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The safety of adenoidectomy in young children
P104
Otolaryngology Head and Neck Surgery August 1995
Scientific Sessions- - Tuesday
tility. Disease prevalence approximates 1:20,000, and in most instances inheritance is autosomal dominant. A variety of ultrastructural ciliary defects occur. The most common defect affects the dynein arms, although short spokes and absence of the central sheath and inner or outer dynein arms have been reported. When situs inversus is also present, the disease is known as Siewert or Kartagener syndrome. Because affected persons are predisposed to recurrent otitis media, sinusitis, and bronchiectasis, PCD must be considered in the differential diagnosis of children with recurrent or chronic upper respiratory disease refractory to medical therapy. The diagnosis requires light microscopic examination of the ciliated mucosa and, if motile cilia are not observed, electron microscopy to study axoneme ultrastructure. To avoid delays in diagnosis and ensure adequacy of the tissue sample, we recommend biopsying the tracheal mucosa and examining the tissue in the operating room under light microscopy. If the magnified image demonstrates normal ciliary motility, PCD can be excluded and electron microscopy is not ordered. In the absence of normal ciliary motility, the specimen is placed in glutaraldehyde and ultrastructural axoneme morphology is evaluated. In the past 5 years we have evaluated ciliary motility in 20 patients with recurrent or chronic upper respiratory conditions characterized by the triad of chronic sinusitis, chronic mucoid otitis, and chronic bronchitis. Three patients had abnormal or absent ciliary motility by light microscopy, and PCD was confirmed histologically in each patient. In the remaining 17 patients, normal ciliary motility was observed and electron microscopy was unnecessary. We advocate intraoperative microscopic study of ciliary motility as a rapid, simple, accurate, and inexpensive technique to evaluate patients for PCD. 8:24 A.M.
Discussion 8:30 A.M.
The Safety of Adenoidectomy in Young Children ANDREW PEDERSON, MD (presenter), KATHLEEN E. MEIXNER, MD, and MICHAEL POOLE, MD, PHD, Gainesville, Fla.
The efficacy and safety of adenoidectomy in children less than 4 years of age is poorly defined in the literature. As a result, some practitioners are hesitant to recommend adenoidectomy in these patients. We retrospectively examined all adenoidectomies with or without concurrent procedures performed in patients less than 4 years of age at our institution from 1989 to 1994. A total of 346 Procedures were performed, with an overall complication rate of 9.3%. Only two major complications occurred (0.6%), both of which were respiratory distress requiring intubation. Minor complications (8.7%) included dehydration, self-limited bleeding, fever, and mild respiratory distress. All of the major complications and 33% of the minor complications occurred
in children with associated medical problems. Adenotonsillectomy was performed in 88 patients for obstructive sleep apnea and in 44 patients for recurrent tonsillitis. Otitis media was the reason that 198 patients underwent adenoidectomy with or without myringotomy and tube placement. Complication rates were 13%, 18%, and 2% for obstructive sleep apnea, tonsillitis, and otitis media, respectively. When patients with associated diseases were excluded, the minor complication rates were 7%, 17%, and 2%, respectively, with no complications considered major. Of the 346 patients, 130 were scheduled admissions with only four unscheduled admissions the day of surgery and five later (>24 hours postoperatively). Adenoidectomy alone or in combination with tonsillectomy appears to be a reasonably safe procedure in children less than 4 years of age. In addition, outpatient management, with admission as necessary, also appears to be a reasonable strategy in this population because all airway problems were manifested within the first several hours postoperatively. 8:38 A.M.
Balance in Otitis Media With Effusion: A Prospective Study ELLEN M. FRIEDMAN, MD (presenter), DANIEL C, LAI, NEWTON O. DUNCAN, MD, and MARK PELUCER, MD, Houston, Tex.
Parents and physicians have reported that children with otitis media with effusion (OME) display symptoms of equilibrium and balance disturbances such as occasional falling, stumbling, or clumsiness. A prospective study of 30 children, ages 1 to 4 years old, who were diagnosed with OME were evaluated for imbalance using the Peabody Developmental Motor Scales. The diagnosis of OME was established by pneumatic otoscopy and typmanometry. Pure tone audiometry for air and bone conduction thresholds were also performed. Of the children with bilateral OME, 40% performed significantly below the norm for their age group in balance tasks (p <0.05). In contrast, only 20% of the children with unilateral OME performed significantly below the norm. No correlation was established between parents' perception of imbalance and the actual presence of balance disturbances as detected by the Peabody Developmental Motor Scales. This project reflects that middle ear effusions have a negative effect on vestibular function in children. 8:46 A.M,
Fine-Needle Aspiration in Pediatric Head and Neck Surgery HASSAN H. RAMADAN, MD, FACS (presenter), and MARK K. WAX, MD, FACS, FRCS(C), Morgantown, W.V.
Head and neck masses are very common in children. Persistent masses are referred to the otolaryngologist, who is faced with the dilemma of which ones require surgical excision. Fine-needle aspiration (FNA) in adults helps distinguish lesions that require excision from those that do not
Otolaryngology Head and Neck Surgery August 1995
Scientific Sessions- - Tuesday
tility. Disease prevalence approximates 1:20,000, and in most instances inheritance is autosomal dominant. A variety of ultrastructural ciliary defects occur. The most common defect affects the dynein arms, although short spokes and absence of the central sheath and inner or outer dynein arms have been reported. When situs inversus is also present, the disease is known as Siewert or Kartagener syndrome. Because affected persons are predisposed to recurrent otitis media, sinusitis, and bronchiectasis, PCD must be considered in the differential diagnosis of children with recurrent or chronic upper respiratory disease refractory to medical therapy. The diagnosis requires light microscopic examination of the ciliated mucosa and, if motile cilia are not observed, electron microscopy to study axoneme ultrastructure. To avoid delays in diagnosis and ensure adequacy of the tissue sample, we recommend biopsying the tracheal mucosa and examining the tissue in the operating room under light microscopy. If the magnified image demonstrates normal ciliary motility, PCD can be excluded and electron microscopy is not ordered. In the absence of normal ciliary motility, the specimen is placed in glutaraldehyde and ultrastructural axoneme morphology is evaluated. In the past 5 years we have evaluated ciliary motility in 20 patients with recurrent or chronic upper respiratory conditions characterized by the triad of chronic sinusitis, chronic mucoid otitis, and chronic bronchitis. Three patients had abnormal or absent ciliary motility by light microscopy, and PCD was confirmed histologically in each patient. In the remaining 17 patients, normal ciliary motility was observed and electron microscopy was unnecessary. We advocate intraoperative microscopic study of ciliary motility as a rapid, simple, accurate, and inexpensive technique to evaluate patients for PCD. 8:24 A.M.
Discussion 8:30 A.M.
The Safety of Adenoidectomy in Young Children ANDREW PEDERSON, MD (presenter), KATHLEEN E. MEIXNER, MD, and MICHAEL POOLE, MD, PHD, Gainesville, Fla.
The efficacy and safety of adenoidectomy in children less than 4 years of age is poorly defined in the literature. As a result, some practitioners are hesitant to recommend adenoidectomy in these patients. We retrospectively examined all adenoidectomies with or without concurrent procedures performed in patients less than 4 years of age at our institution from 1989 to 1994. A total of 346 Procedures were performed, with an overall complication rate of 9.3%. Only two major complications occurred (0.6%), both of which were respiratory distress requiring intubation. Minor complications (8.7%) included dehydration, self-limited bleeding, fever, and mild respiratory distress. All of the major complications and 33% of the minor complications occurred
in children with associated medical problems. Adenotonsillectomy was performed in 88 patients for obstructive sleep apnea and in 44 patients for recurrent tonsillitis. Otitis media was the reason that 198 patients underwent adenoidectomy with or without myringotomy and tube placement. Complication rates were 13%, 18%, and 2% for obstructive sleep apnea, tonsillitis, and otitis media, respectively. When patients with associated diseases were excluded, the minor complication rates were 7%, 17%, and 2%, respectively, with no complications considered major. Of the 346 patients, 130 were scheduled admissions with only four unscheduled admissions the day of surgery and five later (>24 hours postoperatively). Adenoidectomy alone or in combination with tonsillectomy appears to be a reasonably safe procedure in children less than 4 years of age. In addition, outpatient management, with admission as necessary, also appears to be a reasonable strategy in this population because all airway problems were manifested within the first several hours postoperatively. 8:38 A.M.
Balance in Otitis Media With Effusion: A Prospective Study ELLEN M. FRIEDMAN, MD (presenter), DANIEL C, LAI, NEWTON O. DUNCAN, MD, and MARK PELUCER, MD, Houston, Tex.
Parents and physicians have reported that children with otitis media with effusion (OME) display symptoms of equilibrium and balance disturbances such as occasional falling, stumbling, or clumsiness. A prospective study of 30 children, ages 1 to 4 years old, who were diagnosed with OME were evaluated for imbalance using the Peabody Developmental Motor Scales. The diagnosis of OME was established by pneumatic otoscopy and typmanometry. Pure tone audiometry for air and bone conduction thresholds were also performed. Of the children with bilateral OME, 40% performed significantly below the norm for their age group in balance tasks (p <0.05). In contrast, only 20% of the children with unilateral OME performed significantly below the norm. No correlation was established between parents' perception of imbalance and the actual presence of balance disturbances as detected by the Peabody Developmental Motor Scales. This project reflects that middle ear effusions have a negative effect on vestibular function in children. 8:46 A.M,
Fine-Needle Aspiration in Pediatric Head and Neck Surgery HASSAN H. RAMADAN, MD, FACS (presenter), and MARK K. WAX, MD, FACS, FRCS(C), Morgantown, W.V.
Head and neck masses are very common in children. Persistent masses are referred to the otolaryngologist, who is faced with the dilemma of which ones require surgical excision. Fine-needle aspiration (FNA) in adults helps distinguish lesions that require excision from those that do not