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Fulltext Transoral endoscopic adenoidectomy: initial experience

Jong YH, Gendeh BS

Med J Malaysia, 2008 Mar;63(1):81-3.
PMID: 18935747 MyJurnal

Adenoidectomy is a common ENT procedure performed in hospitals in Malaysia. Adenoidectomy is indicated in patients with recurrent adenoiditis, nasal obstruction or sleep apnoea secondary to adenoid hypertrophy when conservative management has failed. Over the years, there are advances in the techniques of adenoidectomy, from the conventional transoral to endoscopic transnasal/transoral adenoidectomy. The purpose of this article is to describe the technique and emphasize the advantages of this procedure to that of the conventional technique.

Matched MeSH terms: Adenoidectomy/methods*
Fulltext Daycare tonsillectomy: a safe outpatient procedure. Hospital Sultanah Bahiyah, Alor Setar Malaysia experience

Nurliza I, Norzi G, Azlina A, Hashimah I, Sabzah MH

Med J Malaysia, 2011 Dec;66(5):474-8.
PMID: 22390104 MyJurnal

OBJECTIVE: We present our experience with daycare tonsillectomy and evaluate patient satisfaction and the post operative complication rate.
METHODS: A prospective audit review of 38 patients from March 2009 till May 2010 was conducted in our ambulatory care center.
RESULTS: There were 38 patients involved in this review. All patients were satisfied with our Ambulatory care services. No admission was reported after daycare tonsillectomy.
CONCLUSION: Daycare tonsillectomy with or without adenoidectomy is safe. It can reduce the waiting time and also bed occupancy thus cost effective. Proper selection of patient is very important.

Matched MeSH terms: Adenoidectomy/methods
The efficacy of a subhypnotic dose of propofol in preventing laryngospasm following tonsillectomy and adenoidectomy in children

Batra YK, Ivanova M, Ali SS, Shamsah M, Al Qattan AR, Belani KG

Paediatr Anaesth, 2005 Dec;15(12):1094-7.
PMID: 16324030 DOI: 10.1111/j.1460-9592.2005.01633.x

BACKGROUND: Laryngospasm is a well-known problem typically occurring immediately following tracheal extubation. Propofol is known to inhibit airway reflexes. In this study, we sought to assess whether the empiric use of a subhypnotic dose of propofol prior to emergence will decrease the occurrence of laryngospasm following extubation in children.
METHODS: After approval from the Institutional Ethics Committee and informed parental consent, we enrolled 120 children ASA physical status I and II, aged 3-14 years who were scheduled to undergo elective tonsillectomy with or without adenoidectomy under standard general anesthesia. Before extubation, the patients were randomized and received in a blinded fashion either propofol 0.5 mg.kg(-1) or saline (control) intravenously. Tracheal extubation was performed 60 s after administration of study drug, when the child was breathing regularly and reacting to the tracheal tube.
RESULTS: Laryngospasm was seen in 20% (n = 12) of the 60 children in the control group and in only 6.6% (n = 4) of 60 children in the propofol group (P < 0.05).
CONCLUSIONS: During emergence from inhalational anesthesia, propofol in a subhypnotic dose (0.5 mg.kg(-1)) decreases the likelihood of laryngospasm upon tracheal extubation in children undergoing tonsillectomy with or without adenoidectomy.

Matched MeSH terms: Adenoidectomy*
Regression of a sphenochoanal polyp in a child

Lim WK, Sdralis T

Laryngoscope, 2004 May;114(5):903-5.
PMID: 15126753

To present an unusual case of a sphenochoanal polyp that regressed and review the etiology of such polyps in comparison to the commoner antrochoanal polyp.

Matched MeSH terms: Adenoidectomy/methods
Primary Adenotonsillar Tuberculosis in an Immunocompetent Child -A Case Report

Lim CC, Misron K, Loong SP, Liew YT, Sawali H

Iran J Otorhinolaryngol, 2019 Sep;31(106):319-322.
PMID: 31598501

Introduction: Primary tuberculosis (TB) of the oropharynx and nasopharynx is an extremely rare form of extra-pulmonary TB in children. Primary tuberculosis occurs more likely secondary to pulmonary TB and is more common in immunocompromised patients.
Case Report: We reported the case of a young male presented with the symptoms of non-specific chronic adenotonsillitis, mild obstructive sleep apnoea, and cervical lymphadenopathy. Subsequently, he underwent adenotonsillectomy and excision of the cervical lymph node with the tissue specimens came back strongly positive for TB. Then, he started using antituberculous medication and recovered well.
Conclusion: The authors would like to highlight this rare clinical entity in which accurate diagnosis is essential for complete treatment.

Matched MeSH terms: Adenoidectomy
Pre-operative parameters do not reliably identify post-operative respiratory risk in children undergoing adenotonsillectomy

Thavagnanam S, Cheong SY, Chinna K, Nathan AM, de Bruyne JA

J Paediatr Child Health, 2018 May;54(5):530-534.
PMID: 29168911 DOI: 10.1111/jpc.13789

AIM: Adenotonsillectomy is performed in children with recurrent tonsillitis or obstructive sleep apnoea. Children at risk of post-operative respiratory complications are recommended to be monitored in paediatric intensive care unit (PICU). The aim of the study is to review the risk factors for post-operative complications and admissions to PICU.
METHODS: A review of medical records of children who underwent adenotonsillectomy between January 2011 and December 2014 was performed. Association between demographic variables and post-operative complications were examined using chi-square and Mann-Whitney tests.
RESULTS: A total of 214 children were identified, and of these, 19 (8.8%) experienced post-operative complications. Six children (2.8%) had respiratory complications: hypoxaemia in four and laryngospasm requiring reintubation in a further two. Both of the latter patients were extubated upon arrival to PICU and required no escalation of therapy. A total of 13 (6.1%) children had non-respiratory complications: 8 (3.7%) had infection and 5 (2.3%) had haemorrhage. A total of 26 (12.1%) children were electively admitted to PICU and mean stay was 19.5 (SD ± 13) h. No association between demographic characteristics, comorbid conditions or polysomnographic parameters and post-operative complications were noted. A total of 194 (90.7%) children stayed only one night in hospital (median 1 day, range 1-5 days).
CONCLUSION: The previously identified risk factors and criteria for PICU admission need revision, and new recommendations are necessary.

Matched MeSH terms: Adenoidectomy*
Adenoid mast cells and their role in the pathogenesis of otitis media with effusion

Abdullah B, Hassan S, Sidek D, Jaafar H

J Laryngol Otol, 2006 Jul;120(7):556-60.
PMID: 16834804 DOI: 10.1017/S002221510

INTRODUCTION: Otitis media with effusion (OME) is an inflammation of the middle ear in which a collection of liquid is present in the middle-ear space while the tympanic membrane is intact. The association between adenoid inflammation and OME has long been noted but the exact mechanism is still much debated. We studied the role of adenoid mast cells in the causation of OME.
OBJECTIVE: To study the distribution and role of adenoid mast cells in the causation of OME.
METHODOLOGY: A cross-sectional, prospective study was carried out in the otorhinolaryngologic clinic, department of otorhinolaryngology (ORL), Science University of Malaysia, from June 1999 to September 2001. A total number of 50 cases were studied. Twenty-five of these patients underwent adenoidectomy, while another 25 patients underwent adenoidectomy and myringotomy with ventilation tube insertion. The adenoid specimens from all patients were examined for the number of adenoid mast cells present, using light microscopy and toluidine blue as the staining agent. The results were analysed using SPSS version 10.0 computer software.
RESULT: The population of adenoid mast cells in children with OME was significantly greater than that in children without OME (p=0.000).
CONCLUSION: The increased number of adenoid mast cells in patients with OME suggests that inflammation may play a role in this condition.

Matched MeSH terms: Adenoidectomy
Fulltext Adeno-tonsillar hypertrophy as a cause of sleep apnoea syndrome

Ravindran VK

Med J Malaysia, 1983 Jun;38(2):164-6.
PMID: 6621450

An interesting case is described here in which partial airway obstruction resulted in sleep apnoea and which was relieved by adeno-tonsillectomy. Enlarged tonsils and adenoids causing upper airway obstruction represent one facet of a continuum of hypoventilation - sleep disorders and clinical examination with x-rays will help in determining patients at risk of developing these syndromes.

Matched MeSH terms: Adenoidectomy
Fulltext Paediatric transoral robotic-assisted adenotonsillectomy: a new anaesthetic experience in Malaysia.

Zawiah Kassim, Fauziah Ahmad, Rusnaini Mustapha Kamar, Karis Misiran

Journal of Clinical and Health Sciences, 2019;4(2):91-96.
MyJurnal

Safety and feasibility of transoral robotic surgery (TORS) in adults for otolaryngology surgery,
mainly in the treatment of oropharyngeal carcinoma and obstructive sleep apnoea has already
been established several years ago. However, less is known with respect to the role and safety
of TORS for otolaryngology surgery in the paediatric age group and its description in the
literature is currently insufficient. As paediatric patients are unique in their anatomy, physiology
and pharmacological kinetic, special attention and consideration has to be applied when using
TORS, hence this increases the perioperative challenges. Herewith we present our experience
in anaesthetising a paediatric patient for TORS adenotonsillectomy which is the first not only
in our centre but in Malaysia. Our major obstacle was the limited airway access as the area of
concern was shared by the anaesthesiologist, surgeon and also the robotic system.
Haemodynamic stabilisation was a challenge compared to the conventional method as the
operative time increased due to robot docking time and the new surgical learning process. In
our opinion, the key point for the success of TORS adenotonsillectomy in paediatric patients is
good communication and teamwork between all personnel involved in the surgery.

Matched MeSH terms: Adenoidectomy
Fulltext Outcome of laser-assisted uvulopalatoplasty (LAUP) in the management of snoring in Hospital Universiti Sains Malaysia (USM)

Abdullah B, Othman NA, Daud MK

Malays J Med Sci, 2008 Apr;15(2):29-32.
PMID: 22589622

To determine the outcome of laser-assisted uvulopalatoplasty for the management of patients with snoring in Universiti Sains Malaysia Hospital (HUSM). A retrospective review of patients who underwent LAUP with or without tonsillectomy or adenoidectomy under general anaesthesia between December 2003 to December 2006. Data was obtained from admission and follow-up records in the otorhinolaryngology clinic of USM Hospital (HUSM). A total of nineteen patients underwent procedure for the treatment of snoring. Majority of these patients presented with symptoms of loud snoring and daytime somnolence. The main operations performed were LAUP with or without tonsillectomy or adenoidectomy. The justification for LAUP were overhanging and excessive uvula or soft palate, whereas for adenotonsillectomy were the hypertrophied adenoids and tonsils. On follow-up, most of the patients claimed improvement of snoring within the first 2 months post-operation. However, majority of them defaulted follow-up after that. One patient (AHI preoperatively was mild) was reviewed up to 8 months with no snoring. One patient (AHI was severe preoperatively and normal post operatively) remained in our follow-up was satisfied with the operation. Two patients continued to experience snoring post LAUP despite trial of non-surgical methods. The outcome of LAUP in our patients showed variable results. This showed that patient selection is very important to achieve good result in LAUP. Long-term follow-up is also essential to document the success for LAUP.

Study site: otorhinolaryngology clinic of USM Hospital (HUSM)

Matched MeSH terms: Adenoidectomy
Assessment of tracheal intubating conditions in children using remifentanil and propofol without muscle relaxant

Batra YK, Al Qattan AR, Ali SS, Qureshi MI, Kuriakose D, Migahed A

Paediatr Anaesth, 2004 Jun;14(6):452-6.
PMID: 15153205

Tracheal intubation in children can be achieved by deep inhalational anaesthesia or an intravenous anaesthetic and a muscle relaxant, suxamethonium being widely used despite several side-effects. Studies have shown that oral intubation can be facilitated safely and effectively in children after induction of anaesthesia with propofol and alfentanil without a muscle relaxant. Remifentanil is a new, ultra-short acting, selective mu-receptor agonist that is 20-30 times more potent than alfentanil. This clinical study was designed to assess whether combination of propofol and remifentanil could be used without a muscle relaxant to facilitate tracheal intubation in children.

Matched MeSH terms: Adenoidectomy