Routine histologic examination is unnecessary for tonsillectomy or adenoidectomy

OBJECTIVE: To determine whether the current practice and incurred cost of histologic examination of tonsillectomy and adenoidectomy specimens is warranted. STUDY DESIGN: Review article based on medical literature. SUBJECTS AND METHODS: A retrospective PubMed review of all pertinent literature regarding tonsillectomy, adenoidectomy, and related surgical pathology was conducted. References of the articles obtained were reviewed for additional sources. RESULTS: Twenty studies report 54,901 patients and found 54 malignancies (0.087% prevalence). Of these, 48 (88% of the patients) had suspicious features such as tonsillar asymmetry, cervical lymphadenopathy, or abnormal tonsil appearance, preoperatively. The remaining six patients without any suspicious features (better representing true occult malignancy) were 0.011% of the total cases. CONCLUSION: Submission of tonsillectomy, adenoidectomy, or both specimens is warranted only when patients demonstrate findings associated with malignancy: tonsillar asymmetry, history of cancer, neck mass, tonsil firmness or lesion, weight loss, and constitutional symptoms.     

Role of nasopharyngeal bacterial flora in the evaluation of recurrent middle ear infections in children

Objectives: To study the nasopharyngeal colonization in otitis-prone children before and after adenoidectomy.
Methods: The study population consisted of 35 children between 11 months and 4 years of age, undergoing adenoidectomy and tube placement for recurrent acute otitis media. All these children were otitis prone (OP). During general anesthesia, bacteriologic samples were obtained from the nasopharynx and the middle ear fluid, if present. During the follow-up visit, a new nasopharyngeal culture was taken. The control population consisted of 35 children undergoing surgery for non-ear-nose-throat pathology. These children had no history of recurrent upper respiratory tract infections.
Results: Colonization of the nasopharynx with potential pathogens ( Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae ) occurred significantly more in the OP children than in the non-OP children. Adenoidectomy resulted in a substantial decrease of potential middle ear pathogens in the nasopharynx and an increase of normal commensal flora. In about half of the patients, middle ear fluid was still present at the time of tube placement; in most instances, H. influenzae was cultured. Typing with arbitrarily primed PCR indicated substantial genetic diversity among the H. influenzae isolates studied.
Conclusions: Both cross-colonization (between sampling sites within the same patient and between siblings) and turnover appeared to be high.     

Cervical subcutaneous emphysema: an unusual complication of adenotonsillectomy

Removal of the tonsils and adenoid tissue because of recurrent infection and/or respiratory obstruction is one of the most commonly performed operations. A rare complication during this intervention is subcutaneous surgical emphysema. The awareness of anaesthesiologists and otolaryngological surgeons will protect the patient from serious consequences. We report our experience with this complication and provide a review of the literature.     

鼻内镜辅助经口腔腺样体切除与传统腺样体刮除术临床分析

目的探讨鼻内镜辅助经151腔腺样体切除与传统腺样体刮除术的临床效果及应用价值。方法选择2008年9月～2012年9月东阳市人民医院巍山院区的240例腺样体肥大患者，按照入院时间先后、对照的原则分为观察组和对照组，各为120例。对照组患者采用传统腺样体刮除术进行手术，观察组患者则采用鼻内镜辅助经口腔腺样体切除进行手术。术后随访12个月，观察两组患者临床治疗效果及腺样体残留情况．并比较两组患者并发症发生情况。结果观察组患者临床治疗总有效率为98．3％，对照组患者临床治疗总有效率为90．0％，观察组治疗效果明显优于对照组（P〈0．01）；观察组患者并发症发生率为0．8％，对照组患者并发症发生率为6．6％，观察组明显好于对照组（P〈0．05）。结论临床采用鼻内镜辅助经口腔腺样体切除术式对腺样体肥大患者的治疗效果较好，对患者的创伤小，恢复好．值得临床进一步推广应用。     

Investigation of resectability degree for adenoidal surgery in OSA children with the method of computational fluid dynamics

Conclusion: From aspect of fluid dynamics, expanding patients’ nasopharyngeal coronal-sectional area to 48.3–54.7% of normal area will bring the airflow velocity back to normal in adenoidal hypertrophy children. It might provide a suggestion for adenoidectomy range selection and whether total resection is necessary.

Objectives: To evaluate the nasopharyngeal airflow characteristics in pediatric OSA patients with adenoidal hypertrophy, and to explore the proper resection range for adenoidectomy

Method: Nine OSA patients and four normal children were recruited. The CT scans of their upper airway were collected and used to construct three dimensional models for fluid dynamics analysis. Using computational fluid dynamics, indices such as velocity, pressure, and coronal-sectional area were calculated.

Results: Compared with the normal, the OSA children showed three characteristics in nasopharyngeal: the airflow velocity was significantly higher (p?p?p?>?0.05). In a study of the relationship between velocity and coronal-sectional area, this study investigates different coronal-sectional areas from 30–300?mm². It was found that, when patients’ nasopharyngeal coronal-sectional area was expanded over 155–170?mm², namely 48.3–54.7% of normal area, airflow velocity in nasopharyngeal showed no difference than normal.     

腺样体及扁桃体切除术后应激性胃溃疡出血1例

患儿，男，ll岁，因睡眠时打鼾伴憋气2年，加重3个月入院。临床诊断为腺样体肥大及慢性扁桃体炎。全身麻醉鼻内镜下行腺样体动力刀切除术及双侧扁桃体挤切术。术中经过顺利，出血约80ml，棉球压迫后再以双极电凝行扁桃体窝电凝止血，鼻内镜下检查术区无出血。     

儿童OSAHS的手术疗效分析

目的：探讨扁桃体腺样体切除术治疗儿童OSAHS的疗效。方法全麻下切除扁桃体,鼻内镜下切除肥大的腺样体。结果术后随访6~12个月,临床症状完全消失者370例（92.5%）,21例症状明显减轻（5.25%）,9例症状改善不明显（2.25%）。结论切除扁桃体和腺样体是治疗儿童OSAHS的有效方法。