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At least 19 recordsLinked to original sources
PubMed1975

Certain effects of adenoidectomy of Eustachian tube ventilatory function.

In an effort to develop a simple and accurate method to identify children in whom adenoidectomy might prevent otitis media, the ventilatory function of the Eustachian tube was assessed by a manometric technique. Nasal pressures during swallowing were also determined in some. The study group consisted of 23 children with otitis media in whom tympanostomy tubes had been inserted. All were judged clinically and roentgenographically to have prominent adenoids. Inflation-deflation Eustachian tube ventilation studies were obtained in 36 ears that remained intubated, aerated and dry both before and eight weeks after adenoidectomy. Fifteen of the 36 (42 percent) ears had improvement in Eustachian tube ventilatory function postadenoidectomy which was attributed to relief of extrinsic mechanical obstruction of the tube. In the remaining 21 (58 percent) ears in which Eustachian tube function was not improved, mechanical obstruction was not apparent preoperatively. The effect of nasopharyngeal pressures on a pliant Eustachian tube (Toynbee phenomenon) due to obstruction of the posterior nasal choanae by the adenoid mass was suggested as a possible cause of functional Eustachian tube obstruction. In several instances in which preadenoidectomy mechanical obstruction of the Eustachian tube was not demonstrated, the tube appeared to have been made more pliant by the operation. This increase in compliance of the Eustachian tube was attributed to loss of adenoid support of the tube in the fossa of Rosenmuller. From this study, preliminary recommendations for selection of patients for adenoidectomy are the following: 1. Eustachian tube ventilation function tests in a dry, intubated middle ear; 2. if extrinsic mechanical obstruction of the Eustachian tube is present and chronic inflammation is absent, adenoidectomy will probably improve Eustachian tube function. The surgical technique should include adequate removal of the adenoid tissue in the fossa of Rosenmuller; 3. if the Eustachian tube does not appear to be mechanically obstructed, the adenoids should not be removed unless functional obstruction is suspected due to obstruction of the posterior nasal choanae. Adenoid tissue within the fossa of Rosenmuller should not be removed when such circumstances exist; and 4. in the abscence of obstructive adenoids to the nasal choanae or Eustachian tube, adenoidectomy probably will not improve Eustachian tube function and could make it worse. A more rational and effective approach to adenoidectomy for the prevention of otitis media in children may be possible through this type of preoperative evaluation.

Adenoidectomy↗
PubMed1978

Allergy, otitis media and serum immunoglobulins after adenoidectomy.

The incidence of atopic disease and of episodes of otitis media, respiratory tract infections as well as levels of serum immunoglobulins were followed during 16 months after adenoidectomy in a consecutive group of 274 children. The total incidence of atopic disease was high (23.6%) at the start of the study and increased further to 39.0% during the study. Increased serum IgE levels, positive RAST tests and/or positive provocation tests were found before the onset of atopic symptoms in 13 out of the 19 children developing such symptoms during the observation period. Otitis media continued to occur in 42.9% of the children. The incidence of episodes of otitis media after the adenoidectomy was higher with lower age, a high number of episodes of otitis media before the operation and/or a history of atropic disease. None of the laboratory tests could predict subsequent episodes of otitis media. Protracted respiratory tract infections developed only in children with laboratory findings indicative of atopy. Serum IgE and IgM levels decreased significantly. No serious infections and no dysgammaglobulinaemias developed. Adenoidectomy seems to be a rather minor trauma from an immunological point of view, but further and controlled studies are needed concerning the possible clinical benefit of adenoidectomy in children with recurrent otitis media.

Adenoidectomy↗
PubMed1978

Tonsillectomy and adenoidectomy.

Tonsillectomy and adenoidectomy is the definitive treatment for chronic tonsillitis and adenoid hypertrophy. It is most important to determine if the patient has chronic tonsillitis--a diagnosis that can only be made between acute attacks when the patient is clinically well. Decisions regarding the need for a tonsillectomy and adenoidectomy should be made only at this time and never during an episode of acute tonsillitis. Frequency of acute attacks should not by itself be the indication for surgery. The family physician who performs tonsillectomy and adenoidectomies has an opportunity to correlate the preoperative and postoperative clinical course of the patient with the findings at the time of surgery. In my experience, patients carefully selected for tonsillectomy and adenoidectomy on the basis of these criteria do benefit from the surgery, and the clinical improvement is sustained in the long-term follow up of these patients.

Adenoidectomy↗
PubMedDate not supplied

Adenoidectomy in relation to otitis media.

Past studies of the efficacy of adenoidectomy in the management of children with otitis media have been inconclusive due to significant limitations in experimental design. At the Children's Hospital of Pittsburgh, the effect of adenoidectomy on the outcome of otitis media is currently being studied in a prospective manner. An attempt is being made to document and to control those factors cited as lacking in the previous studies. This report describes the techniques for assessment of nasal and Eustachian tube function and for the completeness of adenoidectomy.

Adenoidectomy↗
PubMedDate not supplied

Effects of adenoidectomy: a controlled two-year follow-up.

A prospective controlled study was made on the effect of adenoidectomy performed on 105 children. For various reasons, mainly severe long-standing nasal obstruction, 29 children were omitted from the study. The remaining 76 children were randomly divided into two groups, one adenoidectomy, and one control. Both groups were slightly reduced in number due to drop out. Thus 36 adenoidectomized children were followed during one year and 35 children during two years. The corresponding numbers for the children in the control group were 37 and 33. The incidence of common cold, purulent and serous otitis media and moderate nasal obstruction was compared in the two groups. A considerable reduction in the incidence of these variables was observed in both groups. The occurrence of moderate nasal obstruction was reduced more among the operated than among the unoperated children. The difference was only slightly significant during the first and not at all during the second year. Regarding the other variables, the differences were not significant, implying that adenoidectomy seems to have no effect on the incidence of common cold, serous and purulent otitis media.

Adenoidectomy↗
PubMed1978

Critical evaluation of adenoidectomy.

In two matched groups of thirty-two children, one which had tonsillectomy alone and the other which had tonsillectomy plus adenoidectomy, the symptoms generally attributed to adenoidal hypertrophy were equally common in both groups before operation and improved with equal frequency after operation whether or not the adenoids were removed.

Adenoidectomy↗
PubMed1977

Elective surgical rates--do high rates mean lower standards? Tonsillectomy and adenoidectomy in Manitoba.

We used claims data from the Canadian province of Manitoba to test alternative explanations for regional differences in tonsillectomy and adenoidectomy rates. Respiratory morbidity, standards of selection for operation, and surgical resources were compared with elective surgical rates across geographic areas. Statistically significant correlations were not found. Individual practice patterns were then examined. In some regions, a few physicians accounted for the great majority of tonsil/adenoid operations. In other regions, the work was much more widely distributed. Despite great variation among individual physicians in the frequency of performing tonsil/adenoid operations and the standards of selection for operation, use of these procedures and standards applied were only weakly related to such variables as physician age, place of training and specialty.

Adenoidectomy↗
PubMed1978

Tonsillectomies, adenoidectomies, audits: have surgical indications been met?

In the Seattle Prepaid Health Care Project, we studied medical records and claims information for all 97 children undergoing tonsillectomy and/or adenoidectomy in an independent practice plan from February 1971, through January 1975. Overall only 32 per cent of the procedures met commonly promulgated indications of surgery. Of 77 persons having one of these procedures performed because of recurrent pharyngeal or ear infections, 86 per cent did not meet the indications for surgery suggested by screening criteria adapted from model guidelines for PSRO use. The average number of episodes of illness was estimated to be 1.71/per year in the year prior to surgery using lenient assumptions. It is concluded that a major reduction in the frequency of these procedures would be effected by developing an audit strategy that assures the stated indications meet commonly recommended guidelines. The reduction in surgery would occur irrespective of the debate about the efficacy of these procedures.

Adenoidectomy↗
PubMed1976

Clinical trials of tonsillectomy and adenoidectomy: limitations of existing studies and a current effort to evaluate efficacy.

Indications for tonsillectomy and adenoidectomy (T&A) are both uncertain and controversial. Only five prospective clinical trials of T&A have been reported. These studies provided important data, but failed to test the efficacy of the procedures in children most affected by tonsil- and adenoid-related conditions. A study currently under way focuses on just such children and also explores related immunologic issues.

Adenoidectomy↗
PubMed1978

Adenoidectomy: an evaluation of the indications.

A group of 76 children who had been listed for adenoidectomy was investigated by scoring the symptoms and signs usually attributed to adenoidal hypertrophy, and removing the adenoids and weighing them. With the possible exception of snoring there was no correlation between the size of the adenoids and the symptoms usually attributed to hypertrophy of this organ. We wish to acknowledge our gratitude to those consultants who allowed us access to their patients, to Dr Ian McDicken, Department of Pathology, University of Liverpool who did the histological examination, and to Mrs P. O'Brien who did the typing.

Adenoidectomy↗
PubMedDate not supplied

Tonsillectomy and adenoidectomy: incidence and mortality, 1968--1972.

To determine the number of tonsillectomies and adenoidectomies (T-As) from 1968 to 1972 and their associated morbidity and mortality rates, a questionnaire was sent to all the hospitals listed in the Directory of the American Hospital Association (6,759). The data were analyzed and statistical projections were made. An analysis was also made of the summary report of the "Study on Surgical Services for the United States," with regard to the incidence of T-A was also made. The results are presented in the following report.

Adenoidectomy↗
PubMed1977

Status of tonsillectomy and adenoidectomy: 1977.

Tonsillectomy and adenoidectomy, performed either in combination or separately, still constitute the most common major operations performed in the United States. This report is an attempt to present briefly the current status of knowledge concerning the epidemiology and natural history of conditions for which these operations are performed, the incidence of the operations, and the type and qualifications of the physicians performing the procedures, a review of the problems of the previous studies designed to determine efficacy, an update of the current study being conducted in Pittsburgh, and, finally, what little is known of the morbidity, mortality, and costs of these procedures.

Adenoidectomy↗
PubMed1979

The effect of adenoidectomy on secretory otitis media in children.

139 patients, 80 boys and 59 girls aged 1 1/4--13 1/2 years suffering from serous otitis media based on otoscopy and tympanometry had adenoidectomy performed and no other surgical measures taken. The efficiency of the treatment was assessed 2--4 months later. Intially flat tympanometry curves were found in 155 ears, negative middle ear pressure in 70 ears and low curves in 20 ears. 78% of all ears and 73% of the ears with flat curves were seen to normalize during the observation periods.

Acoustic Impedance Tests↗
PubMed1979

Pediatric adenoidectomy and tonsillectomy--personal viewpoints.

A report on experience with adenoidectomies, tonsillectomies, and adenotonsillectomies carried out at the Hospital for Sick Children, Toronto in the period 1968-75. Operations were performed on 25,443 patients during this period. Reasons for the reduction in T&A operations in recent years are considered, and views are expressed regarding when such operations are indicated, age of patient for surgery, the allergic child, cleft palate patient, the presence of quinsy, cardiopulmonary changes, subluxation of cervical spines, anesthesia, and postoperative care and complications.

Adenoidectomy↗
PubMed1977

The tonsillectomy-adenoidectomy dilemma.

Tonsillectomy and adenoidectomy (T&A) is the most commonly performed surgical procedure in the U.S. Considerable controversy surrounds this operation because all previous studies have demonstrated experimental flaws that compromise the value of the findings. While an apparent immunologic deficit following T&A has been demonstrated, the clinical significance of this finding is unknown. Normal humoral antibody responses are found after surgery and no increase in clinically apparent viral infection has been shown. T&A consistently normalizes pharyngeal microflora.

Adenoidectomy↗