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Necrotising otitis externa, turbinate surgery, tonsillotomy, and care of octogenarian head and neck cancer patients. The Journal of Laryngology & Otology 2022; 136:377-378. [DOI: 10.1017/s0022215122000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kubala ME, Turner M, Gardner JR, Williamson A, Richter GT. Impact of Oral Steroids on Tonsillectomy Postoperative Complications and Pain. EAR, NOSE & THROAT JOURNAL 2021; 102:NP206-NP211. [PMID: 33734886 DOI: 10.1177/01455613211000832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To analyze the impact of steroids on postoperative tonsillectomy recovery and implement findings for improvement in postoperative management. METHODS Institutional review board approved prospective study with retrospective analysis of private practice setting tonsillectomy patients (November 2015 to January 2017). A questionnaire was provided postoperatively to patients undergoing tonsillectomy with or without adenoidectomy. The study population was separated into 2 groups: patients who received steroids (3 days of either dexamethasone or prednisolone), postoperative steroid (POS), versus patients who did not receive steroids (PONS). RESULTS The questionnaire had a return rate of 27.3% (254/931). Nine of the 254 responses were disqualified for lack of information; therefore, the total number of responses was 245. Of these, 115 were POS and 130 were PONS. The groups were similar in mean age (POS: 13.2 ± 10.4 years, PONS: 14.7 ± 12.1 years, P = .32) and sex (POS: Male 40.0%, PONS: Male 40.0%, P = .97). There was an overall decrease of pain and nausea/vomiting (N/V) in the steroid group (P = .0007). There was reduction in pain (P < .05) from postoperative day (POD) 2, 3, 4, and 6 in the POS group. Otherwise, there was no significant reduction in pain from POD 7 to 14, day-by-day rate of N/V, bleeding, or rate of emergency department (ED) or clinic visit (P > .05). CONCLUSION Postoperative steroid reduced overall pain and N/V, as well as daily pain on POD 2, 3, 4, and 6. Pain from POD 7 to 14, rate of ED or clinic visit, or daily N/V and bleeding rate were not significantly different between cohorts.
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Affiliation(s)
- Michael E Kubala
- Department of Otolaryngology-Head and Neck Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Merit Turner
- Department of Otolaryngology-Head and Neck Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - James Reed Gardner
- Department of Otolaryngology-Head and Neck Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Adrian Williamson
- Department of Otolaryngology-Head and Neck Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Arkansas Otolaryngology Centers, Little Rock, AR, USA
| | - Gresham T Richter
- Department of Otolaryngology-Head and Neck Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Division of Pediatric Otolaryngology, Arkansas Children's Hospital, Little Rock, AR, USA
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Gustafsson ML, Laaksonen C, Aromaa M, Asanti R, Heinonen OJ, Koski P, Koivusilta L, Löyttyniemi E, Suominen S, Salanterä S. Association between amount of sleep, daytime sleepiness and health-related quality of life in schoolchildren. J Adv Nurs 2016; 72:1263-72. [DOI: 10.1111/jan.12911] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - Camilla Laaksonen
- Turku University of Applied Sciences, Health and Well-being; Finland
| | - Minna Aromaa
- Policlinic for Children and Adolescents; City of Turku; Finland
| | - Riitta Asanti
- Department of Teacher Education; Turku Unit; University of Turku; Finland
| | - Olli J. Heinonen
- Paavo Nurmi Centre & Department of Health and Physical Activity; University of Turku; Finland
| | - Pasi Koski
- Department of Teacher Education; Rauma Unit; University of Turku; Finland
| | - Leena Koivusilta
- University Consortium of Seinäjoki; School of Health Sciences; University of Tampere; Finland
| | | | | | - Sanna Salanterä
- Department of Nursing Science, and Turku University Hospital; University of Turku; Finland
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Regrowth of the adenoids after adenoidectomy down to the pharyngobasilar fascial surface. The Journal of Laryngology & Otology 2015; 129:662-5. [DOI: 10.1017/s0022215115001437] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectives:This study aimed to explore adenoid regrowth after transoral power-assisted adenoidectomy down to the pharyngobasilar fascial surface.Methods:Transoral adenoidectomy down to the pharyngobasilar fascia surface was performed on 39 patients under endoscopic guidance, using a power-assisted system. The operation time, amount of blood loss and iatrogenic injury, presence of complications, and success and regrowth rates were recorded to assess the feasibility, safety and effectiveness of our surgical technique.Results:In this adenoidectomy procedure, the pharyngobasilar fascia was left intact. The estimated blood loss was 5–50 ml (mean 15 ml), and the success rate was 97.3 per cent. Early complications occurred in 2.3 per cent of patients, while no long-term complications occurred in the cohort. No regrowth was found in the follow-up assessments, which were performed for 18–36 months after surgery.Conclusion:Adenoid regrowth was rare after adenoidectomy down to the pharyngobasilar fascial surface. The pharyngobasilar fascia can therefore be considered a surgical boundary for adenoidectomy.
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Smith CB, Walker K, Badawi N, Waters KA, MacLean JE. Impact of sleep and breathing in infancy on outcomes at three years of age for children with cleft lip and/or palate. Sleep 2014; 37:919-25. [PMID: 24790270 DOI: 10.5665/sleep.3660] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
STUDY OBJECTIVES To evaluate the relationship between sleep disordered breathing (SDB) in early infancy and outcomes at 3 years of age in children with cleft lip and/or palate (CL/P). DESIGN Observational follow-up study. SETTING Multidisciplinary CL/P clinic, tertiary centre. PARTICIPANTS Children with CL/P who participated in a study of sleep and breathing in infancy. MEASUREMENTS AND RESULTS The families of 52 children were approached for this follow-up study. The children underwent neurocognitive (Bayley Scales of Infant and Toddler Development, Third Edition; BSID-III), quality of life (Infant/Toddler Quality of Life Questionnaire; ITQOL), and growth assessments at 3 years. The families of 33 children (66%) completed follow-up at 36.7 ± 1.4 months. The apnea-hypopnea index (AHI) in infancy was 23.9 ± 18.0 events/h. Mean group BSID-III scores fell within the standardized normal range (10 ± 3) for all domains; however, language scores were lower than control children. Quality of life scores and growth parameter z-scores were similar to published control data. PSG variables in infancy showed significant relationships with outcomes at 3 years of age; lower percentage of AS/REM sleep was associated with lower cognition score; more obstructive events were associated with lower global behavior ITQOL score; and higher number of respiratory events in infancy was associated with lower weight z-score. CONCLUSION Neurocognition, quality of life, and growth measures from children with CL/P fall within a normal range; however, scores in the language domain are lower than controls. Sleep and respiratory elements of SDB in infancy appear to modify these outcomes at 3 years of age.
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Affiliation(s)
- Courtney B Smith
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia ; Medical Program, University of New South, Sydney, NSW, Australia
| | - Karen Walker
- Discipline of Paediatrics & Child Health, University of Sydney, Sydney, NSW, Australia ; Neonatal Intensive Care Unit, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Nadia Badawi
- Discipline of Paediatrics & Child Health, University of Sydney, Sydney, NSW, Australia ; Neonatal Intensive Care Unit, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Karen A Waters
- Discipline of Paediatrics & Child Health, University of Sydney, Sydney, NSW, Australia ; Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Joanna E MacLean
- Department of Pediatrics & The Women & Children's Research Institute, University of Alberta, Edmonton, AB, Canada ; Discipline of Paediatrics & Child Health, University of Sydney, Sydney, NSW, Australia ; Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia
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Abstract
AbstractAs providers of health care, we face increasing demand on our limited, indeed diminishing, resources. Economic appraisal of our interventions means assessing the trade-off between effectiveness, efficiency and equity. When rationing becomes inevitable, calculation of utility values is a valuable decision-making tool. This paper reviews objective measures of patient benefit, such as quality of life, and focuses on their application within otolaryngology.
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Mohsen N, Susan A, Shahin B, Soheila D. Sleep related quality of life before and after adenotonsillar surgery in pediatric population. Int J Pediatr Otorhinolaryngol 2014; 78:330-3. [PMID: 24377491 DOI: 10.1016/j.ijporl.2013.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 12/01/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the quality of life in children with adenotonsillar problems before and after adenotonsillectomy in short term follow-up. METHODS Quasi-experimental study (before and after study) of children with adenotonsillar problems at Tehran University of Medical Sciences, Amir'Alam hospital. Eighty six pediatric patients aged 3 through 13 years (58 boys and 28 girls) who underwent adenotonsillectomy, for treatment of sleep disordered breathing or recurrent throat infection, were recruited. Parents completed OSA-18 quality of life survey and Brouillette score questionnaire before and one month after surgery. RESULTS Reliability of the Brouillette score and OSA-18 survey was established by evaluating the Cronbach α value. Cronbach α for Brouillette score was 0.70 and for OSA-18 survey it was 0.88. Preoperative values for the OSA-18 total and domain scores were high in children: mean±SD; 61.65±20.78. Preoperative values for the Brouillette score were: mean±SD; 0.41±2.34. The total OSA-18 survey score and the scores for all domains showed significant improvement after surgery: mean±SD; 28.01±9.09 (P<0.001). Post-operative Brouillette score had a significant improvement: mean±SD; -3.57±0.91 (P<0.001). CONCLUSION Considering the OSA-18 survey and Brouillete score results, surgical therapy with adenotonsillectomy is associated with marked improvement in quality of life in both obstructive and infective adenotonsillar disease.
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Affiliation(s)
- Naraghi Mohsen
- Department of Otorhinolaryngology, Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran; Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran; Rhinology Research Society, Iran
| | - Adil Susan
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bastaninejad Shahin
- Department of Otorhinolaryngology, Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran; Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Dabiran Soheila
- Department of Community Medicine, Tehran University of Medical Sciences, Iran
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Abreu C, Fuchs S, Pascoto G, Weber R, Guedes M, Pignatari S, Stamm A. Effect of adenotonsillectomy on visual attention tests among children with sleep-disordered breathing: a controlled prospective cohort study. Clin Otolaryngol 2013; 38:487-93. [DOI: 10.1111/coa.12192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2013] [Indexed: 11/28/2022]
Affiliation(s)
- C.B. Abreu
- Complexo Hospitalar Edmundo Vasconcelos; São Paulo Brazil
| | - S.C. Fuchs
- Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - G.R. Pascoto
- Complexo Hospitalar Edmundo Vasconcelos; São Paulo Brazil
| | - R. Weber
- Complexo Hospitalar Edmundo Vasconcelos; São Paulo Brazil
| | - M.C. Guedes
- Complexo Hospitalar Edmundo Vasconcelos; São Paulo Brazil
| | - S.S. Pignatari
- Complexo Hospitalar Edmundo Vasconcelos; São Paulo Brazil
| | - A.C. Stamm
- Complexo Hospitalar Edmundo Vasconcelos; São Paulo Brazil
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Gomes ADM, Santos OMD, Pimentel K, Marambaia PP, Gomes LM, Pradella-Hallinan M, Lima MG. Quality of life in children with sleep-disordered breathing. Braz J Otorhinolaryngol 2013; 78:12-21. [PMID: 23108815 PMCID: PMC9450709 DOI: 10.5935/1808-8694.20120003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Accepted: 08/10/2012] [Indexed: 11/20/2022] Open
Abstract
Children may present sleep-disordered breathing (SDB) and suffer with adverse effects upon their quality of life. Objective This study assessed the quality of life of children with SDB, compared subjects with obstructive sleep apnea syndrome (OSAS) and primary snoring (PS), and identified which areas in the OSA-18 questionnaire are more affected. Methods This is a historical cohort cross-sectional study carried out on a consecutive sample of children with history of snoring and adenotonsillar hyperplasia. The subject's quality of life was assessed based on the answers their caregivers gave in the OSA-18 questionnaire and on diagnostic polysomnography tests. Results A number of 59 children participated in this study with mean age of 6.7 ± 2.26 years. The mean score of the OSA-18 was 77.9 ± 13.22 and the area most affected were “caregiver concerns” (21.8 ± 4.25), “sleep disturbance” (18.8 ± 5.19), “physical suffering” (17.3 ± 5.0). The impact was low in 6 children (10.2%), moderate in 33 (55.9%) and high in 20 (33.9%). PS was found in 44 children (74.6%), OSAS in 15 (25.6%). OSAS had higher score on “physical suffering” area than PS (p = 0.04). The AI (r = 0.22; p = 0.08) and AHI (r = 0.14; p = 0.26) were not correlated with OSA-18. Conclusion Sleep disordered breathing in childhood cause impairment in quality of life and areas most affected the OSA-18 were: “caregiver concerns”, “sleep disturbance” and “physical suffering”. OSAS has the domain “physical suffering” more affected than primary snorers.
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A four year follow-up of sleep and respiratory measures in elementary school-aged children with sleep disordered breathing. Sleep Med 2013; 14:440-8. [PMID: 23499429 DOI: 10.1016/j.sleep.2013.01.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 01/18/2013] [Accepted: 01/20/2013] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Little is known of the long-term prognosis of children treated for sleep disordered breathing (SDB) and even less of children with milder forms of SDB who remain untreated. We aimed to investigate the long-term sleep and respiratory outcomes of children with a range of SDB severities. METHODS 41 children with SDB and 20 non snoring controls (mean age, 12.9±0.2 y), underwent repeat overnight polysomnography (PSG) 4.0±0.3years after initial diagnosis. SDB severity, presence of snoring, sleep and respiratory parameters, sleep fragmentation index (SFI), the Pediatric Daytime Sleepiness Scale (PDSS), Sleep Disturbance Scale for Children (SDSC), and obstructive sleep apnea 18-item quality of life questionnaire were re assessed. Children with SDB were grouped into resolved (no snoring and obstructive apnea-hypopnea index [OAHI] <1) and unresolved (snoring or an OAHI > or =1). RESULTS At follow-up OAHI was reduced in both SDB groups (p<0.05); however, 54% (n=22) of children still continued to snore, having either persistent or new OSA (n=4). In this unresolved group, sleep was significantly disrupted; % nonrapid eye movement stage 1 (NREM1) sleep and SFI were increased (p<0.05), and total sleep time (TST) and sleep efficiency were decreased compared to the resolved and control groups (p<0.05). Overall, 29% of children were treated, and of these, 67% had resolved SDB. SDB groups had higher PDSS, SDSC, and OSA-18 scores compared to controls at follow-up (p<0.01). CONCLUSIONS Our study demonstrated that although SDB improved in the long-term, more than 50% of children had residual SDB (mostly primary snoring) and sleep disturbance. As even mild forms of SDB are known to have adverse cardiovascular, learning, and behavioral outcomes, which have implications for the health of these children.
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Childhood obstructive sleep apnea syndrome: an interdisciplinary approach: a prospective epidemiological study of 4,318 five-and-a-half-year-old children. J Orofac Orthop 2012; 73:342-58. [PMID: 22874975 DOI: 10.1007/s00056-012-0096-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 03/26/2012] [Indexed: 01/09/2023]
Abstract
UNLABELLED Population-representative data on sleep disorders in children is scarce. BACKGROUND AND OBJECTIVE The aim of this epidemiological study was to determine the prevalence of various sleep-related breathing disorders (SRBD) and any correlations with occlusion and jaw abnormalities in preschool children. MATERIALS AND METHODS The study material consisted of 4,318 children (5.5 years old) whose parents completed the Pediatric Sleep Questionnaire (PSQ); 60 out of 140 children (6.3 ± 0.78 years old) with a positive questionnaire score (> 0.33) were examined by an orthodontist and ENT specialist. From this cohort, 15 children who presented a dental occlusion and jaw abnormality but no indication for surgical reduction of adenotonsillar tissue underwent polysomnography in a sleep laboratory. RESULTS According to the PSQ, 3.3% of the 5.5-year-olds showed evidence of a SRBD. Boys were affected significantly more frequently. Lack of concentration, hyperactivity, morning fatigue, mouth breathing, loud snoring, and breathing interruptions were indicators of SRBD. The SRBD children more frequently presented with jaw abnormalities such as mandibular retrognathia, lateral cross-bite, and increased overjet. The SRBD cohort showed a higher rate of orofacial dysfunctions. Adenotonsillar hyperplasia still played a significant role in the development of SRBD. CONCLUSION In contrast to previous reports in the literature, the frequency of SRBD in our group of 5- to 6-year-olds was lower (3%). Boys with adenotonsillar hyperplasia and/or mandibular retrognathia, lateral cross bite, and an enlarged overjet require special attention.
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Cazzavillan A, Castelnuovo P, Berlucchi M, Baiardini I, Franzetti A, Nicolai P, Gallo S, Passalacqua G. Management of chronic rhinosinusitis. Pediatr Allergy Immunol 2012; 23 Suppl 22:32-44. [PMID: 22762852 DOI: 10.1111/j.1399-3038.2012.01322.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
: Chronic rhinosinusitis (CRS) in children is difficult to treat, with resultant frequent recurrences and failures. There are controversies in the treatment, mirroring the debate over the exact etiology of this disorder. The available medical treatments are antibiotics, topical nasal corticosteroids, and nasal lavage with saline solutions; though, there is no general agreement on the efficacy of the latter. The new technique of balloon sinuplasty allows ventilation to the sinuses to be restored with minimal risk and trauma to the tissues, and initial outcome seems promising, being successful in most treated children. Concerning the surgical approach, adenoidectomy is among the most frequent surgical procedures performed on children, but its therapeutic effect is controversial, because randomized studies have failed to prove that adenoidectomy alone is sufficient in curing CRS. Instead, functional endoscopic sinus surgery is a minimally invasive technique which restores the sinus ostia patency and can re-establish ventilation and drainage through the natural pathways. It is important that the effectiveness of any treatment is also evaluated by patient-reported outcomes (PROs) that refer to all health-related reports coming from the patients, without any involvement or interpretations by physician or others. Among PROs, health-related quality of life (HRQL) is the one most widely known and used. HRQL can be measured by means of validated questionnaires, which provide scores proportional to the degree of well-being perceived by patients. Concerning diseases of the upper airway including RS, there are numerous instruments specifically designed for children and caregivers, which allow to assess the effects of treatments in a more extensive and complete manner.
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Affiliation(s)
- Alessandro Cazzavillan
- Pediatric ENT Department, Buzzi Children's Hospital, Istituti Clinici di Perfezionamento, Via Castelvetro 32, Milan, Italy.
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