adenoidectomy

アデノイド切除術 　

WordNet

1. surgical removal of the adenoids; commonly performed along with tonsillectomy

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/03/03 11:58:28」(JST)

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Adenoidectomy
Intervention
Location of the adenoid
ICD-9-CM	28
MeSH	D000233
eMedicine	872216

Adenoidectomy is surgical removal of the adenoids for reasons which include impaired breathing through the nose, chronic infections, or recurrent earaches. The surgery is less commonly performed in adults in whom adenoids are considered vestigial and purposeless. It is most often done on an outpatient basis under general anesthesia. Post-operative pain is generally minimal and reduced by icy or cold foods. The procedure can be combined with tonsillectomy if indicated and recovery time can range from several hours to two or three days (though as age increases so does recovery time).

Adenoidectomy is not often performed under one year of age as adenoid function is part of the body's immune system but its contribution to this decreases progressively beyond this age.

History

Adenoidectomy was first performed using a ring forceps through the nasal cavity by William Meyer in 1867. By the early 1930s the operation had become nearly universal in children of school age.

In the early 1900's, adenoidectomies began to be routinely combined with tonsillectomy. Initially, the procedures were performed by otolaryngologists, general surgeons, and general practitioners but over the past 30 years have been performed almost exclusively by otolaryngologists.

Then, adenoidectomies were performed as treatment of anorexia nervosa, mental retardation, and enuresis or to promote 'good health'. By current standards, these indications seem odd but may be explained by the hypothesis that children might have failed to thrive if they had chronically sore throats or severe obstructive sleep apnea (OSA). Also, children who heard poorly because of chronic otitis media might have had unrecognized speech delay mistaken for mental retardation. Adenoidectomy might have helped to resolve ear fluid problems, speech delays, and consequent perceptions of low intelligence.

The relationship between enuresis and obstructive apnea, and the benefit of adenoidectomy by implication, is complex and controversial. On one hand, the frequency of enuresis declines as children grow older. On the other, the size of the adenoids, and again by implication, any obstruction that they might be causing, also declines with increasing age. These two factors make it difficult to distinguish the benefits of adenoidectomy from age-related spontaneous improvement. Further, most of the studies in the medical literature which appear to show benefit from adenoidectomy have been case reports or case series. Such studies are prone to unintentional bias. Finally, a recent study of six thousand children has not shown an association between enuresis and obstructive sleep in general but an increase with advancing severity of obstructive sleep apnea, observed only in girls.

A decline in the frequency of the procedure started in the 1930s as its use became controversial. Tonsillitis and adenoiditis requiring surgery became less frequent with the development of antimicrobial agents and a decline in upper respiratory infections among older school-aged children. Also, several studies had shown that adenoidectomy and tonsillectomy was ineffective for many of the indications used at that time as well as the suggestion of an increased risk of developing poliomyelitis after the procedure, later disproved. Prospective clinical trials, performed over the last 2 decades, have redefined the appropriate indications for tonsillectomy and adenoidectomy (T&A), tonsillectomy alone, and adenoidectomy alone.

Frequency

Removed adenoid

In 1971, more than one million Americans underwent tonsillectomies and/or adenoidectomies, of which 50,000 consisted of adenoidectomy alone.

By 1996, roughly a half million children underwent some surgery on their adenoids and/or tonsils in both outpatient and inpatient settings. This included approximately 60,000 tonsillectomies, 250,000 combined tonsillectomies and adenoidectomies,  and 125,000 adenoidectomies. By 2006, the total number had risen to over 700,000 but when adjusted for population changes, the tonsillectomy "rate" had dropped from 0.62 per thousand children to 0.53 per thousand. A larger decline for combined tonsillectomy and adenoidectomy was noted - from 2.20 per thousand to 1.46.  There was no significant change in adenoidectomy rates for chronic infectious reasons (0.25 versus 0.21 per 1000.

Indications

The indications for adenoidectomy are controversial. Widest agreement surrounds their removal for obstructive sleep apnea, usually combined with tonsillectomy. Even then, it has been observed that a significant percentage of the study population (18%) did not respond. There is also support for adenoidectomy in recurrent otitis media in children previously treated with tympanostomy tubes.  Finally, the effectiveness of adenoidectomy in children with recurrent upper respiratory tract infections has been questioned with the outcome, in some studies, being no better than watchful waiting.

Etiology

Adenoids develop from a subepithelial infiltration of lymphocytes after the 16th week of embryonic life. They are part of the so-called Waldeyer ring of lymphoid tissue which includes the palatine tonsils and the lingual tonsil.

After birth, enlargement begins and continues until aged 5 to 7 years. Symptomatic enlargement between 18 to 24 months of age is not uncommon, meaning that snoring, nasal airway obstruction and obstructed breathing may occur during sleep. However, this may be reasonably expected to decline when children reach school age, and progressive shrinkage may be expected thereafter.

The establishment of the upper respiratory tract is initiated at birth. Species of bacteria such as lactobacilli, anaerobic streptococci, actinomycosis, Fusobacterium species, and Nocardia are normally present by 6 months of age. Normal flora found in the adenoid consists of alpha-hemolytic streptococci and enterococci, Corynebacterium species, coagulase-negative staphylococci, Neisseria species, Haemophilus species, Micrococcus species, and Stomatococcus species.

Pathophysiology

It is currently believed that bacterial biofilms play an integral role in the harboring of chronic infection by tonsil and adenoid tissue so contributing to recurrent sinusitis and recurrent or persistent ear disease. Also, enlarged adenoids and tonsils may lead to the obstruction of the breathing patterns in children, causing apnea during sleep.

The most common bacteria isolated are Haemophilus influenzae, group A beta-hemolytic Streptococcus, Staphylococcus aureus, Moraxella catarrhalis, and Streptococcus pneumoniea. Heamophilus influenza, Moraxella catarrhalis and Streptococcus pneumonia are the three most resistant pathogens of otitis and rhinosinisitis in children suffering from these diseases.

References

• Darrow D, Siemens C (2002). "Indications for tonsillectomy and adenoidectomy". Laryngoscope 112 (8 Pt 2 Suppl 100): 6–10. doi:10.1002/lary.5541121404. PMID 12172229.
• Derkay C, Darrow D, LeFebvre S (1995). "Pediatric tonsillectomy and adenoidectomy procedures". AORN J 62 (6): 885–904. doi:10.1016/S0001-2092(06)63556-4. PMID 9128745.

External links

• Adenoidectomy Information
• Adenoidectomy at eMedicine

UpToDate Contents

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• 1. 小児におけるアデノイド切除：術後ケアおよび合併症 adenoidectomy in children postoperative care and complications
• 2. Tonsillectomy and adenoidectomy in children: Indications and contraindications
• 3. 小児における扁桃摘出、アデノイド切除：術前および術中のケア tonsillectomy and or adenoidectomy in children preoperative and intraoperative care
• 4. 小児における扁桃摘出（アデノイド切除同時施行例を含む）：術後ケアおよび合併症 tonsillectomy with or without adenoidectomy in children postoperative care and complications
• 5. 小児における滲出性（漿液性）中耳炎のマネージメント management of otitis media with effusion serous otitis media in children

English Journal

• Correlation of mucociliary clearance and symptomatology before and after adenoidectomy in children.

• Arnaoutakis D, Collins WO.SourceUniversity of Florida College of Medicine, United States.
• International journal of pediatric otorhinolaryngology.Int J Pediatr Otorhinolaryngol.2011 Oct;75(10):1318-21. Epub 2011 Aug 17.
• OBJECTIVE: The goal of this study is to better understand the role of adenoid hypertrophy and its impact on mucociliary clearance as it relates to the symptoms of chronic sinusitis in children. More specifically, the goal is to better understand which symptoms of chronic rhinosinusitis might be most
• PMID 21851991

• Comparison of two minimally invasive techniques for treating chronic rhinosinusitis in the pediatric population.

• Deckard NA, Kruper GJ, Bui T, Coticchia J.SourceWayne State University, Department of Otolaryngology, Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI 48201, United States.
• International journal of pediatric otorhinolaryngology.Int J Pediatr Otorhinolaryngol.2011 Oct;75(10):1296-300. Epub 2011 Aug 10.
• OBJECTIVE: To compare two minimally invasive techniques for the treatment of chronic rhinosinusitis in young children.BACKGROUND: Chronic rhinosinusitis (CRS) is a common diagnosis in young children. Maxillary sinus aspiration & irrigation with adenoidectomy (MSI) followed by an extended course
• PMID 21831457

Japanese Journal

• 治療と対策-治療効果の予測含めて

• 新谷 朋子,才川 悦子,氷見 徹夫,宮崎 総一郎
• 小児耳鼻咽喉科 31(3), 216-219, 2010-12-01
• NAID 10027695892

• 乳幼児OSAHSに対する手術治療の安全性に関する臨床的検討

• 能田 淳平,濱田 昌史,松本 昇,宋 碩柱,兵頭 政光
• 頭頸部外科 20(1), 57-61, 2010
• 幼齢の閉塞性睡眠時無呼吸低呼吸症候群（以下OSAHS）症例に対する外科的治療の安全性を検討するため，2004年4月より2008年12月までに当科にて治療をした147例を年少群（0?3歳）と年長群（4?6歳）に分けて比較検討した。検討項目は口蓋扁桃摘出術及びアデノイド切除術の手術時間，術中出血量，術後肺野異常陰影の出現，後出血の有無，術後在院日数である。その結果，年少群のアデノイド切除術において有意 …
• NAID 130000302528

Related Links

• Adenoidectomy - Wikipedia, the free encyclopedia

Adenoidectomy is the surgical removal of the adenoids. They may be removed for several reasons, including impaired breathing through the nose and chronic infections or earaches. The surgery is less common for adults. It is most often done ...

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リンク元	「アデノイド切除術」

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英

adenoidectomy

同

咽頭扁桃切除術 adenotomy

関

アデノイド切除。ベックマン式咽頭扁桃切除刀、ラ・フォース咽頭扁桃切除刀