PubMed · 3283049
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W P Potsic. 1988. Tonsillectomy and adenoidectomy.. https://doi.org/10.1097/00004311-198802610-00012
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OBJECTIVE: To investigate the relationship between the resistant bacteria in the adenoid tissue and the middle ear effusion of children who underwent myringotomy and adenoidectomy with the diagnosis of otitis media with effusion (OME). METHODS: This study was performed in the ENT Clinic, Firat University between January 2001 and June 2001. Forty-one subjects who were enrolled in the study were diagnosed as OME, their age ranged from 1 to 11 years, and they underwent a myringotomy together with an adenoidectomy because of adenoid hyperthrophy. Bacteriological cultures were performed on the samples obtained from adenoid tissues and middle ear fluids, in the bacteria that were cultured; the resistance to oxacilline sodium and beta-lactamase were investigated. The resistance of penicillin was confirmed by MIC test. The control group composed of individuals who did not have OME but who underwent adenotonsillectomy due to adenotonsillary hyperthrophy. RESULTS: In the adenoid tissue cultures; Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis species were isolated from the 70% (29/41) of the study group and 40% (20/41) of the control group (P<0.01). In the isolated bacteria, the resistance rates for oxacilline or beta-lactamase were found to be 48% (20/41) in the study group and 16% (4/25) in the control group (P<0.05). We observed that bacterial growth in 29% (9/31) of the middle ear cultures of the study group and resistant bacteria were isolated in 77% (7/9) of them. The same pathogens which have grown in the middle ear cultures were also present in the adenoid tissue cultures. CONCLUSION: The isolation of resistant bacteria in most of the adenoid tissue samples of the children with OME, makes us to consider the possible role of these bacteria in the development of OME.
RATIONALE: Children with neurologic impairment often present with airway obstruction that may require intervention. No single method of airway intervention is universally appropriate and effective in this patient population. This study was performed to examine the effectiveness of using adenotonsillectomy and uvulopalatopharyngoplasty (UPPP) in resolving obstructive apnea (OA) in patients with neurologic impairment. METHODS: A retrospective chart review of 15 patients with neurologic impairment and OA treated with adenotonsillectomy and UPPP between 1986 and 1998 at Children's Hospital of Wisconsin (CHW) was performed. All patients in the series had their primary area of obstruction in the posterior oropharynx involving the soft palate, pharyngeal walls and base of tongue. Post-operative improvement following adenotonsillectomy and UPPP was examined. Measures of improvement were based primarily on recorded lowest oxygen saturations, but clinical parameters, flexible upper airway endoscopy and polysomnography were used as well. RESULTS: Patient improvement was documented in 87% of patients treated with this modality. For the group, the mean lowest recorded oxygen saturation demonstrated a statistically significant improvement from 65% pre-operatively to 85% post-operatively (P = 0.005). In long-term follow-up of these patients, 77% (10 of 13) of those showing initial improvement have done well and have required no further airway intervention. However, 23% of these patients demonstrated the need for further airway intervention during follow-up. CONCLUSIONS: Adenotonsillectomy with UPPP is worthy of consideration in certain neurologically impaired patients with moderate to severe OA, limited primarily to the posterior pharyngeal area. Initial improvement may not be permanent and close long-term follow-up of patients is imperative.
Tonsillectomy, in 90% of cases combined with adenoidectomy, is one of the most frequently carried out operations on children in the Netherlands: in 1998 there were 33,471 operations in children aged 0-14 years. This high frequency is in stark contrast to the scientific basis for the efficacy of this intervention. A meta-analysis carried out recently revealed just one good study. The lack of scientifically based clinical guidelines, partly explains the large international and regional differences in the number of operations carried out. In the Netherlands only 35% of the children operated on satisfy one of the criteria for which the effectiveness of (adeno)tonsillectomy has been established: frequent recurrent tonsillitis or obstructive sleep apnoea. A project has been started in the Netherlands to further study the effectiveness of this intervention, the results of which must contribute to a more thoroughly substantiated indication.