RESUMO
Összefoglaló. Bevezetés és célkituzés: A szerzok a posztoperatív fájdalom és a sebgyógyulás tekintetében prospektív vizsgálattal hasonlították össze gyermekeken (67 fo, 1-12 év) a hagyományos hidegeszközzel történo extracapsularis tonsillectomiát (23 fo) a microdebriderrel (23 fo) és a coblatorral (21 fo) végzett intracapsularis tonsillotomiával. Módszer: A vizsgálatok a betegek által kitöltött kérdoívek, valamint prospektív klinikai adatgyujtés alapján történtek. Eredmények: Az intracapsularis tonsillotomia gyógyulási idejét 50%-kal rövidebbnek találtuk, és az elso 13 napban szignifikánsan kevesebb fájdalommal és fájdalomcsillapító igénnyel járt, mint az extracapsularis tonsillectomia eseteiben. A tonsillotomiás csoporton belül egyedül a posztoperatív elso napi fájdalom tekintetében észleltünk szignifikáns különbséget a két különbözo módszer között a coblator javára (p<0,05). A vizsgálatokat retrospektív áttekintéssel is kiegészítettük, 4 évi gyermek- (1-15 éves) tonsillamutéten átesett beteganyagunk (1487 fo) eredményeinek feldolgozásával. Tonsillectomia (1253 fo) után 7,7%-os utóvérzési arányt észleltünk, mutéti vérzéscsillapításra 1,3%-ban volt szükség. Tonsillotomia esetén (234 fo) 0,43%-os utóvérzési arányt regisztráltunk. Ebben a csoportban vérzés miatt nem, de 2 esetben ismételt obstrukciót okozó hypertrophia, 1 esetben góctünetek miatt reoperációt végeztünk (1,28%). Következtetés: Eredményeiket a szerzok a nemzetközi ajánlások tükrében elemezték. Az intracapsularis tonsillotomia kisebb fájdalommal, kisebb vérzéssel és kisebb megterheléssel jár. A közösségbe való aktív visszatérés akár egy hét után lehetséges a tonsillectomiára jellemzo 3 héttel szemben, mindez jelentos szocioökonómiai elonyökkel járhat. Orv Hetil. 2020; 161(45): 1920-1926. INTRODUCTION AND OBJECTIVE: Examining operated children in this prostective study inditerscompared (67 pts, 1-12 yrs) the extracapsular tonsillectomy with conventional cold-knife (23 pts) to extracapsular tonsillotomy with microdebrider (23 pts) and coblator (21 pts) for postoperative pain and wound-healing disorders. METHOD: The study was based on patient-completed questionnaires as well as prospective clinical data collection. RESULTS: The recovery time of intracapsular tonsillotomy was found less than 50%, with less pain than in the cases of extracapsular tonsillectomy. Postoperative pain was significantly less in the tonsillototomy group than the tonsillectomy group. Within the tonsillotomy group, a significant difference was observed between the two different methods in favor of the coblator for only the postoperative first-day pain. The studies were supplemented with a retrospective review by processing the 4 yrs results of their pediatric (1-15-yrs) patients who underwent tonsillectomy (1487 pts). After tonsillectomy (1253 pts), a postoperative bleeding rate of 7.7% was observed, and surgical hemostasis was required in 1.3%. In the case of tonsillotomy (234 pts), a postoperative bleeding rate of 0.43% was recorded. In this group, reoperation was not performed due to bleeding, whereas it was neccesary in 2 cases due to hypertrophy causing repeated obstruction, in 1 case due by virtue of focal symptomes (1.28%). CONCLUSION: Our results were analyzed on the basis of international recommendations. Intracapsular tonsillotomy is associated with less pain, less bleeding, and less strain. Active return to the community is possible after up to a week compared to the 3 weeks typical of tonsillectomy, all of which can have significant socioeconomic benefits. Orv Hetil. 2020; 161(45): 1920-1926.
Assuntos
Tonsilectomia , Criança , Humanos , Dor Pós-Operatória , Hemorragia Pós-Operatória , Estudos Prospectivos , Estudos RetrospectivosRESUMO
INTRODUCTION: The authors report about the efficacy of inserted tympanostomy tube in children with serous otitis media. AIM: The aim of the authors was to assess the status of eardrum, the function of Eustachian tube and hearing level 10 years after the use of tympanostomy tube. METHOD: Patients filled out a questionnaire and microscopic examination of tympanic membrane, tympanometry, Eustachian tube function examination, and audiometry tests were performed. RESULTS: In the period of 2003-2004, ventilation tube insertion was performed in 711 patients in the ENT Department of Pediatric Health Center of University of Szeged. In 349 patients adenotomy and tympanostomy tube insertion, in 18 cases tonsillectomy and grommet insertion and in 344 patients only typmanostomy tube insertion were performed. Due to objective difficulties (address change, no phone number) 453 patients were asked for control test and 312 persons accepted the invitation. Normal hearing level was found in 84.6% of patients and normal tympanometry result occurred in 82%. Tympanic ventilation disorder, perforation of tympanic membrane, sensorineural hearing loss and sensorineural hearing loss due to noise exposure were diagnosed. CONCLUSIONS: Application of tympanostomy tube is effective in the treatment of serous otitis media resulting from ventilation disorder. The authors draw attention to the importance of tympanometry examination to prevent the adhesive processes and cholesteatoma in chronic ventilation disorder of the middle ear.
Assuntos
Testes de Impedância Acústica , Audição , Ventilação da Orelha Média , Otite Média com Derrame/fisiopatologia , Otite Média com Derrame/cirurgia , Adolescente , Audiometria , Criança , Pré-Escolar , Feminino , Seguimentos , Perda Auditiva Provocada por Ruído/diagnóstico , Perda Auditiva Neurossensorial , Humanos , Masculino , Ventilação da Orelha Média/efeitos adversos , Otite Média com Derrame/complicações , Autorrelato , Índice de Gravidade de Doença , Tonsilectomia , Resultado do TratamentoRESUMO
Bacterial cultures from nasopharyngeal swabs of children after adenoidectomy and from the removed adenoid tissue in the same patient group were compared. At the same time, the colony-forming unit, as a measure of viable bacterial cells and the composition of isolated bacteria were also determined in the case of adenoid tissue. Our findings showed that the culture results of nasopharyngeal swabs and inner part of the adenoid tissue are in close correlation. Polymicrobial aerobic-anaerobic flora was present in all instances. The predominant aerobic isolates in all two groups were S. pneumoniae, H. influenzae and M. catarrhalis. Anaerobic bacteria most commonly recovered in the adenoid were Peptostreptococcus spp., Prevotella spp., and Fusobacterium spp.
