Summerschool 2019 : Pediatric ENT · → topical steroids (1 à 3 mois) Asthma?Allergia?...
24
Summerschool 2019 : Pediatric ENT Adenoidectomy-Tonsillectomy Indications (Dre H Cao Van, Geneva) Surgical technics (Dre S Niederer-Wüst, Zurich) Complications ( Dr M Vischer, Bern) Questions
Transcript of Summerschool 2019 : Pediatric ENT · → topical steroids (1 à 3 mois) Asthma?Allergia?...
Summerschool 2019 Pediatric ENT
Adenoidectomy-Tonsillectomy
Indications (Dre H Cao Van Geneva)
Surgical technics (Dre S Niederer-Wuumlst Zurich)
Complications ( Dr M Vischer Bern)
Questions
AdenoidectomyTonsillectomy in children indications
Dre Heacutelegravene Cao VanUniteacute drsquoORL peacutediatrique
300819
Definitions
bull Tonsils (palatine tonsils)
bull Adenoids (pharyngeal tonsils)
= lymphoid tissues from Waldeyerrsquos ring
rarr production of B-cells
Clinical assessment
bull Size of adenoisbull aspect
bull Adenoid Facies
ndash Mouth breathing low tongue placement
ndash Narrow upper jaw steep mandible open anteriorbite
ndash Long and narrow face
Score de Brodsky ou Friedman
Score de Mallampati
Management
bull Obstruction (70)bull snoringrarr OSASbull Adenoid faciesbull Hyponasalitybull Dysphagiabull Serous otitis media
bull Infection (30)bull Recurrent throat infection andor peritonsillar abscessbull Aute otitis media
bull Asymetrical tonsilsbull Halitosis
Medical treatment
bull adenoids
prevalence of adenoidal hypertrophy 42 agrave 70Meacuteta analyse 2017Pereira et al
ndash Cochrane 2008
rarr topical steroids (1 agrave 3 mois)
AsthmaAllergia
ndash Nasopharyngeal flux lt38
Ad adenoidectomy (orthodontist view) Krasny et al 2011
Indications to an adenoidectomy
Pediatric ENT Graham et al 2007
Nasal obstruction
bull Other reasons excluded
bull OSAS -------- rarr adenoTonsillectomy
bull If no response wit the conservative treatment and if gt 1 year +- impaired olfaction rarr surgery
bull Retrospective study (Joshua et al 2006)
ndash Follow up 3 to 6 years (children between 2-7 years old)
ndash Spontaneous resolution between 74 to 87
ndash 25 of recurrence (Johnston et al 2017)
OSAS
bull Apnea repiratory pause gt 2 respiratory cycle Obstructive VS central rarr night polygraphy
AHI gt 1 mild gt5 moderate gt10 severerarr anamnesis (daytime fatiguehyperactivity awakening and nocturnal agitation snoring
weight school difficultieshellip)
bull Surgical tretment (80 of succes rate) adenoidectomy + tonsillectomy oradenoidectomy + tonsillotomy
bull Why treated ndash Psychosocial and cognitive developmentndash Adenoid facies growth hormonendash Cardiovascular morbidities
OME AOM
bull Indication to transtympanic tubes only
bull Adenoidectomy associated if nasal obstruction andor chronic rhnitis associated
bull If recurrence of OME andor AOM after expulsion of TT indication of adenoidectomy +TT
Adenoidal Faciegraves reversible
bull non conclusives data hellip
bull Favorable observationnal studies
bull Face growing untill 5-6 years old
Gerhardsson et al 2016
Tonsillectomy indication
1 OSAS (70)bull 67 Gerhardsson et al 2016
bull 42 prior sleeping test hellip movie
bull Long term effect Cochrane 2010
2 Recurrent throat infection (30)Criteria from Paradise et al 1984-2002
ndash 7 episods or + on 1 year
ndash 5 episods or + on the 2 last years
ndash 3 episods or + on the 3 last years
(35 children from Holland 2013)
Improvement first year only (Pediatrics 2017)
3 Peritonsillar abscess
4 PFAPA
5 Dysphagia
6 Halitosis
7 Chronic tonsillitis
Particular cases
bull Down Syndrom other syndroms
bull MucoPolySaccharidosis
bull Sickle cell disease
bull Disorder of hemostasis anemia
bull Bifid uvula
bull hellip
Conclusions
bull Adenoid and tonsils = lymphoid tissues declinespontaneously with increasing age
bull Most frequent surgery in children (3-6 years old)
bull Indication obstruction (70)gt infection (30)
bull Criteria exist but consider casecase
bull Consider values and preferences of the family
bull No emergencyhellip (behavior disorder schooldifficulties growing disorder)
Surgery indications update 2019
bull Adenoidectomy
ndash NOgt 1 year refractory to medical treatment
ndash Chronic rhinitis refractory to medical treatment
ndash Adenoid Faciegraves
ndash Possible recurrence (25 Asthma allergia)
ndash Velopharyngeal contraindication
bull Tonsillectomy
ndash OSAS (+adeno) to objectify (PGPSG) if doubt or lt2-3 years old or syndromic or other potential risk
ndash Infections (gt 7 on 1 year gt5 on 2 years gt3 on 3 years)Otolaryngol Head Neck Surg 2019 Feb160(1_suppl)S1-S42 doi 1011770194599818801757
Clinical Practice Guideline Tonsillectomy in Children (Update)
Mitchell RB1 Archer SM2 Ishman SL3 Rosenfeld RM4 Coles S5 Finestone SA6 Friedman NR7 Giordano T8 Hildrew DM9 Kim TW10 Lloyd RM11 Parikh SR12
Shulman ST13 Walner DL14 Walsh SA6 Nnacheta LC15
Remind
bull Consider risk and morbidity of the surgery
bull Natural course of desease spontaneously favorable long term quality of life
bull Evolution in surgical technicshellip
AdenoidectomyTonsillectomy in children indications
Dre Heacutelegravene Cao VanUniteacute drsquoORL peacutediatrique
300819
Definitions
bull Tonsils (palatine tonsils)
bull Adenoids (pharyngeal tonsils)
= lymphoid tissues from Waldeyerrsquos ring
rarr production of B-cells
Clinical assessment
bull Size of adenoisbull aspect
bull Adenoid Facies
ndash Mouth breathing low tongue placement
ndash Narrow upper jaw steep mandible open anteriorbite
ndash Long and narrow face
Score de Brodsky ou Friedman
Score de Mallampati
Management
bull Obstruction (70)bull snoringrarr OSASbull Adenoid faciesbull Hyponasalitybull Dysphagiabull Serous otitis media
bull Infection (30)bull Recurrent throat infection andor peritonsillar abscessbull Aute otitis media
bull Asymetrical tonsilsbull Halitosis
Medical treatment
bull adenoids
prevalence of adenoidal hypertrophy 42 agrave 70Meacuteta analyse 2017Pereira et al
ndash Cochrane 2008
rarr topical steroids (1 agrave 3 mois)
AsthmaAllergia
ndash Nasopharyngeal flux lt38
Ad adenoidectomy (orthodontist view) Krasny et al 2011
Indications to an adenoidectomy
Pediatric ENT Graham et al 2007
Nasal obstruction
bull Other reasons excluded
bull OSAS -------- rarr adenoTonsillectomy
bull If no response wit the conservative treatment and if gt 1 year +- impaired olfaction rarr surgery
bull Retrospective study (Joshua et al 2006)
ndash Follow up 3 to 6 years (children between 2-7 years old)
ndash Spontaneous resolution between 74 to 87
ndash 25 of recurrence (Johnston et al 2017)
OSAS
bull Apnea repiratory pause gt 2 respiratory cycle Obstructive VS central rarr night polygraphy
AHI gt 1 mild gt5 moderate gt10 severerarr anamnesis (daytime fatiguehyperactivity awakening and nocturnal agitation snoring
weight school difficultieshellip)
bull Surgical tretment (80 of succes rate) adenoidectomy + tonsillectomy oradenoidectomy + tonsillotomy
bull Why treated ndash Psychosocial and cognitive developmentndash Adenoid facies growth hormonendash Cardiovascular morbidities
OME AOM
bull Indication to transtympanic tubes only
bull Adenoidectomy associated if nasal obstruction andor chronic rhnitis associated
bull If recurrence of OME andor AOM after expulsion of TT indication of adenoidectomy +TT
Adenoidal Faciegraves reversible
bull non conclusives data hellip
bull Favorable observationnal studies
bull Face growing untill 5-6 years old
Gerhardsson et al 2016
Tonsillectomy indication
1 OSAS (70)bull 67 Gerhardsson et al 2016
bull 42 prior sleeping test hellip movie
bull Long term effect Cochrane 2010
2 Recurrent throat infection (30)Criteria from Paradise et al 1984-2002
ndash 7 episods or + on 1 year
ndash 5 episods or + on the 2 last years
ndash 3 episods or + on the 3 last years
(35 children from Holland 2013)
Improvement first year only (Pediatrics 2017)
3 Peritonsillar abscess
4 PFAPA
5 Dysphagia
6 Halitosis
7 Chronic tonsillitis
Particular cases
bull Down Syndrom other syndroms
bull MucoPolySaccharidosis
bull Sickle cell disease
bull Disorder of hemostasis anemia
bull Bifid uvula
bull hellip
Conclusions
bull Adenoid and tonsils = lymphoid tissues declinespontaneously with increasing age
bull Most frequent surgery in children (3-6 years old)
bull Indication obstruction (70)gt infection (30)
bull Criteria exist but consider casecase
bull Consider values and preferences of the family
bull No emergencyhellip (behavior disorder schooldifficulties growing disorder)
Surgery indications update 2019
bull Adenoidectomy
ndash NOgt 1 year refractory to medical treatment
ndash Chronic rhinitis refractory to medical treatment
ndash Adenoid Faciegraves
ndash Possible recurrence (25 Asthma allergia)
ndash Velopharyngeal contraindication
bull Tonsillectomy
ndash OSAS (+adeno) to objectify (PGPSG) if doubt or lt2-3 years old or syndromic or other potential risk
ndash Infections (gt 7 on 1 year gt5 on 2 years gt3 on 3 years)Otolaryngol Head Neck Surg 2019 Feb160(1_suppl)S1-S42 doi 1011770194599818801757
Clinical Practice Guideline Tonsillectomy in Children (Update)
Mitchell RB1 Archer SM2 Ishman SL3 Rosenfeld RM4 Coles S5 Finestone SA6 Friedman NR7 Giordano T8 Hildrew DM9 Kim TW10 Lloyd RM11 Parikh SR12
Shulman ST13 Walner DL14 Walsh SA6 Nnacheta LC15
Remind
bull Consider risk and morbidity of the surgery
bull Natural course of desease spontaneously favorable long term quality of life
bull Evolution in surgical technicshellip
Definitions
bull Tonsils (palatine tonsils)
bull Adenoids (pharyngeal tonsils)
= lymphoid tissues from Waldeyerrsquos ring
rarr production of B-cells
Clinical assessment
bull Size of adenoisbull aspect
bull Adenoid Facies
ndash Mouth breathing low tongue placement
ndash Narrow upper jaw steep mandible open anteriorbite
ndash Long and narrow face
Score de Brodsky ou Friedman
Score de Mallampati
Management
bull Obstruction (70)bull snoringrarr OSASbull Adenoid faciesbull Hyponasalitybull Dysphagiabull Serous otitis media
bull Infection (30)bull Recurrent throat infection andor peritonsillar abscessbull Aute otitis media
bull Asymetrical tonsilsbull Halitosis
Medical treatment
bull adenoids
prevalence of adenoidal hypertrophy 42 agrave 70Meacuteta analyse 2017Pereira et al
ndash Cochrane 2008
rarr topical steroids (1 agrave 3 mois)
AsthmaAllergia
ndash Nasopharyngeal flux lt38
Ad adenoidectomy (orthodontist view) Krasny et al 2011
Indications to an adenoidectomy
Pediatric ENT Graham et al 2007
Nasal obstruction
bull Other reasons excluded
bull OSAS -------- rarr adenoTonsillectomy
bull If no response wit the conservative treatment and if gt 1 year +- impaired olfaction rarr surgery
bull Retrospective study (Joshua et al 2006)
ndash Follow up 3 to 6 years (children between 2-7 years old)
ndash Spontaneous resolution between 74 to 87
ndash 25 of recurrence (Johnston et al 2017)
OSAS
bull Apnea repiratory pause gt 2 respiratory cycle Obstructive VS central rarr night polygraphy
AHI gt 1 mild gt5 moderate gt10 severerarr anamnesis (daytime fatiguehyperactivity awakening and nocturnal agitation snoring
weight school difficultieshellip)
bull Surgical tretment (80 of succes rate) adenoidectomy + tonsillectomy oradenoidectomy + tonsillotomy
bull Why treated ndash Psychosocial and cognitive developmentndash Adenoid facies growth hormonendash Cardiovascular morbidities
OME AOM
bull Indication to transtympanic tubes only
bull Adenoidectomy associated if nasal obstruction andor chronic rhnitis associated
bull If recurrence of OME andor AOM after expulsion of TT indication of adenoidectomy +TT
Adenoidal Faciegraves reversible
bull non conclusives data hellip
bull Favorable observationnal studies
bull Face growing untill 5-6 years old
Gerhardsson et al 2016
Tonsillectomy indication
1 OSAS (70)bull 67 Gerhardsson et al 2016
bull 42 prior sleeping test hellip movie
bull Long term effect Cochrane 2010
2 Recurrent throat infection (30)Criteria from Paradise et al 1984-2002
ndash 7 episods or + on 1 year
ndash 5 episods or + on the 2 last years
ndash 3 episods or + on the 3 last years
(35 children from Holland 2013)
Improvement first year only (Pediatrics 2017)
3 Peritonsillar abscess
4 PFAPA
5 Dysphagia
6 Halitosis
7 Chronic tonsillitis
Particular cases
bull Down Syndrom other syndroms
bull MucoPolySaccharidosis
bull Sickle cell disease
bull Disorder of hemostasis anemia
bull Bifid uvula
bull hellip
Conclusions
bull Adenoid and tonsils = lymphoid tissues declinespontaneously with increasing age
bull Most frequent surgery in children (3-6 years old)
bull Indication obstruction (70)gt infection (30)
bull Criteria exist but consider casecase
bull Consider values and preferences of the family
bull No emergencyhellip (behavior disorder schooldifficulties growing disorder)
Surgery indications update 2019
bull Adenoidectomy
ndash NOgt 1 year refractory to medical treatment
ndash Chronic rhinitis refractory to medical treatment
ndash Adenoid Faciegraves
ndash Possible recurrence (25 Asthma allergia)
ndash Velopharyngeal contraindication
bull Tonsillectomy
ndash OSAS (+adeno) to objectify (PGPSG) if doubt or lt2-3 years old or syndromic or other potential risk
ndash Infections (gt 7 on 1 year gt5 on 2 years gt3 on 3 years)Otolaryngol Head Neck Surg 2019 Feb160(1_suppl)S1-S42 doi 1011770194599818801757
Clinical Practice Guideline Tonsillectomy in Children (Update)
Mitchell RB1 Archer SM2 Ishman SL3 Rosenfeld RM4 Coles S5 Finestone SA6 Friedman NR7 Giordano T8 Hildrew DM9 Kim TW10 Lloyd RM11 Parikh SR12
Shulman ST13 Walner DL14 Walsh SA6 Nnacheta LC15
Remind
bull Consider risk and morbidity of the surgery
bull Natural course of desease spontaneously favorable long term quality of life
bull Evolution in surgical technicshellip
Clinical assessment
bull Size of adenoisbull aspect
bull Adenoid Facies
ndash Mouth breathing low tongue placement
ndash Narrow upper jaw steep mandible open anteriorbite
ndash Long and narrow face
Score de Brodsky ou Friedman
Score de Mallampati
Management
bull Obstruction (70)bull snoringrarr OSASbull Adenoid faciesbull Hyponasalitybull Dysphagiabull Serous otitis media
bull Infection (30)bull Recurrent throat infection andor peritonsillar abscessbull Aute otitis media
bull Asymetrical tonsilsbull Halitosis
Medical treatment
bull adenoids
prevalence of adenoidal hypertrophy 42 agrave 70Meacuteta analyse 2017Pereira et al
ndash Cochrane 2008
rarr topical steroids (1 agrave 3 mois)
AsthmaAllergia
ndash Nasopharyngeal flux lt38
Ad adenoidectomy (orthodontist view) Krasny et al 2011
Indications to an adenoidectomy
Pediatric ENT Graham et al 2007
Nasal obstruction
bull Other reasons excluded
bull OSAS -------- rarr adenoTonsillectomy
bull If no response wit the conservative treatment and if gt 1 year +- impaired olfaction rarr surgery
bull Retrospective study (Joshua et al 2006)
ndash Follow up 3 to 6 years (children between 2-7 years old)
ndash Spontaneous resolution between 74 to 87
ndash 25 of recurrence (Johnston et al 2017)
OSAS
bull Apnea repiratory pause gt 2 respiratory cycle Obstructive VS central rarr night polygraphy
AHI gt 1 mild gt5 moderate gt10 severerarr anamnesis (daytime fatiguehyperactivity awakening and nocturnal agitation snoring
weight school difficultieshellip)
bull Surgical tretment (80 of succes rate) adenoidectomy + tonsillectomy oradenoidectomy + tonsillotomy
bull Why treated ndash Psychosocial and cognitive developmentndash Adenoid facies growth hormonendash Cardiovascular morbidities
OME AOM
bull Indication to transtympanic tubes only
bull Adenoidectomy associated if nasal obstruction andor chronic rhnitis associated
bull If recurrence of OME andor AOM after expulsion of TT indication of adenoidectomy +TT
Adenoidal Faciegraves reversible
bull non conclusives data hellip
bull Favorable observationnal studies
bull Face growing untill 5-6 years old
Gerhardsson et al 2016
Tonsillectomy indication
1 OSAS (70)bull 67 Gerhardsson et al 2016
bull 42 prior sleeping test hellip movie
bull Long term effect Cochrane 2010
2 Recurrent throat infection (30)Criteria from Paradise et al 1984-2002
ndash 7 episods or + on 1 year
ndash 5 episods or + on the 2 last years
ndash 3 episods or + on the 3 last years
(35 children from Holland 2013)
Improvement first year only (Pediatrics 2017)
3 Peritonsillar abscess
4 PFAPA
5 Dysphagia
6 Halitosis
7 Chronic tonsillitis
Particular cases
bull Down Syndrom other syndroms
bull MucoPolySaccharidosis
bull Sickle cell disease
bull Disorder of hemostasis anemia
bull Bifid uvula
bull hellip
Conclusions
bull Adenoid and tonsils = lymphoid tissues declinespontaneously with increasing age
bull Most frequent surgery in children (3-6 years old)
bull Indication obstruction (70)gt infection (30)
bull Criteria exist but consider casecase
bull Consider values and preferences of the family
bull No emergencyhellip (behavior disorder schooldifficulties growing disorder)
Surgery indications update 2019
bull Adenoidectomy
ndash NOgt 1 year refractory to medical treatment
ndash Chronic rhinitis refractory to medical treatment
ndash Adenoid Faciegraves
ndash Possible recurrence (25 Asthma allergia)
ndash Velopharyngeal contraindication
bull Tonsillectomy
ndash OSAS (+adeno) to objectify (PGPSG) if doubt or lt2-3 years old or syndromic or other potential risk
ndash Infections (gt 7 on 1 year gt5 on 2 years gt3 on 3 years)Otolaryngol Head Neck Surg 2019 Feb160(1_suppl)S1-S42 doi 1011770194599818801757
Clinical Practice Guideline Tonsillectomy in Children (Update)
Mitchell RB1 Archer SM2 Ishman SL3 Rosenfeld RM4 Coles S5 Finestone SA6 Friedman NR7 Giordano T8 Hildrew DM9 Kim TW10 Lloyd RM11 Parikh SR12
Shulman ST13 Walner DL14 Walsh SA6 Nnacheta LC15
Remind
bull Consider risk and morbidity of the surgery
bull Natural course of desease spontaneously favorable long term quality of life
bull Evolution in surgical technicshellip
bull Adenoid Facies
ndash Mouth breathing low tongue placement
ndash Narrow upper jaw steep mandible open anteriorbite
ndash Long and narrow face
Score de Brodsky ou Friedman
Score de Mallampati
Management
bull Obstruction (70)bull snoringrarr OSASbull Adenoid faciesbull Hyponasalitybull Dysphagiabull Serous otitis media
bull Infection (30)bull Recurrent throat infection andor peritonsillar abscessbull Aute otitis media
bull Asymetrical tonsilsbull Halitosis
Medical treatment
bull adenoids
prevalence of adenoidal hypertrophy 42 agrave 70Meacuteta analyse 2017Pereira et al
ndash Cochrane 2008
rarr topical steroids (1 agrave 3 mois)
AsthmaAllergia
ndash Nasopharyngeal flux lt38
Ad adenoidectomy (orthodontist view) Krasny et al 2011
Indications to an adenoidectomy
Pediatric ENT Graham et al 2007
Nasal obstruction
bull Other reasons excluded
bull OSAS -------- rarr adenoTonsillectomy
bull If no response wit the conservative treatment and if gt 1 year +- impaired olfaction rarr surgery
bull Retrospective study (Joshua et al 2006)
ndash Follow up 3 to 6 years (children between 2-7 years old)
ndash Spontaneous resolution between 74 to 87
ndash 25 of recurrence (Johnston et al 2017)
OSAS
bull Apnea repiratory pause gt 2 respiratory cycle Obstructive VS central rarr night polygraphy
AHI gt 1 mild gt5 moderate gt10 severerarr anamnesis (daytime fatiguehyperactivity awakening and nocturnal agitation snoring
weight school difficultieshellip)
bull Surgical tretment (80 of succes rate) adenoidectomy + tonsillectomy oradenoidectomy + tonsillotomy
bull Why treated ndash Psychosocial and cognitive developmentndash Adenoid facies growth hormonendash Cardiovascular morbidities
OME AOM
bull Indication to transtympanic tubes only
bull Adenoidectomy associated if nasal obstruction andor chronic rhnitis associated
bull If recurrence of OME andor AOM after expulsion of TT indication of adenoidectomy +TT
Adenoidal Faciegraves reversible
bull non conclusives data hellip
bull Favorable observationnal studies
bull Face growing untill 5-6 years old
Gerhardsson et al 2016
Tonsillectomy indication
1 OSAS (70)bull 67 Gerhardsson et al 2016
bull 42 prior sleeping test hellip movie
bull Long term effect Cochrane 2010
2 Recurrent throat infection (30)Criteria from Paradise et al 1984-2002
ndash 7 episods or + on 1 year
ndash 5 episods or + on the 2 last years
ndash 3 episods or + on the 3 last years
(35 children from Holland 2013)
Improvement first year only (Pediatrics 2017)
3 Peritonsillar abscess
4 PFAPA
5 Dysphagia
6 Halitosis
7 Chronic tonsillitis
Particular cases
bull Down Syndrom other syndroms
bull MucoPolySaccharidosis
bull Sickle cell disease
bull Disorder of hemostasis anemia
bull Bifid uvula
bull hellip
Conclusions
bull Adenoid and tonsils = lymphoid tissues declinespontaneously with increasing age
bull Most frequent surgery in children (3-6 years old)
bull Indication obstruction (70)gt infection (30)
bull Criteria exist but consider casecase
bull Consider values and preferences of the family
bull No emergencyhellip (behavior disorder schooldifficulties growing disorder)
Surgery indications update 2019
bull Adenoidectomy
ndash NOgt 1 year refractory to medical treatment
ndash Chronic rhinitis refractory to medical treatment
ndash Adenoid Faciegraves
ndash Possible recurrence (25 Asthma allergia)
ndash Velopharyngeal contraindication
bull Tonsillectomy
ndash OSAS (+adeno) to objectify (PGPSG) if doubt or lt2-3 years old or syndromic or other potential risk
ndash Infections (gt 7 on 1 year gt5 on 2 years gt3 on 3 years)Otolaryngol Head Neck Surg 2019 Feb160(1_suppl)S1-S42 doi 1011770194599818801757
Clinical Practice Guideline Tonsillectomy in Children (Update)
Mitchell RB1 Archer SM2 Ishman SL3 Rosenfeld RM4 Coles S5 Finestone SA6 Friedman NR7 Giordano T8 Hildrew DM9 Kim TW10 Lloyd RM11 Parikh SR12
Shulman ST13 Walner DL14 Walsh SA6 Nnacheta LC15
Remind
bull Consider risk and morbidity of the surgery
bull Natural course of desease spontaneously favorable long term quality of life
bull Evolution in surgical technicshellip
Score de Brodsky ou Friedman
Score de Mallampati
Management
bull Obstruction (70)bull snoringrarr OSASbull Adenoid faciesbull Hyponasalitybull Dysphagiabull Serous otitis media
bull Infection (30)bull Recurrent throat infection andor peritonsillar abscessbull Aute otitis media
bull Asymetrical tonsilsbull Halitosis
Medical treatment
bull adenoids
prevalence of adenoidal hypertrophy 42 agrave 70Meacuteta analyse 2017Pereira et al
ndash Cochrane 2008
rarr topical steroids (1 agrave 3 mois)
AsthmaAllergia
ndash Nasopharyngeal flux lt38
Ad adenoidectomy (orthodontist view) Krasny et al 2011
Indications to an adenoidectomy
Pediatric ENT Graham et al 2007
Nasal obstruction
bull Other reasons excluded
bull OSAS -------- rarr adenoTonsillectomy
bull If no response wit the conservative treatment and if gt 1 year +- impaired olfaction rarr surgery
bull Retrospective study (Joshua et al 2006)
ndash Follow up 3 to 6 years (children between 2-7 years old)
ndash Spontaneous resolution between 74 to 87
ndash 25 of recurrence (Johnston et al 2017)
OSAS
bull Apnea repiratory pause gt 2 respiratory cycle Obstructive VS central rarr night polygraphy
AHI gt 1 mild gt5 moderate gt10 severerarr anamnesis (daytime fatiguehyperactivity awakening and nocturnal agitation snoring
weight school difficultieshellip)
bull Surgical tretment (80 of succes rate) adenoidectomy + tonsillectomy oradenoidectomy + tonsillotomy
bull Why treated ndash Psychosocial and cognitive developmentndash Adenoid facies growth hormonendash Cardiovascular morbidities
OME AOM
bull Indication to transtympanic tubes only
bull Adenoidectomy associated if nasal obstruction andor chronic rhnitis associated
bull If recurrence of OME andor AOM after expulsion of TT indication of adenoidectomy +TT
Adenoidal Faciegraves reversible
bull non conclusives data hellip
bull Favorable observationnal studies
bull Face growing untill 5-6 years old
Gerhardsson et al 2016
Tonsillectomy indication
1 OSAS (70)bull 67 Gerhardsson et al 2016
bull 42 prior sleeping test hellip movie
bull Long term effect Cochrane 2010
2 Recurrent throat infection (30)Criteria from Paradise et al 1984-2002
ndash 7 episods or + on 1 year
ndash 5 episods or + on the 2 last years
ndash 3 episods or + on the 3 last years
(35 children from Holland 2013)
Improvement first year only (Pediatrics 2017)
3 Peritonsillar abscess
4 PFAPA
5 Dysphagia
6 Halitosis
7 Chronic tonsillitis
Particular cases
bull Down Syndrom other syndroms
bull MucoPolySaccharidosis
bull Sickle cell disease
bull Disorder of hemostasis anemia
bull Bifid uvula
bull hellip
Conclusions
bull Adenoid and tonsils = lymphoid tissues declinespontaneously with increasing age
bull Most frequent surgery in children (3-6 years old)
bull Indication obstruction (70)gt infection (30)
bull Criteria exist but consider casecase
bull Consider values and preferences of the family
bull No emergencyhellip (behavior disorder schooldifficulties growing disorder)
Surgery indications update 2019
bull Adenoidectomy
ndash NOgt 1 year refractory to medical treatment
ndash Chronic rhinitis refractory to medical treatment
ndash Adenoid Faciegraves
ndash Possible recurrence (25 Asthma allergia)
ndash Velopharyngeal contraindication
bull Tonsillectomy
ndash OSAS (+adeno) to objectify (PGPSG) if doubt or lt2-3 years old or syndromic or other potential risk
ndash Infections (gt 7 on 1 year gt5 on 2 years gt3 on 3 years)Otolaryngol Head Neck Surg 2019 Feb160(1_suppl)S1-S42 doi 1011770194599818801757
Clinical Practice Guideline Tonsillectomy in Children (Update)
Mitchell RB1 Archer SM2 Ishman SL3 Rosenfeld RM4 Coles S5 Finestone SA6 Friedman NR7 Giordano T8 Hildrew DM9 Kim TW10 Lloyd RM11 Parikh SR12
Shulman ST13 Walner DL14 Walsh SA6 Nnacheta LC15
Remind
bull Consider risk and morbidity of the surgery
bull Natural course of desease spontaneously favorable long term quality of life
bull Evolution in surgical technicshellip
Management
bull Obstruction (70)bull snoringrarr OSASbull Adenoid faciesbull Hyponasalitybull Dysphagiabull Serous otitis media
bull Infection (30)bull Recurrent throat infection andor peritonsillar abscessbull Aute otitis media
bull Asymetrical tonsilsbull Halitosis
Medical treatment
bull adenoids
prevalence of adenoidal hypertrophy 42 agrave 70Meacuteta analyse 2017Pereira et al
ndash Cochrane 2008
rarr topical steroids (1 agrave 3 mois)
AsthmaAllergia
ndash Nasopharyngeal flux lt38
Ad adenoidectomy (orthodontist view) Krasny et al 2011
Indications to an adenoidectomy
Pediatric ENT Graham et al 2007
Nasal obstruction
bull Other reasons excluded
bull OSAS -------- rarr adenoTonsillectomy
bull If no response wit the conservative treatment and if gt 1 year +- impaired olfaction rarr surgery
bull Retrospective study (Joshua et al 2006)
ndash Follow up 3 to 6 years (children between 2-7 years old)
ndash Spontaneous resolution between 74 to 87
ndash 25 of recurrence (Johnston et al 2017)
OSAS
bull Apnea repiratory pause gt 2 respiratory cycle Obstructive VS central rarr night polygraphy
AHI gt 1 mild gt5 moderate gt10 severerarr anamnesis (daytime fatiguehyperactivity awakening and nocturnal agitation snoring
weight school difficultieshellip)
bull Surgical tretment (80 of succes rate) adenoidectomy + tonsillectomy oradenoidectomy + tonsillotomy
bull Why treated ndash Psychosocial and cognitive developmentndash Adenoid facies growth hormonendash Cardiovascular morbidities
OME AOM
bull Indication to transtympanic tubes only
bull Adenoidectomy associated if nasal obstruction andor chronic rhnitis associated
bull If recurrence of OME andor AOM after expulsion of TT indication of adenoidectomy +TT
Adenoidal Faciegraves reversible
bull non conclusives data hellip
bull Favorable observationnal studies
bull Face growing untill 5-6 years old
Gerhardsson et al 2016
Tonsillectomy indication
1 OSAS (70)bull 67 Gerhardsson et al 2016
bull 42 prior sleeping test hellip movie
bull Long term effect Cochrane 2010
2 Recurrent throat infection (30)Criteria from Paradise et al 1984-2002
ndash 7 episods or + on 1 year
ndash 5 episods or + on the 2 last years
ndash 3 episods or + on the 3 last years
(35 children from Holland 2013)
Improvement first year only (Pediatrics 2017)
3 Peritonsillar abscess
4 PFAPA
5 Dysphagia
6 Halitosis
7 Chronic tonsillitis
Particular cases
bull Down Syndrom other syndroms
bull MucoPolySaccharidosis
bull Sickle cell disease
bull Disorder of hemostasis anemia
bull Bifid uvula
bull hellip
Conclusions
bull Adenoid and tonsils = lymphoid tissues declinespontaneously with increasing age
bull Most frequent surgery in children (3-6 years old)
bull Indication obstruction (70)gt infection (30)
bull Criteria exist but consider casecase
bull Consider values and preferences of the family
bull No emergencyhellip (behavior disorder schooldifficulties growing disorder)
Surgery indications update 2019
bull Adenoidectomy
ndash NOgt 1 year refractory to medical treatment
ndash Chronic rhinitis refractory to medical treatment
ndash Adenoid Faciegraves
ndash Possible recurrence (25 Asthma allergia)
ndash Velopharyngeal contraindication
bull Tonsillectomy
ndash OSAS (+adeno) to objectify (PGPSG) if doubt or lt2-3 years old or syndromic or other potential risk
ndash Infections (gt 7 on 1 year gt5 on 2 years gt3 on 3 years)Otolaryngol Head Neck Surg 2019 Feb160(1_suppl)S1-S42 doi 1011770194599818801757
Clinical Practice Guideline Tonsillectomy in Children (Update)
Mitchell RB1 Archer SM2 Ishman SL3 Rosenfeld RM4 Coles S5 Finestone SA6 Friedman NR7 Giordano T8 Hildrew DM9 Kim TW10 Lloyd RM11 Parikh SR12
Shulman ST13 Walner DL14 Walsh SA6 Nnacheta LC15
Remind
bull Consider risk and morbidity of the surgery
bull Natural course of desease spontaneously favorable long term quality of life
bull Evolution in surgical technicshellip
Medical treatment
bull adenoids
prevalence of adenoidal hypertrophy 42 agrave 70Meacuteta analyse 2017Pereira et al
ndash Cochrane 2008
rarr topical steroids (1 agrave 3 mois)
AsthmaAllergia
ndash Nasopharyngeal flux lt38
Ad adenoidectomy (orthodontist view) Krasny et al 2011
Indications to an adenoidectomy
Pediatric ENT Graham et al 2007
Nasal obstruction
bull Other reasons excluded
bull OSAS -------- rarr adenoTonsillectomy
bull If no response wit the conservative treatment and if gt 1 year +- impaired olfaction rarr surgery
bull Retrospective study (Joshua et al 2006)
ndash Follow up 3 to 6 years (children between 2-7 years old)
ndash Spontaneous resolution between 74 to 87
ndash 25 of recurrence (Johnston et al 2017)
OSAS
bull Apnea repiratory pause gt 2 respiratory cycle Obstructive VS central rarr night polygraphy
AHI gt 1 mild gt5 moderate gt10 severerarr anamnesis (daytime fatiguehyperactivity awakening and nocturnal agitation snoring
weight school difficultieshellip)
bull Surgical tretment (80 of succes rate) adenoidectomy + tonsillectomy oradenoidectomy + tonsillotomy
bull Why treated ndash Psychosocial and cognitive developmentndash Adenoid facies growth hormonendash Cardiovascular morbidities
OME AOM
bull Indication to transtympanic tubes only
bull Adenoidectomy associated if nasal obstruction andor chronic rhnitis associated
bull If recurrence of OME andor AOM after expulsion of TT indication of adenoidectomy +TT
Adenoidal Faciegraves reversible
bull non conclusives data hellip
bull Favorable observationnal studies
bull Face growing untill 5-6 years old
Gerhardsson et al 2016
Tonsillectomy indication
1 OSAS (70)bull 67 Gerhardsson et al 2016
bull 42 prior sleeping test hellip movie
bull Long term effect Cochrane 2010
2 Recurrent throat infection (30)Criteria from Paradise et al 1984-2002
ndash 7 episods or + on 1 year
ndash 5 episods or + on the 2 last years
ndash 3 episods or + on the 3 last years
(35 children from Holland 2013)
Improvement first year only (Pediatrics 2017)
3 Peritonsillar abscess
4 PFAPA
5 Dysphagia
6 Halitosis
7 Chronic tonsillitis
Particular cases
bull Down Syndrom other syndroms
bull MucoPolySaccharidosis
bull Sickle cell disease
bull Disorder of hemostasis anemia
bull Bifid uvula
bull hellip
Conclusions
bull Adenoid and tonsils = lymphoid tissues declinespontaneously with increasing age
bull Most frequent surgery in children (3-6 years old)
bull Indication obstruction (70)gt infection (30)
bull Criteria exist but consider casecase
bull Consider values and preferences of the family
bull No emergencyhellip (behavior disorder schooldifficulties growing disorder)
Surgery indications update 2019
bull Adenoidectomy
ndash NOgt 1 year refractory to medical treatment
ndash Chronic rhinitis refractory to medical treatment
ndash Adenoid Faciegraves
ndash Possible recurrence (25 Asthma allergia)
ndash Velopharyngeal contraindication
bull Tonsillectomy
ndash OSAS (+adeno) to objectify (PGPSG) if doubt or lt2-3 years old or syndromic or other potential risk
ndash Infections (gt 7 on 1 year gt5 on 2 years gt3 on 3 years)Otolaryngol Head Neck Surg 2019 Feb160(1_suppl)S1-S42 doi 1011770194599818801757
Clinical Practice Guideline Tonsillectomy in Children (Update)
Mitchell RB1 Archer SM2 Ishman SL3 Rosenfeld RM4 Coles S5 Finestone SA6 Friedman NR7 Giordano T8 Hildrew DM9 Kim TW10 Lloyd RM11 Parikh SR12
Shulman ST13 Walner DL14 Walsh SA6 Nnacheta LC15
Remind
bull Consider risk and morbidity of the surgery
bull Natural course of desease spontaneously favorable long term quality of life
bull Evolution in surgical technicshellip
Indications to an adenoidectomy
Pediatric ENT Graham et al 2007
Nasal obstruction
bull Other reasons excluded
bull OSAS -------- rarr adenoTonsillectomy
bull If no response wit the conservative treatment and if gt 1 year +- impaired olfaction rarr surgery
bull Retrospective study (Joshua et al 2006)
ndash Follow up 3 to 6 years (children between 2-7 years old)
ndash Spontaneous resolution between 74 to 87
ndash 25 of recurrence (Johnston et al 2017)
OSAS
bull Apnea repiratory pause gt 2 respiratory cycle Obstructive VS central rarr night polygraphy
AHI gt 1 mild gt5 moderate gt10 severerarr anamnesis (daytime fatiguehyperactivity awakening and nocturnal agitation snoring
weight school difficultieshellip)
bull Surgical tretment (80 of succes rate) adenoidectomy + tonsillectomy oradenoidectomy + tonsillotomy
bull Why treated ndash Psychosocial and cognitive developmentndash Adenoid facies growth hormonendash Cardiovascular morbidities
OME AOM
bull Indication to transtympanic tubes only
bull Adenoidectomy associated if nasal obstruction andor chronic rhnitis associated
bull If recurrence of OME andor AOM after expulsion of TT indication of adenoidectomy +TT
Adenoidal Faciegraves reversible
bull non conclusives data hellip
bull Favorable observationnal studies
bull Face growing untill 5-6 years old
Gerhardsson et al 2016
Tonsillectomy indication
1 OSAS (70)bull 67 Gerhardsson et al 2016
bull 42 prior sleeping test hellip movie
bull Long term effect Cochrane 2010
2 Recurrent throat infection (30)Criteria from Paradise et al 1984-2002
ndash 7 episods or + on 1 year
ndash 5 episods or + on the 2 last years
ndash 3 episods or + on the 3 last years
(35 children from Holland 2013)
Improvement first year only (Pediatrics 2017)
3 Peritonsillar abscess
4 PFAPA
5 Dysphagia
6 Halitosis
7 Chronic tonsillitis
Particular cases
bull Down Syndrom other syndroms
bull MucoPolySaccharidosis
bull Sickle cell disease
bull Disorder of hemostasis anemia
bull Bifid uvula
bull hellip
Conclusions
bull Adenoid and tonsils = lymphoid tissues declinespontaneously with increasing age
bull Most frequent surgery in children (3-6 years old)
bull Indication obstruction (70)gt infection (30)
bull Criteria exist but consider casecase
bull Consider values and preferences of the family
bull No emergencyhellip (behavior disorder schooldifficulties growing disorder)
Surgery indications update 2019
bull Adenoidectomy
ndash NOgt 1 year refractory to medical treatment
ndash Chronic rhinitis refractory to medical treatment
ndash Adenoid Faciegraves
ndash Possible recurrence (25 Asthma allergia)
ndash Velopharyngeal contraindication
bull Tonsillectomy
ndash OSAS (+adeno) to objectify (PGPSG) if doubt or lt2-3 years old or syndromic or other potential risk
ndash Infections (gt 7 on 1 year gt5 on 2 years gt3 on 3 years)Otolaryngol Head Neck Surg 2019 Feb160(1_suppl)S1-S42 doi 1011770194599818801757
Clinical Practice Guideline Tonsillectomy in Children (Update)
Mitchell RB1 Archer SM2 Ishman SL3 Rosenfeld RM4 Coles S5 Finestone SA6 Friedman NR7 Giordano T8 Hildrew DM9 Kim TW10 Lloyd RM11 Parikh SR12
Shulman ST13 Walner DL14 Walsh SA6 Nnacheta LC15
Remind
bull Consider risk and morbidity of the surgery
bull Natural course of desease spontaneously favorable long term quality of life
bull Evolution in surgical technicshellip
Nasal obstruction
bull Other reasons excluded
bull OSAS -------- rarr adenoTonsillectomy
bull If no response wit the conservative treatment and if gt 1 year +- impaired olfaction rarr surgery
bull Retrospective study (Joshua et al 2006)
ndash Follow up 3 to 6 years (children between 2-7 years old)
ndash Spontaneous resolution between 74 to 87
ndash 25 of recurrence (Johnston et al 2017)
OSAS
bull Apnea repiratory pause gt 2 respiratory cycle Obstructive VS central rarr night polygraphy
AHI gt 1 mild gt5 moderate gt10 severerarr anamnesis (daytime fatiguehyperactivity awakening and nocturnal agitation snoring
weight school difficultieshellip)
bull Surgical tretment (80 of succes rate) adenoidectomy + tonsillectomy oradenoidectomy + tonsillotomy
bull Why treated ndash Psychosocial and cognitive developmentndash Adenoid facies growth hormonendash Cardiovascular morbidities
OME AOM
bull Indication to transtympanic tubes only
bull Adenoidectomy associated if nasal obstruction andor chronic rhnitis associated
bull If recurrence of OME andor AOM after expulsion of TT indication of adenoidectomy +TT
Adenoidal Faciegraves reversible
bull non conclusives data hellip
bull Favorable observationnal studies
bull Face growing untill 5-6 years old
Gerhardsson et al 2016
Tonsillectomy indication
1 OSAS (70)bull 67 Gerhardsson et al 2016
bull 42 prior sleeping test hellip movie
bull Long term effect Cochrane 2010
2 Recurrent throat infection (30)Criteria from Paradise et al 1984-2002
ndash 7 episods or + on 1 year
ndash 5 episods or + on the 2 last years
ndash 3 episods or + on the 3 last years
(35 children from Holland 2013)
Improvement first year only (Pediatrics 2017)
3 Peritonsillar abscess
4 PFAPA
5 Dysphagia
6 Halitosis
7 Chronic tonsillitis
Particular cases
bull Down Syndrom other syndroms
bull MucoPolySaccharidosis
bull Sickle cell disease
bull Disorder of hemostasis anemia
bull Bifid uvula
bull hellip
Conclusions
bull Adenoid and tonsils = lymphoid tissues declinespontaneously with increasing age
bull Most frequent surgery in children (3-6 years old)
bull Indication obstruction (70)gt infection (30)
bull Criteria exist but consider casecase
bull Consider values and preferences of the family
bull No emergencyhellip (behavior disorder schooldifficulties growing disorder)
Surgery indications update 2019
bull Adenoidectomy
ndash NOgt 1 year refractory to medical treatment
ndash Chronic rhinitis refractory to medical treatment
ndash Adenoid Faciegraves
ndash Possible recurrence (25 Asthma allergia)
ndash Velopharyngeal contraindication
bull Tonsillectomy
ndash OSAS (+adeno) to objectify (PGPSG) if doubt or lt2-3 years old or syndromic or other potential risk
ndash Infections (gt 7 on 1 year gt5 on 2 years gt3 on 3 years)Otolaryngol Head Neck Surg 2019 Feb160(1_suppl)S1-S42 doi 1011770194599818801757
Clinical Practice Guideline Tonsillectomy in Children (Update)
Mitchell RB1 Archer SM2 Ishman SL3 Rosenfeld RM4 Coles S5 Finestone SA6 Friedman NR7 Giordano T8 Hildrew DM9 Kim TW10 Lloyd RM11 Parikh SR12
Shulman ST13 Walner DL14 Walsh SA6 Nnacheta LC15
Remind
bull Consider risk and morbidity of the surgery
bull Natural course of desease spontaneously favorable long term quality of life
bull Evolution in surgical technicshellip
OSAS
bull Apnea repiratory pause gt 2 respiratory cycle Obstructive VS central rarr night polygraphy
AHI gt 1 mild gt5 moderate gt10 severerarr anamnesis (daytime fatiguehyperactivity awakening and nocturnal agitation snoring
weight school difficultieshellip)
bull Surgical tretment (80 of succes rate) adenoidectomy + tonsillectomy oradenoidectomy + tonsillotomy
bull Why treated ndash Psychosocial and cognitive developmentndash Adenoid facies growth hormonendash Cardiovascular morbidities
OME AOM
bull Indication to transtympanic tubes only
bull Adenoidectomy associated if nasal obstruction andor chronic rhnitis associated
bull If recurrence of OME andor AOM after expulsion of TT indication of adenoidectomy +TT
Adenoidal Faciegraves reversible
bull non conclusives data hellip
bull Favorable observationnal studies
bull Face growing untill 5-6 years old
Gerhardsson et al 2016
Tonsillectomy indication
1 OSAS (70)bull 67 Gerhardsson et al 2016
bull 42 prior sleeping test hellip movie
bull Long term effect Cochrane 2010
2 Recurrent throat infection (30)Criteria from Paradise et al 1984-2002
ndash 7 episods or + on 1 year
ndash 5 episods or + on the 2 last years
ndash 3 episods or + on the 3 last years
(35 children from Holland 2013)
Improvement first year only (Pediatrics 2017)
3 Peritonsillar abscess
4 PFAPA
5 Dysphagia
6 Halitosis
7 Chronic tonsillitis
Particular cases
bull Down Syndrom other syndroms
bull MucoPolySaccharidosis
bull Sickle cell disease
bull Disorder of hemostasis anemia
bull Bifid uvula
bull hellip
Conclusions
bull Adenoid and tonsils = lymphoid tissues declinespontaneously with increasing age
bull Most frequent surgery in children (3-6 years old)
bull Indication obstruction (70)gt infection (30)
bull Criteria exist but consider casecase
bull Consider values and preferences of the family
bull No emergencyhellip (behavior disorder schooldifficulties growing disorder)
Surgery indications update 2019
bull Adenoidectomy
ndash NOgt 1 year refractory to medical treatment
ndash Chronic rhinitis refractory to medical treatment
ndash Adenoid Faciegraves
ndash Possible recurrence (25 Asthma allergia)
ndash Velopharyngeal contraindication
bull Tonsillectomy
ndash OSAS (+adeno) to objectify (PGPSG) if doubt or lt2-3 years old or syndromic or other potential risk
ndash Infections (gt 7 on 1 year gt5 on 2 years gt3 on 3 years)Otolaryngol Head Neck Surg 2019 Feb160(1_suppl)S1-S42 doi 1011770194599818801757
Clinical Practice Guideline Tonsillectomy in Children (Update)
Mitchell RB1 Archer SM2 Ishman SL3 Rosenfeld RM4 Coles S5 Finestone SA6 Friedman NR7 Giordano T8 Hildrew DM9 Kim TW10 Lloyd RM11 Parikh SR12
Shulman ST13 Walner DL14 Walsh SA6 Nnacheta LC15
Remind
bull Consider risk and morbidity of the surgery
bull Natural course of desease spontaneously favorable long term quality of life
bull Evolution in surgical technicshellip
OME AOM
bull Indication to transtympanic tubes only
bull Adenoidectomy associated if nasal obstruction andor chronic rhnitis associated
bull If recurrence of OME andor AOM after expulsion of TT indication of adenoidectomy +TT
Adenoidal Faciegraves reversible
bull non conclusives data hellip
bull Favorable observationnal studies
bull Face growing untill 5-6 years old
Gerhardsson et al 2016
Tonsillectomy indication
1 OSAS (70)bull 67 Gerhardsson et al 2016
bull 42 prior sleeping test hellip movie
bull Long term effect Cochrane 2010
2 Recurrent throat infection (30)Criteria from Paradise et al 1984-2002
ndash 7 episods or + on 1 year
ndash 5 episods or + on the 2 last years
ndash 3 episods or + on the 3 last years
(35 children from Holland 2013)
Improvement first year only (Pediatrics 2017)
3 Peritonsillar abscess
4 PFAPA
5 Dysphagia
6 Halitosis
7 Chronic tonsillitis
Particular cases
bull Down Syndrom other syndroms
bull MucoPolySaccharidosis
bull Sickle cell disease
bull Disorder of hemostasis anemia
bull Bifid uvula
bull hellip
Conclusions
bull Adenoid and tonsils = lymphoid tissues declinespontaneously with increasing age
bull Most frequent surgery in children (3-6 years old)
bull Indication obstruction (70)gt infection (30)
bull Criteria exist but consider casecase
bull Consider values and preferences of the family
bull No emergencyhellip (behavior disorder schooldifficulties growing disorder)
Surgery indications update 2019
bull Adenoidectomy
ndash NOgt 1 year refractory to medical treatment
ndash Chronic rhinitis refractory to medical treatment
ndash Adenoid Faciegraves
ndash Possible recurrence (25 Asthma allergia)
ndash Velopharyngeal contraindication
bull Tonsillectomy
ndash OSAS (+adeno) to objectify (PGPSG) if doubt or lt2-3 years old or syndromic or other potential risk
ndash Infections (gt 7 on 1 year gt5 on 2 years gt3 on 3 years)Otolaryngol Head Neck Surg 2019 Feb160(1_suppl)S1-S42 doi 1011770194599818801757
Clinical Practice Guideline Tonsillectomy in Children (Update)
Mitchell RB1 Archer SM2 Ishman SL3 Rosenfeld RM4 Coles S5 Finestone SA6 Friedman NR7 Giordano T8 Hildrew DM9 Kim TW10 Lloyd RM11 Parikh SR12
Shulman ST13 Walner DL14 Walsh SA6 Nnacheta LC15
Remind
bull Consider risk and morbidity of the surgery
bull Natural course of desease spontaneously favorable long term quality of life
bull Evolution in surgical technicshellip
Adenoidal Faciegraves reversible
bull non conclusives data hellip
bull Favorable observationnal studies
bull Face growing untill 5-6 years old
Gerhardsson et al 2016
Tonsillectomy indication
1 OSAS (70)bull 67 Gerhardsson et al 2016
bull 42 prior sleeping test hellip movie
bull Long term effect Cochrane 2010
2 Recurrent throat infection (30)Criteria from Paradise et al 1984-2002
ndash 7 episods or + on 1 year
ndash 5 episods or + on the 2 last years
ndash 3 episods or + on the 3 last years
(35 children from Holland 2013)
Improvement first year only (Pediatrics 2017)
3 Peritonsillar abscess
4 PFAPA
5 Dysphagia
6 Halitosis
7 Chronic tonsillitis
Particular cases
bull Down Syndrom other syndroms
bull MucoPolySaccharidosis
bull Sickle cell disease
bull Disorder of hemostasis anemia
bull Bifid uvula
bull hellip
Conclusions
bull Adenoid and tonsils = lymphoid tissues declinespontaneously with increasing age
bull Most frequent surgery in children (3-6 years old)
bull Indication obstruction (70)gt infection (30)
bull Criteria exist but consider casecase
bull Consider values and preferences of the family
bull No emergencyhellip (behavior disorder schooldifficulties growing disorder)
Surgery indications update 2019
bull Adenoidectomy
ndash NOgt 1 year refractory to medical treatment
ndash Chronic rhinitis refractory to medical treatment
ndash Adenoid Faciegraves
ndash Possible recurrence (25 Asthma allergia)
ndash Velopharyngeal contraindication
bull Tonsillectomy
ndash OSAS (+adeno) to objectify (PGPSG) if doubt or lt2-3 years old or syndromic or other potential risk
ndash Infections (gt 7 on 1 year gt5 on 2 years gt3 on 3 years)Otolaryngol Head Neck Surg 2019 Feb160(1_suppl)S1-S42 doi 1011770194599818801757
Clinical Practice Guideline Tonsillectomy in Children (Update)
Mitchell RB1 Archer SM2 Ishman SL3 Rosenfeld RM4 Coles S5 Finestone SA6 Friedman NR7 Giordano T8 Hildrew DM9 Kim TW10 Lloyd RM11 Parikh SR12
Shulman ST13 Walner DL14 Walsh SA6 Nnacheta LC15
Remind
bull Consider risk and morbidity of the surgery
bull Natural course of desease spontaneously favorable long term quality of life
bull Evolution in surgical technicshellip
Gerhardsson et al 2016
Tonsillectomy indication
1 OSAS (70)bull 67 Gerhardsson et al 2016
bull 42 prior sleeping test hellip movie
bull Long term effect Cochrane 2010
2 Recurrent throat infection (30)Criteria from Paradise et al 1984-2002
ndash 7 episods or + on 1 year
ndash 5 episods or + on the 2 last years
ndash 3 episods or + on the 3 last years
(35 children from Holland 2013)
Improvement first year only (Pediatrics 2017)
3 Peritonsillar abscess
4 PFAPA
5 Dysphagia
6 Halitosis
7 Chronic tonsillitis
Particular cases
bull Down Syndrom other syndroms
bull MucoPolySaccharidosis
bull Sickle cell disease
bull Disorder of hemostasis anemia
bull Bifid uvula
bull hellip
Conclusions
bull Adenoid and tonsils = lymphoid tissues declinespontaneously with increasing age
bull Most frequent surgery in children (3-6 years old)
bull Indication obstruction (70)gt infection (30)
bull Criteria exist but consider casecase
bull Consider values and preferences of the family
bull No emergencyhellip (behavior disorder schooldifficulties growing disorder)
Surgery indications update 2019
bull Adenoidectomy
ndash NOgt 1 year refractory to medical treatment
ndash Chronic rhinitis refractory to medical treatment
ndash Adenoid Faciegraves
ndash Possible recurrence (25 Asthma allergia)
ndash Velopharyngeal contraindication
bull Tonsillectomy
ndash OSAS (+adeno) to objectify (PGPSG) if doubt or lt2-3 years old or syndromic or other potential risk
ndash Infections (gt 7 on 1 year gt5 on 2 years gt3 on 3 years)Otolaryngol Head Neck Surg 2019 Feb160(1_suppl)S1-S42 doi 1011770194599818801757
Clinical Practice Guideline Tonsillectomy in Children (Update)
Mitchell RB1 Archer SM2 Ishman SL3 Rosenfeld RM4 Coles S5 Finestone SA6 Friedman NR7 Giordano T8 Hildrew DM9 Kim TW10 Lloyd RM11 Parikh SR12
Shulman ST13 Walner DL14 Walsh SA6 Nnacheta LC15
Remind
bull Consider risk and morbidity of the surgery
bull Natural course of desease spontaneously favorable long term quality of life
bull Evolution in surgical technicshellip
Tonsillectomy indication
1 OSAS (70)bull 67 Gerhardsson et al 2016
bull 42 prior sleeping test hellip movie
bull Long term effect Cochrane 2010
2 Recurrent throat infection (30)Criteria from Paradise et al 1984-2002
ndash 7 episods or + on 1 year
ndash 5 episods or + on the 2 last years
ndash 3 episods or + on the 3 last years
(35 children from Holland 2013)
Improvement first year only (Pediatrics 2017)
3 Peritonsillar abscess
4 PFAPA
5 Dysphagia
6 Halitosis
7 Chronic tonsillitis
Particular cases
bull Down Syndrom other syndroms
bull MucoPolySaccharidosis
bull Sickle cell disease
bull Disorder of hemostasis anemia
bull Bifid uvula
bull hellip
Conclusions
bull Adenoid and tonsils = lymphoid tissues declinespontaneously with increasing age
bull Most frequent surgery in children (3-6 years old)
bull Indication obstruction (70)gt infection (30)
bull Criteria exist but consider casecase
bull Consider values and preferences of the family
bull No emergencyhellip (behavior disorder schooldifficulties growing disorder)
Surgery indications update 2019
bull Adenoidectomy
ndash NOgt 1 year refractory to medical treatment
ndash Chronic rhinitis refractory to medical treatment
ndash Adenoid Faciegraves
ndash Possible recurrence (25 Asthma allergia)
ndash Velopharyngeal contraindication
bull Tonsillectomy
ndash OSAS (+adeno) to objectify (PGPSG) if doubt or lt2-3 years old or syndromic or other potential risk
ndash Infections (gt 7 on 1 year gt5 on 2 years gt3 on 3 years)Otolaryngol Head Neck Surg 2019 Feb160(1_suppl)S1-S42 doi 1011770194599818801757
Clinical Practice Guideline Tonsillectomy in Children (Update)
Mitchell RB1 Archer SM2 Ishman SL3 Rosenfeld RM4 Coles S5 Finestone SA6 Friedman NR7 Giordano T8 Hildrew DM9 Kim TW10 Lloyd RM11 Parikh SR12
Shulman ST13 Walner DL14 Walsh SA6 Nnacheta LC15
Remind
bull Consider risk and morbidity of the surgery
bull Natural course of desease spontaneously favorable long term quality of life
bull Evolution in surgical technicshellip
3 Peritonsillar abscess
4 PFAPA
5 Dysphagia
6 Halitosis
7 Chronic tonsillitis
Particular cases
bull Down Syndrom other syndroms
bull MucoPolySaccharidosis
bull Sickle cell disease
bull Disorder of hemostasis anemia
bull Bifid uvula
bull hellip
Conclusions
bull Adenoid and tonsils = lymphoid tissues declinespontaneously with increasing age
bull Most frequent surgery in children (3-6 years old)
bull Indication obstruction (70)gt infection (30)
bull Criteria exist but consider casecase
bull Consider values and preferences of the family
bull No emergencyhellip (behavior disorder schooldifficulties growing disorder)
Surgery indications update 2019
bull Adenoidectomy
ndash NOgt 1 year refractory to medical treatment
ndash Chronic rhinitis refractory to medical treatment
ndash Adenoid Faciegraves
ndash Possible recurrence (25 Asthma allergia)
ndash Velopharyngeal contraindication
bull Tonsillectomy
ndash OSAS (+adeno) to objectify (PGPSG) if doubt or lt2-3 years old or syndromic or other potential risk
ndash Infections (gt 7 on 1 year gt5 on 2 years gt3 on 3 years)Otolaryngol Head Neck Surg 2019 Feb160(1_suppl)S1-S42 doi 1011770194599818801757
Clinical Practice Guideline Tonsillectomy in Children (Update)
Mitchell RB1 Archer SM2 Ishman SL3 Rosenfeld RM4 Coles S5 Finestone SA6 Friedman NR7 Giordano T8 Hildrew DM9 Kim TW10 Lloyd RM11 Parikh SR12
Shulman ST13 Walner DL14 Walsh SA6 Nnacheta LC15
Remind
bull Consider risk and morbidity of the surgery
bull Natural course of desease spontaneously favorable long term quality of life
bull Evolution in surgical technicshellip
Particular cases
bull Down Syndrom other syndroms
bull MucoPolySaccharidosis
bull Sickle cell disease
bull Disorder of hemostasis anemia
bull Bifid uvula
bull hellip
Conclusions
bull Adenoid and tonsils = lymphoid tissues declinespontaneously with increasing age
bull Most frequent surgery in children (3-6 years old)
bull Indication obstruction (70)gt infection (30)
bull Criteria exist but consider casecase
bull Consider values and preferences of the family
bull No emergencyhellip (behavior disorder schooldifficulties growing disorder)
Surgery indications update 2019
bull Adenoidectomy
ndash NOgt 1 year refractory to medical treatment
ndash Chronic rhinitis refractory to medical treatment
ndash Adenoid Faciegraves
ndash Possible recurrence (25 Asthma allergia)
ndash Velopharyngeal contraindication
bull Tonsillectomy
ndash OSAS (+adeno) to objectify (PGPSG) if doubt or lt2-3 years old or syndromic or other potential risk
ndash Infections (gt 7 on 1 year gt5 on 2 years gt3 on 3 years)Otolaryngol Head Neck Surg 2019 Feb160(1_suppl)S1-S42 doi 1011770194599818801757
Clinical Practice Guideline Tonsillectomy in Children (Update)
Mitchell RB1 Archer SM2 Ishman SL3 Rosenfeld RM4 Coles S5 Finestone SA6 Friedman NR7 Giordano T8 Hildrew DM9 Kim TW10 Lloyd RM11 Parikh SR12
Shulman ST13 Walner DL14 Walsh SA6 Nnacheta LC15
Remind
bull Consider risk and morbidity of the surgery
bull Natural course of desease spontaneously favorable long term quality of life
bull Evolution in surgical technicshellip
Conclusions
bull Adenoid and tonsils = lymphoid tissues declinespontaneously with increasing age
bull Most frequent surgery in children (3-6 years old)
bull Indication obstruction (70)gt infection (30)
bull Criteria exist but consider casecase
bull Consider values and preferences of the family
bull No emergencyhellip (behavior disorder schooldifficulties growing disorder)
Surgery indications update 2019
bull Adenoidectomy
ndash NOgt 1 year refractory to medical treatment
ndash Chronic rhinitis refractory to medical treatment
ndash Adenoid Faciegraves
ndash Possible recurrence (25 Asthma allergia)
ndash Velopharyngeal contraindication
bull Tonsillectomy
ndash OSAS (+adeno) to objectify (PGPSG) if doubt or lt2-3 years old or syndromic or other potential risk
ndash Infections (gt 7 on 1 year gt5 on 2 years gt3 on 3 years)Otolaryngol Head Neck Surg 2019 Feb160(1_suppl)S1-S42 doi 1011770194599818801757
Clinical Practice Guideline Tonsillectomy in Children (Update)
Mitchell RB1 Archer SM2 Ishman SL3 Rosenfeld RM4 Coles S5 Finestone SA6 Friedman NR7 Giordano T8 Hildrew DM9 Kim TW10 Lloyd RM11 Parikh SR12
Shulman ST13 Walner DL14 Walsh SA6 Nnacheta LC15
Remind
bull Consider risk and morbidity of the surgery
bull Natural course of desease spontaneously favorable long term quality of life
bull Evolution in surgical technicshellip
Surgery indications update 2019
bull Adenoidectomy
ndash NOgt 1 year refractory to medical treatment
ndash Chronic rhinitis refractory to medical treatment
ndash Adenoid Faciegraves
ndash Possible recurrence (25 Asthma allergia)
ndash Velopharyngeal contraindication
bull Tonsillectomy
ndash OSAS (+adeno) to objectify (PGPSG) if doubt or lt2-3 years old or syndromic or other potential risk
ndash Infections (gt 7 on 1 year gt5 on 2 years gt3 on 3 years)Otolaryngol Head Neck Surg 2019 Feb160(1_suppl)S1-S42 doi 1011770194599818801757
Clinical Practice Guideline Tonsillectomy in Children (Update)
Mitchell RB1 Archer SM2 Ishman SL3 Rosenfeld RM4 Coles S5 Finestone SA6 Friedman NR7 Giordano T8 Hildrew DM9 Kim TW10 Lloyd RM11 Parikh SR12
Shulman ST13 Walner DL14 Walsh SA6 Nnacheta LC15
Remind
bull Consider risk and morbidity of the surgery
bull Natural course of desease spontaneously favorable long term quality of life
bull Evolution in surgical technicshellip
Remind
bull Consider risk and morbidity of the surgery
bull Natural course of desease spontaneously favorable long term quality of life
bull Evolution in surgical technicshellip
