TONSILLECTOMY AND ADENOIDECTOMY
Pediatric Clinics of North AmericaPublished 1 December 1996
Ellen S. Deutsch
Citations97
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SJR score0.72
SNIP0.96
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TL;DR
Although the total number of tonsillectomies has decreased, the percentage performed for upper airway obstruction has increased, and scepticism about the appropriate indications fortonsillectomy developed in the next few decades.
Abstract
Obstructive sleep apnea and upper airway obstruction (even without complete apnea) from adenotonsillar hypertrophy is either occurring more frequently or is becoming better recognized. Tonsillectomy or adenoidectomy is indicated for these children. Most patients who would benefit from surgery can be identified by a thorough history and physical examination. Occasionally, additional methods of evaluation, such as lateral neck radiographs or polysomnograms, are helpful. The indications for tonsillectomy and adenoidectomy are varied. No review can cogently encompass all clinical scenarios. Tonsillectomy and adenoidectomy remain valuable procedures for carefully selected patients.
Keywords
MedicineNeuroscience
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210 Citations1989Christian Guilleminault, Markku Partinen +4 more
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American Review of Respiratory DiseaseDriving Simulator Performance in Patients with Sleep Apnea
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191 Citations1966Mary Jane Luke, Ali Abouei Mehrizi +2 more
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OtolaryngologyNocturnal Enuresis in Children with Upper Airway Obstruction
182 Citations1991Dudley J. Weider, Michael J. Sateia +1 more
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180 Citations1982David Carmody, T. Vamadevan +1 more
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New England Journal of MedicineHypertrophied Adenoids Causing Pulmonary Hypertension and Severe Congestive Heart Failure
176 Citations1967A Lévy, Burton S. Tabakin +2 more
Very few cases of cor pulmonale in association with hypertrophied adenoids or tonsils have been reported, suggesting that upper-airway obstruction is a common phenomenon in children.
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176 Citations1995Jeffrey G. Demain, David W. Goetz
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166 Citations1992Carol D. Burk, Alan R. Cohen +2 more
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159 Citations1986Kingman P. Strohl, Susan Redline
CPAP may act as a pneumatic splint and passively open the upper airway to prevent obstructive apnea and the reduction in EMG activity observed with nasal CPAP was closely related to the improvement in hemoglobin oxygen saturation.
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157 Citations1983A. Richard Maw
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156 Citations1986Steven A. Telian, Steven D. Handler +4 more
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OtolaryngologyThe effects of adenotonsillectomy on growth in young children
139 Citations1991Edwin F. Williams, Peak Woo +2 more
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123 Citations1991Brian J. Wiatrak, Charles M. Myer +1 more
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118 Citations1987Kenneth H. Richmond, Ralph F. Wetmore +1 more
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117 Citations1994Ronald S. Litman, Christopher L. Wu +1 more
There were no significant differences between the two groups with regard to age, weight, sex, time to endotracheal intubation,duration of surgery, duration of anesthesia, or number of patients having adenoidectomy.
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117 Citations1977Devinder S. Mangat, William C. Orr +1 more
None of the patienqs had developed pulmonary hypertension, cor pulmonale, or other reported complications of prolonged upper airway obstruction, all of which may have been averted by early diagnosis and treatment.
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111 Citations1988George A. Gates, Christine Avery +1 more
The two groups receivingadenoidectomy did significantly better than those who did not, and the effect was independent of adenoid size, suggesting that reduction of the adenoidal bacterial reservoir may be the mechanism whereby adenoidsectomy is effective.
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110 Citations1982M. G. Lind, Bo Lundell
Tonsillar hyperplasia causing obstructive sleep apneas in children is a well-defined clinical entity with nocturnal CO2 retention, retarded growth, and impaired physical and psychological status.
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102 Citations1992Charles D. Bluestone
The decision for or against otic and/or pharyngeal surgery should be individualized on the basis of severity, duration, and frequency of illness; previous treatment; and risk.
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101 Citations1987Allen D. Everett, William C. Koch +1 more
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100 Citations1988Shaul Sofer, Elliott Weinhouse +5 more
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99 Citations1982Kenneth M. Grundfast, Donald J. Wittich
Pediatric Clinics of North AmericaTONSILLECTOMY AND ADENOIDECTOMY
97 Citations1996Ellen S. Deutsch
Although the total number of tonsillectomies has decreased, the percentage performed for upper airway obstruction has increased, and scepticism about the appropriate indications fortonsillectomy developed in the next few decades.
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90 Citations1980I. Eliaschar, Peretz Lavie +3 more
The results suggest that polysomnographic recordings can provide useful information regarding the necessity of adenotonsillectomy in children with adenoid and tonsillar hyperplasia.
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86 Citations1980Mark A. Richardson, Allan B. Seid +3 more
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85 Citations1977Richard E. Kravath, Charles P. Pollak +1 more
The nasopharyngeal tube was well tolerated, easy to use, and effective in diagnosis and treatment in children with sleep apnea, alveolar hypoventilation, apparent mental retardation, and poor growth associated with chronically enlarged tonsils and adenoids.
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79 Citations1988Jane Ahlqvist-Rastad, Elisabeth Hultcrantz +1 more
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79 Citations1978Jack L. Paradise, Charles D. Bluestone +12 more
It is concluded that undocumented histories of recurrent throat infection do not validly forecast subsequent experience and hence do not constitute an adequate basis for subjecting children to tonsillectomy.
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78 Citations1984J. W. R. Capper, C. J. Randall
A second anaesthetic for bleeding after adeno-tonsillectomy in children in children represents a significant hazard and both occur most frequently within 12 hours of operation.
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77 Citations1994Michael A. Rothschild, Peter J. Catalano +1 more
High-risk subgroups of children undergoing tonsillectomy who are at greater risk for these complications, and therefore may benefit from an inpatient setting are identified.
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75 Citations1990R. G. Berkowitz, George H. Zalzal
Age should not be a factor in determining whether or not to proceed with a tonsillectomy, according to the Children's National Medical Center, Washington, DC, retrospective study.
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75 Citations1992Stephen B. Freeman, J. Kevin Markwell
Sucralfate is a safe and well-tolerated topical agent that offers significant pain reduction and may promote healing in tonsillectomy patients.
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72 Citations1981A R Wilkinson, M.S. McCormick +2 more
The prevalence of pulmonary hypertension in children with enlarged tonsils and adenoids is still underestimated and when signs and symptoms of sleep disturbance, particularly snoring, are present an electrocardiogram should be obtained and a cardiologist's opinion sought before embarking on routine surgery.
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71 Citations1989George A. Gates, James Cooper +2 more
It is recommended that adenoidectomy be considered in the initial surgical management of 4- to 8-year-old children with hearing loss due to chronic secretory otitis media that is refractory to medical management and, further, that the size of theadenoid not be used as a criterion for adenoidsectomy.
PubMedThe detection and quantification of sleep apnea by tracheal sound recordings.
71 Citations1982Joseph Cummiskey, Thomas Williams +2 more
The durations of apneic and hypopneic events were significantly longer when recorded by thermistors and strain gauges than by breath sounds.
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70 Citations1992Lawrence W.C. Tom, Robert M. Dedio +4 more
A retrospective analysis of the records of 223 children, 36 months of age and younger who had tonsillectomies, found that preoperative apnea, an age of less than 12 months, and the presence of accompanying medical conditions were associated with a higher incidence of postoperative airway complications.
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69 Citations1992George A. Gates, Harlan R. Muntz +1 more
Three recent randomized, controlled studies showed the efficacy of adenoidectomy in the treatment of chronic secretory otitis media, and all three studies showed that the effect of adanoidectomy was independent of adnoid size.
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68 Citations1987Robert J. Shprintzen, Aaron E. Sher +1 more
Twenty patients with hypernasal speech were studied with both flexible fiber optic nasopharyngoscopy and multi-view videofluoroscopy, as well as behavioral speech assessment, showing the hypernasality to be caused by hypertrophic tonsils with posterior placement of the upper poles of the tonsils into the oropharyngeal and nasopharyngeals airway.
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65 Citations1987Sally R. Shott, Charles M. Myer +1 more
An analysis of complications requiring readmission to the hospital (bleeding, dehydration, poor social situation), patients who had their original surgery performed on an ambulatory basis had no more complications than patients who were hospitalized following their surgery.
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61 Citations1984Tom Bate, David Price +2 more
After tonsillectomy a 5 year old girl presented to a growth clinic with short stature and her symptoms were alleviated and her rate of growth increased from 4.0 cm/year to 13.6 cm/ year.
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55 Citations1980Peter E. Krumpe, Joseph Cummiskey
It is found that apnea could be identified by the cessation of laryngeal sounds during continuous monitoring, which could be useful in sleep studies.
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54 Citations1969F J Macartney, J. Panday +1 more
The clinical, electrocardiographic, and radiological findings in 3 patients, together with the results of cardiac catheterization in 2 of them are presented.
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54 Citations1983Joseph Werthammer, Jerome Krasner +2 more
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It is demonstrated that sleep sonography is a reliable method for evaluating patients with upper airway obstruction due to adenotonsillar hypertrophy.
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52 Citations1992B. Tucker Woodson, Marvin R. Wooten
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49 Citations1979A. H. Felman, GM Loughlin +2 more
Cinefluoroscopic findings are described in nine children with sleep-related upper airway obstruction who are asymptomatic while awake who show strikingly similar changes in the region of the hypopharynx during sleep.
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49 Citations1992Lance M. Cohen, Peter J. Koltai +1 more
It is concluded that LSTN is an appropriate examination in the preoperative assessment of children being considered for adenoidectomy, however, this test must be interpreted by recognizing the inherent limitations of evaluating a dynamic structure, such as the nasopharynx, through a non-dynamic modality.
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48 Citations1983Karin Mauer, Bruce A. Staats +1 more
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47 Citations1995Pamela J. Nicklaus, Fred S. Herzon +1 more
The findings in this study suggest that short periods of observation are safe for outpatient pediatric patients undergoing adenotonsillectomy after discharge criteria are met.
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46 Citations1989Hans Pasterkamp, Érico R. Cardoso +1 more
Rises in intracranial pressure from normal baseline values up to 50 cm H2O occurred shortly after the onset of obstructive sleep apnea in a patient with myelomeningocele, hydrocephalus, Arnold-Chiari malformation, and syringomyelia.
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39 Citations1977Sylvan E. Stool, Roland D. Eavey +2 more
Three children with chronic airway obstruction due to hypertrophied tonsillar and adenoidal tissue developed pronounced obesity, which in turn helped to provoke sleep alternations, cardiac signs, and abnormal arterial blood gas values.
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36 Citations1990Edward J. O’Connell
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32 Citations1985M. Z. SIODLAK, Michael J. Gleeson +1 more
A higher incidence of secondary haemorrhage in those patients in whom diathermy was used for haemostasis rather than ligatures supports previous studies.
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30 Citations1993Scott D. Price, Donald B. Hawkins +1 more
Archives of Otolaryngology - Head and Neck SurgeryIndications for Adenotonsillectomy
29 Citations1986G. A. GATES, T. W. FOLBRE
The wide-ranging and intense controversies expressed in the literature about the indications and benefits of adenotonsillectomy have been fueled by limited data and socioeconomic overtones.
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28 Citations1967R. G. Williams
A review of 18,184 operations at the Victoria Hospital for Sick Children, Hull, has been made with a view to finding that the incidence of post-operative bleeding in these operations is low.
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27 Citations1992Jack L. Paradise
In children severely affected with recurrent throat infection, tonsillectomy is generally effective and is sometimes a desirable option, and when penicillin treatment does not eradicate carriage, other drugs may be efficacious.
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27 Citations1993Scott D. Price, Donald B. Hawkins +1 more
It is suggested that children with a history of severe obstructive symptoms with apnea and moderate or strongly positive sleep study, daytime somnolence, need for urgent T&A, and cardiomegaly not be considered as candidates for outpatient T &A surgery.
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26 Citations1994P. G. Bicknell
Tonsil and adenoid diseases in children continue to result in considerable morbidity despite the age of antibiotics, and the indications for surgery remain controversial, each child must be considered on a case-by-case basis.
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26 Citations1988Michael Wolf, Jona Kronenberg +3 more
Neither the pre-PTA history (T+ versus T-) nor the mode of treatment during the acute event showed any significant differences in comparing the recurrency rate of PTA or tonsillitis.
The Pediatric Infectious Disease JournalIdentification of streptococcal pharyngitis in the office laboratory
25 Citations1987Michael Radetsky, Jeffrey A. Solomon +1 more
Ear Nose & Throat JournalTreatment of Otherwise Normal Children with Obstructive Sleep Apnea
19 Citations1993Lee J. Brooks
There are many therapeutic approaches to children with OSA, but the most appropriate approach can be devised for the individual once the severity and underlying cause of OSA have been established.
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18 Citations1995Robert D. Klausner, Lawrence W.C. Tom +2 more
It is believed that depression following tonsillectomy occurs more frequently than has been recognized and is described to increase the otolaryngologist's awareness of this entity.
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18 Citations1991Daniel B. Kearns, Seth M. Pransky +1 more
Better understanding of the implications of adenoid disease in chronic otitis and sinusitis, along with appreciation of obstructive airway problems secondary to adenotonsillar hypertrophy, has changed the scope of the operation.
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17 Citations1992Jonathan I. Singer
The emergency physician should be cognizant of the potential postoperative complications of tonsillectomy or adenoidectomy.
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15 Citations1989William P. Potsic
Obstructive sleep disorders and apnea are commonly seen in children of all ages and usually causes snoring and varying periods of interrupted breathing during sleep.
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14 Citations1986A. Richard Maw
Although data for the incidence, morbidity, and mortality of adenoidectomy and tonsillectomy have in the past been linked, the long established relation should be stopped because of uncertainty both at general practitioner and specialist level concerning the indications for operation and the expectations for outcome.
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14 Citations1968F. L. Dey
The following case illustrates that hemorrhage from tonsillectomy may occur at a much later date and any hemoptysis during the first month following surgery should be considered as coming from the operative site unless proven otherwise.
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13 Citations1992Rodney P. Lusk
Almost 20% of the patients treated with tonsilectomy and adenoidectomy do not have resolution of symptoms of chronic sinusitis, and it is prudent, however, to remove an enlarged obstructive adenoids pad as a first course of therapy.
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12 Citations1995Ellen S. Deutsch, Glenn Isaacson
The most common problems attributed to the tonsils and adenoids are recurrent infection and OSA, or its milder manifestation, adenotonsillar hypertrophy with obstruction.
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7 Citations1994Georges Peter, Donald M. Selcer +3 more
PubMedTonsillectomy and adenoidectomy in children: current indications.
6 Citations1994P E Noel, J L Guarisco
The indications for tonsillectomy have undergone considerable refinement in recent years, and surgical management often yields excellent results in patients that fail to respond to conservative medical management for tonsils and adenoid disorders in children.
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