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Deniz I, Eyigor H, Yalcin M, Ozturk Yilmaz G, Yilmaz MD, Osma U, Selcuk OT, Renda L. The usefulness of transcervıcal ultrasonography for the predıctıon of obstructıve sleep apnea ın chıldren. Cranio 2024:1-8. [PMID: 38863170 DOI: 10.1080/08869634.2024.2358740] [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: 06/13/2024]
Abstract
OBJECTIVE It was aimed to investigate the role of tonsil ultrasonography(USG) in the diagnosis of pediatric OSAS. METHODS Before tonsillectomy (±adenoidectomy) for OSAS, all patients tonsil USG and polysomnography (PSG) tests were performed. Tonsil volume was measured preoperatively with the Brodsky tonsil grading scale and by postoperative water displacement test. RESULTS In total, 47 patients were included in the study. We observed a positive correlation between tonsil volumes measured by preoperative USG and water displacement test postoperatively. There was a statistically significant correlation between tonsil sizes measured by tonsil USG, PSG AHI and questionnaire scores(p < .05). CONCLUSION Preoperative tonsil USG may be helpful test in children with suspected OSAS.
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Affiliation(s)
- Ismail Deniz
- Department of Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Hulya Eyigor
- Department of Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mustafa Yalcin
- Department of Radiology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Gamze Ozturk Yilmaz
- Department of Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mustafa Deniz Yilmaz
- Department of Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ustun Osma
- Department of Otorhinolaryngology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Omer Tarik Selcuk
- Department of Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Levent Renda
- Department of Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey
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Cassano M, De Corso E, Fiore V, Giancaspro R, Moffa A, Casale M, Trecca EMC, Mele DA, Cassano P, Gelardi M. Update of endoscopic classification system of adenoid hypertrophy based on clinical experience on 7621 children. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:257-264. [PMID: 35396589 PMCID: PMC9330757 DOI: 10.14639/0392-100x-n1832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/29/2021] [Indexed: 11/23/2022]
Abstract
Introduction Nasal endoscopy is likely to be the method of choice to evaluate nasal obstruction and adenoid hypertrophy (AH) in children given its excellent diagnostic accuracy and low risk for the patient. The aim of this study was to update the previous classification of AH to guide physicians in choosing the best therapeutic option. Materials and methods This is a retrospective observational study including 7621 children (3565 females; mean age 5.92; range: 3-14 years) who were managed for adenoid hypertrophy at our institution between 2003 and 2018. All patients were initially treated with medical therapy and then with surgery if not adequately controlled. We performed a specific analysis based on the presence or absence of comorbidities. Results In 1845 (24.21%) patients, adenoid obstruction was classified as Grade I when the fiberoptic endoscopy showed adenoid tissue occupying < 25% of choanal space. In 2829 of 7621 (37.12%) patients, the adenoid tissue was scored as Grade II since it was confined to the upper half of nasopharynx, with sufficiently pervious choana and visualisation of tube ostium. In 1611 of 7621 (21.14%) cases, adenoid vegetation occupied about 75% of the nasopharynx with partial involvement of tube ostium and considerable obstruction of choanal openings, and was classified as Grade III. Finally, 1336 of 7621 (17.53%) patients were scored as Grade IV due to complete obstruction with adenoid tissue reaching the lower choanal border without allowing the visualisation of the tube ostium. Based on resolution of symptoms in Grade III obstruction after medical therapy (that was mostly seen in patients without comorbidities), we divided patients in two subclasses: Grade IIIA was not associated with comorbidities, while Grade IIIB was correlated with important comorbidities. Conclusions These results can be useful to guide medical or surgical therapeutic intervention. In patients with class IIIB AH, surgical treatment offered adequate control not only of nasal symptoms but also of associated comorbidities.
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Adenoid Hypertrophy Risk in Children Carriers of G-1082A Polymorphism of IL-10 Infected with Human Herpes Virus (HHV6, EBV, CMV). Life (Basel) 2022; 12:life12020266. [PMID: 35207552 PMCID: PMC8877194 DOI: 10.3390/life12020266] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/21/2022] [Accepted: 02/02/2022] [Indexed: 11/26/2022] Open
Abstract
Adenoid hypertrophy (AH) is considered one of the most common diseases in the ear, nose and throat (ENT) practice. The cause of adenoid hypertrophy in children is still unknown. The main aim of the current study was to investigate IL-10 (interleukin 10) gene polymorphisms and human herpesviruses 6 (HHV6), cytomegalovirus (CMV), and Epstein–Barr virus (EBV) infections in children with AH. A total of 106 children with adenoid hypertrophy and 38 healthy children aged 2–11 years were included in this study. All children with adenoid hypertrophy were divided into three subgroups depending on the adenoid size. The viruses were determined via quantitative real-time polymerase chain reaction (PCR) using commercially available kits (QIAGEN, Germany). HHV6 was more frequently detected in patients with AH compared with CMV and EBV. Among the three subgroups of children with AH, HH6 and EBV were prevalent in the children with the largest adenoid size. The frequency of genotype GG tended to be higher in the control group of children. We found significantly higher frequencies of the G allele and GG and GA genotypes for IL-10 rs1800896 in the subgroup of children with the smallest size of adenoid compared with other subgroups. In conclusion, HHV6 and EBV infection could contribute to the adenoid size. The genotype GG for IL-10 rs1800896 could contribute to the resistance to adenoid hypertrophy and the spread of the adenoid tissue.
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Lee SY, Kim JW. Nasopharyngeal Width and Its Association With Sleep-Disordered Breathing Symptoms in Children. Clin Exp Otorhinolaryngol 2019; 12:399-404. [PMID: 30832459 PMCID: PMC6787469 DOI: 10.21053/ceo.2018.01151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 12/26/2018] [Indexed: 01/07/2023] Open
Abstract
Objectives Although adenotonsillar hypertrophy is the main cause of sleep-disordered breathing in children, surrounding anatomic factors, such as the width of the nasopharynx, can affect upper airway patency. However, there have been no reports of the association of nasopharyngeal width with sleep-disordered breathing in children. This study was undertaken to measure nasopharyngeal width in children undergoing adenotonsillectomy for sleep-disordered breathing and to investigate the clinical implications of this factor. Methods This was a retrospective study with a follow-up period of 1 year, performed at a tertiary referral center. We reviewed the operative records of children who underwent adenotonsillectomy at our center for symptoms of sleep-disordered breathing, such as snoring, apnea, and mouth breathing. The nasopharyngeal width was measured immediately before adenotonsillectomy, which was performed under general anesthesia with a microscopy-assisted mirror view. Adenotonsillar hypertrophy was graded on a four-point scale, and symptoms of sleep-disordered breathing were evaluated by using the Korean version of the Obstructive Sleep Apnea-18 questionnaire before and after surgery. The relationships between the average nasopharyngeal width and patient age and sex, adenotonsillar hypertrophy, and the Korean version of the Obstructive Sleep Apnea-18 score were analyzed. Results The study included 549 children (343 boys) with a mean age of 6.0 years (range, 2 to 11 years). The average nasopharyngeal width was 11.9 mm (range, 7.0 to 18.0 mm) and increased with age (range, 11.2 to 13.3; β=0.264; P<0.001). At 1 year after surgery, children with a greater nasopharyngeal width at the time of surgery exhibited additional improvements in symptoms of obstruction relative to those at 1 month after surgery. Conclusion The average nasopharyngeal width in children is approximately 11.9 mm and exhibits a slight increase with age. The width of the nasopharynx may be a factor associated with the degree of improvement in symptoms of sleep-disordered breathing after adenotonsillectomy.
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Affiliation(s)
- Sang-Youp Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Gul F, Muderris T, Yalciner G, Mise HI, Canan Y, Babademez MA, Erel O. A novel method for evaluation of oxidative stress in children with OSA. Int J Pediatr Otorhinolaryngol 2016; 89:76-80. [PMID: 27619033 DOI: 10.1016/j.ijporl.2016.07.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 07/24/2016] [Accepted: 07/26/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the role of adenotonsillar hypertrophy and the outcomes of adenotonsillectomy (AT) on oxidative stress for obstructive sleep apnea (OSA) in children using a new method; thiol/disulfide homeostasis. METHODS The study is consisted of 45 children with OSA and 38 healthy control subjects with similar age and sex. Children 3-12 years of age with OSA, defined as having an apnea/hypopnea index (AHI) of 5 or more in an overnight polysomnography, underwent adenotonsillectomy. OSA was classified as mild (1 ≤ AHI<10), moderate (10 ≤ AHI<20) or severe (AHI≥20). Venous blood samples were taken preoperatively and one month after surgery. The blood levels of thiol/disulfide homeostasis were assessed and compared between patients and control group, before and after adenotonsillectomy. RESULTS Body mass index (BMI), mean age and gender distribution were similar between the study and control groups. Statistically significant higher disulfide levels and ratios were found in the study group compared to the control group; in patients with moderate to severe OSA compared to mild OSA; in the preoperative period compared to postoperative period (p < 0.001, for all). CONCLUSIONS The current study provides preliminary evidence between oxidative stress and OSA in children with adenotonsillar. Adenotonsillectomy for OSA may result in a dramatic improvement in oxidative stress as measured by thiol/disulfide homeostasis.
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Affiliation(s)
- Fatih Gul
- Bitlis Tatvan State Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Bitlis, Turkey.
| | - Togay Muderris
- FEBORL-HNS, Ataturk Training and Research Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Ankara, Turkey.
| | - Gokhan Yalciner
- Ataturk Training and Research Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Ankara, Turkey.
| | - Halil Ibrahim Mise
- Ataturk Training and Research Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Ankara, Turkey.
| | - Yagmur Canan
- Yıldırım Beyazıt University School of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, Ankara, Turkey.
| | - Mehmet Ali Babademez
- Yıldırım Beyazıt University School of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, Ankara, Turkey
| | - Ozcan Erel
- Yıldırım Beyazıt University School of Medicine, Department of Clinical Biochemistry, Ankara, Turkey
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Qu XP, Huang ZX, Sun Y, Ye T, Cui SJ, Huang Q, Ma LJ, Yang QW, Wang H, Fan EZ, Li Y, Zhang L, Zhou B. Expression of Innate Immunity Genes in Epithelial Cells of Hypertrophic Adenoids with and without Pediatric Chronic Rhinosinusitis: A Preliminary Report. Chin Med J (Engl) 2016; 128:2913-8. [PMID: 26521790 PMCID: PMC4756897 DOI: 10.4103/0366-6999.168056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Adenoid hypertrophy (AH) is associated with pediatric chronic rhinosinusitis (pCRS), but its role in the inflammatory process of pCRS is unclear. It is thought that innate immunity gene expression is disrupted in the epithelium of patients with chronic rhinosinusitis (CRS), including antimicrobial peptides and pattern recognition receptors (PRRs). The aim of this preliminary study was to detect the expression of innate immunity genes in epithelial cells of hypertrophic adenoids with and without pCRS to better understand their role in pCRS. METHODS Nine pCRS patients and nine simple AH patients undergoing adenoidectomy were recruited for the study. Adenoidal epithelium was isolated, and real-time quantitative polymerase chain reaction (RT-qPCR) was employed to measure relative expression levels of the following messenger RNAs in hypertrophic adenoid epithelial cells of pediatric patients with and without CRS: Human β-defensin (HBD) 2 and 3, surfactant protein (SP)-A and D, toll-like receptors 1-10, nucleotide-binding oligomerization domain (NOD)-like receptors NOD 1, NOD 2, and NACHT, LRR and PYD domains-containing protein 3, retinoic acid-induced gene 1, melanoma differentiation-associated gene 5, and nuclear factor-κB (NF-κB). RT-qPCR data from two groups were analyzed by independent sample t-tests and Mann-Whitney U-tests. RESULTS The relative expression of SP-D in adenoidal epithelium of pCRS group was significantly lower than that in AH group (pCRS 0.73 ± 0.10 vs. AH 1.21 ± 0.15; P = 0.0173, t = 2.654). The relative expression levels of all tested PRRs and NF-κB, as well as HBD-2, HBD-3, and SP-A, showed no statistically significant differences in isolated adenoidal epithelium between pCRS group and AH group. CONCLUSIONS Down-regulated SP-D levels in adenoidal epithelium may contribute to the development of pCRS. PRRs, however, are unlikely to play a significant role in the inflammatory process of pCRS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Bing Zhou
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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Babademez MA, Gul F, Muz E, Muderris T, Kale H. Impact of partial and total tonsillectomy on adenoid regrowth. Laryngoscope 2016; 127:753-756. [DOI: 10.1002/lary.25982] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 02/16/2016] [Accepted: 02/25/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Mehmet Ali Babademez
- Department of Otorhinolaryngology-Head and Neck Surgery; Yildirim Beyazit University School of Medicine; Ankara Turkey
| | - Fatih Gul
- Department of Otorhinolaryngology-Head and Neck Surgery; Bitlis Tatvan State Hospital; Bitlis Turkey
| | - Engin Muz
- Department of Otorhinolaryngology-Head and Neck Surgery; Elaziğ Training and Research Hospital; Elaziğ Turkey
| | - Togay Muderris
- Department of Otorhinolaryngology-Head and Neck Surgery; Ataturk Training and Research Hospital; Ankara Turkey
| | - Hayati Kale
- Department of Otorhinolaryngology-Head and Neck Surgery; Ataturk Training and Research Hospital; Ankara Turkey
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ACE grading-A proposed endoscopic grading system for adenoids and its clinical correlation. Int J Pediatr Otorhinolaryngol 2016; 83:155-9. [PMID: 26968070 DOI: 10.1016/j.ijporl.2016.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/31/2016] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To propose a novel endoscopic adenoid grading system using a rigid nasal endoscope and to study its correlation with the clinical diagnosis. METHODOLOGY Prerecorded video clips of rigid nasal endoscopy taken during endoscopic adenoidectomy were retrieved. Otolaryngology consultants blinded to the clinical diagnosis of the child were presented these videos and asked to grade the adenoid hypertrophy as per the proposed endoscopic ACE (Airway/Choana/Eustachian tube) grading system. The clinical diagnosis was correlated with the different aspects of the descriptive endoscopic grading system. RESULTS 152 video clips were presented to the otolaryngology consultants for grading. The average age was 8.6 years (SD-3.48), while the male female ratio was 3:2. The A subcomponent of the ACE grading showed significant correlation with the diagnosis of sleep disordered breathing and chronic adenotonsillitis, C subcomponent with sleep disordered breathing and the E subcomponent with the diagnosis of otitis media. CONCLUSION The proposed endoscopic grading is easily applicable and at the same time clearly describes the relation of the adenoids to the nasopharynx, choana and Eustachian tube. Different aspects of the grading system correlated differently with the clinical diagnosis emphasizing that a descriptive scoring rather than a comprehensive scoring is a more relevant clinical tool.
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Friedman NR, Prager JD, Ruiz AG, Kezirian EJ. A Pediatric Grading Scale for Lingual Tonsil Hypertrophy. Otolaryngol Head Neck Surg 2015; 154:171-4. [DOI: 10.1177/0194599815601403] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/28/2015] [Indexed: 11/16/2022]
Abstract
Lingual tonsil hypertrophy (LTH) is a common finding for children with residual obstructive sleep apnea (OSA) following an adenotonsillectomy. Secondary to the significant morbidity associated with OSA, identification and treatment of residual OSA are paramount. A dedicated LTH grading scale for children does not exist. The current adult LTH scale is impractical for children. Imaging is not routine for children, since it frequently requires sedation. We present a pediatric LTH grading scale with substantial interrater reliability to facilitate standardization of endoscopy findings and promote outcomes-based research for OSA surgery in children.
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Affiliation(s)
- Norman R. Friedman
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, USA
- Division of Pediatric Otolaryngology, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Jeremy D. Prager
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, USA
- Division of Pediatric Otolaryngology, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Amanda G. Ruiz
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, USA
- Division of Pediatric Otolaryngology, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Eric J. Kezirian
- Department of Otolaryngology Head and Neck Surgery, Keck School of Medicine of USC, Los Angeles, California, USA
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Camacho M, Zaghi S, Certal V, Abdullatif J, Means C, Acevedo J, Liu S, Brietzke SE, Kushida CA, Capasso R. Inferior turbinate classification system, grades 1 to 4: development and validation study. Laryngoscope 2014; 125:296-302. [PMID: 25215619 DOI: 10.1002/lary.24923] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/27/2014] [Accepted: 08/18/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To develop a validated inferior turbinate grading scale. STUDY DESIGN Development and validation study. METHODS Phase 1 development (alpha test) consisted of a proposal of 10 different inferior turbinate grading scales (>1,000 clinic patients). Phase 2 validation (beta test) utilized 10 providers grading 27 standardized endoscopic photos of inferior turbinates using two different classification systems. Phase 3 validation (pilot study) consisted of 100 live consecutive clinic patients (n = 200 inferior turbinates) who were each prospectively graded by 18 different combinations of two independent raters, and grading was repeated by each of the same two raters, two separate times for each patient. RESULTS In the development phase, 25% (grades 1-4) and 33% (grades 1-4) were the most useful systems. In the validation phase, the 25% classification system was found to be the best balance between potential clinical utility and ability to grade; the photo grading demonstrated a Cohen's kappa (κ) = 0.4671 ± 0.0082 (moderate inter-rater agreement). Live-patient grading with the 25% classification system demonstrated an overall inter-rater reliability of 71.5% (95% confidence interval [CI]: 64.8-77.3), with overall substantial agreement (κ = 0.704 ± 0.028). Intrarater reliability was 91.5% (95% CI: 88.7-94.3). Distribution for the 200 inferior turbinates was as follows: 25% quartile = grade 1, 50% quartile (median) = grade 2, 75% quartile = grade 3, and 90% quartile = grade 4. Mean turbinate size was 2.22 (95% CI: 2.07-2.34; standard deviation 1.02). Categorical κ was as follows: grade 1, 0.8541 ± 0.0289; grade 2, 0.7310 ± 0.0289; grade 3, 0.6997 ± 0.0289, and grade 4, 0.7760 ± 0.0289. CONCLUSIONS The 25% (grades 1-4) inferior turbinate classification system is a validated grading scale with high intrarater and inter-rater reliability. This system can facilitate future research by tracking the effect of interventions on inferior turbinates. LEVEL OF EVIDENCE 2c.
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Affiliation(s)
- Macario Camacho
- Department of Psychiatry, Sleep Medicine Division, Stanford Outpatient Medical Center, Redwood City, California, U.S.A
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Brambilla I, Pusateri A, Pagella F, Caimmi D, Caimmi S, Licari A, Barberi S, Castellazzi AM, Marseglia GL. Adenoids in children: Advances in immunology, diagnosis, and surgery. Clin Anat 2014; 27:346-52. [PMID: 24535951 DOI: 10.1002/ca.22373] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 01/01/2014] [Indexed: 11/06/2022]
Abstract
Adenoids are strategically located for mediating local and regional immune functions as they are exposed to antigens from both the outside air and the alimentary tract. Recurrent or chronic respiratory infections can induce histomorphological and functional changes in the adenoidal immunological barrier, sometimes making surgical treatment necessary. Our aim in this review is to summarize the crucial points about not only the immunological histopathology of adenoidal tissue, especially in patients with adenoid hypertrophy, but also the most common and useful diagnostic techniques and surgical options.
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Affiliation(s)
- Ilaria Brambilla
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Italy
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Berger KI, Fagondes SC, Giugliani R, Hardy KA, Lee KS, McArdle C, Scarpa M, Tobin MJ, Ward SA, Rapoport DM. Respiratory and sleep disorders in mucopolysaccharidosis. J Inherit Metab Dis 2013; 36:201-10. [PMID: 23151682 PMCID: PMC3590419 DOI: 10.1007/s10545-012-9555-1] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 10/12/2012] [Accepted: 10/15/2012] [Indexed: 12/24/2022]
Abstract
MPS encompasses a group of rare lysosomal storage disorders that are associated with the accumulation of glycosaminoglycans (GAG) in organs and tissues. This accumulation can lead to the progressive development of a variety of clinical manifestations. Ear, nose, throat (ENT) and respiratory problems are very common in patients with MPS and are often among the first symptoms to appear. Typical features of MPS include upper and lower airway obstruction and restrictive pulmonary disease, which can lead to chronic rhinosinusitis or chronic ear infections, recurrent upper and lower respiratory tract infections, obstructive sleep apnoea, impaired exercise tolerance, and respiratory failure. This review provides a detailed overview of the ENT and respiratory manifestations that can occur in patients with MPS and discusses the issues related to their evaluation and management.
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Affiliation(s)
- Kenneth I Berger
- Department Medicine, Physiology and Neuroscience, André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York University School of Medicine, New York, NY, USA.
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Sapthavee A, Bhushan B, Penn E, Billings KR. A Comparison of Revision Adenoidectomy Rates Based on Techniques. Otolaryngol Head Neck Surg 2013; 148:841-6. [DOI: 10.1177/0194599813477830] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective No studies are available specifically comparing revision rates between suction coagulator and microdebrider-performed adenoidectomies. Our objective was to compare revision adenoidectomy rates between these instrument groups. Study Design Historical cohort study. Setting Patients included in this study had surgery at the Ann and Robert H. Lurie Children’s Hospital in Chicago, Illinois, from June 2007 through December 2011. Subjects and Methods The patients were divided into 2 groups based on technique of adenoidectomy used at the time of initial surgery and the regrowth rate analyzed. Results During the 4.5-year study period, the microdebrider was used in 4071 adenoidectomies, and 3328 cases were performed with suction coagulation. There was a revision rate of 0.84% (34 patients) for the microdebrider group. The rate was 1.50% (50 patients) for suction coagulation. This difference was found to be statistically significant on univariate analysis. The suction coagulator group had a younger mean age at initial surgery and a higher incidence of gastroesophageal reflux disease. No difference in revision rates between the 2 groups was noted on multivariate analysis. Conclusion Symptomatic regrowth of adenoid tissue occurs infrequently. Both suction coagulation and microdebrider methods are commonly used when performing adenoidectomies due to more consistent ease of use in removal of tissue. The incidence of regrowth likely relates to variables other than the technique used, as there was no difference in the regrowth rate between the 2 groups.
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Affiliation(s)
- Andrew Sapthavee
- Division of Otolaryngology–Head and Neck Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, and the Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Otolaryngology–Head and Neck Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Bharat Bhushan
- Division of Otolaryngology–Head and Neck Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, and the Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Edward Penn
- Division of Otolaryngology–Head and Neck Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, and the Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kathleen R. Billings
- Division of Otolaryngology–Head and Neck Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, and the Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Sarny S, Ossimitz G, Habermann W, Stammberger H. Preoperative coagulation screening prior to tonsillectomy in adults: current practice and recommendations. Eur Arch Otorhinolaryngol 2012; 270:1099-104. [PMID: 22791470 DOI: 10.1007/s00405-012-2099-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 06/18/2012] [Indexed: 11/28/2022]
Abstract
The hypotheses of the study are: (1) a positive history of coagulopathy predicts a higher postoperative haemorrhage risk, (2) a positive laboratory screening for coagulopathy can forecast a higher haemorrhage risk and (3) the haemorrhage risk in patients with known bleeding disorder is elevated. In a multicentre study information on 3,041 tonsillectomies in adults over 9 months, from 1st October 2009 until 30th June 2010, was evaluated. The outcome variables were patient characteristics, postoperative haemorrhage, history of coagulopathy and laboratory screening for coagulopathy. A history of coagulopathy and laboratory screening for coagulopathy were performed in almost all patients (98.6 %, 2,998/3,041). The overall haemorrhage rate was 16 %, including all bleeding episodes after extubation, with 4.8 % returning to theatre. A positive history was reported in 2 % (55/3,041) and a positive laboratory screening in 3 % (94/3,041) of all patients. A positive history is significantly associated with a higher risk of postoperative haemorrhage (31 %, 17/55, p < 0.002) compared to patients with a negative history (16 %, 387/2,497). A positive laboratory for coagulopathy was not significantly associated with an increased haemorrhage risk (20 %, 19/94, p < 0.235) compared to patients with a negative laboratory (16 %, 390/2,249). The haemorrhage risk for adults with a bleeding disorder is twice as high (31 %, 17/55) as for adults without bleeding disorder (16 %, 476/2,973). In conclusion, an adult patient's history of coagulopathy should be taken prior to tonsillectomy as a positive history doubles the haemorrhage risk while a laboratory screening for coagulopathy has no significant power to predict an elevated haemorrhage risk. Bleeding disorders double the risk of postoperative haemorrhage.
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Affiliation(s)
- Stephanie Sarny
- Department of General Oto-Rhino-Laryngology, Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26-28, 8036, Graz, Austria.
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Pagella F, Pusateri A, Chu F, Cairello F, Benazzo M, Matti E, Marseglia GL. Adenoid assessment in paediatric patients: the role of flexible nasal endoscopy. Int J Immunopathol Pharmacol 2011; 24:49-54. [PMID: 22032787 DOI: 10.1177/03946320110240s410] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Adenoid hypertrophy is the most common cause of nasal obstruction in paediatric patients. Over the years, various methods to assess the adenoid size were proposed such as the posterior rhinoscopy and the radiological examination of the nasopharynx. Nasal endoscopy was introduced for children in the 80's, and nowadays this is a known and diffuse method in routine practice. The purpose of this article is to describe the personal experience in the assessment of the adenoid size in children, with a particular regard to the flexible nasal endoscopy, and to analyse the literature reports. The personal technique is described in performing nasal endoscopy in paediatric patients, reporting advantages and possible disadvantages of the procedure. A retrospective analysis was conducted on 6036 children since 1999 to 2010. In most cases children fully collaborated to complete the exam. No major or minor complications (such as nose bleedings or other traumatic injuries) were observed. No topical intranasal decongestant, local or general anaesthesia were used in our series. In our opinion, nasal endoscopy in children is a reliable, safe, accurate, easily tolerated and dynamic diagnostic method to assess the adenoid size.
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Affiliation(s)
- F Pagella
- Department of Otorhinolaryngology - Foundation IRCCS Policlinico San Matteo, Pavia, Italy.
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16
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Lee DH. In reference to proposed definitive grading system tool for the assessment of adenoid hyperplasia. Laryngoscope 2011; 121:1348; author reply 1349-50. [PMID: 21557235 DOI: 10.1002/lary.21760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 01/26/2011] [Indexed: 11/11/2022]
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