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Adekanye AG, Akaba K, U Umana AN, Mgbe RB, Francis PM, Okoi-Obuli J. Demographics of tonsillar hypertrophy among sickle cell disease patients in calabar. Niger J Clin Pract 2023; 26:1023-1028. [PMID: 37635590 DOI: 10.4103/njcp.njcp_59_23] [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] [Indexed: 08/29/2023]
Abstract
Background Sickle cell disease (SCD) is the most common genetic disorder, with Africa bearing the highest burden. In this cohort study, sickle cell subjects are immunocompromised and predisposed to recurrent infections and tonsillar hypertrophy, especially in children. Subsequently, tonsillar hypertrophy leads to sleep-disordered breathing (SDB) with resulting hypoxemia, hypercapnia, and acidosis, raising the risk of HbS polymerization and, consequently, vaso-occlusive phenomena and other complications. Aims This study aimed to compare tonsillar hypertrophy between sickle cell patients and controls. Materials and Methods A cross-sectional descriptive study was conducted at, University of Calabar Teaching Hospital, Calabar from September 2019 to September 2021. The cohort of the study was an SCD patient confirmed using hemoglobin electrophoresis at the hematology laboratory of University of Calaabr teaching hospital and recruited via the adult and pediatric hematology unit of University of Calabar teaching hospital, and Calabar sickle cell club. The data were analyzed using Microsoft Excel and IBM Statistical Package and Service Solution (SPSS) version 22. Results Using Brodsky's grading, the prevalence of grade 3 and 4 hypertrophic tonsils in sickle cell subjects was 41.6% but 17.3% in control. The age range of 0-25 years was the most frequently affected with the peak at 0-5 years. The males among the sickle cell subjects were slightly more affected than the females (M: F =1.2:1), while the females were slightly more in the control (M: F =1:1.1). Conclusions Hypertrophic tonsils affect control and SCD, but the obstructive grades are commoner in genotypes SCD- Sickle cell disease Haemoglobin SS, SC and AA.
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Affiliation(s)
- A G Adekanye
- Department of Otorhinolaryngology, University of Calabar, Calabar Cross River State, Nigeria
| | - K Akaba
- Department of Haematology and Blood Transfusion, University of Calabar, Calabar Cross River State, Nigeria
| | - A N U Umana
- Department of Otorhinolaryngology, University of Calabar, Calabar Cross River State, Nigeria
| | - R B Mgbe
- Department of Otorhinolaryngology, University of Calabar, Calabar Cross River State, Nigeria
| | - P M Francis
- Department of Otorhinolaryngology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - J Okoi-Obuli
- Department of Pediatrics, University of Calabar, Calabar Cross River State, Nigeria
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Han Y, Guo R, Feng Z, Wang H, Li Y, Zou J, Wang Y. Associations of systemic inflammation markers with myocardial enzymes in pediatric adenotonsillar hypertrophy: A cross-sectional study. Heliyon 2023; 9:e17719. [PMID: 37483768 PMCID: PMC10359822 DOI: 10.1016/j.heliyon.2023.e17719] [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: 01/23/2023] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 07/25/2023] Open
Abstract
Objective The present study aimed to investigate the relationship between systemic inflammation markers and myocardial enzymes in children with adenotonsillar hypertrophy (ATH). Methods The levels of myocardial enzymes were detected and the systemic inflammatory biomarkers including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and systemic immune inflammation index (SII) were calculated. Regression analyses were performed and a prediction model for screening myocardial injury was established by receiver operating characteristic (ROC) curve. Results Finally, a total of 804 children with ATH were included. After adjusting for age, BMI, fasting blood glucose and lipid profiles, both NLR and SII were significantly associated with CK-MB (p = 0.041 and 0.034, respectively) and LDH (p = 0.002 and 0.001, respectively), and PLR was associated with CK-MB (p = 0.008). In addition, NLR, SII were independently associated with hyper-LDH [OR = 1.447, 95%CI (1.063, 1.968); OR = 1.001, 95%CI (1.000, 1.002), respectively] and the associations were more significant in girls. A prediction model for hyper-LDH based on SII was developed with the area under the ROC curve of 0.715 (0.682, 0.746). Conclusion Systemic inflammation markers were only independently associated with serum hyper-LDH in children with ATH, especially in girls. Further investigation was needed to determine the relationship between systemic inflammation with myocardial enzymes in ATH children.
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Affiliation(s)
- Yingying Han
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| | - Ruixiang Guo
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| | - Ziyu Feng
- School of Basic Medical Sciences, Shandong University, Jinan, China
| | - Haipeng Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Zibo Central Hospital, Zibo, China
| | - Yanzhong Li
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| | - Juanjuan Zou
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| | - Yan Wang
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
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Nemati S, Aghajankhah M, Banan R, Haddadi S, Mehri M, Aghsaghloo V, Leili EK. The effects of adeno/tonsillectomy on cardiopulmonary function based on echocardiography indices in children with primary snoring and mild obstructive sleep apnea. Am J Otolaryngol 2022; 43:103317. [PMID: 35093617 DOI: 10.1016/j.amjoto.2021.103317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The goal of this study was to evaluate the effects of adenotonsillectomy on heart function based on echocardiography indices in children with primary snoring (PS) and mild obstructive sleep apnea due to adenotonsillar hypertrophy (ATH). METHODS 55 children (aged 7 to 11 years old) with PS and ATH who were a candidate for adenotonsillectomy from August 2018 to June 2019 evaluated. A history of Upper Respiratory Tract Obstruction was obtained, clinical examination was performed and the cases suspicious for moderate to severe degrees of Obstructive Sleep Apnea Syndrome were excluded. Echocardiography was performed one week before and 3-6 months after surgery. All data were analyzed by SPSS version 19 and P-value<0.05 was considered significant. RESULTS From 55 enrolled cases, 42 [30 boys (71.5%) and 12 girls (28.5%)] completed the study course. Tricuspid Annular Plane Systolic Excursion (TAPSE), Ejection Fraction (EF), Right Ventricular Peak Systolic Myocardial Velocity (RVSM), Right Ventricular Fractional Area Change (RVFAC) were increased significantly and Isovolumic Contraction Time (IVCT) index was decreased significantly after surgery (P-value<0.05). The difference of indices between the two sexes was not significant after surgery (P-value>0.05). CONCLUSION Adenotonsillectomy can improve cardiac function indices in patients with PS due to ATH especially in terms of right ventricle (RV) function and reduction in pulmonary artery pressure. So, although "subclinical", it is better to be considered PS not just as annoying noise for roommates before significant clinical cardiac problems happen.
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Affiliation(s)
- Shadman Nemati
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Rahmatollah Banan
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Soudabeh Haddadi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mostafa Mehri
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Vahid Aghsaghloo
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Ehsan Kazemnezhad Leili
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Shuaibu I, Usman M, Ajiya A, Chitumu D, Mohammed I, Abdullahi H, Adebola S, Adamu A. Adenoid and tonsil hypertrophy in Zaria, North Western Nigeria: Review of clinical presentation and surgical outcome. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:23-27. [PMID: 36203928 PMCID: PMC9531741 DOI: 10.4103/jwas.jwas_71_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/28/2022] [Indexed: 11/04/2022]
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Kim DY, Ko KO, Lim JW, Yoon JM, Song YH, Cheon EJ. The improvement of right ventricular function after adenotonsillectomy in children with obstructive sleep apnea. KOREAN JOURNAL OF PEDIATRICS 2018; 61:392-396. [PMID: 30360034 PMCID: PMC6313087 DOI: 10.3345/kjp.2018.06436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/06/2018] [Indexed: 11/27/2022]
Abstract
Purpose Adenotonsillar hypertrophy (ATH) that causes upper airway obstruction might lead to chronic hypoxemic pulmonary vasoconstriction and right ventricular (RV) dysfunction. We aimed to evaluate whether adenotonsillectomy (T&A) in children suffering from obstructive sleep apnea (OSA) due to severe ATH could improve RV function. Methods Thirty-seven children (boy:girl=21:16; mean age, 9.52±2.20 years), who underwent T&A forsleep apnea due to ATH, were included. We analyzedthe mean pulmonary artery pressure (mPAP), the presence and the maximal velocity of tricuspid regurgitation (TR), the tricuspid annular plane systolic excursion (TAPSE), and the right ventricular myocardial performance index (RVMPI) with tissue Doppler echocardiography (TDE) by transthoracic echocardiography pre- and post-T&A. The follow-up period was 1.78±0.27 years. Results Only the RVMPI using TDE improved after T&A (42.18±2.03 vs. 40±1.86, P=0.001). The absolute value of TAPSE increased (21.45±0.90 mm vs. 22.30±1.10 mm, P=0.001) but there was no change in the z score of TAPSE pre- and post-T&A (1.19±0.34 vs. 1.24±0.30, P=0.194). The mPAP was within normal range in children with ATH, and there was no significant difference between pre- and post-T&A (19.6±3.40 vs. 18.7±2.68, P=0.052). There was no difference in the presence and the maximal velocity of TR (P=0.058). Conclusion RVMPI using TDE could be an early parameter of RV function in children with OSA due to ATH.
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Affiliation(s)
- Dong Yeop Kim
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Kyung Ok Ko
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Jae Woo Lim
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Jung Min Yoon
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Young Hwa Song
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Eun Jeong Cheon
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
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Góis CRTD, D'Ávila JS, Cipolotti R, Lira ADS, Silva ALL. Adenotonsillar Hypertrophy in Pre-School Children with Sickle Cell Disease and Diagnostic Accuracy of the Sleep Disturbance Scale for Children. Int Arch Otorhinolaryngol 2018; 22:55-59. [PMID: 29371899 PMCID: PMC5783688 DOI: 10.1055/s-0037-1602702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 03/18/2017] [Indexed: 11/10/2022] Open
Abstract
Introduction
Adenotonsillar hypertrophy is more common in children with sickle cell disease, and can lead to sleep-disordered breathing.
Objectives
To determine the frequency of adenotonsillar hypertrophy in pre-school children with sickle cell disease and assess the diagnostic accuracy of the sleep-disordered breathing subscale in the Sleep Disturbance Scale for Children.
Method
Observational study with a group of 48 children with sickle cell disease and a control group of 35 children without the disease. The children underwent oropharingoscopy and video nasal endoscopy. The parents and/or guardians answered the questions of the subscale.
Results
Adenotonsillar hypertrophy was observed in 25% of the children in the study group, and in 20% of the children in the control group, with no statistical difference between the groups. The subscale score ranged from 3 to 11 in both groups. There was a statistical significance in the study group. The average was 4.79 (standard deviation [SD] ± 2.50), with 4.19 (SD ± 1.72) among the children without adenotonsillar hypertrophy, and 6.5 (SD ± 3.40) among the children with adenotonsillar hypertrophy. There was also a statistical significance in the control group. The average was 5.23 (SD ± 2.81), with 4.44 (SD ± 2.2) among the children without adenotonsillar hypertrophy, and 7.87 (SD ± 2.89) among the children with adenotonsillar hypertrophy.
Conclusion
Adenotonsillar hypertrophy was not associated with sickle cell disease in pre-school children. The subscale of sleep-disordered breathing in the Sleep Disturbance Scale for Children was a useful tool for the diagnostic suspicion of adenotonsillar hypertrophy in children in this age group.
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Affiliation(s)
| | | | - Rosana Cipolotti
- Department of Medicine, Universidade Federal de Sergipe (UFS), Aracaju, SE, Brazil
| | - Amanda da Silva Lira
- Department of Statistics and Actuarial Sciences, Universidade Federal de Sergipe (UFS), São Cristóvão, SE, Brazil
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Ehsan Z, Ishman SL, Kimball TR, Zhang N, Zou Y, Amin RS. Longitudinal Cardiovascular Outcomes of Sleep Disordered Breathing in Children: A Meta-Analysis and Systematic Review. Sleep 2017; 40:2962446. [PMID: 28329042 DOI: 10.1093/sleep/zsx015] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives The presence of sleep disordered breathing (SDB) is known to impact long-term cardiovascular morbidity in adults; however, the long-term effects in children are poorly understood. We aimed to systematically review and synthesize studies published to date on the long-term effects of SDB in children. Study Design Meta-analysis and systematic review using PubMed, CINAHL, Embase, and Scopus (all indexed years). Methods We searched for English-language articles containing original human data from prospective studies, with ≥7 participants, in children ≤18 years of age. Data regarding study design, demographics, clinical characteristics, outcomes, level of evidence, and risk of bias were obtained. Articles were independently reviewed by three investigators. Retrospective and cross-sectional studies were excluded. Results Of 1701 identified abstracts, 25 articles (combined n = 1418) were ultimately included. All studies reported longitudinal outcomes following treatment of SDB, 21 studies exclusively reporting outcomes after adenotonsillectomy. Therefore, studies were combined to objectively assess the effect of SDB treatment on cardiovascular outcomes. Although all cardiovascular parameters were within the normal range at baseline, at follow-up there was a significant decrease in mean pulmonary artery pressure, right ventricular end diastolic diameter, heart rate, mitral Em/Am ratio, and C-reactive protein. There was no significant change in interventricular septum thickness, left ventricular parameters (shortening fraction, systolic and end diastolic diameters, ejection fraction, posterior wall thickness, isovolumetric relaxation time), left atrial diameter, and aortic and pulmonary valve peak velocities. Conclusions Studies assessing the long-term cardiovascular effects of SDB in children are limited. The available literature indicates effects on autonomic function, right, and left heart function following treatment for SDB. However, well-designed, large-scale, prospective cohort studies (using standardized outcomes) are needed to better understand the relationship of cardiovascular morbidity in the context of pediatric SDB.
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Affiliation(s)
- Zarmina Ehsan
- Division of Pulmonary and Sleep Medicine, Children's Mercy Hospital, Kansas City, MO
| | - Stacey L Ishman
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Thomas R Kimball
- Division of Cardiology, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Nanhua Zhang
- Department of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Yuanshu Zou
- Department of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Raouf S Amin
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Cardiopulmonary functions and adenotonsillectomy: surgical indications need revision. The Journal of Laryngology & Otology 2016; 130:1120-1124. [PMID: 27786148 DOI: 10.1017/s0022215116009129] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess cardiac functions in adenotonsillar or tonsillar hypertrophy. METHODS A prospective, interventional, academic centre based study was conducted on 25 children with adenotonsillar or tonsillar hypertrophy. All patients underwent pulsed 2-dimensional Doppler echocardiography, pulse oximetry and 12-lead electrocardiography. These assessments were repeated three months later to determine the impact of adenotonsillectomy. RESULTS There were significant differences in mean arterial oxygen saturation, pulmonary flow acceleration time and mean pulmonary artery pressure post-operatively. Adenotonsillectomy led to significant improvements in pulmonary flow acceleration time and pulmonary flow velocity time index, while tonsillectomy resulted in right ventricular early and late diastolic velocity index improvement. CONCLUSION Upper airway obstruction in children affects cardiac functioning and this can subsequently lead to morbidity and delayed growth. Hence, revision of surgical indications is advocated in adenotonsillar hypertrophy to avoid irreversible damage to cardiopulmonary functions.
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Abstract
Adenoid hypertrophy (AH) is a common disorder in children, resulting in chronic nasal congestion. This chronic congestion should be evaluated carefully because it can lead to chronic upper airway obstruction. Many authors have suggested that increased nasal resistance to respiration may cause disturbances in the pulmonary ventilation and carry the risk of cardiopulmonary diseases. Mean platelet volume (MPV) is a marker of platelet function and is positively associated with indicators of platelet activity. Mean platelet volume is an indicator of larger and more reactive platelets and has been shown to be increased in patients with vascular disease, including peripheral, pulmonary, and coronary artery disease. Recently, MPV levels have also been shown to be increased in patients with severe obstructive sleep apnea, and marked nasal septal deviation. Moreover, increased MPV has also been shown to have a prognostic role in cardiovascular disease. We investigated whether MPV is higher in patients with AH and whether higher MPV levels can be reduced by adenoidectomy. To the best of our knowledge, this is the first study to investigate MPV in patients with AH. Our results suggest that MPV, a determinant of platelet activation, is elevated in patients with AH and adenoidectomy is an effective therapeutic measure in such patients. Increased platelet activation may be related to an increase of cardiopulmonary risk in patients with AH.
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Weber SAT, Pierri Carvalho R, Ridley G, Williams K, El Dib R. A systematic review and meta-analysis of cohort studies of echocardiographic findings in OSA children after adenotonsilectomy. Int J Pediatr Otorhinolaryngol 2014; 78:1571-8. [PMID: 25108873 DOI: 10.1016/j.ijporl.2014.07.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/13/2014] [Accepted: 07/14/2014] [Indexed: 11/24/2022]
Abstract
CONTEXT There is evidence that OSA in children can be associated with acute and chronic effects on the cardiovascular system due to repetitive episodes of apnea and hypoxemia. OBJECTIVE To assess whether there is an association between OSA and echocardiographic findings in children and whether that association persists after adenotonsillectomy. DATA SOURCES A literature search was conducted based on PUBMED, EMBASE and LILACS. STUDY SELECTION Children with OSA and children who did not have OSA, who were aged ≤12 years. DATA EXTRACTION Two reviewers extracted data independently; the risk of bias was assessed by examining the selected sample, the recruitment method, completeness of follow up, and blinding. RESULTS Seven studies met all the inclusion criteria and methodological requirements. There was a significant difference with elevated mean pulmonary arterial pressure levels in OSA participants compared to those without OSA at preoperative assessment [mean difference (MD) 8.67; confidential interval (CI) 95% 6.09, 11.25]. OSA participants showed a statistically significant increased interventricular septum (IVS) thickness (mm) [MD 0.60; CI 95% 0.09, 1.11]; and right ventricular (RV) dimension (cm/m) [MD 0.19; CI 95% 0.10, 0.28]. There was also a significant increase in right ventricular (RV) dimension (cm/m) [MD 0.10; CI 95% 0.05, 0.14] in OSA children. CONCLUSION There is moderate quality evidence regarding possible association between OSA and right heart repercussions. More prognosis studies are needed, to allow the combination of results in a meta-analysis.
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Affiliation(s)
| | | | - Greta Ridley
- Cochrane Prognosis Group, Sydney Children's Hospital Network, Sydney, NSW, Australia
| | - Katrina Williams
- Cochrane Prognosis Group, University of Melbourne, Parkville, VIC, Australia; Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Regina El Dib
- Evidence-Based Medicine Unit, Anaesthesiology Department, Botucatu Medical School, Univ Estadual Paulista-UNESP, Sao Paulo, SP, Brazil; McMaster Institute of Urology, McMaster University, Hamilton, Canada.
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Double-blind placebo-controlled randomized clinical trial on the efficacy of Aerosal in the treatment of sub-obstructive adenotonsillar hypertrophy and related diseases. Int J Pediatr Otorhinolaryngol 2013; 77:1818-24. [PMID: 24041858 DOI: 10.1016/j.ijporl.2013.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 08/07/2013] [Accepted: 08/09/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Adenotonsillar hypertrophy (ATH) is a frequent cause of upper airways obstructive syndromes associated to middle ear and paranasal sinuses disorders, swallowing and voice disorders, sleep quality disorders, and occasionally facial dysmorphisms. ATH treatment is essentially based on a number of medical-surgical aids including nasal irrigation with topical antibiotics and corticosteroids and/or treatment with systemic corticosteroids, immunoregulators, thermal treatments, adenotonsillectomy, etc. OBJECTIVES The aim of the present study is to assess the efficacy of Aerosal halotherapy in the treatment of sub-obstructive adenotonsillar disease and correlated conditions compared to placebo treatment. METHODS A total of 45 patients with sub-obstructive adenotonsillar hypertrophy were randomized to receive either Aerosal halotherapy or placebo for 10 treatment sessions. The main outcome was a reduction greater than or equal to 25% from the baseline of the degree of adenoid and/or tonsillar hypertrophy. RESULTS In the intention-to-treat analysis, a reduction of the degree of adenoid and/or tonsillar hypertrophy ≥25% from baseline after 10 therapy sessions was found in 44.4% of the patients in the halotherapy arm and in 22.2% of the patients in the placebo arm (P=0.204). Among the secondary outcomes, the reduction of hearing loss after 10 treatment sessions in the halotherapy arm was higher than the placebo arm (P=0.018) as well as the time-dependent analysis showed significantly improved peak pressure in the Aerosal group (P=0.038). No side effects were reported during the trial. In addition, the therapy was well accepted by the young patients who considered it as a time for play rather than a therapy. CONCLUSIONS Aerosal halotherapy can be considered a viable adjunct, albeit not a replacement, to conventional medical treatment of sub-obstructive adenotonsillar syndrome and related conditions. Further research is however needed to improve ATH treatment.
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Stefanini DDOS, Barros ELD, Stefanini R, Pradella-Hallinan MLDC, Pignatari SSN, Fujita RR. Comparing the clinical profile of non obese children with sleep apnea and snoring. Braz J Otorhinolaryngol 2013; 78:22-6. [PMID: 23108816 PMCID: PMC9450707 DOI: 10.5935/1808-8694.20120004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 07/01/2012] [Indexed: 11/28/2022] Open
Abstract
Few studies in the literature have looked into the cardiovascular and metabolic effects of Obstructive Sleep Apnea Syndrome (OSAS) in children. Objective This study aims to evaluate the metabolic profile of non-obese children with OSAS. Methods Fifty-two children were enrolled in this study, 21 girls and 31 boys. Patients were divided into two groups: OSAS (28 children) and Snore (22 children) according to polysomnographic evaluation. All children were submitted to ENT examination, measurements of weight, height and blood pressure. Blood samples were tested for hemoglobin, hematocrit, fasting glucose, fasting insulin, triglycerides, total cholesterol, HDL, LDL, VLDL, TSH and T4. The gathered data sets were compared between groups and also within the OSAS group according to the severity of the syndrome. Results The children from both groups had no alterations in blood pressure levels. The results of the blood tests were normal for both groups. Results of hemoglobin, hematocrit, and HDL were all significantly higher in the Snore group when compared to the OSAS group; by their turn, VLDL levels were higher in the OSAS group. There was no statistical difference between the groups based on OSAS severity. Conclusion Non-obese children with OSAS present no significant alterations in metabolic tests or blood pressure levels.
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Teo DT, Mitchell RB. Systematic Review of Effects of Adenotonsillectomy on Cardiovascular Parameters in Children with Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2012; 148:21-8. [DOI: 10.1177/0194599812463193] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To systematically review current studies on the effects of adenotonsillectomy (T&A) for obstructive sleep apnea (OSA) on cardiovascular parameters in children. Data Sources PubMed database. Review Methods A comprehensive PubMed MeSH search was done between 1970 and 2012. Results Fourteen articles were included. The total number of children was 418. The mean sample size was 30 (range, 1-62), and the mean age of the sample population was 6 years (range, 2-10 years). Criteria used for the diagnosis of OSA ranged from full-night polysomnography (PSG) to clinical parameters. Three studies had results from preoperative and postoperative PSG. Cardiovascular parameters studied included blood pressure, heart rate, cardiac morphology, and cardiac function. All studies reported an improvement in cardiovascular parameters and OSA symptoms after surgery. Three studies reported improvement in blood pressure, 6 reported improvement in mean pulmonary artery pressures, 7 reported improvement in echocardiographic findings, and 1 reported a decrease in pulse rate and pulse rate variability after T&A for OSA. Conclusion There is evidence that cardiovascular morbidities associated with OSA are potentially reversible. T&A may have a significant role in reversing the cardiovascular sequelae of OSA. However, there is a paucity of well-designed and powered studies to address this issue.
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Affiliation(s)
- Dawn T. Teo
- Department of Otolaryngology–Head and Neck Surgery, Division of Pediatric Otolaryngology, UT Southwestern Medical Center, Children’s Medical Center Dallas, Texas, USA
| | - Ron B. Mitchell
- Department of Otolaryngology–Head and Neck Surgery, Division of Pediatric Otolaryngology, UT Southwestern Medical Center, Children’s Medical Center Dallas, Texas, USA
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Koc S, Aytekin M, Kalay N, Ozcetin M, Burucu T, Ozbek K, Celik A, Kadi H, Gulturk S, Koc F. The effect of adenotonsillectomy on right ventricle function and pulmonary artery pressure in children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2012; 76:45-8. [PMID: 22000211 DOI: 10.1016/j.ijporl.2011.09.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 09/20/2011] [Accepted: 09/24/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Adenotonsillar hypertrophy (ATH) is the most common cause of upper airway obstruction in children. Severe upper airway obstruction may have an effect on chronic alveolar hypoventilation, which consequently may lead to right ventricle (RV) dysfunction induced by hypoxemic pulmonary vasoconstriction. The investigators aimed to study RV function and mean pulmonary artery pressure (mPAP) in patients with ATH who were undergoing adenotonsillectomy by using tissue Doppler echocardiography (TDE). METHODS The study examined 27 children with ATH who had a mean age of 8 ± 2 years. The subjects were comprised 17 (63%) males and 10 (37%) females. Hypertrophy of the tonsils was graded according to the Brodsky scale. Children having either grade 3 or 4 hypertrophied adenotonsils were recruited for the study. Adenotonsillectomy was performed on all subjects in the study group and echocardiographic examination was repeated 3 months postoperatively. RESULTS Tricuspid Em significantly increased after adenotonsillectomy (17.7 ± 3.6 vs. 19.1 ± 5.5, p=0.04). The RV myocardial performance index (MPI) and mPAP significantly decreased after adenotonsillectomy (RV MPI: 0.57 ± 0.13 vs. 0.40 ± 0.12, p<0.001 and mPAP (mmHg): 31 ± 9 vs. 25 ± 7, p=0.001). CONCLUSION The results of this study, evaluated with the results of previous studies, demonstrated that adenotonsillectomy improved RV performance and reduced mPAP in children with ATH.
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Affiliation(s)
- Sema Koc
- Gaziosmanpasa University, Medical Faculty, Otolaryngology Department, Tokat, Turkey
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Abstract
Adenoid hypertrophy is the most common cause of pediatric upper airway obstruction, and it can lead to cardiopulmonary complications such as pulmonary hypertension, cor pulmonale, and even heart failure. The aim of this study was to detect the asymptomatic cardiopulmonary changes that could happen in children with adenoid hypertrophy.Eighty children with adenoid hypertrophy were included in this study. Chest x-ray was used to assess the cardiothoracic ratio, whereas echocardiography was used for measuring the pulmonary arterial pressures, right ventricular diastolic filling parameters, and right ventricular end-diastolic diameters. All patients underwent adenoidectomy with or without tonsillectomy, and they were subjected again to echocardiographic assessment 6 months after the operation. No patient showed an increase in the cardiothoracic ratio on x-ray. Preoperative echocardiography showed an increase in pulmonary artery pressure (22.7 [SD, 3.8] mm Hg), a decrease in right ventricular diastolic filling parameters (E/A = 1.03 [SD, 0.17]), and an increase in right ventricular end-diastolic diameters (1.89 [SD, 0.19] cm). Postoperatively, pulmonary artery pressure decreased to 17.2 [SD, 2.1] mm Hg, right ventricular diastolic filling (E/A) increased to 1.25 [SD, 0.11], and right ventricular end-diastolic diameters decreased to 1.68 [SD, 0.12] cm. The comparison between preoperative and postoperative results for each individual parameter was statistically significant. Clinically asymptomatic cardiopulmonary changes due to adenoid hypertrophy are not rare. Early diagnosis and treatment of upper airway obstruction can prevent these serious complications. Echocardiographic examination should be recommended for these patients as a part of preoperative preparation to avoid anesthetic complications.
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Moghaddam YJ, Bavil SG, Abavisani K. Do pre-adenotonsillectomy echocardiographic findings change postoperatively in children with severe adenotonsillar hypertrophy. J Saudi Heart Assoc 2011; 23:31-5. [PMID: 23960632 PMCID: PMC3727552 DOI: 10.1016/j.jsha.2010.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 09/25/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Hypertrophy of adenotonsillar tissue is one of the most common problems in childhood age and causes upper airway obstruction and even obstructive sleep apnea symptoms in severe forms. The aim of this study is to evaluate the changes of pre-adentonsillectomy echocardiographic findings after operation. MATERIAL AND METHODS From August 2007 to November 2008, 55 children with adenotonsillar hypertrophy and obstructive-sleep symptoms (aged 3-11 years old of which 35 were males and 20 females) were randomly selected. Preoperatively echocardiography was performed for all patients by the pediatric cardiologist. In control group 55 children who referred to otolaryngology clinic because of non adenotonsillar related disease evaluated. One month and six months after operation, patients with positive findings were followed up and again echocardiography was performed separately. RESULTS No complaints of apnea were reported. Tonsillar grades of all cases were type III or IV. The preoperative mean pulmonary arterial pressure levels of the 4 (7.3%) children were higher than normal range (25 mm Hg) and it decreased significantly after operation (P < 0.000) (Preoperative MPAP = 32 ± 3 mm Hg, and six months postoperative follow up, MPAP = 11 ± 5 mm Hg). All the patients' parents complained about severe open mouth snoring, agitated sleep and hyperpnoea of their children. The preoperative tricuspid regurgitation pressure level of 7 children was higher than normal range and it decreased significantly after operation (P < 0.000 preoperative TR = 34 ± 8 mm Hg postoperative TR = 19 ± 6 mm Hg). AC/ET in these seven patients were lower than 0.4. In control group echocardiography findings are normal. CONCLUSION Severe chronic hypertrophic adenotonsillar tissue caused higher tricuspid regurgitation pressure and mean pulmonary arterial pressure.
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Affiliation(s)
- Yalda Jabbari Moghaddam
- Department of Otolaryngology-Head and Neck Surgery, Tabriz University of Medical Sciences, Iran
| | | | - Khosrou Abavisani
- Department of Otolaryngology-Head and Neck Surgery, Tabriz University of Medical Sciences, Iran
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Naiboglu B, Deveci S, Duman D, Kaya KS, Toros S, Kinis V, Sürmeli M, Deveci I, Gokceer T. Effect of upper airway obstruction on pulmonary arterial pressure in children. Int J Pediatr Otorhinolaryngol 2008; 72:1425-9. [PMID: 18639345 DOI: 10.1016/j.ijporl.2008.06.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 05/31/2008] [Accepted: 06/05/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Our aim was to examine the elevation of pulmonary arterial pressure in children with upper airway obstruction caused by adenotonsillar hypertrophy according to their disease severity assessed with symptom scoring and to demonstrate the profit for echocardiographic monitorization of the children with adenotonsillar hypertrophy regardless of their clinical status. METHODS Thirty-nine children with a diagnosis of upper airway obstruction caused by adenotonsillar hypertrophy were included for the study. There were 16 female and 23 male patients. Ages of the children were between 3 and 10 years with a mean age of 5.78+/-1.98. Twenty children composed the control group with a similar age and sex distribution but without any sign and symptom of upper airway obstruction. Mean pulmonary arterial pressures were measured by Doppler echocardiography preoperatively and 6 months postoperatively. Symptom scores were calculated for each patient in the study group to assess their disease severity. The significances of changes and relations between pressure levels and symptom scores were calculated by statistical package for social sciences (SSPS) computer program in terms of Student's test, chi(2)-test and Mc Nemar's test. RESULTS Mean pulmonary arterial pressure were 26.26+/-5.40 (14-36) preoperatively, 16,61+/-2.68 (10.15-22.3) postoperatively and 16.54+/-2.63 (10.5-21.7) in the control group. There were a statistically significant decrease at pressure levels postoperatively and a significant difference from the levels in the control group (Student's t-test, p<0.01). We found no correlation between the pressure levels and disease severity assessed in terms of symptom scoring. CONCLUSION This study showed that upper airway obstruction caused by adenotonsillar hypertrophy causes significant elevation of pulmonary arterial pressures and adenotonsilectomy is an absolute therapeutic method in these children. Every child with adenotonsillar hypertrophy has some probability of having pulmonary hypertension regardless of his or her disease severity. Therefore, performing echocardiographic examination to all children with adenotonsillar hypertrophy is beneficial for assessing the cardiopulmonary status of the patient and may be useful at decision making for adenotonsilectomy.
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Affiliation(s)
- Baris Naiboglu
- Haydarpasa Numune Education and Research Hospital Otolaryngology Clinic, Turkey.
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Yilmaz F, Gunduz H, Karaaslan K, Arinc H, Cosgun M, Sessiz N, Uyan C. Holter analyses in children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2006; 70:1443-7. [PMID: 16650903 DOI: 10.1016/j.ijporl.2006.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2006] [Revised: 03/12/2006] [Accepted: 03/12/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The cardiac complications of adenotonsillar hypertrophy (ATH) have been investigated by many scientists by using supplemental diagnostic modalities such as echocardiography. But, arrhythmia analysis has not been studied adequately in patients with ATH. This study aimed at evaluating the prevalence of arrhythmias, heart rate variability (HRV) and heart rate turbulence (HRT) analyses by means of 24 h Holter ECG monitoring in pre- and post-operative periods in children with ATH. METHODS Twenty-five children with ATH consisting of 12 female and 13 male patients (mean age 66+/-15 months, range 24-108 months) included in this study. All children were assessed pre-operatively and at 1 month post-operatively with 24-h Holter monitoring and ECG analysis. The prevalence analysis of arrhythmias, heart rate variability and heart rate turbulence analysis was assessed. These data were compared. RESULTS Although some ECG and holter findings such as sinusal tachycardia, Mobitz type 1 second-degree AV block improved after the operation, the prevalence of arrhythmias, HRV and HRT values were not changed significantly in post-operative period (p>0.05). CONCLUSION Measurement of HRT and HRV are attractive and easily applicable ways of non-invasive risk prediction of cardiac complications. But, these parameters have not changed significantly in post-operative period. However, ECG and 24-h Holter monitoring of electrocardiography may be useful at evaluating the prevalence of arrhythmias and determining cardiac complications in pre-operative period.
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Affiliation(s)
- Fahrettin Yilmaz
- Abant Izzet Baysal University, Izzet Baysal Faculty of Medicine, Department of Otorhinolaryngology, 14280 Bolu, Turkey.
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