Matches in SemOpenAlex for { <https://semopenalex.org/work/W22933132> ?p ?o ?g. }
- W22933132 endingPage "Doc07" @default.
- W22933132 startingPage "Doc07" @default.
- W22933132 abstract "Surgery of the tonsils is still one of the most frequent procedures during childhood. Due to a series of fatal outcomes after hemorrhage in children in Austria in 2006, the standards and indications for tonsillectomy have slowly changed in Germany. However, no national guidelines exist and the frequency of tonsil surgery varies across the country. In some districts eight times more children were tonsillectomized than in others. A tonsillectomy in children under six years should only be done if the child suffers from recurrent acute bacterially tonsillitis. In all other cases (i.e. hyperplasia of the tonsils) the low risk partial tonsillectomy should be the first line therapy. Postoperative pain and the risk of hemorrhage are much lower in partial tonsillectomy (=tonsillotomy). No matter whether the tonsillotomy is done by laser, radiofrequency, shaver, coblation, bipolar scissor or Colorado needle, as long as the crypts are kept open and some tonsil tissue is left behind. Total extracapsular tonsillectomy is still indicated in severely affected children with recurrent infections of the tonsils, allergy to antibiotics, PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis) and peritonsillar abscess. With regard to the frequency and seriousness of the recurrent tonsillitis the indication for tonsillectomy in children is justified if 7 or more well-documented, clinically important, adequately treated episodes of throat infection occur in the preceding year, or 5 or more of such episodes occur in each of the 2 preceding years (according to the paradise criteria). Diagnosis of acute tonsillitis is clinical, but sometimes it is hard to distinguish viral from bacterial infections. Rapid antigen testing has a very low sensitivity in the diagnosis of bacterial tonsillitis and swabs are highly sensitive but take a long time. In all microbiological tests the treating physician has to keep in mind, that most of the bacterials, viruses and fungi belong to the healthy flora and do no harm. Ten percent of healthy children even bear strepptococcus pyogenes all the time in the tonsils with no clinical signs. In these children decolonization is not necessary. Therefore, microbiological screening tests in children without symptoms are senseless and do not justify an antibiotic treatment (which is sometimes postulated by the kindergartens). The acute tonsillitis should be treated with steroids (e.g. dexamethasone), NSAIDs (e.g. ibuprofene) and betalactam antibiotics (e.g. penicillin or cefuroxime). With respect to the symptom reduction and primary healing the short-term late-generation antibiotic therapy (azithromycin, clarithromycin or cephalosporine for three to five days) is comparable to the long-term penicilline therapy. There is no difference in the course of healing, recurrence or microbiological resistance between the short-term penicilline therapy and the standard ten days therapy. On the other hand, only the ten days antibiotic therapy has proven to be effective in the prevention of rheumatic fever and glomerulonephritic diseases. The incidence of rheumatic heart disease is currently 0.5 per 100,000 children of school age. The main morbidity after tonsillectomy is pain and the late haemorrhage. Posttonsillectomy bleeding can occur till the whole wound is completely healed, which is normally after three weeks. Life-threatening haemorrhages occur often after smaller bleedings, which can spontaneously cease. That is why every haemorrhage, even the smallest, has to be treated properly and in ward. Patients and parents have to be informed about the correct behaviour in case of haemorrhage with a written consent before the surgery. The handout should contain important addresses, phone numbers and contact persons. Almost all cases of fatal outcome after tonsillectomy were due to false management of haemorrhage. Haemorrhage in small children can be especially life-threatening because of the lower blood volume and the danger of aspiration with asphyxia. A massive haemorrhage is an extreme challenge for every paramedic or emergency doctor because of the difficult airway management. Intubation is only possible with appropriate inflexible suction tubes. All different surgical techniques have the risk of haemorrhage and even the best surgeon will experience a postoperative haemorrhage. The lowest risk of haemorrhage is after cold dissection with ligature or suturing. All hot techniques with laser, radiofrequency, coblation, mono- or bipolar forceps have a higher risk of late haemorrhage. Children with a hereditary coagulopathy have a higher risk of haemorrhage. It is possible, that these children were not identified before surgery. Therefore it is recommended by the Society of paediatrics, anaesthesia and ENT, that a standardised questionnaire should be answered by the parents before tonsillectomy and adenoidectomy. This 17-point-checklist questionnaire is more sensitive and easier to perform than a screening with blood tests (e.g. INR and PTT). Unfortunately, a lot of surgeons still screen the children preoperatively by coagulative blood tests, although these tests are inappropriate and incapable of detecting the von Willebrand disease, which is the most frequent coagulopathy in Europe. The preoperative information about the surgery should be done with the child and the parents in a calm and objective atmosphere with a written consent. A copy of the consent with the signature of the surgeon and both custodial parents has to be handed out to the parents." @default.
- W22933132 created "2016-06-24" @default.
- W22933132 creator A5075741125 @default.
- W22933132 date "2014-01-01" @default.
- W22933132 modified "2023-10-12" @default.
- W22933132 title "Tonsillitis and sore throat in children." @default.
- W22933132 cites W118866748 @default.
- W22933132 cites W122718341 @default.
- W22933132 cites W133442400 @default.
- W22933132 cites W133692813 @default.
- W22933132 cites W144491527 @default.
- W22933132 cites W1487016743 @default.
- W22933132 cites W152723690 @default.
- W22933132 cites W1531203897 @default.
- W22933132 cites W1565526581 @default.
- W22933132 cites W1567156856 @default.
- W22933132 cites W1592176024 @default.
- W22933132 cites W1593750203 @default.
- W22933132 cites W1593784418 @default.
- W22933132 cites W1646003564 @default.
- W22933132 cites W167074831 @default.
- W22933132 cites W16955094 @default.
- W22933132 cites W1764222411 @default.
- W22933132 cites W182437799 @default.
- W22933132 cites W1868345323 @default.
- W22933132 cites W1899445442 @default.
- W22933132 cites W1930710867 @default.
- W22933132 cites W1942427735 @default.
- W22933132 cites W1957096219 @default.
- W22933132 cites W1965580277 @default.
- W22933132 cites W1966128925 @default.
- W22933132 cites W1967452251 @default.
- W22933132 cites W1969558815 @default.
- W22933132 cites W1971760062 @default.
- W22933132 cites W1973199027 @default.
- W22933132 cites W1973663494 @default.
- W22933132 cites W1974830583 @default.
- W22933132 cites W1975117315 @default.
- W22933132 cites W1975146034 @default.
- W22933132 cites W1975266447 @default.
- W22933132 cites W1975342728 @default.
- W22933132 cites W1975391517 @default.
- W22933132 cites W1976496426 @default.
- W22933132 cites W1977302004 @default.
- W22933132 cites W1977600418 @default.
- W22933132 cites W1978033020 @default.
- W22933132 cites W1979702887 @default.
- W22933132 cites W1980591406 @default.
- W22933132 cites W1982010188 @default.
- W22933132 cites W1983820249 @default.
- W22933132 cites W1984337579 @default.
- W22933132 cites W1986322084 @default.
- W22933132 cites W1986486298 @default.
- W22933132 cites W1987305871 @default.
- W22933132 cites W1987978405 @default.
- W22933132 cites W1988382736 @default.
- W22933132 cites W1988638383 @default.
- W22933132 cites W1991834988 @default.
- W22933132 cites W1992856976 @default.
- W22933132 cites W1993307769 @default.
- W22933132 cites W1994583813 @default.
- W22933132 cites W1994873695 @default.
- W22933132 cites W1997805086 @default.
- W22933132 cites W1998101889 @default.
- W22933132 cites W1998106704 @default.
- W22933132 cites W1998716340 @default.
- W22933132 cites W2000822290 @default.
- W22933132 cites W2001807066 @default.
- W22933132 cites W2002749488 @default.
- W22933132 cites W2008001942 @default.
- W22933132 cites W2008106194 @default.
- W22933132 cites W2008623535 @default.
- W22933132 cites W2012209584 @default.
- W22933132 cites W2012735724 @default.
- W22933132 cites W2013268584 @default.
- W22933132 cites W2014020336 @default.
- W22933132 cites W2014236273 @default.
- W22933132 cites W2014427949 @default.
- W22933132 cites W2015503812 @default.
- W22933132 cites W2019007559 @default.
- W22933132 cites W2019019431 @default.
- W22933132 cites W2019970876 @default.
- W22933132 cites W2020234441 @default.
- W22933132 cites W2021317407 @default.
- W22933132 cites W2022195561 @default.
- W22933132 cites W2022499157 @default.
- W22933132 cites W2022584023 @default.
- W22933132 cites W2022591987 @default.
- W22933132 cites W2023323277 @default.
- W22933132 cites W2023768451 @default.
- W22933132 cites W2024596748 @default.
- W22933132 cites W2024623733 @default.
- W22933132 cites W2024954249 @default.
- W22933132 cites W2029504148 @default.
- W22933132 cites W2029671126 @default.
- W22933132 cites W2031984343 @default.
- W22933132 cites W2033170256 @default.
- W22933132 cites W2033589583 @default.