Predictors of Tonsillectomy after Previous Adenoidectomy for Upper Airway Obstruction

Gov-Ari, Eliav; Mills, Jonathan C.; Basler, Keith

doi:10.1177/0194599811430912

Cited by 8 publications

(10 citation statements)

References 7 publications

(15 reference statements)

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“…Figure 1 summarises the selection process. Twenty-four studies 14–37 used cohorts to examine ETS exposure, and four 38–41 used case–control methodologies.…”

Section: Resultsmentioning

confidence: 99%

Impact of environmental tobacco smoke exposure on anaesthetic and surgical outcomes in children: a systematic review and meta-analysis

Chiswell

Akram

2016

Arch Dis Child

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BackgroundTobacco smoke exposure in adults is linked to adverse anaesthetic and surgical outcomes. Environmental tobacco smoke (ETS) exposure, including passive smoking, causes a number of known harms in children, but there is no established evidence review on its impact on intraoperative and postoperative outcomes.ObjectivesTo undertake a systematic review of the impact of ETS on the paediatric surgical pathway and to establish if there is evidence of anaesthetic, intraoperative and postoperative harm.Eligibility criteria participantsChildren aged 0–18 years undergoing anaesthetic or surgical procedures, any country, English language papers.ExposureETS exposure assessed via questioning, observation or biological marker.Outcome measuresFrequency of respiratory and other adverse events during anaesthesia, surgery and recovery, and longer term surgical outcomes.Results28 relevant studies were identified; 15 considered anaesthetic outcomes, 12 surgical outcomes, and 1 a secondary outcome. There was sufficient evidence to demonstrate that environmental smoke exposure significantly increased risk of perianaesthetic respiratory adverse events (Pooled risk ratio 2.52 CI 95% 1.68 to 3.77), and some evidence that ear and sinus surgery outcomes were poorer for children exposed to ETS.ConclusionsETS exposure increases the risk of anaesthetic complications and some negative surgical outcomes in children, and this should be considered when planning surgery. Research is required to demonstrate whether changes in household smoking behaviour prior to surgery reduces risk of adverse outcomes, and to close the evidence gap around other outcomes such as wound healing and respiratory infections.Trial registration numberReview registration number 42014014557.

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“…Figure 1 summarises the selection process. Twenty-four studies 14–37 used cohorts to examine ETS exposure, and four 38–41 used case–control methodologies.…”

Section: Resultsmentioning

confidence: 99%

Impact of environmental tobacco smoke exposure on anaesthetic and surgical outcomes in children: a systematic review and meta-analysis

Chiswell

Akram

2016

Arch Dis Child

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“…The rate of obesity in our cohort was 16.5%, which is lower than some related US studies, but is similar to others. 27,34,35,40 This study has several limitations that may guide future prospective research. Above all, the decision to perform adenoidectomy or adenotonsillectomy depended on ENT and parental decision and not on designed randomization.…”

Section: Discussionmentioning

confidence: 98%

“…Young age, female sex, and large tonsil size may further increase the risk for subsequent tonsillectomy. 27 Moreover, the American Academy of Pediatrics recommendation suggests that "adenoidectomy or tonsillectomy alone may not be sufficient, because residual lymphoid tissue may contribute to persistent obstruction." 3 Since the morbidity, rate of complications, and cost of adenotonsillectomy are substantially higher, it can be assumed that ENT surgeons would choose to perform adenoidectomy alone if supportive data, guidelines, and limitations were presented.…”

Section: Discussionmentioning

confidence: 99%

Adenoidectomy for Obstructive Sleep Apnea in Children

Domany

Dana

Tauman

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objective: Adenotonsillectomy is the recommended treatment for children with obstructive sleep apnea (OSA). Since adenoidectomy alone may be associated with significantly lower morbidity, mortality, and cost, we aimed to investigate whether adenoidectomy alone is a reasonable and appropriate treatment for children with OSA. Methods: Five-hundred fifteen consecutive children diagnosed with moderate-to-severe OSA (apnea-hypopnea index > 5) based on polysomnography and who underwent adenoidectomy or adenotonsillectomy were reevaluated after 17-73 months (mean 41) for residual or recurrent OSA using a validated questionnaire (Pediatric Sleep Questionnaire, PSQ). Failure of OSA resolution was defined as a positive mean PSQ score ≥ 0.33. Contribution of age, obesity, tonsil size, and OSA severity at baseline to adenoidectomy or adenotonsillectomy failure was examined. Results: Positive PSQ score occurred in 15% of the entire sample and was not influenced by age or gender. No difference in failure rate was observed between adenoidectomy and adenotonsillectomy for children who were not obese with apnea-hypopnea index < 10 and had small tonsils (< 3). Children with apnea-hypopnea index ≥ 10 and/or tonsil size ≥ 3 showed a higher failure rate after adenoidectomy compared to adenotonsillectomy (20% versus 9.8%, p = 0.028). Conclusions:We suggest that subjective, long term outcomes of adenoidectomy are comparable to those of adenotonsillectomy in non-obese children under 7 years old with moderately OSA and small tonsils. Hence, adenoidectomy alone is a reasonable option in some children. Future prospective randomized studies are warranted to define children who may benefit from adenoidectomy alone and those children in whom adenoidectomy alone is unlikely to succeed.

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“…ile Gov-Ari ve ark., artmış tonsil boyutunun adenoidektomi sonuçlarını belirgin bir şekilde olumsuz etkilediğini göstermişlerdir. 29,30 Cohen-Levy ve ark., iki yaşın altında erken cerrahi yapıldığında, ileri dönemlerde uykuda nefes bozukluğu semptomlarının daha çok görüldüğünü ortaya koymuşlar ve bunun olası nedenini; bu yaş grubuna daha az invaziv olan sadece adenoidektominin uygulanmış olmasına bağlamışlardır. Dokunun yeniden büyüme ihtimalinin yüksek olması nedeni ile eğer semptomlar ciddi değilse cerrahinin ertelenmesi gerektiğini belirtmişlerdir.…”

Section: Discussionunclassified

Early Postoperative Weight and Height Gain After Adenoidectomy and Parental Satisfaction

Koçdor¹,

Elhakan²,

Şenkal³

et al. 2019

KBB ve BBC Dergisi

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Çocuklarda adenoidektomi sonrası erken postoperatif dönemde, uyku bozukluğu açısından ebeveyn memnuniyeti ve fiziksel değişimi (kilo, boy) araştırmaktır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Okan Üniversitesi Tıp Fakültesi Hastanesi Kulak Burun Boğaz Kliniğinde adenoidektomi olan pediatrik hastalarda, ameliyat öncesi ve sonrası üçüncü ayda boy, kilo, ayrıca Z skorlarına bakıldı. Bu hastaların ebeveynlerine Pediatrik Uyku Anketi uygulandı. Kontrol grubu olarak; aynı dönemde Pediatri Kliniği Sağlıklı Çocuğa başvuran bir grup hastanın; ilk başvuru kilo, boy, Z skorları ve üçüncü ay değerleri belirlendi. B Bu ul lg gu ul la ar r: : Adenoidektomi olan bireylerde (n=32), preoperatif ve postoperatif kilo ve boy ortalamaları arasında istatistiksel olarak anlamlı farklılık mevcuttur. Aynı şekilde, kontrol grubunda da (n=37) birinci ay ve üçüncü ay ölçümler arasında istatistiksel anlamlı fark bulundu. Adenoidektomi grubundaki postoperatif kilo Z-skor ortancaları, preoperatif kilo Z-skor ortancalarına göre daha yüksek iken, kontrol grubunda ilk muayene ve üçüncü ay muayene kilo Z-skor ortancaları arasında istatistiksel olarak anlamlı fark bulunmadı. Adenoidektomi grubundaki bireylerin postoperatif boy Z-skor ortancaları, preoperatif boy Zskor ortancalarına göre daha yüksek idi, kontrol grubundaki bireylerde ise ilk muayene ve üçüncü ay muayene boy Z-skor ortancaları arasında istatistiksel olarak anlamlı fark belirlenmedi. Adenoidektomili bireylerde, Pediatrik Uyku Anketi preoperatif uyku anketi skor ortalaması 9,23±3,73 iken, Pediatrik Uyku Anketi postoperatif uyku anketi skor ortalamasının 2,77±2,55 olduğu saptandı. S So on nu uç ç: : Adenoidektomi kilo alımı, boy artışına erken dönemde katkı sağlamakta, uyku anket skorlarında düzelmeye neden olmaktadır. Uyku bozuklukları veya tıkayıcı uyku apnesi nedeni ile adenotonsillektomi planlanan bazı hastalarda adenoidektominin de tek başına belirgin bir iyileşme sağlayabildiğini bilmek, cerrahiye karar vermede, gerek cerraha gerekse ebeveyn beklentilerine yardımcı olacaktır.

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Predictors of Tonsillectomy after Previous Adenoidectomy for Upper Airway Obstruction

Cited by 8 publications

References 7 publications

Impact of environmental tobacco smoke exposure on anaesthetic and surgical outcomes in children: a systematic review and meta-analysis

Impact of environmental tobacco smoke exposure on anaesthetic and surgical outcomes in children: a systematic review and meta-analysis

Adenoidectomy for Obstructive Sleep Apnea in Children

Early Postoperative Weight and Height Gain After Adenoidectomy and Parental Satisfaction

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