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Int J Pediatr Otorhinolaryngol ; 112: 193-194, 2018 09.
Article En | MEDLINE | ID: mdl-30055732
S Afr Med J ; 99(11): 805-9, 2009 Nov.
Article En | MEDLINE | ID: mdl-20218481

OBJECTIVE: We aimed to determine the incidence of abnormal pathological findings in the tonsils and/or adenoids of children undergoing tonsillectomy and/or adenoidectomy, and the incidence of tuberculosis of the tonsils and adenoids; suggest criteria to identify children at risk for adenotonsillar tuberculosis; and investigate the association between HIV and adenotonsillar abnormality, the cost-effectiveness of routine pathological examination of adenotonsillectomy specimens, and criteria to decide which specimens to send for histological examination. METHODS: We undertook an 8-month prospective study on all children (< or =12 years) undergoing consecutive tonsillectomy or adenotonsillectomy (T&A) at Red Cross War Memorial Children's Hospital. Patients were assessed pre-operatively and tonsil sizes graded pre- and intra-operatively. Blood was taken for HIV testing, and all tonsils and adenoids were examined histologically. A cost-benefit analysis was done to determine the cost-effectiveness of adenotonsillectomy routine pathology. RESULTS: A total of 344 tonsils were analysed from 172 children (102 boys, 70 girls); 1 patient had nasopharyngeal tuberculosis, and 1 lymphoma of the tonsils; 13 (7.6%) patients had clinically asymmetrically enlarged tonsils but no significant abnormal pathological finding. The average cost of detecting a clinically significant abnormality was R22 744 (R45 488 + 2 abnormalities). CONCLUSIONS: The following criteria could improve cost-effectiveness of pathological examination of adenotonsillectomy specimens: positive tuberculosis contact at home, systemic symptoms of fever and weight loss, cervical lymphadenopathy >3 cm, suspicious nasopharyngeal appearance, HIV-positive patient, rapid tonsillar enlargement or significant tonsillar asymmetry. On our evidence, routine pathological investigation for South African children does not seem to be justified.

Adenoidectomy/economics , HIV Infections/complications , Tonsillectomy/economics , Tonsillitis/pathology , Tuberculosis, Lymph Node/pathology , Child , Child, Preschool , Cost-Benefit Analysis , Developing Countries , Female , HIV Infections/diagnosis , HIV Infections/pathology , Humans , Infant , Male , Patient Selection , Prospective Studies , South Africa , Tuberculosis, Lymph Node/complications
J Laryngol Otol ; 122(8): 810-3, 2008 Aug.
Article En | MEDLINE | ID: mdl-17623497

OBJECTIVES: To assess the significance of Streptococcus milleri in acute rhinosinusitis with complications. METHODS: A retrospective case note review was undertaken of in-patients at both the Red Cross Children's Hopital and the Groote Schuur Hospital (for adults), Cape Town, South Africa, between 1999 and 2003, with a diagnosis of acute rhinosinusitis with complications. The following were documented: age, gender, complications, organisms cultured and their sensitivity, type and number of operations, and length of hospital stay. RESULTS: Seventy-one case notes were reviewed, for 30 female and 41 male patients, representing 38 adults and 33 children. Streptococcus milleri was the most commonly implicated organism (52.1 per cent; 37/71). Patients from whom this organism was isolated tended to require more than one operative procedure, and had a protracted hospital stay.

Rhinitis/microbiology , Sinusitis/microbiology , Streptococcal Infections/microbiology , Streptococcus milleri Group/isolation & purification , Acute Disease , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Length of Stay , Male , Middle Aged , Reoperation , Retrospective Studies , Rhinitis/surgery , Sinusitis/surgery , South Africa , Statistics, Nonparametric , Streptococcal Infections/surgery
Int J Pediatr Otorhinolaryngol ; 71(12): 1883-8, 2007 Dec.
Article En | MEDLINE | ID: mdl-17919741

OBJECTIVES: The objective of the study was to establish the incidence of Actinomycosis in the tonsils of children undergoing tonsillectomy or adenotonsillectomy, and to evaluate its role in clinical tonsillar disease. METHODS: This was a prospective controlled study done at the Red Cross Children's Hospital in Cape Town, South Africa over an 8-month period and included all children undergoing tonsillectomy or adenotonsillectomy. All resected tonsils were examined for the presence of Actinomycosis and any signs of significant cryptitis or active tonsillitis. A comparison was made in the incidence of Actinomycosis in children with obstructive sleep apnoea, recurrent tonsillitis or obstructive sleep apnoea and recurrent tonsillitis. The data was further analysed to determine the statistical significance of the association between Actinomycosis of the tonsils and age, sex and histopathological and clinical diagnosis. RESULTS: A total of 344 tonsils were analysed on 172 patients. We found 20 patients (11.6%) with Actinomycosis in the tonsils. The mean age of patients with Actinomycosis was 7.25 years and without Actinomycosis was 5.4 years (p=0.002). Most specimens (16) had no evidence of tissue reaction to Actinomyces, and their presence was found to be due to colonisation of the tonsils only. Actinomycosis was present in 11% of patients with obstructive sleep apnoea, 11% of patients with recurrent tonsillitis and in 9% with obstructive sleep apnoea and recurrent tonsillitis. The difference in incidence of Actinomycosis between these three groups (p=0.94), and between the recurrent tonsillitis group alone compared to the obstructive group (p=0.83), was not statistically significant. There was therefore no statistical significance found between Actinomyces and OSA+/- recurrent tonsillitis. CONCLUSIONS: There was no correlation found between the presence of tonsillar Actinomycosis and recurrent tonsillitis and/or obstructive tonsillar hypertrophy. Histopathologic findings showed no evidence of tissue reaction to Actinomyces and its presence was found to be due to colonisation of the tonsils only. The series did however show a statistically significant correlation between Actinomycosis colonisation and age with Actinomycosis being more common in older children, especially those over 5 years of age.

Actinomycosis/complications , Tonsillitis/complications , Child , Child, Preschool , Female , Humans , Male , Prospective Studies
Int J Pediatr Otorhinolaryngol ; 71(11): 1687-92, 2007 Nov.
Article En | MEDLINE | ID: mdl-17720256

OBJECTIVE: To evaluate the effectiveness of lignocain 2% and oxymetazoline 0.025% compared to oxymetazoline 0.025% alone when administered prior to fibreoptic nasendoscopy in paediatric patients. STUDY DESIGN: Prospective, randomized controlled, double-blind study. A group of 56 children, undergoing nasendoscopy to determine adenoidal size, were randomized into two groups and received either lignocain 2% and oxymetazoline 0.025% or oxymetazoline 0.025% alone prior to fibreoptic nasendoscopy. SETTING: A tertiary care Paediatric Hospital. METHOD: The endoscopist recorded the ease of performance of the procedure, cooperation of patient and quality of the view achieved using a visual analogue scale (VAS). The pain and anxiety levels of the child were recorded before, during and immediately after the procedure, using a VAS. The duration of performing the procedure was recorded from insertion of the endoscope into the nostril until removal. RESULTS: All 56 children were able to undergo the endoscopy and the full anxiety and pain assessment was done. Three children were excluded because they have undergone nasendoscopies before. Of the 53 patients included, 27 children received solution A (oxymetazoline 0.025%) and 26 children received solution B (oxymetazoline 0.025% and lignocain 2%). There was no statistical difference between the two groups regarding the duration of the endoscopy, quality of view, ease of performance and cooperation of the patients. The median pain and anxiety scores were not significantly different between the two groups. CONCLUSIONS: This study concludes that the use of a decongestant (oxymetazoline) for paediatric nasendoscopy is just as effective as the use of oxymetazoline with lignocain. Pain and anxiety is not increased in the absence of lignocain.

Anesthetics, Local/administration & dosage , Endoscopy/methods , Fiber Optic Technology/instrumentation , Lidocaine/administration & dosage , Oxymetazoline/administration & dosage , Administration, Topical , Anxiety/diagnosis , Anxiety/psychology , Child , Double-Blind Method , Drug Combinations , Female , Follow-Up Studies , Humans , Male , Nasal Cavity , Pain/diagnosis , Pain Measurement , Prospective Studies , Time Factors
Int J Pediatr Otorhinolaryngol ; 71(10): 1555-62, 2007 Oct.
Article En | MEDLINE | ID: mdl-17628705

OBJECTIVE: To compare adenoidectomy using suction-diathermy ablation to curettage adenoidectomy with respect to operative time and adenoid regrowth at 6 months after surgery. STUDY DESIGN: A prospective, randomized, single-blind, study to compare two methods of performing adenoidectomy. A group of 100 children, undergoing adenoidectomy alone or in combination with tonsillectomy, were randomized into two groups and underwent either suction diathermy or curettage adenoidectomy by a single surgeon. SETTING: A tertiary care Paediatric Hospital. METHOD: Indication for surgery, adenoidal size, duration of surgery and complications were recorded and compared. Six-month follow-up was conducted and adenoidal size and symptom status were recorded and compared. Statistical analysis was performed using Microsoft Excel. RESULTS: One hundred patients participated in this study and underwent adenoidectomy alone or adenotonsillectomy. Ninety-two patients returned for follow-up and 91 patients completed the study. The two treatment groups were well matched for age and gender. The main indications for both groups were snoring, nasal obstruction and obstructive sleep apnoea. For adenoidectomy alone there was no significant difference in duration of surgery between the curette and suction diathermy groups. When performing tonsillectomy and adenoidectomy together suction diathermy took significantly longer to complete than curettage (P<0.001). Overall 96% of patients' symptoms had either improved or resolved. The post-operative comparison at 6 months showed a significant difference in the residual adenoidal size between the two groups, the suction diathermy group being generally smaller than the curettage group. CONCLUSIONS: Suction diathermy was better at reducing the adenoidal size 6 months after surgery. Although the difference in size was statistically significant it did not seem to be of clinical significance.

Adenoidectomy/methods , Electrocoagulation/instrumentation , Child, Preschool , Female , Humans , Infant , Male , Prospective Studies , Single-Blind Method
S Afr Med J ; 97(5): 367-70, 2007 May.
Article En | MEDLINE | ID: mdl-17599220

OBJECTIVES: The aims of the study were: (i) to determine the necessity for diagnostic tonsillectomy in children with asymmetrically enlarged tonsils; (ii) to determine the accuracy of clinical assessment of tonsillar asymmetry; and (iii) to determine how to manage children with clinical tonsillar asymmetry in a developing-world practice. METHODS: A prospective study was carried out at Red Cross War Memorial Children's Hospital in Cape Town, over an 8-month period. All children undergoing tonsillectomy or adenotonsillectomy had a clinical assessment of tonsil symmetry done, and all tonsil and adenoid specimens were examined histologically. The maximum diameter and volume of the resected tonsils were measured. A comparison was done of true tonsil asymmetry in patients with asymmetrical tonsils and a subgroup of matched controls with symmetrical tonsils. RESULTS: A total of 344 tonsils were analysed (172 patients). The 13 patients (7.6%) diagnosed as having clinically asymmetrically enlarged tonsils had no significant pathological diagnosis. In the patients with symmetrical tonsils there were 2 abnormal pathological findings (tuberculosis of the adenoids and T-cell lymphoma of the tonsils and adenoids). In the clinically asymmetrical tonsil group, true tonsillar asymmetry was 3 mm (maximum diameter), and 2.2 cm(3) (volume), compared with 1.9 mm and 1.5 cm(3) in the symmetrical tonsil group. When patients with clinical tonsillar asymmetry and symmetry were compared, the difference in maximum diameter (p = 0.62) and volume (p = 0.73) was not significantly different. CONCLUSIONS: Clinical tonsillar asymmetry is usually apparent rather than real. The incidence of significant pathology in children with asymptomatic, asymmetrical tonsils is low. Diagnostic tonsillectomy is indicated in children with asymmetrically enlarged tonsils associated with constitutional symptoms, cervical lymphadenopathy, rapid tonsil enlargement or significant tonsillar asymmetry.

Palatine Tonsil/pathology , Tonsillectomy , Adenoids/pathology , Adenoids/surgery , Case-Control Studies , Child , Child, Preschool , Female , Humans , Hypertrophy , Infant , Male , Palatine Tonsil/surgery , Prospective Studies
Int J Pediatr Otorhinolaryngol ; 71(7): 1125-8, 2007 Jul.
Article En | MEDLINE | ID: mdl-17498816

UNLABELLED: Tracheostomy in adults with HIV/AIDS has been reported to be associated with both high and early mortality of 47-100%. There is minimal data regarding the role of tracheostomy in HIV infected children. We did a retrospective analysis of HIV positive children that underwent tracheostomy at our institution over a 5-year period, 2002-2006. A total of 70 tracheostomies were done during the period and 15 (21.4%) of these children were confirmed as HIV infected. The average age at presentation for HIV infected children with upper airway obstruction resulting eventually in tracheostomy was 9.4 months and 60% were under 1 year of age. Only three (20%) were on Anti-Retroviral Therapy (ART) prior to presentation. The cause of upper airway obstruction was croup in 14 (93%) of these 15 children. Following tracheostomy all were treated with ART. To date six children have been successfully decannulated (40%) and there have been three deaths (20%) which were unrelated to tracheostomy. CONCLUSION: Tracheostomy in HIV positive children is not associated with the high mortality that has been reported in adults provided such children are started on treatment with antiretroviral therapy.

Croup/surgery , HIV Infections/complications , Tracheostomy/statistics & numerical data , Child , Child, Preschool , Croup/etiology , Humans , Infant , Medical Records , Nutritional Status , South Africa
Int J Pediatr Otorhinolaryngol ; 67(5): 473-7, 2003 May.
Article En | MEDLINE | ID: mdl-12697349

The congenital anomaly of extreme microglossia is uncommon and fewer than 50 cases have been described. The microglossia has often occurred in association with limb abnormalities and, therefore, these cases have been grouped together as the hypoglossia-hypodactylia syndrome within the oromandibular-limb hypogenesis syndromes. We present five cases seen at our referral centre. Surprisingly for this number none had limb anomalies but all had marked micrognathia-Gorlin-Hall classification type 5-two requiring tracheostomy for upper airway obstruction. All required tube feeding for between 4 and 17 months. Long term follow-up is not yet available.

Micrognathism/complications , Tongue/abnormalities , Airway Obstruction/etiology , Airway Obstruction/surgery , Enteral Nutrition , Female , Humans , Infant, Newborn , Male , Micrognathism/classification , Micrognathism/therapy , Tracheostomy