Revisiting Outpatient Tonsillectomy in Young Children

2003 ◽  
Vol 128 (3) ◽  
pp. 326-331 ◽  
Author(s):  
Adam T. Ross ◽  
Ken Kazahaya ◽  
Lawrence W. C. Tom
Keyword(s):  
Retrospective Study ◽  
Young Children ◽  
Airway Obstruction ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Postoperative Treatment ◽  
Medical Comorbidity ◽  
Respiratory Compromise ◽  
Postsurgical Complications ◽  
Same Day Discharge

OBJECTIVE: Postoperative same-day discharge is safe for most children undergoing tonsillectomy. However, young children with upper airway obstruction have a higher risk of postoperative complications. We review our tonsillectomy experience in children under 36 months to evaluate the safety of outpatient tonsillectomy in this population. STUDY DESIGN AND SETTING: We conducted a retrospective study of all children under 36 months who underwent tonsillectomy during a recent 2-year period at The Children's Hospital of Philadelphia. RESULTS: The indication for tonsillectomy in 96% of 421 children was upper airway obstruction. Eighteen percent required postoperative treatment to prevent respiratory compromise; 56% of these patients had no associated medical comorbidity. Patients younger than 24 months and those with medical comorbidities were more likely to require intervention. CONCLUSION AND SIGNIFICANCE: It is not possible to preoperatively anticipate which children will have postsurgical complications. We recommend planning an overnight admission for children younger than 36 months undergoing tonsillectomy.

The Aerodigestive Clinic: Multidisciplinary Management of Pediatric Dysphagia

2008 ◽  
Vol 17 (3) ◽  
pp. 101-109 ◽  
Author(s):  
Laura Haibeck ◽  
David L. Mandell
Keyword(s):  
Young Children ◽  
Airway Obstruction ◽  
Multidisciplinary Approach ◽  
Laryngopharyngeal Reflux ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Pediatric Airway ◽  
Common Causes ◽  
The Individual ◽  
The Relationship

Abstract The purposes of this article are (a) to explore the relationship between pediatric upper airway obstruction and dysphagia and (b) to highlight the benefits of using a multidisciplinary approach when assessing infants and children with upper respiratory and swallowing disorders. The functions of breathing and swallowing are tightly coordinated in infants and young children, and pediatric upper airway disorders can often adversely affect the swallowing mechanism and may even predispose the individual to aspiration. Some of the more common causes of pediatric airway obstruction seen in this setting are laryngomalacia, vocal fold paralysis, laryngeal cleft, and Pierre Robin's sequence. In the setting of all of these disorders, associations may also exist with gastroesophageal reflux (GER) and laryngopharyngeal reflux, and this topic is also reviewed. In the multidisciplinary assessment of young children with aerodigestive disorders, fiberoptic flexible endoscopic evaluation of swallowing has gained traction as a useful test for simultaneous evaluation of pediatric upper airway obstruction and dysphagia and has provided complimentary information to the more traditional pediatric videofluoroscopic swallowing evaluation. A representative case study is provided that illustrates the relationship between pediatric upper airway obstruction and dysphagia and demonstrates the effectiveness of a multidisciplinary approach.

Nasopharyngeal Turbinates in Brachycephalic Dogs and Cats

2008 ◽  
Vol 44 (5) ◽  
pp. 243-249 ◽  
Author(s):  
Jennifer A. Ginn ◽  
M.S.A. Kumar ◽  
Brendan C. McKiernan ◽  
Barbara E. Powers
Keyword(s):  
Retrospective Study ◽  
Airway Obstruction ◽  
Respiratory Disease ◽  
Medical Records ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Study Population ◽  
Upper Respiratory

This retrospective study reports the presence and incidence of nasal turbinates in the nasopharynx (nasopharyngeal turbinates) in a population of brachycephalic dogs and cats exhibiting signs of upper respiratory disease. Medical records were reviewed for 53 brachycephalic dogs and 10 brachycephalic cats undergoing upper airway endoscopy. Nasopharyngeal turbinates were identified in 21% of brachycephalic animals, including 21% of dogs and 20% of cats. Pugs accounted for 32% of all dogs in the study population and 82% of dogs with nasopharyngeal turbinates. The presence of nasopharyngeal turbinates may play a role in upper airway obstruction in the brachycephalic airway syndrome.

Post-operative nausea and vomiting following paediatric day-case tonsillectomy: audit of the Epsom protocol

2011 ◽  
Vol 125 (10) ◽  
pp. 1049-1052 ◽  
Author(s):  
P J Robb ◽  
B N Ewah
Keyword(s):  
Airway Obstruction ◽  
Discharge Rate ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Nausea And Vomiting ◽  
Day Case ◽  
Recurrent Tonsillitis ◽  
Same Day Discharge ◽  
Post Operative Nausea ◽  
Haemorrhage Rate

AbstractObjective:To audit a protocol for elective, day-case, paediatric ENT surgery, previously reported as enabling an overall post-operative nausea and vomiting rate of 2 per cent and a discharge rate of 100 per cent on the day of surgery.Method:The audit included 91 children (45 boys and 46 girls) aged three to 14 years. Forty-seven children underwent tonsillectomy, 36 adenotonsillectomy and eight tonsillectomy with postnasal space examination; indications included recurrent tonsillitis, tonsillitis and nasal block, upper airway obstruction, and a combination of upper airway obstruction and recurrent tonsillitis.Results:No post-operative nausea or vomiting was recorded in any of the children on the day of surgery, and no discharges were delayed. The reactionary haemorrhage rate was 1 per cent and the secondary haemorrhage rate 3.3 per cent.Conclusion:These findings have implications for the safe same-day discharge of children following tonsillectomy.

scholarly journals Aspiration before and after Supraglottoplasty regardless of Technique

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Jeffrey C. Rastatter ◽  
James W. Schroeder ◽  
Stephen R. Hoff ◽  
Lauren D. Holinger
Keyword(s):  
Retrospective Study ◽  
Airway Obstruction ◽  
Outcome Measures ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Pediatric Hospital ◽  
Inclusion Criteria ◽  
Significant Difference ◽  
Before And After ◽  
New Onset

Objective. To determine the incidence of preoperative and postoperative aspiration in infants who undergo supraglottoplasty. To determine the effect of cold steel and CO2laser supraglottoplasty on aspiration in infants with severe laryngomalacia.Design. Retrospective study.Setting. Tertiary pediatric hospital.Patients. Thirty-nine patients who underwent CO2laser-assisted supraglottoplasty (CLS) or cold steel supraglottoplasty (CSS) for severe laryngomalacia.Main Outcome Measures. Aspiration and upper-airway obstruction.Results. Thirty-nine patients met inclusion criteria (18 males, 21 females). Eighteen patients underwent CSS and 21 patients underwent CLS. 10/39 (25.6%) of the patients had preoperative aspiration, and 2/10 (20%) resolved after supraglottoplasty. New onset aspiration was found in 4/13 (30.8%) in the CSS group and 9/16 (56.3%) in the CLS group.Conclusions. There is no significant difference in the rate of postoperative new-onset aspiration or relief of upper-airway obstruction in the CLS or CSS, is temporary and can be managed with thickened diet or temporary tube feedings. The rate of persistent postoperative aspiration was statistically similar regardless of the method of surgery.

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