PubMed · 10954975
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R Maw. 2000. Re-evaluating the ENT procedures.. https://pubmed.ncbi.nlm.nih.gov/10954975/
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In a population-based case-control study among adults in Italy, of 261 lymphoid and 313 myeloid leukaemias and 1718 controls, a later age at adenoidectomy and tonsillectomy (after age 10 years) increased considerably the risk of lymphocytic (but not myeloid) leukaemia (odds ratio 4.2, 95% confidence interval 1.1-16.2). We propose that late infection is a proliferative stimulus for B-cells.
OBJECTIVES: To test the effect of adenoidectomy in connection with tympanostomy compared with tympanostomy only in preventing otitis media in children younger than 2 years. DESIGN: Prospective trial with randomized and nonrandomized arms. SETTING: Primary care study clinics. PARTICIPANTS AND INTERVENTIONS: The study participants were selected from 2497 children who had been enrolled in the Finnish Otitis Media Vaccine Trial at the age of 2 months. A total of 306 children, aged 1 to 2 years, who had experienced recurrent episodes of otitis media were randomized into 2 treatment groups: tympanostomy with or without adenoidectomy. Of the 306 children, 137 were operated on according to random basis (randomized trial). The 169 children whose parents declined participation in the randomized trial were operated on according to the parents' preferences (nonrandomized trial). All children were followed up until 2 years of age. The mean follow-up time was 7 months. MAIN OUTCOME MEASURE: The rate of acute otitis media episodes. RESULTS: The average reduction in the rate of all acute otitis media episodes in the adenoidectomy group was 19% (95% confidence interval [CI], -14% to 43%) among children enrolled in the randomized trial and 25% (95% CI, -13% to 50%) in the nonrandomized trial. The reduction in the randomized trial was mainly due to reduction in the rate of pneumococcal otitis media (58%, 95% CI, 16%-79%). CONCLUSION: In children younger than 2 years, concurrent adenoidectomy during the insertion of tympanostomy tubes does not seem to have a major advantage over the insertion of tympanostomy tubes alone in preventing otitis media.
OBJECTIVES: To assess the feasibility of suction coagulator adenoidectomy relative to adenoid size and to document patient-based outcomes and satisfaction with surgery. DESIGN: Historical cohort study. SETTING: Referral-based academic pediatric otolaryngology practice. PARTICIPANTS: Consecutive series of 118 children older than 3 years (mean age, 6.5 years) undergoing adenoidectomy alone. INTERVENTION: Video nasopharyngoscopy followed by suction coagulator adenoidectomy as part of routine clinical care. An outcome survey was completed by telephone. OUTCOME MEASURES: Duration of surgery, estimated blood loss, complications, parent satisfaction, and clinical outcomes. RESULTS: The distribution of preoperative adenoid grades as determined by nasal endoscopy were as follows: grade 2 (>or=33% to <66% choanal obstruction), 7%; grade 3 (>or=66% to <90% obstruction), 48%; and grade 4 (90%-100% obstruction), 45%. The mean (SD) surgical time of 10.5 (3.0) minutes was unrelated to adenoid grade (R = 0.014; P =.88). All blood loss was less than 15 mL (<5 mL for 67%), and the only complication was a loose tooth. The parents of 98 patients (83%) were contacted a mean of 30.4 days after surgery: 95 (97%) reported less-labored breathing, and 94 (96%) were satisfied with the surgical results. Only 5 patients (5%) required a follow-up visit within 30 days of surgery. CONCLUSIONS: Suction coagulator adenoidectomy proved safe and rapid, regardless of the adenoid size. Surgical outcomes were very favorable, with nearly all parents reporting satisfaction with the procedure and improvement in their child's breathing.