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Campisi ES, Reyna ME, Brydges M, Dubeau A, Moraes TJ, Campisi P, Subbarao P. Adenotonsillectomy, bronchoscopy and bronchoalveolar lavage in the management of preschool children with severe asthma: pilot study. Eur Arch Otorhinolaryngol 2021; 279:319-326. [PMID: 34542655 DOI: 10.1007/s00405-021-07084-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/10/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This is a pilot study that describes the feasibility and clinical course of a cohort of preschool children with severe asthma undergoing a combined adenotonillectomy (TA), bronchoscopy (B), and bronchoalveolar lavage (BAL) procedure. METHODS A retrospective cohort study of preschool patients with severe asthma who underwent a combined TA-B-BAL procedure between 2012 and 2019. Subjects were treated at a tertiary care asthma clinic and had a diagnosis of preschool asthma according to the Canadian Thoracic Society Guidelines. Data on demographics, clinical characteristics, medication use, virology and microbiology from bronchoalveolar lavage, and asthma control questionnaires were collected. Variables were analyzed using paired t test. RESULTS Eighteen preschool subjects (mean age 3.19 ± 1.13 years) with severe asthma were identified through the asthma clinic. Patients treated with standard asthma care and a combined TA-B-BAL procedure experienced a decrease in the number of oral steroid courses (p = 0.017), emergency department visits (p = 0.03) and wheezing exacerbations (p = 0.026) following the procedure. Ten patients experienced clinically meaningful improvements in TRACK scores after the procedure (p < 0.001). CONCLUSION This pilot study provides early evidence that a combined TA-B-BAL procedure is feasible in preschool children with severe asthma and that the procedure may reduce asthma medication use and hospital visits.
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Affiliation(s)
- Emma S Campisi
- Department of Otolaryngology-Head & Neck Surgery, Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Myrtha E Reyna
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada
| | - May Brydges
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada
| | - Aimee Dubeau
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada
| | - Theo J Moraes
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada
| | - Paolo Campisi
- Department of Otolaryngology-Head & Neck Surgery, Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Padmaja Subbarao
- Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada.,Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, 27 King's College Circle, Toronto, Canada
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AlAbdullah ZA, Alali K, Al Jabr I. Clinical Assessment of Weight Gain in Pediatric Patients Post-Tonsillectomy: A Retrospective Study. Cureus 2020; 12:e12005. [PMID: 33457116 PMCID: PMC7797454 DOI: 10.7759/cureus.12005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Tonsillectomy is one of the most commonly performed surgeries among children. It is indicated for the treatment of obstructive sleep apnea and chronic throat infections. Although a relatively safe surgery, post-operative complications have been reported in multiple studies. Over the past century, tonsillectomy has played a role in post-operative weight gain. Aim To measure weight gain in pediatric patients post-tonsillectomy. Methods A retrospective study was conducted in the Al-Ahsa region in Saudi Arabia. Overall, 240 children (male, 110 [44.2%]; female, 130 [52.2%]; mean±SD age, 7.45±2.89 years) from tertiary hospitals were included in the study. The height (m2) and weight (kg) of the children were measured, and the BMI (body mass index) was calculated preoperatively and one and six months post-operatively. Results There were significant differences observed between the mean weight one-month and six months post-operation (P = 0.0001) and the mean BMI measured at the baseline one month and six months post-operation (P = 0.0001). In addition, a positive linear correlation between the BMI six months post-operation and the weight at the same period (R = 0.375) was noted. Conclusion The findings of this study suggest an increase in weight post-tonsillectomy, mostly six months post-operation. Future studies, however, are warranted to evaluate the risk factors associated with weight gain in children and its relation to tonsillectomy.
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Affiliation(s)
| | - Khadijah Alali
- Miscellaneous, College of Medicine, King Faisal University, Al-Ahsa, SAU
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Abraham ZS, Kahinga AA, Mapondella KB, Massawe ER, Ntunaguzi D. <p>Indications and Postoperative Outcomes of Pediatric Adenotonsillectomy at a Private Hospital in Dar es Salaam, Tanzania</p>. OPEN ACCESS SURGERY 2020. [DOI: 10.2147/oas.s249844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Altwairqi RG, Aljuaid SM, Alqahtani AS. Effect of tonsillectomy on humeral and cellular immunity: a systematic review of published studies from 2009 to 2019. Eur Arch Otorhinolaryngol 2019; 277:1-7. [PMID: 31664514 DOI: 10.1007/s00405-019-05672-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 09/24/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although tonsillectomy is the most commonly performed surgical operation for children, its postoperative effect on the immune response was a source of debate among physicians. PURPOSE The aim of this systemic review was study the effect of tonsillectomy on children immune response. DATA SOURCES PubMed, Medline, Embase and Cochrane Library. REVIEW METHODS All relevant articles published English language addressing the effect of tonsillectomy on the immune system were included. One investigators extracted data regarding: year of the study, sample size, study design, sample size, timing of analysis, studied immune factors, result and conclusion were identified. Another investigator independently reviewed data accuracy. RESULTS Ten articles published between from January 2009 to January 2019 in about this issue that included 404 children were reviewed. All reviewed studies showed a non-significant difference between levels of indicators of the humeral immunity (IgA, IgG, IgM, C3 and C4) pre- and postoperatively. Studies that measured these indicators only after surgery, showed a non-significant difference in their levels between patients and healthy controls. Levels of indicators of cellular immunity (CD4+ , CD3+ , CD8+ , CD19+ , CD25+ , CD16+ , CD+ 56) showed slight reduction or increase in some studies but without a significant difference compared to their levels preoperatively, postoperatively at different intervals or with healthy controls. Other studies found no changes in these indicators postoperatively. CONCLUSION There was enough evidence to conclude that tonsillectomy has no negative affect on both humeral and cellular immunity of children.
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Affiliation(s)
- R G Altwairqi
- Medical Intern, College of Medicine, Taif University, Taif City, Saudi Arabia.
| | - S M Aljuaid
- Senior Registrar ORL Head and Neck Surgery, King Abdulaziz Specialist Hospital, Taif City, Saudi Arabia
| | - A S Alqahtani
- Senior Registrar ORL Head and Neck Surgery, King Abdulaziz Specialist Hospital, Taif City, Saudi Arabia
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Kim SY, Oh DJ, Choi HG. Tonsillectomy does not reduce asthma in children: A longitudinal follow-up study using a national sample cohort. Sci Rep 2019; 9:13382. [PMID: 31527814 PMCID: PMC6746861 DOI: 10.1038/s41598-019-49825-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 08/27/2019] [Indexed: 11/09/2022] Open
Abstract
This study aimed to investigate the occurrence of tonsillectomy in asthmatic children using a control group with a comparable frequency of a preoperative history of asthma. Asthmatic children ≤15 years old were collected from the Korean Health Insurance Review and Assessment Service - National Sample Cohort (HIRA-NSC) from 2002 through 2013. In study I, asthmatic children who had undergone a tonsillectomy (n = 2,326) and control I participants (n = 9,304) were selected and matched 1:4 for age, sex, income, and region of residence but not a preoperative history of asthma. In study II, a preoperative history of asthma was additionally matched for between the tonsillectomy (n = 2,280) and the new control II participants (n = 9,120). The margin of equivalence of difference (control-tonsillectomy) for asthma was set at -0.05 to 0.05 per year. In addition, repeated measures ANOVA was performed for tonsillectomy according to yearly changes in asthma, status asthmaticus, and admission. In study I, the preoperative frequencies of asthma, status asthmaticus, and admission were higher in the tonsillectomy group than in the control group (P ≤ 0.001). The frequencies of postoperative asthma, status asthmaticus, and admission were lower in the tonsillectomy group than in the control I group for 3 years. In study II, the frequencies of postoperative 1-, 2-, and 3-year asthma and admission were not lower in the tonsillectomy group than in the control II group. Tonsillectomy did not further reduce the frequency of asthma in patients who underwent this procedure compared to the control group when a preoperative history of asthma history was equally matched between the two groups.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Dong Jun Oh
- Department of Internal medicine, Soonchunhyang University College, Seoul, Republic of Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea. .,Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Republic of Korea.
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Rotsides JM, Krakovsky GM, Pillai DK, Sehgal S, Collins ME, Noelke CE, Bauman NM. Is a Multidisciplinary Aerodigestive Clinic More Effective at Treating Recalcitrant Aerodigestive Complaints Than a Single Specialist? Ann Otol Rhinol Laryngol 2017; 126:537-543. [DOI: 10.1177/0003489417708579] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: To determine the utility of a pediatric multidisciplinary aerodigestive clinic (ADC) in treating recalcitrant aerodigestive conditions. Methods: Longitudinal observational study of presenting complaints, evaluation, management, and outcome of patients seen during 12 monthly ADCs beginning August 2013. Results: Fifty-five patients were seen by the ADC team (otolaryngology/gastroenterology/pulmonology/speech pathology/nurse practitioner) and followed for a mean 17.6 months (range, 12-26 months). Mean age was 4.3 years (range, 0.5-19 years). All were seen by at least 1 specialist before ADC referral but without significant improvement. Chronic cough was the most common primary symptom (44%). Clinic evaluation included flexible nasopharyngolaryngoscopy (FFL, 53%) and pulmonary function testing (36%.) FFL influenced management in 79%. An operative procedure usually combined endoscopy was warranted in 58%. Endoscopy provided high diagnostic yield, detecting laryngeal cleft (8), adenoid hypertrophy (8), vocal cord dysfunction (4), pulmonary infection (4), reflux disease (3), laryngomalacia (3), tracheomalacia (2), cilia abnormality (2), celiac disease (1), Helicobacter pylori (1), duodenal web (1), and eosinophilic esophagitis (1). Outcome was available for 48 of 55 patients, with 73% reporting resolved to markedly improved symptoms and 27% minimal to no improvement. Conclusions: The ADC team approach resulted in resolved to markedly improved symptoms in 73% of patients whose symptoms persisted despite seeing a single specialist prior to referral.
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Affiliation(s)
- Janine M. Rotsides
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Gina M. Krakovsky
- Department of Otolaryngology-Head and Neck Surgery, Children’s National Health System, Washington, DC, USA
| | - Dinesh K. Pillai
- Department of Pulmonary and Sleep Medicine, Children’s National Health Services, Washington, DC, USA
| | - Sona Sehgal
- Department of Gastroenterology, Hepatology, and Nutrition, Children’s National Health System, Washington, DC, USA
| | - Maura E. Collins
- Department of Speech and Language Pathology, Children’s National Health Services, Washington, DC, USA
| | - Carolyn E. Noelke
- Department of Speech and Language Pathology, Children’s National Health Services, Washington, DC, USA
| | - Nancy M. Bauman
- Department of Otolaryngology-Head and Neck Surgery, Children’s National Health System, Washington, DC, USA
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Castro-Rodriguez JA, Brockmann PE, Marcus CL. Relation between asthma and sleep disordered breathing in children: is the association causal? Paediatr Respir Rev 2017; 22:72-75. [PMID: 27818068 DOI: 10.1016/j.prrv.2016.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 08/16/2016] [Indexed: 11/30/2022]
Abstract
Over the last few decades, asthma and sleep disordered breathing (SDB) in children have experienced similar increases in prevalence, and have both been shown to have airway inflammation, leading investigators to postulate an association between asthma and SDB. However, whether this relationship is causal or not needs to be proven. In this manuscript, we use the most widely accepted epidemiologic criteria for causality, the Bradford Hill criteria, to test step-by-step whether the relation between asthma and SBD in children is causal or not. We found studies supporting 8 of the 9 criteria (strength, consistency, specificity, biological gradient, coherence and biological plausibility, experiment, and analogy) for association between asthma and SDB. However, we did not find any study showing temporality or directionality between asthma and SDB. Therefore, establishing a causal association between asthma and SDB is not yet possible.
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Affiliation(s)
- Jose A Castro-Rodriguez
- Department of Pediatric Cardiology and Respiratory, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Pablo E Brockmann
- Department of Pediatric Cardiology and Respiratory, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Sleep Medicine Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carole L Marcus
- Sleep Center, Children's Hospital of Philadelphia. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Kohli N, DeCarlo D, Goldstein NA, Silverman J. Asthma outcomes after adenotonsillectomy: A systematic review. Int J Pediatr Otorhinolaryngol 2016; 90:107-112. [PMID: 27729114 DOI: 10.1016/j.ijporl.2016.08.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/30/2016] [Accepted: 08/31/2016] [Indexed: 12/30/2022]
Abstract
OUTCOME OBJECTIVE For over fifty years, otolaryngologists, allergists, and immunologists have debated the effect of adenoidectomy or adenotonsillectomy on asthma outcomes in children. Although some have suggested that adenotonsillectomy may contribute to the subsequent development of asthma in children, others have argued that a common mechanism may cause both upper and lower airway disease, and that children who have symptoms severe enough to warrant adenotonsillectomy are also at increased risk of asthma and atopic disease. The link between asthma and upper airway disease may involve upper airway inflammation. Our goal is to perform a systematic review of asthma outcomes following adenoidectomy or adenotonsillectomy in the pediatric population. Our goal is to assess the effect of adenoidectomy or adenotonsillectomy on markers of asthma severity in children with obstructive sleep apnea. METHODS We performed a systematic review using the PubMed, EMBASE, and CINAHL databases using search terms related to asthma, adenoidectomy, and adenotonsillectomy. Inclusion criteria were defined as pediatric subjects aged 18 years or younger with a history of asthma, undergoing adenoidectomy, or adenotonsillectomy for obstructive sleep apnea. Database studies and case studies with or without control groups were included in the study. Exclusion criteria were patients with follow-up greater than 1 year after surgery, craniofacial syndromes, or additional significant comorbidities. RESULTS A total of 567 abstracts were identified; 549 were excluded immediately. Eighteen full-text articles were assessed for eligibility and four articles were included in the qualitative synthesis. These data are consistent in correlating adenotonsillectomy in asthmatic children with decreased asthma severity. Markers of asthma severity including respiratory medication use, emergency room visits for asthma-related symptoms, overall asthma symptoms, and asthma-related exacerbations were all significantly reduced following adenotonsillectomy. CONCLUSION We present a systematic review of asthma outcomes following surgical intervention for sleep apnea in the pediatric population. All included studies found clinically significant reductions in markers of asthma severity after adenotonsillectomy. Though further prospective trials are needed to determine a causal relationship between adenotonsillectomy and modulation of asthma, the compilation of data suggest a definitive association.
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Affiliation(s)
- Nikita Kohli
- Department of Otolaryngology, State University of New York Downstate Medical Center, 450 Clarkson Ave Box 126, Brooklyn, NY 11203, USA.
| | - Dana DeCarlo
- School of Medicine, State University of New York Downstate Medical Center, USA
| | - Nira A Goldstein
- Department of Otolaryngology, State University of New York Downstate Medical Center, 450 Clarkson Ave Box 126, Brooklyn, NY 11203, USA
| | - Joshua Silverman
- Department of Otolaryngology, State University of New York Downstate Medical Center, 450 Clarkson Ave Box 126, Brooklyn, NY 11203, USA
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Yildizoglu U, Polat B, Gumral R, Kilic A, Tosun F, Gerek M. Effect of antibiotic use on bacterial flora of tonsil core in patients with recurrent tonsillitis. Eur Arch Otorhinolaryngol 2014; 272:1525-8. [PMID: 25510984 DOI: 10.1007/s00405-014-3434-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 12/04/2014] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate the effects of commonly used antibiotics on bacterial flora of the tonsil core. Patients who underwent tonsillectomy for recurrent chronic tonsillitis were included in the study. Three groups were formed: group 1 was treated for 10 days preoperatively with amoxicillin/clavulanic acid; group 2 was treated for 10 days preoperatively with clarithromycin; and group 3 included patients who underwent tonsillectomy without preoperative antibiotic use. The removed palatine tonsils were sent to our microbiology department in sterile tubes for bacteriological analysis. Seventy-three patients (group 1 = 19, group 2 = 20, group 3 = 34 patients) aged 3-18 years (mean 7 years) were included in the study. At least one bacterium was isolated from all tonsils, except for two cases in group 1; the difference in single bacterial growth among groups was not significant (p = 0.06). On the other hand, the numbers of patients with pathogenic bacterial growth was significantly lower in group 2 (n = 2) compared with group 1 (n = 10) and group 3 (n = 27) (p < 0.001). The bacterium isolated most frequently from the tonsils was Streptococcus viridans. Pseudomonas aeruginosa was the only pathogenic bacterium that grew in all three groups. Clarithromycin was more effective than amoxicillin/clavulanic acid in eradicating pathogenic bacteria in the tonsil core. Pseudomonas aeruginosa might be responsible for resistant or recurrent tonsil infections. To prevent endocarditis, antibiotic prophylaxis toward S. viridians, which is the most prevalent bacterium in the tonsil core, should be kept in mind for patients with heart valve damage.
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Affiliation(s)
- Uzeyir Yildizoglu
- Department of Otorhinolaryngology Head and Neck Surgery, Beytepe Military Hospital, Cankaya, 06800, Ankara, Turkey,
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