Food bolus/foreign body obstruction of the upper aerodigestive tract
S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague in ENT Head & Neck Emergencies, 2018
In our practice, patients will generally stay for 24 hours observation before being discharged home, as long as their pain is under control and they are managing oral intake. There is no evidence on the optimal duration of hospital stay, probably because it is impossible to predict if and when a patient may bleed again. The reported risk of repeated episodes of PTH come from large retrospective case series and is between 9.9 and 11.7% (Attner, Haraldsson, Hemlin, & Hessen Soderman, 2009; JP Windfuhr, Verspohl, Chen, Dahm, & Werner, 2015). They can occur anytime between post-operative day 1–15, and the longest reported time following tonsillectomy is post-operative day 58 (JP Windfuhr et al., 2008b). It is important to remember that patients presenting with repeated episodes of PTH should be taken seriously, as this can be a typical course of life-threatening PTH. It is also prudent to investigate if the patient has an underlying coagulation disorder in repeated episodes of PTH.
Infection and immunology
Jagdish M. Gupta, John Beveridge in MCQs in Paediatrics, 2020
5.11. A child of 8 years has had a fever of 40°C (104°F) for 2 days. The tonsils are enlarged and inflamed and partly covered by a mucopurulent exudate. The cervical lymph nodes are enlarged and tender. Which of the following is/are true?A negative Paul-Bunnell test would exclude glandular fever.Hypertrophy of the lingual papillae and a confluent desquamating skin rash indicates haemolytic streptococcal infection.If streptococci are grown from the throat swab, tetracycline is the treatment of choice in patients with penicillin allergy.Palatal paralysis would indicate the need for immediate isolation.Tonsillectomy should be advised following recovery.
Evidence-Based Approach to Therapy
Mark A. Richardson, Norman R. Friedman in Clinician’s Guide to Pediatric Sleep Disorders, 2016
Recent studies have evaluated the partial or intracapsular tonsillectomy as compared to the traditional total tonsillectomy. Although preliminary studies have demonstrated that partial tonsillectomy is less painful and results in a more rapid recovery (17,23,37,38), only two studies have evaluated the efficacy of the procedure. Hultcrantz et al. (23) found that there was no recurrence of sleep-apnea symptoms in 21 children who underwent tonsillotomy performed with the CO2 laser and 20 children who underwent traditional tonsillectomy at one-year follow-up, although two children who underwent tonsillotomy still snored. Sorin et al. (17) found that two of 278 (0.7%) children who had undergone powered intracapsular tonsillectomy and adenoidectomy (PITA) required complete tonsillectomy because of recurrence of OSA symptoms. PSG was not performed in either of these studies.
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
Tonsillectomy remains one of the most frequently performed surgical interventions in otolaryngology. The incidence of post-tonsillectomy hemorrhage (PTH) varies between 2% and 22.2% [1,2] with a mortality rate of 1: 12000 [3]. Primary PTH occurs within the first 24 h postoperatively and is mainly attributed to surgical factors secondary PTH typically begins 5–10 days post-operatively [4,5]. Between 2006 and 2007, in Austria, six children died due to PTH. To address the unexpected increased mortality rate, the Austrian Society of Otorhinolaryngology and the Austrian Society of Pediatrics released a Consensus Statement regarding indications, preoperative evaluation, surgery and postoperative management [6]. The extension of the hospitalization after tonsillectomy up to three nights was implemented with the intention to decrease mortality due to PTH. Intensive postoperative care with improved pain therapy treatment, food and fluid intake, a monitored physical care and a reduced physical activity was expected to have a positive effect on the bleeding rate. A prolonged observation management might reduce postoperative complications. However, given the rising cost of health care, the decision to extend the postoperative stay should also be considered to be cost-effective as outpatient management of tonsillectomy might decrease hospitalization time and save costs.
Ibuprofen and postoperative bleeding in children undergoing tonsillectomy or adenotonsillectomy: a systematic review and meta-analysis of randomized clinical trials.
Published in Expert Review of Clinical Pharmacology, 2021
Alessandro Simonini, Francesco Murgia, Marco Cascella, Franco Marinangeli, Alessandro Vittori, Maria Grazia Calevo
Tonsillectomy is the most common pediatric surgical procedure in the United States [1]. Its postoperative course can be characterized by significant pain requiring adequate analgesic therapy. In this context, opiates are often used although their use is burdened with adverse effects such as nausea, vomiting, excessive sedation, and respiratory depression. The most common indications for surgery are recurrent throat infections and Obstructive Sleep Apnea Syndrome (OSAS). Since one-third of OSAS persist even after surgery, the use of opiates is a potential cause of postoperative respiratory complications, even serious ones [2]. A well-known and potentially serious complication of tonsillectomy is intraoperative or postoperative bleeding. In the published reports, the rate of primary bleeding (in the first 24 hours after surgery) varies from 0.2% to 2.2%; the secondary bleeding rate (>24 hours after surgery) varies from 0.1% to 3% [3].
Remarkable effectiveness of tocilizumab in familial Mediterranean fever exon 3 variant with severe abdominal pain and PFAPA-like symptoms: a child case report and review of the literature
Published in Modern Rheumatology Case Reports, 2019
Makiko Tajika, Yusuke Takeuchi, Mai Arai, Koichiro Fujimaki, Takashi Soga, Kazunaga Agematsu, Atsushi Kawakami, Yoh Umeda
A range of partial responses were observed for colchicine or prednisolone treatment in the majority of exon 3 variant patients, including our own (Table 1). It was noteworthy that a single dose of oral prednisolone was immediately effective for each periodic fever attack in one case [4]. The patient received a tonsillectomy at the age of 9 years, but recurrent episodes had continued at intervals of 2–3 weeks at 6 months afterwards. Another case achieved resolution of symptoms following tonsillectomy [2]. In our patient, the attacks were completely prevented by monthly administration of tocilizumab, an IL-6 receptor blocker, which has been widely used in the treatment of rheumatoid arthritis. Koga et al. have proposed that IL-6 inhibitors represent an effective alternative treatment for severe FMF [22] since IL-6 plays a critical role in the synergistic activation of the human serum amyloid A gene by IL-6, IL-1β, and TNF-α [23]. Fujikawa et al. reported the first case of a 19-year-old Japanese FMF patient with a heterozygous M694I mutation who was successfully managed with tocilizumab [24], after which Umeda et al. described a 64-year-old Japanese woman with the E148Q hetero variant of the MEFV gene whose attacks of FMF fever and myalgia disappeared after tocilizumab administration [25]. Hamanoue et al. and Yilmaz et al. also reported on high effectiveness of tocilizumab for AA amyloidosis secondary to FMF [26,27]. Regarding patients with exon 3 variants, Yabuuchi et al. described a case that developed into end-stage renal failure due to secondary amyloidosis but showed a remarkable response to tocilizumab [10].
Related Knowledge Centers
- Bleeding
- Dehydration
- Obstructive Sleep Apnea
- Pharyngitis
- Quality of Life
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- Vomiting
- Tonsillitis
- Palatine Tonsil
- Throat
- Quality of Life