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Adenotonsillar Hypertrophy

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AG Schilder – 1st expert on this subject based on the ideXlab platform

  • effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or Adenotonsillar Hypertrophy open randomised controlled trial
    Clinical Otolaryngology, 2005
    Co-Authors: Birgit K Van Staaji, Emma H. Van Den Akker, Maroeska M. Rovers, Gerrit Jan Hordijk, Arno W Hoes, AG Schilder

    Abstract:

    OBJECTIVE: To assess the effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or Adenotonsillar Hypertrophy. DESIGN: Open, randomised controlled trial. SETTING: 21 general hospitals and three academic centres in the Netherlands. PARTICIPANTS: 300 children aged 2-8 years requiring adenotonsillectomy. INTERVENTION: Adenotonsillectomy compared with watchful waiting. MAIN OUTCOME MEASURES: Episodes of fever, throat infections, upper respiratory tract infections, and health related quality of life. RESULTS: During the median follow up period of 22 months, children in the adenotonsillectomy group had 2.97 episodes of fever per person year compared with 3.18 in the watchful waiting group (difference -0.21%, 95% confidence interval -0.54 to 0.12), 0.56 throat infections per year compared with 0.77 (-0.21, -0.36 to -0.06), and 5.47 upper respiratory tract infections per person year compared with 6.00 (-0.53, -0.97 to -0.08). No clinically relevant differences were found for health related quality of life. Adenotonsillectomy was more effective in children with a history of three to six throat infections than in those with none or two. 12 children had surgery related complications. CONCLUSION: Adenotonsillectomy in children with mild symptoms of throat infections or Adenotonsillar Hypertrophy has no major clinical benefits over watchful waiting.

  • Effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or Adenotonsillar Hypertrophy: open, randomised controlled trial.
    Clin Otolaryngol, 2005
    Co-Authors: AG Schilder

    Abstract:

    To assess the effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or Adenotonsillar Hypertrophy.

  • effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or Adenotonsillar Hypertrophy open randomised controlled trial
    BMJ, 2004
    Co-Authors: Birgit K. Van Staaij, Emma H. Van Den Akker, Maroeska M. Rovers, Gerrit Jan Hordijk, Arno W Hoes, AG Schilder

    Abstract:

    Objective To assess the effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or Adenotonsillar Hypertrophy.

    Design Open, randomised controlled trial.

    Setting 21 general hospitals and three academic centres in the Netherlands.

    Participants 300 children aged 2-8 years requiring adenotonsillectomy.

    Intervention Adenotonsillectomy compared with watchful waiting.

    Main outcome measures Episodes of fever, throat infections, upper respiratory tract infections, and health related quality of life.

    Results During the median follow up period of 22 months, children in the adenotonsillectomy group had 2.97 episodes of fever per person year compared with 3.18 in the watchful waiting group (difference -0.21, 95% confidence interval -0.54 to 0.12), 0.56 throat infections per person year compared with 0.77 (-0.21, -0.36 to -0.06), and 5.47 upper respiratory tract infections per person year compared with 6.00 (-0.53, -0.97 to -0.08). No clinically relevant differences were found for health related quality of life. Adenotonsillectomy was more effective in children with a history of three to six throat infections than in those with none to two. 12 children had complications related to surgery.

    Conclusion Adenotonsillectomy has no major clinical benefits over watchful waiting in children with mild symptoms of throat infections or Adenotonsillar Hypertrophy.

Jay N Dolitsky – 2nd expert on this subject based on the ideXlab platform

  • Treatment of symptomatic chronic Adenotonsillar Hypertrophy with amoxicillin/clavulanate potassium: short- and long-term results.
    Pediatrics, 1998
    Co-Authors: Anthony P Sclafani, Jeffrey Ginsburg, M K Shah, Jay N Dolitsky

    Abstract:

    To evaluate the short- and long-term effects of treatment of symptomatic chronic Adenotonsillar Hypertrophy (CATH) with a 30-day course of amoxicillin/clavulanate potassium (AMOX/CLAV).
    Children 2 to 16 years of age with obstructive symptoms attributable to CATH, who did not have a history of recurrent adenotonsillitis.
    A prospective, randomized, double-blinded, placebo-controlled trial.
    Ambulatory clinic of a tertiary care hospital.
    Patients were randomly treated with 30-day courses of either placebo (PLAC) or AMOX/CLAV (40 mg/kg in 3 divided doses daily).
    Patients’ signs and symptoms were assessed by physical examination and by both physician and parental forced-choice questionnaires 1, 3, and 24 months after treatment. The decision to proceed to surgery or to continue expectant management was made for all patients by the same physician, based on reported symptoms and physical findings.
    Treatment with a 30-day course of AMOX/CLAV significantly reduced the need for surgery in the short term compared with PLAC (37.5% vs 62.7%) at 1-month follow-up). The reduced need for surgery in the AMOX/CLAV-treated group persisted at 3 months (AMOX/CLAV 54.5% vs PLAC 85.7%) and 24 months (AMOX/CLAV 83.3% vs PLAC 98.0%).
    A 30-day course of AMOX/CLAV significantly reduces the need for surgery in children with obstructive Adenotonsillar Hypertrophy at 1-month follow-up. This relative reduction persists at 3 and 24 months posttreatment, although the absolute percentages of patients requiring surgery increased in both groups as time after treatment increased. The reduction in symptoms in AMOX/CLAV-treated patients is modest but significant even in long-term follow-up. The precise role of this treatment for CATH is yet to be determined; however, our results suggest that a 30-day course of AMOX/CLAV can be used in situations when a temporary relief in symptoms is desirable or surgery would incur unacceptable risk.

  • treatment of symptomatic chronic Adenotonsillar Hypertrophy with amoxicillin clavulanate potassium short and long term results
    Pediatrics, 1998
    Co-Authors: Anthony P Sclafani, Jeffrey Ginsburg, M Shah, Jay N Dolitsky

    Abstract:

    Objective. To evaluate the short- and long-term effects of treatment of symptomatic chronic Adenotonsillar Hypertrophy (CATH) with a 30-day course of amoxicillin/clavulanate potassium (AMOX/CLAV). Patients. Children 2 to 16 years of age with obstructive symptoms attributable to CATH, who did not have a history of recurrent adenotonsillitis. Design. A prospective, randomized, double-blinded, placebo-controlled trial. Setting. Ambulatory clinic of a tertiary care hospital. Intervention. Patients were randomly treated with 30-day courses of either placebo (PLAC) or AMOX/CLAV (40 mg/kg in 3 divided doses daily). Outcome Measures. Patients9 signs and symptoms were assessed by physical examination and by both physician and parental forced-choice questionnaires 1, 3, and 24 months after treatment. The decision to proceed to surgery or to continue expectant management was made for all patients by the same physician, based on reported symptoms and physical findings. Results. Treatment with a 30-day course of AMOX/CLAV significantly reduced the need for surgery in the short term compared with PLAC (37.5% vs 62.7%) at 1-month follow-up). The reduced need for surgery in the AMOX/CLAV-treated group persisted at 3 months (AMOX/CLAV 54.5% vs PLAC 85.7%) and 24 months (AMOX/CLAV 83.3% vs PLAC 98.0%). Conclusions. A 30-day course of AMOX/CLAV significantly reduces the need for surgery in children with obstructive Adenotonsillar Hypertrophy at 1-month follow-up. This relative reduction persists at 3 and 24 months posttreatment, although the absolute percentages of patients requiring surgery increased in both groups as time after treatment increased. The reduction in symptoms in AMOX/CLAV-treated patients is modest but significant even in long-term follow-up. The precise role of this treatment for CATH is yet to be determined; however, our results suggest that a 30-day course of AMOX/CLAV can be used in situations when a temporary relief in symptoms is desirable or surgery would incur unacceptable risk.

  • Treatment of Symptomatic Chronic Adenotonsillar Hypertrophy With Amoxicillin/Clavulanate Potassium: Short- and Long-term Results
    Pediatrics, 1998
    Co-Authors: Anthony P Sclafani, M Shah, Jeffrey B. Ginsburg, Jay N Dolitsky

    Abstract:

    Objective. To evaluate the short- and long-term effects of treatment of symptomatic chronic Adenotonsillar Hypertrophy (CATH) with a 30-day course of amoxicillin/clavulanate potassium (AMOX/CLAV). Patients. Children 2 to 16 years of age with obstructive symptoms attributable to CATH, who did not have a history of recurrent adenotonsillitis. Design. A prospective, randomized, double-blinded, placebo-controlled trial. Setting. Ambulatory clinic of a tertiary care hospital. Intervention. Patients were randomly treated with 30-day courses of either placebo (PLAC) or AMOX/CLAV (40 mg/kg in 3 divided doses daily). Outcome Measures. Patients9 signs and symptoms were assessed by physical examination and by both physician and parental forced-choice questionnaires 1, 3, and 24 months after treatment. The decision to proceed to surgery or to continue expectant management was made for all patients by the same physician, based on reported symptoms and physical findings. Results. Treatment with a 30-day course of AMOX/CLAV significantly reduced the need for surgery in the short term compared with PLAC (37.5% vs 62.7%) at 1-month follow-up). The reduced need for surgery in the AMOX/CLAV-treated group persisted at 3 months (AMOX/CLAV 54.5% vs PLAC 85.7%) and 24 months (AMOX/CLAV 83.3% vs PLAC 98.0%). Conclusions. A 30-day course of AMOX/CLAV significantly reduces the need for surgery in children with obstructive Adenotonsillar Hypertrophy at 1-month follow-up. This relative reduction persists at 3 and 24 months posttreatment, although the absolute percentages of patients requiring surgery increased in both groups as time after treatment increased. The reduction in symptoms in AMOX/CLAV-treated patients is modest but significant even in long-term follow-up. The precise role of this treatment for CATH is yet to be determined; however, our results suggest that a 30-day course of AMOX/CLAV can be used in situations when a temporary relief in symptoms is desirable or surgery would incur unacceptable risk.

Ali M Strocker – 3rd expert on this subject based on the ideXlab platform

  • Adenotonsillar Hypertrophy and epstein barr virus in pediatric organ transplant recipients
    Laryngoscope, 2001
    Co-Authors: Nina L Shapiro, Ali M Strocker

    Abstract:

    Objectives/Hypothesis: Epstein-Barr virus‐related (EBV-related) lymphoid hyperplasia of the tonsils and adenoids is a precursor to post-transplantation lymphoproliferative disorder (PTLD). The incidence of posttransplantation Adenotonsillar Hypertrophy, a potential early sign of PTLD or EBV-related lymphoid hyperplasia, is not known. We sought to identify potential risk factors for Adenotonsillar Hypertrophy manifested as EBV-related hyperplasia and early PTLD in the pediatric solid organ transplant population. Study Design: Cross-sectional analysis. Methods: We developed a 65-point questionnaire concerning obstructive sleep disorder and upper respiratory tract infections and an 8-point focused physical examination, to identify prevalence of and risk factors for Adenotonsillar Hypertrophy in the pediatric transplant population. We evaluated 120 pediatric solid organ transplant recipients by parental questionnaire and focused Adenotonsillar physical examination. Results: Of the 120 patients, 62 had undergone liver transplantation and 58 had undergone kidney transplantation. Overall, the mean questionnaire score was 8.36 (range, 0‐40) and the mean physical examination score was 3.86 (range, 1‐8). Patients whose EBV serological test result was negative at the time of transplant had higher scores for both the questionnaire (mean score, 10.24) and the physical examination (mean score, 4.56) than those whose EBV serological test result was positive at the time of transplantation (scores of 7.38 and 3.30 for questionnaire and physical examination, respectively). The difference in examination scores was statistically significant (P <.003). Conclusions: Epstein-Barr virus seronegativity at the time of organ transplantation is a known risk factor for PTLD, with associated risk of developing EBV-related lymphoid hyperplasia. Our results indicate a higher incidence of symptoms and signs consistent with Adenotonsillar Hypertrophy in the EBV seronegative population. Adenotonsillar Hypertrophy may be a precursor to EBV-related lymphoid hyperplasia and PTLD and must be identified in this patient population.

  • Adenotonsillar Hypertrophy and Epstein-Barr virus in pediatric organ transplant recipients
    Laryngoscope, 2001
    Co-Authors: Nina L Shapiro, Ali M Strocker

    Abstract:

    Objectives/Hypothesis: Epstein-Barr virus‐related (EBV-related) lymphoid hyperplasia of the tonsils and adenoids is a precursor to post-transplantation lymphoproliferative disorder (PTLD). The incidence of posttransplantation Adenotonsillar Hypertrophy, a potential early sign of PTLD or EBV-related lymphoid hyperplasia, is not known. We sought to identify potential risk factors for Adenotonsillar Hypertrophy manifested as EBV-related hyperplasia and early PTLD in the pediatric solid organ transplant population. Study Design: Cross-sectional analysis. Methods: We developed a 65-point questionnaire concerning obstructive sleep disorder and upper respiratory tract infections and an 8-point focused physical examination, to identify prevalence of and risk factors for Adenotonsillar Hypertrophy in the pediatric transplant population. We evaluated 120 pediatric solid organ transplant recipients by parental questionnaire and focused Adenotonsillar physical examination. Results: Of the 120 patients, 62 had undergone liver transplantation and 58 had undergone kidney transplantation. Overall, the mean questionnaire score was 8.36 (range, 0‐40) and the mean physical examination score was 3.86 (range, 1‐8). Patients whose EBV serological test result was negative at the time of transplant had higher scores for both the questionnaire (mean score, 10.24) and the physical examination (mean score, 4.56) than those whose EBV serological test result was positive at the time of transplantation (scores of 7.38 and 3.30 for questionnaire and physical examination, respectively). The difference in examination scores was statistically significant (P