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The Pharynx and Oral Cavity
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
The adenoids are rudimentary at birth but enlarge to occupy a substantial part of the nasopharynx between the ages of about 2 and 7 years. Adenoids can obstruct the nasopharyngeal airway and the orifices of the Eustachian tube, contributing respectively to OSA and OME. There has been increasing focus in recent years on the role of the adenoids as a reservoir of chronic infection. ‘Biofilms’ are aggregates of bacteria in a complex mucopolysaccharide matrix which is resistant to conventional antimicrobial therapy and may contribute to recurrent infections in the nose, sinuses and middle ear. Adenoidectomy – often in association with an intervention such as tonsillectomy (typically for OSA) or insertion of grommets – is a common ORL procedure in children. Indications include OSA, OME and persistent rhinitis that has been resistant to medical therapy. Blind curettage with a sharp blade has been the traditional technique, but ORL specialists are increasingly moving towards surgery under direct vision (coblation and suction diathermy) using an endoscope and a screen/monitor, permitting much more accurate and thorough removal of tissue. The main complication of adenoidectomy is bleeding. Velopharyngeal insufficiency, characterised by escape of air from the nasal cavity during phonation (rhinolalia aperta), is often noted in the weeks and months following surgery but is usually temporary. Persistent cases can be troublesome and, very occasionally, warrant corrective pharyngeal or palatal surgery.
Adenotonsillar Conditions and Obstructive Sleep Apnoea
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Adenoidectomy techniques include: CurettageSuction diathermyCoblation®MicrodebriderKTP laser (high risk of nasopharyngeal stenosis)
Hereditary Plasma Protein Disorders
Published in Genesio Murano, Rodger L. Bick, Basic Concepts of Hemostasis and Thrombosis, 2019
A new coagulation factor was described in 1965. In this interesting disorder, a family from eastern Kentucky was involved in a fire, necessitating hospitalization of several children. During hospitalization adenoidectomy was contemplated for one child. A preoperative hemostasis screen revealed a markedly prolonged PTT. In all, four of fourteen siblings had markedly prolonged activated partial thromboplastin times. Careful investigation of the family failed to reveal evidence of any hemorrhagic tendency. The family surname is Fletcher and the defect is now known as Fletcher factor deficiency.46 Subsequently, six to eight es of Fletcher factor deficiency have been found. Investigations into Fletcher factor deficiency have revealed this defect to be characterized by a normal prothrombin time, a long activated partial thromboplastin time, and plasma recalcification time. Both of these latter tests are completely corrected by longer incubation with kaolin, celite, or glass. A screening test for Fletcher factor deficiency is simple and consists of correcting a markedly prolonged PTT by incubating the mixture with kaolin for 10 min, rather than 2 to 3 min.
Hypoxia induced factor-1α levels in patients undergoing adenoidectomy
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2021
Kamile Yucel, Isa Aydin, Said Sami Erdem
AH is a common condition in children and leads to hypoxia by blocking the upper airway. The main purpose of the adenoidectomy is to eliminate the nasopharyngeal reservoir of potential respiratory pathogens and to remove the cause of obstruction in the nasal airway [6,22,23]. In most children, enlarged adenoids can obstruct breathing patterns and can cause upper respiratory tract obstruction. Airway obstruction can be due to adenoid size alone and can lead to hypoxia [4,9,10,24]. ANR is used to determine nasopharyngeal obstruction ratio. Fujioka et al. found that in 34 out of 36 cases (94%) of AH, the ANR was above 0.80 [9]. In another study conducted by Eyibilen et al. examined adenoid tissue size and ANR values in 100 cases and compared these results with postoperative adenoid weight. The findings suggest a significant relationship between ANR and adenoid weight (r = 0.46, p < .001) [25]. In our study, the average ANR was 0.80 ± 0.21, similar to the results of other studies. As we are determining ANR values from data obtained from patient files, we were unable to measure adenoid weights and we could not make any comparisons.
Local Bacteriotherapy – a promising preventive tool in recurrent respiratory infections
Published in Expert Review of Clinical Immunology, 2020
Giorgio Ciprandi, Ignazio La Mantia, Valerio Damiani, Desiderio Passali
Tarantino and colleagues provided real-world experience in 80 children with RRI [47]. Local Bacteriotherapy halved RI’s number, reduced school days and parental working days missed per month. La Mantia and coworkers investigated an intriguing issue, such as avoiding adenoidectomy [48]. This open study included 44 children candidates for adenoidectomy and tympanocentesis to treat adenoid hypertrophy and otitis media with effusion. Twenty-two children were treated with both strains administered by nasal spray. Control children were treated with hypertonic saline. In the active group, 6/22 children required adenoidectomy, compared to 20/22 children in the control group (p < 0.0001). The treated children also had a significant reduction of adenoid size (p < 0.0001) and improvement of middle ear effusion measured with tympanometry (p < 0.0001).
Post-tonsillectomy hemorrhage: cost-benefit analysis of prolonged hospitalization
Published in Acta Oto-Laryngologica, 2020
Erich Vyskocil, Wolf-Dieter Baumgartner, Matthaeus Ch. Grasl, Stephan Grasl, Christoph Arnoldner, Johannes Steyrer, Boban M. Erovic
Preoperative examinations included full blood count, clotting screen (prothrombin time, partial thromoboplastin time). Treatment was adapted to minimize bleeding risk if patients received medication which had an effect on blood coagulation due to their comorbidities. All interventions were performed under general anesthesia, using cold-steel dissection with bipolar diathermy. Adenoidectomy was performed with adenotoms. Patients were hospitalized for three nights. One week after surgery a routine follow-up appointment in the outpatient clinic. Some patients required prolonged postoperative observation (e.g. pain, poor general condition, long travel time to the next emergency department, postoperative bleeding, severe nausea or pain). Pain control was accomplished by paracetamol, mefenamic acid and diclofenac in the standard dosages. Patients with severe pain, which could not be sufficiently treated with above-mentioned drugs, also received Metamizole given intravenously. In some cases of persisting pain, adults received synthetic opioid analgesic (Piritramide). Fever, vomiting and dehydration were treated symptomatically. Postoperative care also included monitoring during two surgeon rounds per day and permanent observation by the nursing staff.