{"id":13352,"date":"2023-10-17T10:22:59","date_gmt":"2023-10-17T10:22:59","guid":{"rendered":"https:\/\/leicesterleicestershireandrutland.icb.nhs.uk\/?p=13352"},"modified":"2023-10-17T10:23:03","modified_gmt":"2023-10-17T10:23:03","slug":"llr-policy-for-tonsillectomy-and-adenoidectomy","status":"publish","type":"post","link":"https:\/\/leicesterleicestershireandrutland.icb.nhs.uk\/pl\/llr-policy-for-tonsillectomy-and-adenoidectomy\/","title":{"rendered":"Polityka LLR dotycz\u0105ca wyci\u0119cia migda\u0142k\u00f3w i adenoidektomii\u00a0"},"content":{"rendered":"

<\/p>\n\n\n\n

Kategoria<\/strong><\/p>\n\n\n\n

Kryteria progowe<\/p>\n\n\n\n

Migda\u0142ki znajduj\u0105 si\u0119 po bokach gard\u0142a i s\u0105 cz\u0119\u015bci\u0105 uk\u0142adu odporno\u015bciowego. S\u0105 potrzebne przez pierwszy rok naszego \u017cycia, ale potem s\u0105 ju\u017c zb\u0119dne. U niekt\u00f3rych os\u00f3b s\u0105 nadreaktywne i staj\u0105 si\u0119 zbyt du\u017ce. Mo\u017ce to powodowa\u0107 chrapanie, oddychanie przez usta, a nawet obturacyjny bezdech senny. Mog\u0105 r\u00f3wnie\u017c wychwytywa\u0107 bakterie, takie jak paciorkowiec i powodowa\u0107 nawracaj\u0105ce zapalenie gard\u0142a.<\/p>\n\n\n\n

Najcz\u0119stsz\u0105 przyczyn\u0105 usuni\u0119cia migda\u0142k\u00f3w jest obturacyjny bezdech senny spowodowany du\u017cym rozmiarem migda\u0142k\u00f3w. Innymi przyczynami usuni\u0119cia migda\u0142k\u00f3w s\u0105 nawracaj\u0105ce infekcje anginy, ropie\u0144 oko\u0142omigda\u0142kowy, przewlek\u0142y b\u00f3l gard\u0142a lub u doros\u0142ych podejrzenie choroby nowotworowej. Usuni\u0119cie migda\u0142k\u00f3w nie os\u0142abia uk\u0142adu odporno\u015bciowego.<\/p>\n\n\n\n

Migda\u0142ki s\u0105 podobne do migda\u0142k\u00f3w. Znajduj\u0105 si\u0119 w tylnej cz\u0119\u015bci gard\u0142a nad podniebieniem. Zwykle s\u0105 usuwane u dzieci w tym samym czasie co migda\u0142ki, poniewa\u017c mog\u0105 r\u00f3wnie\u017c powodowa\u0107 zablokowanie oddychania.<\/p>\n\n\n\n

Kwalifikacja do wyci\u0119cia migda\u0142k\u00f3w u doros\u0142ych i dzieci<\/strong><\/p>\n\n\n\n

<\/p>\n\n\n\n

LLR ICB sfinansuje wyci\u0119cie migda\u0142k\u00f3w, je\u015bli wyst\u0105pi\u0105 nast\u0119puj\u0105ce wska\u017aniki kliniczne<\/strong>
\u00a0
\u00b7 Ropie\u0144 oko\u0142omigda\u0142kowy
\u00b7 Ostra niedro\u017cno\u015b\u0107 g\u00f3rnych dr\u00f3g oddechowych
\u00b7 Nawracaj\u0105cy b\u00f3l gard\u0142a, je\u015bli udokumentowano jeden z poni\u017cszych objaw\u00f3w
\u2013 7 lub wi\u0119cej odcink\u00f3w w ci\u0105gu ostatniego roku
\u2013 5 lub wi\u0119cej epizod\u00f3w w ci\u0105gu ostatnich dw\u00f3ch lat
\u2013 3 lub wi\u0119cej odcink\u00f3w w ka\u017cdym z ostatnich trzech lat

I <\/strong>
\u00b7 Znacz\u0105cy powa\u017cny wp\u0142yw na jako\u015b\u0107 \u017cycia wskazany przez
- Nieobecno\u015b\u0107 w pracy
\u2013 Nieobecno\u015b\u0107 w szkole
- Brak prawid\u0142owego rozwoju

ORAZ jedno z poni\u017cszych <\/strong>

o Temperatura s\u0142uchowa co najmniej 38,3\u00b0C
o Bolesne przednie szyjne w\u0119z\u0142y ch\u0142onne
o Wysi\u0119k migda\u0142kowy
o Pozytywny wynik hodowli paciorkowc\u00f3w beta hemolizuj\u0105cych grupy A
o Epizody uniemo\u017cliwiaj\u0105 normalne funkcjonowanie
o Powi\u0119kszenie migda\u0142k\u00f3w prowadz\u0105ce do objaw\u00f3w niedro\u017cno\u015bci<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

<\/p>\n\n\n\n

LLR ICB sfinansuje wyci\u0119cie migda\u0142k\u00f3w w zespole bezdechu sennego u dzieci, je\u015bli spe\u0142niony jest jeden lub wi\u0119cej z poni\u017cszych warunk\u00f3w<\/strong>
\u00a0<\/strong>
\u00b7 Pozytywne badanie snu
LUB<\/strong>
\u00b7 Wykazano istotny wp\u0142yw na jako\u015b\u0107 \u017cycia
LUB<\/strong>
\u00b7 Silna historia kliniczna sugeruj\u0105ca bezdech senny<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Kwalifikacja do adenotomii u dzieci<\/strong><\/p>\n\n\n\n

LLR ICB sfinansuje adenotomi\u0119 u dzieci, u kt\u00f3rych spe\u0142nione s\u0105 nast\u0119puj\u0105ce wskazania kliniczne<\/strong>
\u00a0<\/strong>
\u00b7 Dzieci z wysi\u0119kowym zapaleniem ucha \u015brodkowego (OME), kt\u00f3re spe\u0142niaj\u0105 zalecenia NICE dotycz\u0105ce rurek wentylacyjnych (przelotek) w przypadku utrzymuj\u0105cych si\u0119 i\/lub cz\u0119stych infekcji g\u00f3rnych dr\u00f3g oddechowych

LUB<\/strong>
\u00b7 W przypadku zaburze\u0144 oddychania podczas snu u dzieci, zdiagnozowanych klinicznie. Nale\u017cy udokumentowa\u0107 nast\u0119puj\u0105cy wp\u0142yw na rozw\u00f3j
\u2013 zachowanie np. nadpobudliwo\u015b\u0107, senno\u015b\u0107 w ci\u0105gu dnia
\u2013 jako\u015b\u0107 \u017cycia, np. wzrost i waga
- Niedro\u017cno\u015b\u0107 nosa
\u2013 wielko\u015b\u0107 migda\u0142k\u00f3w

LUB<\/strong>
\u2013 badanie snu (w obecno\u015bci zbyt du\u017cych migda\u0142k\u00f3w)<\/td><\/tr><\/tbody><\/table>

Przewodnictwo<\/strong><\/figcaption><\/figure>\n\n\n\n

<\/p>\n\n\n\n

Wyci\u0119cie migda\u0142k\u00f3w w przypadku nawracaj\u0105cego zapalenia migda\u0142k\u00f3w \u2013 EBI (aomrc.org.uk)<\/a>
\u00a0
NHS Choices \u2013 Zapalenie migda\u0142k\u00f3w
http:\/\/www.nhs.uk\/conditions\/tonsillitis\/Pages\/Introduction.aspx<\/a> \u00a0
\u00a0<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
Data przegl\u0105du LLR ARP 91: 2026 r<\/td><\/tr><\/tbody><\/table><\/figure>","protected":false},"excerpt":{"rendered":"

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