The safety and risk factors of revision adenoidectomy in children and adolescents: A nationwide retrospective population-based cohort study.

OBJECTIVE: To investigate the safety of adenoidectomy and risk factors of re-adenoidectomy, and intend to provide evidence-based information to clinicians for further consideration. METHODS AND MATERIALS: This study was based on data obtained from Taiwan's National Health Insurance Research Database from the period 2002-2011. We utilized that data from the hospitalization group and collected information regarding those individuals who accepted adenoidectomy with or without tonsillectomy and post-adenoidectomy bleeding. Thereafter, we performed univariate and multi-variate analysis to explore the possible risk factors of re-adenoidectomy. RESULTS: A total of 5435 individuals who accepted a first adenoidectomy with or without tonsillectomy were collected. After further tracing treatment of these individuals, 107 (1.97%) accepted the revision adenoidectomy until 2011. Post-op bleeding was approximately 0.28%. The revision rate associated with patient age showed the following: 0-4 years (0.61%), 4-12 years (2.06%) and 12-18 years (2.56%). The revision rate associated with surgeon age showed: 28-41 years (1.42%), 41-50 years (2.96%), 50-65 years (2.74%); the surgeons' surgery volume showed low (4.34%), medium (0.71%), and higher (1.02%). There are 4 diseases (otitis media with effusion, sinusitis, chronic pharyngitis, and sleep disorder) that showed a significant relationship with the revision rate when subject to univariate and multivariate analysis. The revision rate incorporating hospital locations, volumes and levels revealed no significant difference with each other. CONCLUSIONS: Adenoidectomy is a generally safe surgical procedure, with low complication and low revision rate. Our study indicated that the revision rate of adenoidectomy might be lower when performed by young visiting staff with medium to higher surgical volume in the medium to higher volume hospital. If patients had diseases such as otitis media with effusion, sinusitis, chronic pharyngitis, and sleep disorder, they would be subject to higher rate of re-adenoidectomy. Surgeons should be aware and sufficiently explain this information to the parents before surgery.

Twice-daily application of topical corticosteroids with a squirt system for patients with steroid-responsive olfactory impairment.

CONCLUSION: Twice-daily topical corticosteroid treatment using a squirt system was beneficial in maintaining improvements in olfactory dysfunction which had been achieved by oral steroid treatment. OBJECTIVES: Some patients suffering from olfactory dysfunction respond well to corticosteroids. However, maintaining these improvements is challenging. The aim of this study was to evaluate the maintenance effect of twice-daily topical steroid treatment using a squirt system. METHODS: Twenty-two anosmic patients with an increase in odor threshold, discrimination, and identification (TDI) scores in Sniffin' Sticks tests by more than six points after 1-week of oral steroid treatment were enrolled. All the patients used a squirt system to apply topical corticosteroids and were followed up at 1, 3, and 6 months. RESULTS: Nineteen, 16, and 10 patients were followed-up at 1, 3, and 6 months after treatment, respectively. All the patients had significant visual analog scale scores improvements compared to pre-treatment. The mean improvements in TDI scores were 9.80 (p < 0.001), 11.58 (p = 0.001), and 13.87 (p = 0.005) after 1, 3, and 6 months of treatment, respectively. The self-rated and objective olfactory function scores were maintained with steroid squirt therapy without significant decline, even in the patients who were followed up for 6 months.