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Wang Y, Zhao L, Wang J, Li X. The efficacy of perioperative antibiotic therapy in adenotonsillectomy children. Eur Arch Otorhinolaryngol 2024; 281:267-272. [PMID: 37737873 DOI: 10.1007/s00405-023-08244-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE To evaluate the role of perioperative antibiotics use in children after adenotonsillectomy. METHODS SPSS 27.0 was used for statistical analysis. Two independent samples mean T test was used to evaluate the throat pain scores consecutive 3 days after the surgery, the time to resume to normal diet, and the wound healing time. Logistic regression analysis was used to evaluate the independent risk factors of the two groups. The generalized estimation model was used to evaluate the correlation between age and postoperative pain scores, and the relationship between different tonsillar bed gradings and postoperative pain scores. RESULTS The pain scores were 5.83 ± 1.879, 5.20 ± 1.933, and 4.02 ± 1.936 in the observation group; and 6.83 ± 1.892, 6.17 ± 2.001, and 5.29 ± 2.068 in the control group on days 1-3 after surgery, respectively. The time of pain disappearance was 6.24 ± 2.121 days in the observation group and 7.73 ± 2.210 days in the control group. The wound repair time was 18.66 ± 2.200 days in the observation group and 18.70 ± 2.468 days in the control group. Logistic regression analysis showed that fever was an independent risk factor for the two groups and was negatively correlated (B = - 1.237, P < 0.001, OR = 0.290). Generalized estimation model showed that there was a positive correlation between age and pain scores (P < 0.001), and with the increasing grading of tonsillar bed, the higher the pain scores was (P < 0.001). CONCLUSIONS Perioperative use of antibiotics in children with adenotonsillectomy can effectively reduce postoperative fever, throat pain symptoms, and shorten the pain time. With the increasing of tonsillar bed grading, perioperative antibiotic therapy was more necessary.
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Affiliation(s)
- Ying Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No.355, Luding Road, Shanghai, 200062, People's Republic of China
| | - Limin Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No.355, Luding Road, Shanghai, 200062, People's Republic of China
| | - Jing Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No.355, Luding Road, Shanghai, 200062, People's Republic of China
| | - Xiaoyan Li
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No.355, Luding Road, Shanghai, 200062, People's Republic of China.
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Abdelhamid AO, Sobhy TS, El-Mehairy HM, Hamid O. Role of antibiotics in post-tonsillectomy morbidities; A systematic review. Int J Pediatr Otorhinolaryngol 2019; 118:192-200. [PMID: 30641307 DOI: 10.1016/j.ijporl.2018.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/14/2018] [Accepted: 12/07/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the role of postoperative antibiotics on post-tonsillectomy morbidities. STUDY DESIGN Systematic Review. METHODS Published papers and electronic databases (Medline, Web of Science, Embase) were searched from January 1985 up to March 2016 using the following key words in different combinations; Tonsil; Tonsillectomy; Post-tonsillectomy; Adenotonsillectomy; Antibiotics; Post-tonsillectomy morbidity; Bleeding; Secondary Hemorrhage. Twelve randomized control clinical trials fit the inclusion criteria and were included in the meta-analysis. We evaluated 5 outcomes, hemorrhage, return to normal diet, return to normal activities, fever and pain. RESULTS As regards secondary hemorrhage pooled analysis of 1397 patients revealed a relative risk (risk ratio, RR) of 1.052 with a 95% confidence interval (95% CI) of 0.739-1.497 (P-value, 0.779). As for return to normal diet pooled analysis of 527 patients showed a standardized mean difference (SMD) of -0.058 day with 95% CI of -0.233 to 0.118 (P-value, 0.518). As for return to normal activities pooled analysis of 257 patients showed a SMD of -0.014 day with a 95% CI of -0.258 to 0.230 (P-value, 0.908). As for Fever pooled analysis of 656 patients revealed a relative risk of 1.265 with 95% CI of 0.982-1.629 (P-value, 0.068). Finally for the postoperative pain due to the variability in the parameters used to assess the pain following tonsillectomy, we could not perform meta-analysis for this outcome. CONCLUSION The results of this study fail to support clear evidence to use routinely post-operative antibiotics to reduce post-tonsillectomy morbidities.
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Affiliation(s)
- Amr Ossama Abdelhamid
- Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, Egypt.
| | - Tamer Shoukry Sobhy
- Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, Egypt
| | | | - Ossama Hamid
- Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, Egypt
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Esteller E, Villatoro JC, Pedemonte G, Agüero A, Ademà JM, Girabent-Farrés M. Surgical Treatment for Childhood Obstructive Sleep Apnoea: Cold-Knife Tonsillar Dissection Versus Bipolar Radiofrequency Thermal Ablation. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016. [DOI: 10.1016/j.otoeng.2015.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Esteller E, Villatoro JC, Pedemonte G, Agüero A, Ademà JM, Girabent-Farrés M. Surgical treatment for childhood obstructive sleep apnoea: Cold-knife tonsillar dissection versus bipolar radiofrequency thermal ablation. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016; 67:261-7. [PMID: 26992775 DOI: 10.1016/j.otorri.2015.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 10/28/2015] [Accepted: 11/02/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVE Adenotonsillectomy for treatment of childhood obstructive sleep apnoea is effective. The uncomfortable postoperative period and possible complications have significantly increased the use of partial techniques, seeking to improve these aspects while achieving the same results in resolving sleep apnoea. The aim was to present the experience with 2 consecutive groups of patients, comparing total tonsillectomy to bipolar radiofrequency ablation (RFA). METHOD A group of 96 children that underwent total tonsilloadenoidectomy using cold dissection were compared to another group of 101 children that underwent RFA. In all cases, polysomnography was performed before and 1 year after surgery. The percentage of cases with persistent disease (apnea-hypopnea index ≥ 3) and the improvement of clinical symptoms at one year were evaluated. The percentages of surgical and anaesthetic complications in both groups were also compared. RESULT The persistence of the syndrome was comparable in both groups: 25% in the cold dissection and 22.77% in the radiofrequency ablation group. Anaesthetic complications (5% in the group where cold dissection was used and 4.2% in the radiofrequency ablation group) and postoperative bleeding rates were very low and statistically comparable with both techniques. CONCLUSION In the treatment of childhood obstructive sleep apnoea syndrome, both extracapsular surgery using cold scalpel and bipolar radiofrequency tunnelling techniques are safe. Likewise, results as to resolution of the syndrome show no statistically significant differences.
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Affiliation(s)
- Eduard Esteller
- Servicio de Otorrinolaringología, Hospital General de Catalunya, Sant Cugat del Vallès (Barcelona), España; Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), España.
| | - Juan Carlos Villatoro
- Servicio de Otorrinolaringología, Hospital General de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Gabriel Pedemonte
- Servicio de Otorrinolaringología, Hospital General de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Adriana Agüero
- Servicio de Otorrinolaringología, Hospital General de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Joan Manel Ademà
- Servicio de Otorrinolaringología, Hospital General de Catalunya, Sant Cugat del Vallès (Barcelona), España
| | - Montserrat Girabent-Farrés
- Unidad de Bioestadística, Departamento de Fisioterapia, Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), España
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Ericsson E, Graf J, Lundeborg-Hammarstrom I, Hultcrantz E. Tonsillotomy versus tonsillectomy on young children: 2 year post surgery follow-up. J Otolaryngol Head Neck Surg 2014; 43:26. [PMID: 25064139 PMCID: PMC6389138 DOI: 10.1186/s40463-014-0026-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Indexed: 11/24/2022] Open
Abstract
Objectives To study the long-term effect of tonsillotomy and tonsillectomy in young children after two years in comparison to the results after six months. Method Children, age 4-5 with Sleep Disordered Breathing (SDB) and tonsil hyperplasia, were randomized to TE (32) or TT (35). TT was performed ad modum Hultcrantz with radiofrequency technique (Ellman). An adenoidectomy with cold steel was performed in the same session for 80% of cases. The patients were assessed prior to surgery, at six and 24 months postoperatively. Effects of surgery were evaluated clinically, through questionnaire (general health/snoring/ENT-infections), Quality of Life (QoL), survey of pediatric obstructive sleep apnea with OSA-18, and children’s behavior with the Child Behavior Checklist. Results After two years there was still no difference between the groups with respect to snoring and frequency or severity of upper airway infections. Both TT and TE had resulted in large improvement in short and long term QoL and behavior. Three TT-children and one TE child had been re-operated due to recurrence of obstructive problems, the TE-child and one of the TT-children with adenoidectomy and two of the TT-children with tonsillectomy. Three of the TT-children had tonsil tissue protruding slightly out of the tonsil pouch and twelve TE-children had small tonsil remnants within the tonsil pouches, but with no need for surgery. Conclusion Younger children have a small risk of symptom-recurrence requiring re-surgery within two years after TT. For the majority, the positive effect on snoring, infections, behavior and quality of life remain and is similar to TE. Electronic supplementary material The online version of this article (doi:10.1186/s40463-014-0026-6) contains supplementary material, which is available to authorized users.
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Role of subtotal tonsillectomy (‘tonsillotomy’) in children with sleep disordered breathing. The Journal of Laryngology & Otology 2013; 128 Suppl 1:S3-7. [DOI: 10.1017/s0022215113003058] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroduction:Sleep disordered breathing in children causes disturbance in behaviour and also in cardiorespiratory and neurocognitive function. Subtotal tonsillectomy (‘tonsillotomy’) has been performed to treat sleep disordered breathing, with outcomes comparable to established therapies such as total tonsillectomy or adenoidectomy. This review critically assesses the role of subtotal tonsillectomy in a paediatric setting.Method:The Medline database (1966 to October 2012) was electronically searched using key terms including subtotal or intracapsular tonsillectomy, tonsillotomy, tonsillectomy, paediatrics, and sleep disordered breathing.Results:Eighteen papers were identified and reviewed. Subtotal tonsillectomy would appear to have an efficacy equal to that of total tonsillectomy for the treatment of sleep disordered breathing, and has significant benefits in reducing post-operative pain and analgesia use. Subtotal tonsillectomy patients appear to have less frequent post-operative haemorrhage compared with total tonsillectomy patients.Conclusion:In children, subtotal tonsillectomy is associated with fewer post-operative complications whilst having a comparable effect in improving sleep disordered breathing, compared with total tonsillectomy.
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Walner DL, Karas A. Standardization of Reporting Post-Tonsillectomy Bleeding. Ann Otol Rhinol Laryngol 2013; 122:277-82. [DOI: 10.1177/000348941312200411] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hultcrantz E, Ericsson E. Factors Influencing the Indication for Tonsillectomy: A Historical Overview and Current Concepts. ACTA ACUST UNITED AC 2013; 75:184-91. [DOI: 10.1159/000342322] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Rotenberg BW, Wickens B, Parnes J. Intraoperative ice pack application for uvulopalatoplasty pain reduction: a randomized controlled trial. Laryngoscope 2012; 123:533-6. [PMID: 22907796 DOI: 10.1002/lary.23627] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVES/HYPOTHESIS Pain after uvulopalatoplasty continues to cause patients significant morbidity, especially from the tonsillectomy portion. The literature describes multiple techniques to reduce post-tonsillectomy pain, none being definitive. The purpose of this study was to evaluate the effect of intraoperative ice pack application on post-uvulopalatoplasty pain. STUDY DESIGN Single-blinded, randomized controlled trial. METHODS After inclusion and exclusion criteria were met, patients were enrolled and randomized, and subsequently underwent standard electrocautery uvulopalatoplasty. Packs were placed into the tonsillar fossae immediately following tonsil removal and into the palate after the palatoplasty. Patients then completed a questionnaire that evaluated their experience for 10 days following surgery. The primary outcome was pain rated on a visual analog scale. Return to work and return to normal diet were also assessed. T test and Mann-Whitney statistical analyses, as well as routine descriptive statistics, were conducted. RESULTS Eighteen subjects were recruited. Patients that received intraoperative cold packs experienced a statistically significant change in VAS average pain [3.4 ± 1.1 cm (p = 0.00001)] when compared with patients receiving room temperature packs. No difference in return to work (p = 0.16) and return to normal diet (p = 0.12) was identified. CONCLUSIONS Intraoperative ice pack administration results in significantly reduced pain following electrocautery uvulopalatoplasty.
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Affiliation(s)
- Brian W Rotenberg
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, the University of Western Ontario, London, Ontario, Canada.
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Antibiotics do not reduce post-tonsillectomy morbidity in children. Eur Arch Otorhinolaryngol 2012; 270:367-70. [DOI: 10.1007/s00405-012-2119-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 07/17/2012] [Indexed: 10/28/2022]
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Abstract
Pediatricians play an important role in the perioperative care of hospitalized children after tonsillectomy and are often called upon to manage posttonsillectomy problems in the outpatient setting. The tonsillectomy operation has changed in recent years. More children are operated upon for sleep disordered breathing and fewer for recurrent pharyngitis. New instruments now permit less invasive surgery. Systematic reviews by the Cochrane Collaboration and others have helped define best practices for preoperative assessment and postoperative care. This article will outline these practices as defined in the 2011 American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guideline "Tonsillectomy in Children." It will describe the different tonsillectomy operations, discuss patterns of normal healing, and review management of pain and posttonsillectomy hemorrhage to form a foundation for improved pediatric care.
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Affiliation(s)
- Glenn Isaacson
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, 1077 Rydal Rd, Suite 201, Rydal, PA 19046, USA.
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[Current techniques in tonsil surgery]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011; 61 Suppl 1:60-8. [PMID: 21354496 DOI: 10.1016/s0001-6519(10)71248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In recent years, consolidation of tonsillar hypertrophy as the principal surgical procedure has led to the emergence of new techniques. Most aim to reduce volume (tonsillectomy or tonsil reduction). These techniques have considerably decreased intra- and postoperative hemorrhages and pain intensity. The present article describes the mechanisms and the advantages and disadvantages of the various techniques, including electro-dissection using electrical scalpels, reduction using a microdebrider, ultrasonic scalpel, radiofrequency (with its different variations) and CO(2) laser. When techniques that reduce tonsil volume are used, the possibility of recurrence of the tonsillar hypertrophy is high if less than 85% of the tonsil is removed. There is also a considerable possibility of infection of the remaining tonsils, whichever technique is used, and therefore these techniques are not valid in the case of repetitive tonsillitis. Recently, alternatives to classical adenoidectomy using adenoid curette have also appeared. Bleeding can be minimized by using a microdebrider, radiofrequency or a blood coagulator. We also discuss the concept of partial adenoidectomy, which is preferred in patients at risk of velopharyngeal insufficiency.
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