German to English Medical Medical (general) Ear, Nose and Throat (ENT)

German medical report of adenoid and tonsil enlargement that led to adenotonsillectomy. On one separated line it states:

[date]: Adenoide +++, Tons.++, je 2 Umst.

The date listed is the same date the patient was admitted and had the surgery. The surgery was successful. Patient had antibiotic prophyaxis and then after surgery after swelling of uvula put on a steroid as well.

My question is what does Umst. stand for? (in German and/or English translation) I am thinking "Umstellung", but what exactly could that mean here?

I would especially appreciate input with someone familiar with the ENT field and this type of surgery.
I am assuming the +++ and ++ refer to the degree of enlargement of the organs.

Thanks,

Stephen