The effect of adenotonsillectomy on serum insulin like growth factors and the adenoid/nasopharynx ratio in pediatric patients: a blind, prospective clinical study.

OBJECTIVES: Obstructive adenoid and tonsillar hyperplasia may present with retardation of growth. An adenoid-nasopharynx (A/N) ratio determined by means of lateral cephalometric radiographs has long been used as a diagnostic tool in the assessment of adenoid size. This study was designed to investigate the effect of adenotonsillectomy on insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) levels and correlation between A/N ratio and IGF-I and IGFBP-3 levels. METHODS: Patients (n=48) that had been operated on our clinic with a diagnosis of adenotonsillar hypertrophy between July 2009 and January 2010 were included in the study. The routine ear-nose and throat examination was done in all patients. Blood samples were taken, and lateral cephalometric radiographs were obtained preoperatively and repeated at 6-9 months (mean 7.2 ± 1.0 mo) following tonsillectomy and adenoidectomy. The chemiluminescent enzyme-linked immunosorbent method was used to IGF-I and IGFBP-3 levels. Each cephalometric radiograph was evaluated by a blinded radiologist. The A/N ratio was calculated using the Fujioka method. RESULTS: When the preoperative and postoperative results were compared, a statistically significant increase in serum IGF-I and IGFBP-3 and a decreased A/N ratio were found. However, although correlation between the Δ(preoperative-postoperative difference) IGFBP-3 and ΔA/N ratio was 40%, it was not statistically significant. Additionally, no statistically significant correlation between the ΔIGF-I and ΔA/N ratio was found. CONCLUSIONS: The results of the present study indicate that adenotonsillectomy could result in the relief of nasopharyngeal obstruction and have a positive effect on growth in children by decreasing the A/N ratio and increasing IGF-I and IGFBP-3. There was no correlation between the ΔA/N ratio and ΔIGF-I and ΔIGFBP-3 levels.

[Evaluation of the duration of postoperative pain control obtained with bupivacaine injection into the tonsillar region in children who underwent tonsillectomy]. / Tonsillektomi yapilan çocuklarda tonsiller bölgeye bupivakain enjeksiyonu ile saglanan ameliyat sonrasi agri kontrolü süresinin degerlendirilmesi.

OBJECTIVES: In this study the effectiveness of postoperative pain control and its probable duration, in the group of pediatric tonsillectomy patients after peroperative application of long acting local anesthetic agent bupivacain to tonsillar fossa is searched. PATIENTS AND METHODS: Our study is a prospective, double-blind, case-control study. A total of 80 children consisting of 50 cases (24 girls, 26 boys; mean age 8.4 ± 2.1 years; range 6 to 12 years) and 30 controls (16 girls, 14 boys; mean age 8.1 ± 1.7 years; range 6 to 12 years) undergoing tonsillectomy were included in this study. Before tonsillectomy 2 ml (0.5 mg/ml) adrenaline-free bupivacain (Marcain, AstraZeneca) injected both of tonsillar fossa in study group, and normal saline injected with the same technique to control group. Face scale is used for pain measurement in both groups. Pain scores were measured at 2, 6, and 24 hours, seventh day and during the first oral intake postoperatively in both groups. RESULTS: We found a significant difference in postoperative second and sixth hours value, when compared control and study groups (p<0.001). No significant difference is found in postoperative 24th hours and first week between study and control group (p>0.001). In our study preincisional bupivacain infiltration makes significant reduction in postoperative pain according to placebo at postoperative second and sixth hours. In both groups at postoperative 24th hours and first week we ascertain significant pain reduction according to postoperative second and sixth hours, but no difference is found between study and control group. CONCLUSION: Intraoperative preincisional bupivacain injection is useful in postoperative pain control at early period of time in children undergoing tonsillectomy. But it has no effect in pain reduction after 24 hours.

Effect of adenotonsillectomy on endothelin-1 and C-reactive protein levels in children with sleep-disordered breathing.

OBJECTIVE: This study aimed to evaluate the influence of adenotonsillectomy on the plasma concentration of endothelin-1 (ET-1) and C-reactive protein (CRP) in children with sleep-disordered breathing (SDB). The relationship between quality of life and ET-1 levels was also evaluated. SETTING: Tertiary referral center. STUDY DESIGN: Before-and-after case series. METHODS: Fasting blood samples for ET-1 and high-sensitivity CRP were drawn preoperatively in all patients and at 3 to 4 months postoperatively. The Obstructive Sleep Apnea-18 (OSA-18) survey and Brouilette symptom score were completed by each child's parents during the same time periods. RESULTS: The mean ET-1 level decreased from 3.51 ± 0.93 fmol/mL to 2.67 ± 0.69 fmol/mL postoperatively (P < .01). OSA-18 survey scores and Brouilette symptom scores also decreased in the postoperative period (P < .01). When comparing moderate and severe cases to mild cases according to Brouilette scores, ET-1 levels were significantly higher in moderate and severe cases (P < .01). There was a significant correlation between ET-1 and the OSA-18 survey scale (r = 0.442; P = .001). Although CRP levels decreased from 0.63 ± 1.19 mg/dL to 0.31 ± 0.23 mg/dL postoperatively, this was not statistically significant. CONCLUSION: Adenotonsillectomy effectively lowered plasma ET-1 levels in children with SDB and thus may have reduced their related risk for cardiovascular disease. In addition, adenotonsillectomy improved quality of life in this group.