, United States
| | - Christopher Liu
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Divisions of Pediatric Otolaryngology, Department of Anesthesiology and Pain Management, University of Texas Southwestern, Dallas, TX, United States
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Bautista D, Romero-Sánchez C, Franco M, Angel J. Expression of Homing Receptors in IgM +IgD +CD27 + B Cells and Their Frequencies in Appendectomized and/or Tonsillectomized Individuals. Immunol Invest 2023:1-15. [PMID: 36943113 DOI: 10.1080/08820139.2023.2187303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND In humans, blood circulating IgM+IgD+CD27+ B cells are considered analogous to those described in the marginal zone of the spleen and are involved in important immunological processes. The homing receptors they express, and the organs involved in their development (for example, intestinal organs in rabbits) are only partially known. We recently reported that this population is heterogeneous and composed of at least two subsets: one expressing high levels of IgM - IgMhi B cells - and another low levels - IgMlo B cells. OBJECTIVES To evaluate the expression of homing receptors on IgD+CD27+ IgMhi and IgMlo B cells and quantify their frequencies in blood of control and appendectomized and/or tonsillectomized volunteers. MATERIALS AND METHODS Using spectral flow cytometry, the simultaneous expression of 12 previously reported markers that differentiate IgMhi B cells and IgMlo B cells and of α4β7, CCR9, CD22 and CCR10 were evaluated in blood circulating B cells of control and appendectomized and/or tonsillectomized volunteers. RESULTS The existence of phenotypically defined IgMlo and IgMhi B cell subsets was confirmed. They differentially expressed intestinal homing receptors, and the expression of α4β7 and CCR9 seems to determine new IgM subpopulations. IgMlo and IgMhi B cells were detected at lower frequencies in the appendectomized and/or tonsillectomized volunteers relative to controls. CONCLUSIONS Human blood circulating IgD+CD27+ IgMlo and IgMhi B cell subsets differentially express homing receptors, and it is necessary to investigate if mucosal organs are important in their development.
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Affiliation(s)
- Diana Bautista
- Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
- GIBAT, Facultad de Medicina, Universidad El Bosque, Bogotá, Colombia
| | - Consuelo Romero-Sánchez
- Cellular and Molecular Immunology Group/INMUBO, Universidad El Bosque, Bogotá, Colombia
- Clinical Immunology Group, Hospital Militar Central/Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Manuel Franco
- Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Juana Angel
- Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
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Al-Shaikh AA, Alhelali A, Mahmood SE, Riaz F, Hassan AAH, Hassan AAH, Asiri BMM, Al-Shahrani ASM, Korkoman AJM, Alahmari AF, Hassan AAH, Shami MO, Ahmad A, Bharti RK, Zeyaullah M. Awareness and Perceptions of the Impact of Tonsillectomy on the Level of Immunity and Autoimmune Diseases among the Adult Population in Abha City, Kingdom of Saudi Arabia. Healthcare (Basel) 2023; 11:healthcare11060890. [PMID: 36981547 PMCID: PMC10048734 DOI: 10.3390/healthcare11060890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
The widespread misconception that tonsillectomy leads to a decrease in immunity may lead to fear and avoidance of the operation. This can result in a deterioration of the situation, such as sleep-related breathing issues, frequent infections, and an increase in complications. The current research was conducted to assess the awareness and perception with respect to the impact of tonsillectomy on the immune system and to assess the awareness and perception of the relationship between autoimmune diseases and tonsillectomy. This 6-month descriptive cross-sectional online questionnaire survey was conducted among individuals who were 18 years and above living in Abha city, Saudi Arabia. Out of the 800 study subjects, 104 (13%) had undergone tonsillectomy. Statistically significant associations were found between age group, education, income, and occupation among those who had undergone tonsillectomy. Multivariate logistic regression analysis showed that ages 18-30 years and 31-40 years (OR: 2.36, 95% CI: 1.18-4.71, and OR: 1.46, 95% CI: 0.53-3.97) and education levels of high school, bachelors, and above (OR: 8.30, 95% CI: 3.05-22.58 and OR: 10.89, 95% CI: 4.23-28.05) were found to be associated with tonsillectomy status of the subjects. On the contrary, income levels of 5000-9000 and >9000 (OR: 0.65, 95% CI: 0.36-1.17 and OR: 0.78, 95%CI: 0.42-1.42) and male gender (OR: 0.79, 95% CI: 0.52-1.19) were found to be associated with non-tonsillectomy status of subjects. Almost 36% of study subjects thought that tonsillectomy affects immunity. Only 18% of study subjects thought that there is a relationship between tonsillectomy and autoimmune diseases. About one-third of the respondents had received this information from community members and social media. A small number of study subjects relied on public awareness programs. Therefore, social media can play a vital role in the community to remove misconceptions regarding tonsillectomy and its effect on immunity and autoimmune disease. Further educational interventional studies are required to see the correction to the public perception of tonsillectomy and its effect on immunity and autoimmune diseases.
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Affiliation(s)
- Ayoub A Al-Shaikh
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | - Abdullah Alhelali
- Department of Otolaryngology, Head and Neck Surgery, Aseer Central Hospital, Abha Children Hospital, Abha 62523, Saudi Arabia
| | - Syed Esam Mahmood
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | - Fatima Riaz
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | | | | | | | | | | | | | | | - Mohammed O Shami
- College of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Ausaf Ahmad
- Department of Community Medicine, Integral Institute of Medical Science and Research, Integral University, Kursi Road, Lucknow 226026, India
| | - Rishi K Bharti
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | - Md Zeyaullah
- Department of Basic Medical Science, College of Applied Medical Sciences, Khamis Mushayt Campus, King Khalid University (KKU), Abha 62561, Saudi Arabia
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Hara M, Morimoto N, Watabe T, Morisaki N, Matsumoto K. Can the effectiveness of tonsillectomy for PFAPA syndrome be predicted based on clinical factors. Int J Rheum Dis 2023; 26:480-486. [PMID: 36608697 DOI: 10.1111/1756-185x.14559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/28/2022] [Accepted: 12/26/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To evaluate the clinical factors associated with the outcome of tonsillectomy in children with periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome, thereby clarifying who would most likely benefit from that surgery. METHODS This was a case-control study of 53 PFAPA patients who underwent tonsillectomy and were divided into a complete-resolution group and a postoperative-fever group. Logistic regression analyses were performed using 17 clinical factors as variables to identify factors associated with the surgical outcome. Hierarchical cluster analysis was also performed to evaluate for relationships between phenotypes and surgical outcomes. RESULTS Thirty-nine (73.6%) patients had complete resolution after tonsillectomy. In simple logistic regression analysis, the surgical outcome showed significant positive trends with late-onset (odds ratio [OR] 7.1, P = 0.02) and presence of headache (OR 6.5, P = 0.01). In stepwise multiple logistic regression analysis adjusted for age at onset, presence of headache was significantly associated with complete resolution (OR 6.5, P = 0.01). The complete resolution rates for each combination of headache status and age at onset were as follows: presence of headache/age at onset ≥36 months, 100% (14/14); presence of headache/age at onset <36 months, 76.9% (10/13); absence of headache/age at onset ≥36 months, 75.0% (6/8); and absence of headache/age at onset <36 months, 43.8% (7/16). In hierarchical cluster analysis, complete resolution, age at onset, and headache were in the same cluster. CONCLUSIONS PFAPA patients with headache and late onset responded well to tonsillectomy. The mechanisms underlying this association may warrant further investigation.
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Affiliation(s)
- Mariko Hara
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan.,Department of Otorhinolaryngology, National Center for Child Health and Development, Tokyo, Japan
| | - Noriko Morimoto
- Department of Otorhinolaryngology, National Center for Child Health and Development, Tokyo, Japan
| | - Takahisa Watabe
- Department of Otorhinolaryngology, National Center for Child Health and Development, Tokyo, Japan
| | - Naho Morisaki
- Division of Lifecourse Epidemiology, Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Kenji Matsumoto
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
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Liu Z, Li S, Mu S, Yang Z, Li J, Ding L, Han R, Xie H, Zhang Q. The efficacy of cryogenic plasma tonsillectomy in the treatment of obstructive sleep apnea-hypopnea syndrome in children: A meta-analysis. Pediatr Pulmonol 2023; 58:834-843. [PMID: 36437396 DOI: 10.1002/ppul.26262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/19/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obstructive sleep apnea hypopnea syndrome (OSAHS) refers to the apnea and hypopnea caused by partial or complete obstruction of the upper airway collapse during sleep. The cryogenic plasma tonsillectomy is mostly used for the clinical treatment of children with OSAHS. AIMS The objective of this meta-analysis is to investigate the clinical efficacy of cryogenic plasma tonsillectomy for OSAHS in children. MATERIALS & METHODS The literature search was conducted through China National Knowledge Infrastructure (CNKI), Wanfang Database, Embase, PubMed, and Web of Science databases. The search was from the establishment of each database to June 2022. Randomized controlled trials (RCTs) meeting the criteria for partial/total cryo-plasma tonsillectomy for treating patients with obstructive sleep apnea-hypopnea syndrome in children were included, with data extracted. The meta-analysis was performed using the Stata 16.0 and Review Manager 5.4. Seven RCTs were included in this study. RESULTS The results showed that the partial/complete cryo-plasma tonsillectomy in the experimental group had a better therapeutical effective rate than the control group of patients treated with conventional surgery [Odds ratio (OR) = 2.181, 95% CI: 1.306-3.645, P < 0.05]. Also, in terms of postoperative adverse reactions, the number of adverse reactions in the experimental group was significantly lower than in the control group (OR = 0.445, 95% CI: 0.287-0.689, P = 0.001). The analysis of surgical efficacy showed that the operative time, intraoperative blood loss, and postoperative pain score were all significantly lower than those of the control group. Furthermore, further analysis of the apnea-hypopnea index (AHI) and the lowest oxygen saturation (LSaO2) of the two groups showed that the cryo-plasma tonsillectomy treatment had higher LSaO2 levels than conventional treatment [Standardized mean difference (SMD) = 0.380, 95% CI: 0.094-0.667, P = 0.009]. CONCLUSION The application of cryo-plasma tonsillectomy can significantly improve the treatment effect of OSAHS, reducing adverse reactions.
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Affiliation(s)
- Zhiqing Liu
- Department of Otolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Sha Li
- Department of Otolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Shan Mu
- Department of Otolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zuo Yang
- Department of Otolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jiongke Li
- Department of Otolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Lingyan Ding
- Department of Otolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Rui Han
- Department of Otolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Hui Xie
- Department of Otolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qinxiu Zhang
- Department of Otolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Shimomura A, Smith S, Darki A, Kamberos N, Charous S. Between a Rock and a Hard Place: Anticoagulating an Adolescent with Post- Tonsillectomy Massive PE: A Case Report. Ann Otol Rhinol Laryngol 2023; 132:346-350. [PMID: 35373621 DOI: 10.1177/00034894221088178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To report a case of a morbidly obese 17-year-old boy who presented 4 days post-tonsillectomy with acute deep venous thromboses and a massive pulmonary embolism. To describe a protocol and decision-making tree for providing anticoagulation in the immediate post-tonsillectomy period. METHODS A chart review and review of the literature. RESULTS The patient ultimately did well and had no bleeding from the tonsil beds or further thromboembolic complications. A review of the literature revealed no available data regarding the safety of anticoagulation in the immediate post-tonsillectomy period. CONCLUSIONS We propose that if anticoagulation is needed within 14 days of tonsillectomy, submaximal anticoagulation with a reversible and titratable anticoagulant may be optimal. A multidisciplinary team approach is needed for these complex cases. Future reporting and investigation of anticoagulation post-tonsillectomy is needed.
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Affiliation(s)
- Aoi Shimomura
- Loyola University Stritch School of Medicine, Maywood, IL, USA
| | | | - Amir Darki
- Loyola University Medical Center, Maywood, IL, USA
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77
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Hu X, Yang Z, Ma Y, Wang M, Liu W, Qu G, Zhong C. Development and validation of a machine learning-based predictive model for secondary post- tonsillectomy hemorrhage. Front Surg 2023; 10:1114922. [PMID: 36824494 PMCID: PMC9941337 DOI: 10.3389/fsurg.2023.1114922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023] Open
Abstract
Background The main obstacle to a patient's recovery following a tonsillectomy is complications, and bleeding is the most frequent culprit. Predicting post-tonsillectomy hemorrhage (PTH) allows for accurate identification of high-risk populations and the implementation of protective measures. Our study aimed to investigate how well machine learning models predict the risk of PTH. Methods Data were obtained from 520 patients who underwent a tonsillectomy at The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army. The age range of the patients was 2-57 years, and 364 (70%) were male. The prediction models were developed using five machine learning models: decision tree, support vector machine (SVM), extreme gradient boosting (XGBoost), random forest, and logistic regression. The performance of the models was evaluated using the area under the receiver operating characteristic curve (AUC). Shapley additive explanation (SHAP) was used to interpret the results of the best-performing model. Results The frequency of PTH was 11.54% among the 520 patients, with 10.71% in the training group and 13.46% in the validation set. Age, BMI, season, smoking, blood type, INR, combined secretory otitis media, combined adenoidectomy, surgical wound, and use of glucocorticoids were selected by mutual information (MI) method. The XGBoost model had best AUC (0.812) and Brier score (0.152). Decision curve analysis (DCA) showed that the model had a high clinical utility. The SHAP method revealed the top 10 variables of MI according to the importance ranking, and the average of the age was recognized as the most important predictor variable. Conclusion This study built a PTH risk prediction model using machine learning. The XGBoost model is a tool with potential to facilitate population management strategies for PTH.
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Affiliation(s)
- Xiandou Hu
- The First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, China,Otolaryngology Head and Neck Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Zixuan Yang
- Otolaryngology Head and Neck Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Yuhu Ma
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Mengqi Wang
- The First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, China,Otolaryngology Head and Neck Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Weijie Liu
- Otolaryngology Head and Neck Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China,School of Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Gaoya Qu
- Otolaryngology Head and Neck Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Cuiping Zhong
- Otolaryngology Head and Neck Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China,Correspondence: Cuiping Zhong
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78
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Alrayah M. The Prevalence and Management of Chronic Tonsillitis: Experience From Secondary Care Hospitals in Rabak City, Sudan. Cureus 2023; 15:e34914. [PMID: 36938154 PMCID: PMC10015508 DOI: 10.7759/cureus.34914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/16/2023] Open
Abstract
Background Tonsillitis is defined as an inflammation of the tonsils, which is a common clinical condition caused by either bacterial or viral infections. It affects a significant percentage of the population especially children. Chronic tonsillitis (CT) is described as when an individual suffers from seven or more attacks of tonsillitis per year. Aim This study aimed to determine the prevalence and management of CT among patients attending all secondary care hospitals in Rabak city, Sudan. Methods A cross-sectional descriptive study was conducted in June-September 2022. A structured questionnaire was used to screen 297 Patients who presented to all ENT clinics within the study period. Out of the 297 patients, 77 patients were confirmed to be having CT based on the inclusion criteria. Data collected were analyzed using SPSS version 21 and arranged into a simple frequency table. Results The prevalence of CT was found to be 25.9 % (77) among all screened patients. The majority (67.5%) of the patients with CT were male, and mostly between the age of 11-20 years (32.4%). A considerable number of them (32.4%) were residing in the urban-industrial part of the city, and about 36.3% are not working. All the patients with CT complained of throat pain, while 88% presented with red inflamed tonsils. Laboratory investigations of these patients revealed 64% to have Neutrophilia, while 54 and 50% had high ESR and positive ASO titer, respectively. 57% of the patients underwent tonsillectomy while (30%) were managed medically. Conclusion The prevalence of CT was found to be high in the agro-industrial area of Rabak city and more among teenagers, and most cases were managed by tonsillectomy.
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Affiliation(s)
- Mujtaba Alrayah
- Otolaryngology - Head and Neck Surgery, Al-Baha University, Al-Baha, SAU
- Otolaryngology, Faculty of Medicine, El Emam El Mahadi University, Al-Baha, SAU
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79
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Giordano T, Durkin A, Simi A, Shannon M, Dailey J, Facey H, Ballester L, Wetmore RF, Germiller JA. High-Dose Celecoxib for Pain After Pediatric Tonsillectomy: A Randomized Controlled Trial. Otolaryngol Head Neck Surg 2023; 168:218-226. [PMID: 35412873 DOI: 10.1177/01945998221091695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/12/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Pediatric tonsillectomy causes significant postoperative pain. Newer nonsteroidal anti-inflammatory drugs such as celecoxib control pain without increasing bleeding risk, but in prior studies provided only modest pain reduction at standard doses. We aimed to determine if high-dose celecoxib (double the usual pediatric dose) is effective for pain, without increasing bleeding or other risks. STUDY DESIGN Randomized double-blind trial. SETTING Pediatric tertiary center. METHODS Children aged 3 to 11 years undergoing total tonsillectomy were randomized to receive celecoxib (6 mg/kg/dose) or placebo, twice daily, for up to 10 days. All cases were supplemented with acetaminophen and oxycodone as needed. All participants and personnel were blinded to treatment group. Subjects recorded coanalgesic consumption, pain, diet, and activity. RESULTS The celecoxib group (n = 68) consumed 0.72 mg/kg of oxycodone, as compared with 1.12 mg/kg in the placebo group (n = 62), a 36% difference that was not significant. However, multivariate analysis by treatment group, separate from pain levels, confirmed that this reduction was due to celecoxib treatment (P = .03). In subjects with more prolonged pain (n = 88), celecoxib reduced consumption by 52% (P = .02). Celecoxib showed greater benefit for subjects in the prolonged pain group than for those in the lesser pain group (P = .006). Incidence of adverse events was similar between groups. Minor hemorrhage occurred in 4.6% (5 placebo, 3 celecoxib). CONCLUSION High-dose celecoxib is effective in controlling pain after tonsillectomy, with no adverse effects in this relatively small sample. It reduces narcotic consumption, and its impact appears greater in children with higher degrees of pain. Celecoxib can be considered an effective alternative to ibuprofen after tonsillectomy. This trial was registered at ClinicalTrials.gov: NCT02934191.
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Affiliation(s)
- Teresa Giordano
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alexandra Durkin
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Andrea Simi
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Megan Shannon
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Julia Dailey
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hannah Facey
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lance Ballester
- Biostatistics and Data Management Core, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ralph F Wetmore
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John A Germiller
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Murakami D, Hijiya M, Iyo T, Sugita G, Hayata S, Kono M, Hotomi M. Improvement of Surgical View and Working Space at the Lower Pole by Three-Dimensional Exoscope-Assisted Coblation Tonsillectomy: A Case Series. Medicina (Kaunas) 2023; 59:medicina59020259. [PMID: 36837461 PMCID: PMC9962279 DOI: 10.3390/medicina59020259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/16/2023] [Accepted: 01/27/2023] [Indexed: 02/03/2023]
Abstract
Advantages of hot devices for tonsillectomy, represented by coblation, have been highlighted in recent years. During hot technique tonsillectomy it is important to identify and coagulate the vessels of the tonsillar capsule, especially at the lower pole of the tonsil. Hot technique tonsillectomy under microscope or endoscope has therefore been recommended to achieve accurate identification of the microstructure of the surgical field. We have applied ORBEYE, a three-dimensional surgical exoscope system, to coblation tonsillectomy. Advantages of using ORBEYE include high definition and high magnification images, and flexibility of camera position and angle. This means there is an improved surgical view and working space, particularly at the lower pole during performance of coblation tonsillectomy. Here, we demonstrate that ORBEYE can be an effective surgical instrument in coblation tonsillectomy.
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Affiliation(s)
- Daichi Murakami
- Department of Otorhinolaryngology Head and Neck Surgery, Kinan Hospital, 46-70 Shinjo-cho, Tanabe-shi 646-8588, Wakayama, Japan
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi 641-5810, Wakayama, Japan
| | - Masayoshi Hijiya
- Department of Otorhinolaryngology Head and Neck Surgery, Kinan Hospital, 46-70 Shinjo-cho, Tanabe-shi 646-8588, Wakayama, Japan
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi 641-5810, Wakayama, Japan
| | - Takuro Iyo
- Department of Otorhinolaryngology Head and Neck Surgery, Kinan Hospital, 46-70 Shinjo-cho, Tanabe-shi 646-8588, Wakayama, Japan
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi 641-5810, Wakayama, Japan
| | - Gen Sugita
- Gen ENT Clinic, 3-14-1, Takasu, Mihama-ku, Chiba-shi 261-0004, Chiba, Japan
| | - Sachiko Hayata
- Department of Otorhinolaryngology Head and Neck Surgery, Kinan Hospital, 46-70 Shinjo-cho, Tanabe-shi 646-8588, Wakayama, Japan
| | - Masamitsu Kono
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi 641-5810, Wakayama, Japan
| | - Muneki Hotomi
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi 641-5810, Wakayama, Japan
- Correspondence: ; Tel.: +81-73-447-2300
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81
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Lo SW, Hsu CM, Tsai YT, Tsai MS, Chang GH. Localized Amyloidosis of Bilateral Palatine Tonsils Mimicking Tonsillolithiasis. Ear Nose Throat J 2023:1455613231154057. [PMID: 36710076 DOI: 10.1177/01455613231154057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
A rare disease called localized tonsillar amyloidosis can cause serious problems with airway patency in severe cases. This was the case with an elderly man who experienced difficulty breathing and swallowing due to enlarged palatine tonsils. The physical and imaging findings suggested tonsillolithiasis, and the patient underwent bilateral tonsillectomy. The diagnosis of amyloidosis was confirmed with histopathological examination using Congo red staining. Surgical intervention and careful follow-up care can be effective in these cases, which generally have a good prognosis.
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Affiliation(s)
- Sheng-Wei Lo
- Department of Otolaryngology, Chiayi Chang Gung Memorial Hospital, Puzi, Taiwan
| | - Cheng-Ming Hsu
- Department of Otolaryngology, Chiayi Chang Gung Memorial Hospital, Puzi, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Te Tsai
- Department of Otolaryngology, Chiayi Chang Gung Memorial Hospital, Puzi, Taiwan
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Shao Tsai
- Department of Otolaryngology, Chiayi Chang Gung Memorial Hospital, Puzi, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Geng-He Chang
- Department of Otolaryngology, Chiayi Chang Gung Memorial Hospital, Puzi, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Head and Neck Infectious Treatment Center, Chiayi Chang Gung Memorial Hospital, Puzi, Taiwan
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Kirkham EM, Puglia MP, Haydar B, Jewell ES, Leis AM, Peddireddy N, Chervin RD. Preoperative Predictors of Severe Respiratory Events After Tonsillectomy: Consideration for Pediatric Intensive Care Admission. Otolaryngol Head Neck Surg 2023; 168:1535-1544. [PMID: 36939624 DOI: 10.1002/ohn.238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/19/2022] [Accepted: 12/03/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Few data are available to guide postadenotonsillectomy (AT) pediatric intensive care (PICU) admission. The aim of this study of children with a preoperative polysomnogram (PSG) was to assess whether preoperative information may predict severe respiratory events (SRE) after AT. STUDY DESIGN Retrospective cohort study. SETTING Single tertiary center. METHODS Children aged 6 months to 17 years who underwent AT with preoperative polysomnography (2012-2018) were identified by billing codes. Data were extracted from medical records. SRE were defined as any 1 or more of desaturations <80% requiring intervention; newly initiated positive airway pressure; postoperative intubation; pneumonia/pneumonitis; respiratory code, cardiac arrest, or death. We hypothesized that SRE would be associated with age <24 months, major medical comorbidity, obesity (>95th percentile), apnea-hypopnea index (AHI) ≥ 30, and O2 nadir <70% on PSG. Analysis was performed with multivariable logistic regression. RESULTS Of 1774 subjects, 28 (1.7%) experienced SRE. Compared to those without, children with SRE were on average younger (3 vs 5 years, p < .01) with a greater probability of medical comorbidities (59% vs 18%, p < .001). After adjustment for sex, black race, obesity, and age <24 months, children with major medical comorbidity were more likely than other children to have SRE (odds ratio [OR]: 14.2; 95% confidence interval [CI]: [5.7, 35.2]), as were children with AHI ≥ 30 (OR: 7.7 [3.0, 19.9]), or O2 nadir <70% (OR 6.1 [2.1, 17.9]). Age, obesity, sex, and black race did not independently predict SRE. CONCLUSION PICU admission may be most prudent for children with complex medical co-morbidities, high AHI (>30), and/or low O2 nadir (<70%).
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Affiliation(s)
- Erin M Kirkham
- Department of Otolaryngology-Head & Neck Surgery, The University of Michigan, Ann Arbor, Michigan, USA
| | - Michael P Puglia
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Bishr Haydar
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Elizabeth S Jewell
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Aleda M Leis
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Nithin Peddireddy
- Department of Otolaryngology-Head & Neck Surgery, The University of Michigan, Ann Arbor, Michigan, USA
| | - Ronald D Chervin
- Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
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83
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Halliday E, Grainger J. Diagnostic tonsillectomy for histology in children: An audit of practice at a tertiary paediatric centre over 20 years. Clin Otolaryngol 2023; 48:474-478. [PMID: 36624570 DOI: 10.1111/coa.14033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 10/06/2022] [Accepted: 12/24/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Edwin Halliday
- Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Joe Grainger
- Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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84
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Qian ZJ, Howard JM, Cohen SM, Jin MC, Bhargava S, Cheng AG, Valdez TA. Use of Polysomnography and CPAP in Children Who Received Adeno tonsillectomy, US 2004 to 2018. Laryngoscope 2023; 133:184-188. [PMID: 35285524 DOI: 10.1002/lary.30103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/02/2022] [Accepted: 03/02/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES 1) To determine the prevalence polysomnogram (PSG) and continuous positive airway pressure (CPAP) therapy use in children who received adenotonsillectomy (AT) for sleep symptoms. 2) To identify health care disparities in these regards. STUDY DESIGN Retrospective database analysis. METHODS This study used data from Optum (Health Services Innovation Company) to identify 92,490 children who received AT for sleep symptoms between 2004 and 2018. Prevalence of preoperative PSG and postoperative PSG and CPAP were described. Clinical and demographic characteristics were compared between children who had preoperative PSG and those who did not. Characteristics of children with trisomy 21 (T21) were compared to assess PSG and CPAP use in a high-risk cohort. Predictive modeling was used to identify patient characteristics associated with postoperative PSG and CPAP use. RESULTS Preoperative PSG was obtained in 5.5% of children overall and 33.2% of children with T21. Male sex, obesity, other medical comorbidities, non-White race/ethnicity, and higher parent education were associated with preoperative PSG. Fewer than 3% of children received postoperative PSGs and approximately 3% went on to receive CPAP therapy postoperatively. Multiple logistic regression showed that age at surgery, male sex, obesity, other medical comorbidities, non-White race/ethnicity, and higher parent education were associated with postoperative PSG and CPAP use. CONCLUSIONS AND RELEVANCE This study described the prevalence pre-AT PSG use and post-AT PSG and CPAP use for persistent symptoms and identified sleep health care disparities in these regards. These results show that increased, equitable access to PSG is needed in children, particularly in the workup and treatment persistent symptoms after AT. LEVEL OF EVIDENCE 4 Laryngoscope, 133:184-188, 2023.
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Affiliation(s)
- Z Jason Qian
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Javier M Howard
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Samuel M Cohen
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Michael C Jin
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Sumit Bhargava
- Division of Pulmonary Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Alan G Cheng
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Tulio A Valdez
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
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85
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Sedgwick MJ, Saunders C, Bateman N. Intracapsular Tonsillectomy Using Plasma Ablation Versus Total Tonsillectomy: A Systematic Literature Review and Meta-Analysis. OTO Open 2023; 7:e22. [PMID: 36998549 PMCID: PMC10046729 DOI: 10.1002/oto2.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 02/19/2023] Open
Abstract
Objective To determine whether intracapsular tonsillectomy, using plasma ablation, results in differences in postoperative patient outcomes to total tonsillectomy. Data Sources A systematic review of two databases (Embase and PubMed) was conducted in March 2022 to identify published English-language randomized controlled trials and observational studies which provided a comparison between intracapsular tonsillectomy, using plasma ablation, and total tonsillectomy. Review Methods Qualitative synthesis and meta-analysis were used to compare outcomes between techniques. Results Seventeen studies were identified for inclusion. Across these, 1996 and 4565 patients underwent intracapsular and total tonsillectomy, respectively. Studies included 8 randomized controlled trials, 1 prospective cohort study, and 8 retrospective cohort studies. Time to pain free, time on analgesia, time to normal diet, and time to normal activity were significantly shorter with intracapsular tonsillectomy by on average 4.2 (95% confidence interval [CI] 1.5-5.9; p < .0001), 4.1 (95% CI 2.7-5.4; p < .0001), 3.5 (95% CI 1.7-5.4; p = .0002) and 2.8 (95% CI 1.6-4; p < .0001) days, respectively. Risk of posttonsillectomy hemorrhage was significantly lower following intracapsular tonsillectomy (relative risk [RR] 0.36; 95% CI 0.16-0.81; p = .0131); risk of posttonsillectomy hemorrhage requiring surgical management was lower but failed to reach significance (RR 0.52; 95% CI 0.19-1.39; p = .19). Conclusion Intracapsular tonsillectomy using plasma ablation has similar efficacy in managing indications for tonsil surgery to total tonsillectomy while significantly reducing the postoperative morbidity and likelihood of posttonsillectomy hemorrhage experienced by patients, allowing them to return to their normal life faster.
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Affiliation(s)
| | | | - Neil Bateman
- Paediatric Otolaryngology Department, Manchester Academic Health Science Centre, Royal Manchester Children's HospitalManchester University Hospitals NHS Foundation TrustManchesterUK
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86
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Tovmasyan AS, Golubeva LI, Zotova PK, Muratov DL, Shvedov NV, Golovatyuk AA, Filina EV, Kryukova MS, Ramazanov SR. [The role of tonsillectomy in the treatment of chronic tonsillitis]. Vestn Otorinolaringol 2023; 88:67-73. [PMID: 37184557 DOI: 10.17116/otorino20228802167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The problem of chronic tonsillitis remains one of the urgent problems of modern otorhinolaryngology. The article discusses the statistics and complications of chronic tonsillitis, provides indications for tonsillectomy and its main complications. OBJECTIVE Generalization and systematization of data on the impact of surgical treatment on the quality of life of patients with chronic tonsillitis. MATERIAL AND METHODS Search for literary sources, carried out using the search engines of the RSCI, PubMed, Web of Science, and eLibrary. RESULTS A review of literature sources demonstrates a significant improvement in the quality of life of patients after tonsillectomy; however, data from some studies show a trend towards a decrease in the number of planned tonsillectomies and an associated increase in the detection of local purulent-septic complications.
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Affiliation(s)
- A S Tovmasyan
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - L I Golubeva
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - P K Zotova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - D L Muratov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - N V Shvedov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - A A Golovatyuk
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - E V Filina
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - M S Kryukova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - S R Ramazanov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
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87
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Lackey TG, Tholen K, Pickett K, Friedman N. Residual OSA in Down syndrome: does body position matter? J Clin Sleep Med 2023; 19:171-177. [PMID: 36081330 PMCID: PMC9806788 DOI: 10.5664/jcsm.10288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVES To examine children with Down syndrome with residual obstructive sleep apnea (OSA) to determine if they are more likely to have positional OSA. METHODS A retrospective chart review of children with Down syndrome who underwent adenotonsillectomy at a single tertiary children's hospital was conducted. Children with Down syndrome who had a postoperative polysomnogram with obstructive apnea-hypopnea index (OAHI) > 1 event/h, following adenotonsillectomy with at least 60 minutes of total sleep time were included. Patients were categorized as mixed sleep (presence of ≥ 30 minutes of both nonsupine and supine sleep), nonsupine sleep, and supine sleep. Positional OSA was defined as an overall OAHI > 1 event/h and a supine OAHI to nonsupine OAHI ratio of ≥ 2. Group differences are tested via Kruskal-Wallis test for continuous variables and Fisher's exact tests for categorical. RESULTS There were 165 children with Down syndrome who met inclusion criteria, of which 130 individuals had mixed sleep. Patients who predominately slept supine had a greater OAHI than mixed and nonsupine sleep (P = .002). Sixty (46%) of the mixed-sleep individuals had positional OSA, of which 29 (48%) had moderate/severe OSA. Sleeping off their backs converted 14 (48%) of these 29 children from moderate/severe OSA to mild OSA. CONCLUSIONS Sleep physicians and otolaryngologists should be cognizant that the OAHI may be an underestimate if it does not include supine sleep. Positional therapy is a potential treatment option for children with residual OSA following adenotonsillectomy and warrants further investigation. CITATION Lackey TG, Tholen K, Pickett K, Friedman N. Residual OSA in Down syndrome: does body position matter? J Clin Sleep Med. 2023;19(1):171-177.
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Affiliation(s)
- Taylor G. Lackey
- Department of Otolaryngology and Head and Neck Surgery, University of Colorado Denver, Aurora, Colorado
| | - Kaitlyn Tholen
- Louisiana State University Health Shreveport School of Medicine, Shreveport, Louisiana
| | - Kaci Pickett
- Center for Research Outcomes in Children’s Surgery, Center for Children’s Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Norman Friedman
- Department of Pediatric Otolaryngology, Children’s Hospital Colorado, Aurora, Colorado
- Department of Pediatric Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado
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88
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Ryabova MA, Ulupov MY, Shumilova NA, Kolesnikova OM, Legkova YV. [Comparison of pain after laser and traditional extracapsular tonsillectomy]. Vestn Otorinolaringol 2023; 88:38-43. [PMID: 37184553 DOI: 10.17116/otorino20228802138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To compare the pain during the postoperative period after the extracapsular tonsillectomy, performed with the 1.94 µm laser and cold steel tonsillectomy. MATERIAL AND METHODS Sixty patients with chronic decompensated tonsillitis were enrolled in the study. Patients were randomized into two groups: the first one was subjected to cold steel tonsillectomy; in the second group tonsillectomy was done using a laser with 1.94 µm wavelength at pulsed mode. Patients' anamnesis was evaluated (the presence of signs of a toxic-allergic form of the disease, peritonsillar abscesses, the duration of the disease and the frequency of exacerbations of tonsillitis per year). In the postoperative period patients filled out questionnaires: the severity of pain was assessed for 10 days in points from 0 to 10, and painkiller use frequency per day. RESULTS Statistical analysis revealed that the pain after tonsillectomy depends on the presence of peritonsillar abscesses in the anamnesis. In patients with abscesses, the pain and the need for anesthesia are significantly lower with the laser technique compared with cold steel. The tonsillectomy technique does not affect the risk of postoperative bleeding (in both groups - 1/30). CONCLUSION The postoperative period after extracapsular laser tonsillectomy is characterized by significantly less pain than traditional tonsillectomy with cold instruments in patients with a history of peritonsillar abscess. Laser tonsillectomy does not have an increased risk of bleeding compared to traditional tonsillectomy.
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Affiliation(s)
- M A Ryabova
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| | - M Yu Ulupov
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| | - N A Shumilova
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| | - O M Kolesnikova
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| | - Yu V Legkova
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
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89
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Albazee E, Diab S, Awad AK, Aboeldahab H, Abdella WS, Abu-Zaid A. The analgesic and anti-haemorrhagic efficacy of platelet-rich plasma in tonsillectomy: A systematic review and meta-analysis of randomised controlled trials. Clin Otolaryngol 2023; 48:1-9. [PMID: 36029195 DOI: 10.1111/coa.13977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/08/2022] [Accepted: 08/19/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To evaluate the analgesic and anti-haemorrhagic efficacy of platelet-rich plasma (PRP) among patients undergoing tonsillectomy. DESIGN A systematic review and meta-analysis of randomised controlled trials (RCTs). SETTING PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar databases were screened from inception until July 2021, and updated in December 2021. PARTICIPANTS Patients undergoing tonsillectomy. MAIN OUTCOME MEASURES The efficacy endpoints of postoperative pain and haemorrhage were summarised as standardised mean difference (SMD) and risk ratio (RR), respectively, with 95% confidence interval (CI). RESULTS Seven RCTs Seven RCTs were analysed, comprising a total of 392 patients. Risk of bias evaluation showed an overall high risk in one RCT, low risk in four RCTs and some concerns in two RCTs. The pooled results revealed that the mean postoperative pain score was significantly reduced in favour of the PRP group compared with the control group (SMD = -1.38, 95% CI [-1.91, -0.85], p < 0.001). Subgroup analysis showed the effect estimate was statistically significant for early postoperative pain (Day 0 to Day 3), without substantial difference between both groups on late postoperative pain (Days 5 and 7). Moreover, the rate of postoperative haemorrhage was significantly reduced in favour of the PRP group compared with the control group (RR = 0.16, 95% CI [0.05, 0.50], p = 0.001). Subgroup analysis showed the effect estimate was statistically significant for the rate of primary and secondary haemorrhage. CONCLUSION PRP was associated with significant reduction in postoperative pain and haemorrhage among patients undergoing tonsillectomy.
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Affiliation(s)
- Ebraheem Albazee
- Kuwait Institute for Medical Specializations, Kuwait City, Kuwait
| | - Sherein Diab
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed K Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Heba Aboeldahab
- Biomedical Informatics and Medical Statistics Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | | | - Ahmed Abu-Zaid
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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90
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Chen Y, Ru F, Ye Q, Wu X, Hu X, Zhang Y, Wu Y. Effect of S-ketamine administered at the end of anesthesia on emergence delirium in preschool children undergoing tonsillectomy and/or adenoidectomy. Front Pharmacol 2023; 14:1044558. [PMID: 36874017 PMCID: PMC9981794 DOI: 10.3389/fphar.2023.1044558] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/09/2023] [Indexed: 02/19/2023] Open
Abstract
Background: S-ketamine (the S-isomer of ketamine) is twice as potent as the racemic mixture of this agent and carries fewer side effects when administered to humans. Information regarding the use of S-ketamine for the prevention of emergence delirium (ED) is limited. Thus, we evaluated the effect of S-ketamine administered at the end of anesthesia on ED in preschool children undergoing tonsillectomy and/or adenoidectomy. Methods: We investigated 108 children aged 3-7 years, who were scheduled for elective tonsillectomy and/or adenoidectomy under general anesthesia. They were randomly assigned to receive either S-ketamine 0.2 mg/kg or an equal volume of normal saline at the end of anesthesia. The primary outcome was the highest score on the pediatric anesthesia ED (PAED) scale during the first 30 min post-surgery. The secondary outcomes included the incidence of ED (defined as a score of ≥ 3 on Aono scale), pain score, time to extubation, and incidences of adverse events. Multivariate analyses were also performed using logistic regression to evaluate the independent factors predictive of ED. Results: The median (interquartile range) PAED score of the S-ketamine group (0 [0, 3]) was significantly lower than that in the control group (1 [0, 7]) (estimate median difference = 0, 95% confidence interval -2 to 0, p = 0.040). Significantly fewer patients in the S-ketamine group had an Aono scale score ≥ 3 (4 [7%] vs. 12 [22%], p = 0.030). Patients in the S-ketamine group also had a lower median pain score than did control subjects (4 [4, 6] vs. 6 [5, 8], p = 0.002). The time to extubation and incidences of adverse events were comparable between the two groups. However, multivariate analyses indicated that except S-ketamine use, pain scores, age and duration of anesthesia were independent factors predictive of ED. Conclusion: S-ketamine (0.2 mg/kg) administered at the end of anesthesia effectively reduced the incidence and severity of ED in preschool children undergoing tonsillectomy and/or adenoidectomy without prolonging the time to extubation or increasing adverse events. However, S-ketamine use was not an independent factor predictive of ED.
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Affiliation(s)
- Yang Chen
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.,Department of Anesthesiology, Anhui Medical University, Hefei, China
| | - Feixiang Ru
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.,Department of Anesthesiology, Anhui Medical University, Hefei, China
| | - Qiuping Ye
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xinzhe Wu
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xianwen Hu
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ye Zhang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yun Wu
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
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91
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Jiang M, Li W, Fang Z, Wang W, Yang J, Zhu X, Li S, Liu S, Lu T. Effects of comfort nursing on pain and quality of life in children undergoing tonsillectomy. Am J Transl Res 2023; 15:1159-1167. [PMID: 36915793 PMCID: PMC10006826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/02/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE To observe the effect of comfort nursing on pain, quality of life, and nutritional status in children undergoing tonsillectomy. METHODS In this retrospective study, a total of 114 children who underwent tonsillectomy in Chun'an Hospital of Traditional Chinese Medicine were divided into a research group and a control group according to the nursing methods, with 57 cases in each group. The control group received routine nursing care, and the research group received additional comfort nursing. We compared the pain level (assessed by visual analogue scale (VAS) scale), quality of life (assessed by Generic Quality of Life Inventory-74 (GQOLI-74)), relevant clinical indicators (postoperative swallowing recovery time, wake-up time, and hospital stay), nutrition indicators (total blood protein and albumin), sleep quality (assessed by Pittsburgh Sleep Quality Index (PAQI)), nursing satisfaction, and postoperative complications between the two groups. RESULTS After postoperative nursing, the VAS scores and PSQI scores were significantly decreased (both P<0.05), and the GQOLI-74 scores were significantly increased (P<0.05) in both groups. The postoperative swallowing recovery time, wake-up time, and hospital stay in the research group were significantly shorter than those in the control group (all P<0.05). The levels of total serum protein and albumin in the research group were significantly higher than those in the control group (both P<0.05). The research group showed a significantly higher satisfaction rate and lower incidence of complications as compared with the control group (both P<0.05). The results of the logistic regression analysis showed that postoperative upper respiratory infection and the degree of tonsillar embedment were independent risk factors for hemorrhage after tonsillectomy (P<0.05). CONCLUSION In children undergoing tonsillectomy, providing comfort nursing can significantly reduce pain and improve their quality of life.
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Affiliation(s)
- Meijuan Jiang
- Department of Surgery, Chun'an Hospital of Traditional Chinese Medicine Hangzhou 311700, Zhejiang, China
| | - Wei Li
- Department of Outpatient, Yantai Penglai People's Hospital Yantai 265600, Shandong, China
| | - Zonglan Fang
- Department of Infectious Diseases, Yantai Penglai Traditional Chinese Medicine Hospital Yantai 265699, Shandong, China
| | - Wenjuan Wang
- Department of Pediatric Surgery, Maternity and Child Health Care of Zaozhuang Zaozhuang 277102, Shandong, China
| | - Junpeng Yang
- Department of Orthopedics, Yantai Penglai Traditional Chinese Medicine Hospital Yantai 265699, Shandong, China
| | - Xiaoyan Zhu
- Department of Obstetrics and Gynecology, Yantai Penglai Traditional Chinese Medicine Hospital Yantai 265699, Shandong, China
| | - Suting Li
- Internal Medicine Teaching and Research Office, Binzhou Polytechnic Binzhou 256603, Shandong, China
| | - Sudan Liu
- Department of New Pediatric, Shijiazhuang Fourth Hospital (Affiliated Maternity Hospital of Hebei Medical University) Shijiazhuang 050011, Hebei, China
| | - Tao Lu
- Department of Surgery, Chun'an Hospital of Traditional Chinese Medicine Hangzhou 311700, Zhejiang, China
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Bernhart K, Becke-Jakob K, Lehmann T, Harnik M, Seiler S, Meissner W, Stüber F, Stamer UM. Analgesic use and favourable patient-reported outcome measures after paediatric surgery: an analysis of registry data. Br J Anaesth 2023; 130:74-82. [PMID: 36470745 DOI: 10.1016/j.bja.2022.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/30/2022] [Accepted: 09/26/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Pain after paediatric appendectomy and tonsillectomy is often undertreated. Benchmarking of hospitals could reveal which measures are associated with improved patient- or parent-reported pain-related outcomes. METHODS A total of 898 anonymised cases from 11 European hospitals participating in PAIN OUT infant were analysed. The children completed a questionnaire on patient-reported outcomes (PROs) 24 h after surgery. According to a composite PRO measure, including pain intensity and pain-related interference, hospitals were allocated to Group I (favourable results), II (average results), and III (unfavourable results). Benchmarking of hospital groups was performed investigating process variables (dosing of non-opioid analgesics, opioids, and dexamethasone) associated with PROs, side-effects, and children's perception of care. Variables associated with PROs were analysed using multinomial regression analysis with the PRO score-related hospital group as a dependent variable (estimated odds ratios [OR], 95% confidence interval [CI]). RESULTS During the first 24 h after surgery, 1.2 (1.1-1.3) full daily doses of non-opioid analgesics (non-steroidal anti-inflammatory drug [NSAID], paracetamol, metamizole) were administered in group I and 0.7 (0.6-0.8) in group III (P<0.001). Intraoperative dexamethasone was administered to 70.1 and 52.6% of the children in Group I and Group III, respectively (P<0.001). A lower number of full daily doses of non-opioid analgesics: 0.22 [0.15-0.31]), less dexamethasone (0.49 [0.33-0.71]), fewer non-opioid analgesics before the end of surgery (0.37 [0.22-0.62]) and higher opioid doses were associated with hospital allocation to group III vs group I (Nagelkerke's R2=0.433). CONCLUSIONS The results indicated substantial deficits in the concept, application, and dosing of analgesics in paediatric patients after surgery. Timely administration of adequate analgesic doses can easily be introduced into daily clinical practice. CLINICAL TRIAL REGISTRATION clinicaltrials.gov NCT02083835.
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93
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Shahhosseini S, Naderi Boldaji H, Shetabi H, Shafa A. Comparative Study of the Effect of Two Different Doses of Dexmedetomidine to Prevent Emergence Agitation in Tonsillectomy in Children Aged 2 to 12 Years Old. Adv Biomed Res 2023; 12:57. [PMID: 37200744 PMCID: PMC10186030 DOI: 10.4103/abr.abr_30_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/10/2022] [Accepted: 04/17/2022] [Indexed: 05/20/2023] Open
Abstract
Background Emergence agitation (EA) is one of the complications following anesthesia in pediatric surgery. Various drugs are used to prevent this complication, and one of them is dexmedetomidine. Choosing the right dose of this drug for the best efficiency is an important issue due to this complication.The main purpose of this study is to evaluate the prophylactic effect of intravenous dexmedetomidine in different doses in preventing EA after tonsillectomy in children. Materials and Methods Our study was a double-blind clinical trial performed on 75 children ASAI, II candidates for tonsillectomy. Patients were divided into three groups. The group 1 received a dose of 0.6 μg/kg per hour and group 2 received a dose of 0.3 μg/kg per hour and group 3 was the control group. Then vital signs and observational pain score (OPS) and pediatric anesthesia emergence delirium (PAEDS) criteria were measured in patients. The collected data were analyzed by using SPSS software version 23 and non-parametric tests such as Friedman, Mann-Whitney. Results According to the data analysis, mean blood pressure, mean heart rate, OPS and PAEDS score in group 1 were lower than other groups. Also, the average time of staying in recovery and extubation in group 1 was less than other groups. Conclusion A dose of 0.6 μg/kg dexmedetomidine has a better effect on reducing EA (emergence agitation) after pediatric tonsillectomy.
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Affiliation(s)
- Sedighe Shahhosseini
- Department of Anesthesiology, School of Medicine, Imam Hossein Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
- Address for correspondence: Dr. Sedighe Shahhosseini, Department of Anesthesiology, School of Medicine, Imam Hossein Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
| | | | - Hamidreza Shetabi
- Department of Anesthesiology, School of Medicine, Imam Hossein Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Shafa
- Department of Anesthesiology, School of Medicine, Imam Hossein Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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94
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Johnston J, Wagner Mackenzie B, Biswas K, Waldvogel-Thurlow S, Clark ST, Radcliff F, Mahadevan M, Douglas RG. The Effect of Amoxicillin with Clavulanate on the Microbiota of Tonsillar Tissue in Disease: a Randomized Control Trial. Microbiol Spectr 2022; 10:e0123922. [PMID: 36318025 PMCID: PMC9769914 DOI: 10.1128/spectrum.01239-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/13/2022] [Indexed: 12/23/2022] Open
Abstract
Despite antibiotics being the primary medical treatment for recurrent tonsillitis, the impact of antibiotics on the tonsillar microbiome is not well understood. This study aimed to determine the effect of amoxicillin with clavulanate on the composition and quantity of bacteria in the tonsils of children with recurrent tonsillitis. A multicenter randomized clinical trial in Auckland, New Zealand was undertaken between August 1, 2017, and June 30, 2018. Sixty children undergoing tonsillectomy for the indication of recurrent tonsillitis were recruited for this study. Following random allocation, 30 participants were prescribed amoxicillin with clavulanate for the week before surgery. The remaining 30 received no antibiotics. Immediately following surgery, the crypts of the right and left tonsils were swabbed. Bacterial 16S rRNA gene-targeted amplicon sequencing and histological techniques were utilized. In the control group, there were significantly higher relative abundances of Haemophilus, Streptococcus, Neisseria, and Porphyromonas. Members from the genera Fusobacterium and Treponema were found to be significantly more abundant in the antibiotic group. There were no significant differences in the absolute quantities of bacteria between the groups. Microscopic examination found fewer bacterial microcolonies present in the tonsillar crypts of participants in the antibiotic group. Streptococcus pyogenes was not present in these bacterial microcolonies. These results suggest that a single course of antibiotics has a significant impact on the tonsil microbiota composition. The duration of this effect and the effect that the altered microbiome has on the course of the condition need to be determined. IMPORTANCE Several studies have identified the presence of multiple pathogenic bacteria in hyperplastic adenoids and palatine tonsils. However, there are currently no studies that utilize this technology to investigate the effect of oral antibiotics in children with recurrent tonsillitis on the tonsillar microbiome. This is the first study to investigate the effect of antibiotics on the microbiome of tonsillar tissue in children with recurrent tonsillitis using molecular techniques. This study has shown that participants who received amoxicillin with clavulanate immediately before tonsillectomy had a significantly reduced number of bacterial taxa commonly associated with recurrent tonsillitis, as well as the number of bacterial microcolonies observed in the tonsillar crypts. This novel finding suggests that either the effect of antibiotics is not sustained or that they are not an effective treatment for recurrent tonsillitis.
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Affiliation(s)
- James Johnston
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | | | - Kristi Biswas
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | | | - Sita Tarini Clark
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Fiona Radcliff
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Murali Mahadevan
- Department of Surgery, University of Auckland, Auckland, New Zealand
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95
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Li Q, Fan J, Zhang W. Low-dose esketamine for the prevention of emergency agitation in children after tonsillectomy: A randomized controlled study. Front Pharmacol 2022; 13:991581. [PMID: 36605396 PMCID: PMC9807658 DOI: 10.3389/fphar.2022.991581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Emergency agitation is a common postoperative complication in pediatric patients after general anesthesia. The aim of this study was to explore the effects of a low dose of esketamine on emergency agitation in children following tonsillectomy. Materials and Methods: Eighty children were recruited prospectively to this study and divided into the esketamine group and the control group (40 cases in each group). The induction and maintenance of anesthesia were the same in both groups. At the end of surgery, the esketamine group received 0.25 μg/kg esketamine, while the control group received the same volume of normal saline. The extubation time, time to eye opening, Ramsay sedation scale and time to discharge from the post-anesthesia care unit (PACU) were recorded during post-anesthesia care unit. Postoperative complications, such as emergency agitation, respiratory depression, hypertension, tachycardia, nightmares, nausea, and vomiting, were also recorded. Results: The incidence of emergency agitation was lower in the esketamine group compared with that in the control group (5% vs. 27.5%, p = 0.006). The time to eye opening was longer in the esketamine group than in the control group (17.2 ± 2.7 vs. 15.5 ± 2.3 min, p = 0.005). However, the extubation time and time to discharge from PACU were similar between the two groups. Conclusion: Low-dose of esketamine decreases the incidence of emergency agitation in children after tonsillectomy without delaying extubation time and increasing the postoperative side effects. (www.chictr.org.cn, registration number: ChiCTR2100054178).
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Affiliation(s)
- Qi Li
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jiaming Fan
- Department of Anesthesiology, Women and Children’s Hospital of Jiaxing University, Jiaxing, China,*Correspondence: Jiaming Fan, ; Wangping Zhang,
| | - Wangping Zhang
- Department of Anesthesiology, Women and Children’s Hospital of Jiaxing University, Jiaxing, China,*Correspondence: Jiaming Fan, ; Wangping Zhang,
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96
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Muacevic A, Adler JR, Schrepfer T. Postoperative Pain Exacerbation After Adeno tonsillectomy Due to Oral Candida Infection? Cureus 2022; 14:e32115. [PMID: 36601179 PMCID: PMC9805389 DOI: 10.7759/cureus.32115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/04/2022] Open
Abstract
Post-tonsillectomy complications can include bleeding, dehydration, edema, airway obstruction, and infection. Oral candidiasis or thrush is a rare complication that can occur post-operatively. We describe a case of a 10-year-old female with oral candidiasis as a postoperative complication of bilateral adenotonsillectomy, presenting on postoperative day (POD) 7 for poor oral intake secondary to worsening odynophagia. A physical exam revealed an easily scrapable, white plaque located mainly over her surgical sites, tongue, and hard palate. Microscopic examination of tissue scrapings revealed pseudohyphae confirming the diagnosis of oral candidiasis. She was treated with seven days of topical nystatin therapy, including topical and systemic pain control with significant improvement of symptoms by POD 13 and complete resolution on POD 21.
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97
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Siddiq S, Stephen S, Lin D, Fox H, Robinson M, Paleri V. Robotic lateral oropharyngectomy following diagnostic tonsillectomy is oncologically safe in patients with human papillomavirus-related squamous cell cancer: Long-term results. Head Neck 2022; 44:2753-2759. [PMID: 36056651 DOI: 10.1002/hed.27186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/19/2022] [Accepted: 08/23/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION To report the long-term oncological and functional outcomes of en bloc TORS lateral oropharyngectomy to address the close/involved margin following diagnostic tonsillectomy in HPV-related SCC of unknown primary. MATERIAL AND METHODS A single tertiary center observational cohort over a 4-year period. Primary outcome measures were disease-specific survival (DSS), overall survival (OS), and PSS NOD (Performance Status Scale-Normalcy of Diet) scores. RESULTS TORS specimens did not evidence residual carcinoma in 93% of patients. Of 14 patients, 50% received surgery alone (median follow-up 57 months; range 46-96), the remainder surgery and adjuvant therapy (median follow-up of 58 months; range 51-69) with 100% DSS, OS and no deterioration of PSS NOD scores. CONCLUSIONS Long-term oncological outcomes confirm TORS lateral oropharyngectomy alone is an oncologically safe treatment. Due consideration of this approach is warranted to mitigate against the morbidity of adjuvant radiotherapy treatment in this group of patients.
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Affiliation(s)
- Somiah Siddiq
- Head and Neck Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sarah Stephen
- Otolaryngology - Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Daniel Lin
- Otolaryngology - Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Hannah Fox
- Otolaryngology - Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Max Robinson
- Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
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98
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Wang Y, Zhao L, Li X. [The effect of antibiotic therapy on recovery after adeno tonsillectomy in children]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2022; 36:930-933. [PMID: 36543401 PMCID: PMC10128282 DOI: 10.13201/j.issn.2096-7993.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Indexed: 12/24/2022]
Abstract
Objective:This prospective study was to evaluate the role of perioperative antibiotics use in children after adenotonsillectomy. Methods:A total of 117 children undergoing adenotonsillectomy admitted to the Department of Otolaryngology Head and Neck Surgery of Shanghai Children's Hospital from November 2021 to June 2022 were collected and randomly divided into observation group (61 cases) and control group (56 cases). The observation group was not given antibiotics before and after operation, but was given saline instead. The control group received ampicillin sulbactam sodium intravenously 30 min before surgery and the day after surgery. SPSSv. 21.0. was used for statistical analysis, and χ² test was used to evaluate postoperative bleeding and fever between the observation group and the control group. Two independent sample mean T-test was used to evaluate the throat pain score consecutive 3 days after the surgery, the time to resume to normal diet and the wound healing time between the two groups. The correlation between age and postoperative pain was assessed by linear correlation analysis. Results:Three cases of hemorrhage in the observation group (4.9%) and 2 cases of hemorrhage in the control group (3.6%). There was no significant difference between the two groups (χ² =0.129, P =0.719). The wound repair time was (18.25±2.353) d in the observation group and (18.05±2.711) d in the control group, and there was no significant difference between the two groups (P =0.671). The Pearson correlation coefficient between age and pain score was 0.071 on the first day after surgery, 0.115 on the second day and 0.243 on day third day. Pearson correlation coefficient between age and time of pain disappearance was 0.136, with no statistical significance (P>0.05). The difference of postoperative body temperature between the two groups was statistically significant (χ²=20.525, P<0.01), perioperative antibiotic use was a protective factor for preventing postoperative fever (OR=0.167); The pain scores were 6.52±1.963, 5.87±2.093, 5.02±2.149 in the observation group and 4.82±1.820, 4.18±1.759, 3.04±1.907 in the control group on day 1 to 3 after surgery, respectively. The difference between the two groups was statistically significant (P<0.01); The time of pain disappearance was (7.36±2.483) days in the observation group and (5.14±2.004) days in the control group, and the difference between the two groups was statistically significant (P<0.01). Conclusion:Perioperative use of antibiotics in children with adenotonsillectomy can effectively reduce postoperative fever, throat pain symptoms and shorten the pain time.
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Affiliation(s)
- Ying Wang
- Department of Otolaryngology Head and Neck Surgery,Shanghai Children's Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai,200062,China
| | - Limin Zhao
- Department of Otolaryngology Head and Neck Surgery,Shanghai Children's Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai,200062,China
| | - Xiaoyan Li
- Department of Otolaryngology Head and Neck Surgery,Shanghai Children's Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai,200062,China
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99
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Keserű F, Sipos Z, Farkas N, Hegyi P, Juhász MF, Jászai VA, Párniczky A, Benedek PE. The risk of postoperative respiratory complications following adenotonsillar surgery in children with or without obstructive sleep apnea: A systematic review and meta-analysis. Pediatr Pulmonol 2022; 57:2889-2902. [PMID: 36030550 DOI: 10.1002/ppul.26121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) appears in 2%-5% of children, with first-line treatment being adenotonsillar (AT) surgery. Our aim was to examine the risk of postoperative respiratory complications (PoRCs) in non-OSA and the different OSA severity (mild, moderate, severe) groups. STUDY DESIGN We conducted a systematic review and meta-analysis of studies comparing PoRCs following AT surgery in children with and without OSA. METHODS Nineteen observational studies were identified with the same search key used in MEDLINE, Embase, and CENTRAL. The connection between PoRCs, the presence and severity of OSA, and additional comorbidities were examined. Odds ratios (OR) were calculated with 95% confidence intervals (CI). RESULTS We found that PoRCs appeared more frequently in moderate (p = 0.048, OR: 1.79, CI [1.004, 3.194]) and severe OSA (p = 0.002, OR: 4.06, CI [1.68, 9.81]) compared to non-OSA patients. No significant difference was detected in the appearance of major complications (p = 0.200, OR: 2.14, CI [0.67, 6.86]) comparing OSA and non-OSA populations. No significant difference was observed in comorbidities (p = 0.669, OR: 1.29, CI [0.40, 4.14]) or in the distribution of PoRCs (p = 0.904, OR: 0.94, CI [0.36, 2.45]) between the two groups. CONCLUSION Uniform guidelines and a revision of postoperative monitoring are called for as children with moderate and severe OSA are more likely to develop PoRCs following AT surgery based on our results, but no significant difference was found in mild OSA. Furthermore, the presence of OSA alone is not associated with an increased risk of developing major complications.
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Affiliation(s)
- Fanni Keserű
- Heim Pál National Paediatric Institute, Budapest, Hungary.,Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Sipos
- Medical School, Institute for Translational Medicine, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Nelli Farkas
- Medical School, Institute for Translational Medicine, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Medical School, Institute for Translational Medicine, Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Center, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Márk Félix Juhász
- Heim Pál National Paediatric Institute, Budapest, Hungary.,Medical School, Institute for Translational Medicine, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Viktória Adrienn Jászai
- Medical School, Institute for Translational Medicine, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Andrea Párniczky
- Heim Pál National Paediatric Institute, Budapest, Hungary.,Medical School, Institute for Translational Medicine, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Pálma Edina Benedek
- Heim Pál National Paediatric Institute, Budapest, Hungary.,Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
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100
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Kang KT, Chiu SN, Weng WC, Lee PL, Hsu WC. Ambulatory Blood Pressure Variability after Adeno tonsillectomy in Childhood Sleep Apnea. Laryngoscope 2022; 132:2491-2497. [PMID: 35156724 DOI: 10.1002/lary.30058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/11/2022] [Accepted: 01/26/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the influence of adenotonsillectomy (T&A) on ambulatory blood pressure (BP) variability in children with obstructive sleep apnea (OSA). STUDY DESIGN Prospective, interventional study. METHODS Children with OSA symptoms were recruited from a tertiary center. After OSA diagnosis was confirmed (ie, apnea-hypopnea index [AHI] > 1), these children underwent T&A for treatment. We performed polysomnography and 24-hour recordings of ambulatory BP before and 3 to 6 months postoperatively. Ambulatory BP variability was presented as the standard deviation of mean blood pressure in the 24-hour monitoring of ambulatory BP. Differences in BP variability among different subgroups were tested using a multivariable linear mixed model. RESULTS A total of 190 children were enrolled (mean age: 7.8 ± 3.3 years; 73% were boys; 34% were obese). The AHI significantly decreased from 12.3 ± 17.0 to 2.7 ± 5.5 events/hr after T&A. Overall, daytime, and nighttime ambulatory BP did not significantly change postoperatively, and overall, daytime, and nighttime ambulatory BP variability did not differ significantly preoperatively and postoperatively. In the subgroup analysis, children aged <6 years demonstrated a significantly greater decrease in ambulatory BP variability postoperatively than those aged >6 years (nighttime diastolic BP variability: 9.9 to 7.7 vs. 8.9 to 9.4). Children with hypertension also showed a significantly greater decrease in ambulatory BP variability than those without hypertension. CONCLUSIONS We concluded that overall ambulatory BP variability does not significantly change after T&A in children with OSA. Moreover, young-aged and hypertensive children demonstrate a significant decrease in BP variability after T&A. LEVEL OF EVIDENCE 4 Laryngoscope, 132:2491-2497, 2022.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.,Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.,Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan
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