Polysomnography outcomes for partial intracapsular versus total tonsillectomy

Objective

To demonstrate similar improvement in pediatric sleep-disordered breathing (SDB) as determined by polysomnography (PSG) with microdebrider-assisted partial intracapsular tonsillectomy and adenoidectomy (PITA) versus Bovie electrocautery complete tonsillectomy and adenoidectomy (T&A).

Methods

In this retrospective cohort study, 30 children found to have SDB by PSG who have undergone either PITA (15 participants) or T&A (15 participants) as treatment were evaluated with standardized history and physical examination and unattended home overnight PSG.

Results

Median change in apnea-hypopnea index (AHI) was 1.7 (−4.9 to 29.8) for the PITA group and 2.3 (−10.9 to 64.1) for the T&A group, although there was substantially more variability in the T&A group. A mixed linear model evaluating the relation of surgical group with change in AHI demonstrated no significant differences in group means (F[1,13] = 0.31, P = .590) but the variances differed significantly (residual likelihood ratio chi-square = 5.24, df = 1, P = .022). Five of 15 (33%) PITA patients and 4 of 15 (27%) T&A patients had postoperative AHI scores of ≤5; this difference was not statistically significant (Fisher exact test P = 1.000). There was no significant interaction or substantial confounding effect of age, sex, race, preoperative tonsil size, preoperative AHI, or body mass index in the model relating surgery type to reduction of postoperative AHI to ≤5.

Conclusions

Our study demonstrates no clinically or statistically significant differences in PSG and clinical outcomes between PITA and T&A for treatment of pediatric SDB in otherwise healthy children.     

扁桃体摘除术治疗咽不适的疗效观察

通过对１５例咽不适患者行扁桃体摘除并观察其疗效，随访１～２０个月。结果：痊愈９例占６０％，有效６例占４０％，总有效率１００％。对长期咽不适的成年人，全身其他系统正常，其真正原因则多系扁桃体已为局部病灶所致。摘除其扁桃体表明确是一行之有效的治疗措施。     

利多卡因超声雾化吸入用于扁桃体术后的镇痛效果分析

目的探讨利多卡因超声雾化吸入用于扁桃体摘除手术后患者的镇痛效果.方法: 将扁桃体摘除手术患者65例随机分成两组,观察组33例,对照组32例,分别给予0.5%的利多卡因超声雾化和0.9% NS超声雾化治疗.结果: 观察组疼痛明显减轻,术后首次进食时间提前,24h睡眠质量提高,咽部异物感减轻(P<0.01).结论: 扁桃体术后利多卡因超声雾化吸入是一种安全、有效、简便、无创的镇痛方法.     

Appendectomy, tonsillectomy, and risk of inflammatory bowel disease

PURPOSE: Appendectomy has been suggested as a possible protective factor in ulcerative colitis and as a risk factor in Crohn's disease. Tonsillectomy has also been associated with Crohn's disease. We performed a case-controlled study to investigate these associations in a homogeneous Greek population. METHODS: One hundred thirty-four consecutive cases of ulcerative colitis and 76 cases of Crohn's disease were included in the study. For each inflammatory bowel disease patient and a corresponding healthy control subject, matched for gender, age, and educational level, a standard record on various risk factors was completed by interview. The association between disease status and risk factors was assessed by Pearson's chi-squared test and the independent contribution of each risk factor was analyzed by means of logistic regression analysis. RESULTS: Appendectomy had been performed in 11 (8.2 percent) patients with ulcerative colitis, in 18 (13.4 percent) of their matched healthy control cases, in 19 (25.0 percent) patients with Crohn's disease, and in 10 (13.2 percent) of their matched healthy control cases. Odds ratio for development of ulcerative colitis after appendectomy was 0.6 (95 percent confidence interval, 0.26–1.27). Odds ratio for Crohn's disease was 2.2 (95 percent confidence interval, 0.94–5.12). Odds ratio for development of ulcerative colitis or Crohn's disease after tonsillectomy was 0.95 (95 percent confidence interval, 0.49–1.82) and 3.29 (95 percent confidence interval, 1.29–8.37), respectively. The logistic regression analysis showed that appendectomy and tonsillectomy have no independent association with the risk of developing ulcerative colitis, whereas in Crohn's disease both appendectomy and tonsillectomy have positive associations. Wellestablished risk factors, such as family history and smoking status, were also verified in this study. CONCLUSIONS: This case-control study, using multivariate logistic regression analysis, showed a less pronounced association between ulcerative colitis and appendectomy than previous reports. Our data also support the conclusion that tonsillectomy is a risk factor for developing Crohn's disease.Poster presentation at the World Congress of Gastroenterology, Vienna, Austria, September 6 to 11, 1998.     

Paediatric ENT day surgery: Is it safe practice?

Day-case surgery is convenient and safe allowing patients to have the appropriate medical service without long waits. The issue of safety has been extensively studied and presented in the literature. In this paper, the Security Forces Hospital experience with otolaryngology day-surgery cases is presented.

Objective

To evaluate the rate of complications and their timing and to assess the safety of day-surgery procedures.

Methods

A total of 300 children undergoing tonsillectomy, adenotonsillectomy, adenoidectomy, myringotomy, and other minor surgeries (e.g. reduction of fracture nasal bone, foreign body removal, etc.) were observed. Post-operatively after recovery from anaesthesia, a number of parameters were recorded at intervals of 15 min for the first 4 h, 30 min for the following 3 h, and hourly until discharge. Bleeding was considered to have occurred only if medical attention was required.

Results

In the evaluation of haemorrhage as an important complication, nine cases (3%) bled in the first 6 h (six following adenoidectomy and three following tonsillectomies) after day-surgery procedures, while six cases bled after 3 days (2%). Results were compared with post-operative haemorrhage after operations done in the main OR and there it was reported in 11 out of 101 cases in whom adenotonsillectomy was performed: only one patient (1%) needed control in the OR.

Conclusion

Post-operative complications after day-surgery procedures are comparable to that after main OR procedures. The common paediatric ENT procedures, e.g. adenoidectomy, tonsillectomy, adenotonsillectomy, and myringotomy, can be done safely as day-case procedures in a busy hospital.     

扁桃体手术局麻药中毒的研究

扁桃体切除术普遍用局麻，少数病人在注射局麻药时突发性意识丧失，惊厥，紫绀，呼吸停止，血压下降，甚至心跳停止而死亡等严并发症。我们认为是中毒反应。在家兔身上所作毒力试验显示，同等剂量１％利多卡因在咽部粘膜与静脉注射各时间点 经浓度比较，     

The role of tonsillectomy for recurrent sore throats in children: A qualitative study

IntroductionDecisions regarding tonsillectomy for children with recurrent sore throats are mainly based on guidelines that take the number of sore throat episodes into consideration. Anecdotally, parents report a number of additional factors that change after the operation. With this in mind, the first follow up tonsillectomy qualitative study was undertaken to identify what the operation truly offers this group of children.Materials and methodsTen families were interviewed between 3 and 14 months after their child's operation. A narrative method was utilised. Interviews with families were transcribed and analysed to identify key themes that had changed due to the operation.ResultsThemes identified included an improvement in general and specific symptoms. Psychosocial aspects such as education, socialising, family consequences and psychological consequences were also important factors that families noticed.ConclusionTonsillectomy has much more to offer families and children than an improvement in the numbers of episodes of sore throats and this study could form the basis of a specific quality of life assessment tool.     

益口含漱液预防扁桃体术后创面感染之疗效观察

目的探讨益口含漱液对扁桃体摘除术后创面感染的影响。方法分别用益口含漱液(观察组)和硼酸漱口液(对照组)对扁桃体摘除术后患者进行含漱,观察患者创面肿胀、疼痛、创面愈合率、平均住院时间。结果观察组平均创面愈合时间(以创面白膜脱落为观察依据)(5.50±0.75)天,对照组为(7.65±0.84)天;创面肿胀、疼痛比例观察组为15/40,对照组为31/40;平均住院时间观察组为(8.20±1.24)天,对照组为(10.40±1.56)天,观察组的疗效明显优于对照组(P<0.05)。结论益口含漱液漱口可有效促进创面愈合,降低创面感染率。