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Wang ST, Kang KT, Chang CF, Lin MT, Hsu WC. Voice Change After Adeno tonsillectomy in Children: A Systematic Review and Meta-Analysis. Laryngoscope 2024; 134:2538-2550. [PMID: 37909678 DOI: 10.1002/lary.31140] [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: 05/27/2023] [Revised: 09/18/2023] [Accepted: 10/10/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Adenotonsillectomy is one of the most common surgical procedures performed on children. Caregivers are often concerned about voice change after the procedure, and such concerns remain unsettled. This meta-analysis analyzed voice change in children after adenotonsillectomy. DATA SOURCES The PubMed, Medline, EMBASE, and Cochrane databases. REVIEW METHODS The study protocol was registered on PROSPERO. Two authors independently searched for articles using keywords "adenoidectomy," "tonsillectomy, "voice," "nasalance,"and "speech." English articles specifying voice changes after adenotonsillectomy were pooled with standardized mean difference (SMD) using random-effects model. Evaluation methods were computerized acoustic voice analysis, aerodynamic analysis, nasometer, rhinomanometry, evaluations from a speech-language pathologist or otolaryngologist, and a caregiver assessment questionnaire. RESULTS Twenty-three studies with 2154 children were analyzed (mean age: 8.0 y; 58% boys; mean sample size: 94 children). Due to insufficient data for other outcome variables, this meta-analysis only summarized changes in the computerized acoustic voice analysis 1 month and 3 months after surgery. The computerized acoustic analysis revealed significant changes in jitter (SMD = -0.36; 95% confidence interval [CI]: -0.60 to -0.11), shimmer (SMD = -0.34; 95% CI: -0.57 to -0.11), and soft phonation index (SMD = -0.36; 95% CI: -0.57 to -0.15) at 1 month after surgery. Parameters including fundamental frequency, jitter, noise-to-harmonics ratio, and shimmer were not significantly changed at 3 months after surgery. CONCLUSIONS This meta-analysis observed small improvements in jitter, shimmer, and soft phonation index 1 month after surgery. No significant effects were observed in voice outcomes 3 months after surgery. Laryngoscope, 134:2538-2550, 2024.
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Affiliation(s)
- Sz-Ting Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - 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
| | - Chi-Fen Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Tzer Lin
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei City, 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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Dritsoula A, Clarke R, Hatziagorou E, Triaridis S, Talimtzi P, Elphick H. The role of rigid laryngo-tracheo-bronchoscopy in children with obstructive sleep apnoea: a case series of 65 children. J Laryngol Otol 2024; 138:679-684. [PMID: 38018216 DOI: 10.1017/s0022215123002116] [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: 11/30/2023]
Abstract
OBJECTIVE To assess the role of laryngo-tracheo-bronchoscopy in children with obstructive sleep apnoea by identifying airway abnormalities at surgery, that occur separately or in addition to adenotonsillar hypertrophy, and examining the correlation with respiratory parameters. METHODS A retrospective study was conducted of children with obstructive sleep apnoea who underwent laryngo-tracheo-bronchoscopy intra-operatively, performed by a single ENT surgeon from February 2016 to July 2019. Pre- and post-operative minimum oxygen saturation, apnoea-hypopnoea index, and oxygen desaturation index were recorded. RESULTS Sixty-five children were identified; 34 were aged less than three years and 31 were aged three years or more. 77 per cent and 13 per cent respectively had an airway abnormality; the t-test showed a significantly higher mean oxygen desaturation index and lower mean minimum oxygen saturation pre-operatively compared to children without an airway abnormality. CONCLUSION An update of the surgical pathway for children aged less than three years with obstructive sleep apnoea is required to include laryngo-tracheo-bronchoscopy intra-operatively. A t-test analysis of the pre-operative respiratory parameters suggests that airway abnormalities contribute to obstructive sleep apnoea severity.
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Affiliation(s)
- Aikaterini Dritsoula
- ENT Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Raymond Clarke
- ENT Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Elpis Hatziagorou
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stefanos Triaridis
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Persefoni Talimtzi
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Heather Elphick
- Paediatric Respiratory and Sleep Medicine, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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Jacob T, Leshno M, Carmel-Neidermann NN, Kampel L, Warshavsky A, Mansour J, Assadi N, Muhanna N, Horowitz G. Antibiotics or Tonsillectomy for Adult Recurrent Tonsillitis: Analyzing the Lesser of Two Evils. Laryngoscope 2024; 134:2153-2161. [PMID: 37937815 DOI: 10.1002/lary.31139] [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: 06/14/2023] [Revised: 09/01/2023] [Accepted: 10/04/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE To determine the best timing for surgical intervention for adults with recurrent tonsillitis (RT). METHODS A Markov model was constructed using variables and ranges based upon a literature review. A 1-way sensitivity analysis was performed to evaluate the number of yearly bouts at which each algorithm (antibiotics or tonsillectomy) would be favored. A Monte-Carlo probabilistic sensitivity analysis was calculated for gains and cost. Model outcomes were measured with quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICER) for tonsillectomy versus repeat antibiotic treatment. RESULTS Patients expected to sustain a single annual tonsillitis event will have a negative QALY of 0.02 if treated with surgery and those with 2 annual events will have a QALY gain from undergoing tonsillectomy of 0.01, 3 events = 0.03, 4 events = 0.05, 5 events = 0.07, 6 events = 0.09, 7 events = 0.1, and 8 events = 0.11. These gains became meaningful only after 2 years of recurrent bouts. The average cost of tonsillectomy was 3,238 USD, and the overall average cost of RT was 7,069 USD (an incremental cost of 3,831 USD). The ICER of tonsillectomy over antibiotic treatment for 1 QALY gain was 44,741 USD. CONCLUSION Adult patients who sustain more than 3 annual bouts of tonsillitis over a period of at least 2 years will gain QALY after tonsillectomy. These gains increase proportionally to the number of yearly events and perennial episodes. The incremental costs of tonsillectomy fail to meet the NICE guidelines but are within other acceptable reference ranges. LEVEL OF EVIDENCE NA Laryngoscope, 134:2153-2161, 2024.
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Affiliation(s)
- Tommy Jacob
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Moshe Leshno
- The 'Coller' School of Management, Tel-Aviv University, Both Affiliated to the Tel-Aviv Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Narin Nard Carmel-Neidermann
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Liyona Kampel
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Anton Warshavsky
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Joubran Mansour
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nidal Assadi
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nidal Muhanna
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Gilad Horowitz
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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Tierney J, Harrison E, Hodge JC, Carney AS. Coblation versus BiZact extra-capsular tonsillectomy in adults: a randomized control trial. ANZ J Surg 2024; 94:861-866. [PMID: 38619224 DOI: 10.1111/ans.19007] [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: 01/09/2024] [Revised: 03/04/2024] [Accepted: 04/01/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Tonsillectomy is a frequently performed otolaryngological procedure and is associated with significant postoperative pain and bleeding. A number of studies have investigated methods to reduce pain and bleeding. Coblation and BiZact devices have both been claimed to have favourable pain outcomes following tonsillectomy. This study was designed to investigate these two techniques in a direct comparison of postoperative pain and bleeding. METHODS In this single blinded, randomized control trial, 61 patients were randomly assigned to undergo tonsillectomy with either the BiZact or Coblation device. Pain scores were collected for 14 days postoperatively using a Visual Analogue Score scale. Secondary outcome data was collected for duration of surgery, intra-operative bleeding, return to normal, and secondary bleeding rates. RESULTS Coblation was found to have lower postoperative pain on day 1 (P < 0.05). BiZact was found to have lower postoperative pain on day 7 (P < 0.05) and day 11 (P < 0.05). Pain scores for other days were not significant. There was no significant difference in set-up time, procedural time and return to normal activities. The BiZact group had a longer time to achieve haemostasis (P < 0.001) and greater intraoperative blood loss (P < 0.01). There was a trend towards more significant secondary bleeding in the BiZact arm, however, this study was not adequately powered to assess this finding. CONCLUSION Both Coblation and BiZact devices appear to provide a safe and effective method for tonsillectomy in adults. Reduced pain on day 1 may make Coblation more suitable for day-case surgery.
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Affiliation(s)
- Jack Tierney
- Division of Surgery, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Ella Harrison
- Division of Surgery, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - John-Charles Hodge
- Department of Otolaryngology - Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - A Simon Carney
- Otolaryngology - Head & Neck Surgery - College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Cordray H, Wright EA, Patel C, Raol N, Prickett KK. A Mobile Application for Child-Focused Tonsillectomy Education: Development and User-Testing. Laryngoscope 2024; 134:2455-2463. [PMID: 37983833 DOI: 10.1002/lary.31198] [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: 08/11/2023] [Revised: 10/17/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE Patient education is central to Enhanced Recovery After Surgery protocols, but child-focused materials are lacking. We developed and piloted a mobile application to support accessible, interactive patient and caregiver education about pediatric tonsillectomy. METHODS Thirty children ages 5-12 who were preparing for tonsillectomy, their caregivers, and six attending otolaryngologists participated in a user-testing trial of a web-based prototype. The trial measured feasibility, fidelity, and patient-centered outcomes. Patients and caregivers rated usability/likeability on the mHealth App Usability Questionnaire. Otolaryngologists rated quality on the Mobile App Rating Scale. The full mobile application, "Ready for Tonsillectomy," was then developed for iOS and Android. RESULTS Enrollment was 88.2%, retention was 90.0%, and use was 96.3%. Mean (SD) patient ratings for usability/likeability were 6.3 (1.1) out of 7; caregiver ratings were 6.5 (1.1). In common themes from open-ended feedback, patients described the application as helpful and appealing, and caregivers described it as informative, easy to understand, calming, and easy to use. Among caregivers who used the application during recovery, 92.3% reported that it helped them manage their child's pain. Providers would recommend the application to many or all of their patients (mean [SD]: 4.7 [0.5] out of 5). Mean provider ratings for domains of engagement, functionality, aesthetics, information quality, subjective quality, and app-specific value ranged from 4.1 to 4.8 out of 5. CONCLUSION Feasibility and fidelity were high. Families and otolaryngologists endorsed the resource as an engaging, informative tool that supports positive coping. Our mobile application offers a patient-centered solution readily scalable to other surgeries. LEVEL OF EVIDENCE NA Laryngoscope, 134:2455-2463, 2024.
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Affiliation(s)
- Holly Cordray
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Emily A Wright
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chhaya Patel
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nikhila Raol
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kara K Prickett
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
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Goff SH, Pickett-Nairne K, Nguyen T, Rove KO, Friedman NR. The Effect of Social Vulnerability on Perioperative Tonsillectomy Outcomes in Children. Laryngoscope 2024; 134:2449-2454. [PMID: 37971081 DOI: 10.1002/lary.31189] [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: 09/26/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To determine if children with greater social vulnerability are more likely to experience a prolonged oxygen requirement (POR) following adenotonsillectomy to inform the need for overnight monitoring prior to discharge. METHODS A previously published prospective study assessing children observed overnight following adenotonsillectomy for obstructive sleep-disordered breathing was reanalyzed including social vulnerability index (SVI). The outcome was POR beyond 3 h following extubation. Logistic regression was used to assess the association of SVI components with POR. SVI components were assessed as quartiles of cohort values. Final adjusted models included race, asthma, Down syndrome, and pre-operative SpO2. RESULTS A total of 462 children had SVI data available and were included. 354 (76.6%) were > = 3 years of age. Overall, 351 (76%) did not have a POR. The median overall SVI percentile was 26.5 (Q1 10.4, Q3 60.1). When categorized by SVI quartiles, there was a statistically significant difference with POR for overall SVI percentile (p = 0.007), SVI household composition percentile (p = 0.033), and median SVI housing/transportation percentile (p = 0.005). Individuals with an overall SVI in the 4th quartile (greatest vulnerability) were 2.63 times more likely to experience a POR than those in the 1st quartile (lowest social vulnerability) in adjusted logistic regression (95% OR CI 1.23-5.62; p = 0.01). CONCLUSIONS There is a significant association between greater neighborhood-level social vulnerability and a POR following adenotonsillectomy. We propose that a child's SVI be considered when planning for the perioperative course following adenotonsillectomy. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2449-2454, 2024.
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Affiliation(s)
- Salina H Goff
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Kaci Pickett-Nairne
- Children's Hospital Colorado, Center for Research in Outcomes for Children's Surgery, Aurora, Colorado, U.S.A
| | - Thanh Nguyen
- Division of Pediatric Anesthesia, Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Kyle O Rove
- Division of Urology, Department of Surgery, Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Norman R Friedman
- Department of Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, U.S.A
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Falz H, von Lücken HJ, Münscher A, Möckelmann N. A comparative study of BiZact™ tonsillectomy versus cold steel dissection technique in adults: Analysis of operating time, intraoperative blood loss, postoperative bleeding rate and pain. Clin Otolaryngol 2024; 49:299-305. [PMID: 38169104 DOI: 10.1111/coa.14140] [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: 03/16/2023] [Revised: 10/18/2023] [Accepted: 11/25/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES To analyse operating time, intraoperative blood loss, postoperative bleeding rate and pain when using the relatively new BiZact™ tonsillectomy device compared to the commonly used cold steel dissection technique with bipolar cautery in adults. DESIGN Retrospective case control study. Parameters analysed for significant association with technique were operating time, intraoperative blood loss, wound pain on postoperative days 1-4 and rate of post-tonsillectomy bleeding (PTB). SETTING Monocentric study at a department of otolaryngology and head and neck surgery at a tertiary centre in Germany. PARTICIPANTS A total of 183 patients who underwent a bilateral tonsillectomy with either the BiZact™ tonsillectomy device or the cold dissection technique with bipolar cautery for haemostasis. MAIN OUTCOME MEASURES Operating time, intraoperative blood loss, postoperative pain on the first to fourth postoperative day (numeric rating scale: 0-10) (PTB, primary bleeding ≤24 h, secondary bleeding >24 h postoperative; Stammberger scale). RESULTS AND CONCLUSION The BiZact™ tonsillectomy device leads to a significant shorter operating time with less intraoperative blood loss compared to cold steel dissection with bipolar haemostasis. No benefits with regards to PTB or postoperative pain could be observed. The use of the BiZact™ device provides major benefits in clinical routine and stands up to conventional tonsillectomy techniques.
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Affiliation(s)
- Hendrik Falz
- Department of Otorhinolaryngology, Head and Neck Surgery, Katholisches Marienkrankenhaus gGmbH, Hamburg, Germany
| | - Hans-Jürgen von Lücken
- Department of Otorhinolaryngology, Head and Neck Surgery, Katholisches Marienkrankenhaus gGmbH, Hamburg, Germany
| | - Adrian Münscher
- Department of Otorhinolaryngology, Head and Neck Surgery, Katholisches Marienkrankenhaus gGmbH, Hamburg, Germany
| | - Nikolaus Möckelmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Katholisches Marienkrankenhaus gGmbH, Hamburg, Germany
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Walsh ME, Retzler R, Huang J, Daglish A, Tweedie D, Pepper C. A prospective cohort study exploring the impact of tonsillectomy on feeding difficulties in children. Clin Otolaryngol 2024; 49:314-319. [PMID: 38415339 DOI: 10.1111/coa.14148] [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: 07/21/2023] [Revised: 10/06/2023] [Accepted: 02/11/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVES Paediatric feeding difficulties are common, affecting up to 25% of otherwise healthy children, symptoms include food refusal, gagging, choking, and excessive mealtime duration. These symptoms are commonly described in pre-operative discussions about tonsillectomy. This prospective study explores the impact of tonsillectomy on paediatric feeding difficulties. DESIGN This prospective cohort study invited caregivers of children undergoing tonsillectomy to complete a PediEAT questionnaire about their children's feeding behaviours, pre and post-operatively. The study was completed in two phases with 9 questions administered in phase 1 and three additional questions added for phase 2. A free text comments box was also provided. Responses were graded from 0 to 5, where 0 is 'never a problem' and 5 is 'always a problem' with eating behaviours. SETTING The study was conducted at our institution, a tertiary paediatric ENT unit. PARTICIPANTS Children aged between 6 months - 7 years undergoing tonsillectomy for any indication were invited to participate. MAIN OUTCOME MEASURES Changes to the Pedi-EAT scores pre and post operatively were the main outcome measure. RESULTS 102 participants were recruited between January 2020 and January 2022. The mean age of participants was 4.1 years, 87% had a concurrent adenoidectomy. The mean time to completion of post-operative questionnaire was 23 weeks after surgery. 9 of the 12 questions showed a statistically significant improvement in post-operative scores using a paired student t-test (p < 0.05). The most significant improvements related to 'gets tired from eating and is not able to finish' (1.49 pre-op, 0.91 post op, p < 0.01) and 'eats food that needs to be chewed' (1.4 pre-op, 0.72 post-op, p < 0.01). 13% of participants only underwent tonsillectomy and this group also showed a statistically significant improvement in fatigue during eating (p < 0.05). CONCLUSION Symptoms of fatigue during eating and avoidance of food requiring mastication are most likely to improve following tonsillectomy in children.
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Affiliation(s)
- M E Walsh
- Evelina London Childrens' Hospital, London, UK
| | - R Retzler
- Evelina London Childrens' Hospital, London, UK
| | - J Huang
- Evelina London Childrens' Hospital, London, UK
| | - A Daglish
- Evelina London Childrens' Hospital, London, UK
| | - D Tweedie
- Evelina London Childrens' Hospital, London, UK
| | - C Pepper
- Evelina London Childrens' Hospital, London, UK
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Law RH, Cena L, Sporn A, Buzi A, Rizzi MD, Ruiz RL, Fedrigo S, Giordano T, Fahmy AN, Dedhia K. Nanoparticle Concentration in Surgical Plume During Tonsillectomy: A Comparison of Four Techniques. Laryngoscope 2024; 134:2444-2448. [PMID: 37983867 DOI: 10.1002/lary.31185] [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: 08/28/2023] [Revised: 10/15/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE Surgical plume has known potential occupational health hazards. This study compares nanoparticle concentrations in surgical plumes generated between different pediatric tonsillectomy surgical techniques and assesses the efficacy of mitigation measures. METHODS This is a cross-sectional study performed at a tertiary care academic center. Extracapsular or intracapsular tonsillectomy was performed in 60 patients using four techniques and in 10 additional patients using mitigation measures. Two nanoparticle counters were used to measure particulate concentrations: CPC™ and DiSCmini™. Tonsillectomy techniques included: (1) microdebrider (MD), (2) Bovie with manual suctioning by an assistant (B), (3) Bovie with built-in smoke evacuation system (BS), and (4) Coblator™ (CB). An additional Yankauer suction was used in the mitigation groups (BSY) and (CBY). Comparative analysis was performed using one-way ANOVA on ranks and pairwise comparisons between the groups. RESULTS The mean concentrations (particles/cm3) and coefficient of variants for the DiSCmini particulate counter were MD: 5140 (1.6), B: 30700 (1.5), BS: 25001 (0.8), CB: 54814 (1.7), CBY: 2395 (1.3) and BSY: 11552 (1.0). Mean concentrations for the CPC particulate counter were MD: 1223 (1.4), B: 3405 (0.7), BS: 5002 (0.9), CB: 13273 (1.0), CBY: 1048 (1.2) and BSY: 3046 (0.6). The lowest mean concentrations were noted in cases using MD and the highest in cases using CB. However, after mitigation, CBY had the lowest overall levels. CONCLUSION Tonsillectomy technique does impact the levels of nanoparticles emitted within the surgical plume, which may present an occupational hazard for operating room personnel. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2444-2448, 2024.
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Affiliation(s)
- Richard H Law
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lorenzo Cena
- Department of Health, West Chester University, West Chester, Pennsylvania, USA
| | - Alec Sporn
- Department of Health, West Chester University, West Chester, Pennsylvania, USA
| | - Adva Buzi
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark D Rizzi
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan L Ruiz
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sabrina Fedrigo
- Department of Health, West Chester University, West Chester, Pennsylvania, USA
| | - Terri Giordano
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alexander N Fahmy
- School of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Kavita Dedhia
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Georgiou AN, Voskarides K, Zanos P, Chatzittofis A. Investigating the shared genetic basis and causal relationships between mucosa-associated lymphoid tissue inflammation and psychiatric disorders. Front Psychiatry 2024; 15:1379922. [PMID: 38742127 PMCID: PMC11089192 DOI: 10.3389/fpsyt.2024.1379922] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/09/2024] [Indexed: 05/16/2024] Open
Abstract
Background Chronic and acute inflammation of the mucosa-associated lymphoid tissue have been positively linked to the development of psychiatric disorders in observational studies. However, it remains unclear whether this association is causal. In the present study, we investigated this association, using as proxies genetically predicted tonsillectomy, appendectomy and appendicitis on psychiatric disorders including major depressive disorder (MDD), schizophrenia (SCZ), bipolar depression (BD) and anxiety (ANX) via a two-sample Mendelian randomization (MR) analysis. Methods Genetic association summary statistics for tonsillectomy, appendectomy and appendicitis were sourced from FinnGen Consortium, comprising data from 342,000 participants. Genetic correlations between all exposures and outcome were calculated with Linkage Disequilibrium Score (LDSC) Regression analysis. MR estimates were then calculated to assess their impact on the risk of developing psychiatric disorders. Sensitivity analysis was employed to test for any directional pleiotropy. Results Our results suggest that there is no direct causal association between tonsillectomy, appendectomy or appendicitis with a heightened risk for development of psychiatric disorders. The robustness of the results of the main MR analysis was further confirmed with additional sensitivity analyses. However, a moderate inverse genetic correlation was observed between tonsillectomy and MDD traits (rg=-0.39, p-value (P)=7.5x10-5). Conclusion Our findings provide, for the first time, evidence that there is no causal association between tonsillectomy or appendectomy on subsequent vulnerability of developing psychiatric disorders. Future studies using larger sample size GWAS should focus on unraveling the confounding factors and mediators to investigate this relationship further.
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Affiliation(s)
| | - Konstantinos Voskarides
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
- School of Veterinary Medicine, University of Nicosia, Nicosia, Cyprus
| | - Panos Zanos
- Department of Psychology, University of Cyprus, Nicosia, Cyprus
| | - Andreas Chatzittofis
- Medical School, University of Cyprus, Nicosia, Cyprus
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
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11
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Moise A, Centomo-Bozzo A, Orishchak O, Alnoury MK, Daniel SJ. Can ChatGPT Replace an Otolaryngologist in Guiding Parents on Tonsillectomy? Ear Nose Throat J 2024:1455613241230841. [PMID: 38563440 DOI: 10.1177/01455613241230841] [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: 04/04/2024] Open
Abstract
Background: ChatGPT is an artificial intelligence tool, which utilizes machine learning to analyze and generate human-like text. The user-friendly accessibility of this tool enables patients conveniently access medical information without intricate terminology challenges. The objective of this study was to assess the accuracy of ChatGPT in providing insights into indications and management of complications after tonsillectomy, a common pediatric otolaryngology procedure. Methods: The responses generated by ChatGPT were compared to the "Clinical practice guidelines: tonsillectomy in children-executive summary" developed by the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF). An assessment was carried out by presenting predetermined questions regarding indications and complications post tonsillectomy to ChatGPT, followed by a comparison of its responses with the established guideline by 2 otolaryngology experts. The responses of both parties were reviewed by the senior author. Results: A total of 16 responses generated by ChatGPT were assessed. After a comprehensive review, it was concluded that 15 out of 16 (93.8%) responses demonstrated a high degree of reliability and accuracy, closely adhering to the standard established by the AAO-HNSF guideline. Conclusion: The results validate the potential of using ChatGPT to enhance healthcare delivery making guidelines more accessible to patients while also emphasizing the importance of ensuring the provision of accurate and reliable medical advice to patients.
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Affiliation(s)
- Alexander Moise
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Adam Centomo-Bozzo
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, Canada
| | - Ostap Orishchak
- Department of Pediatric Otolaryngology, Montreal Children's Hospital, Montreal, QC, Canada
| | - Mohammed K Alnoury
- Department of Otolaryngology-Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sam J Daniel
- Department of Pediatric Otolaryngology, Montreal Children's Hospital, Montreal, QC, Canada
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12
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Nelson A, Baur JW, Lew A, Pettit NN, Nguyen CT. Rethinking Perioperative Antibiotic Prophylaxis for Low-Risk Head and Neck Procedures. Ann Otol Rhinol Laryngol 2024; 133:458-461. [PMID: 38183237 DOI: 10.1177/00034894231222690] [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: 01/07/2024]
Abstract
OBJECTIVE For true clean-contaminated head and neck procedures, the literature supports ≤24 hours of perioperative antibiotics. However, there are certain otolaryngology procedures with low surgical site infection (SSI) risk for which there is negligible benefit from antibiotic prophylaxis. The objective of this evaluation was to describe antibiotic use and adherence to evidence-based institutional guidelines in low-risk head and neck procedures. METHODS This was a single-center, retrospective cohort study of patients undergoing low-risk clean-contaminated head and neck procedures wherein antibiotic prophylaxis was not indicated, based on evidence-based institutional guidelines. RESULTS Among the 291 included patients, perioperative antibiotics were unnecessarily administered in 29% of patients. Among patients who received antibiotics, 76% received preoperative antibiotics and 41% received postoperative antibiotics, for a median duration of 7 days. There were no significant differences in SSIs, mortality, and length of stay for those receiving perioperative antibiotics versus those not receiving perioperative antibiotics. CONCLUSION These data highlight the need for antibiotic stewardship interventions and partnerships between antibiotic stewardship teams and surgical services.
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Affiliation(s)
- Avery Nelson
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Jordan W Baur
- Department of Pharmacy, University of Chicago Medicine, Chicago, IL, USA
| | - Alison Lew
- Department of Pharmacy, University of Chicago Medicine, Chicago, IL, USA
| | - Natasha N Pettit
- Department of Pharmacy, University of Chicago Medicine, Chicago, IL, USA
| | - Cynthia T Nguyen
- Department of Pharmacy, University of Chicago Medicine, Chicago, IL, USA
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13
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Wu J, Zhang Q, Zhang L, Li J. Effect of comprehensive nursing intervention on wound pain and wound complications in patients with tonsillectomy: A meta-analysis. Int Wound J 2024; 21:e14619. [PMID: 38152991 PMCID: PMC10961898 DOI: 10.1111/iwj.14619] [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: 12/07/2023] [Accepted: 12/14/2023] [Indexed: 12/29/2023] Open
Abstract
To systematically evaluate the effects of comprehensive nursing interventions on wound pain and complications in patients after tonsillectomy, with a view to providing a reference basis for future post-tonsillectomy care. According to the developed literature search strategy, PubMed, Web of Science, Cochrane Library, Embase, Wanfang, China Biomedical Literature Database and China National Knowledge Infrastructure database were systematically searched, from database inception to October 2023, for randomised controlled trials (RCTs) of the application of comprehensive nursing interventions in patients undergoing tonsillectomy. Two researchers independently screened the literature, evaluated the risk of bias of the included studies and extracted data in strict accordance with the inclusion and exclusion criteria. RevMan 5.4 software was applied for data analysis. Overall, 18 RCTs involving 1954 patients were included, including 967 in the comprehensive nursing group and 987 in the conventional nursing group. The analyses revealed that compared with conventional nursing, patients who received comprehensive nursing interventions had lower postoperative wound pain scores (standardised mean difference [SMD]: -2.30, 95% confidence interval [CI]: -2.19 to -1.70, p < 0.00001), shorter hospital stays (SMD: -1.95, 95% CI: -2.39 to -1.51, p < 0.00001), incidence of postoperative haemorrhage (1.60% vs. 6.41%, odds ratio [OR]: 0.29, 95% CI: 0.12-0.70, p = 0.006) and complication rates (4.21% vs. 19.01%, OR: 0.19, 95% CI: 0.11-0.32, p < 0.00001) was lower. This study concludes as follows: comprehensive nursing intervention applied to tonsillectomy can significantly reduce patients' postoperative wound pain, shorten hospital stay, reduce postoperative bleeding and postoperative complications, which is worthy of being promoted and applied in the clinic.
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Affiliation(s)
- Jian‐Li Wu
- Department of OtolaryngologyPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Qin Zhang
- Department of EmergencyPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Li‐Hua Zhang
- Department of ObstetricsPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Jun‐Yi Li
- Department of OtolaryngologyPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
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14
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Wei B, Yu C, Xiao J, Xu H, Zheng P, Wang W. The Median Effective Dose of Dexmedetomidine for the Inhibition of Emergence Delirium in Preschool Children Undergoing Tonsillectomy and/or Adenoidectomy: A Retrospective Dose-response Trial. Dose Response 2024; 22:15593258241248919. [PMID: 38645383 PMCID: PMC11032057 DOI: 10.1177/15593258241248919] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/06/2024] [Indexed: 04/23/2024] Open
Abstract
The incidence of emergence delirium (ED) is higher in preschool children undergoing tonsillectomy and/or adenoidectomy. The purpose of this study was to determine the median effective dose (ED50) of dexmedetomidine (DEX) for the inhibition of ED in preschool children by using probit regression analysis. A total of 140 anesthesia records were retrieved and divided into seven groups based on the infusion rate of DEX: .2, .25, .3, .35, .4, .45, and .5 μg·kg-1·h-1. The Pediatric Anesthesia Emergence Delirium Scale (PAEDS) was used to assess ED in preschool children, and ED was defined as a PAEDS score ≥ 10. Probit regression analysis revealed that the ED50 and ED95 of DEX were .31 μg·kg-1·h-1 (95% CI: .29-.35) and .48 μg·kg-1·h-1 (95% CI: .44-.56), respectively. Probit(p) = -2.84 + 9.28 × ln (Dose), (χ2 = 1.925, P = .859). The PAEDS score was significantly increased in the ED group, and the rate of bradycardia was significantly decreased in the ED group compared with the without ED group (27.3% vs 54.1%, P = .02). DEX can effectively inhibit the ED in preschool children undergoing tonsillectomy and/or adenoidectomy, however, bradycardia was the main complication.
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Affiliation(s)
| | | | - JinBo Xiao
- Department of Anesthesiology, The Medical Center of AnQing of Anhui Medical University, AnQing, China
| | - Huang Xu
- Department of Anesthesiology, The Medical Center of AnQing of Anhui Medical University, AnQing, China
| | - Ping Zheng
- Department of Anesthesiology, The Medical Center of AnQing of Anhui Medical University, AnQing, China
| | - WeiBing Wang
- Department of Anesthesiology, The Medical Center of AnQing of Anhui Medical University, AnQing, China
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15
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Gude P, Geldermann N, Gustedt F, Grobe C, Weber TP, Georgevici AI. New postoperative pain instrument for toddlers-Secondary analysis of prospectively collected assessments after tonsil surgery. Paediatr Anaesth 2024; 34:347-353. [PMID: 38140808 DOI: 10.1111/pan.14824] [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: 06/04/2023] [Revised: 11/06/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The Children's and Infant's Postoperative Pain Scale (CHIPPS) and the German version of the Parent's Postoperative Pain Measure (PPPM-D) are used to assess postoperative pain intensity in preschool children. However, they have shown low concordance in previous prospective studies on quality improvement. AIMS Our secondary analysis aimed to estimate the association strength between the pain score items and indication for rescue medication defined as CHIPPS ≥4 and/or PPPD-D ≥ 6. Thus, we intended to create a further developed pain instrument with fewer variables for easier routine use. METHODS We analyzed 1067 pain intensity assessments of hospitalized children for the development of our novel tool in two steps using modern statistical and machine-learning methods: (1) Boruta variable selection to analyze the association strength between CHIPPS score, PPPM-D items, age, weight, and elapsed time after surgery, including their interactions and pattern stability, and the binary outcome (analgesics required yes/no). (2) Symbolic regression to generate a short formula with the least number of variables and highest accuracy for rescue medication indication. RESULTS Additional analgesics were required in 19.96% of pain intensity assessments, whereby the PPPM-D showed higher variance than CHIPPS. Boruta identified PPPM-D score, CHIPPS score, 9 of the 15 PPPM-D variables, and time of assessment as associated with the indication for RM. Symbolic regression revealed that additional analgesics are required if CHIPPS is ≥4 OR PPPM-D item "less energy than usual" AND one of the items "more easily cry" or "more groan/moan" are answered with "yes." These PPPM-D items were not redundant and showed nonlinear course over time. The cross-validated accuracy for this assessment tool was 94.94%. CONCLUSIONS The new instrument is easy to use and may improve postoperative pain intensity assessment in children. However, it requires prospective validation in a new cohort.
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Affiliation(s)
- P Gude
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth-Hospital Bochum, Bochum, Germany
| | - N Geldermann
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth-Hospital Bochum, Bochum, Germany
| | - F Gustedt
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth-Hospital Bochum, Bochum, Germany
| | - C Grobe
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth-Hospital Bochum, Bochum, Germany
| | - T P Weber
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth-Hospital Bochum, Bochum, Germany
| | - A I Georgevici
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth-Hospital Bochum, Bochum, Germany
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16
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Russo E, Festa BM, Costantino A, Bernardocchi A, Spriano G, De Virgilio A. Postoperative Morbidity of Different Tonsillectomy Techniques: A Systematic Review and Network Meta-Analysis. Laryngoscope 2024; 134:1696-1704. [PMID: 37843298 DOI: 10.1002/lary.31116] [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: 05/07/2023] [Revised: 08/31/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To compare different tonsillectomy techniques in terms of postoperative bleeding incidence and postoperative pain. METHODS An arm-based network analysis was conducted using a Bayesian hierarchical model. The primary and secondary outcomes were postoperative bleeding incidence and mean postoperative pain score. RESULTS A total of 6464 patients were included for five different interventions (cold dissection tonsillectomy; extracapsular coblation tonsillectomy; intracapsular coblation tonsillectomy [ICT]; bipolar diathermy tonsillectomy [BDT]; monopolar diathermy tonsillectomy). ICT showed the lowest absolute risk (4.44%) of postoperative bleeding incidence (73.31% chance of ranking first) and the lowest mean postoperative pain score (1.74 ± 0.68) with a 94.0% chance of ranking first, whereas BDT showed both the highest absolute risk of bleeding incidence (10.75%) and the highest mean postoperative pain score (5.67 ± 1.43). CONCLUSIONS ICT seems to offer better postoperative outcomes, in terms of reduced risk of bleeding and reduced pain. Further prospective studies are advised to confirm these findings. LEVEL OF EVIDENCE NA Laryngoscope, 134:1696-1704, 2024.
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Affiliation(s)
- Elena Russo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Bianca Maria Festa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Alice Bernardocchi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
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17
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Sarathy A, An C, Bever T, Callas P, Fujii MH, Sajisevi M. Pain control is comparable between opioid versus non-opioid management after otolaryngology procedures. Laryngoscope Investig Otolaryngol 2024; 9:e1229. [PMID: 38525115 PMCID: PMC10960237 DOI: 10.1002/lio2.1229] [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: 10/16/2023] [Revised: 12/13/2023] [Accepted: 02/11/2024] [Indexed: 03/26/2024] Open
Abstract
Objective The current study aims to measure patient-reported satisfaction with pain control using opioid and non-opioid medications after undergoing the following otolaryngology procedures: parathyroidectomy, thyroid lobectomy, total thyroidectomy, and bilateral tonsillectomy. Materials and Methods A prospective cohort study was performed at an academic medical center that included a telephone questionnaire and chart review. Opioid prescriptions, usage, and patient-reported pain outcomes were recorded. Bivariate analyses were used to compare opioid and non-opioid users. Results Of the 107 total patients undergoing otolaryngology procedures included in the study, 49 (45.8%) used an opioid for pain management postoperatively and 58 (54.2%) did not. Among the 81 patients who underwent endocrine procedures (parathyroidectomy, total thyroidectomy/lobectomy), most patients reported being "very satisfied" or "satisfied" with pain control whether they used opioids (n = 27/30, 90%) or not (n = 50/51, 98%). Of the 26 patients who underwent bilateral tonsillectomy, 19 (73%) were prescribed opioids and among these, most (n = 17/19, 89%) reported they were "very satisfied" or "satisfied" with pain control. In the non-opioid usage group, all patients (n = 7/7, 100%) reported they were "satisfied" with pain control. There was no statistically significant difference in patient-reported satisfaction with pain control between opioid and non-opioid users for any of the procedures listed. Conclusion The results of our study suggest that patients who did not use opioids have a similar level of satisfaction with pain control compared to those using opioids after thyroid, parathyroid and tonsillectomy surgeries. Considering the magnitude of the opioid crisis, providers should reassess the need for opioid prescriptions following certain ENT procedures. Level of Evidence IV.
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Affiliation(s)
- Ashwini Sarathy
- Larner College of MedicineUniversity of VermontBurlingtonVermontUSA
| | - Clemens An
- Larner College of MedicineUniversity of VermontBurlingtonVermontUSA
| | - Ty Bever
- Larner College of MedicineUniversity of VermontBurlingtonVermontUSA
| | - Peter Callas
- Department of SurgeryUniversity of Vermont Medical CenterBurlingtonVermontUSA
| | - Mayo H. Fujii
- Department of SurgeryUniversity of Vermont Medical CenterBurlingtonVermontUSA
| | - Mirabelle Sajisevi
- Department of OtolaryngologyUniversity of Vermont Medical CenterBurlingtonVermontUSA
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18
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Chang HC, Lu HY, Guo YC, Lin CY, Chen SJ, Gau SY. Depression risk in chronic tonsillitis patients underwent tonsillectomy: a global federated health network analysis. Int J Med Sci 2024; 21:949-957. [PMID: 38616998 PMCID: PMC11008477 DOI: 10.7150/ijms.93977] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/21/2024] [Indexed: 04/16/2024] Open
Abstract
Background: Tonsillectomy is a common surgery in the US, with possible postoperative complications. While small studies indicate postoperative depressive symptoms may occur, large-scale evidence is lacking on the tonsillectomy-depression link. Methods: We conducted a retrospective cohort study using the TriNetX US collaborative network, offering de-identified electronic health data from 59 collaborative healthcare organizations (HCOs) in the United States. In this study, people being diagnosed of chronic tonsillitis between January 2005 and December 2017 were enrolled. Patients deceased, with previous record of cancers or psychiatric events before index date were excluded. 14,874 chronic tonsillitis patients undergoing tonsillectomy were propensity score matched 1:1 to controls for age, sex, and race. New-onset depression risks were evaluated over 5 years post-tonsillectomy and stratified by age and sex. Confounders were adjusted for including demographics, medications, comorbidities and socioeconomic statuses. Results: After matching, the difference of key baseline characteristics including age, sex, comedications status and obesity status was insignificant between tonsillectomy and non-tonsillectomy groups. Tonsillectomy had a 1.29 times higher 5-year depression risk versus matched controls (95% CI, 1.19-1.40), with elevated risks seen at 1 year (HR=1.51; 95% CI, 1.28-1.79) and 3 years (HR=1.30; 95% CI, 1.18-1.43). By stratifications, risks were increased for both males (HR=1.30; 95% CI, 1.08-1.57) and females (HR=1.30; 95% CI, 1.18-1.42), and significantly higher in ages 18-64 years (HR=1.37; 1.26-1.49), but no significance observed for those 65 years and older. After performing sensitivity analyses and applying washout periods of 6, 12, and 36 months, the outcome remained consistent with unadjusted results. Conclusion: This real-world analysis found tonsillectomy was associated with a 30% higher 5-year depression risk versus matched non-tonsillectomy patients with chronic tonsillitis. Further mechanistic research is needed to clarify the pathophysiologic association between depression and tonsillectomy. Depression is not commonly mentioned in the current post-tonsillectomy care realm; however, the outcome of our study emphasized the possibility of these suffering condition after operation. Attention to psychological impacts following tonsillectomy is warranted to support patient well-being, leading to better management of post-tonsillectomy individuals.
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Affiliation(s)
- Hui-Chin Chang
- Evidence-based Medicine Center, Chung Shan Medical University Hospital, Taichung, Taiwan
- Library, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hsin-Yo Lu
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Chen Guo
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chen-Yu Lin
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shiu-Jau Chen
- Department of Neurosurgery, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Shuo-Yan Gau
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Orthopedics Department, Chi-Mei Medical Center, Tainan, Taiwan
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19
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Heward E, Rocke J, McNally G, Thompson G, Oladokun D, Timms S, Abbas JR, Chu MMH, Akbar S, Dobbs S, Chudek D, Jaiswal I, Vora D, Harrison A, Oremule B, Sarwar S, Menon SS, Advani R, Daniels J, Ellis S, Abdelaziz M, Husain P, Anmolsingh R, Venugopal A, Beena M, Sheik-Ali S, Saeed H, Shenton C, Ghosh S, Khwaja S, Kumar N. The post-operative tonsillectomy (POPT) study: A multi-centre prospective paediatric cohort study. Clin Otolaryngol 2024; 49:176-184. [PMID: 37915294 DOI: 10.1111/coa.14110] [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: 02/18/2023] [Revised: 06/01/2023] [Accepted: 09/23/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES Tonsillectomy is the most common operation performed by otolaryngologists in the UK, despite this we have a poor understanding of the post-operative recovery. We aimed to investigate post-operative bleeding and pain following paediatric tonsillectomy using a patient diary. DESIGN Prospective observational cohort study. SETTING Multi-centre study involving 12 secondary and tertiary otolaryngology units across the North of England. Patients were recruited from 1st March 2020 to 30th June 2022. Multilevel ordered logistic regression model statistics were performed. PARTICIPANTS Children (≥4 years, ≤16 years) undergoing tonsillectomy (with or without adenoidectomy) for benign pathology. MAIN OUTCOME MEASURES Frequency and severity of post-operative bleeding. Intensity and pattern of post-operative pain. RESULTS In total 297 children were recruited, with 91 (30.6%) diaries eligible for analysis. Post-operative bleeding occurred in 44% of children. Most frequently blood in the saliva was reported (82.9%). Increasing age significantly increased bleeding odds by 17% per year (p = .001). Bleeding frequency decreased with higher surgeon grade (p = .003) and when performing intracapsular coblation tonsillectomy (p = .02) compared with other techniques. Lower age and intracapsular coblation tonsillectomy, against other techniques, significantly reduced rates of pain post-operatively (p < .0001 and p = .0008). CONCLUSION A high level of low-level post-operative bleeding was observed. Pain scores remained high for 5 days post-operatively then gradually reduce to normal by day 13. Intracapsular coblation tonsillectomy appears to be superior to all other techniques in terms of reducing post-operative bleeding and pain. These findings should be used to guide patients in the consent process to inform them of the expected nature of post-surgical recovery.
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Affiliation(s)
- Elliot Heward
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - John Rocke
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - George McNally
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | | | - Dare Oladokun
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | | | | | - Michael M H Chu
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Sarah Akbar
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Sian Dobbs
- Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Dorota Chudek
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Ishank Jaiswal
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Devan Vora
- East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Anna Harrison
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Safdar Sarwar
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Rajeev Advani
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | | | - Sarah Ellis
- Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Mohammed Abdelaziz
- Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | | | - Rajesh Anmolsingh
- Manchester University NHS Foundation Trust, Manchester, UK
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | - Meera Beena
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Shirwa Sheik-Ali
- Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Haroon Saeed
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Catriona Shenton
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Samit Ghosh
- Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Sadie Khwaja
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Nirmal Kumar
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
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20
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Andrade-Carmona VR, Carmona-Araiza LG, Soria-Cespedes D, Gómez-Virgilio L, López-Toledo G. Kaposi Sarcoma Mimicking a Lingual Lesion in an HIV-Negative Patient: A Case Report. Cureus 2024; 16:e57131. [PMID: 38681393 PMCID: PMC11055566 DOI: 10.7759/cureus.57131] [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: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Tonsillar Kaposi sarcoma is rare, reported in patients with human immunodeficiency virus (HIV) infection. This case report of a tonsillar Kaposi sarcoma (KS) in an HIV-negative male patient, initially misinterpreted as a lingual lesion diagnosed with KS following tonsillectomy, highlights the value of a differential diagnosis in atypical presentations. The case report discusses the etiologic agent of KS, its detection and treatment, and a few case reports about tonsillar KS with no association with AIDS. The case underscores the diagnostic challenge of oropharyngeal lesions, particularly in patients with risk factors but negative HIV status.
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21
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Iftikhar H, Zahid N, Zubair A, Wasif M, Baig NN, Abid K, Awan MO, Awan MS. Change in mean postoperative pain in patients undergoing tonsillectomy with cold water versus usual practice: A pragmatic trial. World J Otorhinolaryngol Head Neck Surg 2024; 10:24-28. [PMID: 38560032 PMCID: PMC10979038 DOI: 10.1002/wjo2.102] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/05/2023] [Accepted: 05/08/2023] [Indexed: 04/04/2024] Open
Abstract
Introduction Tonsillectomy is one of the most common procedures performed in otolaryngology. There are various methods to perform tonsillectomies (cold and hot). Thermal damage and inflammation of the surrounding tissue using monopolar cautery is said to point to increased pain whereas immediate cooling of the burnt area is thought to reduce pain owing to heat dissipation. Our objective was to determine the difference in mean post-tonsillectomy pain scores among patients irrigated with cold water (4°C) and in patients not irrigated with cold water. Material and Methods A quasi-experimental trial was conducted from January 2016 to December 2017 at a tertiary care hospital. All tonsillectomies were carried out with monopolar cautery at a power of 20 W. Patients either received cold water irrigation post tonsillectomy of the tonsillar bed (intervention arm) or no irrigation (control arm). The pain score was measured on Days 0, 1, 3, 5, and 7. Pain scores were charted on a visual analog scale on the respective days. Results Seventy-eight patients were included in the study. The mean age of our patients was 10.26 (4.24) years old in the intervention arm, and 11.95 (4.19) years old in the control arm. It was observed that the pain was significantly lower in patients with cold water irrigation of the tonsillar fossa on Days 1, 3, 5, and 7 (p = 0.001). There were no readmissions postprocedure and none of our patients developed any complications postsurgery. Conclusions In this trial, we report a reduced pain score at all days of observation in the intervention group. Irrigation of the tonsillar fossa is a safe, cost-effective, and less technically demanding technique that could be employed to reduce postoperative pain. Further studies with randomization, blinding and a larger sample size could further improve on our results.
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Affiliation(s)
- Haissan Iftikhar
- Department of OtolaryngologyQueen Elizabeth HospitalBirminghamUK
| | - Nida Zahid
- Department of SurgeryAga Khan University HospitalKarachiPakistan
| | - Adan Zubair
- Department of SurgeryAga Khan University HospitalKarachiPakistan
| | - Mohammad Wasif
- Department of SurgeryAga Khan University HospitalKarachiPakistan
| | - Nabeel N. Baig
- Department of SurgeryAga Khan University HospitalKarachiPakistan
| | - Khadijah Abid
- College of Physicians and SurgeonsHigher Education CommissionKarachiPakistan
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22
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Thakrar J, Patel A, Joseph J. UK national survey on surgical gowning for tonsillectomy. J Laryngol Otol 2024:1-4. [PMID: 38563203 DOI: 10.1017/s0022215124000331] [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: 04/04/2024]
Abstract
OBJECTIVE Tonsillectomy is a common procedure performed nationally. The personal protective equipment and surgical gowning practices used during this procedure vary widely. We compiled a survey of ENT specialists to gain a national opinion about gowning in tonsillectomy with the aim of determining whether we could make it more environmentally friendly whilst maintaining the highest safety standards. METHOD We developed a nine-question survey that was piloted prior to final implementation. The questionnaire was sent to senior registrars and consultant otolaryngologists in the UK. RESULTS The survey was completed by a total of 63 ENT specialists. It was found that 82.54 per cent of clinicians would consider wearing a reusable gown that would be sterilised between each procedure. CONCLUSION Our survey suggests most ENT clinicians would consider using a more environmentally friendly surgical gown and some may even consider wearing no gown at all, although many are understandably concerned about the transmission of infection or blood splatter.
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Affiliation(s)
- Jai Thakrar
- School of Medicine, University College London, London, UK
| | - Ankit Patel
- ENT Department, University College London Hospital, London, UK
| | - Jonathan Joseph
- ENT Department, University College London Hospital, London, UK
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23
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Fan ZT, Wang XX, Dong WX, Qiao T, Liu JR, Wang YT, Liu CB. Oropharyngeal Stenosis Caused by Significant Scar Hyperplasia Following Tonsillectomy: A Case Report. Ear Nose Throat J 2024:1455613241233750. [PMID: 38357741 DOI: 10.1177/01455613241233750] [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: 02/16/2024] Open
Abstract
Oropharyngeal stenosis (OPS) is a relatively rare long-term complication of tonsillectomy in children, resulting from the narrowing of the upper aerodigestive tract between the soft palate, pharyngeal sidewalls, and base of the tongue. This is the first reported case of OPS due to significant scar hyperplasia; however, whether it is as prone to recurrence as skin scar hypertrophy remains unknown. In this article, we present the case of a 5-year-old girl who presented to our otolaryngology clinic with sleep snoring and suffocation. Her medical history included tonsillectomy and adenoidectomy, performed 3 years prior to presentation. The patient underwent a combination of surgery and administration of triamcinolone injections, resulting in significant symptomatic improvement. To date, no signs of recurrence have been reported.
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Affiliation(s)
- Zhi-Tao Fan
- Department of Otorhinolaryngology, Hebei Eye Hospital, Xingtai, Hebei Province, China
| | - Xue-Xia Wang
- Department of Otorhinolaryngology, Hebei Eye Hospital, Xingtai, Hebei Province, China
| | - Wen-Xin Dong
- Department of Otorhinolaryngology, Hebei Eye Hospital, Xingtai, Hebei Province, China
| | - Tong Qiao
- Department of Otorhinolaryngology, Hebei Eye Hospital, Xingtai, Hebei Province, China
| | - Jing-Rui Liu
- Department of Otorhinolaryngology, Hebei Eye Hospital, Xingtai, Hebei Province, China
| | - Yue-Tang Wang
- Department of Otorhinolaryngology, Hebei Eye Hospital, Xingtai, Hebei Province, China
| | - Chao-Bing Liu
- Department of Otorhinolaryngology, Hebei Eye Hospital, Xingtai, Hebei Province, China
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24
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Dobrina R, Starec A, Brunelli L, Orzan E, De Vita C, Bicego L, Ronfani L, Castro V, Di Rocco P, Zanchiello S, Dal Cin M, Tagliapietra B, Cinello M, Fontanot D, Stampalija T, Dante A, Petrucci C, Cassone A. Applying the Participatory Slow Design Approach to a mHealth Application for Family Caregivers in Pediatric Ear, Nose, and Throat Surgery. Healthcare (Basel) 2024; 12:442. [PMID: 38391818 PMCID: PMC10888311 DOI: 10.3390/healthcare12040442] [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: 11/29/2023] [Revised: 01/15/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
Pediatric ear, nose, and throat (ENT) surgery is very common, and its outcomes may improve with family education. In this regard, mobile health (mHealth) applications (apps), which are on the rise due to digital transformation, can be beneficial in healthcare. This study outlines the user-centered design and development of a mHealth app (version 5.15.0) to support family caregivers during the perioperative process of pediatric ENT surgery. Conducted over two years in an Italian maternal and child health hospital (January 2020-May 2022), the study employed a participatory design method based on the Information System Research (ISR) framework and guided by the principles of Slow Medicine. Utilizing the Relevance, Rigor, and Design cycles of the ISR framework, the mHealth app's content, functionalities, and technical features were defined and developed. A committee of fifteen experts guided the process with input from 25 family caregivers and 24 healthcare providers enrolled in the study. The mHealth app content was structured around five crucial educational moments characterizing the ENT perioperative period, providing evidence-based information on surgical procedures, strategies for preparing children for hospitalization and surgery, pain management, and post-discharge care. The mHealth app featured a function that sends customized notifications to guide caregivers at specific perioperative stages. The development of mHealth apps by implementing a rigorous, participatory, and Slow design process can foster accessible and family-centered information and care in the field of maternal and child health and beyond.
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Affiliation(s)
- Raffaella Dobrina
- Healthcare Professions Directorate, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | | | - Laura Brunelli
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Eva Orzan
- Audiology and Otorhinolaryngology Unit, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | | | - Livia Bicego
- Healthcare Professions Directorate, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | - Veronica Castro
- Audiology and Otorhinolaryngology Unit, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | - Paola Di Rocco
- Surgery Unit, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | | | - Margherita Dal Cin
- Department of Health Prevention, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy
| | - Benedetta Tagliapietra
- Surgery Unit, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | | | - Donatella Fontanot
- Public Relations Office, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | - Tamara Stampalija
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | - Angelo Dante
- Department of Health, Life and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Cristina Petrucci
- Department of Health, Life and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Andrea Cassone
- Healthcare Professions Directorate, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
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25
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Meiklejohn DA, Khan ZH, Nuñez KM, Imhof L, Osmani S, Benavidez AC, Tarefder R. Environmental Impact of Adult Tonsillectomy: Life Cycle Assessment and Cost Comparison of Techniques. Laryngoscope 2024; 134:622-628. [PMID: 37421241 DOI: 10.1002/lary.30866] [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: 05/04/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES To quantify and compare the cost and environmental impact of different techniques for adult tonsillectomy surgery, and to identify target areas for impact reduction. METHODS Fifteen consecutive adult tonsillectomy surgeries were prospectively randomized to one of three tonsillectomy techniques: cold, monopolar electrocautery, or low-temperature radiofrequency ablation (Coblation). Life cycle assessment was used to comprehensively evaluate the environmental impact of study surgeries. Outcomes assessed included multiple measures of environmental impact, including greenhouse gas (GHG) emissions, and cost. Environmental impact measures were analyzed to identify highest-yield areas for improvement, and outcomes were compared between surgical techniques using statistical analysis. RESULTS GHG emissions for cold, monopolar electrocautery, and Coblation techniques were 157.6, 184.5, and 204.7 kilograms of carbon dioxide equivalents (kgCO2 -eq) per surgery, respectively, with costs totaling $472.51, $619.10, and $715.53 per surgery, respectively. Regardless of surgery technique, anesthesia medications and disposable equipment contributed most to environmental harm. Cold technique demonstrated reduced environmental impact related to disposable surgical equipment in the categories of greenhouse gas emissions, acidification of soil and water, eutrophication of air, ozone depletion, release of carcinogenic, and non-carcinogenic toxic substances, and respiratory pollutant production (p < 0.05 for all comparisons with other techniques). CONCLUSION Within the boundaries of operating room processes, cold technique minimizes cost and environmental impact of adult tonsillectomy surgery, with statistical significance noted in the impact of disposable surgical equipment. Areas of highest potential for improvement identified include reducing use of disposable equipment and collaboration with the Anesthesiology care team to streamline medication use. LEVEL OF EVIDENCE 2, randomized trial Laryngoscope, 134:622-628, 2024.
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Affiliation(s)
- Duncan A Meiklejohn
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico Hospital, Albuquerque, New Mexico, U.S.A
| | - Zafrul H Khan
- Department of Civil Engineering, University of New Mexico, Albuquerque, New Mexico, U.S.A
| | - Karyn M Nuñez
- Alaska Native Tribal Health Consortium, Providence Anchorage Anesthesia Medical Group, Anchorage, Alaska, U.S.A
| | - Lee Imhof
- Department of Planning and Construction, University of New Mexico Hospital, Albuquerque, New Mexico, U.S.A
| | - Sabah Osmani
- University of New Mexico School of Medicine, Albuquerque, New Mexico, U.S.A
| | - Amaris C Benavidez
- University of New Mexico School of Medicine, Albuquerque, New Mexico, U.S.A
| | - Rafiqul Tarefder
- Department of Civil Engineering, University of New Mexico, Albuquerque, New Mexico, U.S.A
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26
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Engelhardt T, Kaspy KR, Daniel SJ. Measuring immediate surgical success in children undergoing adeno tonsillectomy. Br J Anaesth 2024; 132:234-236. [PMID: 38104005 DOI: 10.1016/j.bja.2023.11.025] [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: 10/30/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Adenotonsillectomy is the most common indication for sleep-disordered breathing in children. Measuring pharyngeal closing pressures in anaesthetised children allows identification of severe obstructive sleep apnoea. This technique could help quantify immediate surgical impact and risk stratify postoperative treatment in these patients.
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Affiliation(s)
- Thomas Engelhardt
- Department of Anesthesiology, Montreal Children's Hospital, McGill University, Montreal, QC, Canada.
| | - Kimberley R Kaspy
- Department of Pediatrics, Respiratory Medicine, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Samuel J Daniel
- Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, QC, Canada; Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
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27
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Serrano C, Bedini I, Demarchi MV. Bilateral peritonsillar abscess. A case report and review of controversies surrounding diagnosis and management. ARCH ARGENT PEDIATR 2024; 122:e202303034. [PMID: 37382552 DOI: 10.5546/aap.2023-03034.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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
The bilateral presentation of peritonsillar abscess is uncommon. Its management is controversial and it has been argued whether a quinsy tonsillectomy or an interval tonsillectomy should be performed. Here we describe the case of a 14-year-old boy with sore throat, trismus, and fever. He had bilateral tonsillar hypertrophy, convex arches, and soft palate edema. Computed tomography: bilateral tonsillar hypertrophy, with post-contrast enhancement, both with collection, edema with moderate pharyngeal stenosis. The patient was hospitalized for intravenous therapy and tonsillectomy with bilateral drainage resulting in a complete resolution of his condition and discharge at 48 hours. In the presence of a peritonsillar abscess, an unsuspected contralateral abscess should be considered. It should be diagnosed and managed adequately to prevent complications. Quinsy tonsillectomy could be safe and should be considered in patients who will undergo anesthesia for abscess drainage. The final decision should be made for each patient on an individual basis.
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Affiliation(s)
| | - Ivo Bedini
- Hospital Italiano de Buenos Aires, City of Buenos Aires, Argentina
| | - María V Demarchi
- Hospital Italiano de Buenos Aires, City of Buenos Aires, Argentina
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28
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Amin SN, Thompson T, Wang X, Goldklang S, Martin LD, Low DKW, Parikh SR, Sie KC, Dahl JP. Reducing Pediatric Post tonsillectomy Opioid Prescribing: A Quality Improvement Initiative. Otolaryngol Head Neck Surg 2024; 170:610-617. [PMID: 37747042 PMCID: PMC10841103 DOI: 10.1002/ohn.534] [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: 03/07/2023] [Revised: 08/21/2023] [Accepted: 09/03/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE Postoperative pain is the most common morbidity associated with tonsillectomy. Opioids are frequently used in multimodal posttonsillectomy analgesia regimens; however, concerns regarding respiratory depression, drug-drug interactions, and medication misuse necessitate responsible opioid stewardship among prescribing surgeons. It is unclear if intentionally reducing opioid prescription doses negatively affects the patient experience. METHODS A quality improvement team reviewed all posttonsillectomy opioid prescriptions at a pediatric ambulatory surgery center between January and June 2021 (preintervention, 163 patients). Following this review, we performed an opioid education session for surgeons and studied opioid prescribing habits between July and December 2021 (Plan-Do-Study-Act [PDSA] 1, 152 patients). We then implemented a standardized prescription protocol of 7 doses of oxycodone per patient and again reviewed prescriptions between January and June 2022 (PDSA 2, 178 patients). The following measures were evaluated: initial number of opioid doses prescribed, need for refills, 7-day emergency department (ED) visits, and readmissions. RESULTS Each intervention reduced the average number of initial oxycodone doses per patient (12.2 vs 9.2 vs 6.9 doses, P < .001). There were no changes in the rate of refill requests, 7-day ED visits, and readmissions, by descriptive or Statistical Process Control analyses. DISCUSSION In 2 PDSA cycles, we achieved a 43% reduction in the number of doses of oxycodone prescribed following tonsillectomy. We did not observe any increased rates in balancing measures, which are surrogates for unintentional effects of PDSA changes, including refills, ED presentations, and readmission rates. IMPLICATIONS FOR PRACTICE Directed provider education and standardized posttonsillectomy prescription protocols can safely decrease postoperative opioid prescribing. Further PDSA cycles are required to consider even fewer opioid prescription doses.
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Affiliation(s)
- Shaunak N Amin
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Trey Thompson
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Xing Wang
- Department of Biostatistics, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Samantha Goldklang
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Lynn D Martin
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Daniel K-W Low
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Sanjay R Parikh
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kathleen C Sie
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - John P Dahl
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA
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29
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Lin H, Hajarizadeh B, Wood AJ, Selvarajah K, Ahmadi O. Postoperative Outcomes of Intracapsular Tonsillectomy With Coblation: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2024; 170:347-358. [PMID: 37937711 DOI: 10.1002/ohn.573] [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: 06/05/2023] [Revised: 09/10/2023] [Accepted: 10/07/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE Following tonsillectomy, postoperative pain and hemorrhage from the tonsillar bed are causes of significant morbidity. Intracapsular tonsillectomy with Coblation is suggested to minimize such morbidity while remaining efficacious in long-term outcomes. This systematic review and meta-analysis assessed short-term morbidity and long-term outcomes from intracapsular tonsillectomy with Coblation, focusing primarily on posttonsillectomy hemorrhage. DATA SOURCES Medline, Embase, and the Cochrane Library. REVIEW METHODS Guided by PRISMA guidelines, studies on intracapsular tonsillectomy with Coblation published between December 2002 and July 2022 evaluating frequency of posttonsillectomy hemorrhage were screened. Studies without primary data were excluded. Meta-analysis was conducted using the random-effect model. The primary outcome was the proportion of patients who experienced posttonsillectomy hemorrhage. The secondary outcomes were posttonsillectomy pain, the proportion requiring revision tonsillectomy, and severity of sleep-disordered breathing measured by polysomnography outcomes. RESULTS From 14 studies there were 9821 patients. The proportion of total posttonsillectomy hemorrhage was 1.0% (95% confidence interval [CI] 0.5%-1.6%, n = 9821). The proportion experiencing primary hemorrhage, secondary hemorrhage, and those requiring further tonsil surgery were 0.1% (95% CI 0.0%-0.1%; study n = 7), 0.8% (95% CI 0.2%-1.4%; study n = 7), and 1.4% (95% CI 0.6%-2.2%; study n = 6), respectively. Mean reduction in apnea-hypopnea index was -16.0 events per hour (95% CI -8.8 to -23.3, study n = 3) and mean increase in oxygen nadir was 5.9% (95% CI 2.6%-9.1%, study n = 3). CONCLUSION Intracapsular tonsillectomy with Coblation has been demonstrated to have a low rate of posttonsillectomy hemorrhage. Data regarding long-term tonsil regrowth and need for reoperation were encouraging of the efficacy of this technique.
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Affiliation(s)
- Huiying Lin
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
| | - Behzad Hajarizadeh
- The Kirby Institute, University of New South Wales (UNSW Sydney), Sydney, New South Wales, Australia
| | - Andrew James Wood
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
- Department of Otolaryngology and Head and Neck Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Kumanan Selvarajah
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
- Department of Otolaryngology and Head and Neck Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Omid Ahmadi
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
- Department of Otolaryngology and Head and Neck Surgery, Waikato Hospital, Hamilton, New Zealand
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30
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Buono P, Maines E, Azzolini N, Franceschi R, Ludovica F, Leonardi L, Occhiati L, Mozzillo E, Maffeis C, Marigliano M. Short-Term Weight Gain after Tonsillectomy Does Not Lead to Overweight: A Systematic Review. Nutrients 2024; 16:324. [PMID: 38276561 PMCID: PMC10819022 DOI: 10.3390/nu16020324] [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: 12/18/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Different studies and systematic reviews have reported weight increase after tonsillectomy. However, the odds of a child being overweight or obese after tonsillectomy were no different than before surgery, according to a few studies. This systematic review aims to analyze the impact of adenotonsillectomy (TA) on weight gain and identify subgroups of children and adolescents at risk of experiencing weight gain. A systematic search included studies published in the last ten years. The PICO framework was used in the selection process, and evidence was assessed using the GRADE system. A total of 26 studies were included, and moderate-high level quality ones showed that children who underwent TA could present an increase in BMI z-score. However, this weight gain was significant in individuals younger than six years old and was considered catch-up growth in underweight subjects at baseline. In contrast, for normal-weight or overweight individuals, TA did not lead to overweight per se. At the same time, diet changes and overfeeding did not have a leading role in weight gain. In conclusion, TA may not be an independent risk factor for unfavorable weight gain in children; however, individuals who were underweight pre-operatively or younger than six years reported more weight gain after TA than expected.
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Affiliation(s)
- Pietro Buono
- Directorate General of Health, Campania Region, 80131 Naples, Italy;
| | - Evelina Maines
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Azienda Provinciale per i Servizi Sanitari del Trentino, 38122 Trento, Italy; (E.M.); (N.A.); (L.L.)
| | - Nicolò Azzolini
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Azienda Provinciale per i Servizi Sanitari del Trentino, 38122 Trento, Italy; (E.M.); (N.A.); (L.L.)
| | - Roberto Franceschi
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Azienda Provinciale per i Servizi Sanitari del Trentino, 38122 Trento, Italy; (E.M.); (N.A.); (L.L.)
| | - Fedi Ludovica
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80131 Naples, Italy; (F.L.); (L.O.)
| | - Letizia Leonardi
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Azienda Provinciale per i Servizi Sanitari del Trentino, 38122 Trento, Italy; (E.M.); (N.A.); (L.L.)
| | - Luisa Occhiati
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80131 Naples, Italy; (F.L.); (L.O.)
| | - Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80131 Naples, Italy; (F.L.); (L.O.)
| | - Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy; (C.M.); (M.M.)
| | - Marco Marigliano
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy; (C.M.); (M.M.)
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Kashiwazaki R, Jensen AM, Haemer M, Friedman NR. The Effects of Adeno tonsillectomy for Obstructive Sleep Apnea on Growth Trajectory in Children With Obesity. Otolaryngol Head Neck Surg 2024; 170:277-283. [PMID: 37668178 DOI: 10.1002/ohn.512] [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: 05/24/2023] [Revised: 08/01/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE To analyze the growth trajectory of children with obesity before and after adenotonsillectomy (T&A). We hypothesize that T&A will not affect the growth trajectory but children in a multidisciplinary weight management program (MWMP) will have a healthier growth trajectory. STUDY DESIGN Retrospective review. SETTING Tertiary Children's Hospital. METHODS Body mass index (BMI) trajectories of nonsyndromic children with obesity and obstructive sleep apnea (OSA) who underwent T&A were analyzed. A linear mixed effects model was fit to the BMI expressed as a percentage of the 95th percentile (%BMIp95 ) data. Covariates included demographic variables, pre- and postoperative participation in an MWMP, baseline obesity class, and time. We explored clinically meaningful interactions. BMI slope estimates before and after surgery were calculated and compared for baseline obesity classification and postoperative MWMP visits. RESULTS A total of 177 patients, 58% male with a mean age of 9.7 years at the time of surgery, were studied. Higher baseline obesity class (II and III), time, the interaction between obesity class III and elapsed time relative to surgical date, and the interaction between obesity class III and the postsurgical period were all significantly associated with the outcome of %BMIp95 (P < .05). There was a significantly higher %BMIp95 trajectory following surgery in patients with baseline obesity class III who did not have any postoperative MWMP visits (P < .001). Preoperative obesity visits, however, were not significantly associated with postoperative growth. CONCLUSION The association between T&A and weight trajectory depends upon obesity class and participation in a MWMP. Coordinated care of children with obesity between otolaryngologists and an MWMP may improve OSA and obesity outcomes. LEVEL OF EVIDENCE The level of evidence: 3.
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Affiliation(s)
- Ryota Kashiwazaki
- Department of Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Alexandria M Jensen
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Matthew Haemer
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Norman R Friedman
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
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Modir H, Moshiri E, Naghavi F. Efficacy of peritonsillar infiltration with dexmedetomidine versus tramadol in comparison to placebo for pain control and sedation after tonsillectomy in pediatric patients: A randomized clinical trial. Natl J Maxillofac Surg 2024; 15:40-46. [PMID: 38690235 PMCID: PMC11057600 DOI: 10.4103/njms.njms_507_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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 07/26/2022] [Accepted: 08/09/2023] [Indexed: 05/02/2024] Open
Abstract
Objective This article aimed to assess the efficacy of peritonsillar infiltration with dexmedetomidine-ropivacaine versus tramadol-ropivacaine for pain control and sedation after tonsillectomy in pediatric patients. Materials and Methods This double-blind clinical trial recruited 99 eligible children (4-8 years old) undergoing tonsillectomy and assigned to three block-randomized groups, receiving dexmedetomidine-ropivacaine (group A), tramadol-ropivacaine (group B), or placebo-ropivacaine (group C). The vital signs included blood pressure, heart rate, and SaO2 before anesthesia induction, during surgery at regular intervals until 24 h after surgery. The duration of surgery and recovery, complications, and analgesic consumption were recorded and pain scores were measured by Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Oucher scales as well as sedation scores by the Wilson sedation scale. Data were analyzed within SPSS 20 at a significance level of 0.05. Results The lowest pain scores were measured by the CHEOPS scale in the dexmedetomidine-ropivacaine group (P < 0.05). Statistically significant difference was observed in the CHEOPS pain score between the first two groups at 30 min, 1 h, 2 h, and 4 h after surgery (P < 0.01). The differences were revealed in the Oucher pain assessments among all groups from the time of recovery to four postoperative hours (P < 0.05), with the lowest in the dexmedetomidine-ropivacaine group whose sedation score was greater during recovery and 5 min after surgery (P < 0.05). Subjects in tramadol group had six cases of dizziness and nausea, while no side effects were observed in two other groups (P < 0.05). Only seven participants receiving dexmedetomidine required acetaminophen, but 29 in the tramadol group and all in the placebo group demanded to receive acetaminophen (P = 0.001). Conclusion The authors concluded that dexmedetomidine as an adjuvant to ropivacaine has better performance in local infiltration for intra- and post-tonsillectomy analgesia and postoperative sedation, without any special side effects (like the placebo group), and that it hence is recommended to be used for local infiltration during tonsillectomy.
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Affiliation(s)
- Hesameddin Modir
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Valiasar Hospital, Arak University of Medical Sciences, Arak, Iran
| | - Esmail Moshiri
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Valiasar Hospital, Arak University of Medical Sciences, Arak, Iran
| | - Faezeh Naghavi
- Students Research Committee, Departments of Anesthesiology and Critical Care, Valiasar Hospital, Arak University of Medical Sciences, Arak, Iran
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Takami K, Tsuji S, Jokoji R, Okubo Y, Higashiyama M. Paediatric pustulotic arthro-osteitis patient with an IL36RN variant, heterozygous c.115+6T>C, who was successfully treated with tonsillectomy: A case report and literature review. Exp Dermatol 2024; 33:e15016. [PMID: 38284206 DOI: 10.1111/exd.15016] [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: 11/20/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 01/30/2024]
Abstract
Pustulotic arthro-osteitis (PAO) is an infrequent condition, with its manifestation in children being even rare. Some reports propose an association between genetic variants and the onset of PAO. Currently, no definitive treatment protocol exists for paediatric patients with PAO. In this study, we present the paediatric case of PAO with an IL36RN variant who was successfully treated with tonsillectomy.
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Affiliation(s)
- Kenji Takami
- Department of Orthopaedic Surgery, Nippon Life Hospital, Osaka, Japan
| | - Shigeyoshi Tsuji
- Department of Rehabilitation, Nippon Life Hospital, Osaka, Japan
- Department of Psoriasis Center, Nippon Life Hospital, Osaka, Japan
| | - Ryu Jokoji
- Department of Pathology, Nippon Life Hospital, Osaka, Japan
| | - Yukari Okubo
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Mari Higashiyama
- Department of Psoriasis Center, Nippon Life Hospital, Osaka, Japan
- Department of Dermatology, Nippon Life Hospital, Osaka, Japan
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Nixon GM, Horne RSC. Untangling the relationship between childhood risk factors and obstructive sleep apnoea in adulthood. Respirology 2024; 29:14-15. [PMID: 37771297 DOI: 10.1111/resp.14608] [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: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023]
Abstract
See related article
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Affiliation(s)
- Gillian M Nixon
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Rosemary S C Horne
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
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Shimizu Y, Tomino Y, Suzuki Y. IgA Nephropathy: Beyond the Half-Century. Medicina (Kaunas) 2023; 60:54. [PMID: 38256315 PMCID: PMC10821440 DOI: 10.3390/medicina60010054] [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] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/06/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
Abstract
In 1968, Jean Berger first introduced the medical world to IgA nephropathy (IgAN). Fifty-five years later, its pathogenesis is still unclear, but treatments such as renin-angiotensin-aldosterone system inhibitors (RAAS-Is), tonsillectomies, and glucocorticoids are currently used worldwide. There have been great strides in the past 20 years since the discoveries of the specific dysregulation of mucosal immunity, galactose-deficient IgA1 (Gd-IgA1), and Gd-IgA1 immune complexes in patients with IgAN. According to these findings, a multi-hit hypothesis was developed, and this multi-hit hypothesis has provided several putative therapeutic targets. A number of novel agents, including molecularly targeted drugs for targets such as APRIL, plasma cells, complement systems, and endothelin, are undergoing clinical trials. Some candidate drugs have been found to be effective, with minimal side effects. Over half a century after the discovery of IgAN, these therapies will soon be available for clinical use.
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Affiliation(s)
- Yoshio Shimizu
- Division of Nephrology, Department of Internal Medicine, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni 410-2295, Shizuoka, Japan
- Shizuoka Research Center for Disaster Medicine, Juntendo University, Izunokuni 410-2295, Shizuoka, Japan
| | - Yasuhiko Tomino
- Asian Pacific Renal Research Promotion Office, Medical Corporation SHOWAKAI, 3-12-12 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan;
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Park SJ, Lee SY, Jung HJ, Park MW, Choi HG, Kim H, Wee JH. Association between Tonsillectomy and Cardiovascular Diseases in Adults. J Pers Med 2023; 14:16. [PMID: 38276231 PMCID: PMC10817544 DOI: 10.3390/jpm14010016] [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: 11/24/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
This study aimed to evaluate the association between tonsillectomy and cardiovascular diseases (CVDs) in the Korean adult population. Using data from the 2002-2015 Korean National Health Insurance Service-Health Screening Cohort, a total of 1082 participants aged 40 years or older who had undergone tonsillectomy were matched with 4328 control individuals for age, sex, income, and region of residence. We evaluated the incidence of CVDs in both the tonsillectomy and control groups and calculated the hazard ratios (HRs) of stroke, ischemic heart disease (IHD), and heart failure (HF) for participants who underwent tonsillectomy using a stratified Cox proportional hazard model. The incidence rates of stroke (81.3 vs. 46.6 per 10,000 person-years) and IHD (112.3 vs. 64.9 per 10,000 person-years) were significantly higher in patients who had undergone tonsillectomy than in the control group. After adjustment, the tonsillectomy group exhibited a 1.78-fold and 1.60-fold higher occurrence of stroke (CI = 1.32-2.42, p < 0.001) and IHD (CI = 1.24-2.08, p < 0.001), respectively, compared to the control group. However, there was no significant difference in the incidence rate of tonsillectomy and control groups (11.1 vs. 6.1 per 10,000 person-years). The HR of HF did not differ significantly between the tonsillectomy and control groups in the adjusted model (p = 0.513). We identified a significant relationship between a history of tonsillectomy and occurrence of stroke/IHD in the Korean adult population.
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Affiliation(s)
- Sung Joon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong 14353, Republic of Korea;
| | - Sei Young Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Republic of Korea;
| | - Hahn Jin Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, Republic of Korea;
| | - Min Woo Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangdong Sacred Heart Hospital, Seoul 05355, Republic of Korea;
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Mdanalytics, Suseoseoulent Clinic, Seoul 06349, Republic of Korea;
| | - Heejin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Jee Hye Wee
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
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Odhagen E, Alm F, Axelsson S, Hemlin C, Nerfeldt P, Stalfors J, Sunnergren O. Long-term complications after tonsil surgery: an analysis of 54,462 patients from the Swedish Quality Register for Tonsil Surgery. Front Surg 2023; 10:1304471. [PMID: 38148748 PMCID: PMC10749945 DOI: 10.3389/fsurg.2023.1304471] [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: 09/29/2023] [Accepted: 11/21/2023] [Indexed: 12/28/2023] Open
Abstract
Objective This study aims to evaluate long-term complications after tonsil surgery using an exploratory retrospective cohort study design based on data from the Swedish Quality Register for Tonsil Surgery (SQTS). Methods All patients registered in the SQTS between 1 January 2009 and 31 May 2021 were eligible for the study. In this study, a long-term complication is defined as any complication persisting for a minimum of 6 months after surgery. The definition of a complication was based on individual patient reports, provided in a free text format, of any remaining issues 6 months after tonsil surgery. Complications were categorized as follows: disturbed taste or sense of smell, dysphagia, miscellaneous and general symptoms and signs, miscellaneous throat problems, pain or discomfort in the mouth or throat, problems with jaws or teeth, problems with the ears or hearing, problems with the nose or sinuses, problems with throat secretions or throat clearing, problems with voice or speech, and sensory symptoms. A multivariable logistic regression analysis was used to identify independent predictors of long-term complications. Results In total, 54,462 patients were included in the study. A total of 3,780 patients (6.9%) reported one or more long-term complications. The most frequent long-term complications, with a plausible connection to the surgery, were found in the following categories: pain or discomfort in the mouth or throat (1.9%), problems with throat secretions or throat clearing (0.8%), dysphagia (0.6%), and problems with voice or speech (0.6%). Tonsillotomy was associated with a lower risk of long-term complications than tonsillectomy. Conclusion This study suggests that subjective long-term complications after tonsil surgery, in general, are relatively common (6.9%). However, complications with a plausible connection to the surgery were less common (4.0%), and specific complications seemed to be relatively rare, with no single specific problem reaching a prevalence of ≥0.6%.
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Affiliation(s)
- Erik Odhagen
- Department of Otorhinolaryngology, Södra Älvsborgs Hospital, Borås, Sweden
- Department of Research, Education and Innovation, Södra Älvsborgs Hospital, Borås, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Fredrik Alm
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sara Axelsson
- Department of Otorhinolaryngology, Helsingborg Hospital, Helsingborg, Sweden
| | - Claes Hemlin
- Swedish Quality Register for Tonsil Surgery, Stockholm, Sweden
| | - Pia Nerfeldt
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Joacim Stalfors
- Department of Research, Education and Innovation, Södra Älvsborgs Hospital, Borås, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ola Sunnergren
- Department of Otorhinolaryngology, Region Jönköping County, Jönköping, Sweden
- Centre for Oral Health, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Alzahrani ES, Aseeri IA, Alzahrani WJ, Alharthi MS, Qattan FM, Khan M. The Indications of Tonsillectomy Among Pediatric Patients: Our Nine-Year Retrospective Review. Cureus 2023; 15:e50638. [PMID: 38107208 PMCID: PMC10725620 DOI: 10.7759/cureus.50638] [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: 12/16/2023] [Indexed: 12/19/2023] Open
Abstract
INTRODUCTION Tonsillectomy is a surgical procedure that involves removing the tonsils, often performed alongside adenoidectomy. Dating back to ancient times, it improves quality of life and can be life-saving when done for appropriate reasons. Common indications in children include recurrent tonsillitis and sleep-disordered breathing (SDB). Evidence suggests it reduces how often and how severe sore throats are in highly affected children. Symptoms such as lymphadenopathy, tonsillar pus, fever, or signs of streptococcal infection should be present for diagnosis of tonsillitis. Polysomnography (PSG) is essential to diagnose obstructive sleep apnea (OSA) and confirm airway obstruction. AIM Our aim in this study is to determine the reasons for tonsillectomy in Taif, Saudi Arabia, since it is not well established before in this city. METHODS A nine-year retrospective analysis of case records of patients aged 0-18 years who have had tonsillectomy performed in a tertiary hospital. Data was analyzed using SPSS (IBM Corp., Armonk, NY, USA). RESULTS The research study involved analyzing data from 361 participants. Among the participants, 16.9% (n = 61) underwent tonsillectomy alone, while the majority (83.1%; n = 300) underwent tonsillectomy in combination with other procedures. The most common combined procedure was adenotonsillectomy (71.7%; n = 259). Additionally, adenotonsillectomy and insertion of grommets in other combinations was observed and was equal to 11.4% (n = 41) of the total percentage of our sample. The primary indications for tonsillectomy alone were chronic tonsillitis (42.6%; n = 26) and recurrent tonsillitis (49.2%; n = 30). Conclusion: This research study provides valuable information on the types of procedures performed and the indications for surgery in pediatric patients. The results highlight the prevalence of chronic and recurrent tonsillitis and adenotonsillitis as primary indications for tonsillectomy, either alone or in combination with other procedures. These findings contribute to our understanding of the clinical decision-making process and can aid healthcare professionals in providing optimal care for pediatric patients with tonsillar and adenotonsillar pathologies.
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Affiliation(s)
| | | | | | | | | | - Mohammed Khan
- Otolaryngology Head and Neck Surgery, King Abdullah Medical City, Makkah, SAU
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Lee M, Suzuki H, Nihei Y, Matsuzaki K, Suzuki Y. Ethnicity and IgA nephropathy: worldwide differences in epidemiology, timing of diagnosis, clinical manifestations, management and prognosis. Clin Kidney J 2023; 16:ii1-ii8. [PMID: 38053973 PMCID: PMC10695519 DOI: 10.1093/ckj/sfad199] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Indexed: 12/07/2023] Open
Abstract
Immunoglobulin A nephropathy (IgAN), the most common primary glomerulonephritis, is one of the major causes of end-stage renal disease. Significant variances in epidemiology, clinical manifestation, timing of diagnosis, management and renal prognosis of IgAN have been reported worldwide. The incidence of IgAN is the most frequent in Asia, followed by Europe, and lower in Africa. Moreover, Asian patients show more frequent acute lesions in renal histology and present poorer renal outcomes compared with Caucasians. The comorbidities also show the difference between Asians and Caucasians. Although the frequency of gross hematuria with upper respiratory tract infection is not different, comorbidities with gastrointestinal diseases are reported to be higher in Europe. Recently, genetic studies for variant ethnic patients revealed widely ranging genetic risks in each ethnicity. A genetic risk score is most elevated in Asians, intermediate in Europeans and lowest in Africans, consistent with the disease prevalence of IgAN globally. Ethnic variance might be highly affected by the difference in genetic background. However, it is also essential to mention that the different timing of diagnosis due to variant urinary screening systems and the indication for renal biopsy in different countries may also contribute to these variances. The management of IgAN also varies internationally. Currently, several novel therapies based on the pathogenesis of IgAN are being assessed and are expected to become available soon. Further understanding the ethnic variance of IgAN might help establish individualized care for this disease. Here, we review the issues of ethnic heterogeneities of IgAN.
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Affiliation(s)
- Mingfeng Lee
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hitoshi Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Nephrology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Yoshihito Nihei
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Keiichi Matsuzaki
- Department of Public Health, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
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Houborg HI, Klug TE. Evaluation of Guidelines For Tonsillectomy in Adults With Recurrent Acute Tonsillitis. Ann Otol Rhinol Laryngol 2023; 132:1573-1583. [PMID: 37183925 DOI: 10.1177/00034894231173481] [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
OBJECTIVES The criteria for selecting patients with recurrent acute tonsillitis (RT) for tonsillectomy remain unsettled and different guidelines are used internationally. We aimed to evaluate currently used guidelines for tonsillectomy in adults with RT and identify the best predictive parameters for improved throat-related quality of life (TR-QOL) after surgery. METHODS About 66 RT patients undergoing tonsillectomy was prospectively included and categorized into 3 groups based on which guideline(s) they met: Group 1: patients not meeting any of the Danish/Paradise/Scottish Intercollegiate Guideline Network (SIGN) guidelines. Group 2: patients meeting the Danish guidelines. Group 3: patients meeting the Paradise and/or the SIGN guidelines. TR-QOL was assessed using the Tonsillectomy Outcome Inventory 14 (TOI-14) before and 6 months after tonsillectomy as well as the Glasgow Benefit Inventory (GBI). Predictive parameters for improved TR-QOL were investigated using multiple linear regression. RESULTS About 61 (92%) patients completed the questionnaires. Patients in all groups had significant TR-QOL improvements (Group 1 (n = 20): ΔTOI-14 31.1; GBI 29.4; Group 2 (n = 31): ΔTOI-14 32.0; GBI 36.4; Group 3 (n = 10): ΔTOI-14 45.6; GBI 39.7) and satisfaction rates were high (94%-100%). Preoperative TOI-14 score was the best predictor for improved TR-QOL (P < .001, R2 = .80), followed by the number of tonsillitis episodes with physician verification within the previous 12 months (P = .002, R2 = .25). CONCLUSIONS Patients in all groups experienced massive TR-QOL improvements suggesting that currently used guidelines may be too restrictive. Preoperative TOI-14 score was the best parameter for predicting TR-QOL improvement, and this tool may be useful in the selection of adults with RT for tonsillectomy.
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Affiliation(s)
- Hannah Inez Houborg
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
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Ottinger AM, Singh R, Chen D, Parham K. Unilateral Tonsillar Enlargement as Initial Presentation of Bilateral Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. Ear Nose Throat J 2023:1455613231214634. [PMID: 37997620 DOI: 10.1177/01455613231214634] [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: 11/25/2023] Open
Abstract
Unilateral tonsillar enlargement is a common indication for tonsillectomy, but there are varying rates of malignancy among tonsils removed for asymmetry and a lack of clear guidelines for management within the literature. Lymphoma of the palatine tonsils is among the concerns leading to tonsillectomy, but chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) of the tonsil is rare. We report a case of primary CLL/SLL of the palatine tonsil in a 51-year-old gentleman who presented with tonsillar asymmetry and obstructive sleep apnea (OSA) but lacked signs and symptoms suspicious for malignancy, including lymphadenopathy and "B-symptoms." To our knowledge, only 7 cases of CLL/SLL of the palatine tonsil have been reported in the English literature, with the tonsil being the primary site of involvement in only 4 of those cases. Our unique case highlights the importance of thorough physical exam, family history, and tissue biopsy in patients presenting to the otolaryngologist with OSA and asymmetric tonsils.
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Affiliation(s)
- Allie M Ottinger
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Roshansa Singh
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Dong Chen
- Department of Pathology and Laboratory Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Kourosh Parham
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, USA
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Zięba N, Miśkiewicz-Orczyk K, Misiołek M, Ścierski W. The Clinical Significance of Tonsillar Actinomyces in Histopathological Samples after Tonsillectomy. Pathogens 2023; 12:1384. [PMID: 38133269 PMCID: PMC10745963 DOI: 10.3390/pathogens12121384] [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: 10/26/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Actinomyces is a genus of Gram-positive anaerobic or microaerophilic bacteria with a branched filamentous shape. Their presence in tonsil tissue is usually determined by histopathological examination. In the crypts of removed tonsils, they have a prevalence ranging from 0.8% to 61.6%. The role of Actinomyces in diseases of the palatine tonsils is not clearly defined. The aim of the study was to determine the importance of Actinomyces in the pathology of palatine tonsils and to assess the impact of these bacteria on the clinical data. METHODS the retrospective analysis of the histopathological findings of patients undergoing tonsillectomy in our hospital from January 2017 to the end of December 2019 was performed in terms of the occurrence of Actinomyces. The data were collected based on the medical history. The study included 481 patients aged 3-82 years. From the study group, 100 adult patients were randomly selected, and a telephone survey was conducted. The questions included the co-occurrence of bronchial asthma, halitosis, tonsilloliths, and cigarette smoking. The questions were related to the complications following tonsillectomy and the severity of postoperative pain. Existence of a relationship was investigated between occurrence of tonsillar Actinomyces and age, sex, body mass index, and medical condition (obstructive sleep apnea, chronic palatine tonsillitis), respectively. The size of the removed tonsils was assessed and compared depending on the presence of the bacteria. RESULTS patients aged 18 years and older had a higher probability of presenting Actinomyces. The estimated odds ratio for the presence of the bacteria per year of age was 1.023 [1.007, 1.041]. No statistically significant results were found for the other variables. The co-occurrence of the bacteria and halitosis was close to statistical significance (p = 0.064). CONCLUSIONS multivariate analysis of the role of Actinomyces in tonsillar pathology showed that these microorganisms should be considered saprophytes of the oropharyngeal microflora that had no significant relationship with the pathology of palatine tonsils. Further studies on their influence on halitosis are warranted.
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Affiliation(s)
- Natalia Zięba
- Department of Otorhinolaryngology and Laryngological Oncology in Zabrze, Medical University of Silesia, st. Marii Curie-Skłodowskiej 10, 41-800 Zabrze, Poland (M.M.); (W.Ś.)
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Pecha PP, Nicholas Jungbauer W, Ruggiero KJ, Nietert P, Melvin CL, Ford ME. Parental Experiences With Access to Care for Obstructive Sleep-Disordered Breathing: A Qualitative Study. Otolaryngol Head Neck Surg 2023; 169:1319-1328. [PMID: 37161964 DOI: 10.1002/ohn.365] [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: 01/02/2023] [Revised: 04/03/2023] [Accepted: 04/15/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Despite evidence-based guidelines for obstructive sleep-disordered breathing (SDB), recent studies continue to highlight treatment inequities. We used qualitative research methods to examine parental facilitators and barriers to SDB treatment. STUDY DESIGN Qualitative interviews. SETTING Tertiary care center. METHODS Semistructured interviews were conducted (January-April 2022) with parents of children with SDB who underwent tonsillectomies to understand the processes of SDB detection and accessing specialty care. Interviews were conducted until thematic saturation was reached and coded using NVivo software. RESULTS Of the 17 parents who completed the key informant interviews, 6 (35%) were of non-Hispanic black race, and 3 (17.6%) interviews were conducted in Spanish. Parents noted that the more knowledge their primary care provider (PCP) had about SDB, the easier it was to obtain a diagnostic workup (41%). The most common barrier included difficulty obtaining a specialist (otolaryngology or sleep medicine) referral from their PCP and encountering providers who were dismissive of parent-reported symptoms related to SDB, leading them to seek a second opinion or self-refer (53%). Medicaid coverage was a strong facilitator to receipt of care (59%). Three (17.6%) parents noted alienation in the process due to racial bias or language barriers. CONCLUSION Parental interviews revealed that facilitators of SDB treatment included high clinician knowledge and perceived importance of SDB as well as Medicaid insurance which decreased financial strain. Parents also cited the attainment of referrals as a significant barrier to obtaining specialty evaluation. These findings identify potential modifiable areas to tailor future interventions for timely and equitable SDB care.
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Affiliation(s)
- Phayvanh P Pecha
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Walter Nicholas Jungbauer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kenneth J Ruggiero
- Medical University of South Carolina College of Nursing, Charleston, South Carolina, USA
| | - Paul Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cathy L Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Marvella E Ford
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Charleston, South Carolina, USA
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Manthiram K. What is PFAPA syndrome? Genetic clues about the pathogenesis. Curr Opin Rheumatol 2023; 35:423-428. [PMID: 37467064 PMCID: PMC10538419 DOI: 10.1097/bor.0000000000000956] [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] [Indexed: 07/21/2023]
Abstract
PURPOSE OF REVIEW Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is the most common periodic fever syndrome in childhood. Recent studies report genetic susceptibility variants for PFAPA syndrome and the efficacy of tonsillectomy in a broader cohort of patients with recurrent stereotypical fever. In this review, we highlight the findings of these studies and what they may reveal about the pathogenesis of PFAPA. RECENT FINDINGS Newly identified genetic susceptibility loci for PFAPA suggest that it is a complex genetic disorder linked to Behçet's disease and recurrent aphthous ulcers. Patients who have PFAPA with some features of Behçet's disease have been reported. Moreover, the efficacy of tonsillectomy has now been described in patients who do not meet the full diagnostic criteria for PFAPA, although the immunologic profile in the tonsils is different from those with PFAPA. Factors that predict response to tonsillectomy are also reported. SUMMARY These findings highlight the heterogeneous phenotypes that may be related to PFAPA due to common genetic susceptibility or response to therapy. These relationships raise questions about how to define PFAPA and highlight the importance of understanding of the genetic architecture of PFAPA and related diseases.
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Affiliation(s)
- Kalpana Manthiram
- Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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Schafer A, Worobetz N, Lukens J, Bourgeois T, Onwuka A, Elmaraghy C, Chiang T. Assessing the Relationship Between Infection Frequency and Risk of Post- Tonsillectomy Hemorrhage. Ann Otol Rhinol Laryngol 2023; 132:1424-1429. [PMID: 37005553 DOI: 10.1177/00034894231159328] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
OBJECTIVE To determine the relationship between frequency of tonsillitis and the risk of post-tonsillectomy hemorrhage (PTH) in pediatric patients undergoing tonsillectomy for recurrent tonsillitis. METHODS After obtaining IRB approval from Nationwide Children's Hospital, charts for all patients who underwent a total tonsillectomy in 2017 for recurrent or chronic tonsillitis were retrospectively reviewed (n = 424). Patients were divided into 2 cohorts based on the frequency of tonsillitis prior to surgery: those meeting the 1-year criteria with 7 or more infections in the past year (n = 100), and those who did not meet criteria defined as those with fewer than 7 infections in the past year (n = 324). The primary outcome of interest was PTH. Comparison of cohorts and frequency of PTH were assessed using bivariate analyses. Kaplan-Meier curves were used to compare time to onset of hemorrhage between primary vs. secondary PTH. Generalized mixed and logistic regression models were used to evaluate risk of hemorrhage following tonsillectomy. RESULTS Among a total cohort of 424 patients undergoing tonsillectomy, 23.58% (n = 100) met criteria while 76.42% (n = 324) did not. A total of 8.73% (n = 37) patients experienced PTH. Compared to those who did not meet criteria, those who met criteria had a higher odds of developing PTH; however, this was not significant (OR: 1.42 [95% CI: 0.67, 2.98], P = .3582). Estimated probability of developing PTH for those who met criteria was 11% [95% CI: 6.19, 18.81] compared to 8.03% [95% CI: 5.52, 11.54] for those who did not meet criteria. Among all PTH cases, 5.41% (n = 2) were primary hemorrhage while 94.59% (n = 35) were secondary hemorrhage with 50% of those with secondary PTH having experienced hemorrhage within 6 days [95% CI: 5, 7] of tonsillectomy. Patients with neuromuscular conditions had significantly higher odds of PTH (OR: 4.75 [95% CI: 1.19, 18.97], P = .0276). CONCLUSION Patients who met the 1-year criteria for tonsillectomy did not have a significantly higher odds of PTH. Further research is needed to better evaluate the relationship between infection frequency and risk of PTH.
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Affiliation(s)
- Austin Schafer
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Noah Worobetz
- Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jordan Lukens
- Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Tran Bourgeois
- The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Amanda Onwuka
- The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Charles Elmaraghy
- The Ohio State University College of Medicine, Columbus, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Tendy Chiang
- The Ohio State University College of Medicine, Columbus, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA
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Albazee E, Almahmoud L, Aladwani AA, Ameen J, Alrashidi A, AlKandery M, Abu-Zaid A. Thermal welding tonsillectomy versus cold dissection tonsillectomy: A systematic review and meta-analysis of randomised controlled trials. Clin Otolaryngol 2023; 48:863-871. [PMID: 37680106 DOI: 10.1111/coa.14099] [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: 03/03/2023] [Revised: 07/18/2023] [Accepted: 08/27/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES To evaluate the efficacy of thermal welding (TW) versus cold dissection (CD) strategies among tonsillectomy patients. DESIGN AND SETTING A systematic review and meta-analysis of randomised controlled trials (RCTs). PARTICIPANTS Patients undergoing tonsillectomy. MAIN OUTCOME MEASURES The outcomes were summarised as risk ratio (RR) or mean difference/standardised mean difference (MD/SMD) with 95% confidence interval (CI) in a random-effects model. RESULTS Fourteen RCTs were analysed. The mean operative time (n = 14 RCTs, MD = -7.99 min, 95% CI [-12.88, -3.10], p < .001), mean intraoperative blood loss (n = 11 RCTs, MD = -57.18 mL, 95% CI [-71.58, -42.78], p < .001) and postoperative pain score on day 1 (n = 15 RCTs, SMD = -0.40, 95% CI [-0.75, -0.06], p = .02) were significantly reduced in the TW group compared with the CD group. However, there was no significant difference between both groups regarding the rate of reactionary bleeding (n = 13 RCTs, RR = 0.62, 95% CI [0.23, 1.71], p = .36) and delayed bleeding (n = 13 RCTs, RR = 1.03, 95% CI [0.46, 2.30], p = .95). CONCLUSION Compared with CD, TW significantly reduced the operative time and intraoperative blood loss, without an impact on the rate of postoperative bleeding. The reduction in postoperative pain score provided by the TW strategy was not clinically meaningful in clinical practice. TW might appear superior to CD among tonsillectomy patients.
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Affiliation(s)
- Ebraheem Albazee
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | - Lina Almahmoud
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | | | - Jasem Ameen
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | - Abdullah Alrashidi
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | - Mashael AlKandery
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | - Ahmed Abu-Zaid
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Guntinas-Lichius O, Geißler K, Mäkitie AA, Ronen O, Bradley PJ, Rinaldo A, Takes RP, Ferlito A. Treatment of recurrent acute tonsillitis-a systematic review and clinical practice recommendations. Front Surg 2023; 10:1221932. [PMID: 37881239 PMCID: PMC10597714 DOI: 10.3389/fsurg.2023.1221932] [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: 05/13/2023] [Accepted: 09/11/2023] [Indexed: 10/27/2023] Open
Abstract
Background There is an ongoing debate on the indications for tonsil surgery in both children and adults with recurrent acute tonsillitis. The aim is to provide practical recommendations for diagnostics and treatment for recurrent acute tonsillitis including evidence-based decision making for tonsillectomy. Methods A systematic literature search in PubMed, Embase, Web of Science, and ScienceDirect from 2014 until April 2023 resulted in 68 articles. These were the basis for the review and a comprehensive series of consensus statements on the most important diagnostics and indications for both non-surgical and surgical therapy. A consensus paper was circulated among the authors and members of the International Head and Neck Scientific Group until a final agreement was reached for all recommendations. Results The differentiation between sore throat and tonsillitis patient episodes is mostly not feasible and hence is not relevant for diagnostic decision making. Diagnostics of a tonsillitis/sore throat episode should always include a classification with a scoring system (Centor, McIssac, FeverPAIN score) to estimate the probability of a bacterial tonsillitis, mainly due to group A streptococcus (GAS). In ambiguous cases, a point-of-care test GAS swab test is helpful. Consecutive counting of the tonsillitis/sore throat episodes is important. In addition, a specific quality of life score (Tonsillectomy Outcome Inventory 14 or Tonsil and Adenoid Health Status Instrument) should be used for each episode. Conservative treatment includes a combination of paracetamol and/or non-steroidal anti-inflammatory drugs. In case of high probability of bacterial tonsillitis, and only in such cases, especially in patients at risk, standard antibiotic treatment is initiated directly or by delayed prescription. Tonsillectomy is indicated and is highly effective if the patient has had ≥7 adequately treated episodes in the preceding year, ≥5 such episodes in each of the preceding 2 years, or ≥3 such episodes in each of the preceding 3 years. An essential part of surgery is standardized pain management because severe postoperative pain can be expected in most patients. Conclusion It is necessary to follow a stringent treatment algorithm for an optimal and evidence-based treatment for patients with recurrent acute tonsillitis. This will help decrease worldwide treatment variability, antibiotic overuse, and avoid ineffective tonsillectomy.
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Affiliation(s)
| | - Katharina Geißler
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Program in Systems Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ohad Ronen
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Patrick J. Bradley
- Department Otorhinolaryngology, Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, United Kingdom
| | | | - Robert P. Takes
- Department of Otolaryngology, Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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Kang YJ, Cho JH, Hwang SH. The analgesic Efficacy and Safety of Topically Applied Tramadol in Peritonsillar Space During Pediatric Adeno tonsillectomy: A Meta-Analysis. Ann Otol Rhinol Laryngol 2023; 132:1156-1167. [PMID: 36433693 DOI: 10.1177/00034894221136998] [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: 08/23/2023]
Abstract
OBJECTIVES To evaluate the efficacy of topically applied tramadol in peritonsillar area for pain control and induction of perioperative morbidity in children undergoing adenotonsillectomy. METHODS Two authors independently searched the databases (MEDLINE, SCOPUS, and Cochrane databases) up to April 2022 for randomized controlled trials comparing the efficacy of an intraoperative peritonsillar administered tramadol with placebo or other agents only in pediatric patients. The outcomes were postoperative pain scores, time to take the first pain reducing drugs, and postoperative nausea/vomiting. RESULTS Our analysis was based on 17 trials. Peritonsillar administered tramadol significantly reduced postoperative pain at less than 20 minutes (SMD -1.5852, 95% CI [-2.3900; -0.7804]), 1 hour (SMD -1.5811, 95% CI [-2.3400; -0.8222]), 8 hours (SMD -1.0258, 95% CI [-1.8792; -0.1724]), 16 hours (SMD -0.8397, 95% CI [-1.4266; -0.2529]), and 1 day (SMD -1.0110, 95% CI [-1.5213; -0.5007]) and the time to take the first analgesic drug (SMD 1.6565, 95% CI [0.2838; 3.0293]) compared with the placebo. However, tramadol showed no significant difference on postoperative pain relief effects and the time to take the first analgesic drug compared to the other topical agents (bupivacaine, lidocaine, ketamine, and dexamethasone). Tramadol did not cause significant postoperative nausea and vomiting. CONCLUSIONS This study demonstrated that intraoperatively applied topical tramadol could control postoperative pain and reduce the analgesic uptake compared with a control. However, the efficacy of tramadol in pain control was similar to other agents in pediatric adenotonsillectomy.
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Affiliation(s)
- Yun Jin Kang
- Department of Otolaryngology-Head and Neck Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Hee Cho
- Department of Otolaryngology-Head and Neck Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Fageeh YA. Clinical Impact of Preoperative Tonsil and Adenoid Size on Symptomatic Outcomes Following Adeno tonsillectomy in Pediatric Patients. Cureus 2023; 15:e47093. [PMID: 38021551 PMCID: PMC10646436 DOI: 10.7759/cureus.47093] [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: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background Adenotonsillar hypertrophy is a common clinical problem in pediatric patients. Adenotonsillectomy is a surgical intervention to remove airway obstruction and alleviate symptoms. However, some children continue to experience persistent symptoms after surgery. Objective This study aimed to investigate the relationship between preoperative tonsils and adenoid size and the persistence of symptoms, including snoring, mouth breathing, noisy breathing, and sleep apnea, after adenotonsillectomy in pediatric patients. Method This study was conducted in Taif, Saudi Arabia, and included 109 pediatric patients aged three to 14 years who underwent adenotonsillectomy. Data on preoperative and postoperative symptoms were collected through patient records and follow-up surveys. Tonsil and adenoid size were assessed using the Brodsky scale and endoscopic grading scales, respectively. Statistical analysis was performed using SPSS Version 26 (IBM Corp., Armonk, NY). Results The most prevalent presenting symptoms were snoring, mouth breathing, and noisy breathing. Tonsil size grades 3+ and 4+ were significantly more prevalent than the other grades (p<0.05). Adenoid size grades 3 and 4 were also significantly more prevalent than the other grades (p<0.05). Significant associations were observed between tonsil and adenoid size grades and specific presenting symptoms, such as snoring, mouth breathing, and noisy breathing. No significant correlations were found between preoperative tonsil or adenoid size and postoperative persistent symptoms. Conclusion While tonsil and adenoid size are essential factors in determining the need for surgery, they may not predict postoperative resolution of symptoms. A comprehensive evaluation of various clinical factors is necessary to understand the persistence of symptoms after surgery. Although adenotonsillectomy is an effective treatment for upper airway obstruction in pediatric patients, some individuals may experience residual symptoms.
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Affiliation(s)
- Yahya A Fageeh
- Otolaryngology - Head and Neck Surgery, College of Medicine, Taif University, Taif, SAU
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50
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Trecca EM, Gaffuri M, Molinari G, Russo FY, Turri-Zanoni M, Albera A, Miriam di Lullo A, Russo G, Mannelli G, Ralli M. Impact of the COVID-19 pandemic on paediatric otolaryngology: a nationwide study. Acta Otorhinolaryngol Ital 2023; 43:352-359. [PMID: 37519138 PMCID: PMC10551727 DOI: 10.14639/0392-100x-n2452] [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] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/10/2023] [Indexed: 08/01/2023]
Abstract
Objective The COVID-19 pandemic profoundly modified the work routine in healthcare; however, its impact on the field of paediatric otorhinolaryngology (ORL) has been rarely investigated. The aim of this study was to assess the impact of COVID-19 on paediatric ORL. Methods A questionnaire was developed by the Young Otolaryngologists of the Italian Society of ORL-Head and Neck Surgery (GOS). The questionnaire consisted of 26 questions related to workplace and personal paediatric ORL activities. The link was advertised on the official social media platforms and sent by e-mail to 469 Italian otolaryngologists. Results The questionnaire was completed by 118 responders. During the pandemic, the main reduction was observed for surgical activity (78.8%), followed by outpatient service (16.9%). The conditions that were mostly impacted by a delayed diagnosis were respiratory infections in 45.8% of cases and sensorineural hearing loss in 37.3% of cases. Conclusions Paediatric ORL was highly impacted by the COVID-19 pandemic, with a significant reduction of surgical and outpatient activities and a delay in time-sensitive diagnosis. Therefore, the implementation of new strategies, such as telemedicine, is recommended.
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Affiliation(s)
- Eleonora M.C. Trecca
- Correspondence Eleonora Maria Consiglia Trecca IRCCS Casa Sollievo della Sofferenza, Department of Maxillofacial Surgery and Otolaryngology, viale Cappuccini 1, 71013 San Giovanni Rotondo (FG), Italy E-mail:
| | - Michele Gaffuri
- Research group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giulia Molinari
- Research group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Francesca Yoshie Russo
- Research group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery
- Department of Sense Organs, ENT Department, Sapienza University of Rome, Rome, Italy
| | - Mario Turri-Zanoni
- Research group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Andrea Albera
- Research group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Antonella Miriam di Lullo
- Research group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery
- ENT Unit- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Gennaro Russo
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery
- Otolaryngology Unit, AORN dei Colli, V. Monaldi Hospital, Napoli, Italy
| | - Giuditta Mannelli
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Massimo Ralli
- Research group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery
- Department of Sense Organs, ENT Department, Sapienza University of Rome, Rome, Italy
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