Factors associated with changing indications for adenotonsillectomy: A population-based longitudinal study.

OBJECTIVE: Adenotonsillectomy (AT) is one of the most common surgical procedures performed in children and adults. We aim to assess the factors associated with changes in the incidence of and indications for AT using population-level data. STUDY DESIGN: This retrospective cohort study investigated patients who underwent AT between 1997 and 2010 by using data from the Taiwan National Health Insurance Research Database. We examined surgical rates and indications by the calendar year as well as age, sex, hospital level, and insured residence areas for the correlating factors. RESULTS: The average annual incidence rate of AT was 14.7 per 100,000 individuals during 1997-2010. Pediatric (<18 years) patients represented 48.2% of the total AT population. More than 99% of the patients underwent the AT procedures as an inpatient intervention. Longitudinal data demonstrated an increasing trend in the pediatric AT rates from 1997 (4.3/100,000) to 2010 (5.7/100,000) (p = 0.029). In the adult subgroup, a decreasing prevalence of infectious indications (p = 0.014) coincided with an increasing neoplastic indications (p = 0.001). In the pediatric subgroup, the prevalence of obstructive indications increased (p = 0.002). The logistic regression analyses indicated that the significant factors associated with the changing surgical indications for AT were the age in the adult subgroup and hospital level in the pediatric subgroup. CONCLUSIONS: This study revealed a low AT rate in Taiwan than that in other countries. Pediatric AT incidence increased during 1997-2010. Although a rising prevalence of obstructive and neoplastic indications was noted, infection remained the most common indications for AT. Age in the adult subgroup and hospital level in the pediatric subgroup were factors associated with the changing indications for AT.

Causes, costs, and risk factors for unplanned return visits after adenotonsillectomy in children.

OBJECTIVE: To review the causes, costs, and risk factors for unplanned return visits and readmissions after pediatric adenotonsillectomy (T&A). METHODS: Review of administrative database of outpatient adenotonsillectomy performed at any facility within a vertically integrated health care system in the Intermountain West on children age 1-18 years old between 1998 and 2012. Data reviewed included demographic variables, diagnosis associated with return visit and costs associated with return visits. RESULTS: Data from 39,906 children aged 1-18 years old were reviewed. A total of 2499 (6.3%) children had unplanned return visits. The most common reasons for return visits were bleeding (2.3%), dehydration, (2.3%) and throat pain (1.2%). After multivariate analysis, the main risk factors for any type of return visits were Medicaid insurance (OR=1.64 95% CI 1.47-1.84), Hispanic race (OR=1.36 95% CI 1.13-1.64), and increased severity of illness (SOI) (OR=11.29 95% CI 2.69-47.4 for SOI=3). The only factor associated with increased odds of requiring an inpatient admission on return visit was length of time spent in PACU (p<0.001). A linear relationship was also observed between the child's age and the risk of post-tonsillectomy hemorrhage. CONCLUSION: Children with increased severity of illness, those insured with Medicaid, and children of Hispanic ethnicity should be targeted with increased education and interventions in order to reduce unplanned visits after T&A. Further studies on post-tonsillectomy complications should include evaluating the effect of surgical technique and post-operative pain management on all complications and not solely post-tonsillectomy hemorrhage.

Compliance and efficacy of saline irrigation in pediatric chronic rhinosinusitis.

OBJECTIVE: The objective of this study was to evaluate compliance with and effectiveness of nasal irrigation in children with chronic rhinosinusitis (CRS) and to assess its clinical course. METHODS: Seventy-seven children with refractory CRS resistant to medical treatment including antibiotics and nasal corticosteroids were included. We evaluated patients' nasal symptom and Lund Mackay CT scores at baseline. All patients were educated about nasal irrigation and encouraged to perform nasal irrigation 1-3 times a day. After 1 month, patients were reevaluated regarding compliance with the protocol and improvement of CRS by assessing symptom score and endoscopic evaluation. The patients were followed up for at least two months to assess need for further treatment including surgery. RESULTS: Mean age of patients was 8.3 years ranging from 4 to 13 years. Mean follow-up duration with nasal saline irrigation was 6.2 months (2-32 months). Forty nine patients (63.6%) successfully carried out nasal irrigation during follow-up (good compliance [GC] group) and 28 patients (36.4%) did not successfully carry out nasal irrigation (poor compliance [PC] group). There were no significant differences between GC and PC groups regarding clinical characteristics and baseline Lund-MacKay CT scores. Subjective and objective improvements were observed in 36 patients (73.5%) in the GC group and 14 patients (50.0%) in the PC group. Surgery including endoscopic sinus surgery and/or adenoidectomy was performed in 8 patients (16.3%) in the GC group and 12 patients (42.9%) in the PC group. The rate of surgical treatment was significantly different between the groups (p=0.019). CONCLUSION: Nasal irrigation in children with long standing CRS is relatively well tolerated (63.6%) and effective. Nasal saline irrigation should be considered as a primary treatment tool in CRS even in pediatric age group.

Effect of homoeopathic medicines on daily burden of symptoms in children with recurrent upper respiratory tract infections.

OBJECTIVE: To investigate the intrinsic effects of individually prescribed homoeopathic medicines. DESIGN: Randomised double blind placebo controlled study. SETTING: Paediatric outpatient department of university hospital. PATIENTS: 175 children with frequently recurring upper respiratory tract infections. Of the 170 children evaluable, 86 were randomised to homoeopathic medicines (47 boys, 39 girls; median age at start 4.2 years; median number of episodes in past year 4) and 84 to placebo (43 boys, 41 girls; median age at start 3.6 years; median number of episodes in past year 4). MAIN OUTCOME MEASURES: Mean score for daily symptoms, number of antibiotic courses, and number of adenoidectomies and tonsillectomies over one year of follow up. RESULTS: The mean daily symptom score was 2.61 in the placebo group and 2.21 in the treatment group (difference 0.41; 95% confidence interval -0.02 to 0.83). In both groups the use of antibiotics was greatly reduced compared with that in the year before entering the trial (from 73 to 33 in the treatment group and from 69 to 43 in the placebo group). The proportion of children in the treatment group having adenoidectomies was lower in the treatment group (16%, 8/50) than in the placebo group (21%, 9/42). The proportion having tonsillectomies was the same in both groups (5%). CONCLUSION: Individually prescribed homoeopathic medicines seem to add little to careful counselling of children with recurrent upper respiratory tract infection in reducing the daily burden of symptoms, use of antibiotics, and need for adenoidectomy and tonsillectomy.