PubMed · 10074842
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F O Winther. 1999-01-30. [Tonsillectomy and adenoidectomy].. https://pubmed.ncbi.nlm.nih.gov/10074842/
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OBJECTIVE: Our aim was to determine if there was any detectable clinical and cardiac changes in hypertrophied adenotonsillary disease with obstructive sleep apnea syndrome and to demonstrate the curative effect of adenotonsillectomy on these patients. METHODS: Thirty-three children with adenotonsillary hypertrophy and sleep related breathing disorders were included in this study group. There were 16 female and 17 male patients and the mean age was 6.9+/-2 years. Age and sex matched control group consisted of 33 children (16 female, 17 male) with a mean age of 6.3+/-2. Complete clinical and laboratory examinations were done for each patient. The results were analysed with the SPSS (statistical package for social sciences) computer program. The significance of changes was performed by means of the independent samples of one-tailed t-test. For categorical variables, chi-square analysis was performed. RESULTS: According to our snoring scale, snoring was mild in six patients (18.2%), moderate in 19 patients (57.5%) and severe in eight patients (24.3%). Severe apnea was not observed in any patients, moderate apnea in ten patients (30.3%) and mild apnea was observed in 23 patients (69.7%) preoperatively. Nine patients had Grade IV tonsils, 14 patients Grade III, seven patients Grade II, three patients Grade I. Twelve patients had 3+ (obstructive) adenoids, 21 patients had 2+ adenoids. Chest X-rays showed cardiomegaly in two patients with moderate degree of apnea. Electrocardiogram results were abnormal in four patients. When we compared echocardiographic results of study and control groups, we found several significant differences (RV: 1.6+/-0.3 vs 1.4+/-0.2; P<0.05, LVEDD: 3.6+/-0.5 cm vs 3.3+/-0.4; P<0.05, IVS: 6.8+/-1.4 mm vs 6.1+/-1.1 mm; P<0.05). Also a decreased left ventricular compliance measured by prolongation of deceleration time was found in patient group (DT: 173+/-44 vs. 126+/-22 ms; P<0.001). The echocardiographic results in postoperative group were similar to control group. CONCLUSION: This study illustrated that adenotonsillary disease with obstructive sleep apnea symptoms leaded to right and/or left ventricular enlargement, hypertrophy when compared with control subjects, which were recovered postoperatively.
OBJECTIVE: Control of postoperative bleeding, considered as the major complication following tonsillectomy, serves as a landmark for the safety of the operation. There is a constant decrease of the concentration of hemoglobin during childhood with lowest values around 6 years of age with normal values at the beginning of puberty accompanied by a constant decrease of the number of platelets after birth. Dehydration, poor oral intake and airway problems are predominant complications in early childhood. A retrospective study was undertaken to evaluate if the incidence of bleeding is associated with certain age groups in pediatric patients. We assessed if there is a questionable higher risk for blood transfusions due to the age-specific lower hemoglobin concentration in children. METHODS: Between January 1988 and August 2000, 2330 patients under 12 years of age underwent tonsillectomy, with or without adenoidectomy, in St. Anna Hospital, Duisburg. Group A (age<6 years) consisted of 1467 patients of whom 59.6% were male. Group B (aged 6-12 years) consisted of 863 patients, of whom 48.1% were male. RESULTS: Postoperative bleeding from the tonsillar fossae requiring treatment under general anesthesia occurred in group A (1%) and B (2.3%). Bleeding from the adenoidectomy site was treated in group A (0.3%) and B (0.3%). Primary bleeding occurred in the majority of patients in both groups group A (55%) and group B (75%). The latest bleeding was observed 6 days (group A) and 10 days (group B) following surgery, due to statistical analysis the difference was found to be significant (P<0.025). In group A there was one 42-month-old boy who died due to massive bleeding despite ligature of the external carotid artery and blood transfusions. Statistical evaluation shows a significant increase of postoperative bleeding with age (P=0.024). No blood transfusion was required in other patients. CONCLUSION: Tonsillectomy can be safely performed in children under 6 years of age with no increased risk of postoperative bleeding or risk of receiving blood transfusion. Rare cases of secondary hemorrhage seem to occur more frequently in younger children and should be treated immediately under general anesthesia to avoid severe complications.
BACKGROUND: the efficacy of adenoidectomy in relieving nasal symptoms has been questioned. Although enlarged adenoids are often blamed for nasal obstruction, other causes can be missed if examination is not thorough. We suggest that endoscopy at the time of adenoidectomy may be useful to confirm large adenoids and exclude other causes, and the findings may help predict residual symptoms 2 years after adenoidectomy. METHOD: a prospective study of a consecutive series of children undergoing adenoidectomy for nasal obstruction was performed. All underwent endoscopy with a 4-mm rigid endoscope without decongestants under GA immediately prior to adenoidectomy. Two years later a postal symptom questionnaire was sent, with telephone follow up for non-responders. The findings on endoscopy were compared with residual symptoms at 2 years. RESULTS: Forty-eight children aged 2-9 (mean 4) years were enrolled, 26 of them female. At 2 years follow up, data were available for 34 children (71%). Complete obstruction of the posterior choanae of the nose by adenoids was seen in 21 (62%). Additional findings (e.g. septal deviation, hypertrophic mucosa on the turbinates) were present in 22 (65%). Of them 9 (26%) had residual nasal symptoms. Of the children with less than occlusive adenoids, six (50%) out of 12 had residual symptoms, compared with three (14%) out of 21 with occlusive adenoids (chi(2)=4.91, P<0.05). Although residual symptoms were more common in those with additional findings on the original endoscopy (32 vs. 17%), this did not reach statistical significance. CONCLUSIONS: residual nasal symptoms are common when children are followed up in the medium term. The findings on endoscopy may predict the success of adenoidectomy in relieving the symptoms, and may help to guide further treatment.