Adult ; Female ; Humans ; Male ; Tonsillectomy ; instrumentation ; methods ; Ultrasonic Therapy ; instrumentation

Child ; Humans ; Polysomnography ; Sleep Apnea Syndromes ; physiopathology ; surgery ; Tonsillectomy ; methods

PURPOSE: This study aimed at developing a critical pathway for the children undergoing tonsillectomy. METHOD: Six steps of critical pathway developmental process were used based on the literature review. The researcher reviewed 70 medical records of children who had tonsillectomy between January 4th and April 30th, 2001. They received 76 kinds of medical services during six average hospitalization days. Five of them had post-operative bleeding problem. A professional group carefully screened 67 out of 76 medical services and adopted them with five average hospitalization days as the critical pathway framework. This framework was applied to 34 children undergoing tonsillectomy during June 1st through August 21st, 2001. RESULT: The children who used the pathways with five average hospitalization days had post-operative bleeding problem. In other words, the group who utilized the critical pathway resulted in better outcomes compared to the group who did not use the tool. CONCLUSION: Since the critical pathway is an efficient care management tool, nurses need to participate more positively participate in developing and utilizing the tool for other health problem.
Child ; Critical Pathways* ; Hemorrhage ; Hospitalization ; Humans ; Medical Records ; Methods ; Tonsillectomy*

The feasibility of partial tonsillectomy was reviewed. Compared with total tonsillectomy, partial tonsillectomy has the advantages of less postoperative pain, lower postoperative bleeding rate and faster recovery. Partial tonsillectomy has a potential for tonsil regrowth and its efficacy in treating sleep-disordered breathing in children is still controversial.
Humans ; Sleep Apnea, Obstructive ; surgery ; Tonsillectomy ; adverse effects ; methods

The purpose of this study was to evaluate the effect of informational intervention on postoperative pain following tonsillectomy in children. This study was performed on 30 children, aged 5-15 years, undergoing tonsillectomy and their parents by providing informational intervention with colored figure; operation procedure and information. Pain assessment was done by Pain Questionnaire. The results from this study were as follows : 1. Children in experimental group with mean 16.07 had lower pain scores than control group with mean 14.87 at 4th hours after operation(p < 0.05). It showed "significant difference" and first hypothesis was adopted. 2. Children in experimental group with mean 20.60 had lower pain scores than control group with mean 17.27 at 8th hours after operation(p < 0.05). It showed "significant difference" and second hypothesis was adopted. 3. Children in experimental group with mean 28.80 had lower pain scores than control group with mean 25.70 at 24th hours after operation(p < 0.05). It showed "significant difference" and third hypothesis was adopted. 4. When we analyzed the time difference and difference between two groups simultaneously by repeated measure ANOVA, the significant difference was not found. And so "the experiential group with operation-related information will show the lower pain sense than the control group just as the time flows after operation", fourth hypothesis was rejected. Generally, it was found that providing information about operation to children and their parents reduced effectively postoperative pain in children, but in clinical settings there are minimum preoperative information-providing because of insufficient time and inconvenience although nursing staffs and patients know its needs. Conclusionally providing preoperative information should help children and their parents cope with Pre, Peri and Post operative events effectively.
Adenoidectomy ; Analysis of Variance ; Child* ; Humans ; Methods ; Nursing Staff ; Pain Measurement ; Pain, Postoperative* ; Parents ; Tonsillectomy* ; Child Health

Adolescent ; Child ; Child, Preschool ; Electrosurgery ; Female ; Humans ; Male ; Tonsillectomy ; instrumentation ; methods

BACKGROUND AND OBJECTIVES: Adenotonsillectomy is a highly effective treatment for obstructive sleep apnea symptoms in children. In this study, to investigate the effects of adenotonsillectomy on snoring in children, we analyzed and compared snoring sounds recorded using a smartphone before and after adenotonsillectomy. We also determined whether it is possible to use acoustic analysis to monitor snoring in children. SUBJECTS AND METHOD: A total of 20 children diagnosed with snoring and had undergone adenotonsillectomy performed by the same surgeon were enrolled for the study. Snoring was recorded by patients' caregivers using smartphones before and after the surgery (mean of 8.5 days) and analyzed. Questionnaires were conducted by telephone survey at 3 months and 12 months after the surgery to determine snoring status. RESULTS: Snoring completely ceased in 25% of patients and decreased in the remaining 75% during the immediate follow-up period (mean of 8.5 days; from 58.07±9.35 dB to 42.59±7.89 dB, p<0.001), and disappeared in all of the patients by 3 months after adenotonsillectomy. Snoring recurred only in one patient after 1 year. A frequency analysis offered no evident statistically significant changes during the immediate follow-up period, indicating that although snoring volume had decreased, no anatomical change had developed in the patient. Spectrography was useful in investigating the snoring patterns before and after adenotonsillectomy. CONCLUSION: The results showed that acoustic analysis of snoring sounds obtained using a smartphone may be useful for monitoring snoring during follow-up after adenotonsillectomy in pediatric snoring patients.
Acoustics* ; Caregivers ; Child* ; Follow-Up Studies ; Humans ; Methods ; Sleep Apnea, Obstructive ; Smartphone* ; Snoring* ; Telephone ; Tonsillectomy

BACKGROUND AND OBJECTIVES: Diagnosis by Related Groups (DRG), a system forcibly implemented in all medical institutions from July 2013, was applied to tonsillectomy and adenoidectomy in the field of Otorhinolaryngology. We analyzed the changes in medical costs and evaluated the efficiency of the DRG system by analyzing the data collected before and after the DRG implementation. SUBJECTS AND METHOD: We analyzed the total number of cases, total medical costs and per charge for tonsillectomy and adenoidectomy using the data from the Korean National Health Insurance from 2011 to 2014. We compared the number and cost of tonsillectomy and adenoidectomy by hospital type, region, and patient age. RESULTS: The total number of tonsillectomy and adenoidectomy after the application of DRG systems in July 2013 in all medical institutions was reduced, but the total costs showed a tendancy to increase, resulting in an increase per charge of case. The number of tonsillectomy and adenoidectomy was decreased in general and specialized hospitals, but the costs were increased after DRG systems. CONCLUSION: Medical costs per charge of case related to tonsillectomy and adenoidectomy was higher in the DRG system than in the 'fee for service' system. Increased medical costs, considered to be the most likely cause of patient copayments, are recognized in the DRG system. The results showed that saving effect of medical costs was not significant in the DRG system; it may appear to relieve patient burden in the short term, but the financial state of national health insurance is worsening.
Adenoidectomy ; Diagnosis* ; Diagnosis-Related Groups ; Humans ; Insurance, Health* ; Methods ; National Health Programs ; Otolaryngology ; Tonsillectomy*

BACKGROUND AND OBJECTIVES: Pediatric obstructive sleep apnea (OSA) can have an effect on the quality of life (QOL) such as behavior, school performance, emotional distress and daytime function. We aim to verify changes in sleep disordered breathing based on polysomnographic findings and disease specific health related QOL before and after adenotonsillectomy in Korean children with OSA. SUBJECTS AND METHOD: A total 20 children aged 3 through 13 years old (mean age=6.7 years old and male/female=14/6) with OSA were included. We evaluated respiratory disturbances in patients using the standard polysomnography and the OSA-specific health related QOL based on Korean Obstructive Sleep Apnea-18 Survey (KOSA-18). RESULTS: There were significant improvements in apnea-hypopnea index (from 9.4±7.4 to 1.1±0.8 events/hour, p<0.001) and total score of KOSA-18 (71.3±26.0 to 33.6±10.7, p<0.001) after adenotonsillectomy. CONCLUSION: Sleep disordered breathing and QOL improve significantly after adenotonsillectomy in Korean OSA children.
Adenoidectomy ; Child ; Humans ; Methods ; Polysomnography ; Quality of Life* ; Sleep Apnea Syndromes* ; Sleep Apnea, Obstructive* ; Tonsillectomy

BACKGROUND AND OBJECTIVES: Optimal electrical power required for diathermy during tonsillectomy has not been determined. The aim of this pilot study was to evaluate and compare surgical outcomes of using diathermy power settings at 15 watts (W) and 25W for monopolar microdissection and bipolar hemostasis during tonsillectomy. SUBJECTS AND METHOD: This prospective, single-center, single-blind, randomized study was conducted on 92 patients who underwent 15W or 25W monopolar microdissection and bipolar hemostasis for tonsillectomy. Operation times, post-operative pain severities, and rates of hemorrhage were compared between the 15W and 25W groups. RESULTS: The 92 patients were randomized equally into two study groups. The mean operation duration for the 15W group was significantly longer than in the 25W group (18.5±6.11 versus 13.4±6.04 minutes, p<0.01). The rate of minimal hemorrhage (defined as an episode of bleeding not significant enough for hospital visitation) for the 15W group was significantly higher than for the 25W group (41.3% versus 20.5%, p<0.05). No significant intergroup difference was observed between the rates of primary or secondary hemorrhage or postoperative pain scores. CONCLUSION: Twenty-five watt monopolar microdissection and bipolar hemostasis for tonsillectomy had a shorter mean operation time and a lower post-operative minimal hemorrhage rate than 15W monopolar microdissection and bipolar hemostasis.
Diathermy* ; Hemorrhage ; Hemostasis* ; Humans ; Methods ; Microdissection* ; Operative Time ; Pain, Postoperative ; Pilot Projects ; Prospective Studies ; Tonsillectomy*