Validity of the modified-Distraction-Short-Scale and Verbal-Numeric-Anxiety-Fear-Rating-Scale for children in a preoperative setting.

BACKGROUND: The perioperative period can be stressful for children and families. Minimizing child distress and investigating the quality of anesthetic care is important. There is a paucity of assessment tools available to assess perioperative anxiety in children. AIM: To determine the validity and reliability of the modified-Distraction-Short-Scale and the Verbal-Numeric-Anxiety-Fear-Rating-Scale in a perioperative setting for children. METHODS: Children (n = 189, 3-12 years old) scheduled for ear, nose, and throat surgery had their anxiety rated at induction by a registered nurse anesthetist. Two observers individually evaluated video recordings of the perioperative period. The Verbal-Numeric-Anxiety-Fear-Rating-Scale was used to assess the children's preoperative anxiety and fear, and the modified-Distraction-Short-Scale was used to evaluate coping behavior. The modified-Yale-Preoperative-Anxiety-Scale was used to measure preoperative anxiety and behavioral compliance during anesthesia induction. RESULTS: Interrater reliability showed excellent agreement between observers on modified-Distraction-Short-Scale scores (weighted kappa (Kw ) = 0.91) and Verbal-Numeric-Anxiety-Fear-Rating-Scale (Kw = 0.84). The agreements between the registered nurse anesthetist and observers were moderately good for modified-Distraction-Short-Scale (Kw = 0.65-0.80) and Verbal-Numeric-Anxiety-Fear-Rating-Scale scores (Kw = 0.65-0.75). The intraclass correlation coefficient (ICC) for the registered nurse anesthetist and two observers was excellent for modified-Distraction-Short-Scale scores (ICC = 0.96) and Verbal-Numeric-Anxiety-Fear-Rating-Scale (ICC = 0.90). Regarding concurrent validity, modified-Distraction-Short-Scale and Verbal-Numeric-Anxiety-Fear-Rating-Scale scores were strongly correlated among all three observers (Spearman's correlation coefficient [rs ] = 0.75-0.82). The modified-Yale-Preoperative-Anxiety-Scale scores were moderately correlated with modified-Distraction-Short-Scale (rs = 0.57-0.66) and Verbal-Numeric-Anxiety-Fear-Rating-Scale scores (rs = 0.54-0.67). Construct validity was tested by using age as a discriminating variable, and Verbal-Numeric-Anxiety-Fear-Rating-Scale, modified-Distraction-Short-Scale, and modified-Yale-Preoperative-Anxiety-Scale scores were lower for the older age group; however, only modified-Distraction-Short-Scale (Observer 1: p = .035, Observer 2: p = .022), and modified-Yale-Preoperative-Anxiety-Scale scores were significantly lower (p < .001). CONCLUSION: The modified-Distraction-Short-Scale and the Verbal-Numeric-Anxiety-Fear-Rating-Scale are simple and valid tools for assessing children's perioperative anxiety or fear and evaluating coping behavior. These results suggest that both scales are useful tools for routine clinical practice and research.

On a healing journey together and apart: A Swedish critical incident technique study on family involvement from a patient perspective in relation to elective open-heart surgery.

BACKGROUND: As family members affect patient outcomes following open-heart surgery, the objective was to provide updated knowledge on family involvement in to guide future interventions facilitating family involvement. AIM: The aim was to explore and describe the experiences and actions of important situations of family involvement asexpressed by patients who underwent elective open-heart surgery in Sweden. METHODOLOGICAL DESIGN AND JUSTIFICATION: The critical incident technique (CIT) was used, which is a qualitative research method suitable for clinical problems when a phenomenon is known but the experiences and consequences of it are not. ETHICAL ISSUES AND APPROVAL: Considerations for patient integrity were made during the recruitment phase by ensuring that voluntary informed consent was obtained in two steps. RESEARCH METHODS: Individual interviews were conducted with 35 patients who underwent open-heart surgery in Sweden in 2023. Important situations were analysed according to the CIT method. RESULTS: Two main areas emerged: Patients described important situations of family involvement as experiences of mutual dependency while also being independent individuals. These experiences led to balancing healing and risk-taking activities as a family. The positive consequences of family involvement described by patients included improved recovery through practical help at home and emotional support. CONCLUSIONS: As complements to preserving the existing positive aspects of family involvement, social support screening, the establishment of individualised visitation policies and the provision of professional and peer support earlier can improve patient recovery following open-heart surgery.

Postoperative pain, pain management, and recovery at home after pediatric tonsil surgery.

PURPOSE: To explore the severity and duration of postoperative pain, the management of analgesics, and postoperative recovery in children undergoing tonsil surgery. METHOD: Participants included 299 children aged 4-17 years undergoing tonsillotomy ± adenoidectomy (TT ± A) or tonsillectomy ± adenoidectomy (TE ± A). Data were collected up to 12 days. The child rated pain on the Face Pain Scale-Revised (FPS-R) and recovery using the Postoperative Recovery in Children (PRiC) questionnaire. Caregivers assessed their child's pain, anxiety, and nausea on a numeric analog scale and kept a log of analgesic administration. RESULTS: High pain levels (FPS-R ≥ 4) were reported in all surgical and age groups (TT ± A age 4-11, TE ± A age 4-11, TE ± A age 12-17), but there were variations in pain intensity and duration within and between groups. The TE ± A group scored more days with moderate to very excruciating pain and lower recovery than the TT ± A group, with the worst outcomes reported by older TE ± A children. The majority of the children used paracetamol + COX-inhibitors at home, but regular administration of analgesics was lacking, particularly during late evening and at night. Few were received rescue medication (opioid or clonidine) despite severe pain. Physical symptoms and daily life activities were affected during the recovery period. There was moderate agreement between child and the caregiver's pain assessment scores. CONCLUSION: Children reported a troublesome recovery with significant postoperative pain, particularly older children undergoing tonsillectomy. Pain treatment at home was suboptimal and lacked regular analgesic administration. Patient information needs to be improved regarding the importance of regular administration of analgesics and rescue medication.

Positive effect on patient experience of video information given prior to cardiovascular magnetic resonance imaging: A clinical trial.

AIMS AND OBJECTIVES: To evaluate the effect of video information given before cardiovascular magnetic resonance imaging on patient anxiety and to compare patient experiences of cardiovascular magnetic resonance imaging versus myocardial perfusion scintigraphy. To evaluate whether additional information has an impact on motion artefacts. BACKGROUND: Cardiovascular magnetic resonance imaging and myocardial perfusion scintigraphy are technically advanced methods for the evaluation of heart diseases. Although cardiovascular magnetic resonance imaging is considered to be painless, patients may experience anxiety due to the closed environment. DESIGN: A prospective randomised intervention study, not registered. METHODS: The sample (n = 148) consisted of 97 patients referred for cardiovascular magnetic resonance imaging, randomised to receive either video information in addition to standard text-information (CMR-video/n = 49) or standard text-information alone (CMR-standard/n = 48). A third group undergoing myocardial perfusion scintigraphy (n = 51) was compared with the cardiovascular magnetic resonance imaging-standard group. Anxiety was evaluated before, immediately after the procedure and 1 week later. Five questionnaires were used: Cardiac Anxiety Questionnaire, State-Trait Anxiety Inventory, Hospital Anxiety and Depression scale, MRI Fear Survey Schedule and the MRI-Anxiety Questionnaire. Motion artefacts were evaluated by three observers, blinded to the information given. Data were collected between April 2015-April 2016. The study followed the CONSORT guidelines. RESULT: The CMR-video group scored lower (better) than the cardiovascular magnetic resonance imaging-standard group in the factor Relaxation (p = .039) but not in the factor Anxiety. Anxiety levels were lower during scintigraphic examinations compared to the CMR-standard group (p < .001). No difference was found regarding motion artefacts between CMR-video and CMR-standard. CONCLUSION: Patient ability to relax during cardiovascular magnetic resonance imaging increased by adding video information prior the exam, which is important in relation to perceived quality in nursing. No effect was seen on motion artefacts. RELEVANCE TO CLINICAL PRACTICE: Video information prior to examinations can be an easy and time effective method to help patients cooperate in imaging procedures.

Patient reported pain-related outcome measures after tonsil surgery: an analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009-2016.

The objective of this study was to describe factors affecting pain after pediatric tonsil surgery, using patient reported pain-related outcome measures (pain-PROMs) from the National Tonsil Surgery Register in Sweden. In total, 32,225 tonsil surgeries on children (1 to <18 years) during 2009-2016 were included; 13,904 tonsillectomies with or without adenoidectomy (TE ± A), and 18,321 tonsillotomies with or without adenoidectomy (TT ± A). Adjustments were made for variables included in the register to compensate for contributable factors in the analysis. When compared to TE ± A for surgical indication obstruction, TT ± A resulted in lower pain-PROMs, shorter use of postoperative analgesics, earlier return to regular food intake, and lower risk for contact with health care services due to pain. Children who underwent TE ± A because of obstruction problems stopped taking painkillers and returned to normal eating habits sooner, compared to children who underwent TE ± A for infectious indications. In both indication groups, TE ± A performed with hot rather than cold technique (dissection and haemostasis) generally resulted in higher pain-PROMs. Older children reported more days on analgesics and a later return to regular food intake after TE ± A than younger ones. No clinically relevant difference between sexes was found. Between 2012 and 2016 (pre-and post-implementation of Swedish national guidelines for pain treatment), the mean duration of postoperative analgesic use had increased. In conclusion, TE ± A caused considerably higher ratings of pain-related outcome measures, compared to TT ± A. For TE ± A, cold surgical techniques (dissection and haemostasis) were superior to hot techniques in terms of pain-PROMs. Older children reported higher pain-PROMs after TE ± A than younger ones.

Risk of reoperation after tonsillotomy versus tonsillectomy: a population-based cohort study.

Tonsil surgery to address upper airway obstruction in children can be performed either as a tonsillectomy (TE) or as a tonsillotomy/intracapsular/partial tonsillectomy (TT). The advantage of TT is a decreased risk of postoperative morbidity. The disadvantage is the risk of tonsil regrowth with recurrence of symptoms and/or problems with future tonsil infections, which may demand a reoperation of the tonsils. The aim of this study is to compare the risk of reoperation of the tonsils following TE and TT in children with tonsil-related upper airway obstruction. This is a retrospective register-based cohort study of the Swedish National Patient Register. All children aged 1-12 years who underwent TE or TT from 2007 to 2012 for the main indication of upper airway obstruction were included in the study. The unique Personal Identity numbers were used to follow patients over time in the register and identify additional tonsil surgery. A total of 27,535 patients were included in the study, contributing 76,054 person-years of follow-up. A total of 684 patients (2.5 %) underwent a second tonsil surgery during follow-up. The incidences of reoperation were 1.94 per 1000 person-years in the TE group and 16.34 per 1000 person-years in the TT group. The risk for reoperation was seven times higher (HR 7.16) after TT compared to TE. Younger age was significantly associated with reoperation for both TE and TT and the difference in risk between TE and TT gradually decreased with time. The most common indication for reoperation after both TE and TT was "Upper airway obstruction".

Development and validation of a questionnaire evaluating patient anxiety during Magnetic Resonance Imaging: the Magnetic Resonance Imaging-Anxiety Questionnaire (MRI-AQ).

AIM: To develop and validate a new instrument measuring patient anxiety during Magnetic Resonance Imaging examinations, Magnetic Resonance Imaging- Anxiety Questionnaire. BACKGROUND: Questionnaires measuring patients' anxiety during Magnetic Resonance Imaging examinations have been the same as used in a wide range of conditions. To learn about patients' experience during examination and to evaluate interventions, a specific questionnaire measuring patient anxiety during Magnetic Resonance Imaging is needed. DESIGN: Psychometric cross-sectional study with test-retest design. METHODS: A new questionnaire, Magnetic Resonance Imaging-Anxiety Questionnaire, was designed from patient expressions of anxiety in Magnetic Resonance Imaging-scanners. The sample was recruited between October 2012-October 2014. Factor structure was evaluated with exploratory factor analysis and internal consistency with Cronbach's alpha. Criterion-related validity, known-group validity and test-retest was calculated. RESULTS: Patients referred for Magnetic Resonance Imaging of either the spine or the heart, were invited to participate. The development and validation of Magnetic Resonance Imaging-Anxiety Questionnaire resulted in 15 items consisting of two factors. Cronbach's alpha was found to be high. Magnetic Resonance Imaging-Anxiety Questionnaire correlated higher with instruments measuring anxiety than with depression scales. Known-group validity demonstrated a higher level of anxiety for patients undergoing Magnetic Resonance Imaging scan of the heart than for those examining the spine. Test-retest reliability demonstrated acceptable level for the scale. CONCLUSION: Magnetic Resonance Imaging-Anxiety Questionnaire bridges a gap among existing questionnaires, making it a simple and useful tool for measuring patient anxiety during Magnetic Resonance Imaging examinations.

Mortality after tonsil surgery, a population study, covering eight years and 82,527 operations in Sweden.

The objective of this retrospective cohort study was to evaluate mortality rate and cause of death after tonsil surgery in Sweden. Two national registries were used, both run by The Swedish National Board of Health and Welfare, an agency of the Ministry of Health and Social Affairs. In the National Patient register all tonsil surgeries performed in Sweden from 2004 through 2011 were identified. The result from this search was matched with the National Cause of Death Register to identify all deaths that occurred within 30 days of tonsil surgery. Personal identity numbers were used to do the matching of registers. Details on the cause of death were obtained from the Swedish National Board of Health and Welfare. Two deaths were identified in 82,527 operations. Both patients were male, otherwise healthy, children under the age of five, operated due to tonsil-related upper airway obstruction/snoring with coblation technique. Cause of death was bleeding-related airway obstruction in both cases and hemodynamic failure caused by blood loss. Both deaths occurred after discharge from the hospital within the first postoperative week. No abnormal levels of analgesics were found in the postmortal investigations. Two deaths related to tonsil surgery (performed on benign indications) were identified in 82,527 operations (2004-2011) in a well-defined national population. Both deaths were due to postoperative bleeding. Based on our findings, the frequency of post-tonsil-surgery mortality in Sweden was 1/41,263, 2004-2011. Level of evidence 2b retrospective cohort study.

Radiofrequency tonsillotomy in Sweden 2009-2012.

The Swedish National Registry for Tonsil Surgery has been operational since 1997. All ENT clinics in Sweden are encouraged to submit data for all patients scheduled for tonsil surgery. Preoperatively, age, gender and indication are recorded. Postoperatively, method (tonsillectomy or tonsillotomy), technique, and perioperative complications are recorded. Postoperative bleedings, pain, infections, and symptom relief are assessed through questionnaires. An earlier report from this registry showed that tonsillotomy had become more common than tonsillectomy in children with tonsil-related upper airway obstruction. The aim of this study was to categorize which instruments were used for tonsillotomy in Sweden and to compare their outcome and complication rate. All children 2-18 years, reported to the registry from March 2009 until September 2012, who underwent tonsillotomy on the indication upper airway obstruction, were included in the study. 1,676 patients were identified. In 1,602 cases (96%), a radiofrequency instrument was used. The postoperative bleeding rate was low (1.2%) and the degree of symptom relief was high (95.1%). Three different radiofrequency instruments (ArthroCare Coblation(®), Ellman Surgitron(®), and Sutter CURIS(®)) were used in 96% of the patients. There were no significant differences in the number of postoperative bleedings, postoperative infections or symptom relief between the instruments. The only difference found was in the number of days on analgesics, where more days were registered after use of Coblation(®). In Sweden, radiofrequency tonsillotomy is the dominant surgical technique used for tonsil hypertrophy causing upper airway obstruction in children. There are no significant differences in outcome between the different radiofrequency instruments except for number of days on analgesics after surgery.

Tonsillotomy versus tonsillectomy--a randomized trial regarding dentofacial morphology and post-operative growth in children with tonsillar hypertrophy.

OBJECTIVES: The primary aim of this study was to analyse two different methods of tonsil surgery, tonsillectomy (TE) and tonsillotomy (TT), regarding post-operative dentofacial growth in children with tonsillar hypertrophy. A secondary aim was to analyse these results in relation to cephalometric standards. MATERIAL AND METHODS: The study group consisted of 64 subjects (39 boys and 25 girls), mean age 4.8 years ± 4 months. They were randomized to a complete removal of the pharyngeal tonsil, TE, (n = 31) or a partial removal, TT, (n = 33). Pre-operative and 2 years post-operative study material were obtained and analysed. The results were compared with cephalometric standards. RESULTS: Pre-operative, children with hypertrophic tonsils displayed an increased vertical relation (P < 0.05) compared with cephalometric standards. Post-operative, no significant difference could be detected between the two surgical procedures regarding dentofacial growth. Mandibular growth with an anterior inclination was significant (P < 0.001/TE, P < 0.01/TT) for both groups. An increased upper and lower incisor inclination was noted (P < 0.01/TE,TT). The vertical relation decreased (P < 0.001/TE, P < 0.05/TT) as well as the mandibular angle (P < 0.01/TE, P < 0.001/TT). Reduction was also significant for the sagittal intermaxillar (P < 0.001/TE,TT) relation. These post-operative results, together with a more prognatic mandible (P < 0.05/TE,TT) and chin (P < 0.001/TE, P < 0.01/TT), might indicate a more horizontal direction of mandibular growth. CONCLUSION: TE and TT yielded equal post-operative dentofacial growth in children treated for hypertrophic tonsils. This result should be considered when deciding upon surgical technique.

Pain management after tonsil surgery in children and adults-A national survey related to pain outcome measures from the Swedish Quality Register for tonsil surgery.

OBJECTIVE: The primary aim of this study was to describe the current practice regarding pain management in relation to tonsil surgery among Ear Nose and Throat (ENT) clinics in Sweden. The secondary aim was to determine the impact of the provider's regime of rescue analgesics on the pain related Patient Reported Outcome Measures (pain-PROMs) from the Swedish Quality Register for Tonsil Surgery (SQTS). MATERIALS & METHODS: A descriptive cross-sectional study originating from a validated web-based questionnaire. The survey enrolled one respondent from each ENT clinic (47/48 participated) nationally. Pain-PROMs from the SQTS, recorded from October 2019 to October 2022, were included (8163 tonsil surgeries). RESULTS: Paracetamol was used by all enrolled ENT clinics as preemptive analgesia. The addition of COX inhibitors was used in 40% of the clinics. Betamethasone was usually administered, to prevent pain and nausea (92%). All clinics gave postdischarge instructions on multimodal analgesia with COX inhibitors and paracetamol. Rescue analgesics were prescribed after tonsillectomy for 77% of adults, 62% of older children, 43% of young children and less often after tonsillotomy. The most frequently prescribed rescue analgesic was clonidine in children (55%) and oxycodone in adults (72%). A high proportion of patients reported contact with health care services due to postoperative pain (pain-PROMs/ SQTS). Tonsillectomy procedures were associated with the highest rates of contacts (children/adolescents 13-15%; adults 26%), while tonsillotomy were associated with lower rates, (5-7% of children/adolescents). There was no significant difference in the frequency of health care contacts due to pain regarding whether clinics routinely prescribed rescue analgesics or not after tonsillectomy. CONCLUSION: The Swedish analgesic regimen after tonsil surgery is good overall. Nevertheless, there is a need for increased awareness and knowledge to achieve optimal patient recovery. Pain-PROM data demonstrate the call for improvement in pain management after tonsil surgery.

Paradigm shift in Sweden from tonsillectomy to tonsillotomy for children with upper airway obstructive symptoms due to tonsillar hypertrophy.

Tonsillotomy (TT) is now used more often than tonsillectomy (TE) for tonsil obstructive symptoms in Sweden. Both TE and TT give high patient satisfaction although TT results in fewer postoperative bleedings and shorter time when analgesics are needed. The objective of this study is to analyze the current prevalence of different tonsil surgery procedures, the rates of early and late bleeding and other complications. Data from the National Tonsil Surgery Register in Sweden were analyzed. Patients 1-15 years operated for symptoms due to tonsil hypertrophy were included. Surgical procedure, technique and bleedings during hospital stay were registered. Thirty days after surgery, unplanned contacts due to bleeding, infection or pain were reported as were symptom relief after 6 months. 24,083 patients were registered. Of the 10,826 children 1-15 years operated for obstructive symptoms, 64 % were TT or TT+A, and 34 % TE, TE+A. 69 % answered the 30-day questionnaire and 50 % the 6 months. Bleeding in hospital occurred in 1.38 %, late bleedings in 2.06 %: 3.7 % after TE+A, 0.8 % after TT+A. Differences in readmissions due to bleeding, number of days using analgesics, health care contacts due to pain and nosocomial infections were significant between TT and TE, but not differences with regard to symptom relief after 6 months.

Factors influencing the indication for tonsillectomy: a historical overview and current concepts.

Tonsil surgery has been performed for more than 3,000 years. During the 19th century when anesthesia became available, techniques were refined and the number of procedures performed increased. Repeated throat infections often causing big tonsils was the reason why parents asked for the procedure. During the preantibiotic era, scarlet fever was feared since potential heart or kidney complications were life-threatening. The technique used before 1900 was tonsillotomy since neither a fingernail, snare nor the later 'guillotine' were used extracapsularly. Bleeding was small and the surgery ambulatory. Extracapsular tonsillectomy developed around the turn of the 20th century with the purpose of avoiding remnants - the 'focal infection theory' was prevailing. The whole tonsil was now extirpated with good visibility of the tonsillar area in a deeply anesthetized patient. During the first half of the 20th century, the two methods competed, but by 1950, total tonsillectomy had become the only 'correct' tonsil surgery. The indication was still recurrent infections. The risk for serious bleeding increased; therefore large clinics arose where patients remained for at least a week after tonsillectomy. When oral penicillin for children became available during the 1960s, the threat of throat infection decreased and the number of tonsillectomies declined. The awareness of obstructive problems in children rose at the same time when obstructive sleep apnea syndrome became a disease for adults (1970s). Tonsillotomy was revived during the 1990s and is today used increasingly in many countries. The indication is mainly obstructive sleep apnea syndromeor sleep-disordered breathing, especially in small children. Total tonsillectomy is still preferred for recurrent infections, which include periodic fever/adenitis/pharyngitis/aphthous ulcer syndrome and recurrent peritonsillitis.

The Family Involvement in Care Questionnaire-An instrument measuring family involvement in inpatient care.

BACKGROUND: Family involvement in care can be seen as a prerequisite for high-quality family-centered care. It has been identified to improve both patient safety and the quality of care by reducing patient complications and hospital length of stay. OBJECTIVE: To develop and evaluate the content validity of a questionnaire measuring family involvement in inpatient care. METHODS: The study followed a systematic approach in building a rigorous questionnaire: identification of domain, item generation, and assessment of content validity. The content validity index was calculated based on ratings of item relevance by an expert group consisting of seven senior nurses. Subsequently, 19 online cognitive interviews using the Think-aloud method were conducted with family members of former patients who had undergone open-heart surgery. RESULTS: Five aspects of family involvement were identified, and the initial pool of items were selected from two preexisting questionnaires. The experts' ratings resulted in item content validity of 0.71-1.00, and the scale content validity/averaging was 0.90, leading to rewording, exclusion, and addition of items. The pretesting of items through two rounds of cognitive interviews with family members resulted in the identification of three main problem areas: defining family involvement, misinterpretation of different terms, and underuse of the not relevant response option. The problems were adjusted in the final version of the questionnaire, which consists of 16 items with a four-point Likert scale and two open-ended items. CONCLUSIONS: The Family Involvement in Care Questionnaire has demonstrated potential in evaluating family involvement in inpatient care. Further psychometric properties regarding reliability and validity need to be established.

The symphony of open-heart surgical care: A mixed-methods study about interprofessional attitudes towards family involvement.

PURPOSE: The overall aim of this study was to describe the attitudes towards family involvement in care held by nurses and medical doctors working in open-heart surgical care and the factors influencing these attitudes. METHODS: Mixed-methods convergent parallel design. A web-based survey was completed by nurses (n = 267) using the Families' Importance in Nursing Care-Nurses Attitudes (FINC-NA) instrument and two open-ended questions, generating one quantitative and one qualitative dataset. Qualitative interviews with medical doctors (n = 20) were conducted in parallel, generating another qualitative dataset. Data were analysed separately according to each paradigm and then merged into mixed-methods concepts. Meta-inferences of these concepts were discussed. RESULTS: The nurses reported positive attitudes in general. The two qualitative datasets from nurses and medical doctors resulted in the identification of seven generic categories. The main mixed-methods finding was the attitude that the importance of family involvement in care depends on the situation. CONCLUSIONS: The dependence of family involvement on the situation may be due to the patient's and family's unique needs. If professionals' attitudes rather than the family's needs and preferences determine how the family is involved, care runs the risk of being unequal.

Health-related quality of life after tonsillotomy versus tonsillectomy in young adults: 6 years postsurgery follow-up.

The indication for tonsil surgery is tonsillitis or obstructive symptoms due to tonsillar hypertrophy, associated with morbidity affecting health related quality of life (HRQL). Surgery performed is either tonsillectomy (TE) or partial intra capsular tonsillectomy/tonsillotomy (TT). TT is associated with fewer postoperative complications and rapid recovery, but with risk for regrowth of tonsillar tissue and return of sleep disordered breathing (SDB) or infections. The aim of this study was to investigate the long-term effects of TT and TE in young adults relating to HRQL and well-being as consequence of obstructive symptoms or ENT-infections after 6 years versus effect after 1 year. Young adults with symptoms of tonsillar hyperplasia were randomized to TE (44) or TT (32). Patients were assessed prior to surgery and 1 and 6 years postoperatively. Short Form 36 and the EuroQul Visual Analog Scale evaluated HRQL. Questionnaire was used to explore well-being, obstruction symptoms and infections. Patient BMI was calculated. Six years after surgery, 91 % of young adults (TE39/TT29) reported persisting benefits in well-being, reduced obstructive problems and fewer infections. Some patients in both groups reported a slight increase in snoring compared to 1 year after surgery, but still less than before surgery. Obesity was more frequent among those snoring. Both TT and TE in young adults yielded HRQL improvements and reduction in symptoms defining SDB persisting through 6 years postsurgery. Results indicated that both surgical methods were equally effective. Findings favor choice of TT due to lesser postoperative morbidity.

Establishment of resilience in a challenging recovery at home after pediatric tonsil surgery-Children's and caregivers' perspectives.

The objective of this study was to explore children's and caregivers' experiences and management of postoperative recovery at home after tonsil surgery. The study had an explorative qualitative design with an inductive approach. Twenty children (5-12 years of age) undergoing tonsillectomy or tonsillotomy with or without adenoidectomy participated along with their caregivers in semi-structured interviews at a mean time of 28 days after surgery. The interviews were analyzed with content analysis. One main category emerged from the interviews: children and caregivers struggle to establish resilience in a challenging recovery. The families' resilience relied on their situational awareness and capacity to act, which in turn formed a basis for the ability to return to normal daily life. Children and caregivers described the recovery as an evident interruption of daily life which had an impact on the children's physical and psychological well-being. Both children and caregivers described the pain as a central concern. The families used different pharmacological and complementary strategies to manage the pain, which in some cases were complex. Some families said that the analgesics were insufficient in preventing breakthrough pain, and spoke about a lack of support as well as inadequate and contradictory information from healthcare staff. Caregivers also expressed uncertainty, ambivalence, or anxiety about the responsibility associated with their child's recovery. To optimize and support the recovery after tonsil surgery, it is crucial to obtain knowledge of children's and caregivers' perspectives of postoperative recovery at home. The results indicate that the postoperative period included several troublesome experiences for which neither the children nor the caregivers were informed or prepared. The experience of pain was significant, and often complex to manage. To increase families' resilience, the information provided by healthcare professionals needs to be broadened. Multidisciplinary teamwork is necessary to achieve this goal.

Phonological development in children with obstructive sleep-disordered breathing.

Adeno-tonsillar hypertrophy with obstructive sleep disordered breathing (OSDB) is known to affect oral-motor function, behaviour, and academic performance. Adeno-tonsillectomy is the most frequently performed operation in children, with total tonsillectomy (TE) being more common than partial resection, 'tonsillotomy' (TT). In the present study 67 children, aged 50-65 months, with OSBD were randomized to TE or TT. The children's phonology was assessed pre-operatively and 6 months post-operatively. Two groups of children served as controls. Phonology was affected in 62.7% of OSBD children before surgery, compared to 34% in the control group (p < .001). Also, OSBD children had more severe phonological deficits than the controls (p < .001). Phonology improved 6 months equally after both surgeries. Despite improvement post-operatively, the gap to the controls increased. Other functional aspects, such as oral motor function, were normalized regardless of surgical method--TE or TT. The impact of OSBD should be considered as one contributing factor in phonological impairment.

Psychometric evaluation of the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery and postoperative behavior and recovery in children undergoing tonsil surgery.

The study comprised a prospective, comparative cross-sectional survey in 143 (of 390) children undergoing tonsil surgery. Parents answered the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS), and children answered the questionnaire Postoperative Recovery in Children (PRiC). The PHBQ-AS had positive correlation with the PRiC and with general health. On day 10 after surgery, up to one-third of the children still reported physical symptoms (PRiC). No gender or age differences concerning the items of behavior (PHBQ-AS) were found. The quality of postoperative recovery (PRiC) in girls was lower, with higher levels of nausea, dizziness, coldness, and headache compared to the boys. Children <6 years of age reported higher levels of dizziness and lower sleep quality and lower general health.