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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 1  |  Issue : 1  |  Page : 6-8

Adenotonsillar surgeries in Kaduna, Nigeria


1 National Ear Care Center, Kaduna, Nigeria
2 Department of Clinical Services, National Ear Care Center, Kaduna, Nigeria

Date of Web Publication8-Nov-2017

Correspondence Address:
Abdullahi Musa Kirfi
Department of Clinical Services, National Ear Care Center, Kaduna
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aiao.aiao_1_17

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  Abstract 


Background: Adenotonsillar surgeries are the most common otolaryngology procedures in the pediatric age group worldwide. Aims: The aim is to evaluate the prevalence, indications, complications, and postoperative symptoms resolution after adenotonsillectomy in pediatric patients in our center. Settings and Design: A retrospective study was conducted in a tertiary health facility in Kaduna, Nigeria. Methodology: The medical records of all children that had surgical procedures from January 2009 to December 2012 were extracted. A total of 232 pediatric patients had adenotonsillectomy of a total of 312 who underwent surgical procedures over 4 years. Forty-eight patients did not meet criteria for inclusion in this study. Therefore, 184 patients satisfied the inclusion criteria for this study. Data were analyzed descriptively with Statistical Package for Social Sciences version 16. Results: The mean age at the time of surgery was 3.5 ± 2.43 years. There were 102 males and 82 females in a ratio of 1:0.8. The main indications were obstructive, pharyngeal, and otologic symptoms. The duration of follow-up after adenotonsillectomy range from 4 weeks to 6 months, 177 (96.19%) had complete resolution of symptoms after surgery, 7 (3.80%) had an additional treatment for rhinosinusitis. Four patients had immediate mild postoperative bleeding (reactionary hemorrhage). No deaths were recorded within the period under review. Conclusions: Adenotonsillar surgeries are common otolaryngology procedures in our hospital, mainly done on account of obstructive symptoms. They are rewarding procedures in terms of symptoms resolution and safety.

Keywords: Adenotonsillar surgeries, Kaduna, pediatrics, symptoms resolution


How to cite this article:
Samdi MT, Emmanuel M, Kirfi AM. Adenotonsillar surgeries in Kaduna, Nigeria. Ann Indian Acad Otorhinolaryngol Head Neck Surg 2017;1:6-8

How to cite this URL:
Samdi MT, Emmanuel M, Kirfi AM. Adenotonsillar surgeries in Kaduna, Nigeria. Ann Indian Acad Otorhinolaryngol Head Neck Surg [serial online] 2017 [cited 2019 Mar 23];1:6-8. Available from: http://www.aiaohns.in/text.asp?2017/1/1/6/217837




  Introduction Top


Adenotonsillar disease (adenoiditis and recurrent tonsillitis) is a prevalent otorhinolaryngology disorder resulting from chronic inflammation triggered by a persistent bacterial infection. These bacteria, mostly Staphylococcus aureus, Haemophilus spp., and Streptococcus spp., persist predominantly intracellular and within mucosal biofilms.[1] The recurrent or chronic inflammation of the adenoids and the palatine tonsils leads to chronic activation of the cell-mediated and humoral immune responses, resulting in hypertrophy of the adenotonsillar tissues. This hypertrophic tissue is the cause for the prominent clinical symptoms obstruction of the upper airways, snoring, and sleep apnea for adenoiditis, or a sore throat, dysphagia, and halitosis for recurrent tonsillitis.[1]

Surgery is a standard option for failed medical treatment and usually leads to significant resolution of symptoms. However, obstructive adenotonsillar hypertrophy remains an important problem to be solved to achieve total parental satisfaction in adenotonsillar operations.[2]

The aim of this study was to evaluate the prevalence, indications, and effectiveness of adenotonsillar surgeries among children managed at a tertiary health facility in Kaduna, Nigeria.


  Methodology Top


This was a retrospective cohort study of children who had adenotonsillar surgeries at a tertiary otorhinolaryngology hospital in Kaduna, Nigeria. Ethical clearance was obtained from the study center's Health Research Ethics Committee. Two hundred and thirty-two children had adenotonsillar surgeries of a total of 312 children who had various surgical procedures done from 2009 to 2012.

Inclusion criteria

All pediatric patients <12 years of age who had adenotonsillar surgeries and had at least 4 weeks for follow-up postoperatively.

Exclusion criteria

All pediatric patients <12 years of age who had adenotonsillar surgeries and had defaulted from follow-ups, or had <4 weeks follow-up postoperatively. One hundred and eighty-four children age ranges 9 months to 12 years met the inclusion criteria and were selected for the study, whereas 48 patients were excluded from the study.

The medical records of the patients were reviewed and data on age, sex, presenting symptom(s), duration of the symptom(s), indications, type of surgery, postoperative relief of symptoms 4 weeks or more after surgery as well as complications developed were extracted. All surgeries were performed using the same technique (curettage and dissection) by resident doctors mainly under the supervision of consultant ear, nose, and throat (ENT) surgeons. The data collected were analyzed using Statistical Package for Social Sciences (version 16, IBM, Chicago, Ilinois, USA). Simple descriptive statistics was used for the analysis.


  Results Top


One hundred and eighty-four patients fulfilled the inclusion criteria and were studied. Their age ranged from 9 months to 12 years, the mean age at the time of surgery was 3.5 ± 2.43 years. There were 102 males and 82 females in a ratio of 1:0.8. The main indications were for the relief of obstructive, pharyngeal, and otologic symptoms.

From [Table 1], the average age group with the highest number of cases of adenotonsillectomy were between ages 2 and 5 years. While the type of surgery showed 91 (49.5%) had adenotonsillectomy compared to adenoidectomy 48 (26.1%) or tonsillectomy 45 (24.5%) alone.
Table 1: Distribution of age of patients and types of surgeries performed

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The most common preoperative symptoms occurred as combinations rather than in isolation. Obstructive symptoms such as snoring, mouth breathing and sleep apnea, rhinorrhea and noisy breathing showed up 95.2% improvement which is significant postoperatively, as shown in [Table 2].
Table 2: Distribution of adenotonsillar symptoms in the preoperative and postoperative periods

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Hearing loss from middle ear effusion which sometimes is the primary indication for adenoidectomy showed up to 55.6% improvement. Patients with symptoms of a sore throat had about 79.9% improvement in their symptoms compared to 20.1% who reported persistence of a sore throat postoperatively.


  Discussion Top


The overall prevalence of adenotonsillar procedures in pediatric otorhinolaryngology surgeries of the study center stands at 232 (74.4%). Four years review of 184 children who met the inclusion criteria showed 102 males and 82 female in the ratio of 1:0.8. A study conducted in Ilorin Nigeria by Afolabi et al.,[2] reported the male-female ratio of 3:1.2. This difference in age may be due to the smaller sample size used by the authors.

All patients were within the age range of <1 year 2 (2.72%) to 12 years. High prevalence of surgery in the cohort studied was noted among age 2–5 years (52.7%). Age has also been shown in a study by Brigance et al.,[3] not to contraindicate surgery in children provided there are obstructive symptoms.[3] A study by Price et al.[4] of 160 cases also reported more surgeries in 2,3 and 4 years of age which is similar to our findings.[4] This is similar to our study. This finding is similar to a study in Nigeria by Afolabi et al.[2] and in the United States by Weatherly et al.[2],[5] Bluestone,[6] reported that children who snore do sleep poorly and suffer from daytime fatigue or irritability without documented occurrence of apnea. Similarly, children who eat poorly due to their enlarged adenoid and tonsils may have a hot potato voice.[6] Unfortunately, studies have shown that primary snoring cannot be distinguished from obstructive sleep apnea by history alone.[7] The significant improvement in symptoms recorded in our study shows that they were caused by the enlarged adenoid and tonsils, although no sleep study was done. In a survey of 183 otolaryngologists in the USA, Brigance et al.[3] estimated that they performed 24,000 adenotonsillectomies; however, <10% had any overnight monitoring and <5% had polysomnography.[8]

This study revealed that adenotonsillar operations (adenotonsillectomy 49.5%, adenoidectomy 26% and tonsillectomy 24.5%) accounted for 74.4% of all pediatric ENT surgeries done in the study center within the period under review. This result is similar to a study in Italy which reported adenotonsillectomy accounting for the highest proportion of all adenotonsillar surgeries (56.6%) which was closely followed by adenoidectomy (31.6%) and lastly tonsillectomy (11.8%).[9]

Our study also showed a reduction or complete resolution of obstructive, pharyngeal and otologic symptoms in most cases that were observed within 4 weeks postoperatively. A study by Marcus et al.[10] observed that compared with a strategy of watchful waiting, surgical treatment for the obstructive sleep apnea syndrome in school-age children did not significantly improve attention or executive functions in adults as measured by neuropsychological testing, but did reduce symptoms and improve secondary outcomes of behavior, quality of life, and polysomnographic findings, thus providing evidence of beneficial effects of early adenotonsillectomy.[10],[11]

Although some centers routinely perform adenotonsillectomy in patients with obstructive symptoms, in our study, carefully selected cases had either tonsillectomy or adenoidectomy alone. Re-occurrence of obstructive symptoms was found to be very low (1.4%). Similar findings were reported by Grindle et al.[12] in which he reported revision surgeries on account of re-occurrence of symptoms after adenoidectomy to be about 1.3%.[12]

Complications documented include hemorrhage 7 (3.80%), noted mostly within the 1st h of surgery. In all the 7 cases, the patients had hemostasis secured in the theater. None of the cases of postoperative hemorrhage was life-threatening, and there was no mortality recorded within this period under review. Most of such cases were performed by younger residents. A study by Waters and Cheng.[13] reported perioperative complication rate as 8.8%, and the unplanned admission rate was 8.0%.[13]

The implication of this study to the existing literature showed that performing adenotonsillar surgeries in pediatric patients is safe even in infants <1 year of age. With good patients' selection and careful surgery, symptoms resolution is achieved within the first 4 weeks of surgery.


  Conclusions Top


Adenotonsillectomy is the most common pediatric ENT surgical procedure performed at the study center in Kaduna, Nigeria. The surgeries are safe and can be performed on infants <1 year of age. Obstructive symptoms were the most common indications for surgery. Improvement and complete resolution of symptoms depend on the indication. Complications from these surgeries were minimal and mainly reactionary hemorrhages. The study revealed that the favorable outcome of adenotonsillectomy makes it a good choice of relieving chronic obstructive symptoms occurring as a result of adenotonsillar enlargements.

Acknowledgments

The medical director, Head of Clinical Services of the National Ear Care Centre Kaduna, Nigeria for their support and the medical records staff of the centre for retrieving the case files.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Zautner AE. Adenotonsillar disease. Recent Pat Inflamm Allergy Drug Discov 2012;6:121-9.  Back to cited text no. 1
[PUBMED]    
2.
Afolabi OA, Alabi BS, Ologe FE, Dunmade AD, Segun-Busari S. Parental satisfaction with post-adenotonsillectomy in the developing world. Int J Pediatr Otorhinolaryngol 2009;73:1516-9.  Back to cited text no. 2
[PUBMED]    
3.
Brigance JS, Miyamoto RC, Schilt P, Houston D, Wiebke JL, Givan D, et al. Surgical management of obstructive sleep apnea in infants and young toddlers. Otolaryngol Head Neck Surg 2009;140:912-6.  Back to cited text no. 3
[PUBMED]    
4.
Price SD, Hawkins DB, Kahlstrom EJ. Tonsil and adenoid surgery for airway obstruction: Perioperative respiratory morbidity. Ear Nose Throat J 1993;72:526-31.  Back to cited text no. 4
[PUBMED]    
5.
Weatherly RA, Mai EF, Ruzicka DL, Chervin RD. Identification and evaluation of obstructive sleep apnea prior to adenotonsillectomy in children: A survey of practice patterns. Sleep Med 2003;4:297-307.  Back to cited text no. 5
[PUBMED]    
6.
Bluestone CD. Current indications for tonsillectomy and adenoidectomy. Ann Otol Rhinol Laryngol 1992;101:58-64.  Back to cited text no. 6
    
7.
Indications for Tonsillectomy and Adenotonsillectomy in Children. Available from: http://www.asohns.org.au/about/POSITION%20PAPER%20-%20.•PDFfile. [Last accessed on 2013 Aug 02].  Back to cited text no. 7
    
8.
Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. American Academy of Pediatrics. Clinical practice guideline: Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002;109:704-12.  Back to cited text no. 8
[PUBMED]    
9.
Motta G, Casolino D, Cassiano B, Conticello S, Esposito E, Galletti F, et al. Adeno-tonsillar surgery in Italy. Acta Otorhinolaryngol Ital 2008;28:1-6.  Back to cited text no. 9
[PUBMED]    
10.
Marcus CL, Moore RH, Rosen CL, Giordani B, Garetz SL, Taylor HG, et al. A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med 2013;368:2366-76.  Back to cited text no. 10
[PUBMED]    
11.
Paul D. Sinus infection and adenotonsillitis in pediatric patients. Laryngoscope 1981;91:997-1000.  Back to cited text no. 11
[PUBMED]    
12.
Grindle CR, Murray RC, Chennupati SK, Barth PC, Reilly JS. Incidence of revision adenoidectomy in children. Laryngoscope 2011;121:2128-30.  Back to cited text no. 12
[PUBMED]    
13.
Waters KA, Cheng AT. Adenotonsillectomy in the context of obstructive sleep apnoea. Paediatr Respir Rev 2009;10:25-31.  Back to cited text no. 13
[PUBMED]    



 
 
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