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Tonsillectomy compared to acute tonsillitis in children: a comparison study of societal costs
No full textTonsillectomy compared to acute tonsillitis in children: a comparison study of societal cost. Introduction and aim: Tonsillectomy is one of the most commonly performed surgical procedures in children; its main indications are recurrent episodes of acute tonsillitis and adenotonsillar hypertrophy. The effectiveness of tonsillectomy for severe recurrent tonsillitis is generally accepted; however its socio-economic cost is less well investigated. This study aims to determine and compare the societal cost of a tonsillectomy and a severe throat infection. Materials and methods: The costs for both tonsillectomy and severe throat infection were evaluated. Costs of the surgical procedure and hospital stay were calculated based on resource use and personnel input at the participating hospital. The cost of work-related disability for both treatments was measured based on a questionnaire filled in by 275 parents of children undergoing a tonsillectomy. Data from two Belgian institutions (NIS and FOD) were used to calculate the cost of parents' absenteeism. Results: An episode of acute tonsillitis in the child results in a longer period of parents' work absenteeism (mean of 3.1 +/- 0.3 days) compared to tonsillectomy (2.2 +/- 0.2 days). The cost of economic productivity loss amounts to (sic) 613 (NIS) or (sic) 759 (FOD) for acute tonsillitis and (sic) 435 (NIS) or (sic) 539 (POD) for a tonsillectomy. The medical costs linked to the surgical procedure at the local department correspond to (sic) 535 and for an acute tonsillitis to (sic) 46. Conclusions: From societal perspective, a tonsillectomy costs the equivalent of 1.4 times the cost of a severe throat infection. This indicates that in children suffering from recurrent acute tonsillitis, watchful waiting results in a higher cost compared to tonsillectomy, given the cumulative costs of parents' absenteeism
Effect of adenotonsillectomy on the use of respiratory medication
No full textOBJECTIVE: Recurrent tonsillitis and upper respiratory tract obstruction due to adenotonsillar hypertrophy are the most common indications for (adeno)tonsillectomy ((A)TE). Symptoms of upper respiratory tract infection and obstruction can, however, be attributed to lower airway pathology and thus treated with respiratory medication - this is non-antimicrobial medication used for lower respiratory diseases like bronchitis, bronchiolitis, asthma and episodic wheezing. The aim of this study is to investigate the effect of the current (A)TE practice in Belgium on the use of respiratory medication in subjects aged 0-15. METHODS: Retrospective data on 11.114 subjects aged 0-15years old who underwent (A)TE from January 1st 2002 until Sept 30th 2003 were retrieved from the database of the Christelijke Mutualiteit, the largest mutual health insurance society in Belgium. We compared the use of respiratory medication 12months before and 12months after (A)TE. RESULTS: Out of 11.114 subjects, 4.654 received at least one prescription for respiratory medication in the year before and/or after (A)TE. In this subgroup, the median respiratory medication use reduced with 32% in the year after surgery. CONCLUSION: Compared with the year before surgery, the median use of respiratory medication in subjects aged 0-15 drastically reduces in the year after (A)TE. A possible reason for this reduction is that children with upper airway obstruction and infections are often wrongly diagnosed as having lower airway problems
Tonsillectomy compared to acute tonsillitis in children: a comparison study of societal costs
No full textTonsillectomy compared to acute tonsillitis in children: a comparison study of societal cost. Introduction and aim: Tonsillectomy is one of the most commonly performed surgical procedures in children; its main indications are recurrent episodes of acute tonsillitis and adenotonsillar hypertrophy. The effectiveness of tonsillectomy for severe recurrent tonsillitis is generally accepted; however its socio-economic cost is less well investigated. This study aims to determine and compare the societal cost of a tonsillectomy and a severe throat infection. Materials and methods: The costs for both tonsillectomy and severe throat infection were evaluated. Costs of the surgical procedure and hospital stay were calculated based on resource use and personnel input at the participating hospital. The cost of work-related disability for both treatments was measured based on a questionnaire filled in by 275 parents of children undergoing a tonsillectomy. Data from two Belgian institutions (NIS and FOD) were used to calculate the cost of parents' absenteeism. Results: An episode of acute tonsillitis in the child results in a longer period of parents' work absenteeism (mean of 3.1 +/- 0.3 days) compared to tonsillectomy (2.2 +/- 0.2 days). The cost of economic productivity loss amounts to (sic) 613 (NIS) or (sic) 759 (FOD) for acute tonsillitis and (sic) 435 (NIS) or (sic) 539 (POD) for a tonsillectomy. The medical costs linked to the surgical procedure at the local department correspond to (sic) 535 and for an acute tonsillitis to (sic) 46. Conclusions: From societal perspective, a tonsillectomy costs the equivalent of 1.4 times the cost of a severe throat infection. This indicates that in children suffering from recurrent acute tonsillitis, watchful waiting results in a higher cost compared to tonsillectomy, given the cumulative costs of parents' absenteeism
The Importance of Frailty in Older Adults With Benign Paroxysmal Positioning Vertigo
No full textBackground and Purpose: Even though Benign Paroxysmal Positioning Vertigo (BPPV) is one of the most reported vestibular disorders, its interaction with frailty and postural control in older adults is hardly or not investigated. Methods: Thirty-seven older adults (≥65 years) with a diagnosis of BPPV (oaBPPV) (mean age 73.13 (4.8)) were compared to 22 age-, weight-, and height-matched controls (mean age 73.5 (4.5)). Modified Fried criteria were used to assess frailty. Postural control was assessed with the timed chair stand test, mini Balance Systems Evaluation test (mini-BESTest), a Clinical Test of Sensory Interaction on Balance (CTSIB), and 10-m walk test. Falls were inquired. The Dizziness Handicap Inventory, Falls Efficacy Scale, and 15-item Geriatric Depression Scale assessed dizziness-related handicap, fear of falling, and feelings of depression, respectively. To assess the importance of frailty, all variables were also compared between frail oaBPPV, robust oaBPPV, and robust controls in a sub-analysis. The significance level was set at α = 0.05. Results: oaBPPV reported significantly more multiple falls (P = 0.05) and difficulties to remain standing with increasing task difficulty of the CTSIB (P = 0.004). They were significantly more (pre-)frail compared to controls (P < 0.001). Moreover, frail oaBPPV had a significantly decreased reactive postural control (P < 0.001) and dynamic gait (P < 0.001). Their fear of falling (P < 0.001) and dizziness-related handicap (P < 0.001) were significantly higher compared to robust oaBPPV. Discussion and Conclusions: oaBPPV were less healthy and more (pre-)frail compared to controls, impacting their daily functioning. Future research should investigate whether frailty and postural control were already decreased before the BPPV onset and if this recovers after treatment with repositioning maneuvers or if additional rehabilitation is necessary. Impact Statement: Older adults with Benign Paroxysmal Positional Vertigo (BPPV) can present with an impaired sensory orientation, declined cognition, significantly more multiple falls, and (pre-) frailty compared to controls. Moreover, frail older adults with BPPV also had a significantly decreased reactive postural control and dynamic gait, and an increased odds of falling compared to robust controls. BPPV and frailty appear to be linked with each other, which cannot be ignored in future research and clinicians treating older adults with BPPV.</p
Co-Existing Vestibular Hypofunction Impairs Postural Control, but Not Frailty and Well-Being, in Older Adults with Benign Paroxysmal Positional Vertigo
No full textVestibular hypofunction occurs in 29.5% of older adults with benign paroxysmal positional vertigo (BPPV), but its impact on postural control, well-being and frailty was not studied before. This study compared the well-being, frailty and postural control between older adults with BPPV and vestibular hypofunction (oaBPPV+), and older adults with only BPPV (oaBPPV). Thirty-one older adults (=65 years old) diagnosed with BPPV were recruited. Unilateral vestibular hypofunction was defined as a >25% caloric asymmetry, and bilateral vestibular hypofunction as a total response <6°/s per ear, using bithermal caloric irrigations. The oaBPPV+ group was compared to the oaBPPV group using the measures of well-being (Dizziness Handicap Inventory, Falls Efficacy Scale and 15-item Geriatric Depression Scale), frailty (Modified Fried Criteria), and postural control (timed chair stand test, mini-Balance Evaluation Systems test and Clinical Test of Sensory Interaction on Balance (CTSIB)). Falls and the number of repositioning maneuvers were documented. Significance level was set at a = 0.05. Unilateral vestibular hypofunction was present in 32% of participants, mainly in females ( = 0.04). Bilateral vestibular hypofunction was not found. The oaBPPV+ group ( = 10, mean age 72.5 (4.5)) experienced more comorbidities ( = 0.02) than the oaBPPV group ( = 21, mean age 72.6 (4.9)). Groups did not differ regarding dizziness symptoms ( = 0.46), fear of falling ( = 0.44), depression ( = 0.48), falls ( = 0.08) or frailty ( = 0.36). However, the oaBPPV+ group showed significantly worse postural control under vestibular-dependent conditions ( < 0.001). Despite equally impaired well-being and frailty, the oaBPPV+ group showed greater sensory orientation deficits. Clinicians and researchers should be alert for co-existing vestibular hypofunction in older adults with BPPV, since this may exacerbate their already impaired postural control more than only BPPV
Antibiotic use and doctor visits are reduced after adenotonsillectomy
No full textOBJECTIVE A tonsillectomy, with or without an adenotomy ((A)TE), is a common surgical procedure in children. The most important indications are recurrent tonsillitis and upper airway obstruction secondary to adenotonsillar hypertrophy. The aim of this study was to investigate whether the current (A)TE practice in Belgium reduced the need for medical care. STUDY DESIGN AND METHODS The database of the Christelijke Mutualiteit, one of the most important health insurance organizations in Belgium, provided data on approximately 11,000 (A)TE's in children aged 0 to 15 years, performed by different ENT-specialists from Jan 1st 2002 to Sept 30th 2003. We compared the use of antibiotics during the 12 months before and the 12 months after (A)TE. We also compared the number of visits to pediatricians and general practitioners during the 12 months before and the 12 months after surgery. RESULTS The median antibiotic use dropped from 4 boxes in the year before the operation to 1 box in the year after the operation. The median number of doctor visits also dropped from 7 visits in the year before to 4 visits in the year after (A)TE. CONCLUSION Although there are no generally accepted guidelines on the indications for (A)TE in Belgium, the current practice effectively reduced the need for medical care
(Adeno)tonsillectomy: what is the impact on the immune system?
No full textObjectives: The effect of (adeno) tonsillectomy (ATE) on the immune system is still a point of discussion. In this study, we investigate the local and systemic immunological consequences of removing (adeno) tonsillar tissue, based on changes in immunoglobulin (Ig) levels, T and B lymphocyte counts, and frequency of pre- and post-operative upper airway infections. Methodology: We performed a literature review and included six studies examining short-term effects (= 1 year post-operative) of ATE on humoral and cellular immunity. The use of medication, frequency of visits to the doctor, cost-effectiveness of the procedure, and quality of life pre- and post-operatively were also used as outcome parameters for long-term effects. Results: In the short term, only one study showed a significant post-operative decrease in IgA, IgM, and IgG levels, as well as cytotoxic T-lymphocyte count. Two studies noted both a significant decrease in IgG levels and a significant increase in T helper cells. No significant change in Ig levels or lymphocyte counts were observed after ATE in the long term. Conclusion: There is no evidence that ATE compromises the immune system in either the short or long term. Physicians and researchers agree that ATE is an effective treatment for recurrent adenotonsillitis that improves quality of life and reduces the frequency of upper airway infections. However, additional long-term and large-scale studies are needed
(Adeno)tonsillectomy: what is the impact on the immune system?
No full textObjectives: The effect of (adeno) tonsillectomy (ATE) on the immune system is still a point of discussion. In this study, we investigate the local and systemic immunological consequences of removing (adeno) tonsillar tissue, based on changes in immunoglobulin (Ig) levels, T and B lymphocyte counts, and frequency of pre- and post-operative upper airway infections. Methodology: We performed a literature review and included six studies examining short-term effects (= 1 year post-operative) of ATE on humoral and cellular immunity. The use of medication, frequency of visits to the doctor, cost-effectiveness of the procedure, and quality of life pre- and post-operatively were also used as outcome parameters for long-term effects. Results: In the short term, only one study showed a significant post-operative decrease in IgA, IgM, and IgG levels, as well as cytotoxic T-lymphocyte count. Two studies noted both a significant decrease in IgG levels and a significant increase in T helper cells. No significant change in Ig levels or lymphocyte counts were observed after ATE in the long term. Conclusion: There is no evidence that ATE compromises the immune system in either the short or long term. Physicians and researchers agree that ATE is an effective treatment for recurrent adenotonsillitis that improves quality of life and reduces the frequency of upper airway infections. However, additional long-term and large-scale studies are needed
Antibiotic use and doctor visits are reduced after adenotonsillectomy
No full textOBJECTIVE A tonsillectomy, with or without an adenotomy ((A)TE), is a common surgical procedure in children. The most important indications are recurrent tonsillitis and upper airway obstruction secondary to adenotonsillar hypertrophy. The aim of this study was to investigate whether the current (A)TE practice in Belgium reduced the need for medical care. STUDY DESIGN AND METHODS The database of the Christelijke Mutualiteit, one of the most important health insurance organizations in Belgium, provided data on approximately 11,000 (A)TE's in children aged 0 to 15 years, performed by different ENT-specialists from Jan 1st 2002 to Sept 30th 2003. We compared the use of antibiotics during the 12 months before and the 12 months after (A)TE. We also compared the number of visits to pediatricians and general practitioners during the 12 months before and the 12 months after surgery. RESULTS The median antibiotic use dropped from 4 boxes in the year before the operation to 1 box in the year after the operation. The median number of doctor visits also dropped from 7 visits in the year before to 4 visits in the year after (A)TE. CONCLUSION Although there are no generally accepted guidelines on the indications for (A)TE in Belgium, the current practice effectively reduced the need for medical care
Several components of postural control are affected by benign paroxysmal positional vertigo but improve after particle-repositioning maneuvers: A systematic review and meta-analysis
No full textObjective Benign Paroxysmal Positional Vertigo is a vestibular disorder causing vertigo and imbalance. This systematic review and meta-analysis aims to explore the impact of benign paroxysmal positioning vertigo and repositioning maneuvers on postural control. Data Sources In September 2024, PubMed, Web of Science, Scopus and reference lists of included studies were systematically searched. Articles comparing measures of postural control between patients and controls, and/or pre- and posttreatment were considered relevant. Methods Study selection, data extraction and identification of risk of bias were done by two researchers. If possible, meta-analysis was performed with Review Manager version 5.4.1 and standardized mean differences were calculated with a random-effects model. Results Twenty-one of the 37 included studies were useful for meta-analyses. Meta-analyses revealed that benign paroxysmal positional vertigo negatively affects perception of verticality (p < .001; SMD = 0.73; 95% CI = [0.39;1.08]) and sensory orientation (p < .001; SMD = -1.66; 95% CI = [-2.08, -1.23]). The perception of verticality (p < .001; SMD = 0.99; 95% CI = [0.76;1.21]) and sensory orientation (p < .001; SMD = -0.77; 95% CI = [-1.11, -0.44]) improved after treatment with repositioning maneuvers. Results of systematic review indicate stability in gait was impaired, vertigo but improve after repositioning maneuvers. Limits of stability were impaired in older patients, but did not improved after repositioning maneuvers. Conclusion Benign paroxysmal positioning vertigo affects several underlying components of postural control. Repositioning maneuvers can significantly improve the related postural control impairments. This may partly explain the increased odds of falling in these patients, and the positive treatment effect of repositioning maneuvers on falls and fear of falling.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by Special Research Fund of the Hasselt University (grant number
BOF20OWB12) and (grant number BOF21OWB02), respectively for Sara Pauwels and Laura Casters and Maastricht University and Ziekenhuis Oost-Limburg Genk
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