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Liu Y, Liu T, Li X, Li T, Ma X, Zhao D, Zheng X, Zhao X. Effects of tonsillectomy and adenoidectomy on the immune system. Heliyon 2024; 10:e32116. [PMID: 38975198 PMCID: PMC11226771 DOI: 10.1016/j.heliyon.2024.e32116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 05/25/2024] [Accepted: 05/28/2024] [Indexed: 07/09/2024] Open
Abstract
Surgical removal of the tonsils and adenoids, important immune organs, is a frequent and recurrent class of surgery, and currently, there is no consensus on the effects these surgical procedures may have on the immune system. Here, we examine individual studies on tonsillectomy, adenoidectomy, and adenotonsillectomy, discuss their postoperative humoral and cellular immune changes, and explore their effects on the incidence of related diseases. There is evidence that these three surgeries have no negative effects on humoral immunity; however, there has been contrary results. Furthermore, these procedures seem to have no significant effects on cellular immunity, although tonsil and adenoid removal can cause an increased incidence of certain illnesses, especially infectious diseases. Based on this comprehensive review, we conclude that the removal of tonsils and adenoids does not negatively affect cellular and humoral immunity. However, surgery may lead to an increased incidence of related infectious diseases. This finding may inform the surgeon's decision to perform the procedure in a clinical setting.
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Affiliation(s)
- Yueyang Liu
- Department of Otolaryngology Head and Neck Surgery, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Ting Liu
- Department of Otolaryngology Head and Neck Surgery, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Xinyi Li
- Department of Otolaryngology Head and Neck Surgery, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Tianshu Li
- Department of Otolaryngology Head and Neck Surgery, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Xiangchi Ma
- Department of Otolaryngology Head and Neck Surgery, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Dongxu Zhao
- Department of Otolaryngology Head and Neck Surgery, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Xueke Zheng
- Department of Otolaryngology Head and Neck Surgery, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Xudong Zhao
- Department of Otolaryngology Head and Neck Surgery, Shengjing Hospital of China Medical University, Shenyang, 110004, China
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Onal M, Elsurer C, Duran T, Kocak N, Ulusoy B, Bozkurt MK, Onal O. Possible role of endoplasmic reticulum stress in the pathogenesis of chronic adenoiditis and adenoid hypertrophy: A prospective, parallel-group study. Laryngoscope Investig Otolaryngol 2024; 9:e1240. [PMID: 38596230 PMCID: PMC11002993 DOI: 10.1002/lio2.1240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/22/2024] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
Background Adenoid tissue is a first-line host defense secondary lymphoid organ, especially in childhood. The endoplasmic reticulum (ER) is required to maintain balanced cellular activity. With impaired ER functions, protein accumulation occurs, resulting in ER stress, which plays a role in the etiopathogenesis of many diseases. Objective We aimed to investigate the relationship between ER stress and adenoid tissue disorders, thereby elucidating the mechanisms of immunity-related diseases. Methods Fifty-four pediatric patients (>3 years old) who underwent adenoidectomy for chronic adenoiditis (CA) or adenoid hypertrophy (AH) were enrolled in this prospective, parallel-group clinical study. Adenoids were divided into two groups (CA or AH) based on their size and evaluated for ER stress pathway and apoptosis pathway markers by Real-time PCR and Western blot analysis. Results ER stress pathway markers significantly differed between the CA and AH groups. Children with CA had higher ER stress marker levels than the AH group (p < .001 for ATF-4, ATF-6, and GRP78, and p < .05 for EDEM1, CHOP, EIF2AK3, ERNI, and GRP94). Apoptosis pathway marker levels (BAX and BCL-2) were not different between groups. Conclusions ER stress contributes to the etiopathogenesis of adenoid tissue diseases and the pathogenesis of adenoid tissue disorders, which are part of the immune response. These results may guide the development of new and alternative treatments for immune system disorders.
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Affiliation(s)
- Merih Onal
- Department of OtorhinolaryngologySelcuk University Faculty of MedicineKonyaTurkey
| | - Cagdas Elsurer
- Department of OtorhinolaryngologySelcuk University Faculty of MedicineKonyaTurkey
| | - Tugce Duran
- Department of Medical GeneticsKTO Karatay University Faculty of MedicineKonyaTurkey
| | - Nadir Kocak
- Department of Medical GeneticsSelcuk University Faculty of MedicineKonyaTurkey
| | - Bulent Ulusoy
- Department of OtorhinolaryngologySelcuk University Faculty of MedicineKonyaTurkey
| | - Mete Kaan Bozkurt
- Department of OtorhinolaryngologySelcuk University Faculty of MedicineKonyaTurkey
| | - Ozkan Onal
- Department of Anesthesiology and ReanimationSelcuk University Faculty of MedicineKonyaTurkey
- Outcomes Research ConsortiumCleveland Clinic Main Hospital, Anesthesiology InstituteClevelandOhioUSA
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Liu W, Jiang H, Liu X, Zheng Y, Liu Y, Pan F, Yu F, Li Z, Gu M, Du Q, Li X, Zhang H, Han D. Altered intestinal microbiota enhances adenoid hypertrophy by disrupting the immune balance. Front Immunol 2023; 14:1277351. [PMID: 38090578 PMCID: PMC10715246 DOI: 10.3389/fimmu.2023.1277351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction Adenoid hypertrophy (AH) is a common upper respiratory disorder in children. Disturbances of gut microbiota have been implicated in AH. However, the interplay of alteration of gut microbiome and enlarged adenoids remains elusive. Methods 119 AH children and 100 healthy controls were recruited, and microbiome profiling of fecal samples in participants was performed using 16S rRNA gene sequencing. Fecal microbiome transplantation (FMT) was conducted to verify the effects of gut microbiota on immune response in mice. Results In AH individuals, only a slight decrease of diversity in bacterial community was found, while significant changes of microbial composition were observed between these two groups. Compared with HCs, decreased abundances of Akkermansia, Oscillospiraceae and Eubacterium coprostanoligenes genera and increased abundances of Bacteroides, Faecalibacterium, Ruminococcus gnavus genera were revealed in AH patients. The abundance of Bacteroides remained stable with age in AH children. Notably, a microbial marker panel of 8 OTUs were identified, which discriminated AH from HC individuals with an area under the curve (AUC) of 0.9851 in the discovery set, and verified in the geographically different validation set, achieving an AUC of 0.9782. Furthermore, transfer of mice with fecal microbiota from AH patients dramatically reduced the proportion of Treg subsets within peripheral blood and nasal-associated lymphoid tissue (NALT) and promoted the expansion of Th2 cells in NALT. Conclusion These findings highlight the effect of the altered gut microbiota in the AH pathogenesis.
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Affiliation(s)
- Wenxin Liu
- Department of Clinical Laboratory, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Pediatric Infection, Immunity, and Critical Care Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Huier Jiang
- Department of Clinical Laboratory, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Pediatric Infection, Immunity, and Critical Care Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiling Liu
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
| | - Yue Zheng
- Department of Clinical Laboratory, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Pediatric Infection, Immunity, and Critical Care Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yanan Liu
- Department of Clinical Laboratory, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Pediatric Infection, Immunity, and Critical Care Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fen Pan
- Department of Clinical Laboratory, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Pediatric Infection, Immunity, and Critical Care Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fangyuan Yu
- Department of Clinical Laboratory, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Pediatric Infection, Immunity, and Critical Care Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi Li
- Department of Pathology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Meizhen Gu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qingqing Du
- Department of Clinical Laboratory, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Pediatric Infection, Immunity, and Critical Care Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyan Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hong Zhang
- Department of Clinical Laboratory, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Pediatric Infection, Immunity, and Critical Care Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dingding Han
- Department of Clinical Laboratory, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Pediatric Infection, Immunity, and Critical Care Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Medical School, Guangxi University, Nanning, China
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Hu Z, Dong J, Lou M, Zhang J, Ma R, Wang Y, Gong M, Wang B, Tong Z, Ren H, Zheng G, Zhang Y. Effect of different degrees of adenoid hypertrophy on pediatric upper airway aerodynamics: a computational fluid dynamics study. Biomech Model Mechanobiol 2023; 22:1163-1175. [PMID: 37256522 DOI: 10.1007/s10237-023-01707-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 02/22/2023] [Indexed: 06/01/2023]
Abstract
To improve the diagnostic accuracy of adenoid hypertrophy (AH) in children and prevent further complications in time, it is important to study and quantify the effects of different degrees of AH on pediatric upper airway (UA) aerodynamics. In this study, based on computed tomography (CT) scans of a child with AH, UA models with different degrees of obstruction (adenoidal-nasopharyngeal (AN) ratio of 0.9, 0.8, 0.7, and 0.6) and no obstruction (AN ratio of 0.5) were constructed through virtual surgery to quantitatively analyze the aerodynamic characteristics of UA with different degrees of obstruction in terms of the peak velocity, pressure drop (△P), and maximum wall shear stress (WSS). We found that two obvious whirlpools are formed in the anterior upper part of the pediatric nasal cavity and in the oropharynx, which is caused by the sudden increase in the nasal cross-section area, resulting in local flow separation and counterflow. In addition, when the AN ratio was ≥ 0.7, the airflow velocity peaked at the protruding area in the nasopharynx, with an increase 1.1-2.7 times greater than that in the nasal valve area; the △P in the nasopharynx was significantly increased, with an increase 1.1-6.8 times greater than that in the nasal cavity; and the maximum WSS of the posterior wall of the nasopharynx was 1.1-4.4 times larger than that of the nasal cavity. The results showed that the size of the adenoid plays an important role in the patency of the pediatric UA.
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Affiliation(s)
- Zhenzhen Hu
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Jingliang Dong
- Institute for Sustainable Industries & Liveable Cities, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia
- First Year College, Victoria University, Footscray Park Campus, Footscray, VIC, 3011, Australia
- School of Engineering, RMIT University, Bundoora, VIC, 3083, Australia
| | - Miao Lou
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Jingbin Zhang
- Department of Imaging, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ruiping Ma
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Yusheng Wang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Minjie Gong
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Botao Wang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Zhenbo Tong
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Hongxian Ren
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Guoxi Zheng
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, Shaanxi, China.
| | - Ya Zhang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, Shaanxi, China.
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Gu Z, Wei P, Kou W, Tang XY, Yao HB, Liu EM. Analysis of Multimorbidity of Moderate to Severe Allergic Rhinitis in Children: A Real-World Study. Int Arch Allergy Immunol 2023; 184:882-892. [PMID: 37290409 DOI: 10.1159/000530842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/17/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION Allergic rhinitis (AR) in children is associated with various comorbidities, posing challenges for treatment and management. There have been few investigations of these multimorbidities in Chinese children with AR. Here, we investigated the prevalence of multimorbidities in children with moderate to severe AR and analyzed the influencing factors using real-world data. METHODS In total, 600 children who visited the outpatient clinic of our hospital and were diagnosed with moderate-severe AR were prospectively enrolled. All children underwent allergen detection and electronic nasopharyngoscopy. Parents or guardians completed a questionnaire that included age, sex, mode of delivery, feeding pattern, and familial history of allergy. The multimorbidities investigated included atopic dermatitis (AD), asthma, allergic conjunctivitis (AC), chronic rhinosinusitis (CRS), adenoid hypertrophy (AH), tonsil hypertrophy (TH), recurrent epistaxis, and recurrent respiratory tract infections (RRTIs). RESULTS The AR multimorbidities reported in children were as follows: recurrent epistaxis (46.5%), AC (46.3%), AD (40.7%), asthma (22.5%), RRIs (21.3%), CRS (20.5%), AH (19.7%), and TH (12.5%). In univariate logistic regression analysis, age (<6 years), birth mode, familial history of allergy, and single dust mite allergy were associated with AR multimorbidity (p < 0.05). Multivariate logistic regression revealed that a familial history of allergy was an independent risk factor for AC (odds ratio [OR] = 1.539, 95% confidence interval [CI]: 1.104-2.145) and AH (OR = 1.506, 95% CI: 1.000-2.267) (p < 0.05). Age (<6 years) was independently associated with the risk of AD (OR = 1.405, 95% CI: 1.003-1.969) and RRTIs (OR = 1.869, 95% CI: 1.250-2.793) (p < 0.05), cesarean section with AR and CRS risk (OR = 1.678, 95% CI: 1.100-2.561), and single dust mite allergy with asthma (OR = 1.590, 95% CI: 1.040-2.432) and CRS (OR = 1.600, 95% CI: 1.018-2.515) risk (p < 0.05). Further, non-dust mite allergy was independently associated with AR and CRS (OR = 2.056, 95% CI: 1.084-3.899). CONCLUSION AR was found to be accompanied by different comorbidities, including both allergic and non-allergic comorbidities, complicating disease treatment. These findings demonstrated that age (<6 years), familial history of allergy, types of allergens, and cesarean section were risk factors for different multimorbidities associated with AR.
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Affiliation(s)
- Zheng Gu
- Department of Otolaryngology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China,
| | - Ping Wei
- Department of Otolaryngology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Wei Kou
- Department of Otolaryngology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Xin-Ye Tang
- Department of Otolaryngology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Hong-Bing Yao
- Department of Otolaryngology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - En-Mei Liu
- Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
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Peedikakkal NT, Prakash DRS, Chandrakiran C, Patil SB, Reddy HN. Endoscopic Grading, Radiological Grading and Clinical Features in Children with Chronic Adenoid Hypertrophy: A Correlational Study. Indian J Otolaryngol Head Neck Surg 2023; 75:725-731. [PMID: 37274952 PMCID: PMC10235224 DOI: 10.1007/s12070-022-03438-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023] Open
Abstract
To obtain a correlation between endoscopic findings, radiological findings and clinical features in children with symptomatic Chronic Adenoid hypertrophy. A cross sectional study was conducted in 42 pediatric patients (3-14 years) who visited the Department of Otorhinolaryngology in a tertiary care centre from November 2019 to April 2021 (18 months). The patients were subjected to complete history taking; ENT examination, Rigid nasal endoscopic examination, a lateral X-ray nasopharynx were performed prior to surgery after obtaining consent from the parents of the patients. The endoscopic findings were assessed using ACE grading system and the X-ray nasopharynx was assessed using Adenoid- Nasopharyngeal ratio. A male predominance was noted with mouth breathing, snoring, nasal obstruction and recurrent rhinitis as common presentation. Grade 3 hypertrophy was the most common finding in X-ray Nasopharynx (Mean ANR-0.682). Children with Grade 3 adenoid hypertrophy with more than 50% choanal obstruction and Eustachian tube abutment in nasal endoscopy were noted to be the most symptomatic clinically. A positive correlation between reduced hearing (p value-0.004) and blocked ear sensation (p value- < 0.01) with eustachian tube abutment was noted. The children with more symptoms did not show higher-grade adenoid hypertrophy radiographically in our study. The adenoid- nasopharyngeal ratio on X-ray correlated with endoscopic grading of adenoid hypertrophy (p value-0.006) and degree of choanal obstruction (p value-0.003) but not with the abutment of the eustachian tube. The endoscopic grading correlated with clinical grading, but not the X-ray grading. Hence, endoscopic grading appears to be more accurate in assessing the adenoid size and endoscopic grading is nearer to clinical grading than X-ray grading. Though, the digital X-ray nasopharynx lateral view is a more convenient method, nasal endoscopy is the gold standard method to determine whether the adenoid hypertrophy is clinically significant or not.
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Affiliation(s)
- Nawal Thazhathe Peedikakkal
- Department of Otorhinolaryngology and Head and Neck Surgery, Ramaiah Medical College Hospital, Bangalore, Karnataka 560054 India
| | - D. R. Surya Prakash
- Department of Otorhinolaryngology and Head and Neck Surgery, Ramaiah Medical College Hospital, Bangalore, Karnataka 560054 India
| | - C. Chandrakiran
- Department of Otorhinolaryngology and Head and Neck Surgery, Ramaiah Medical College Hospital, Bangalore, Karnataka 560054 India
| | - Sanjay B. Patil
- Department of Otorhinolaryngology and Head and Neck Surgery, Ramaiah Medical College Hospital, Bangalore, Karnataka 560054 India
| | - Harshavardhan N. Reddy
- Department of Otorhinolaryngology and Head and Neck Surgery, Ramaiah Medical College Hospital, Bangalore, Karnataka 560054 India
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Yang A, Jv M, Zhang J, Hu Y, Mi J, Hong H. Analysis of Risk Factors for Otitis Media with Effusion in Children with Adenoid Hypertrophy. Risk Manag Healthc Policy 2023; 16:301-308. [PMID: 36879827 PMCID: PMC9985384 DOI: 10.2147/rmhp.s399499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/17/2023] [Indexed: 03/03/2023] Open
Abstract
Objective This study aimed to explore whether children with AH have a higher obesity prevalence and analyze the risk factors for otitis media with effusion(OME) in AH children. Methods AH patients aged 3-12 years old that were hospitalized in our hospital for adenoidectomy from June 2020 to September 2022 were included in this study. Height and weight were measured to calculate the body mass index, weight for height and weight z-score to evaluate the development of AH children. Propensity score matching was applied to minimize patient selection bias and adjust for confounding factors to analyze the risk factors for OME in children with AH. Results A total of 887 children with AH were enrolled in this study. The prevalence of overweight or obesity was higher in children with AH than the control group. The size of adenoids is significantly different between AH children with and without OME. For children aged over 5, there are significantly higher counts of white blood cells, neutrophils, and monocytes in the AH children with OME than those without OME. More individuals represent to be atopic in children with OME than those without OME. Conclusion The obstruction of the Eustachian tube is the most important factor of OME in AH children. It seems that there is no apparent correlation between OME and atopic conditions in AH children. In addition to surgical resection of adenoids, active control of infection and inflammation are also important to prevent OME for AH children aged over 5.
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Affiliation(s)
- Anni Yang
- Allergy Center, Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Menglei Jv
- Department of Nephrology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Jun Zhang
- Allergy Center, Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Yuqi Hu
- Allergy Center, Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Jiaoping Mi
- Allergy Center, Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Haiyu Hong
- Allergy Center, Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People's Republic of China
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Ye C, Guo X, Wu J, Wang M, Ding H, Ren X. CCL20/CCR6 Mediated Macrophage Activation and Polarization Can Promote Adenoid Epithelial Inflammation in Adenoid Hypertrophy. J Inflamm Res 2022; 15:6843-6855. [PMID: 36583131 PMCID: PMC9793726 DOI: 10.2147/jir.s390210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Background Adenoid hypertrophy (AH) is a chronic or acute obstruction-related ailment of the upper respiratory tract that arises as an inflammatory response to exposure of bacteria, viruses or allergies. Activation and polarization of macrophages are key processes in inflammation-related disorders like AH and CCL20/CCR6 axis is a critical therapeutic target. Purpose To determine that CCL20/CCR6 mediated macrophage activation and polarization can promote adenoid epithelial inflammation in AH. Methods To support this claim, CCL20 and CCR6 expressions were studied in clinical AH samples. In addition, the expressions of cytokines such as TNF-α, IL-1β, IL-6, IL-17, IL-10 and TGF-β were analysed. In vitro, human adenoid epithelial cells were co-cultured with polarized THP-1 and T lymphocyte H9 cells to study the expressions of several inflammatory markers. Results The expressions of M1 macrophage markers CD86 and IL-17 were significantly increased, whereas the expressions of M2 macrophage markers CD206 and FOXP3 were significantly decreased. The THP-1 cells were successfully polarized to M0, M1 and M2 macrophages. The survival of macrophages improved after 24 hr of induction and enhanced TGF-β expression was observed. The expressions of the inflammatory cytokines IL-6, TNF-α, IL-1β and CCL20 increased significantly. Conclusion Collectively, these results suggest that the CCL20/CCR6 mediated macrophage activation and polarization into M1-type macrophages can promote adenoid epithelial inflammation in AH. Further studies are warranted to determine the roles of inflammatory markers in the pathophysiology of AH and identifying potential targets.
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Affiliation(s)
- Chenchen Ye
- The First Clinical College, Nanjing University of Chinese Medicine, Nanjing, 210046, People’s Republic of China,Department of Pediatrics, Yixing Hospital of Traditional Chinese Medicine, Yixing, 214200, People’s Republic of China
| | - Xinxue Guo
- Department of Pediatrics, Yixing Hospital of Traditional Chinese Medicine, Yixing, 214200, People’s Republic of China
| | - Jiani Wu
- Department of Pediatrics, Yixing Hospital of Traditional Chinese Medicine, Yixing, 214200, People’s Republic of China
| | - Minhua Wang
- Department of Pediatrics, Yixing Hospital of Traditional Chinese Medicine, Yixing, 214200, People’s Republic of China
| | - Haiyan Ding
- Department of Pediatrics, Yixing Hospital of Traditional Chinese Medicine, Yixing, 214200, People’s Republic of China
| | - Xianzhi Ren
- The First Clinical College, Nanjing University of Chinese Medicine, Nanjing, 210046, People’s Republic of China,Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210046, People’s Republic of China,Department of Pediatrics, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, 210046, People’s Republic of China,Correspondence: Xianzhi Ren, Department of Pediatrics, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, 210046, People’s Republic of China, Email
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9
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Zuo L, He L, Huang A, Liu Y, Zhang A, Wang L, Song Y, Geng J. Risk factors and antibiotic sensitivity of aerobic bacteria in Chinese children with adenoid hypertrophy. BMC Pediatr 2022; 22:553. [PMID: 36123658 PMCID: PMC9484187 DOI: 10.1186/s12887-022-03613-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bacterial infection of adenoid is currently considered to be an important cause of adenoid hypertrophy (AH) in children. Although several bacteriology studies on adenoid diseases have been reported, the aerobic bacterial study regarding risk factors and antibiotic sensitivity of AH in Chinese children is lacking. This study aims to investigate the risk factors for aerobic bacterial colonization of AH in Chinese children and to elucidate aerobic bacterial profiles and antibiotic sensitivity. METHODS Samples were collected from the adenoid core and surface tissue of 466 children undergoing adenoidectomy. Aerobic cultures and antibiotic sensitivity were observed. The risk factors for bacterial colonization of adenoid were analyzed statistically. RESULTS A total of 143 children could be detected opportunistic pathogens in adenoid surface and/or core tissue, with a carriage rate of 30.7%. The presence of chronic rhinosinusitis, tonsillar hypertrophy and adenoidal size were the risk factors for aerobic bacterial colonization of adenoid in univariate analysis. Multivariate analysis showed that chronic rhinosinusitis and tonsil hypertrophy were significant variables associated with the aerobic bacterial colonization. The most frequently isolated aerobic bacteria were Haemophilus influenzae, followed by Staphylococcus aureus and Streptococcus pneumoniae. There was no statistically significant difference in bacterial species between the adenoid surface and core. The above common bacteria were more sensitive to cephalosporins and quinolones antibiotics, and significantly resistant to penicillin antibiotics and non-β-lactamase inhibitors. CONCLUSION Our results provide recent aerobic bacterial profiles for AH among Chinese children and confirm the risk factors and antibiotic sensitivity. This study contributes to understanding the role of different risk factors in the development of AH and will be helpful to the treatment of AH among Chinese children.
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Affiliation(s)
- Lujie Zuo
- Department of Otolaryngology, Head and Neck Surgery, Pediatric Clinical Research Centre of Hebei Province, Children's Hospital of Hebei Province, No. 133 Jianhua South Street, Yuhua District, Shijiazhuang, Hebei Province, China
| | - Li He
- Department of Otolaryngology, Head and Neck Surgery, Pediatric Clinical Research Centre of Hebei Province, Children's Hospital of Hebei Province, No. 133 Jianhua South Street, Yuhua District, Shijiazhuang, Hebei Province, China
| | - Aiping Huang
- Department of Otolaryngology, Head and Neck Surgery, Pediatric Clinical Research Centre of Hebei Province, Children's Hospital of Hebei Province, No. 133 Jianhua South Street, Yuhua District, Shijiazhuang, Hebei Province, China
| | - Yingying Liu
- Department of Otolaryngology, Head and Neck Surgery, Pediatric Clinical Research Centre of Hebei Province, Children's Hospital of Hebei Province, No. 133 Jianhua South Street, Yuhua District, Shijiazhuang, Hebei Province, China
| | - Aiying Zhang
- Department of Otolaryngology, Head and Neck Surgery, Pediatric Clinical Research Centre of Hebei Province, Children's Hospital of Hebei Province, No. 133 Jianhua South Street, Yuhua District, Shijiazhuang, Hebei Province, China
| | - Li Wang
- Department of Otolaryngology, Head and Neck Surgery, Pediatric Clinical Research Centre of Hebei Province, Children's Hospital of Hebei Province, No. 133 Jianhua South Street, Yuhua District, Shijiazhuang, Hebei Province, China
| | - Yingluan Song
- Department of Otolaryngology, Head and Neck Surgery, Pediatric Clinical Research Centre of Hebei Province, Children's Hospital of Hebei Province, No. 133 Jianhua South Street, Yuhua District, Shijiazhuang, Hebei Province, China.
| | - Jiangqiao Geng
- Department of Otolaryngology, Head and Neck Surgery, Pediatric Clinical Research Centre of Hebei Province, Children's Hospital of Hebei Province, No. 133 Jianhua South Street, Yuhua District, Shijiazhuang, Hebei Province, China.
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Influences of Airway Obstruction Caused by Adenoid Hypertrophy on Growth and Development of Craniomaxillofacial Structure and Respiratory Function in Children. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5096406. [PMID: 36081428 PMCID: PMC9448534 DOI: 10.1155/2022/5096406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/20/2022] [Accepted: 07/29/2022] [Indexed: 12/04/2022]
Abstract
Adenoid hypertrophy (AH) is a common disease in otorhinolaryngology. Children with chronic snoring and hypoxia are susceptible to long-term nasal obstruction, while long-term open-mouth breathing may cause craniofacial bone development disorders and dull facial expressions, the so-called adenoid face. The purpose of this work is to analyze the influence of AH-induced airway obstruction (AO) on the growth and development of craniomaxillofacial structure and respiratory function (RF) in children. The clinical data of 56 AH children (observation group) and 42 healthy children with physical examination (control group) who visited the Hebei Eye Hospital during the same period were retrospectively analyzed. All children received acoustic rhinometry and X-ray cephalometric measurements. The upper airway structure, sleep disorder score, and A/N value of nasopharyngeal lateral X-ray images were compared between cases and controls. For AH children, sleep tests were also performed to assess their RF. X-ray cephalometric measurements of facial morphology showed obvious vertical growth, mandibular retrognathia, and enlarged mandibular angle in AH children. AH mainly affects the size of the nasopharyngeal and oropharyngeal airway. AH children presented with higher nasal airway resistance (5.11 ± 1.95 cmH2O/L min) and lower nasopharyngeal volume (NPV) (16.86 ± 3.93 cm3) than controls. Of the AH children, 45 had abnormal RF, including 4 with obstructive sleep apnea syndrome. The A/N value of nasopharyngeal lateral X-ray images was significantly higher in AH children than in controls. Besides, worse sleep quality was found in AH children. The above differences were all of statistical significance. The above indicates that AH can affect the size of the nasopharyngeal and oropharyngeal airway, change children's respiratory mode and RF, increase nasal resistance, and decrease NPV, resulting in upper respiratory tract stenosis, as well as craniomaxillofacial and oral malformations, which affects children's normal growth and development.
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11
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Gao D, Sun X, Yang Y, Yang J, Cheng L. Diagnostic value of
CBCT
in Chinese children with adenoid hypertrophy. Laryngoscope Investig Otolaryngol 2022; 7:1308-1314. [PMID: 36258856 PMCID: PMC9575045 DOI: 10.1002/lio2.837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/16/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
Abstract
Objective The main objectives of the study were to investigate the reliability and accuracy of cone‐beam computed tomography (CBCT) in the diagnosis of adenoid hypertrophy in Chinese children and to evaluate its value in clinical diagnosis. Methods From January 2019 to January 2020, 300 children with sleep snoring in Xinhua Hospital Affiliated to Medical College of Shanghai Jiaotong University were retrospectively studied. All patients underwent nasopharyngoscopy (NE) and CBCT scanning. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of CBCT were determined according to the diagnostic criteria of NE, and the consistency between CBCT and NE was evaluated. Results The clinical study of 300 children patients found that compared with NE, CBCT had a sensitivity of 87.3%, specificity of 89.2%, the positive predictive value of 93.20%, the negative predictive value of 80.5%, the positive likelihood ratio of 8.08, the negative likelihood ratio of 0.14, and Kappa value of .748. Conclusion CBCT is a reliable and accurate tool for the diagnosis of adenoid hypertrophy and can be used as an alternative examination method for children with contraindications or intolerance during NE. Level of Evidence 4.
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Affiliation(s)
- Dekun Gao
- Department of Otorhinolaryngology‐Head and Neck Surgery, Xinhua Hospital Shanghai Jiaotong University School of Medicine Shanghai China
- Shanghai Jiaotong University School of Medicine Ear Institute Shanghai China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases Shanghai China
| | - Xiayu Sun
- Department of Otorhinolaryngology‐Head and Neck Surgery, Xinhua Hospital Shanghai Jiaotong University School of Medicine Shanghai China
- Shanghai Jiaotong University School of Medicine Ear Institute Shanghai China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases Shanghai China
| | - Ying Yang
- Department of Otorhinolaryngology‐Head and Neck Surgery, Xinhua Hospital Shanghai Jiaotong University School of Medicine Shanghai China
- Shanghai Jiaotong University School of Medicine Ear Institute Shanghai China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases Shanghai China
| | - Jun Yang
- Department of Otorhinolaryngology‐Head and Neck Surgery, Xinhua Hospital Shanghai Jiaotong University School of Medicine Shanghai China
- Shanghai Jiaotong University School of Medicine Ear Institute Shanghai China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases Shanghai China
| | - Lan Cheng
- Department of Otorhinolaryngology‐Head and Neck Surgery, Xinhua Hospital Shanghai Jiaotong University School of Medicine Shanghai China
- Shanghai Jiaotong University School of Medicine Ear Institute Shanghai China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases Shanghai China
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12
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Orlova YE, Svistushkin VM, Nikiforova GN, Shevchik EA. Treatment principles of children with pharyngeal tonsil pathology in the background of allergic rhinitis (literature review): A review. CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.3.201516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This article provides a review of different treatment for children with adenoids against a background of allergic rhinitis. An analysis of 35 papers published in Scopus and PubMed was carried out. Evaluation of the research results has shown that treatment of patients with pathology of lymphoid structures of the pharynx on the background of allergic rhinitis should be complex and individual in each clinical case.
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13
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Wang Q, Ma XK. Could Mouth Breathing Lead to Adenoid Hypertrophy? DENTAL HYPOTHESES 2022. [DOI: 10.4103/denthyp.denthyp_132_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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14
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Wang H, Qiao X, Qi S, Zhang X, Li S. Effect of adenoid hypertrophy on the upper airway and craniomaxillofacial region. Transl Pediatr 2021; 10:2563-2572. [PMID: 34765480 PMCID: PMC8578754 DOI: 10.21037/tp-21-437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/16/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In recent years, annual incidences of adenoid hypertrophy (AH), a highly common tissue lesion in children, have increased. Currently, research on AH has focused on its obstruction of nasal cavity function, and little has been written on its influence on the upper airway's bone structure. For this reason, our present study seeks to determine the influence of AH on both the morphological development characteristics of the upper airway and the craniofacial features in children, with the goal being to offer more choices for diagnosing and treating the condition in the future. METHODS From June 2019 to December 2020 in Department of Orthodontics, Beijing Stomatological Hospital, Capital Medical University, 38 children with AH admitted to the Department of Otolaryngology [research group (RG)] and 35 children [control group (CG)] who underwent orthodontic treatment over the same time span were selected as the research objects. X-ray examination of the lateral position of the head, observation of the maxillofacial structure, and detection of the children's height, growth factors, and sleep status, and analysis of the differences between the two groups. RESULTS The height of RG, insulin-like growth factor-1 (IGF-1) as well as insulin-like growth factor binding protein-3 (IGFBP-3) were all lower than CG (P<0.05), the upper airway became narrower, and the malocclusion was aggravated (P<0.05). Cephalometric measurement showed that the angle between the subspinale and sella at nasion (SNA angle) and the angle between the subspinale and supraemental at nasion (ANB angle) of RG children decreased, and the angle between the supraemental and sella at nasion (SNB angle) increased (P<0.05). In addition, the sleep quality of RG was significantly lower than that of CG (P<0.05). CONCLUSIONS AH can change a child's breathing mode and function by giving rise to upper airway stenosis, and by inducing deformities of their craniomaxillofacial region and oral cavity, thus disrupting their normal growth and development.
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Affiliation(s)
- Hongwei Wang
- Department of Orthodontics, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Xiaotong Qiao
- Department of Oral Medicine, College of Stomatology, Hebei Medical University, Shijiazhuang, China
| | - Suqing Qi
- Department of Orthodontics, Eye Hospital of Hebei, Xingtai, China
| | - Xiaolan Zhang
- Department of Otolaryngology, Eye Hospital of Hebei, Xingtai, China
| | - Song Li
- Department of Orthodontics, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
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15
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Feng X, Chen Y, Cai W, Lie SA, Hellén-Halme K, Shi XQ. Aerodynamic characteristics in upper airways among orthodontic patients and its association with adenoid nasopharyngeal ratios in lateral cephalograms. BMC Med Imaging 2021; 21:127. [PMID: 34425762 PMCID: PMC8381502 DOI: 10.1186/s12880-021-00659-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adenoid hypertrophy among orthodontic patients may be detected in lateral cephalograms. The study investigates the aerodynamic characteristics within the upper airway (UA) by means of computational fluid dynamics (CFD) simulation. Furthermore, airflow features are compared between subgroups according to the adenoidal nasopharyngeal (AN) ratios. METHODS This retrospective study included thirty-five patients aged 9-15 years having both lateral cephalogram and cone beam computed tomography (CBCT) imaging that covered the UA region. The cases were divided into two subgroups according to the AN ratios measured on the lateral cephalograms: Group 1 with an AN ratio < 0.6 and Group 2 with an AN ratio ≥ 0.6. Based on the CBCT images, segmented UA models were created and the aerodynamic characteristics at inspiration and expiration were simulated by the CFD method for the two groups. The studied aerodynamic parameters were pressure drop (ΔP), maximum midsagittal velocity (Vms), maximum wall shear stress (Pws), and minimum wall static pressure (Pw). RESULTS The maximum Vms exhibits nearly 30% increases in Group 2 at both inspiration (p = 0.013) and expiration (p = 0.045) compared to Group 1. For the other aerodynamic parameters such as ΔP, the maximum Pws, and minimum Pw, no significant difference is found between the two groups. CONCLUSIONS The maximum Vms seems to be the most sensitive aerodynamic parameter for the groups of cases. An AN ratio of more than 0.6 measured on a lateral cephalogram may associate with a noticeably increased maximum Vms, which could assist clinicians in estimating the airflow features in the UA.
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Affiliation(s)
- Xin Feng
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway
| | - Yicheng Chen
- School of Energy Science and Engineering, Harbin Institute of Technology, Xi Da Zhi Street, Nangang, Harbin, 150001, People's Republic of China
| | - Weihua Cai
- School of Energy and Power Engineering, Northeast Electric Power University, Changchun Road 169, Changchun, 132012, People's Republic of China
| | - Stein Atle Lie
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway
| | - Kristina Hellén-Halme
- Department of Oral and Maxillofacial Radiology, Faculty of Odontology, Malmö University, 205 06, Malmö, Sweden
| | - Xie-Qi Shi
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway. .,Department of Oral and Maxillofacial Radiology, Faculty of Odontology, Malmö University, 205 06, Malmö, Sweden.
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16
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Zhao T, Zhou J, Yan J, Cao L, Cao Y, Hua F, He H. Automated Adenoid Hypertrophy Assessment with Lateral Cephalometry in Children Based on Artificial Intelligence. Diagnostics (Basel) 2021; 11:1386. [PMID: 34441320 PMCID: PMC8394806 DOI: 10.3390/diagnostics11081386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/25/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022] Open
Abstract
Adenoid hypertrophy may lead to pediatric obstructive sleep apnea and mouth breathing. The routine screening of adenoid hypertrophy in dental practice is helpful for preventing relevant craniofacial and systemic consequences. The purpose of this study was to develop an automated assessment tool for adenoid hypertrophy based on artificial intelligence. A clinical dataset containing 581 lateral cephalograms was used to train the convolutional neural network (CNN). According to Fujioka's method for adenoid hypertrophy assessment, the regions of interest were defined with four keypoint landmarks. The adenoid ratio based on the four landmarks was used for adenoid hypertrophy assessment. Another dataset consisting of 160 patients' lateral cephalograms were used for evaluating the performance of the network. Diagnostic performance was evaluated with statistical analysis. The developed system exhibited high sensitivity (0.906, 95% confidence interval [CI]: 0.750-0.980), specificity (0.938, 95% CI: 0.881-0.973) and accuracy (0.919, 95% CI: 0.877-0.961) for adenoid hypertrophy assessment. The area under the receiver operating characteristic curve was 0.987 (95% CI: 0.974-1.000). These results indicated the proposed assessment system is able to assess AH accurately. The CNN-incorporated system showed high accuracy and stability in the detection of adenoid hypertrophy from children' lateral cephalograms, implying the feasibility of automated adenoid hypertrophy screening utilizing a deep neural network model.
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Affiliation(s)
- Tingting Zhao
- Department of Orthodontics, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China; (T.Z.); (J.Y.); (L.C.)
| | - Jiawei Zhou
- School of Physics and Technology, Wuhan University, Wuhan 430079, China;
| | - Jiarong Yan
- Department of Orthodontics, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China; (T.Z.); (J.Y.); (L.C.)
| | - Lingyun Cao
- Department of Orthodontics, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China; (T.Z.); (J.Y.); (L.C.)
| | - Yi Cao
- School of Electronic Information, Wuhan University, Wuhan 430079, China;
| | - Fang Hua
- Department of Orthodontics, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China; (T.Z.); (J.Y.); (L.C.)
- Center for Evidence-Based Stomatology, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
| | - Hong He
- Department of Orthodontics, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China; (T.Z.); (J.Y.); (L.C.)
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Abstract
In addition to acute adenoiditis and adenoid hypertrophy/vegetation, chronic adenoiditis is another disease of the adenoids. However, most physicians overlook chronic adenoiditis or confuse it with adenoid hypertrophy/vegetation. The incidence of chronic adenoiditis has increased in recent years as a result of higher rates of chronic nasopharyngeal or upper airway infections. The clinical characteristics of chronic adenoiditis can include but are not restricted to the following: long-term infection (especially bacterial infection); obstruction of the upper airway; infections of adjacent regions, such as the nose, nasal sinus, pharyngeal space, middle ear, and atlantoaxial joint; induced upper airway cough syndrome; and the presence of several “infectious-immune” diseases, including rheumatic fever, autoimmune nephropathy, and anaphylactoid purpura. To date, no consensus on the treatment of chronic adenoiditis is available. However, adenoidectomy can address the local obstruction, and some patients benefit from systemic or local anti-bacterial therapy. Physicians in the Departments of Otolaryngology, Respiration, and Pediatrics should be familiar with the clinical manifestations of chronic adenoiditis and try to develop effective treatment methods for this disease.
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Affiliation(s)
- Hai Wang
- Pediatrics, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
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18
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Ungkanont K, Jootakarn S, Leelaporn A, Kijsinthopchai U, Tanphaichitr A, Vathanophas V, Komoltri C. Association between adenoid bacteriology and clinical characteristics of adenoid-related diseases in children. SAGE Open Med 2021; 9:20503121211006005. [PMID: 33868688 PMCID: PMC8020219 DOI: 10.1177/20503121211006005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: The aim of this research is to find the association between the pathogenic
bacteria obtained from the adenoid culture and clinical characteristics of
adenoid-related diseases in children. Methods: In this retrospective study, we reviewed the medical records of children who
had adenoidectomy for adenoid-related diseases. Demographic data, diagnoses,
indications for adenoidectomy and bacterial culture results were collected.
The adenoid size was measured in the lateral skull X-ray as
adenoid–nasopharyngeal ratio. Associations between the culture results and
the demographic data, adenoid size, and the diagnoses were analyzed. Results: There were 407 children who had adenoidectomy for obstructive
sleep-disordered breathing (75.2%), otitis media with effusion (19.2%), and
chronic sinusitis (5.6%). Median age was 5.9 years. Common pathogenic
bacteria in the adenoid were Haemophilus influenzae
(26.2%), Staphylococcus aureus (23.5%),
Streptococcus pneumoniae (18.2%), and Moraxella
catarrhalis (12%). The patient’s age had significant
association with the prevalence of pathogenic bacteria. S.
pneumoniae was most prevalent in young children up to 7 years.
S. aureus was more common in children over 7 years.
H. influenzae had similar prevalence in all age groups.
Size of the adenoid and type of adenoid-related diseases had no association
with the outcome of bacterial culture. Conclusion: Age of the patients was the significant factor associated with the
bacteriological findings of the adenoid while size and types of
adenoid-related diseases were not associated with the outcome of bacterial
culture.
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Affiliation(s)
- Kitirat Ungkanont
- Department of Otolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sujeenun Jootakarn
- Department of Otolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Amornrut Leelaporn
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Usa Kijsinthopchai
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Archwin Tanphaichitr
- Department of Otolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Vannipa Vathanophas
- Department of Otolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chulaluk Komoltri
- Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Lin Y, Wang M, Xiao Z, Jiang Z. Hypoxia activates SUMO-1-HIF-1α signaling pathway to upregulate pro-inflammatory cytokines and permeability in human tonsil epithelial cells. Life Sci 2021; 276:119432. [PMID: 33794253 DOI: 10.1016/j.lfs.2021.119432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Adenoid hypertrophy (AH) can cause harmful effects on untreated children, which include mouth breathing, chronic intermittent hypoxia, sleep disordered breathing (SDB), and even some behavioral problems. However, the molecular mechanisms underlying this pathophysiological process have remained poorly understood. METHODS In this study, SUMO was induced silencing and overexpression using RNAi and lentiviral-mediated vector. FITC-Dextran and TEER were performed to examine the role of SUMO in cell permeability. Co-immunoprecipitation (Co-IP) assay was performed to examine the interaction between SUMO1 and HIF-1α. Immunohistochemistry staining was used to examine the expressions of ZO-1, Claudin-1 and occluding respectively. RESULTS We found that a hypoxic condition caused a dramatic upregulation of SUMO-1 expression in a time-dependent manner, a member of the ubiquitin-like protein family. Knockdown of SUMO-1 deeply suppressed the secretions of pro-inflammation cytokines including IL-6, IL-8, and TNF-α, and decreased the permeability of HTECs. Moreover, the HIF-1α inhibitor 2-MeOE2 abolished the function of SUMO-1 in HTECs. Furthermore, results obtained from CO-IP had suggested that SUMO-1 interacted with HIF-1α, and prevented its ubiquitination and degradation in HTECs by sumoylating. Importantly, our data showed that hypoxia-induced inflammation was markedly inhibited by M2 macrophages that possess potent anti-inflammatory function. CONCLUSION Our results suggest that selectively inhibiting the SUMO-1-HIF-1α signaling pathway leads to anti-inflammatory responses in human tonsil epithelial cells, which might be a novel therapeutic approach for managing hypoxia-induced SDB resulting from AH.
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Affiliation(s)
- Yan Lin
- Department of Pediatrics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Mingjing Wang
- Department of Pediatrics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Zhen Xiao
- Department of Pediatrics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China.
| | - Zhiyan Jiang
- Department of Pediatrics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China.
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Wang W, Fan X, Huang X, Yan J, Luan J. Serologic false-positive reactions for syphilis in children of adenoidal hypertrophy:2 case reports and review of the literature. Acta Clin Belg 2021; 76:70-74. [PMID: 31368864 DOI: 10.1080/17843286.2019.1649081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Adenoid hypertrophy (AH) is a common disease in children. We describe two cases of AH in children with syphilis enzyme-linked immunosorbent assay (EIA) for false-positive. To our knowledge, there are few reports of false-positive in syphilis EIA in children with AH. Two cases of AH children with syphilis EIA positive samples were confirmed by TPPA and LIA, both showed negative reaction. Therefore, the occurrence of syphilis EIA positive reactions in such diseases should dramatically arouse the attention of docimasters and doctors so as to avoid misdiagnosis caused by false-positive in children with AH.
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Affiliation(s)
- Wei Wang
- Jinling Hospital Department of Blood Transfusion, Nanjing University, School Medicine, Nanjing, China
| | - Xuzhou Fan
- Jinling Hospital Department of Blood Transfusion, Nanjing University, School Medicine, Nanjing, China
| | - Xuelian Huang
- Jinling Hospital Department of Blood Transfusion, Nanjing University, School Medicine, Nanjing, China
| | - Jingmei Yan
- Jinling Hospital Department of Blood Transfusion, Nanjing University, School Medicine, Nanjing, China
| | - Jianfeng Luan
- Jinling Hospital Department of Blood Transfusion, Nanjing University, School Medicine, Nanjing, China
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Pagella F, Lizzio R, Pusateri A, Ugolini S, Maiorano E, Mirabella R, De Silvestri A, Tinelli G, Matti E. Adenoidectomy: Anatomical variables as predictive factors of intraoperative adenoid residues. Int J Pediatr Otorhinolaryngol 2021; 140:110493. [PMID: 33199030 DOI: 10.1016/j.ijporl.2020.110493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Adenoid hypertrophy is a common cause of upper airway obstruction in children. However, after adenoidectomy, nasal obstructive symptoms may persist or recur, requiring surgical revision. The aim of this study is to evaluate if individual patient features can influence the efficacy of the traditional technique. METHODS A retrospective observational study was conducted by recruiting patients from candidates for adenoidectomy. All children underwent conventional transoral curettage adenoidectomy with endoscopic control at the end of procedure, and in presence of adenoid residues, a concomitant revision adenoidectomy was performed. For each patient, the following data were collected: age, sex, weight, height, length of the soft palate and surgical technique used. RESULTS In 18% of patients (113/612), the most critical areas of the nasopharynx were not reached by standard surgery, making a complete adenoidectomy difficult. In this group, the average length of the soft palate was 3.1 cm, 5 mm more than the average of the sample, and 6 mm more than the average length of patients undergoing standard surgery alone (p < 0.001). CONCLUSION Our study confirms the hypothesis that a greater length of the soft palate conditions the results of the intervention. The length of the soft palate can be considered an intraoperative criterion to select the cases in which perform endoscopic control after the standard procedure.
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Affiliation(s)
- Fabio Pagella
- Department of Otolaryngology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Department of Otolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberta Lizzio
- Department of Otolaryngology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy.
| | - Alessandro Pusateri
- Department of Otolaryngology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Sara Ugolini
- Department of Otolaryngology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Eugenia Maiorano
- Department of Otolaryngology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Rosolino Mirabella
- Department of Otolaryngology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Annalisa De Silvestri
- Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Guido Tinelli
- Department of Otolaryngology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Elina Matti
- Department of Otolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Radman M, Ferdousi A, Khorramdelazad H, Jalali P. Long-term impacts of tonsillectomy on children's immune functions. J Family Med Prim Care 2020; 9:1483-1487. [PMID: 32509637 PMCID: PMC7266207 DOI: 10.4103/jfmpc.jfmpc_935_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/22/2020] [Accepted: 02/07/2020] [Indexed: 01/20/2023] Open
Abstract
Background There exist a wide level of discrepancy regarding the role of tonsils and its indication among pediatricians and ENT specialists. This fact sometimes causes confusion and delay in making the right decisions by parents and specialists for appropriate treatment of patients. Objectives Thus, the aim of this study was to investigate the effects of long-term tonsillectomy on the immune system of patients. Methods In this case-control study we measured the status of immune system in 34 children (aged 9-15 years) following 4 to 6 years of tonsillectomy. We have also enrolled 30 healthy children with similar age group. Venous blood samples were taken and the serum levels of IgG, IgA, and IgM were detected along with expression of CD4, CD8, CD10 and CD56. Data were analyzed by SPSS version 18 software and a P < 0.05 was considered as significant. Results We found that the mean serum levels IgM, IgA, and IgG in the case group was significantly (P < 0.0001) lower than the control group. Whereby, the CD4, CD8 and CD56 expressions was examined, there was no significant difference in both groups while only CD10 expression was lower in tonssiloctomized patients (P = 0.108). Conclusion Overall, according to these findings, CD10 as a marker of B lymphocytes in children undergoing tonsillectomy was significantly less than those healthy children. This may indicate a decrease in B cells and further reduced antibody production in these patients.
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Affiliation(s)
- Masoud Radman
- Clinical Research Development Unit (CRDU), Moradi Hospital, Rafsanjan, Iran
| | - Asiyeh Ferdousi
- Student Research Committee, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Hossein Khorramdelazad
- Molecular Medicine Research Center, Research Institute of Basic Medical Sciences, Rafsanjan, Iran
| | - Pooneh Jalali
- Family Medicine Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Thereza-Bussolaro C, Lagravère M, Pacheco-Pereira C, Flores-Mir C. Development, validation and application of a 3D printed model depicting adenoid hypertrophy in comparison to a Nasoendoscopy. Head Face Med 2020; 16:5. [PMID: 32151261 PMCID: PMC7061480 DOI: 10.1186/s13005-020-00216-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 02/12/2020] [Indexed: 11/15/2022] Open
Abstract
Background The exploration of tridimensional (3D) technology of computational tomography and the development of valid 3D printed models may improve the assessment of adenoid obstruction. The identification of an enlarged adenoid in childhood would streamline the referral of appropriately selected cases to an otolaryngologist, leading to early treatment of affected children when indicated. The objective of this study is to validate the use of a 3D printed model depicting adenoid hypertrophy based on the pediatric otolaryngologist, head and neck surgeon (OHNS) participants assessment. Methods A cross-sectional study was performed to develop and validate 3D depictions, including print-outs, of the nasopharynx including different degrees of Adenoidal Hypertrophy (AH). The print-outs were obtained from 14 Cone-beam computed tomography (CBCT) scans of 14 children (12 boys, 2 girls; mean age of 10.61 years) representing grades 1, 2, 3, and 4 nasopharyngeal adenoidal obstructions, according to a previously Nasoendoscopy-graded (NE) classification by a licensed OHNS. The prevalence of AH in this study was 36%. Two OHNS were recruited to assess the print-outs representing two different representations of the nasopharyngeal airway, the lumen (LU) and adenoid mass (AD). LU and AD were visualized in 2D - pictures- and in 3D – printed prototypes. Intraclass correlation was used to assess intra- and inter-reliability. The validity of our depictions was analyzed through comparison (accuracy and correlation) to the reference standard (NE). The data were clustered to calculate the sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV). Cross-tab and Pearson’s T-test were performed. Results Overall, the 3D depiction tools showed different diagnostic capabilities. AD representations showed strong (AD 2D, 75%) to almost perfect (AD 3D, 88%) accuracy compared to NE. Excellent sensitivity and specificity were observed for the AD 3D (100, 70%), as well as adequate PPV and NPV (66 and 97% respectively), with only 5% of false-negative cases. Conclusion The use of Dolphin software for the acquisition of a 3D printed prototype of the nasopharyngeal adenoidal region seems promising. These prototypes may be a practical and readily available alternative for the assessment of the nasopharyngeal obstructed area. CBCT in children must be taken under strong solid indications. Early referral to an OHNS for a full assessment remains the main objective in children with unclear symptoms.
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Affiliation(s)
- Claudine Thereza-Bussolaro
- School of Dentistry, University of Alberta, 11405 87Ave NW, 5528 Edmonton Clinic Health Academy,, Edmonton, AB, T6G1C9, Canada.
| | - Manuel Lagravère
- School of Dentistry, University of Alberta, 11405 87Ave NW, 5528 Edmonton Clinic Health Academy,, Edmonton, AB, T6G1C9, Canada
| | - Camila Pacheco-Pereira
- School of Dentistry, University of Alberta, 11405 87Ave NW, 5528 Edmonton Clinic Health Academy,, Edmonton, AB, T6G1C9, Canada
| | - Carlos Flores-Mir
- School of Dentistry, University of Alberta, 11405 87Ave NW, 5528 Edmonton Clinic Health Academy,, Edmonton, AB, T6G1C9, Canada
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Fasunla AJ, Totyen EL, Onakoya PA, Nwaorgu OG. Short-term effect of adenotonsillectomy on growth and nutritional anthropometric parameters of children with obstructive adenotonsillar enlargement. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2020. [DOI: 10.1186/s43054-019-0016-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Obstructive adenotonsillar enlargement is known to cause failure to thrive in children. The effect of adenotonsillectomy is not well documented on the growth of affected children. The study was carried out to investigate the effect of adenotonsillectomy on growth of children with obstructive adenotonsillar enlargement. It was a quasi-experimental study consisting of 62 children (≤ 12 years) with obstructive adenotonsillar enlargement and 62 healthy controls. Variables measured at baseline, sixth week and 13th week post adenotonsillectomy, were weight, height, mid-upper arm circumference, and triceps skinfold thickness. The percent of weight-for-age and height-for-age were, respectively, calculated by dividing the child’s weight and height by the median expected weight and height (i.e., the 50th percentile) based on the child’s chronological age. The obtained weight-for-age and height-for-age values were used to determine the presence of failure to thrive and stunting, respectively.
Results
Majority (70.6%) of the patients with malnutrition were from a low socioeconomic class. At baseline, failure to thrive and stunting were found among 17 (26.4%) cases and 11 (17.7%) controls, but the proportion reduced to six (9.7%) and three (4.8%), respectively, at the 13th week post adenotonsillectomy. There was a steady increase in weight-for-age, height-for-age, mid-upper arm circumference, and triceps skinfold thickness in both cases and controls from baseline to the 13th week. However, there was a significant difference in percentage variation of these variables between the two groups.
Conclusions
Adenotonsillectomy improved the growth of children with obstructive adenotonsillar enlargement and hence recommended in cases with failure to thrive and stunting.
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Cuppari C, Colavita L, Miraglia Del Giudice M, Chimenz R, Salpietro C. Recurrent respiratory infections between immunity and atopy. Pediatr Allergy Immunol 2020; 31 Suppl 24:19-21. [PMID: 32017215 DOI: 10.1111/pai.13160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2019] [Indexed: 11/30/2022]
Abstract
Recurrent respiratory infections (RRIs) are frequent in children and are characterized by more than 6 airway infections in 1 year or more than 1 upper airway infection per month in the period between September and April or more than 3 lower airway infections in 1 year. Often pediatric RRIs are related to predisposing factors, such as reduced airway size, poor tussive reflex, and immaturity of the immune system. RRIs due to immature immune system are a transient condition, with spontaneous resolution in the school age. However, some RRIs are expression of more complex diseases. Red flags are the onset of symptoms in the first year of life, the involvement of other systems, unusual pathogens, slowing of growth, severe infections of the lower airways, and recurrence of the infection site. To help the pediatrician in the RRI differential diagnosis, we have created a roadmap based on scientific literature data and clinical practice that identifies 6 macro areas: immunodeficiencies, simple minimal genetic immunodeficiency, atopy, obesity, nutritional deficiencies, autoinflammatory diseases, and complex diseases.
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Affiliation(s)
- Caterina Cuppari
- Unit of Pediatric Emergency, Department of Adult and Childhood Human Pathology, University Hospital of Messina, Messina, Italy
| | - Laura Colavita
- Unit of Pediatric Emergency, Department of Adult and Childhood Human Pathology, University Hospital of Messina, Messina, Italy
| | - Michele Miraglia Del Giudice
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Roberto Chimenz
- Unit of Pediatric Nephrology, Department of Adult and Childhood Human Pathology, University Hospital of Messina, Messina, Italy
| | - Carmelo Salpietro
- Unit of Pediatric Emergency, Department of Adult and Childhood Human Pathology, University Hospital of Messina, Messina, Italy
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Brambilla I, Manti S, Savasta S, Valsecchi C, Caimmi SME, Marseglia GL, Licari A. Adenoidal Immune Response in the Context of Inflammation and Allergy. CURRENT RESPIRATORY MEDICINE REVIEWS 2020. [DOI: 10.2174/1573398x15666190703110843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
:The mucosal-associated lymphoid tissues of the upper respiratory tract, including adenoids and palatine tonsils, are considered as the first line of defense against respiratory infections, being important effector organs in both mucosal-type and systemic-type adaptive immunity. They are strategically located for mediating both local and regional immune functions, as they are exposed to antigens from both the inhaled air (allergens and pathogens) and the alimentary tract. Adenoids play a major role in the early and effective immune responses against viral and bacterial upper airway infections, as well as in the development of allergic reactions to respiratory allergens, being influenced by several environmental antigens and pollutants, such as tobacco smoke. In addition, recent studies have focused on new immune-modulating strategies for adenoidal cells as a preventive and therapeutic approach for chronic upper airways inflammation.:Herein, we aimed to summarize what is known about the cellular and molecular mechanisms regulating adenoidal immune responses in the context of inflammation and allergy, with particular reference to scientific literature published within the last five years.
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Affiliation(s)
- Ilaria Brambilla
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Sara Manti
- Department of Pediatrics, University of Messina, Messina, Italy
| | - Salvatore Savasta
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Valsecchi
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Gian Luigi Marseglia
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Amelia Licari
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Parisi GF, Leonardi S. Upper and Lower Airways Diseases in Childhood. CURRENT RESPIRATORY MEDICINE REVIEWS 2020. [DOI: 10.2174/1573398x1503191125160355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
:
In the last decade, extensive research has provided consistent advances in molecular biology and “omics”
science (genomics, metabolomics, proteomics, and transcriptomics), which have led to the detailed characterization of the
etiology, pathophysiological mechanisms, and subtypes of many diseases. Based on these developments, the concept of
precision medicine was established.
:
About a quarter of medical consultations related to primary care in children involves respiratory problems. About 10% of
the cases are asthma, while the other most important respiratory diseases includes bronchiolitis, acute bronchitis and
respiratory infections. Today, beyond the most common respiratory pathology, it is appropriate to discuss what are the
novelties in the management of more complex, frequent and infrequent, pathologies because they are those in which it is
possible to implement the concept of precision medicine.
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Affiliation(s)
- Giuseppe Fabio Parisi
- Department of Clinical and Experimental Medicine University of Catania Catania, Italy
| | - Salvatore Leonardi
- Department of Clinical and Experimental Medicine University of Catania Catania, Italy
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Selected cytokines in hypertrophic adenoids in children suffering from otitis media with effusion. Int J Pediatr Otorhinolaryngol 2020; 128:109700. [PMID: 31606684 DOI: 10.1016/j.ijporl.2019.109700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The aim of the current study was to assess the levels of MMP-8, MMP-9 and TIMP-1 in the group of children with adenoids who suffered from exudative otitis media. METHODS The study included 20 patients (10 females and 10 males) with adenoid hypertrophy coexisting with otitis media with effusion. The reference group included 24 patients (10 females and 14 males) with adenoid hypertrophy without otitis media. The levels of MMP-8, MMP-9 and TIMP-1 were determined in supernatants obtained from phytohemagglutinin (PHA)-stimulated cell cultures of the tonsils, using commercial enzyme-linked immunosorbent assay kits (R@D Systems, USA). RESULTS The median MMP-8, MMP-9 and TIMP-1 concentrations (220.8 ng/mL, 311.1 ng/mL, 53.5 ng/mL, respectively) in the study group were significantly higher (p = 0.000, p = 0.000, p = 0.048, respectively) than those in the reference group (93.5 ng/mL, 112.5 ng/mL, 36.95 ng/mL, respectively). ROC analysis revealed that the area under a curve (AUC) for both metalloproteinases MMP-8 and MMP-9 was 1 with a diagnostic sensitivity of 100% and diagnostic specificity of 95.8%, as compared to 0.690 for TIMP-1. Significant differences were found between the AUC for MMP-8 and TIMP-1 and MMP-9 and TIMP-1 (p < 0.001 for both comparisons). CONCLUSIONS The changes in the concentrations of MMP-8, MMP-9 and TIMP-1 may indicate an increased remodeling of the extracellular matrix in children with adenoid hypertrophy and otitis media with effusion. The findings can have clinical as well as diagnostic utility. Determination of MMP-8 and MMP-9 may help qualify a child for adenoidectomy and differentiate pediatric patients affected by adenoid hypertrophy with and without otitis media.
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Adamu A, Jibril Y, Hasheem M, Abdullahi H, Salisu A, Nwaorgu OB. Comparison of flexible nasopharyngoscopy with plain radiograph in the assessment of children with adenoid hypertrophy. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2020; 10:6-10. [PMID: 35814967 PMCID: PMC9267043 DOI: 10.4103/jwas.jwas_37_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/27/2022] [Indexed: 12/14/2022]
Abstract
Background: Obstructive adenoid hypertrophy is one of the commonest disorder seen in paediatric otorhinolaryngology clinics. It has a wide range of complications that can lead to cardiopulmonary and developmental problems; hence, early diagnosis and treatment are paramount in preventing the complications. Several modalities for the assessment of adenoid hypertrophy have been described in the literature, of which plain radiograph and flexible nasopharyngoscopy are the most popular. In this study, traditional method of evaluating adenoid hypertrophy (plain radiograph) has been compared with newer flexible nasopharyngoscopy. Materials and Methods: This is a cross-sectional study of randomly selected children with clinical diagnosis of obstructive adenoid disease. All eligible participants underwent clinical examinations, flexible nasopharyngoscopy and postnasal space X-ray. The findings were compared using the chi-square test and Pearson’s correlation test. Results: The age of the participants ranged between 2 and 10 years with mean of 4.5 ± 2.5 years. There were 79 (56.4%) males and 61 (43.6%) females. The adenoid hypertrophy observed using flexible nasopharyngoscopy among the participants ranged between 20 and 90% with mean of 67.4 ± 15.4%. The adenoid enlargement measured using adenoidal–nasopharyngeal ratio on plain radiograph ranged between 0.40 and 0.96 with mean of 0.7 ± 0.09. The Pearson’s correlation test revealed strong correlation between flexible nasopharyngoscopy and plain radiograph (r = 0.858, P = .000), and there was statistically significant association between the two methods (χ2 = 148.8, P = .000). Conclusion: There was a strong correlation between flexible nasopharyngoscopy and plain radiograph of the postnasal space in the assessment of obstructive adenoid disease in children.
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Grønlund C, Howitz MF, Djurhuus BD. No impact on the incidence rate of adenoidectomy 1998-2014 on a national level in Denmark by the use of nasal steroid and the introduction of pneumococcal vaccines. Clin Otolaryngol 2019; 45:111-118. [PMID: 31724810 DOI: 10.1111/coa.13475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/31/2019] [Accepted: 11/09/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe trends in incidence rates of adenoidectomy in children in Denmark from 1998-2014 and to look for possible explanatory factors such as intranasal steroids and pneumococcal vaccination. DESIGN A nationwide, population-based, retrospective, interrupted time-series analysis, using data from Danish registries. SETTING Hospitals and private Ear, Nose and Throat clinics. PARTICIPANTS Children who underwent adenoidectomy from 1998 to 2014 in Denmark. MAIN OUTCOME MEASURE Adenoidectomy. METHODS The National Patient Register and the National Health insurance Service Register were used to identify all adenoidectomies performed in children. The National Prescription Register supplied data on intranasal steroids. RESULTS A total of 174,557 adenoidectomies were identified, distributed among 153 022 children. The annual incidence rate was stable at around 11 per 1000 person-years from 1998 to 2004. A decrease was seen from 2004 reaching 7.9 in 2009, followed by an increase to 9.1 in 2014. The highest age-specific incidence rates were seen at 2-3 years of age. An estimated 14% of children born in 2014 will have had adenoidectomy performed before turning 16 years old. The proportion of adenoidectomies performed in private clinics compared with hospitals was 90%. CONCLUSION From 1998 to 2004 the incidence rate of adenoidectomy in children in Denmark was among the highest in the world with around 11 per 1000 person-years. A decrease to 7.9 was seen from 2004 to 2009. We found no inverse correlation on a national level between the incidence rates of adenoidectomy and intranasal steroid, nor the introduction of the pneumococcal vaccine. The amount of intranasal steroids used in children in Denmark was negligible compared with adenoidectomy.
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Affiliation(s)
- Casper Grønlund
- Department of Otorhinolaryngology & Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Michael Frantz Howitz
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, North Zealand Hospital, Hillerød, Denmark
| | - Bjarki Ditlev Djurhuus
- Department of Otorhinolaryngology & Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
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Licari A, Castagnoli R, Tosca MA, Marseglia G, Ciprandi G. Personalized therapies for the treatment of allergic rhinitis. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2019. [DOI: 10.1080/23808993.2019.1681896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Amelia Licari
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Riccardo Castagnoli
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | - Gianluigi Marseglia
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Bulfamante AM, Saibene AM, Felisati G, Rosso C, Pipolo C. Adenoidal Disease and Chronic Rhinosinusitis in Children-Is there a Link? J Clin Med 2019; 8:E1528. [PMID: 31548504 PMCID: PMC6832509 DOI: 10.3390/jcm8101528] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/08/2019] [Accepted: 09/18/2019] [Indexed: 12/16/2022] Open
Abstract
Adenoid hypertrophy (AH) is an extremely common condition in the pediatric and adolescent populations that can lead to various medical conditions, including acute rhinosusitis, with a percentage of these progressing to chronic rhinosinusitis (CRS). The relationship between AH and pediatric CRS has been extensively studied over the past few years and clinical consensus on the treatment has now been reached, allowing this treatment to become the preferred clinical practice. The purpose of this study is to review existing literature and data on the relationship between AH and CRS and the options for treatment. A systematic literature review was performed using a search line for "(Adenoiditis or Adenoid Hypertrophy) and Sinusitis and (Pediatric or Children)". At the end of the evaluation, 36 complete texts were analyzed, 17 of which were considered eligible for the final study, dating from 1997 to 2018. The total population of children assessed in the various studies was of 2371. The studies were categorized as surgical-observational, microbiological, genetic-immunological, and radiological. The analysis of the studies confirms the relationship between AH and CRS and supports the existing consensus on medical and surgical therapy. Furthermore, these studies underline the necessity to adapt medical and surgical treatment considering age, comorbidities including asthma and, if present, the Computed Tomography (CT) score.
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Affiliation(s)
- Antonio Mario Bulfamante
- Otorhinolaryngology Unit, Department of Health Sciences, San Paolo Hospital, Università degli Studi di Milano, 20142 Milan, Italy; (G.F.); (C.R.); (C.P.)
| | | | - Giovanni Felisati
- Otorhinolaryngology Unit, Department of Health Sciences, San Paolo Hospital, Università degli Studi di Milano, 20142 Milan, Italy; (G.F.); (C.R.); (C.P.)
| | - Cecilia Rosso
- Otorhinolaryngology Unit, Department of Health Sciences, San Paolo Hospital, Università degli Studi di Milano, 20142 Milan, Italy; (G.F.); (C.R.); (C.P.)
| | - Carlotta Pipolo
- Otorhinolaryngology Unit, Department of Health Sciences, San Paolo Hospital, Università degli Studi di Milano, 20142 Milan, Italy; (G.F.); (C.R.); (C.P.)
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Yan Y, Song Y, Liu Y, Su J, Cui L, Wang J, Geng J, Liu X, Shi Y, Quan S, Hang A, Zuo L. Short- and long-term impacts of adenoidectomy with/without tonsillectomy on immune function of young children <3 years of age: A cohort study. Medicine (Baltimore) 2019; 98:e15530. [PMID: 31083200 PMCID: PMC6531274 DOI: 10.1097/md.0000000000015530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
To investigate the short- and long-term impacts of adenoidectomy with/without tonsillectomy on the immune functions of young children < 3 years of age.This longitudinal prospective study included 40 pediatric patients (age <3 y) undergoing adenoidectomy with/without tonsillectomy for snoring and sleep apnea. Serum immunoglobulin IgA, IgG, IgM, complement C3, and C4 levels were measured for the status of humoral immunity; CD3+, CD4+, CD8+, CD4+/CD8+, CD19+, CD56+, CD3+CD4-CD8-, and CD3+CD4+CD8+ T cells were measured for the status of cellular immunity. Blood samples were taken at 3 time points: before surgery, 1 month after surgery (short-term), and 3 months after surgery (long-term). All patients were assessed for short-term outcome at 1-month postoperation, but only 30 patients were followed at 3 months after surgery. The incidence of recurrent respiratory tract infections and other immune-related conditions were recorded at each follow-up.The levels of IgA significantly decreased from the preoperative level at 1-month follow-up (P < .05), but still within normal range. No significant changes were found in the levels of IgA, IgG, IgM, C3, C4, CD3+, CD4+, CD8+, CD4+/CD8+, CD19+, CD56+, CD3+CD4-CD8-, and CD3+CD4+CD8+ T cell at 3-month follow-up in comparison with preoperative levels. There was also no episode of recurrent respiratory tract infection and other immune-deficiency conditions.Adenoidectomy with/without tonsillectomy may result in a reduction in individual antibodies in children <3 years of age, but did not show negative impacts on their immune functions. Also, the surgery does not lead to the increased risk of upper respiratory tract infection in these children.
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Sun YL, Zheng HT, Tao JL, Jiang MC, Hu CC, Li XM, Yuan B. Effectiveness and safety of Chinese herbal medicine for pediatric adenoid hypertrophy: A meta-analysis. Int J Pediatr Otorhinolaryngol 2019; 119:79-85. [PMID: 30684690 DOI: 10.1016/j.ijporl.2019.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Chinese herbal medicine has been gradually used to treat pediatric adenoid hypertrophy. This meta-analysis were conducted to evaluate the clinical efficacy and safety of Chinese herbal medicine in the treatment of pediatric adenoid hypertrophy. METHODS Randomized controlled trials involving Chinese herbal medicine in the treatment of pediatric adenoid hypertrophy were identified from Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Chinese National Knowledge Infrastructure, Chinese Biomedical Database, Wanfang Database and VIP Information Database. The methodological quality of trials was evaluated with Cochrane Handbook criteria, and the Cochrane Collaboration's Review Manager 5.3 software was used for Meta-analysis. RESULTS A total of 13 valid articles involving 1038 patients were included. The meta-analysis showed that: Compared with western medicine treatment, Chinese herbal medicine significantly improved clinical efficacy (RR = 1.33, 95% CI [1.24,1.43]), and significantly decreased A/N ratio (MD = -0.04,95%CI [-0.05,-0.03]). Chinese herbal medicine also prominently improved the quality of life (MD = -4.77,95%CI [-8.35,-1.20]). Meanwhile, it dramatically improved snoring (MD = -0.46,95%CI [-0.62,-0.30]); mouth breathing (MD = -0.52,95%CI [-0.66,-0.39]); nasal obstruction (MD = -0.56,95%CI [-0.68,-0.45]). CONCLUSION Chinese herbal medicine has good clinical efficacy and safety on pediatric adenoid hypertrophy, which need to be confirmed by high quality, multiple-centre, large sample randomized controlled trials.
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Affiliation(s)
- Ya-Lei Sun
- Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Pediatrics, Nanjing, China.
| | - Hai-Tao Zheng
- Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Pediatrics, Nanjing, China.
| | - Jia-Lei Tao
- Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Pediatrics, Nanjing, China.
| | - Ming-Chen Jiang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Pediatrics, Nanjing, China.
| | - Chan-Chan Hu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Pediatrics, Nanjing, China.
| | - Xin-Min Li
- Department of Integrated Chinese and Western Medicine, Henan University of Chinese Medicine, Zhengzhou, China.
| | - Bin Yuan
- Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Pediatrics, Nanjing, China.
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Yan Y, Song Y, Liu Y, Su J, Cui L, Wang J, Geng J, Liu X, Shi Y, Quan S, Zuo L. Early Stage Impacts of Adenoidectomy With/Without Tonsillectomy on Immune Functions of Children Aged Less Than Three Years. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2019; 32:18-22. [PMID: 31508251 DOI: 10.1089/ped.2018.0964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/27/2018] [Indexed: 01/06/2023]
Abstract
Objective: To evaluate the early stage effects of adenoidectomy with/without tonsillectomy on immune functions in children aged <3 years. Methods: Twenty-four children aged <3 years underwent adenoidectomy with/without tonsillectomy were included. The levels of IgG, IgA, IgM, C3, and C4 were measured for humoral immunity, and the levels of CD3+, CD4+, CD8+, CD19+, CD56+, CD3+CD4-CD8-, and CD3+CD4+CD8+ T cells were measured for cellular immunity before and 2 weeks after the operation. Results: The postoperative levels of IgA, IgG, IgM, C3, and C4 were significantly increased compared with the preoperative levels (P < 0.05). The levels of CD3+, CD4+, CD8+, CD56+, CD3+CD4-CD8-, and CD3+CD4+CD8+ T cells were increased, while the level of CD19+ was decreased in postoperative period compared with preoperative period. Compared with those in the control group, the preoperative levels of IgA, IgG, and CD3+CD4+CD8+ T cells were significantly increased (P < 0.05), while the levels of IgM, C3, C4 and CD3+, CD4+, CD8+, CD56+, and CD3+CD4-CD8- T cells were not significantly changed. The postoperative levels of IgA, IgG, C3, C4, CD3+CD4-CD8-, and CD3+CD4+CD8+ T cells were significantly increased (P < 0.05), while the levels of IgM, CD3+, CD4+, CD8+, and CD56+ T cells were not significantly changed compared with those in the control group. Conclusion: Adenoidectomy with/without tonsillectomy could stimulate the immune responses, which could avoid significant immune deficiency in a short period of time in children aged <3 years.
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Affiliation(s)
- Yuyan Yan
- Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Yingluan Song
- Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Yingying Liu
- Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Jinzhu Su
- Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Li Cui
- Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Juan Wang
- Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Jiangqiao Geng
- Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Xiaofeng Liu
- Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Yanan Shi
- Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Shan Quan
- Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Lujie Zuo
- Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
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The Adenoids but Not the Palatine Tonsils Serve as a Reservoir for Bacteria Associated with Secretory Otitis Media in Small Children. mSystems 2019; 4:mSystems00169-18. [PMID: 30801022 PMCID: PMC6372837 DOI: 10.1128/msystems.00169-18] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 01/19/2019] [Indexed: 01/05/2023] Open
Abstract
Our findings that the microbiome differs between crypts of the adenoids and crypts of the palatine tonsils, including the relative abundances of potential pathogens such as Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis, may be the stepping stone for further investigation of individual microbiomes in a longitudinal design that includes recording of the fluctuating health status of the child. Such studies may have the potential to lead to new preventive measurements such as implantation of protective nonpathogens at the nasopharynx as an alternative to adenoidectomy. Acute otitis media (AOM), secretory otitis media (SOM), and acute pharyngotonsillitis are the most frequent reasons for visits to general practitioners, pediatricians, and otolaryngologists. Microbial colonization of the epithelial lining of Waldeyer’s lymphatic tissues, consisting of the palatine tonsils, lingual tonsils, adenoids, and Eustachian tube tonsil, is a well-known clinical challenge during infancy due to frequent episodes of upper respiratory tract infections. However, no previous studies have investigated the combined role of the palatine tonsils and the adenoids as a reservoir for pathogens associated with SOM in small children. We analyzed the combined crypt microbiome of the palatine tonsils and adenoids from 14 small children with hyperplasia of the tonsils or adenoids and 14 small children with SOM using 16S rRNA gene pyrosequencing. Our study demonstrated a significant difference between the microbiome of the adenoids and that of the palatine tonsils in the two groups but not between the two anatomical locations within the two groups. In particular, the potential pathogens Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis were almost exclusively found in the adenoids of both patient groups, indicating that the adenoids and not the palatine tonsils are the main reservoir for potential pathogens leading to AOM and SOM. IMPORTANCE Our findings that the microbiome differs between crypts of the adenoids and crypts of the palatine tonsils, including the relative abundances of potential pathogens such as Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis, may be the stepping stone for further investigation of individual microbiomes in a longitudinal design that includes recording of the fluctuating health status of the child. Such studies may have the potential to lead to new preventive measurements such as implantation of protective nonpathogens at the nasopharynx as an alternative to adenoidectomy.
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Li HT, Chen ZG, Lin YS, Liu H, Ye J, Zou XL, Wang YH, Yang HL, Zhang TT. CpG-ODNs and Budesonide Act Synergistically to Improve Allergic Responses in Combined Allergic Rhinitis and Asthma Syndrome Induced by Chronic Exposure to Ovalbumin by Modulating the TSLP-DC-OX40L Axis. Inflammation 2018; 41:1304-1320. [PMID: 29654433 DOI: 10.1007/s10753-018-0779-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The experimental model of combined allergic rhinitis and asthma syndrome (CARAS) has shown that CpG oligodeoxynucleotides (CpG-ODNs) are potential inhibitors of type 2 helper cell-driven inflammatory responses. Currently available CpG-ODNs modestly inhibit allergic responses in CARAS, while a combination strategy for upper airway treatment by co-administration of CpG-ODNs and glucocorticoids may show good efficacy. This study aimed to assess the therapeutic effects of CpG-ODNs combined with budesonide (BUD) on upper and lower-airway inflammation and remodeling in mice with CARAS induced by chronic exposure to ovalbumin (OVA), exploring the possible underlying molecular mechanisms. A BALB/c mouse model of chronic CARAS was established by systemic sensitization and repeated challenge with OVA. Treatment with CpG-ODNs or BUD by intranasal administration was started 1 h after OVA challenge. Then, nasal mucosa and lung tissues were fixed and stained for pathologic analysis. The resulting immunologic variables and TSLP-DC-OX40L axis parameters were evaluated. Both CpG-ODNs and BUD intranasal administration are effective on reducing Th2-type airway inflammation and tissue remodeling. Co-administration of CpG-ODNs and BUD was more effective than each monotherapy in attenuating upper and lower-airway inflammation as well as airway remodeling in chronic CARAS. Notably, combination of CpG-ODNs with BUD modulated the TSLP-DC-OX40L axis, as demonstrated by decreased TSLP production in the nose and lung, alongside decreased TSLPR and OX40L in DC. Intranasal co-administration of CpG-ODNs and BUD synergistically alleviates airway inflammation and tissue remodeling in experimental chronic CARAS, through shared cellular pathways, as a potent antagonist of the TSLP-DC-OX40L axis.
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Affiliation(s)
- Hong-Tao Li
- Department of Respiratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Zhuang-Gui Chen
- Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yu-Sen Lin
- Department of Respiratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Hui Liu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jin Ye
- Department of Otolaryngology, Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiao-Ling Zou
- Department of Respiratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yan-Hong Wang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Hai-Ling Yang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Tian-Tuo Zhang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China.
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Johnston J, Hoggard M, Biswas K, Astudillo-García C, Waldvogel-Thurlow S, Radcliff FJ, Mahadevan M, Douglas RG. The bacterial community and local lymphocyte response are markedly different in patients with recurrent tonsillitis compared to obstructive sleep apnoea. Int J Pediatr Otorhinolaryngol 2018; 113:281-288. [PMID: 30174001 DOI: 10.1016/j.ijporl.2018.07.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/23/2018] [Accepted: 07/23/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is now a more common indication for tonsillectomy than recurrent tonsillitis (RT) [1,2]. Few studies have addressed possible differences in pathogenesis between these two conditions. Children with RT and OSA are often being treated in the community with multiple courses of antibiotics before surgery. Current understanding of the role of bacteria in disorders of the tonsils is mainly based on the culture of tonsil swabs. Swab cultures reflect only a very small fraction of the bacteria present on the mucosal surface and may not represent the bacterial communities within the tonsil crypts [3,4]. This study aimed to evaluate the local lymphocyte response and associations with bacterial community composition using molecular techniques of the tonsils removed from children for RT or OSA. METHOD The palatine tonsils were removed by extracapsular dissection from 24 patients with age range one to ten years, 14 of whom had RT and 10 had OSA. The fixed tonsil tissues were evaluated for bacteria by Gram-staining and presence of connective tissue by safranin staining. B lymphocytes and T lymphocytes were also measured immunohistochemically. Finally, previously published bacterial community data for this cohort were reassessed for associations with RT and OSA, and with the observed lymphocyte patterns. RESULTS In tonsils from patients with RT, large micro-colonies of bacteria were observed in the tonsil crypts, and a large number of B and T lymphocytes were noted immediately adjacent to the tonsil crypt itself. In marked contrast, the tonsils from patients with OSA had no bacteria identified, and no significant skewing of lymphocytes based on site (such as follicles or crypts). We observed that the majority of lymphocytes surrounding the bacterial micro-colonies were B lymphocytes with a mean ratio of 109:55 (B lymphocytes: T lymphocytes). Bacterial community diversity was not different between the two cohorts; however, there were significant differences in bacterial community composition. Children with RT had a higher relative abundance of members from the genera Parvimonas, Prevotella, and Treponema. While children with OSA had a higher relative abundance of Haemophilus, and Capnocytophaga. CONCLUSION These results demonstrate significant differences in the local lymphocyte response and bacterial community composition in tonsil tissue between RT and OSA patients. It suggests that the response to antibiotics used in the treatment of these two conditions may be different. Furthermore, the presence of lymphocytes in RT within the tonsil crypt outside the tonsil epithelium is a unique observation of the location of these cells.
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Affiliation(s)
- James Johnston
- Department of Surgery, The University of Auckland, Auckland, New Zealand.
| | - Michael Hoggard
- School of Biological Sciences, The University of Auckland, Auckland, New Zealand
| | - Kristi Biswas
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | | | | | - Fiona J Radcliff
- Department of Molecular Medicine and Pathology, The University of Auckland, Auckland, New Zealand
| | - Murali Mahadevan
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Richard G Douglas
- Department of Surgery, The University of Auckland, Auckland, New Zealand
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Tagliacarne SC, Valsecchi C, Benazzo M, Nichelatti M, Marseglia A, Ciprandi G, Bernasconi S. Low-dose multicomponent medication modulates humoral and cellular immune response in an ex-vivo study on children subjected to adenoid surgery. Immunol Lett 2018; 203:95-101. [PMID: 30261195 DOI: 10.1016/j.imlet.2018.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/13/2018] [Accepted: 09/21/2018] [Indexed: 12/15/2022]
Abstract
Respiratory infections, mainly in children, are a demanding challenge for physicians. Commonly, a relative immune-defect sustains their recurrence. At present, there is no standardized treatment for their prevention acting on the immune system. Citomix is a low-dose multicomponent medication largely used in this issue. The current study evaluated its ex vivo effect on adenoidal mononuclear cells recovered from children operated for adenoid hypertrophy. B cell phenotype, and IFN-γ, IL-6, IL-10, IgG, IgA, IgM in culture supernatants were evaluated. Citomix was able to significantly increase the expression of B memory cells, IFN-γ, IL-6, IgA and IgM, and significantly decrease IL-10 and IgG. The current outcomes could be consistent with a strategy deputed to improve the early immune response to pathogens. In conclusion, the present ex vivo study suggests that Citomix might be a promising medication in preventing and early treating respiratory infections.
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Affiliation(s)
- Sara Carlotta Tagliacarne
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Chiara Valsecchi
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Marco Benazzo
- Department of Otolaryngology, University of Pavia and Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Michele Nichelatti
- Service of Biostatistics Hematology Department, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Alessia Marseglia
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giorgio Ciprandi
- Department of Medicine, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy.
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Prevalence of adenoid hypertrophy: A systematic review and meta-analysis. Sleep Med Rev 2018; 38:101-112. [DOI: 10.1016/j.smrv.2017.06.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 03/16/2017] [Accepted: 06/06/2017] [Indexed: 11/24/2022]
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Pachêco-Pereira C, Alsufyani N, Major M, Palomino-Gómez S, Pereira JR, Flores-Mir C. Correlation and reliability of cone-beam computed tomography nasopharyngeal volumetric and area measurements as determined by commercial software against nasopharyngoscopy-supported diagnosis of adenoid hypertrophy. Am J Orthod Dentofacial Orthop 2017; 152:92-103. [PMID: 28651774 DOI: 10.1016/j.ajodo.2016.11.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the diagnostic correlation and reliability of Dolphin Imaging fully automated segmentation (Dolphin Imaging and Management Solutions, Chatsworth, Calif) for assessing adenoid hypertrophy. This was investigated through 3 modes: (1) intraobserver and interobserver agreement of repeated airway auto-segmentation procedures, (2) correlation between auto-segmentation measures of volume and minimal cross-sectional airway against nasopharyngoscopy, and (3) optimum diagnostic cutoff thresholds for volume and minimal cross-sectional airway identified and tested with sensitivity and specificity analyses. METHODS Cone-beam computed tomography scans of 38 patients with suspected upper airway obstruction were analyzed. Two calibrated evaluators applied a previously validated method to quantify nasopharyngeal minimal cross-sectional airway and volume using Dolphin Imaging. Assessments were compared against grades of obstruction provided by otolaryngologists' diagnoses. RESULTS The reliability between the 2 assessments by the same evaluator on the Dolphin automatic segmentation function for volume (ICC, 0.97; 95% CI, 0.95, 0.98) and minimal cross-sectional airway (ICC, 0.84; 95% CI, 0.69, 0.91) was excellent. The interoperator reliability for volume was also excellent (ICC, 0.97; 95% CI, 0.95, 0.98), but only good (ICC, 0.701; 95% CI, 0.44, 0.85) for minimal cross-sectional airway. In contrast, the Spearman rank correlation test demonstrated weak associations between the values of the automatic measurements for both volume (4.9%; ρ = -0.22) and minimal cross-sectional airway (3.7%; ρ = 0.19). Assessments of accuracy via Receiver Operating characteristic analysis, sensitivity, specificity, negative predictive values, positive predictive values, and likelihood ratios demonstrated the poor clinical applicability of volume and minimal cross-sectional airway numbers provided by Dolphin Imaging. CONCLUSIONS The evaluators were reliable at manipulating the selected software, achieving consistent volume and minimal cross-sectional airway measurements, However, Dolphin Imaging volumetric and minimal cross-sectional airway measurements did not correlate well with the nasopharyngoscopy-supported reference standard for adenoid hypertrophy assessment. Under these study conditions, volume and minimal cross-sectional airway used to assess localized adenoid hypertrophy with cone-beam computed tomography imaging based on automated measurements may not yield high-quality clinically relevant information about upper airway constriction related to adenoid hypertrophy.
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Affiliation(s)
- Camila Pachêco-Pereira
- School of Dentistry, Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Noura Alsufyani
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Michael Major
- School of Dentistry, Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra Palomino-Gómez
- Department of Pediatric Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - José Roberto Pereira
- School of Dentistry, Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Carlos Flores-Mir
- School of Dentistry, Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Pachêco-Pereira C, Alsufyani NA, Major M, Heo G, Flores-Mir C. Accuracy and reliability of orthodontists using cone-beam computerized tomography for assessment of adenoid hypertrophy. Am J Orthod Dentofacial Orthop 2017; 150:782-788. [PMID: 27871704 DOI: 10.1016/j.ajodo.2016.03.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Our objectives were to evaluate the reliability of agreement between orthodontists, with various degrees of cone-beam computed tomography (CBCT) imaging manipulation comfort, in classifying adenoid hypertrophy through CBCT generated images and also to determine how accurate orthodontists are compared with the gold standard diagnosis, nasopharyngoscopy. METHODS This was a cross-sectional study in which a randomized list of board-certified orthodontists evaluated different degrees of adenoid hypertrophy of a stratified sampling of 10 scans. The available pool of CBCT images was from a multidisciplinary airway clinic in which children and adolescents had a CBCT scan and a nasopharyngoscopy (reference standard) by an otolaryngologist (head and neck surgeon) on the same day. The participating orthodontists used the same viewer software and computer, and had access to a previously published visual guideline for evaluating adenoid size. RESULTS Fourteen orthodontists evaluated 10 CBCT reconstructions. Interoperator reliability was excellent (intraclass correlation coefficient [ICC], 0.941; 95% confidence interval, 0.882-0.984). However, the orthodontists' evaluations against the reference standard demonstrated poor accuracy, (ICC mean, 0.39; ICC range, 0.0-0.74). Dichotomous data representing healthy and unhealthy patients were analyzed individually, and the orthodontists' evaluations and the nasopharyngoscopy results (accuracy) showed, on average, poor kappa values (mean, 0.44; range, 0.20-0.80). CONCLUSIONS Different levels of CBCT expertise impacted the assessment accuracy. The participating orthodontists showed excellent consistency among themselves; however, poor agreement between their CBCT assessments compared with nasopharyngoscopy demonstrated that this sample of clinical orthodontists had poor diagnostic accuracy. Together, these findings suggest that orthodontists may make consistent and systematic errors in this type of evaluations.
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Affiliation(s)
- Camila Pachêco-Pereira
- Assistant clinical professor, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Noura A Alsufyani
- Assistant clinical professor, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Assistant professor, King Saud University, Riyadh, Saudi Arabia
| | - Michael Major
- Director of the Inter-disciplinary Airway Research Clinic and assistant clinical professor, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Giseon Heo
- Associate professor in statistics, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Carlos Flores-Mir
- Professor and Orthodontic Graduate Program Director, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Karpova EP, Kharina DV. [The possibilities for the rational pharmacotherapy of adenoiditis in the children]. Vestn Otorinolaringol 2017; 81:73-76. [PMID: 27876743 DOI: 10.17116/otorino201681573-76] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The available literature data give evidence that viral infection is the main cause underlying the development of inflammatory nasopharyngeal pathology in the children. According to ICD-10, nether acute nor chronic adenoiditis should be considered as a self-consistent nosological entity. Acute adenoiditis is usually regarded as a form of acute nasopharyngitis (J02) or acute respiratory viral infection (J06.9) whereas chronic adenoiditis is commonly referred to as representing other chronic diseases of the tonsils and adenoids (J 35.8). The reactive changes in the nasopharyngeal tonsils begin to be manifested on days 3-5 after the onset of acute respiratory viral infection; thereafter, they persist and gradually disappear within the next 2-3 weeks. In the majority of the cases, acute adenoiditis is actually a physiological reaction of the nasopharyngeal tonsils as the organs of regional mucosal immunity to antigenic stimulation. There is no universally accepted opinion as regards the duration of the inflammatory process which would allow these pathological changes to be considered as turned into chronic ones. This condition is actually not a serious pathology provided it is not associated with the concomitant complications and produces no clinically significant effect on the child's quality of life. Under practical conditions, such children are most frequently treated with the use of irrigation therapy. Taking into account that otorhinolaryngologists all over the world do not consider chronic adenoiditis as an independent nosological entity but distinguish only hypertrophy of adenoid vegetations or chronic rhinosinusitis (in the presence of inflammatory changes in the nasopharynx), it appears correct to speak about chronic adenoiditis provided the clinical manifestations of the disease persist for more than 12 weeks. Based on the predominant etiological component, the viral, bacterial, and allergic forms of nasopharyngeal adenoiditis can be distinguished even though it is rather difficult to actually determine which etiological factor prevails in each concrete case. The aforedescribed situation poses a large number of questions pertaining to the choice of either systemic or topical antibacterial therapy.
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Affiliation(s)
- E P Karpova
- Russian Medical Academy of Post-Graduate Education, Moscow, Russia, 123242
| | - D V Kharina
- Russian Medical Academy of Post-Graduate Education, Moscow, Russia, 123242
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Mariño-Sánchez FS, Valls-Mateus M, Ruiz-Echevarría K, Alobid I, Cardenas-Escalante P, Jiménez-Feijoo R, Lozano-Blasco J, Giner-Muñoz MT, Rodríguez-Jorge J, Haag O, Plaza-Martin AM, Mullol J. Nasal obstructive disorders induce medical treatment failure in paediatric persistent allergic rhinitis (The NODPAR Study). Pediatr Allergy Immunol 2017; 28:176-184. [PMID: 27801958 DOI: 10.1111/pai.12679] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Allergic rhinitis (AR) is the most common chronic disease among children. To characterize the disease, a modified classification of severity (m-ARIA) has recently been validated in AR children. When medical treatment fails, surgery for nasal obstructive disorders (NOD) may be a therapeutic option. Our objective was to assess the prevalence of NOD and their influence in medical treatment response among children with persistent AR (PER). METHODS In a prospective, real-life study, 130 paediatric PER patients (13.1 ± 2.8 years, females 31.5%, severe rhinitis 49%) referred from Allergy to ENT department were assessed for their response (R, responders; NR, non-responders) to medical treatment (intranasal steroids and antihistamines or antileukotrienes) by direct questioning and nasal symptom visual analogue scale, the presence of NOD (septal deformity, turbinate enlargement and adenoidal hyperplasia), comorbidities, nasal symptoms, rhinitis severity (modified ARIA criterion) and asthma control (International Consensus On Pediatric Asthma criterion). RESULTS After 2 months of treatment, the NR group presented a higher prevalence of obstructive septal deformity and severe inferior turbinate enlargement when compared with the R group. Higher septal deformity and turbinate enlargement scores were strongly associated with treatment refractoriness. The prevalence of severe PER was also higher for the NR group. Higher asthma control scores were associated with the probability of treatment-induced improvement. CONCLUSIONS In paediatric PER patients, medical therapy refractoriness was associated with NOD, mainly septal deformity and turbinate enlargement. In those patients, ENT examination will facilitate an early NOD diagnosis in order to indicate potential corrective surgery.
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Affiliation(s)
- Franklin S Mariño-Sánchez
- Unidad de Rinología Pediátrica, Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain.,Unidad de Rinología, Servicio de Otorrinolaringología, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain. Research Group of Excellence 2014-SGR-748, (Generalitat de Catalunya)
| | - Meritxell Valls-Mateus
- Unidad de Rinología Pediátrica, Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain.,Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Karen Ruiz-Echevarría
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Isam Alobid
- Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain. Research Group of Excellence 2014-SGR-748, (Generalitat de Catalunya).,Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Paulina Cardenas-Escalante
- Unidad de Rinología Pediátrica, Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Rosa Jiménez-Feijoo
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Jaime Lozano-Blasco
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - María T Giner-Muñoz
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | | | - Oliver Haag
- Unidad de Rinología Pediátrica, Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Ana M Plaza-Martin
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Joaquim Mullol
- Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain. Research Group of Excellence 2014-SGR-748, (Generalitat de Catalunya).,Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain
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Licari A, Castagnoli R, Denicolò CF, Rossini L, Marseglia A, Marseglia GL. The Nose and the Lung: United Airway Disease? Front Pediatr 2017; 5:44. [PMID: 28316969 PMCID: PMC5334318 DOI: 10.3389/fped.2017.00044] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/16/2017] [Indexed: 12/31/2022] Open
Abstract
Epidemiologic, pathophysiologic, and clinical evidences recently revealed the link between upper and lower airways, changing the global pathogenic view of respiratory allergy. The aim of this review is to highlight the strong interaction between the upper and lower respiratory tract diseases, in particular allergic rhinitis and asthma.
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Affiliation(s)
- Amelia Licari
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
| | - Riccardo Castagnoli
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
| | - Chiara Francesca Denicolò
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
| | - Linda Rossini
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
| | - Alessia Marseglia
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
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Accuracy and reliability of oral maxillofacial radiologists when evaluating cone-beam computed tomography imaging for adenoid hypertrophy screening: a comparison with nasopharyngoscopy. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:e168-74. [DOI: 10.1016/j.oooo.2016.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/23/2016] [Accepted: 03/09/2016] [Indexed: 11/19/2022]
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Karpova EP, Karpycheva IE, Tulupov DA. [Prophylaxis of chronic adenoiditis in the children]. Vestn Otorinolaringol 2016; 80:43-45. [PMID: 26978751 DOI: 10.17116/otorino201580643-45] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was undertaken with the purpose of improving the effectiveness of the preventive treatment of chronic adenoiditis in the children. The open randomized comparative study included 219 children aged from 6 to 7 years presenting with clinical and anamnestic signs of chronic adenoiditis. The study group was comprised of 113 patients given the Streptococcus salivarius K12-based probiotic complex during 30 days in combination with the nasal-douche. The control group consisted of 106 patients treated with the nasal douche alone. The analysis of the results of the study has demonstrated that episodes of exacerbation of adenoiditis on day 30 after the onset of the treatment occurred in 56 (49.6%) children of the study group compared with 95 (88.7%) patients of the control group. Three months later, acute sinusitis was diagnosed in 4 (3.5%) children of the study group compared with 14 (13.2%) ones in the control group. Acute otitis media was documented in 2 (1.8%) and 5 (4.7%) children of the study and control groups respectively. It is concluded that the treatment with the use of the Streptococcus salivarius K12-based probiotic complex permits to decrease the frequency of exacerbations of chronic adenoiditis and its complications in the children and reduces the requirement for medication therapy.
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Affiliation(s)
- E P Karpova
- Russian Medical Academy of Post-Graduate Education, Moscow, Russia, 125993
| | - I E Karpycheva
- Russian Medical Academy of Post-Graduate Education, Moscow, Russia, 125993
| | - D A Tulupov
- Russian Medical Academy of Post-Graduate Education, Moscow, Russia, 125993
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Adenoids and clinical symptoms: Epidemiology of a cohort of 795 pediatric patients. Int J Pediatr Otorhinolaryngol 2015; 79:2137-41. [PMID: 26478108 DOI: 10.1016/j.ijporl.2015.09.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 09/24/2015] [Accepted: 09/30/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Adenoid hypertrophy (AH) is very common in children and can cause airway obstruction. The aim of this retrospective study was to investigate the relationship between AH and other factors, including age, possible related symptoms, and allergies. METHODS Seven hundred and ninety-five patients (460 males, 335 females; mean age=5.9 years; range age: 1-14 years) were seen in an ENT clinic for nasal symptoms. Nasal endoscopy was performed with a pediatric flexible endoscope. One hundred and sixty-nine patients had documented allergy sensitization. Patients were divided into two groups according to their age: group 1 included children aged 1-7 years, and group 2 included subjects aged 8-14 years. RESULTS Adenoid size was related to age (p<0.0001). A logistic regression model - performed to evaluate adenoid grade considering, as dependent variables, age, sex, and the presence or absence of symptoms - was statistically significant (p<0.001). Moreover, AH was more common (p=0.0104) in patients with allergy sensitization, in particular in patients aged 8-14 years (p=0.0043). Nasal obstruction (OR=3.27) significantly predicted AH, whereas major age was not associated with pathological AH (OR=0.81). CONCLUSIONS The present retrospective study described the relationship between AH and other demographic and clinical factors. In conclusion, our findings demonstrated a significant association among pathological AH, age, and nasal obstruction.
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Morris MC, Kozara K, Salamone F, Benoit M, Pichichero ME. Adenoidal follicular T helper cells provide stronger B-cell help than those from tonsils. Laryngoscope 2015; 126:E80-5. [PMID: 26511445 DOI: 10.1002/lary.25536] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/30/2015] [Accepted: 07/06/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVES/HYPOTHESIS The tonsils and adenoids are secondary lymphoid organs, where antigen processing and immune cell development occur to control bacterial colonization and infection in the upper respiratory tract. Both organs are abundant in follicular T helper cells (TFH), a subset of T cells specialized for promoting B-cell development. There are no prior studies on differences between the immune cells of the tonsils and adenoids and whether the cells function differently. STUDY DESIGN In vitro assays to assess cell phenotype of tonsils and adenoids from young children (median age = 40 months). METHODS Mononuclear cells from tonsils and adenoids were cultured with or without 1 µg/mL Staphylococcus enterotoxin B (SEB) for 4 days. Cell phenotype and function were assessed by flow cytometry and multiplex enzyme-linked immunosorbent assay. RESULTS We found that in resting adenoids, TFH expressed higher CXCR5 and inducible costimulator but lower PD-1 than those from the tonsils, and that adenoidal B cells expressed higher CD27. Upon polyclonal stimulation with SEB, both TFH and B cells from the adenoids proliferated to a greater extent, and culture supernatants contained higher levels of interleukin 21. CONCLUSIONS We conclude that the cells of the adenoid are disposed toward the provision of more robust B-cell help than the tonsils. LEVEL OF EVIDENCE NA.
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Affiliation(s)
| | | | | | - Margo Benoit
- Otolaryngology Associates, University of Rochester, Rochester, New York, U.S.A
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