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PubMed1997

[The effect of tonsillectomy on the level of circulating immune complexes and urine changes in patients with glomerulonephritis].

The influence of tonsillectomy on circulating immune complexes (C.I.C.) level, proteinuria and erythrocyturia was studied in 42 patients with chronic tonsillitis (Ch.T.) and urine abnormalities. The level of C.I.C. was examined by two methods: the 3.5% polyethyleneglycol (PEG) precipitation method and the 125I-C1q binding method. After tonsillectomy, bacteriological analysis of removes facial tonsilla was performed in 7 patients and morphological analysis in 11. Renal biopsy was done in 28 patients. The control group was consisted of 18 patients with Ch.T. without urine abnormalities. The presence of C.I.C. was established in 48% of patients with urine abnormalities using PEG method and in 33% with 125I-C1q binding method. Mean values of C.I.C. in patients with proteinuria or erythrocyturia were statistically higher than in the control group. After tonsillectomy, transitory increase of C.I.C. level was observed in 60% of patients, accompanied by augmentation in urine changes, especially proteinuria. During one year of observation, significant decrease in C.I.C. levels detected by PEG method, as well as in proteinuria and in erythrocyturia was found. In 10 patients urine abnormalities disappeared. No differences between both groups of patients were found in the results of bacteriological and morphological studies of removed tonsilla. However, the normalisation of urine changes was noticed in patients without hypertension and in whom renal disease did not exceed two years. Renal histology revealed mesangocapillary proliferative Gn in 14, mesangial proliferative Gn in 11, and focal/segmental glomerulosclerosis in 3 patients. In one patient with mesangial proliferative Gn complete retreat of urine changes was observed. We suggest that the presence of Ch.T. influences on the C.I.C. detectability in patients with chronic glomerulonephritis. The tonsillectomy can lead do the decrease of C.I.C. levels, as well as to the decrease of proteinuria and/or erythrocyturia. Serum C.I.C. examination seems to be helpful in qualifying patients with Ch.T. for tonsillectomy, in immunological monitoring after the operation and in later prognosis in case of chronic glomerulonephritis.

Adolescent↗

PubMed2005

A parallel group analysis of tonsillectomy using the harmonic scalpel vs electrocautery.

OBJECTIVE: To evaluate efficiency and postoperative morbidity in tonsillectomy using the harmonic scalpel (HS) vs conventional electrocautery (EC). DESIGN: A retrospective medical chart review of all patients who underwent tonsillectomy at a single children's hospital during a 32-month period from January 2001 to August 2003. PATIENTS: The charts of 605 patients who underwent tonsillectomy or adenotonsillectomy were reviewed. The patients were stratified into 2 groups based on the dissecting instrument used (HS vs EC). Each group consisted of 2 subcategories based on age (< or =7 years and >7 years). Data collected included age, sex, operative indication, operative time, postanesthetic recovery room time, pain scale scores, postoperative admissions, and postoperative morbidities. RESULTS: There were significant differences in mean age (P<.001), mean weight (P<.001), and indication for surgery (P<.001) between the 2 methods: HS patients were younger, weighed less, and more often had obstructive symptoms as their primary operative indication compared with the EC group. Average operative times were not significantly different between methods. No differences were noted with respect to recovery time (HS group, P = .10; EC group, P = .30), postoperative oxygen requirements (HS group, P = .07; EC group, P = .09), and postoperative pain scores (HS group, P = .31; EC group, P = .58). There was a significant difference in postoperative admissions between the 2 methods in patients 7 years or younger (P = .005). Finally, we noted a significant difference in postoperative bleeding between the HS (2/292) and EC (13/313) methods when the data were compared per age group (P = .006), but the overall bleeding rate was not statistically significant owing to the small number of total bleeding instances (15/605). CONCLUSIONS: Recent prospective studies indicate that the HS provides advantages over conventional EC with respect to postoperative pain and return to normal activity. This study shows that HS tonsillectomy was as efficient as the conventional EC method. In addition, there was evidence that the rate of postoperative bleeding was significantly reduced by using the HS vs conventional EC.

Adenoidectomy↗

PubMed1987

Cervical osteomyelitis. An unusual complication of tonsillectomy.

Tonsillectomy is one of the most common operations performed by the otolaryngologist. Deep-neck infections are among the possible complications associated with this procedure. We encountered a case of osteomyelitis of the cervical spine occurring subsequent to an otherwise uncomplicated tonsillectomy. Although never previously reported with tonsillectomy to our knowledge, cervical osteomyelitis has been associated with other procedures and infections of the head, neck, and maxillofacial regions. Mechanisms that might explain this occurrence include direct extension via fascial planes, direct venous and lymphatic spread, and hematogenous dissemination from the contaminated surgical site. Treatment consisted of drainage and débridement of the infection, cervical immobilization, and long-term antibiotic administration. Healing was complete and cervical mobility and stability were normal at three months. Early recognition of this unusual complication of tonsillectomy is imperative to avoid potential neurologic sequelae.

Adult↗

PubMed1993

Control of early postoperative pain with bupivacaine in adult local tonsillectomy.

Early postoperative pain following tonsillectomy remains a significant obstacle to speedy recovery and smooth convalescence. Inadequate analgesia causes poor oral intake and occasionally requires overnight hospitalization in same-day surgery practices. Although several otolaryngologists anecdotally support intraoperative infiltration with long-acting anesthetic agents for postoperative pain control, to our knowledge, no previous study confirms this claim. In a prior investigation, we found no difference between bupivacaine hydrochloride and saline placebo in pediatric patients undergoing tonsillectomy. In this trial, we performed a similar study in an adult population. Fifty-one patients undergoing tonsillectomy with local anesthesia were randomized into bupivacaine or saline placebo groups. Patients provided the following data: (1) pain level; (2) oral intake; (3) number of pain medication doses; and (4) level of pain on jaw opening, all at 10 hours postoperatively. Bupivacaine administration resulted in no adverse effects. No difference was noted in pain level, amount of oral intake, or pain on full jaw opening. Bupivacaine group patients received fewer though not statistically significant doses of pain medication than placebo group patients. We conclude that bupivacaine is a safe medication but offers no advantage in the control of early postoperative pain in adult patients undergoing local tonsillectomy.

Adult↗

PubMed1999

Effect of treating obstructive sleep apnea by tonsillectomy and/or adenoidectomy on obesity in children.

BACKGROUND: Obstructive sleep apnea is common in obese children who have enlarged tonsils and adenoids. OBJECTIVE: To determine if treatment of obstructive sleep apnea by tonsillectomy and/or adenoidectomy will result in normalization of an obese child's weight, as it does in underweight children, and as it does with other signs and symptoms. DESIGN: Retrospective cohort study. We recorded weight and height changes after tonsillectomy and/or adenoidectomy and compared changes of the obese and morbidly obese patients with those of the other patients. SETTING: A tertiary care inner-city hospital. PARTICIPANTS: Children (n = 45) who underwent tonsillectomy and/or adenoidectomy for obstructive sleep apnea in 1994-1995; their mean (+/-SD) age was 4.9+/-2.4 years at operation. RESULTS: At the time of surgery, 25 children were of normal weight; 3, underweight; 7, obese; and 10, morbidly obese. Postoperatively, 31 children (69%), including 10 of the 17 who were obese or morbidly obese, had substantial weight gain: the z score +/- SD for weight of the entire group increased from 1.37+/-2.49 to 2+/-2.27 (P<.001). The mean z score +/- SD for height increased from 0.03+/-1.08 to 0.58+/-0.94 (P<.001). The body mass index (BMI or Quetelet index): calculated as weight in kilograms divided by the square of the height in meters increased in 28 patients (62%) (P = .004). CONCLUSION: Treating obstructive sleep apnea by tonsillectomy and/or adenoidectomy is associated with increased gain in height, weight, and body mass index in most children, including the obese and morbidly obese.

Adenoidectomy↗

PubMed1997

Risk of Hodgkin's disease subsequent to tonsillectomy: a population-based cohort study in Sweden.

Although some studies have linked excess of Hodgkin's disease (HD) to tonsillectomy, the findings have not been consistent. In particular, risk of HD by age at tonsillectomy has not been fully evaluated, despite the notable change in immunologic function of the tonsils between childhood and adulthood. To evaluate the risk of HD and other lymphomas, associated with tonsillectomy according to age at surgery, a population-based cohort study was conducted. Using nationwide Swedish hospitalization records, 55,169 patients undergoing tonsillectomy with/without adenoidectomy (T/A) were identified during the period 1964-1983. By linkage with the nationwide Total Population, Migration, Cancer and Causes-of-Death registries, these patients were followed up for as long as 25 years. After exclusion of the first post-operative year, a total of 533 first primary-cancer cases was identified between 1965 and 1989. Small excess risk was observed for HD (20 cases, SIR = 1.4, 95% CI 0.9-2.2). HD risk was more pronounced among patients tonsillectomized before age 12 (7 observed vs. 1.7 expected, SIR = 4.1, 95% CI 1.6-8.4), but declined significantly with older ages at T/A. While our data suggest a small increase in HD among all patients undergoing T/A and a significant excess for those under age 12 at surgery, we cannot exclude the possibility that the excess may be due to factors underlying the disorders that led to surgery.

Adolescent↗

PubMed2005

Non-steroidal anti-inflammatory drugs and perioperative bleeding in paediatric tonsillectomy.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for pain relief following tonsillectomy in children. However, as they inhibit platelet aggregation and prolong bleeding time, they could cause increased perioperative bleeding. The overall risk remains unclear. OBJECTIVES: The primary objective of this review was to assess the effects of NSAIDs on bleeding for paediatric tonsillectomy. There is good evidence (Kokki 2003; Romsing 1997) to show that NSAIDs are effective analgesics in children. It was not the remit of our review to question this, but rather to assess the risk of bleeding when NSAIDs are used for pain relief following paediatric tonsillectomy. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 3, 2004); MEDLINE (inception until August 2004); EMBASE (from inception until August 2004), Current Problems (produced by the UK Medicines Control Agency); MedWatch (produced by the US Food and Drug Administration) and the Australian Adverse Drug Reactions Bulletin in December 2001. The Cochrane Anaesthesia Review Group's handsearch co-ordinator performed handsearching as required. We also contacted manufacturers and researchers in the field. SELECTION CRITERIA: We included randomized controlled trials assessing NSAIDs in children up to and including 16 years of age, undergoing elective tonsillectomy or adenotonsillectomy. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted the data. We contacted study authors where necessary for additional information. We also collected information on adverse effects from the trials. MAIN RESULTS: We included 13 trials involving 955 children. All included trials compared NSAIDs with other analgesics or placebo and looked at bleeding requiring surgical intervention. NSAIDs did not significantly alter number of perioperative bleeding events requiring surgical intervention; Peto odds ratio 1.46 (95% confidence interval 0.49 to 4.40). Seven trials involving 471 children looked at bleeding not requiring surgical intervention. NSAIDs did not significantly alter number of perioperative bleeding events not requiring surgical intervention; Peto odds ratio 1.23 (95% confidence interval 0.44 to 3.43). Ten trials involving 837 children looked at post-operative nausea and vomiting. There was less nausea and vomiting when NSAIDs were used as part of the analgesic regime, compared to when NSAIDs were not used; Odds ratio 0.40 (95% confidence interval 0.23 to 0.72). AUTHORS' CONCLUSIONS: NSAIDs did not cause any increase in bleeding requiring a return to theatre. There was significantly less nausea and vomiting when NSAIDs were used compared to alternative analgesics.

Adolescent↗

PubMed2002

Electrosurgery for tonsillectomy.

OBJECTIVE: To describe the electrophysical principles, techniques, and morbidity associated with electrosurgical tonsillectomy. STUDY DESIGN: Review. METHODS: In electrosurgery, radiofrequency energy is applied directly to tissues to generate heat. Electrosurgery devices are radiofrequency generators coupled with application handpieces. The most common electrosurgery techniques are the monopolar blade, monopolar suction, bipolar, and microscopy-assisted procedures. Several studies have compared electrosurgery with other methods for performing tonsillectomy. RESULTS: Electrosurgery has been found to be equivalent to or better than other methods used for tonsillectomy with respect to perioperative and delayed bleeding, postoperative pain, operating time, and time to return to normal activity. CONCLUSION: Several safe and effective techniques are available for tonsillectomy, including electrosurgery. The choice of method depends on the surgeon's training, comfort with the technology, experience, and impressions concerning morbidity.

Child↗

PubMed1995

Oral ondansetron decreases vomiting after tonsillectomy in children.

Vomiting is a common, unpleasant aftermath of tonsillectomy in children. Intraoperative intravenous ondansetron (OND) reduces vomiting after this operation. Our double-blind, placebo-controlled, randomized investigation studied the effect of the oral form of OND on vomiting after outpatient tonsillectomy in children. We studied 233 healthy children age 2-14 yr undergoing elective tonsillectomy. Subjects were given placebo (PLAC) or OND 0.1 mg.kg-1 rounded off to the nearest 2 mg one hr before surgery. Anaesthesia was induced with either propofol or halothane/N2O. Vecuronium 0.1 mg.kg-1 was administered at the discretion of the anaesthetist. Anaesthesia was maintained with halothane/N2O, 50 micrograms.kg-1 midazolam iv and 1-1.5 mg.kg-1 codeine im. At the end of surgery, residual neuromuscular blockade was reversed with neostigmine and atropine. All episodes of in-hospital emesis were recorded by nursing staff. Rescue antiemetics in the hospital were 1 mg.kg-1 dimenhydrinate iv for vomiting x 2 and 50 micrograms.kg-1 droperidol iv for vomiting x 4. Parents kept a diary of emesis after discharge. Postoperative pain was treated with morphine, codeine and/or acetaminophen. The two groups were similar with respect to demographic data, induction technique and anaesthesia time. Oral OND (n = 109) reduced postoperative emesis from 54% to 39%, P < 0.05. This effect was most dramatic in-hospital, where 10% of the OND-patients and 30% of the PLAC-group vomited, P < 0.05. The OND-subjects required fewer rescue antiemetics, 7% vs 17%, P < 0.05. In conclusion, oral ondansetron decreased the incidence of vomiting after outpatient tonsillectomy in children.

Administration, Oral↗

PubMed1995

Post-tonsillectomy infiltration with bupivacaine reduces immediate postoperative pain in children.

Pain management after tonsillectomy in children remains a dilemma for the anaesthetist. A previous study demonstrated that the administration of lidocaine 1% topical spray to the peritonsillar fossae before tracheal extubation provided considerable immediate postoperative pain relief in infants and children. However, the pain relief was of short duration. We were hopeful that the use of bupivacaine would offer more prolonged pain relief because of its pharmacological characteristics. Therefore, this study was designed to compare the effects of bupivacaine 0.5% with 1:200,000 epinephrine administered after tonsillectomy either as topical spray or submucosal infiltration on postoperative pain in children. Forty-three patients aged two to ten years were randomized into three groups after tonsillectomy was performed. Group (1) received 0.5 ml.kg-1 normal saline spray; (2) received 2 mg.kg-1 bupivacaine 0.5% with 1:200,000 epinephrine peritonsillar infiltration in a similar volume to Group 1 and; (3) received 2 mg.kg-1 bupivacaine 0.5% with 1:200,000 epinephrine spray to both tonsillar beds. The patients in each group were compared postoperatively with regard to the quality of pain control using the Objective Pain Score, and their analgesic requirements. Peritonsillar infiltration of bupivacaine provided superior immediate postoperative analgesia as reflected by lower recovery room pain scores (P < 0.05) and opioid requirements (P < 0.01). Ward pain scores and analgesic requirements were similar among groups. Peritonsillar infiltration of bupivacaine 0.5% with 1:200,000 epinephrine provides better post-tonsillectomy pain control in the immediate postoperative period than bupivacaine spray or placebo.

Anesthetics, Local↗

PubMed2004

[On the accumulation of tonsillectomies in young females].

BACKGROUND: The clinical observation of an accumulation of tonsillectomies in young women raises two questions: (1) Can this observation be proved statistically? and, if yes, (2) are there any hints as to a possible psychological reason of this phenomenon? MATERIAL AND METHODS: A total of 24 young females (15-20 years old) admitted to the ENT-department for tonsillectomy were given a preoperative personality screening using the Freiburger personality inventory (FPI-R). RESULTS: A significant, sex specific accumulation of tonsillectomies was found in females aged 10-20 years. The personality screening revealed a significant increase of the subscales "social orientation" and "aggressivity" in the entire group. Eight out of the 24 females showed an abnormal personality profile with statistically unexpected correlations between the subscales "somatic complaints", "excitability" and "aggressivity". CONCLUSION: In spite of the low sample size, these results suggest that in some young females in the postadolescent age group, an abnormal personality structure influences the indication of tonsillectomy.

Adolescent↗

PubMed2006

[Histological examination following adenoidectomy and tonsillectomy in children. Surprising results are very rare].

BACKGROUND: The histological examination of lymphatic tissue resected in children during adenoidectomy or tonsillectomy has to be considered as a screening method. Its purpose is to detect rare diseases that differ from "chronic inflammation" or "lymphatic hyperplasia". That this examination is economically reasonable in relation to the frequency of surprising results with therapeutic consequences is doubtful. The aim of this study was to define the frequency of surprising or clinically relevant results in histological reports following adenoidectomy and/or tonsillectomy in children. METHODS: From both 1999 and 2004, 200 patients were identified, 10 years old or less, who underwent adenoidectomy/tonsillectomy due to recurrent throat infections or stenotic symptoms of the upper airways or upper swallowing path. The histological reports on these 400 children were evaluated. RESULTS: At the date of surgery, the median age was 4 years. In 140 children, an adenoidectomy-tonsillectomy was performed, 26 underwent tonsillectomy alone and 234 adenoidectomy alone. No reports with a histological diagnosis other than "lymphatic hyperplasia" or "chronic tonsillitis" were found. DISCUSSION: A histological report that is surprising or might influence the further treatment of the patient is rare. From the literature, an unusual diagnosis in children occurs in less than 1 per 1,000. The routine histological examination of adenoidectomy/tonsillectomy tissue cannot nowadays be economically justified. On the other hand, the ethical aspects of the abolition of this inefficient but established method should be discussed. If routine histological examination is abandoned, the surgeon would be responsible for the decision of whether a histological examination is necessary for each individual case (asymmetry of tonsils, extraordinary cervical lymph node status, striking history e.g.).

Adenoidectomy↗

PubMed2007

[Tonsillectomy technique: bipolar scissors vs raspatory: results of a case control study in 138 patients].

BACKGROUND: Postoperative bleeding is the major complication in tonsillectomy, and pain the most common side effect. The use of bipolar scissors versus blunt dissection tonsillectomy were compared in this study in order to evaluate postoperative bleeding and pain, as well as operative time. METHODS: In this case control study, 138 patients with the diagnosis of chronic tonsillitis, mononucleosis or a peritonsillar abscess were divided into two groups. A total of 78 patients were operated using bipolar scissors while 60 patients underwent tonsillectomy by blunt dissection. Operating time, frequency of postoperative bleeding and the postoperative pain score were compared between these two groups. RESULTS: The average operating time in the bipolar scissor group showed a tendency to be shorter than in the blunt dissection group (mean 4.1 min), although this did not reach a level of statistical significance. No differences were seen in pain scores or in the incidence of postoperative bleeding. CONCLUSION: The data documented in this study show that tonsillectomy with bipolar scissors might represent a surgical option to reduce surgical time in a larger patient group. Postoperative pain and the incidence of postoperative bleeding did not show any statistical difference between the two surgical techniques.

Adolescent↗

PubMed2002

[Risk of postoperative hemorrhage in tonsillectomy. A comparison between general anesthesia and local anesthesia].

BACKGROUND: Postoperative bleeding after tonsillectomy is still a life-threatening problem. The incidence of postoperative bleeding, as well as many factors (kind of surgery, hemostasic problems) affecting this risk have been investigated. A possible factor that has not been well studied is the used anaesthetic procedure. METHODS: A prospective study was completed comparing the risk of postoperative bleeding in patients operated in local vs. general anaesthesia. RESULTS: The study enrolled 1063 patients, who consecutively underwent tonsillectomy. In 16 (4.12%) of 388 patients operated under general and 51 (7.55%) of 675 patients operated under local anaesthesia postoperative bleeding occurred. After local anaesthesia postoperative bleeding was seen mainly at the day of operation (46 of 51), there was no late bleeding after the 6th postoperative day. After general anaesthesia in 6 of 16 cases postoperative bleeding occurred after the 6th postoperative day. DISCUSSION: Postoperative bleeding occurs more frequent in patients who underwent tonsillectomy in local anaesthesia. The risk of late postoperative bleeding however is higher with tonsillectomy in general anaesthesia.

Adolescent↗

PubMed2003

Post-tonsillectomy haemorrhage: reusable and disposable instruments compared.

The aim of this study was to determine if the introduction of disposable instruments for tonsillectomy resulted in a significant change in post-tonsillectomy haemorrhage rates. This is a prospective comparative study of haemorrhage rates for cold dissection (CD) tonsillectomy in adults using reusable instruments during 1999-2000 ( n=83) and disposable instruments between August and December 2001 ( n=111). Haemorrhage rates in children with reusable instruments ( n=156) and disposable instruments ( n=115) were also compared. Confidence intervals were established for the differences between study groups along with exact levels of significance. No difference was found in the overall reactionary haemorrhage rate [ P=0.32, Diff 0.9% (95% CI; -3.2 to +0.4)] or secondary haemorrhage rate [ P=1.00, Diff 3.4% (95% CI; -0.09 to +0.01)] between reusable and disposable instruments. The introduction of disposable instruments has not produced a statistically significant increase in post-tonsillectomy haemorrhage rates in our centre.

Adolescent↗

PubMed2006

Efficacy of tonsillectomy pulse therapy versus multiple-drug therapy for IgA nephropathy.

We evaluated the efficacy of tonsillectomy plus pulse prednisolone, warfarin, and dipyridamole including methylprednisolone pulse (tonsillectomy plus pulse therapy), versus prednisolone, warfarin, and dipyridamole including mizoribine (PWDM) for the treatment diffuse IgA nephropathy (IgAN) in children. The patients were randomly assigned to be treated by tonsillectomy plus pulse therapy for 2 years (Group A, n=16) or PWDM for 2 years (Group B, n=16). The clinical features and pathological findings in both groups were analyzed prospectively. The mean urinary protein excretion after 6 months of treatment in both groups had decreased significantly compared with pre-therapy. The activity index (AI) in both groups was lower at the time of the second biopsy than at the time of the first biopsy. The chronicity index (CI) in Groups A and B did not differ between the first and second biopsy. At the latest follow-up examination none (0%) of the patients in either group had renal insufficiency. None of the patients in Group A, but six patients in Group B experienced an acute exacerbation of IgAN as a result of tonsillitis (P<0.05). In conclusion, although there was no untreated control group in this study, the results suggested that tonsillectomy plus pulse therapy is as effective as PWDM in ameliorating proteinuria and histological severity in IgAN patients and in preventing acute exacerbation of IgAN by tonsillitis.

Adolescent↗

PubMed1995

The indication for tonsillectomy in children following peritonsillar abscess.

The clinical course of 19 consecutive children treated for peritonsillar abscess (PTA), in the Chaim Sheba Medical Center, between 1988-1992 was retrospectively reviewed. The abscess was drained through an incision (12 children) and by needle aspiration (7 children), under local (11 children) or general (8 children) anesthesia. One child suffered from recurrent bouts of tonsillitis after the abscess resolved and eventually underwent tonsillectomy. Two others, with a pre-PTA history of recurrent tonsillitis (T+) underwent interval tonsillectomy. Recurrent PTA did not develop in any of the 16 non-operated children. The involvement of mainly older children can explain both the low rate of the pre-PTA history of T+ and the number of children whose abscess could be drained under local anesthesia. Tonsillectomy should be indicated in cases of recurrent PTA or in children with a pre-PTA history of T+. The need for general anesthesia for draining the abscess in young children does not seem, in itself, to warrant a routine hot tonsillectomy.

Adolescent↗

PubMed1996

Changes in deglutition following tonsillectomy in neurologically impaired children.

Tonsillectomy for improvement of dysphagia in children is well recognized, but its effects upon deglutition in the neurologically impaired child have not been described. A review was performed of pre- and post-operative oral-pharyngeal motility (OPM) studies obtained on 15 children (aged 1-10 years; mean 4.6 years) with neurologically-based dysphagia who underwent tonsillectomy for upper airway obstruction (13) or recurrent tonsillitis (2). Each OPM study was rated independently by two trained observers for the presence or absence of 13 features of deglutition. Subjects served as their own control in comparative analysis. There was a mean improvement of 4.33 features of deglutition (mode: 4, range: -1(-)+7) following tonsillectomy. Of 10 children with pre-existing laryngeal penetration or aspiration, two had partial resolution and five had complete resolution following surgery. Post-operatively, two children developed new laryngeal penetration with one also having aspiration. The inter-observer reliability for the OPM study interpretation was 0.90. We conclude that tonsillectomy has a role in the neurologically impaired child with dysphagia, but a pre-operative OPM study is indicated to identify silent aspiration and to aid in necessary counseling for the possibility of a deterioration of deglutition following surgery.

Brain Diseases↗