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Introduction and objective: Obstructive sleep apnea (OSA) is a multifactorial etiology disease that leads to the collapse of the upper airway. Hypertrophy of lymphoid tissues contributes to airway collapsibility. Conceptual review of adenotonsillectomy in the adult patient with OSA. Synthesis: In the presence of grade ≥3 tonsillar hypertrophy, tonsillectomy is the first-line treatment. The different available adenotonsillectomy techniques are suitable for treating patients with OSA. The integrity of the palatoglossus and palatopharyngeus muscles must be respected. In addition to healing and surgical success, tonsillectomy offers benefits such as reducing necessary pressure applied to CPAP and consequently increasing its tolerance. Conclusions: The removal of hypertrophic lymphoid tissues in adult patients with OSA is essential. This surgery eliminates obstructive elements from the upper airway, favoring its patency and stability. [ABSTRACT FROM AUTHOR]

INTRODUCCIÓN: La amigdalectomía es el procedimiento más antiguo y frecuente de la Otorrinolaringología. Su realización no está exenta de complicaciones, siendo la más grave la hemorragia del lecho quirúrgico, pudiendo requerir internación y/o reintervención. OBJETIVO: Determinar prevalencia de sangrado postquirúrgico en pacientes amigdalectomizados con o sin adenoidectomía. MATERIAL Y METODO: Estudio observacional, retrospectivo y descriptivo que se llevó a cabo en el servicio de Otorrinolaringología de la Clínica Universitaria Reina Fabiola y en el que se incluyeron pacientes amigdalectomizados desde el uno de enero del año 2017 al 31 de diciembre del año 2021. Variables del estudio: edad, sexo, presencia de sangrado, el tiempo de aparición del sangrado, la necesidad de reintervención, el motivo de la cirugía, la técnica quirúrgica utilizada y la de hemostasia, de que fosa amigdalina sangraron, si hubo transgresión de medidas higiénico dietéticas o fue un sangrado espontaneo. El análisis estadístico para las variables cuantitativas se calculó medidas de centralización y dispersión (media y desvío estándar), y para las variables categóricas se calcularon las distribuciones absolutas y porcentuales. RESULTADOS: Se estudiaron un total de 1392 casos, de los cuales 27 (1,94 %) presentaron sangrado. La media de edad de los pacientes fue de 19,7 años, con una desviación estándar (DE) de 11,2 años. De estos pacientes, 18 (66,7 %) eran de sexo masculino. De la totalidad de los casos de sangrado, 22 (81,5 %) fueron desencadenados espontáneamente. El sangrado ocurrió con mayor frecuencia antes de las 48 horas del postoperatorio en 13 (50%) pacientes. Diecisiete (63%) pacientes requirieron reintervención para controlar el sangrado. La técnica quirúrgica de amigdalectomía más utilizada fue la técnica sin utilización de energía térmica. CONCLUSIÓN: El estudio realizado encontró una prevalencia de sangrado postoperatorio del 1,94 %, especialmente en hombres jóvenes. La mayoría de los sangrados ocurrieron dentro de las primeras 48 horas, requiriendo algunos pacientes reintervención quirúrgica. Las técnicas quirúrgicas más usadas fueron la disección fría y la electrocauterización, empleando compresión, sutura y cauterización bipolar para la hemostasia.

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction and objective: COVID-19 has had various consequences for the health care system. Focusing on our ENT Service, we have observed a decrease in the occurrence of peritonsillar infections (PTI). The aim of this study is to evaluate epidemiological aspects of PTIs over a 6-year period. Method: Retrospective and longitudinal descriptive study with data obtained from the computerized hospital registry of León over a 6-year period. Results: A total of 327 patients were included, pre-pandemic 201 (61.47%), pandemic 64 (19.54%) and post-pandemic 62 (18.96%), with a decrease of 48.58% in the incidence of IPA. Discussion: We found similar results to those analyzed in other series about the incidence of peritonsillar abscesses during the pandemic, however, we have a longer mean hospital stay in admissions for this pathology. Conclusions: The pandemic has affected and changed the way we look at certain conditions. In our case, when looking at peritonsillar abscesses we have observed a clear decrease. [ABSTRACT FROM AUTHOR]

Introduction: Obstructive sleep apnoea (OSA) is highly prevalent in children and a major public health problem. An attempt is made to determine the clinical and polysomnographic presentation of paediatric OSA in our area. Patients and methods: Retrospective descriptive study of sleep tests conducted on children up to 14 years old from 1999 to 2012 in the Sleep Unit of the University Hospital of Albacete. Age, gender, anthropometric, clinical data, indication and variables of sleep study, treatment, and outcomes were collected. Results: The study included 234 children. OSA was found in 71.8%, with 42.3% moderate and 44.6% severe. The majority were male (60.7%) and the mean age was 5 years, of whom 78% were pre-school or school age. There was overweight/obesity in 44%, with 93.4% snoring, apnoea 84.5%, and 5.4% daytime sleepiness. There were 23 polysomnographies and 145 polygraphies, with a median apnoea/hypopnoea index (AHI) of 10, SatO2 minimum 84%, desaturation index 8, and mean sleep supine 53.65% and supine events 57.61%. Treatment was lifestyle modifications 29.2%, CPAP 6%, and surgery 42.9%. Improved snoring and/or apnoea 69.4%, and weight 32.4% of overweight/obesity children. Conclusions: Most of the studied children had a pathological AHI. Almost half were overweight/obese, and a high percentage had moderate-severe OSA. Most frequent treatment was surgery. The clinical outcome was favourable in almost 70%. Less than a third with OSA and overweight/obesity improved weight. Resumen: Introducción: El síndrome de apneas-hipopneas del sueño (SAHS) es altamente prevalente en la edad pediátrica y un problema importante de salud pública. Se pretende conocer la presentación clínica y polisomnográfica del SAHS infantil en nuestro medio. Pacientes y métodos: Estudio descriptivo retrospectivo de los estudios del sueño realizados a menores de 14 años desde 1999 hasta 2012 en la Unidad del Sueño del Complejo Hospitalario Universitario de Albacete. Se recogen edad, sexo, datos antropométricos, clínicos, indicación y variables del estudio del sueño, tratamiento y evolución. Resultados: Doscientos treinta y cuatro niños. SAHS el 71,8%: moderado 42,3% y grave 44,6%. 60,7% varones y mediana de edad 5 años; el 78% en edad preescolar o escolar. Presentaban sobrepeso/obesidad 44%, ronquidos 93,4%, apneas 84,5% y somnolencia diurna 5,4%; 23 polisomnografías y 145 poligrafías: mediana de índice de apneas-hipopneas (IAH) 10, de SatO2 mínima 84% y de índice de desaturaciones 8, y media de sueño en supino 53,65% y de eventos en supino 57,61%. El tratamiento fue medidas higiénico-dietéticas en el 29,2%, CPAP el 6% y cirugía el 42,9%. Mejoraron los ronquidos y/o apneas el 69,4% y el peso el 32,4% de los niños con sobrepeso/obesidad. Conclusiones: La mayoría de los niños estudiados tenían un IAH patológico. Casi la mitad presentaban sobrepeso/obesidad y un alto porcentaje tenía SAHS moderado-grave. El tratamiento más indicado fue la cirugía. La evolución clínica fue favorable en casi el 70%. Menos de un tercio con SAHS y sobrepeso/obesidad mejoraron el peso.

BACKGROUND: The use of perioperative antibiotics is a common practice in otolaryngology surgeries, even when the majority of those procedures are considered clean or clean-contaminated surgeries. OBJECTIVE: To know the use of perioperative antibiotics in otolaryngologic surgeries. MATERIAL AND METHOD: A survey-study was applied to Mexican otolaryngologists from December 2017 to February 2018 about their use of antibiotics in rhinoseptoplasty, tonsillectomy, neck surgery, otologic surgical procedures and sinus surgery interventions, as well as the antibiotic family prescribed. RESULTS: There were included 250 participants. The perioperative antibiotics use in rhinoseptoplasty was of 88% of 95% in sinus surgery procedures, 53% in tonsillectomy, 74% in otologic surgeries and 90% in neck surgery. The main antibiotic family prescribed were the beta-lactams. CONCLUSIONS: The use of perioperative antibiotics in Mexico is superior compared with other countries, because of that it is important to analyze our daily practice and the possible complications related to the indiscriminate use of antibiotics. [ABSTRACT FROM AUTHOR]

A agitação ao despertar da anestesia é um comportamento negativo comumente registrado após amigdalectomia pediátrica. Avaliamos a eficácia da pré‐medicação com dexmedetomidina via transmucosa oral no pré‐operatório sobre a incidência e gravidade da agitação ao despertar em crianças pré‐escolares submetidas à amigdalectomia sob anestesia com sevoflurano. Noventa pacientes entre três e seis anos e estado físico ASA I ‐ II foram incluídos em três grupos (n = 30) para receber 0,5 μg.kg‐1 ou 1 μg.kg‐1 de dexmedetomidina via transmucosa oral (Grupo DEX I e Grupo DEX II, respectivamente) ou solução salina (Grupo C). O desfecho primário foi o escore de agitação ao despertar medido com a escala de Watcha na SRPA. Os desfechos secundários foram escore de sedação pré‐operatória, hemodinâmica intraoperatória, escore OPS (Objective Pain Scale) e efeitos adversos no pós‐operatório. A demografia dos pacientes, os escores de sedação pré‐operatória e o tempo de extubação não apresentaram diferença entre os grupos. Diferenças significativas entre os grupos na distribuição da incidência e frequência de cada grau do escore de Watcha foram evidentes aos 5 minutos (p = 0,007), 10 minutos (p = 0,034), 30 minutos (p = 0,022), 45 minutos (p = 0,034) e 60 minutos (p = 0,026) no pós‐operatório, com diferenças significativas entre os grupos DEX I e II. Os grupos DEX apresentaram escores OPS mais baixos aos 5 minutos (p = 0,011), 10 minutos (p = 0,037) e 30 minutos (p = 0,044) após a chegada à SRPA, sem diferença entre os grupos DEX I e II. Os pacientes do grupo DEX II apresentaram menor frequência cardíaca média aos 15 minutos de intraoperatório (p = 0,020) e menor pressão arterial média aos 30 minutos, (p = 0,040), 45 minutos (p = 0,002) e 60 minutos (p = 0,006), sem diferenças significativas entre os grupos em outros momentos. Este estudo demonstra a vantagem clínica e a técnica simples da pré‐medicação com DEX por via transmucosa oral para agitação ao despertar em crianças pré‐escolares submetidas à amigdalectomia sob anestesia com sevoflurano, comparado à solução salina. Clinical Trials.gov trial registry: NCT02720705. Emergence agitation is a negative behavior commonly recorded after pediatric tonsillectomy. We investigated the efficacy of preoperative premedication with oral transmucosal buccal dexmedetomidine on the incidence and severity of emergence agitation in preschool children undergoing tonsillectomy under sevoflurane anesthesia. Ninety patients aged (3‐6 years), ASA I‐II were enrolled into three groups (n = 30) to receive oral transmucosal dexmedetomidine 0.5 μg.kg‐1 (Group DEX I), 1 μg.kg‐1 (Group DEX II) or saline placebo (Group C). Our primary endpoint was the Watcha agitation score at emergence in PACU. Secondary outcomes were preoperative sedation score, intraoperative hemodynamics, postoperative Objective Pain Scale (OPS) and adverse effects. The patients' demographics, preoperative sedation scores and extubation time showed no difference between groups. Significant differences between groups in incidence and frequency distribution of each grade of Watcha score were evident at 5 minutes (p = 0.007), 10 minutes (p = 0.034), 30 minutes (p = 0.022), 45 minutes (p = 0.034) and 60 minutes (p = 0.026), postoperatively with significant differences between DEX I and II groups. DEX groups showed lower OPS scores at 5 minutes (p = 0.011), 10 minutes (p = 0.037) and 30 minutes (p = 0.044) after arrival at PACU, with no difference between DEX I and II groups. Patients in DEX II group exhibited lower intraoperative mean heart rate at 15 minutes (p = 0.020), and lower mean arterial pressure at 30 minutes, (p = 0.040), 45 minutes (p = 0.002) and 60 minutes (p = 0.006) with no significant differences between groups in other time points. This study demonstrates the clinical advantage and the simple technique of oral transmucosal DEX premedication for emergence agitation in preschool children undergoing tonsillectomy under sevoflurane anesthesia compared with saline placebo. Clinical Trials.gov trial registry: NCT02720705. [ABSTRACT FROM AUTHOR]

Copyright of Revista Brasileira de Anestesiologia is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

INTRODUCCIÓN: las inmunodeficiencias primarias están subdiagnosticadas en todo el mundo, aun en centros de tercer nivel de atención. Los defectos de anticuerpos constituyen el grupo más prevalente y suelen manifestarse clínicamente después de los 6 meses de edad como infecciones respiratorias recurrentes causadas por bacterias encapsuladas. Algunas cirugías de oído-nariz y garganta se indican en pacientes con infecciones respiratorias recurrentes o complicadas que no han respondido adecuadamente al tratamiento médico. Estos niños sometidos a procedimientos quirúrgicos luego de una historia de infecciones respiratorias recurrentes pueden constituir un grupo de alto riesgo para inmunodeficiencias primarias. OBJETIVO: indagar qué tan frecuentes son los defectos de anticuerpos en niños sometidos a cualquiera de tres cirugías de otorrinolaringología. MATERIALES Y MÉTODOS: revisamos los expedientes electrónicos de niños que hubieran sido sometidos a adenoamigdalectomía (ATT), drenaje endoscópico de senos paranasales (ESD) y colocación de tubos timpánicos de ventilación (TVT) en nuestro instituto durante 2011-2012, en busca de niveles séricos de inmunoglobulinas (IgE, IgG, IgA, IgM). RESULTADOS: encontramos 112 procedimientos quirúrgicos en 87 pacientes, de los cuales la indicación para cirugía fue infecciosa en 37 (21 varones, 1 muerto, edad media 7.3 años), más frecuentemente rinosinusitis (19/37) y amigdalitis (9/37) crónicas. Los procedimientos incluyeron: 24 adenoamigdalectomías, 13 drenajes endoscópicos de senos paranasales y 6 colocaciones de tubos timpánicos de ventilación, para un total de 43; ocho pacientes (21.6%) fueron sometidos a más de una cirugía. La IgE sérica se encontró en el expediente de 27 pacientes (72.9%), y “al menos IgG” en 18 (48.6%). Sólo 70% de las pruebas fueron ordenadas antes de la cirugía. Los resultados anormales incluyeron: IgE elevada en 10/27, IgG elevada en 8/18, IgG baja 1/18, IgM elevada 3/17 e IgA elevada en 5/17. Dos niños con enfermedad granulomatosa crónica fueron identificados a través de esta búsqueda electrónica. CONCLUSIONES: describimos 37 pacientes sometidos a cirugía de otorrinolaringología por una historia de infecciones respiratorias recurrentes, complicadas o refractarias, de los cuales al menos nueve eran alérgicos y al menos dos tenían una inmunodeficiencia primaria. Sólo 18 de esos 37 tenían determinación de IgG como parte de su evaluación preoperatoria; un índice alarmantemente bajo de sospecha para defectos de anticuerpos. Estudios previos en adultos con rinosinusitis crónica han encontrado defectos de anticuerpos. Planeamos completar la evaluación inmunológica de los 37 pacientes, incluyendo para deficiencia específica de anticuerpos (SAD). Banderas rojas como IgE >2,000 IU/mL, neumonía complicada o cultivo de Aspergillus pueden ser útiles para detectar pacientes con inmunodeficiencia primaria no diagnosticada.

OBJECTIVE: To determine if the use of muscular relaxant (rocuronium) and sugammadex decreases the laryngospasm and transoperative bleeding in patients subjected to an adenotonsillectomy. MATERIAL AND METHOD: A randomized, controlled, prospective and comparative clinical test was done in patients from 2 to 13 years old, subjected to an adenotonsillectomy as an elective manner from August 2015 to June 2016 at the Hospital Infantil de Chihuahua, divided into two groups: one group was administered rocuronium and sugammadex; the other group was not administered any muscular relaxant. RESULTS: There were done 50 surgeries. It was obtained that the average intraoperative bleeding in the group without relaxant was of 71.6 cc, while the one in group with relaxant was of 81.6 cc (p = 0.698); p 0.05 was not significant for the study; however, in the group without relaxant 8 patients (32%) had laryngospasm vs the group with relaxant: 3 (12%), with a p value of 0.01708 (p < 0.05), being statistically significant. Average surgical time of groups with and without relaxant was 15 and 13 minutes, respectively (p = 0762). CONCLUSION: The administration of rocuronium and concomitant sugammadex to revert the muscle relaxation on tonsillectomy decreases the laryngospam and can alter the transoperative bleeding. [ABSTRACT FROM AUTHOR]

BACKGROUND: In current otorhinolaringology, tonsillectomy is one of the most frequently executed procedures, nevertheless there are no up to date reports on Actinomyce's prevalance in the national literature, or information on its relation with tonsil hypertrophy and obstructive pathology. OBJECTIVE: To determine the prevalence of Actinomyes spp in palatine tonsils and its relation with obstructive tonsils and chronic infectious pathology. MATERIAL AND METHOD: A retrospective, transversal, descriptive and observational protocol was done with post-tonsillectomy patients treated at National Institute of Rehabilitation of Mexico from January 2012 to June 2015. Two groups were formed according to the hystopathologic results, which were either positive or negative to the presence of Actinomyces, and its relation with obstructive pathology and chronic tonsillitis. RESULTS: There were included 417 patients. The prevalence of Actinomyces in the 417 patients was 10.5%. Out of the 44 patients with positivity to Actinomyces, 27 (61%) presented obstructive pathology, and 17 (39%) chronic tonsillitis; in comparison, out of the 373 patients with negative bacteria result, 161 (43%) had obstructive pathology and 212 (57%) chronic tonsillitis. The comparative analysis demonstrated significant differences between both groups (p = 0.025).\ CONCLUSIONS: Actinomyces prevalence is similar to the one reported in the international literature. This study demonstrates that there is a relation between patients with obstructive pathology and the presence of Actinomyces. [ABSTRACT FROM AUTHOR]

BACKGROUND: Tonsillectomy is one of the most frequent surgical procedures performed around the world. Post-tonsillectomy bleeding is one of the most common complications of this procedure. Bleeding can be primary or secondary, the latter is the most frequent reported in the literature, it is related to the hot technique and the risk is higher in adults. OBJECTIVE: To determine the prevalence and factors associated with post-tonsillectomy bleeding. MATERIAL AND METHOD: An observational, retrospective, transversal and descriptive study. General description of the study: the files of patients diagnosed with post-tonsillectomy bleeding treated from January 2012 to December 2015 were reviewed. Socio-demographic data, comorbidities, laboratory results, surgical technique used, degree of tonsillar hypertrophy were taken, as well as the administration of peri-operative steroids. RESULTS: Of a total of 1687 procedures, 37 (2.19%) presented bleeding, of which 19 (51.4%) were female. The age range was from 2 to 51 years with an average of 17.11 years; in 6 patients (16.2%) tonsillectomy was also performed in conjunction with adenoidectomy; 67.6% was secondary type. On average, bleeding was presented at 5.57 days after surgery within a range of 0 to 12 days. With respect to surgical technique, 5 (13.5%) were with cold technique and 32 (86.5%) with hot technique. Only 19 (51.4%) received perioperative steroids. The months of the year when the greatest number of bleeding events occurred were February and March. CONCLUSIONS: The prevalence of post-tonsillectomy bleeding in our unit is low; the secondary predominates and is more common in adults. [ABSTRACT FROM AUTHOR]

Los trastornos respiratorios del sueño (TRS), incluyendo la apnea obstructiva del sueño, afectan a un grupo importante de los pacientes pediátricos. Su más frecuente síntoma, el ronquido, debe ser buscado dirigidamente en los controles pediátricos e investigado cuando esté presente. La principal causa de los TRS en niños es la hipertrofia adenoamigdalina, pudiendo contribuir también la obesidad, cuadros alérgicos, trastornos neuromusculares y malformaciones craneofaciales. La apnea del sueño en población pediátrica se asocia a trastornos neurocognitivos, retraso del crecimiento, aumento de la resistencia vascular pulmonar, trastornos metabólicos y enuresis. La evaluación es inicialmente clínica, pudiendo ser complementada con una nasofibroscopía y, en casos dudosos, con estudios del sueño (saturometría ambulatoria de O2, polisomnograma). El tratamiento de elección es la adenoamigdalectomía, cirugía con una alta efectividad en resolver los TRS infantiles y con una baja tasa de complicaciones. En casos seleccionados puede ser necesario utilizar equipos de presión positiva (C-PAP).

It has been stated, that the administration of Dexamethasone has an impact on the morbidity following tonsillectomy. OBJECTIVE: To re-calculate the blood values for Dexamethasone when given as fixed doses and to evaluate the effect of Dexamethasone on post-operative nausea, vomiting and bleeding rates following tonsillectomy. MATERIALS AND METHODS: The charts of 272 children (2-15 years) who had undergone tonsillectomy were analyzed. The rates of post-operative nausea, vomiting and bleeding in relation to Dexamethasone were calculated-in general and different doses (0 mg/kg, 0.15 mg/kg). STUDY DESIGN: Retrospective cohort study. RESULTS: Dexamethasone was administered in 121 children (43.7%) according to the preference of the anesthesist (mean dose: 0.2 +/- 0.12 mg/kg; range: 0.04 - 0.62 mg/kg). There was no significant difference in nausea and vomiting (p=0.953) or bleeding (p=0.827) across groups receiving or not receiving Dexamethasone. Stratification into three different groups of Dexamethasone concentration also did not identify a dose-related risk of postoperative nausea or vomiting (p=0.98) or bleeding (p=0.71). CONCLUSION: At least under common non-controlled conditions in the clinic, Dexamethasone does not appear to have an effect on nausea or vomiting or bleeding following tonsillectomy.É conhecido o impacto da administração de dexametasona sobre a morbidade no pós-operatório de amigdalectomia. OBJETIVO: Recalcular os valores séricos para dexametasona quando administrada em doses fixas e avaliar seus efeitos sobre as taxas de náusea, vômito e sangramento no pós-operatório de amigdalectomia. MATERIAIS E MÉTODOS: Analisamos os prontuários de 272 crianças (idades entre 2-15 anos) submetidas a amigdalectomias. As taxas de náusea, vômitos e sangramentos foram calculadas para a dexametasona em geral e em diferentes doses (0 mg/kg; 0,15 mg/ kg). TIPO DE ESTUDO: Coorte retrospectivo. RESULTADOS: A dexametasona foi administrada em 121 crianças (43,7%), baseado na preferência do anestesista (dose média: 0,2 +/- 0,12 mg/kg; variação: 0,04 - 0,62 mg/kg). Não houve diferença significativa em termos de náuseas e vômitos (p=0,953) ou sangramento (p=0,827) entre os grupos de pacientes que receberam e não receberam dexametasona. Mesmo a estratificação em três grupos de diferentes concentrações de dexametasona não identificou risco dose-dependente de náusea ou vômito pós-operatório (p=0,98) ou sangramento (p=0,71). CONCLUSÃO: Pelo menos sob condições não-controladas normais da clínica, a dexametasona parece não ter efeito sobre a incidência de náuseas, vômito ou sangramento após amigdalectomia.

Introdução: A distorção persistente da sensação gustativa (disgeusia), sendo transitória ou permanente, pode ter influência significativa no quotidiano dos doentes, relacionando-se com perda ponderal, anorexia, desnutrição, quadros depressivos e redução significativa da qualidade de vida. A disgeusia pode ter várias causas, sendo uma delas a cirúrgica, nomeadamente a amigdalectomia. Descrição do caso: Doente do sexo feminino, 38 anos, com história de amigdalite crónica bilateral. Realiza amigdalectomia por lâmina fria e eletrocauterização de pontos hemorrágicos da loca amigdalina, sem complicações cirúrgicas. Inicia quadro de disgeusia caracterizada pela não discriminação dos gostos, referindo que tudo parecia amargo. Na consulta de seguimento hospitalar em otorrinolaringologia (ORL), seis meses após cirurgia, efetuou-se avaliação gustométrica por tiras teste, revelando alterações na discriminação gustativa, referindo o gosto amargo, mesmo quando estimulada com tiras ácidas, doces ou salgadas. A doente iniciou reabilitação gustativa diária, fazendo associação mental com a sensorial. Repetiu-se gustometria um ano após cirurgia. A doente melhorou bastante, mas manteve uma disgeusia seletiva para o amargo na presença de estímulo salgado em baixa concentração. Comentário: A disgeusia é uma complicação rara da amigdalectomia e de elevada importância para o doente. O procedimento cirúrgico pode atingir os nervos responsáveis pela transmissão sensorial gustativa, direta ou indiretamente, não havendo muitas opções terapêuticas. Estes casos estão subreportados na literatura e os que foram tiveram evolução benigna. A disgeusia pode ser várias etiologias, como higiene oral precária, cirurgia, infeção e tabaco, diabetes, doenças autoimunes, fármacos antimicrobianos, anti-hipertensores e anti-inflamatórios. Nos cuidados de saúde primários, as queixas gustativas são vagas e sem relação patológica aparente, não existindo em Portugal dados acerca da incidência da mesma. É importante sensibilizar os clínicos para esta patologia. Não devemos descuidar a queixa do doente, quer pelo impacto que a mesma tem na qualidade de vida do mesmo, quer pela possibilidade de haver uma patologia de base tratável. É nosso papel avaliar, orientar e tratar.

INTRODUCTION: Primary immunodeficiencies (PID) are underdi- agnosed all around the world, even at tertiary care centers. Antibody defects make the most prevalent defect group, and usually manifest themselves clinically after 6 months of age with recurrent respiratory infections caused by encapsulated bacteria. A number of ear-nose and throat surgeries are indicated in patients with recurrent or complicated respiratory infections, who have not adequately responded to medical therapy. These children who underwent a surgical procedure after a history of recurrent respiratory infections might constitute a high-risk group for PID. OBJECTIVE: To enquire how frequent antibody defects are among children with a history of respiratory infections who underwent any of three otolaryngology surgeries. METHODS: We reviewed the electronic medical records of children who underwent adenoid-tonsillectomy (ATT), endoscopic paranasal sinus drainage (ESD), and tympanic ventilation tube placement (TVT) at our center during 2011-2012, for serum immunoglobulins (IgE, IgG, IgA, IgM) levels. RESULTS: We found 112 surgical procedures in 87 patients. Of these, the indication for surgery was infectious in 37 (21 male, 1 dead, mean age 7.3 years), more often chronic rhinosinusitis (19/37) and tonsillitis (9/37). The procedures included: 24 ATT, 13 ESD, and 6 TVT, for a total of 43. Eight patients (21.6%) underwent more than one surgery. Serum IgE was found in 27 (72.9%), and "at-least-IgG" in 18 (48.6%). Only 70% of these tests were ordered before surgery. Abnormal results included: High IgE 10/27, high IgG 8/18, low IgG 1/18, high IgM 3/17, and high IgA 5/17. Two children with known Chronic granulomatous disease (CGD) were identified through this electronic search. DISCUSSION: We describe 37 patients who underwent ENT surgery for a history of complicated, recurrent or refractory respiratory infec- tions, of whom at least nine were allergic and at least two had PID (CGD). Only 18 of those 37 had IgG measured as part of their workup; an alarmingly low index of suspicion for antibody defects. Previous studies in adults with refractory CRS have found antibody defects. We intend to complete the immunological evaluation of the 37, includ- ing for specific antibody deficiency (SAD). "Red flags" such as IgE >2,000 IU/mL, complicated pneumonia, or Aspergillus sp. culture growth may prove to be useful to detect patients with previously undiagnosed PID. [ABSTRACT FROM AUTHOR]

Introduction: tonsillectomy, with or without adenoidectomy, is one of the most frequent surgical procedures generally performed, especially in young patients. Several studies suggest that there is a relationship between tonsillectomy and altered MALT immune system. Objective: to examine the possible association between tonsillectomy or adenoidectomy and the risk of subsequent appendicitis. Material and method: a cross-sectional study was performed in 650 patients admitted to the emergency department of a general hospital in Valencia, Spain. Previous history of tonsillectomy and/or adenoidectomy was related to a history of appendectomy. A descriptive study and an analysis of the relationship between previous operations and appendicitis was performed. A multivariable analysis controlled for age and sex was also performed, including the possible interaction of the gender variable. The independent effect of each of the procedures (tonsillectomy, adenoidectomy) was tested. Results: the 25.5% of patients had undergone tonsillectomy and 11.5% adenoidectomy; 17.5% had had an appendectomy. On average, women were operated on more frequently than men. In the bivariate analysis, both tonsillectomy and adenoidectomy were significantly associated with subsequent appendectomy. In the multivariate analysis, this association was only maintained for tonsillectomy (OR: 3.23; 95% CI: 2.11-4.94). A stratified analysis controlling for sex showed a modification of this effect, with a higher association in women (OR: 5.20; 95% CI: 2.91-9.28) than in men (OR: 1.74; 95% CI: 0.90-3.39). Conclusions: a clear association has been found, especially in women, between previous tonsillectomy and subsequent acute appendicitis. Due to a lack of data on acute appendicitis there should be further studies to explain the findings of this study, as this could be the first described risk factor of acute appendicitis.Introducción: la amigdalectomía, sola o acompañada de adenoidectomía, es una de las intervenciones quirúrgicas más frecuentes, especialmente en las personas más jóvenes. Diversos estudios sugieren la existencia de algún tipo de relación entre el hecho de sufrir una amigdalectomía y la inmunidad a nivel del sistema MALT digestivo. Objetivo: examinar la posible asociación entre el hecho de haber sido sometido a la extirpación de las amígdalas o las adenoides y padecer posteriormente una apendicitis aguda. Material y método: encuesta transversal en 650 pacientes que acuden al Servicio de Urgencias de un Hospital de Valencia, España. Se relacionaron los antecedentes de apendicectomía con amigdalectomía y/o adenoidectomía previa. Se llevó a cabo la descripción de las variables así como el análisis de la relación entre las intervenciones previas y la apendicitis. Se efectuó un análisis multivariante controlando por las variables edad y sexo así como la posible interacción con la variable sexo. Se comprobó el efecto independiente de cada una de las dos intervenciones (amigdalectomía, adenoidectomía). Resultados: el 25,5% de pacientes habían sido intervenidos de amigdalectomía, el 11,5% de adenoidectomía y el 17,5% de apendicectomía. En promedio, las mujeres han sido sometidas a intervenciones con mayor frecuencia que los hombres. En el análisis simple, los antecedentes, tanto de amigdalectomía, como de adenoidectomía, se asociaron significativamente con haber sido sometidos posteriormente a apendicectomía. En el análisis multivariante, dicha asociación sólo se mantuvo para la amigdalectomía (OR: 3,23; IC 95%: 2,11-4,94). Por otro lado, se encontró una modificación de dicho efecto según la variable sexo, siendo la asociación más alta en mujeres (OR: 5,20; IC 95% 2,91-9,28) que en hombres (OR: 1,74; IC 95%: 0,90-3,39). Conclusiones: se ha encontrado una asociación clara, especialmente en mujeres, entre el hecho de ser amigdalectomizado y sufrir apendicitis con posterioridad. Dada la escasez de conocimientos de apendicitis aguda se debería investigar con mayor profundidad los factores que explicaran los hallazgos de este estudio, ya que podría ser el primer factor de riesgo descrito de apendicitis aguda.

Paciente de sexo masculino de dos y medio anos de edad. Enfermedad Actual: EI presente caso describe un inhibidor de la coagulación tipo anticoagulante lúpico (AL), detectado incidental mente en un paciente de dos y medio años de edad, con historia de adenoiditis y episodios de faringoamigdalitis a repetición y en tratamiento con amoxicilina. Se le practicaron pruebas de coagulación previas a amigdalectomía, diagnósticas del inhibidor, el cual desapareció al cabo de un mes después de suspendido el antibiótico. El curso clínico evoluciono sin complicaciones.

Background: The prevalence of sleep disordered breathing (obstructive sleep apnea and upper airway resistance syndrome) in children is 1%-3%. This condition is associated with chronic cardiovascular disease, metabolic disease, failure to thrive, enuresis, cognitive deficits, behavioral disturbances, poor school performance and poor quality of life. Although polysomnography is the diagnostic method of choice for obstructive sleep apnea, it is an expensive study and not available in all centers, so the diagnosis is controversial. Objectives: To detect clinically respiratory sleep disorders in post adenotonsillectomy children and to assess changes in symptoms after surgical procedure. Material and method: A prospective, observational and longitudinal study was performed in which a previously validated questionnaire (CAS- 15) was applied in children after adenotonsillectomy, adenoidectomy or tonsillectomy. The questionnaire was administered preoperatively and postoperative at days 15 and 30. Results: Thirty-seven patients were included. Significant difference between pre and postoperative values was found, both when comparing the score at 15 days and 30 days with the preoperative score (p ≤ 0.001). Conclusions: The CAS-15 is a useful tool for diagnosing sleep disordered breathing. [ABSTRACT FROM AUTHOR]

Background: Tonsillectomy is one of the most common procedures around the world. Objectives: To show the efficacy of the harmonic scalpel and the advantages in tonsillectomy, to identify the main complications and primary or secondary hemorrhage after the procedure, and to perform the histopathologic study of the stroma and vasculature of the tonsil. Patients and method: A descriptive and retrospective study included all patients who underwent tonsillectomy with harmonic scalpel at the Hospital Angeles Torreon, Coahuila, Mexico, from March 2003 to March 2006. After the tonsillectomy, we used the harmonic scalpel to cut through the stroma and vasculature and were sent to pathology for further study. Results: Of 223 patients, 5 (2.2%) presented posttonsillectomy hemorrhage and needed revision surgery and hemostasis between the 5th and 10th days after the surgery. Most cases of secondary hemorrhage occurred in the first year with better results in the next years. Conclusion: There was a definitive lowering in the bleeding incidence, with only 5 cases, which accounted for 2.2% of the total. The harmonic scalpel should be considered a safe and better option in tonsillectomy. [ABSTRACT FROM AUTHOR]

Introduction and Objective: Tonsillectomy performed on an outpatient basis in adult patients presents bleeding and pain as main postoperative complications. Following rules such as cold surgical technique, analgesic protocols, preoperative interview, and postoperative follow-up help to better control the process. However, there are patient-dependent factors such as sex, age, indication for tonsillectomy and the time elapsed between the last tonsil infection and surgical intervention that can influence postoperative complications and should be considered. The objective of this work is to evaluate the influence of age, sex, the indication for tonsillectomy and the period elapsed between the last tonsil infection and surgery on bleeding and pain control., Methods: A prospective, descriptive, and observational study was carried out in 96 adult patients who underwent outpatient surgery under general anaesthesia, using cold surgical technique, evaluating these complications based on age, sex, indication for tonsillectomy and time elapsed after the last tonsillitis., Results: The patients operated on during the 4 weeks after an episode of tonsillitis presented more postoperative pain. No relationship was found between this period and postoperative bleeding., Conclusions: Male patients had a higher incidence of bleeding than women. The period elapsed between the last tonsil infection and the surgical procedure was associated with greater postoperative pain, but not with greater postoperative bleeding., (Copyright © 2022 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Published by Elsevier España, S.L.U. All rights reserved.)

BACKGROUND: The palatine tonsils are an anatomical and functional barrier that depend on the intervention of the adaptive immune system. In cases of chronic tonsillitis, antigen presentation and cell activation processes can be modified, so removing therapeutically tonsils which are chro-nically sick should be considered a potential advantage. OBJECTIVES: To identify the phenotypic and functional characteristics of lym-phocytes T and B and tonsillar tissue dendritic cells. To assess the therapeutic impact of this measure on decision-making for the ma-nagement of these patients. PATIENTSAND: METHODS Ten pediatric patients referred to tonsillectomy were studied to ob-tain palatal mononuclear cells and to identify lymphoid and myeloid subpopulations byflow cytometry. Later, we assessed thefunctionality of T lymphocytes CD4 and CD8. RESULTS: T lymphocytes CD4 and CD8 are considered functional due to their ability to produce multiple cytokines, to exert cytotoxic activity and to differentiate in populations of memory. The study of populations of myeloid, plasmacytoidand dendritic cells revealed that there is 1.39% myeloid cells and 0.19% plasmocytoid cells in the tonsillar tissue. CONCLUSIONS: T lymphocytes CD4 and CD8 of tonsillar tissue are functional despite being subjected to chronic stimulation for repeat infections. Contrary to the literature, we reject that this tissue is dysfunctional. [ABSTRACT FROM AUTHOR]

INTRODUCTION Adenotonsillectomy (AT) or tonsillectomy (T) is one of the most common procedures, which has few complications, but one of them is bleeding. Bismuth subgallate (SGB) has been used topically on the tonsillar fossa in order to reduce intraoperative bleeding. OBJECTIVE To determine the efficacy of topically applied SGB to reduce perioperative bleeding in patients undergoing adenotonsillectomy (AA) or tonsillectomy (A). DESIGN A prospective, randomized controlled and multicenter trial. Accepted by the Central Committee of Investigation of the IMSS. PATIENTS AND METHODS One hundred and eigtheen patients aged 3 to 60 admitted for elective AT or T. These patients were randomized. In the study group SGB was used after removal. In the control group dry gauze was used. Bleeding, surgical time and the number of tonsilar sutures used were quantified. RESULTS A total of 118 patients were randomized to the study, between 3 and 60 years old, who underwent T or AT. The distribution was 55 patients for subgallate group and 63 patients in the placebo group. No significant differences were found with the use of SBG in intraoperative bleeding (p = 0.85), but there were significant differences in the use of points in the tonsillar bed (p = 0.010) postoperative bleeding was present in 1.7%, there were no significant differences with the use of subgallate (p = 0.283). CONCLUSION SGB applied on the tonsillar bed showed no activity as a hemostatic agent to decrease intraoperative bleeding after adenotonsillectomy or tonsillectomy. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to review some issues on tonsils and adenoids surgery, with emphasis on preoperative evaluation, ancillary diagnostic test and careful patient selection for such surgeries. Some methods and techniques of tonsillectomy, adenoidectomy or both are here reviewed. Some relevant issues on postoperative morbidity and management of suffering associated diseases are studied. [ABSTRACT FROM AUTHOR]