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The Role of Allergen-Specific Immunotherapy in ENT Diseases: A Systematic Review. J Pers Med 2022; 12:jpm12060946. [PMID: 35743730 PMCID: PMC9224998 DOI: 10.3390/jpm12060946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/26/2022] [Accepted: 06/06/2022] [Indexed: 12/16/2022] Open
Abstract
Previous studies have demonstrated that both subcutaneous (SCIT) and sublingual specific immunotherapy (SLIT) are effective in treating allergic rhinitis (AR). Further studies have evaluated the efficacy of allergen-specific immunotherapy (AIT) on different ear, nose, and throat (ENT) manifestations, in which allergy might have an etiopathogenetic role, such as local allergic rhinitis (LAR), rhinosinusitis (RS), otitis media (OM), and adenotonsillar (AT) disease. Nevertheless, the management of allergy in ENT diseases is still debated. To the best of our knowledge, this is the first systematic review assessing the efficacy of AIT in ENT diseases aside from AR. Literature data confirmed that AIT might be an effective therapeutic option in LAR, although its effect is restricted to studies with short-term follow-up. Furthermore, previous research demonstrated that AIT may improve symptoms and surgical outcomes of chronic rhinosinusitis when used as an adjunctive treatment. Few studies supported the hypothesis that AIT may exert positive therapeutic effects on recurrent upper airway infections as adenotonsillar disease. Finally, some clinical observations suggested that AIT may add some benefits in the management of otitis media with effusion (OME). The results of this systematic review allow us to conclude that the efficacy of AIT in ENT disorders has been only slightly investigated and additional studies are needed.
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De Corso E, Galli J, Di Cesare T, Lucidi D, Ottaviano G, Seccia V, Bussu F, Passali GC, Paludetti G, Cantone E. A systematic review of the clinical evidence and biomarkers linking allergy to adeno-tonsillar disease. Int J Pediatr Otorhinolaryngol 2021; 147:110799. [PMID: 34153930 DOI: 10.1016/j.ijporl.2021.110799] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/09/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION allergy may be an important risk factor for adenotonsillar disease in children, although conflicting results have been reported in the literature. In previous articles, authors often failed in distinguishing between adeno-tonsillar hypertrophy and recurrent tonsillitis and in not discriminating between isolated or combined adenoid and tonsillar hypertrophy. AIM to evaluate clinical evidence and biomarkers linking allergy to different phenotypes of adeno-tonsillar disease. Furthermore, we questioned whether anti-allergy treatment might prevent occurrence of adeno-tonsillar disease or improve its specific management. METHODS our systematic review, in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) process, yielded 1010 articles finally screened. This resulted in 21 full texts that were included in a qualitative analysis. RESULTS literature data support the association between allergy and combined adeno-tonsillar hypertrophy and isolated adenoid hypertrophy, whereas describe a mainly negative correlation between allergy and isolated tonsillar hypertrophy. The results of this review suggest that local allergic inflammation may play a role in adeno-tonsillar hypertrophy. Data correlating bacterial recurrent tonsillitis and allergy are few, although evidence from the lab revealed that allergy might suppress innate immunity in tonsillar tissue by reducing levels of anti-microbial proteins. CONCLUSION basing on our qualitative analyses allergy should not be misdiagnosed in children with combined adenotonsillar hypertrophy or isolated adenoid hypertrophy, whereas evidence do not support a link between allergy and isolated tonsil hypertrophy. Finally, some data support a link between allergy and recurrent adeno-tonsillar infection although future studies are required to confirm this data. We summarized our conclusions in a practical algorithm.
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Affiliation(s)
- Eugenio De Corso
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Department of Head and Neck Surgery - Otorhinolaryngology, Rome, Italy
| | - Jacopo Galli
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Department of Head and Neck Surgery - Otorhinolaryngology, Rome, Italy
| | - Tiziana Di Cesare
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Department of Head and Neck Surgery - Otorhinolaryngology, Rome, Italy.
| | - Daniela Lucidi
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Giancarlo Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
| | - Veronica Seccia
- Otolaryngology Audiology, and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology, and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Francesco Bussu
- Azienda Ospedaliero Universitaria, Sassari, Otorinolarinoiatria, Dipartimento Delle Scienze Mediche, Chirurgiche e Sperimentali, Università di Sassari, Italy
| | - Giulio Cesare Passali
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Department of Head and Neck Surgery - Otorhinolaryngology, Rome, Italy
| | - Gaetano Paludetti
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Department of Head and Neck Surgery - Otorhinolaryngology, Rome, Italy
| | - Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatological Sciences - ENT Section, University "Federico II", Naples, Italy
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Bani-Ata M, Aleshawi A, Alali M, Kanaan Y, Al-Momani W, Kanaan N, Abdalla K, Alhowary A. Familial and Environmental Risk Predisposition in Tonsillectomy: A Case-Control Study. Risk Manag Healthc Policy 2020; 13:847-853. [PMID: 32801960 PMCID: PMC7382756 DOI: 10.2147/rmhp.s258748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/25/2020] [Indexed: 11/23/2022] Open
Abstract
Background Tonsillectomy is one of the most commonly performed procedures among children and it is the gold standard management to reduce episodes of tonsillitis and obstructive symptoms. Many studies showed a significantly higher incidence of previous tonsillectomy in the parents and siblings. This study investigated the influence of familial and environmental trends in tonsillectomy. Methods Retrospectively, we identified those patients who underwent tonsillectomy (the case group). Also, a control group of participants attending the hospital as visitors who had not undergone tonsillectomy was collected. Both groups are compared using the proper statistical tests. Results This study included 1,232 participants; 615 underwent tonsillectomy (cases) and 617 did not (controls). It was found that paternal and maternal history of tonsillectomy, childhood asthma, and daycare attendance are independent factors influencing tonsillectomy in the offspring. Of about 85.4% of fathers who underwent tonsillectomy their children will also have tonsillectomy. Also, regarding the maternal history, 72.5% of offspring will have tonsillectomy if the mothers underwent the procedure. Conclusion This study reveals that genetic predisposition factors may have a role for tonsillectomy and its underlying causative indications. Also, it highlights the importance of asthma control in children. Moreover, the role of ethnicity may be minimal due to the similar trend of this study with other studies. Further studies and prospective research are recommended.
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Affiliation(s)
- Majid Bani-Ata
- Otolaryngology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Abdelwahab Aleshawi
- Intern, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Maulla Alali
- Otolaryngology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Yazan Kanaan
- Otolaryngology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Wala Al-Momani
- Otolaryngology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Nadia Kanaan
- Intern, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Khalid Abdalla
- Radiology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Ala''a Alhowary
- Anesthesia Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
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Bulut F, Cumbul A, Safak AS. An analysis of the histomorphometric and clinical significance of mucosal biofilm in tonsil tissue of the children with a history of recurrent/chronic tonsillitis in both the mother and father. Eur Arch Otorhinolaryngol 2020; 277:3381-3389. [PMID: 32577899 DOI: 10.1007/s00405-020-06111-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this study is to analyse the histomorphometric and clinical features of the mucosal biofilm in tonsil tissue of children with a history of recurrent/chronic tonsillitis in both the mother and father. METHODS This study enrolled 82 children (between 3 and 14 years of age). These children were divided into two main groups according to the present of recurrent/chronic tonsillitis. Patients in group 1 were divided into four subgroups (A, B, C, D) according to the history of recurrent/chronic tonsillitis in mother and/or father. 30 patients in group 1 were underwent tonsillectomy and the 52 patients in control group (2) have not had history of recurrent/chronic tonsillitis. To that end, among children with a history of recurrent/chronic tonsillitis certain changes in the volume and thickness of mucosal biofilm in tonsil tissue have been exhibited with respect to it is histomorphometric and clinical significance. RESULTS The children with a parental history of recurrent/chronic tonsillitis in group A, an increase in the thickness and volume of mucosal biofilm samples was detected according to the other subgroups (B, C, D). Parents history of group A patients statistically significant differences were detected with respect to halitosis symptoms, attack age of the first tonsillitis and resistant fever despite antibiotic treatment for children under the age of 3 years. CONCLUSIONS This study showed that children under the age of 3 years of age with a history of recurrent/chronic tonsillitis in both the mother and father, halitosis symptoms, attack age of the first tonsillitis and resistant fever despite antibiotic treatment are collectively linked.
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Affiliation(s)
- Fuat Bulut
- Department of Otorhinolaryngology, Rumeli University REYAP Hospital, Istanbul, Turkey.
| | - Alev Cumbul
- Histology and Embryology, Yeditepe University Faculty of Medicine, Istanbul, Turkey
| | - Ayse Sezim Safak
- Department of Otorhinolaryngology, Private Gebze Central Hospital, Gebze, Kocaeli, Turkey
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González-Andrade B, Santos-Lartigue R, Flores-Treviño S, Ramirez-Ochoa NS, Bocanegra-Ibarias P, Huerta-Torres FJ, Mendoza-Olazarán S, Villarreal-Treviño L, Camacho-Ortiz A, Villarreal-Vázquez H, Garza-González E. The carriage of interleukin-1B-31*C allele plus Staphylococcus aureus and Haemophilus influenzae increases the risk of recurrent tonsillitis in a Mexican population. PLoS One 2017; 12:e0178115. [PMID: 28542534 PMCID: PMC5443552 DOI: 10.1371/journal.pone.0178115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 05/07/2017] [Indexed: 12/25/2022] Open
Abstract
The aim of the present study was to estimate the relative contribution of immunogenetic and microbiological factors in the development of recurrent tonsillitis in a Mexican population. Patients (n = 138) with recurrent tonsillitis and an indication of tonsillectomy (mean age: 6.05 years ± 3.00; median age: 5 years, female: 58; age range: 1–15 years) and 195 non-related controls older than 18 years and a medical history free of recurrent tonsillitis were included. To evaluate the microbial contribution, tonsil swab samples from both groups and extracted tonsil samples from cases were cultured. Biofilm production of isolated bacteria was measured. To assess the immunogenetic component, DNA from peripheral blood was genotyped for the TNFA-308G/A single-nucleotide polymorphism (SNP) and for the IL1B -31C/T SNP. Normal microbiota, but no pathogens or potential pathogens, were identified from all control sample cultures. The most frequent pathogenic species detected in tonsils from cases were Staphylococcus aureus (48.6%, 67/138) and Haemophilus influenzae (31.9%, 44/138), which were found more frequently in patient samples than in samples from healthy volunteers (P < 0.0001). Importantly, 41/54 (75.9%) S. aureus isolates were biofilm producers (18 weak and 23 strong), whereas 17/25 (68%) H. influenzae isolates were biofilm producers (10 weak, and 7 strong biofilm producers). Patients with at least one copy of the IL1B-31*C allele had a higher risk of recurrent tonsillitis (OR = 4.03; 95% CI = 1.27–14.27; P = 0.013). TNFA-308 G/A alleles were not preferentially distributed among the groups. When considering the presence of IL1B-31*C plus S. aureus, IL1B-31*C plus S. aureus biofilm producer, IL1B-31*C plus H. influenzae or IL1B-31*C plus H. influenzae biofilm producer, the OR tended to infinite. Thus, the presence of IL1B-31*C allele plus the presence of S. aureus and/or H. influenzae could be related to the development of tonsillitis in this particular Mexican population.
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Affiliation(s)
- Baltazar González-Andrade
- Servicio de Otorrinolaringología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Ramiro Santos-Lartigue
- Servicio de Otorrinolaringología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Samantha Flores-Treviño
- Servicio de Gastroenterología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Natalie Sonia Ramirez-Ochoa
- Hospital Materno Infantil de Alta Especialidad, Secretaria de Salud de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Paola Bocanegra-Ibarias
- Servicio de Gastroenterología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Francisco J. Huerta-Torres
- Servicio de Gastroenterología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Soraya Mendoza-Olazarán
- Servicio de Gastroenterología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Licet Villarreal-Treviño
- Departamento de Microbiología, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Adrián Camacho-Ortiz
- Coordinación de Epidemiología Hospitalaria, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Hipólito Villarreal-Vázquez
- Departamento de Microbiología, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Elvira Garza-González
- Servicio de Gastroenterología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
- * E-mail:
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Olusesi AD, Undie NB, Amodu JE. Allergy history as a predictor of early onset adenoids/adenotonsillar hypertrophy among Nigerian children. Int J Pediatr Otorhinolaryngol 2013; 77:1032-5. [PMID: 23642586 DOI: 10.1016/j.ijporl.2013.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 04/03/2013] [Accepted: 04/06/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous reports have established the association of allergy with adenoidal and tonsillar hypertrophy, and adenotonsillar hypertrophy is a well known co-morbid factor in patients with allergic rhinitis. Very little is known about the association of history of allergy with timing of first presentation in adenotonsillitis patients. SETTING Tertiary care urban referral hospital. STUDY DESIGN Descriptive analysis of prospectively collected data. METHODS All cases which had adenotonsillectomy carried out between September 2005 and September 2012 at National Hospital Abuja that met the selection criteria were recruited and analyzed on the basis of family history of allergy in first degree relatives, clinical history of allergic rhinitis, asthma and atopic dermatitis. RESULT Total of 434 cases were recruited. Mean age was 5 years (range 9 months-15 years, std. dev. 3.535). 56% of participants were aged 3 years and below. 22, 15, and 16% of participants aged 3 years and below had family history of allergy, allergic rhinitis and atopic dermatitis respectively compared to 6, 4 and 4% for participants aged above 3 years. The mean age at onset of symptoms is 7.59, 10.32, and 13.62 months for participants with family history of allergy, clinical allergic rhinitis and atopic dermatitis respectively and 23.890 months for participants with no history of atopy or allergy. Family history of allergy significantly predicts onset of symptoms before age 6 months (OR 7.59, 95% CI 4.74-12.12, P<0.0001). CONCLUSIONS Family history of allergy and presence of clinical allergic or atopic dermatitis are related to early onset of symptoms in Nigerian children with adenoids/adenotonsillar hypertrophy.
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Affiliation(s)
- Abiodun Daud Olusesi
- Department of Ear, Nose & Throat, National Hospital Abuja, Plot 132, Central Area, Garki (Phase 2), Abuja, FCT 900001, Nigeria.
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Parikh SR, Sadoughi B, Sin S, Willen S, Nandalike K, Arens R. Deep cervical lymph node hypertrophy: a new paradigm in the understanding of pediatric obstructive sleep apnea. Laryngoscope 2013; 123:2043-9. [PMID: 23666635 DOI: 10.1002/lary.23748] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 07/16/2012] [Accepted: 08/24/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine if adenotonsillar hypertrophy is an isolated factor in pediatric obstructive sleep apnea (OSA), or if it is part of larger spectrum of cervical lymphoid hypertrophy. STUDY DESIGN Prospective case control study. METHODS A total of 70 screened patients (mean age 7.47 years) underwent polysomnography to confirm OSA, and then underwent MRI of the upper airway. Seventy-six matched controls (mean age 8.00 years) who already had an MRI underwent polysomnography. Volumetric analysis of lymphoid tissue volumes was carried out. Chi-square analysis and Student's t test were used to compare demographic data and lymph node volumes between cohorts. Fisher's Exact test and Chi-square analysis were used to compare sleep data. RESULTS Patients and controls demonstrated no significant difference in mean age (7.47 vs. 8.00 yrs), weight (44.87 vs. 38.71 kg), height (124.68 vs. 127.65 cm), or body-mass index (23.63 vs. 20.87 kg/m(2)). OSA patients demonstrated poorer sleep measures than controls (P < 0.05) in all polysomnography categories (sleep efficiency, apnea index, apnea-hypopnea index, baseline SpO2, SpO2 nadir, baseline ETCO2, peak ETCO2 , and arousal awakening index). Children with OSA had higher lymphoid tissue volumes than controls in the retropharyngeal region (3316 vs. 2403 mm(3), P < 0.001), upper jugular region (22202 vs. 16819 mm(3), P < 0.005), and adenotonsillar region (18994 vs. 12675 mm(3), P < 0.0001). CONCLUSIONS Children with OSA have larger volumes of deep cervical lymph nodes and adenotonsillar tissue than controls. This finding suggests a new paradigm in the understanding of pediatric OSA, and has ramifications for future research and clinical care.
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Affiliation(s)
- Sanjay R Parikh
- Department of Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital-University of Washington School of Medicine, Seattle, Washington 98105, USA.
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Boss EF, Marsteller JA, Simon AE. Outpatient tonsillectomy in children: demographic and geographic variation in the United States, 2006. J Pediatr 2012; 160:814-9. [PMID: 22183449 DOI: 10.1016/j.jpeds.2011.11.041] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 10/21/2011] [Accepted: 11/15/2011] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To examine geographic and demographic variation for outpatient tonsillectomy in children nationally. STUDY DESIGN The 2006 National Survey of Ambulatory Surgery was analyzed to describe outpatient tonsillectomy in children. Rates by age, sex, region, urban/rural residence, and payment source were calculated with 2006 population estimates from the Census Bureau and the National Health Interview Survey as denominators. Rates were compared with Z tests. RESULTS In 2006, approximately 583 000 (95% CI, 370 000-796 000) outpatient tonsillectomy procedures were performed in children in the United States. Rates per 10 000 children were lower in children 13 to 17 years old (33.8 per 10 000) than in both children 7 to 12 years old (91.3; P < .05) and children 0 to 6 years old (102.9; P < .001). Compared with the South, tonsillectomy rates were lower in the West (29 per 10 000 versus 125 per 10 000; P < .01) and not significantly different in other regions. Compared with large central metropolitan areas, tonsillectomy rates were higher in small/medium metropolitan areas (118 per 10 000 versus 42 per 10 000; P < .05), and not significantly different in large fringe or non-metropolitan areas. Tonsillectomy rates were similar for children insured by Medicaid compared with those insured by private sources. Compared with older children (13-17 years), children in the younger age groups (0-6 years, 7-12 years) underwent tonsillectomy more commonly for airway obstruction (69.5% and 59.2% versus 34.3%, P < .05 for both). Compared with older children, younger children (0-6 years) underwent tonsillectomy less commonly for infection (40.4% versus 61.0% [7-12 years] and 72.2% [13-17 years], P < .001 for both). CONCLUSIONS Use of tonsillectomy in the ambulatory setting varies across age groups, geographic regions, levels of urbanization, and indication. Further research is warranted to examine these differences.
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Affiliation(s)
- Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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