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Brandão Marquis V, de Oliveira Melo A, Pradella-Hallinan M, de Vasconcelos Ataíde G, Ramos Amorim MM, de Barros Miranda-Filho D, Arraes de Alencar Ximenes R. Sleep in children from northeastern Brazil with congenital Zika syndrome: assessment using polysomnography. J Clin Sleep Med 2023; 19:1759-1767. [PMID: 37259896 PMCID: PMC10545994 DOI: 10.5664/jcsm.10674] [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: 11/20/2022] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/02/2023]
Abstract
STUDY OBJECTIVES We performed this study to describe the characteristics of sleep in children with congenital Zika syndrome through polysomnographic assessment. METHODS Polysomnography with neurological setup and capnography was performed. Respiratory events were scored according to American Academy of Sleep Medicine criteria. Children were classified based on neuroclinical examination as having corticospinal plus neuromuscular abnormalities or exclusively corticospinal abnormalities. Neuroradiological classification was based on imaging exams, with children classed as having supratentorial plus infratentorial abnormalities or exclusively supratentorial abnormalities. RESULTS Of 65 children diagnosed with congenital Zika syndrome, sleep apnea was present in 23 children (35.4%), desaturation in 26 (40%), and snoring in 13 (20%). The most prevalent apnea type was central in 15 children (65.2%), followed by obstructive apnea in 5 (21.7%) and mixed type in 3 (13%). The average of the lowest saturation recorded was slightly below normal (89.1 ± 4.9%) and the mean partial pressure of end-tidal carbon dioxide value was normal. Periodic leg movements were present in 48 of 65 children. Lower ferritin levels were observed in 84.6% of children. Palatine and pharyngeal tonsils (adenoids) were small in most children and not associated with the presence of obstructive apnea. Ventriculomegaly and subcortical and nucleus calcification were the most frequent neuroimaging findings. Supratentorial and infratentorial anomalies were present in 26.7% (16 of 60) and exclusively supratentorial changes in 73.3% (44 of 60). In the neuroclinical classification, isolated corticospinal changes were more frequent and the mean peak in capnography was lower in this group. There was no difference regarding the presence of apnea for children in the neuroclinical and neuroradiological classification groups. CONCLUSIONS Sleep disorders were frequent in children with congenital Zika syndrome, with central sleep apnea being the main finding. CITATION Brandão Marquis V, de Oliveira Melo A, Pradella-Hallinan M, et al. Sleep in children from northeastern Brazil with congenital Zika syndrome: assessment using polysomnography. J Clin Sleep Med. 2023;19(10):1759-1767.
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Affiliation(s)
- Valéria Brandão Marquis
- Federal University of Campina Grande, Campina Grande, Paraíba, Brazil
- Professor Joaquim Amorim Neto Research Institute, Campina Grande, Paraíba, Brazil
| | - Adriana de Oliveira Melo
- Federal University of Campina Grande, Campina Grande, Paraíba, Brazil
- Professor Joaquim Amorim Neto Research Institute, Campina Grande, Paraíba, Brazil
| | | | | | - Melânia Maria Ramos Amorim
- Federal University of Campina Grande, Campina Grande, Paraíba, Brazil
- Professor Joaquim Amorim Neto Research Institute, Campina Grande, Paraíba, Brazil
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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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Senthilvel E, Nguyen QL, Gunaratnam B, Feygin YB, Palani R, El-Kersh K. Role of neck radiography in assessing recurrent/residual adenoid hypertrophy in children with OSA and history of adenotonsillectomy: a sleep physician perspective. J Clin Sleep Med 2023; 19:1027-1033. [PMID: 36727478 PMCID: PMC10235720 DOI: 10.5664/jcsm.10468] [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: 09/03/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Recurrent/residual adenoid hypertrophy after adenotonsillectomy in children can result in obstructive sleep apnea (OSA). We aimed to assess the role of soft tissue neck X-ray (STN-XR) in evaluating recurrent/residual adenoid tissue hypertrophy. METHODS This was a single-center retrospective study that included children with sleep study-confirmed OSA and a known history of adenotonsillectomy who underwent STN-XR to evaluate for recurrent/residual adenoid tissue hypertrophy. STN-XR nasopharyngeal obliteration and baseline polysomnographic data were analyzed. Multiple linear regression was used to assess the independent relationship between the results of STN-XR and the total apnea-hypopnea index, while controlling for relevant characteristics. RESULTS The study included 160 participants with a median age of 10 years (quartile [Q] 1 = 7, Q3 = 12.25). More than half of the children were male (59.4%) and the median body mass index z-score was 2.11 (Q1 = 1.23, Q3 = 2.54). STN-XR was normal in 39.4%, and it showed mild, moderate, and complete nasopharyngeal obliteration in 20.6%, 32.5%, and 7.5% of the participants, respectively. Multiple regression analysis showed that moderate and complete nasopharyngeal obliteration was associated with an increase in the mean total apnea-hypopnea index by 109% (P = .0002) and 185% (P = .001), respectively, when compared with children without nasopharyngeal obliteration. However, mild nasopharyngeal obliteration, body mass index z-score, age, sex, and race were not significantly associated with an increase in the total apnea-hypopnea index. CONCLUSIONS STN-XR was useful in assessing recurrent/residual adenoid tissue hypertrophy in children with OSA and a history of adenotonsillectomy. Moderate and complete nasopharyngeal obliteration were associated with significantly increased apnea-hypopnea index. Pediatric sleep physicians may consider STN-XR in the evaluation of children with OSA and previous history of adenotonsillectomy. CITATION Senthilvel E, Nguyen QL, Gunaratnam B, Feygin YB, Palani R, El-Kersh K. Role of neck radiography in assessing recurrent/residual adenoid hypertrophy in children with OSA and history of adenotonsillectomy: a sleep physician perspective. J Clin Sleep Med. 2023;19(6):1027-1033.
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Affiliation(s)
- Egambaram Senthilvel
- Department of Pediatrics, University of Louisville and Norton Children Medical Group, Louisville, Kentucky
| | - Quang L. Nguyen
- Deaconess Health, Division of Pulmonary Critical Care and Sleep Medicine, University of Louisville, Louisville, Kentucky
| | | | - Yana B. Feygin
- Department of Pediatrics, University of Louisville and Norton Children Medical Group, Louisville, Kentucky
| | - Rajaneeshankar Palani
- Department of Pediatrics, University of Louisville and Norton Children Medical Group, Louisville, Kentucky
| | - Karim El-Kersh
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
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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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Rhinomanometry with and without decongestant used to select children for adenoidectomy: a cohort study. Eur Arch Otorhinolaryngol 2023; 280:723-729. [PMID: 35881192 DOI: 10.1007/s00405-022-07549-7] [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: 04/10/2022] [Accepted: 07/06/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Adenoid hypertrophy may coexist, and often does, with rhinitis. Therefore, in some cases, adenoidectomy alone, despite the fact that it reduces nasal resistance, may be insufficient to restore nasal breathing. Juliusson et al. suggested using rhinomanometry with and without nasal decongestant as a method for selecting patients for adenoidectomy. In this study, we aim to assess whether the decongestant test, when using normative data, is useful to select children for adenoidectomy. METHODS Children between 4 and 15 years old undergoing adenoidectomy were selected from two tertiary referral university hospitals. Participants underwent anterior active rhinomanometry with and without nasal decongestant before and after surgery. Parents fill in the sinus and nasal quality-of-life survey (SN5). RESULTS 47 participants were included, and mean age 6.5 ± 2.15. 2 cohorts were defined according to the result of the nasal decongestant test (> 40% improvement in nasal resistance or not). There is a statistically significant difference between groups, with a higher improvement in nasal resistance and airflow after adenoidectomy in the group with less than 40% improvement in nasal resistance. CONCLUSIONS In conclusion, this study supports the use of the decongestant test with rhinomanometry to select children for adenoidectomy; especially as it has proven to be a simple technique, harmless, fast, and easily performed on collaborative children.
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Prevalence of mouth breathing, with or without nasal obstruction, in children with moderate to severe obstructive sleep apnea. Sleep Med 2022; 98:98-105. [DOI: 10.1016/j.sleep.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 10/17/2022]
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Calvo-Henriquez C, Lechien JR, Méndez-Benegassi I, Benoliel AL, Faraldo-García A, Martínez-Capoccioni G, Neves JC, Martin-Martin C. Pediatric turbinate radiofrequency ablation improves quality of life and rhinomanometric values. A prospective study. Int J Pediatr Otorhinolaryngol 2022; 154:111050. [PMID: 35065329 DOI: 10.1016/j.ijporl.2022.111050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 12/05/2021] [Accepted: 01/16/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE turbinate surgery in pediatric patients is gradually increasing in popularity amongst pediatric otolaryngologists. However, despite this, there is scarce information regarding this surgical procedure in children. The present research is designed with the aim of assessing changes in nasal resistance, nasal airflow and quality of life in pediatric patients undergoing turbinate radiofrequency ablation. METHODS A prospective uncontrolled intervention clinical trial design was followed. Children between 4 and 15 years old undergoing turbinate radiodiofrequency ablation (TRA) were consecutively selected. Children were examined preoperatively and 1, 3, 6 and 12 months after turbinate surgery. Anterior active rhinomanometry with and without nasal decongestant and examination of the turbinates and adenoid size were carried out in each follow-up visit. The SN5 quality of live survey was answered by parents. RESULTS 81 children were included, 28 with associated adenoidectomy. A significant improvement in quality of life was demonstrated since the first month after TRA. Regarding nasal resistance, there was an improvement 1 month after surgery, but it only reached statistical significance for the whole sample (p < 0.001)) and for the cohort of isolated turbinate surgery (p < 0.001) at 3 months, while the values for the cohort of children who underwent adenoidectomy reached significance at 6 months after surgery (p = 0.04). The difference in nasal resistance before and after decongestant was compared to the change in nasal resistance after surgery. It demonstrated a strong correlation with the change in nasal resistance at 1 month (R = 0.985; p < 0.001), 3 months (R = 0.995; p < 0.001), 6 months (R = 0.98; p < 0.001) and 12 months (R = 0.98; p < 0.001) after surgery. CONCLUSIONS turbinate surgery in pediatric patients seems to be a safe procedure which objectively and subjectively improves the symptoms of children suffering from nasal obstruction.
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Affiliation(s)
- Christian Calvo-Henriquez
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Rhinology Unit. Hospital Complex of Santiago de Compostela. - Santiago de Compostela, Spain.
| | - Jerome R Lechien
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology. Foch Hospital, University of Paris Saclay, Paris, France
| | - Iván Méndez-Benegassi
- Service of Otolaryngology, Rhinology Unit. University Hospital Rey Juan Carlos, Madrid, Spain
| | - Alejandro Lowy Benoliel
- Service of Otolaryngology, Pediatric Otolaryngology Unit. Gregorio Marañol University Hospital, Madrid, Spain
| | - Ana Faraldo-García
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Pediatric Otolaryngology acUnit. Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Gabriel Martínez-Capoccioni
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Rhinology Unit. Hospital Complex of Santiago de Compostela. - Santiago de Compostela, Spain
| | - J Carlos Neves
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; MyFace Clinics and Academy. Lisbon, Portugal
| | - Carlos Martin-Martin
- Service of Otolaryngology, Rhinology Unit. Hospital Complex of Santiago de Compostela. - Santiago de Compostela, Spain
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Narang VP, Loroch A, Sambiagio G. Versatility and Benefits of 4.0mm Flexible Nasal Endoscopy in 118 Children up to 10 Years of Age. Cureus 2022; 14:e22656. [PMID: 35371672 PMCID: PMC8963822 DOI: 10.7759/cureus.22656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose This retrospective study looked at the feasibility of using adult 4.0 mm flexible nasendoscopes (FNE) examination under local anesthetic (LA) in children three to 10 years old to diagnose adenoid hypertrophy (AH) and other conditions. We also looked for a correlation between the adenoid size on FNE and a) tonsil size, b) the typical symptoms of snoring, mouth breathing, impaired hearing, and apnoeic episodes c) the management options of otitis media with effusion (OME) and d) the adenoid size intraoperatively. Methods A retrospective, observational study of 118 children in an NHS pediatric otolaryngology clinic led by a single consultant. One hundred ten consecutive patients with suspected AH were divided into two groups of three to five years and six to 10 years. We compared the acceptance rate to FNE in two subgroups (three to five years and six to 10 years old) and examined the correlation between various parameters as outlined above, using the Chi-square test. Eight children underwent FNE for other reasons of change of voice and epistaxis. Results FNE was successfully performed in 86% of the patients without restraint. Thirty-three percent of patients had non-obstructive adenoids (OA) and did not require surgical intervention. The intraoperative adenoid size, symptoms of snoring, mouth-breathing, and apnoeic episodes positively correlated with OA; however, no correlation was seen with the tonsil size (p=0.1143). All patients with OA and type B tympanogram needed adenoidectomy and grommet insertion (p=0.0119), and those with type C curves recovered with adenoidectomy alone. Conclusions 4.0 mm adult scope helped reach a definitive diagnosis for AH in most children above three years of age, thus proving cost-effective. The symptoms of snoring, mouth-breathing, and apnoeic episodes had a positive correlation to the presence of OA; however, the tonsil size was seen to be independent of adenoid size. Primary surgical management can be considered the treatment of choice for all patients with OA and type B tympanogram without a trial of conservative therapy.
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Calvo-Henriquez C, Mariño-Sánchez F, Lechien JR, Maldonado-Alvarado B, Maniaci A, Maza-Solano J, Martínez-Capoccioni G, Neves JC, Martin-Martin C. Radiofrequency ablation turbinoplasty improves the sense of smell in pediatric patients: A prospective study. Int J Pediatr Otorhinolaryngol 2021; 150:110935. [PMID: 34649156 DOI: 10.1016/j.ijporl.2021.110935] [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: 06/05/2021] [Revised: 08/25/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The olfactory sense is of paramount importance for the adequate development of a child. Olfactory loss in children might have different origins. One of the most common is conductive, when nasal obstruction prevents odorants from reaching the olfactory epithelium. Rhinitis and turbinate enlargement have been proven to diminish the sense of smell in pediatric patients. A common treatment for resistant rhinitis in these patients is turbinate radiofrequency ablation (TRA). However, despite an increasing research effort in this field, there are no studies instrumentally assessing olfaction in children undergoing turbinate surgery to date. This study was designed with the aim of assessing changes in olfaction through validated instrumental tools in pediatric patients undergoing TRA for the first time. METHODS A prospective uncontrolled intervention clinical trial design was conducted. Two cohorts of children ranging 4-15 years old were consecutively selected from a third level referral Hospital and subjected to the universal sniff test (U-Sniff), alcohol sniff test (AST), and sniffin sticks threshold test (SST) before and 1, 3 and 6 months after surgery. Cohort A consisted of children solely undergoing TRA. Cohort B consisted of children on whom adenoidectomy and TRA had been performed. Additionally, a cohort of Spanish healthy controls, paired by sex and age, were asked to perform the U-Sniff. RESULTS A total of 81 participants with a mean age of 10.31 ± 2.56 years were included. Fifty-three patients underwent TRA exclusively and 28 were subjected to associated adenoidectomy. Despite a tendency toward improvement in the U-sniff scores, there were no statistically significant differences after surgery. However, statistically significant differences were obtained for threshold tasks measured with SST and AST, revealing differences at 1, 3 and 6 months after surgery compared to preoperative scores. CONCLUSIONS In summary, this research demonstrated adequate levels in the sense of smell regarding identification tasks, but decreased olfactory threshold scores in pediatric patients suffering from TE. TRA, alone or with adenoidectomy, improved smell threshold scores, but had no significant effect on identification tasks.
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Affiliation(s)
- Christian Calvo-Henriquez
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Franklin Mariño-Sánchez
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Rhinology and Skull Base Surgery Unit, Otorhinolaryngology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Jerome R Lechien
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Foch Hospital, University of Paris Saclay, Paris, France
| | - Byron Maldonado-Alvarado
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Antonino Maniaci
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, ENT Department of University of Catania, Catania, Italy
| | - Juan Maza-Solano
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Rhinology and Skull Base Surgery Unit, Otolaryngology Department, Hospital Virgen de la Macarena, Seville, Spain
| | - Gabriel Martínez-Capoccioni
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - J Carlos Neves
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; MyFace Clinics and Academy, Lisbon, Portugal
| | - Carlos Martin-Martin
- Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
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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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Pisutsiri N, Vathanophas V, Boonyabut P, Tritrakarn S, Vitayaudom N, Tanphaichitr A, Ungkanont K. Adenoid measurement accuracy: A comparison of lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy (gold standard). Auris Nasus Larynx 2021; 49:222-228. [PMID: 34334217 DOI: 10.1016/j.anl.2021.07.005] [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: 03/10/2021] [Revised: 06/21/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the accuracy of lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy in assessment of adenoid size. METHODS A cross-sectional study was conducted in 43 pediatric patients undergoing ENT surgery from July 2017 to December 2018. All patients underwent preoperative lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy. RESULTS The average adenoidal-nasopharyngeal (A/N) ratio obtained from lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy was 72.9, 79.5, and 81.6, respectively. There was a moderate correlation between A/N ratio from lateral skull film and intraoperative rigid endoscopy (Pearson's correlation: 0.567, p˂0.001). Whereas, the A/N ratio from flexible endoscopy compared to intraoperative rigid endoscopy showed a stronger correlation (Pearson's correlation: 0.791, p˂0.001). From linear regression analysis, the intraoperative adenoid measurement was estimated from the results of flexible endoscopy (intraoperative rigid endoscopy: 0.72 [flexible endoscopy] +24.47) and lateral skull film (intraoperative rigid endoscopy = 0.65 [lateral skull film] + 34) CONCLUSION: Flexible endoscopy yields the most accuracy in the assessment of adenoid size and nasopharynx visualization, without radiation exposure or anesthesia. Despite less accuracy, lateral skull film is more availability in every hospital. The correlation of adenoid size measurement in this study can also be applied for the actual size of adenoid.
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Affiliation(s)
| | - Vannipa Vathanophas
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Panrasee Boonyabut
- Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand
| | - Sirion Tritrakarn
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nichanun Vitayaudom
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Archwin Tanphaichitr
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kitirat Ungkanont
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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12
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Modified adenoid grading system for evaluating adenoid size in children: a prospective validation study. Eur Arch Otorhinolaryngol 2021; 278:2147-2153. [PMID: 33797600 DOI: 10.1007/s00405-021-06768-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 03/17/2021] [Indexed: 01/19/2023]
Abstract
Nasal endoscopy is the best choice for evaluation of adenoid size, but very few studies published on the endoscopic quantitative assessment. This study aimed to newly propose and validate a modified adenoid grading system (MAGS) with the existing endoscopic scoring methods of adenoid size. A prospective study on children with chronic mouth breathing and having endoscopic nasal examination was conducted. Digital images obtained during endoscopic examination were evaluated with the traditional method and the MGAS. Adenoid size was also evaluated by intraoperative nasal endoscopy among those underwent adenoidectomy. One hundred and thirty patients were enrolled. The MAGS showed high inter-rater reliability with a Kappa score of 0.869. Sixty of 130 patients underwent adenoidectomy and assessed with intraoperative nasal endoscopy. The MAGS significantly correlated to the percentage of nasopharyngeal obstruction of intraoperative endoscopy (Spearman's r = 0.796, gamma coefficient = 0.94), and the percentage of choanal obstruction of preoperative endoscopy (Spearman's r = 0.816, gamma coefficient = 0.859). Our findings suggest that the MAGS has high reliability and validity for assessment of adenoid size. It may be a more suitable and reliable grading system for endoscopic evaluation of adenoid size.
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Markkanen S, Rautiainen M, Himanen S, Satomaa A, Katila M, Peltomäki T, Saarenpää‐Heikkilä O. Snoring toddlers with and without obstructive sleep apnoea differed with regard to snoring time, adenoid size and mouth breathing. Acta Paediatr 2021; 110:977-984. [PMID: 32734640 DOI: 10.1111/apa.15496] [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: 04/05/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 11/27/2022]
Abstract
AIM The difficulty of assessing the likelihood of obstructive sleep apnoea (OSA) in children who snore without full-night polysomnography is widely recognised. Our aim was to identify features that were characteristic of two-year-old children with OSA and evaluate whether this information could be used to assess the likelihood of OSA. METHODS The study was carried out as part of the Child-Sleep Project, a longitudinal birth cohort study of children born at Tampere University Hospital, Finland. This part of the study focused on the children in the cohort who snored and was carried out between 2013 and 2015. The primary outcomes were measured using parental questionnaires, polysomnography and clinical examinations. RESULTS In total, 52 children participated at a mean age of 27 months (range 23-34). Of these, 32 (44% male) snorers and 20 (70% male) controls. The most significant findings were that children who had OSA demonstrated longer snoring time (P = .003), a greater tendency for mouth breathing (P = .007) and bigger adenoid size (P = .008) than snorers without OSA. CONCLUSION Snoring time, adenoid tissue size and mouth breathing were important features that identified the likelihood of OSA in snoring toddlers.
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Affiliation(s)
- Saara Markkanen
- Department of Ear and Oral Diseases Tampere University Hospital Tampere Finland
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Markus Rautiainen
- Department of Ear and Oral Diseases Tampere University Hospital Tampere Finland
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Sari‐Leena Himanen
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
- Department of Clinical Neurophysiology Tampere University Hospital Tampere Finland
| | - Anna‐Liisa Satomaa
- Department of Clinical Neurophysiology Tampere University Hospital Tampere Finland
| | - Maija Katila
- Department of Paediatrics Tampere University Hospital Tampere Finland
- Centre for Child Health Research Faculty of Medicine and Health Technology Tampere University and Tampere University Hospital Tampere Finland
| | - Timo Peltomäki
- Department of Ear and Oral Diseases Tampere University Hospital Tampere Finland
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
- Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Outi Saarenpää‐Heikkilä
- Department of Paediatrics Tampere University Hospital Tampere Finland
- Centre for Child Health Research Faculty of Medicine and Health Technology Tampere University and Tampere University Hospital Tampere Finland
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Looking for a cutoff value for the decongestant test in children suffering with turbinate hypertrophy. Eur Arch Otorhinolaryngol 2021; 278:3821-3826. [PMID: 33566176 DOI: 10.1007/s00405-021-06657-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The main causes for objectively confirmed chronic impaired nasal breathing in children are adenoid and turbinate hypertrophy. Turbinate hypertrophy may be addressed by turbinate surgery. However, specialized guidelines include no specific indications for pediatric patients. The decongestant test consists of simulating the effect of turbinate surgery by means of a nasal decongestant. This project, developed by the YO-IFOS rhinology group, aims to establish a cutoff value for the nasal decongestant test with rhinomanometry to select children for turbinate surgery. METHODS Children between 4 and 15 years of age were included. Cases were consecutively selected from children affected by turbinate hypertrophy undergoing turbinate radiofrequency ablation with or without adenoidectomy. Controls were consecutively selected from a sample of healthy children. All the subjects were examined with anterior active rhinomanometry with and without nasal decongestant. RESULTS Sample included 72 cases and 24 healthy controls. There was a statistically significant difference in the improvement with the decongestant between cases (57.91%) and controls (15.67%). The ROC curve revealed an area under the curve of 0.97. The highest amount of correctly classified individuals (93.44%) corresponded to the cutoff value of 31.66%. However, the value with the highest specificity and highest Youden's index was the 38.88% improvement in nasal resistance with nasal decongestant. CONCLUSIONS In conclusion, a preliminary cutoff value for the decongestant test used with rhinomanometry in children has been established. This test could help identify children for turbinate surgery.
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Leal MC, Seabra Ramos D, Pinto Bezerra T, Vilela AESC, Maciel RJDF, Rodrigues M, Lira M, Cavalcanti KPDS, Van der Linden V, Cordeiro MT, Miranda-Filho D, Ximenes R, Brickley EB, Caldas SS. The Prevalence of Adenoid Hypertrophy among Children with Zika Related Microcephaly. Viruses 2021; 13:62. [PMID: 33466404 PMCID: PMC7824820 DOI: 10.3390/v13010062] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/13/2020] [Accepted: 11/19/2020] [Indexed: 12/18/2022] Open
Abstract
Upper respiratory obstruction is a common sequela in children with Zika-related microcephaly (ZRM). As a cross-sectional analysis nested in a cohort study, this study aims to investigate the prevalence of adenoid hypertrophy (AH) in children with ZRM and symptoms of respiratory obstruction. The data were collected in the first three years of life from children with ZRM who were followed in two reference centers for otorhinolaryngological care of patients with congenital Zika syndrome. Out of 92 children with confirmed ZRM, 57 were evaluated by nasopharyngoscopy after presenting with upper respiratory obstruction symptoms. In this study, 31 of the 57 (54%) children with ZRM who were evaluated had obstructive AH. Thirteen children with obstructive AH were submitted to surgery, which resulted in the complete resolution of symptoms for 11, partial resolution in 1, and no improvement in 1. No evidence of direct involvement by Zika virus (ZIKV) infection in the adenoid tissues was demonstrated by histology or immunohistochemistry. Our results suggest that there is a high prevalence and early presentation of AH in children with ZRM, with consequent upper airway obstruction causing upper airway obstructive disorder, secretory otitis media, and dysphagia.
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Affiliation(s)
- Mariana C. Leal
- Surgery Department, Federal University of Pernambuco, Recife 50670-901, Brazil; (D.S.R.); (T.P.B.); (R.J.d.F.M.); (M.R.); (R.X.); (S.S.C.)
- Agamenon Magalhães Hospital, Recife 52070-230, Brazil;
| | - Danielle Seabra Ramos
- Surgery Department, Federal University of Pernambuco, Recife 50670-901, Brazil; (D.S.R.); (T.P.B.); (R.J.d.F.M.); (M.R.); (R.X.); (S.S.C.)
- Medicine Department, Catholic University of Pernambuco, Recife 50050-900, Brazil
| | - Thiago Pinto Bezerra
- Surgery Department, Federal University of Pernambuco, Recife 50670-901, Brazil; (D.S.R.); (T.P.B.); (R.J.d.F.M.); (M.R.); (R.X.); (S.S.C.)
| | | | - Rebeka Jacques de F. Maciel
- Surgery Department, Federal University of Pernambuco, Recife 50670-901, Brazil; (D.S.R.); (T.P.B.); (R.J.d.F.M.); (M.R.); (R.X.); (S.S.C.)
| | - Mirella Rodrigues
- Surgery Department, Federal University of Pernambuco, Recife 50670-901, Brazil; (D.S.R.); (T.P.B.); (R.J.d.F.M.); (M.R.); (R.X.); (S.S.C.)
| | - Mariana Lira
- Clinical Hospital, Federal University of Pernambuco, Recife 50740-900, Brazil; (M.L.); (K.P.d.S.C.)
| | - Karen Pena de Souza Cavalcanti
- Clinical Hospital, Federal University of Pernambuco, Recife 50740-900, Brazil; (M.L.); (K.P.d.S.C.)
- Immunopathology Laboratory Keizo Asami, Federal University of Pernambuco, Recife 50670-901, Brazil
| | | | - Marli T. Cordeiro
- Barão de Lucena Hospital, Recife 50731-000, Brazil; (V.V.d.L.); (M.T.C.)
| | | | - Ricardo Ximenes
- Surgery Department, Federal University of Pernambuco, Recife 50670-901, Brazil; (D.S.R.); (T.P.B.); (R.J.d.F.M.); (M.R.); (R.X.); (S.S.C.)
| | | | - Silvio S. Caldas
- Surgery Department, Federal University of Pernambuco, Recife 50670-901, Brazil; (D.S.R.); (T.P.B.); (R.J.d.F.M.); (M.R.); (R.X.); (S.S.C.)
- Oswaldo Cruz University Hospital, University of Pernambuco, Recife 50100-130, Brazil;
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Patel A, Brook CD, Levi JR. Comparison of adenoid assessment by flexible endoscopy and mirror exam. Int J Pediatr Otorhinolaryngol 2020; 134:110073. [PMID: 32371357 DOI: 10.1016/j.ijporl.2020.110073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Assessment of adenoid hypertrophy can be completed through various methods including flexible endoscopy and intraoperative mirror exam. The objective of this study was to compare the effect of adenoid size on the accuracy of these techniques. METHODS Patients younger than 18 years old who underwent adenoidectomy at Boston Medical Center from October 2012 to December 2018 and had documented preoperative and intraoperative adenoid sizes were included. Cases were identified through Current Procedural Terminology (CPT) codes 42,830 and 42,831 with exclusion of CPT 42820 for tonsillectomy and adenoidectomy. Patients who had less obstruction (75% or less obstruction) and more obstruction (>75%) were compared using Chi-square analysis and t-tests. RESULTS Of 276 patients who underwent adenoidectomy from October 2012 to December 2018, 84 patients had adenoid size determined both preoperatively by flexible endoscopy and intraoperatively. Thirty-eight (45.2%) patients had intraoperative adenoids that were characterized as less obstructive hypertrophy and 46 (54.8%) had intraoperative adenoids that were characterized as more obstructive hypertrophy. In patients with less obstruction, the mean preoperative adenoid obstruction size of 72% was significantly higher than the mean intraoperative adenoid obstruction size of 63% (p = 0.0212). However, in patients with more obstruction, the mean preoperative adenoid size of 86% was not significantly different from the mean intraoperative adenoid size of 90% (p = 0.1237). CONCLUSION Adenoid assessment by flexible endoscopy and intraoperative mirror exam may not correlate as closely in patients who have less obstructive hypertrophy.
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Affiliation(s)
- Aneesh Patel
- Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA
| | - Christopher D Brook
- Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA; Boston University Medical Center, Department of Otolaryngology, 800 Harrison Ave, BCD Building, 5th Floor, Boston, MA, 02118, USA
| | - Jessica R Levi
- Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA; Boston University Medical Center, Department of Otolaryngology, 800 Harrison Ave, BCD Building, 5th Floor, Boston, MA, 02118, USA.
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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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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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Pathak K, Ankale NR, Harugop AS. Comparison Between Radiological Versus Endoscopic Assessment of Adenoid Tissue in Patients of Chronic Adenoiditis. Indian J Otolaryngol Head Neck Surg 2019; 71:981-985. [PMID: 31742106 DOI: 10.1007/s12070-019-01669-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/03/2019] [Indexed: 11/25/2022] Open
Abstract
The adenoids are a common cause for morbidity in pre-school and school going children. Adenoid hypertrophy is common cause of nasal obstruction in pediatric population. The assessment of the size of palatine tonsil hypertrophy is quiet easy to perform, however, measuring the size of nasopharyngeal tonsil and establishing its connection with the given symptoms is more difficult. This is basically due to the location of a tonsil in the nasopharyngeal cavity. Since the cavity is inaccessible directly and cannot be examined visually, many direct and indirect methods of adenoid size evaluation have been developed. The objective of this study is to compare the diagnostic efficacy of both X-ray soft tissue nasopharynx lateral view and nasoendoscopy in evaluation of adenoid size in patients having chronic adenoiditis. Our study included 50 children in age group of 3-14 years who had signs and symptoms of adenoiditis clinically. After comparing X-ray and endoscopic findings we found that there was good agreement between X-ray and endoscopic method. Sensitivity of X-ray was 79.41% and specificity of 75% whereas sensitivity of nasoendoscopy was 87.10% and specificity was 63.16%. Nasal endoscopy is good screening method and more accurate method to assess the size of adenoids in patients of chronic adenoiditis.
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Affiliation(s)
- Kshitija Pathak
- Department of ENT and HNS, J.N. Medical College, Belagavi, India
| | - N R Ankale
- Department of ENT and HNS, J.N. Medical College, Belagavi, India
| | - A S Harugop
- Department of ENT and HNS, J.N. Medical College, Belagavi, India
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A Case–Control Study on the Association Between Endoscopic ACE Grade of Adenoid Hypertrophy and Hearing Loss in Children and Its Impact on Speech and Language Development. Indian J Otolaryngol Head Neck Surg 2019; 71:150-154. [DOI: 10.1007/s12070-018-1506-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 09/26/2018] [Indexed: 11/25/2022] Open
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Duan H, Xia L, He W, Lin Y, Lu Z, Lan Q. Accuracy of lateral cephalogram for diagnosis of adenoid hypertrophy and posterior upper airway obstruction: A meta-analysis. Int J Pediatr Otorhinolaryngol 2019; 119:1-9. [PMID: 30658139 DOI: 10.1016/j.ijporl.2019.01.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/08/2019] [Accepted: 01/08/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Accurate diagnosis of adenoid hypertrophy and posterior upper airway obstruction using a lateral cephalogram is challenging. No universal guidelines for assessing adenoidal enlargement and upper airway obstruction have been established. We performed a meta-analysis to assess the diagnostic accuracy of a lateral cephalogram for adenoid hypertrophy. METHODS After searching a wide range of electronic databases and screening titles and abstracts, we evaluated full papers describing potentially eligible studies according to predefined inclusion criteria. Quality assessment was conducted by adapting the Quality Assessment of Diagnostic Accuracy Studies-2 checklist, and a 2 × 2 contingency table was constructed based on these results. Two authors independently judged the studies and extracted the data. The diagnostic accuracy of a lateral cephalogram for adenoid hypertrophy and posterior upper airway obstruction was calculated using a bivariate meta-analysis model. The Q-test and I2 index were used to test the heterogeneity. RESULTS Nine studies were included in the meta-analysis. The pooled sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio were 0.86 [95% confidence interval (CI): 0.76-0.92], 0.59 (95% CI: 0.42-0.73), 9.00 (95% CI: 5-17), 2.1 (95% CI: 1.5-3.0), and 0.24 (95% CI: 0.15-0.37), respectively. The area under the summary receiver operator characteristic curve was 0.83 (95% CI: 0.80-0.86). Meta-regression analysis revealed that the sample size and study design significantly contributed to the heterogeneity of sensitivity. CONCLUSIONS Our findings suggest that the lateral cephalogram exhibits very good diagnostic accuracy (area under the curve: 0.86) for the diagnosis of adenoid hypertrophy and posterior upper airway obstruction. Nevertheless, the rate of false-positive diagnoses should be further considered.
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Affiliation(s)
- Hanzhong Duan
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, 1055#Sanxiang Road, Suzhou, Jiangsu Province, 215004, PR China; Department of Otolaryngology, Zhejiang Xiaoshan Hospital, 728#Yucaibei Road, Hangzhou, Zhejiang Province, 311201, PR China.
| | - Li Xia
- Department of Otolaryngology, Zhejiang Xiaoshan Hospital, 728#Yucaibei Road, Hangzhou, Zhejiang Province, 311201, PR China.
| | - Wangfang He
- Department of Otolaryngology, Zhejiang Xiaoshan Hospital, 728#Yucaibei Road, Hangzhou, Zhejiang Province, 311201, PR China.
| | - Yongdong Lin
- Department of Otolaryngology, Zhejiang Xiaoshan Hospital, 728#Yucaibei Road, Hangzhou, Zhejiang Province, 311201, PR China.
| | - Zhihui Lu
- Department of Otolaryngology, Zhejiang Xiaoshan Hospital, 728#Yucaibei Road, Hangzhou, Zhejiang Province, 311201, PR China.
| | - Qing Lan
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, 1055#Sanxiang Road, Suzhou, Jiangsu Province, 215004, PR China.
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Sojak J, Durdik P, Pecova R. The effect of adenoidectomy on transnasal airflow in children with hypertrophy of adenoid tissue. Afr J Paediatr Surg 2018; 15:126-130. [PMID: 32769362 PMCID: PMC7646687 DOI: 10.4103/ajps.ajps_135_15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The aim of this study was to clarify changes of transnasal airflow resulting from adenoidectomy and to assess the effect of surgery depending on adenoid hypertrophy (AH) obstruction grade. MATERIALS AND METHODS Altogether fifty children having symptoms of nasal obstruction and adenoids were submitted to a rhinomanometric assessment before and after adenoidectomy. At the same time, using the nasal fiberoptic endoscopy, the grade of AH obstruction was determined, according to which the children were divided into four classes. We assessed the change of total transnasal inspiratory airflow and total nasal resistance due to adenoidectomy. RESULTS Values of transnasal airflow and nasal resistance measured in the study group of fifty children were preoperatively 262 mL/s and 0.565 kPa/L/s; postoperatively 288 mL/s and 0.52 kPa/L/s. We have noticed statistically significant increase of the airflow (P = 0.015); however, decrease of the resistance (P = 0.054) was not significant. In the group of children suffering from the 1st to 2nd grade (29 children) preoperatively measured values presented 280 mL/s and 0.52 kPa/L/s; postoperatively, 276 mL/s and 0.54 kPa/L/s; change of the airflow (P = 0.634) and resistance (P = 0.829) was not significant. In the study group having the 3rd and 4th grade (21 children), the values indicated preoperatively 240 mL/s and 0.62 kPa/L/s; postoperatively, 340 mL/s and 0.44 kPa/L/s; there were significant airflow increase (P = 0.012) and resistance decrease (P = 0.033). CONCLUSIONS Adenoidectomy significantly increased the airflow; however, we observed the different effect in the group of children with the 1st and 2nd grade compared to the group with the 3rd and 4th grade. A significant increase of the airflow and decrease of the resistance were present only in the group with the 3rd and 4th grade; therefore, the significant reduction of nasal obstruction symptoms might be expected only in this group of patients.
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Affiliation(s)
- Jan Sojak
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin (JFM CU), Department of Pathological Physiology JFM CU and Biomedical Center in Martin JFM CU; Outpatient Department of Otorhinolaryngology Rhino Ltd. in Bratislava; Slovak Medical University in Bratislava, Faculty of Medicine, The Clinic of Otorhinolaryngology and Head and Neck Surgery, Central Military Hospital in Ruzomberok, Slovak Republic
| | - Peter Durdik
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, The Clinic of Children and Adolescents, University Hospital in Martin, Slovak Republic
| | - Renata Pecova
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin (JFM CU), Department of Pathological Physiology JFM CU and Biomedical Center in Martin JFM CU, Slovak Republic
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Role of Adenoid-Nasopharyngeal Ratio in Assessing Adenoid Hypertrophy. Indian J Otolaryngol Head Neck Surg 2018; 71:469-473. [PMID: 31742005 DOI: 10.1007/s12070-018-1359-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 04/10/2018] [Indexed: 10/17/2022] Open
Abstract
Most of the time, pediatrician is the first to see children with adenotonsillar hypertrophy (AH) and they mostly rely on clinical assessment with or without some investigation to refer these children to otorhinolaryngologist. Numerous methods have been described for evaluation of AH, but many of these methods are not possible to follow in busy pediatric outpatient unit either because of lack of cooperation from child or due to limited availability of test or due to cost constraints. This study has been conducted to determine the diagnostic accuracy of lateral neck X-ray (LNX) for assessing AH and to assess the correlation between adenoid size in LNX and clinical symptoms in a pediatric unit. Prospective study conducted in Department of ENT, Pathmavathy Medical Foundation, Kollam, Kerala, India from January 2015 to March 2016. 60 consecutive children of both genders, between the age group of 5 to 14 years, attending Department of Pediatrics with a provisional diagnosis of AH were included in the study. The symptom scores, radiographic ratio of adenoid to nasopharynx and endoscopic scorings were calculated. Lateral neck X-ray with calculation of adenoid-to-nasopharynx ratio is found to have significant correlation with patient reported symptoms and findings in nasal endoscopic examination (NE). LNX can be considered as a useful objective tool in evaluation of children with adenoid hypertrophy. Primary care physicians or pediatricians can confidently use lateral neck X-ray for making clinical decisions and can consider nasopharyngoscopy when clinical picture remains unclear or more evaluation is needed.
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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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Wu J, Gu M, Chen S, Chen W, Ni K, Xu H, Li X. Factors related to pediatric obstructive sleep apnea-hypopnea syndrome in children with attention deficit hyperactivity disorder in different age groups. Medicine (Baltimore) 2017; 96:e8281. [PMID: 29049225 PMCID: PMC5662391 DOI: 10.1097/md.0000000000008281] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 08/21/2017] [Accepted: 09/21/2017] [Indexed: 12/14/2022] Open
Abstract
This study aimed to retrospectively investigate the factors related to pediatric obstructive sleep apnea-hypopnea syndrome (OSAHS) with attention deficit hyperactivity disorder (ADHD) in children younger than 6 years and those older than 6 years.A total of 437 children who were hospitalized due to OSAHS between January 2014 and December 2014 were retrospectively reviewed. The children were further divided into OSAHS group and OSAHS + ADHD group. The general characteristics, OSA-18 quality of life, intention-hyperactivity score, and polysomnographic parameters (apnea-hypopnea index and the lowest oxygen saturation) were collected and compared between groups.There were 298 boys and 139 girls with the male to female ratio of 2.14:1. ADHD was found in 146 children including 105 boys and 41 girls with the male to female ratio of 2.56:1. Of these children, 31.62% and 35.46% had concomitant ADHD in children aged 4 to 5 years and those aged 6 to 11 years, respectively. In children aged 4 to 5 years, the incidence of allergic rhinitis was significantly higher (P = .016) and the adenoid hypertrophy was more severe (P = .001) in those with concomitant ADHD. In children aged 6 to 11 years, the tonsil hypertrophy was more severe in those with concomitant ADHD (P = .019). In children with concomitant ADHD, OSA-18 score was higher than in those with OSAHS alone (P < .001). Higher frequency of respiratory events (P < .001) and more severe hypoxia (P < .001) were found in children with concomitant ADHD than in those with OSAHS alone.As high as 30% of OSAHS children have concomitant ADHD, and the incidence of ADHD in OSAHS children is increasing over age. Boys are more likely to develop OSAHS and incidence of ADHD in OSAHS boys is higher than in OSAHS girls. In addition, risk factors of ADHD also vary between age groups. The ADHD is related to the severity of allergic rhinitis and adenoid hypertrophy in children aged 4 to 5 years, and to the severity of tonsil hypertrophy in children aged 6 to 11 years. Hypoxia may be an important factor causing ADHD. OSAHS should be treated as early as possible to reduce the incidence of ADHD in children.
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Dawood MR, Khammas AH. Diagnostic Accuracy of Radiology and Endoscopy in the Assessment of Adenoid Hypertrophy. ACTA ACUST UNITED AC 2017. [DOI: 10.5005/jp-journals-10003-1251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Aim
To clarify the diagnostic accuracy of the lateral X-ray of nasopharynx, and the flexible nasopharyngoscopy in the assessment of adenoid hypertrophy, with the preoperative rigid nasal endoscopic observation, as it was considered as a reference standard guide.
Materials and methods
This is a prospective observational study that included 80 children who planned to undergo adenoidectomy due to the symptoms found related to adenoid hypertrophy. All the children underwent a relevant clinical history and full ear, nose, and throat (ENT) examination, and the grading of adenoid hypertrophy was done preoperatively with the lateral X-ray of the nasopharynx and the flexible nasopharyngoscopy. These findings were analyzed and compared with the peroperative rigid nasal endoscopic assessment of adenoid hypertrophy, which was considered as a reference guide.
Results
There were 44 boys (55%) and 36 girls (45%), with mean age of 5.176 (±1.873) years, and the highest frequency of adenoid hypertrophy was found in the age group of 4 to 6 years (62.45%); the most common grade of the adenoid size in all the types of the assessment was grade 3. The assessment of adenoid grading by both flexible and peroperative rigid nasal endoscopy versus radiology was statistically significant, with p value of 0.0001, while the adenoid grading between flexible and peroperative rigid nasal endoscopic assessment was almost comparable, as no significant difference was found, with p value of 0.46.
Conclusion
Flexible nasopharyngoscopy was a more reliable diagnostic tool in the assessment of the adenoid size than lateral nasopharyngeal X-ray, as it correlates well with peroperative rigid nasal endoscopic finding.
How to cite this article
Dawood MR, Khammas AH. Diagnostic Accuracy of Radiology and Endoscopy in the Assessment of Adenoid Hypertrophy. Int J Otorhinolaryngol Clin 2017;9(1):6-9.
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Balaban O, Walia H, Tumin D, Jatana KR, Raman V, Tobias JD. Assessment of adenotonsillar size and caregiver-reported sleep symptoms among 3-6 year old children undergoing adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2016; 91:43-48. [PMID: 27863640 DOI: 10.1016/j.ijporl.2016.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Adenotonsillectomy remains the accepted first-line treatment for obstructive sleep apnea syndrome (OSAS) in children. Tonsillar size may be especially relevant in risk stratification as it may impact symptoms of sleep disordered breathing (SDB). This study assesses correlations among subjective tonsillar grading, measured tonsillar size, and degree of adenoid obstruction in patients age 3-6 years with caregiver-reported symptoms. METHODS Children 3-6 years old undergoing adenotonsillectomy for OSAS were enrolled prospectively. The subjective tonsillar grade and degree of adenoid obstruction were recorded on physical examination by the otolaryngologist, and the objective tonsillar size was obtained from pathology reports. Spearman's rho was used to assess agreement among measures of tonsillar size and adenoid obstruction; and to correlate these measures with caregiver-reported SDB symptoms obtained from a pre-operative standardized questionnaire. RESULTS The cohort included 103 boys and 97 girls of median age 4.8 (interquartile range [IQR]: 3.9, 5.9) years. Median subjective tonsillar grade was 3+ (IQR: 3+, 4+) while median tonsillar size was 2.7 cm (IQR: 2.5, 3) and median adenoid obstruction was 60% (IQR: 50%, 80%). The subjective tonsillar grade and measured tonsillar size were strongly correlated (ρ = 0.31, p < 0.001), whereas adenoid obstruction was uncorrelated with either subjective tonsillar grade (ρ = 0.01, p = 0.860) or measured size (ρ = -0.05, p = 0.497). Tonsillar grade was positively correlated with 3 common caregiver-reported SDB symptoms (loud snoring, trouble breathing at night, and daytime sleepiness). Objective tonsillar size was positively correlated only with difficulty organizing tasks or activities, and adenoid obstruction was positively correlated only with stopping breathing during sleep. CONCLUSION Subjective tonsillar grading by the otolaryngologist achieved better correlation than measured tonsillar size or degree of adenoid obstruction with caregiver-reported SDB symptoms in children 3-6 years of age undergoing adenotonsillectomy.
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Affiliation(s)
- Onur Balaban
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Hina Walia
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Dmitry Tumin
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kris R Jatana
- Department of Otolaryngology, Nationwide Children's Hospital and Wexner Medical Center at Ohio State University, Columbus, OH, USA
| | - Vidya Raman
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Anesthesiology & Pain Medicine, The Ohio State University, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Anesthesiology & Pain Medicine, The Ohio State University, Columbus, OH, USA
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Torretta S, Marchisio P, Succo G, Capaccio P, Pignataro L. Nasopharyngeal fiberendoscopy in children: a survey of current Italian pediatric otolaryngological practices. Ital J Pediatr 2016; 42:24. [PMID: 26931408 PMCID: PMC4774007 DOI: 10.1186/s13052-016-0234-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/23/2016] [Indexed: 11/10/2022] Open
Abstract
Background Nasopharyngeal fiberendoscopy (NFE) is the gold standard diagnostic procedure for adenoidal disease, but there is no consensus concerning the optimal technical approach. The aim of this study was to investigate the attitudes of Italian otolaryngologists towards diagnostic NFE in children, and the most widely used methods. Methods Nine hundred randomly selected members of the two largest Italian otolaryngological scientific societies were e-mailed an anonymous web-based questionnaire containing 29 multiple-choice items regarding their opinions about, and use of NFE in children. Results Questionnaires were returned by 764 clinicians (84.9 %). About 75 % declared they used NFE, but 35 % said they preferred alternative diagnostic methods. Most of the respondents considered NFE safe, but more than 80 % judged it to be poorly or only fairly well tolerated. Almost all declared that they generally use flexible, small-diameter instruments, with the patient seated on a chair or a parent’s lap; 65 % use gentle restraining methods. Fewer than 50 % reported using a standardised hypertrophy grading system. Conclusion Italian otolaryngologists have a generally positive attitude towards using NFE in children. However, some have reservations, and there was no unanimous agreement concerning how it should be done. Given the medical advantages of NFE, it is essential to clarify the many still controversial aspects of the procedure by means of comparative studies and educational programmes.
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Affiliation(s)
- Sara Torretta
- Otolaryngology Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
| | - Paola Marchisio
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giovanni Succo
- Academic Oncologic Department, Otolaryngology Service, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.
| | - Pasquale Capaccio
- Otolaryngology Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
| | - Lorenzo Pignataro
- Otolaryngology Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
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Basart H, König A, Bretschneider J, Hoekstra C, Oomen K, Pullens B, Rinkel R, van Gogh C, van der Horst C, Hennekam R. Awake Flexible Fiberoptic Laryngoscopy to diagnose glossoptosis in Robin Sequence patients. Clin Otolaryngol 2016; 41:467-71. [DOI: 10.1111/coa.12552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 11/30/2022]
Affiliation(s)
- H. Basart
- Department of Pediatrics; Academic Medical Center/Emma Pediatric Hospital; Amsterdam Netherlands
- Department of Plastic, Reconstructive and Hand Surgery; Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | - A.M. König
- Department of Otolaryngology; Academic Medical Center; Amsterdam Netherlands
| | | | - C.E.L. Hoekstra
- Department of Otolaryngology; Academic Medical Center; Amsterdam Netherlands
| | - K.P.Q. Oomen
- Department of Otolaryngology; Utrecht Medical Center/Wilhelmina Children's Hospital; Utrecht Netherlands
| | - B. Pullens
- Department of Otolaryngology; Erasmus Medical Center/Sophia Pediatric Hospital; Rotterdam Netherlands
| | - R.N.P.M. Rinkel
- Department of Otolaryngology; VU Medical Center; Amsterdam Netherlands
| | - C.D.L. van Gogh
- Department of Otolaryngology; VU Medical Center; Amsterdam Netherlands
| | - C.M.A.M. van der Horst
- Department of Plastic, Reconstructive and Hand Surgery; Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | - R.C. Hennekam
- Department of Pediatrics; Academic Medical Center/Emma Pediatric Hospital; Amsterdam Netherlands
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Method of the diagnosis of adenoid hypertrophy for physicians: adenoid-nasopharynx ratio. J Craniofac Surg 2015; 25:e438-40. [PMID: 25153063 DOI: 10.1097/scs.0000000000000952] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We aimed to describe the feasibility of a prediction of adenoid hypertrophy by pediatricians for diagnostic accuracy of nasopharyngeal x-ray in a pediatric unit. METHODS Forty-six patients with a history of probable adenoid hypertrophy between January 2013 and August 2013 were included in the study. Participants were excluded from the study if they had previous adenoidectomy; anatomic anomaly in the nose, palate, or nasopharynx; and acute infection. Nasal endoscopy was performed and evaluated adenoid size (choanal obstruction ratio) in all patients by an otorhinolaryngologist who was blinded to the information of other data. Lateral nasopharyngeal x-ray graphs of all patients were evaluated by pediatricians with adenoid-nasopharynx (A-N) ratio, who were blinded to the information of other data. The A-N ratio was calculated by Fujioka method. The A-N ratio of each patient was compared with the choanal obstruction ratio that was determined in the nasal endoscopic examination. Spearman correlation test was used for statistical analysis, and P < 0.05 was described as significant. RESULTS Forty-six patients were included in this study. The study sample consisted of 25 male (54.3%) and 21 female (45.7%) patients. The mean age of the patients was 6.17 years (range, 2-14 y). In the nasal endoscopic examination, the mean (SD) choanal obstruction ratio was 64.6% (19.5%) (range, 12.5%-90%). Mean (SD) A-N ratio was found to be 16.7 (14.4). The A-N ratio correlated with nasal endoscopic examination findings (r = 0.334, P = 0.023) CONCLUSIONS: The A-N ratio was found to be a useful, tolerable, and confident diagnostic method in pediatric patients for adenoid hypertrophy. Pediatricians can confidently use this method for decision after follow-up or operation.
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Feres MFN, Hermann JS, Sallum AC, Pignatari SSN. Radiographic adenoid evaluation: proposal of an objective parameter. Radiol Bras 2015; 47:79-83. [PMID: 25741053 PMCID: PMC4337152 DOI: 10.1590/s0100-39842014000200008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 10/17/2013] [Indexed: 11/21/2022] Open
Abstract
Objective The objective of the present study was to evaluate current radiographic parameters
designed to investigate adenoid hypertrophy and nasopharyngeal obstruction, and to
present an alternative radiographic assessment method. Materials and Methods In order to do so, children (4 to14 years old) who presented with nasal
obstruction or oral breathing complaints were submitted to cavum radiographic
examination. One hundred and twenty records were evaluated according to
quantitative radiographic parameters, and data were correlated with a
gold-standard videonasopharyngoscopic study, in relation to the percentage of
choanal obstruction. Subsequently, a regression analysis was performed in order to
create an original model so the percentage of the choanal obstruction could be
predicted. Results The quantitative parameters demonstrated moderate, if not weak correlation with
the real percentage of choanal obstruction. The regression model (110.119*A/N)
demonstrated a satisfactory ability to "predict" the actual percentage of choanal
obstruction. Conclusion Since current adenoid quantitative radiographic parameters present limitations,
the model presented by the present study might be considered as an alternative
assessment method in cases where videonasopharyngoscopic evaluation is
unavailable.
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Affiliation(s)
| | - Juliana Sato Hermann
- Master, Fellow PhD degree of Pediatric Otorhinolaryngology, Department of Otorhinolaryngology and Head & Nerck Surgery, Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | | | - Shirley Shizue Nagata Pignatari
- PhD, Professor, Division of Pediatric Otorhinolaryngology and Head & Neck Surgery, Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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Major MP, Witmans M, El-Hakim H, Major PW, Flores-Mir C. Agreement between cone-beam computed tomography and nasoendoscopy evaluations of adenoid hypertrophy. Am J Orthod Dentofacial Orthop 2014; 146:451-9. [DOI: 10.1016/j.ajodo.2014.06.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 06/01/2014] [Accepted: 06/01/2014] [Indexed: 11/25/2022]
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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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Kang KT, Chou CH, Weng WC, Lee PL, Hsu WC. Associations between adenotonsillar hypertrophy, age, and obesity in children with obstructive sleep apnea. PLoS One 2013; 8:e78666. [PMID: 24205291 PMCID: PMC3808373 DOI: 10.1371/journal.pone.0078666] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 09/14/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate the contributions of adenoid and tonsil size to childhood obstructive sleep apnea (OSA) and the interactions between adenotonsillar hypertrophy, age, and obesity in children with OSA. METHODS In total, 495 symptomatic patients were recruited. The patients were assigned to four groups according to age: toddler (age 1-3, n=42), preschool (age 3-6, n=164), school (age 6-12, n=200), and adolescence (age 12-18, n=89). All subjects had tonsil size graded by otolaryngologists, adenoid size determined on lateral radiographs (Fujioka method), and a full-night polysomnography. The apnea-hypopnea index (AHI), adenoid size, and tonsil size were compared in obese and non-obese children in the four age groups. Adjusted odds ratios (ORs) and 95% confidence interval (CI) of adenotonsillar hypertrophy and OSA risk were estimated by multi-logistic regression. RESULTS The AHI was positively related to tonsil grade (r=0.33, p <0.001) and adenoid size (r=0.24, p <0.01) in all patients. Tonsil grade was positively related to AHI in all four age groups. Adenoid size was positively related to AHI in the toddler, preschool, school groups, but not in the adolescent group (r=0.11, p=0.37). Tonsil grade and adenoid size were both positively related to AHI in obese and non-obese children. In the regression model, obesity (OR=2.89; 95% CI 1.47-5.68), tonsillar hypertrophy (OR=3.15; 95% CI 2.04-4.88), and adenoidal hypertrophy (OR=1.89; 95% CI 1.19-3.00) significantly increased OSA risk. CONCLUSIONS Adenotonsillar hypertrophy and obesity are the major determinants of OSA in children. However, the influence of adenoid size decreases in adolescence.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan, R.O.C.
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan, R.O.C.
| | - Chen-Han Chou
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
| | - Wen-Chin Weng
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail:
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Waters K, Kol-Castro C, Varghese A, Lam LT, Prelog K, Cheng A. Correlations between polysomnographic and lateral airway radiograph measurements in paediatric obstructive sleep apnoea. J Paediatr Child Health 2013; 49:445-51. [PMID: 23621401 DOI: 10.1111/jpc.12212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2013] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the ability of lateral airway radiography (LAR) to assess adenoidal hypertrophy in children and correlate with the severity of obstructive sleep apnoea (OSA). METHODS This cohort study was undertaken in 72 children who presented consecutively for evaluation of OSA to the outpatients of the Children's Hospital at Westmead. All children had LAR and overnight polysomnography (PSG). Five assessors, with varying experience, were blinded to the PSG results and independently analysed the LAR. Inter-rater reliability was determined for four published assessment methods; Hibbert, Johannesson, Fujioka and Cohen and Konak. We then compared the four LAR results with PSG-determined criteria for OSA. RESULTS Using intraclass correlations, inter-rater correlations were moderate to high for all four standardised evaluations of LAR with values ranging from 0.51 to 0.96. With the radiologist taken as the 'gold standard', individual assessors ranged from 0.05 to 0.91. LAR correlated best with PSG determined obstructive apnoea hypopnea index and minimum oxygen saturation for the anterior airway measurement (Hibbert) with r-values of -0.25 and 0.25 respectively (P < 0.05). CONCLUSION Amongst four methods of evaluating adenoid size, the anterior airway size correlated best with PSG variables of obstructive respiratory index and minimum oxygen saturation. However, the methods are not able to be used as a predictor for OSA.
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Affiliation(s)
- Karen Waters
- Department of Respiratory Support Service, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
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Abstract
BACKGROUND AND OBJECTIVES To assess the possibility of adenoid size asymmetry in both nasal sides by nasopharyngoscopy. DESIGN AND SETTINGS This is a prospective study involving 100 children, with age ranging between 1 and 12 years, performed in Saudi Arabia between January 2010 and December 2011. METHODS Adenoid was examined and graded I-IV in relation to posterior choana bilaterally by flexible nasopharyngoscopy. The adenoid grade was compared with the other side in each child. RESULTS The findings from endoscopy were analyzed: there was a high degree of agreement in grading both sides, that was 92% with kappa=0.868. Moreover, there was grade asymmetry in 8% of the cases. CONCLUSION Adenoid grading using flexible nasopharyngoscopy through one side of the nose may not represent the adenoid grade of the other side in all cases.
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Affiliation(s)
- Ahmed Yousif Al-Ammar
- Otolaryngology, H&N Surgery,, King Saud University, Riyadh, Saudi Arabia. ahmedalamma2hotmail.com
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Nasopharyngeal fiberendoscopy in children: a diagnostic challenge in current clinical practice: how we do it. Int J Pediatr Otorhinolaryngol 2013; 77:747-51. [PMID: 23485256 DOI: 10.1016/j.ijporl.2013.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 01/27/2013] [Accepted: 02/01/2013] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Nasopharyngeal fiberendoscopy (NFE) is the gold standard diagnostic procedure in children with suspected adenoidal disease, but it is not always easily feasible in younger children, and there is no consensus on the optimal technical approach according to children's age or disease. This paper aims to report our experience with NFE performed during routine paediatric clinical examination, also with regards to tolerability and patients' satisfaction. METHODS NFE was performed in paediatric patients with suspected adenoidal obstruction by means of a 2.7 mm-diameter flexible endoscope with the child seated in a chair or on parent's knees under outpatients basis and without administering local decongestants, anaesthetic agents, or sedatives. Relationship between possible confounders and patients' satisfaction, NFE tolerability, or needing for restraining was evaluated. RESULTS NFE was successfully performed in all but one syndromic 2-year old patient. Analysis was conducted on 191 children (mean age = 5.58; standard error, SE = 2.52 years). Restraining was required more frequently (p < 0.001) in younger children; NFE tolerability was good, as documented by mean visual analogue scale (VAS) values of 2.06 (SE = 1.58), and a better NFE tolerance was reported more frequently (p < 0.001) in older children. No significant relationship was found between needing for restraining or VAS and gender. No major or minor adverse events occurred. CONCLUSIONS Our results support the feasibility and tolerability of flexible NFE performed by a skilled ENT specialist for nasopharyngeal evaluation in children aged more than 2 years with suspected adenoidal disease.
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Feres MFN, Hermann JS, Pignatari SSN. Cephalometric evaluation of adenoids: an analysis of current methods and a proposal of a new assessment tool. Am J Orthod Dentofacial Orthop 2012; 142:671-8. [PMID: 23116508 DOI: 10.1016/j.ajodo.2012.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 07/01/2012] [Accepted: 07/01/2012] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Although the scientific literature recognizes that lateral cephalometric radiographs might be clinically useful, there is no consensus in relation to the best parameter available. Therefore, this research was aimed at evaluating current radiographic assessment methods designed to investigate adenoid hypertrophy and nasopharyngeal obstruction. METHODS Children from 4 to 14 years old with nasal obstruction or oral breathing complaints, suspected to be caused by adenoid hypertrophy, received cephalometric examinations. One hundred twenty radiographic records were evaluated according to several current methods, and data were compared with respective gold-standard videonasopharyngoscopic examinations, in relation to the percentage of choanal obstruction. RESULTS Groups derived from a grading system had significantly different percentages of choanal obstruction. However, this parameter showed low sensitivity. Significant but moderate correlations were observed between most of the quantitative radiographic parameters and the percentage of choanal obstruction. Alternatively, a regression model was introduced; it demonstrated satisfactory ability to predict choanal obstruction percentage. Despite limitations, this model could also distinguish patients who might benefit from referral to otolaryngologic care. CONCLUSIONS Current adenoid assessment methods have significant limitations. A novel assessment method introduced here might be clinically useful.
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Affiliation(s)
- Murilo Fernando Neuppmann Feres
- Division of Pediatric Otolaryngology, Department of Otolaryngology, Head and Neck Surgery, Federal University of São Paulo, São Paulo, Brazil.
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Evaluation of airway obstruction by adenoid tissue: comparison of measures in the sitting and recumbent. Int J Pediatr Otorhinolaryngol 2012; 76:1278-84. [PMID: 22704675 DOI: 10.1016/j.ijporl.2012.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 05/13/2012] [Accepted: 05/15/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To measure the airway obstruction caused by adenoid hypertrophy in the sitting and recumbent positions in search of hypothesized differences. METHODS Forty eight children between the ages of 2 and 12 years who sought the department of otorhinolaryngology spontaneously complaining of snoring and/or nasal obstruction. Children could be either male or female and belong to any social or racial group. Patients underwent nasal videoendoscopy sitting and lying performed by the same investigator. An image of the posterior nasopharynx was obtained from each nasal cavity of each patient for both positions. The free area of the nasopharynx was measured and compared in both positions. Image analysis was performed by two researchers other than that who carried out the examination. RESULTS The nasopharynx free area obtained with seated patient is, on average, 53% bigger than the free area obtained with the patient lying down (confidence interval: 95%; p<0.001). Thus, adenoidal obstruction is larger when the examination is performed with the patient lying down. CONCLUSIONS Nasal videoendoscopy to evaluate adenoid hypertrophy with the patient lying down makes testing more reliable, better reproducing the patient's position when sleeping. Such accuracy is essential since it influences the decision for surgical intervention in this important and widespread disease in the pediatric population.
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Zicari AM, Magliulo G, Rugiano A, Ragusa G, Celani C, Carbone MP, Occasi F, Duse M. The role of rhinomanometry after nasal decongestant test in the assessment of adenoid hypertrophy in children. Int J Pediatr Otorhinolaryngol 2012; 76:352-6. [PMID: 22209257 DOI: 10.1016/j.ijporl.2011.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 12/01/2011] [Accepted: 12/07/2011] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Nasal respiratory obstruction is a very common otolaryngologic problem, often caused by adenoid hypertrophy (AH). Nasal fiberoptic endoscopy (NFE) represents the gold standard method to diagnose AH. Rhinomanometry represents a valid diagnostic support. OBJECTIVE The aim of our study was to analyze the diagnostic value of rhinomanometry after nasal decongestant (ND) test for the evaluation of adenoid hypertrophy in children. MATERIALS AND METHODS Seventy-one of 97 collaborative children, aged 6-12 years, affected by upper airways obstructive symptoms and diagnosed as 'chronic oral breathers' by a standardized questionnaire were included in the study. The first evaluation included a complete physical examination, anterior rhinoscopy and anterior active rhinomanometry. Patients with a positive rhinomanometry underwent a second rhinomanometry after the administration of the nasal decongestant (ND) xylometazoline. All children were evaluated using nasal fiberoptic endoscopy (NFE). RESULTS At rhinomanometry a normal nasal airflow was found in 19 (26.8%) of children while nasal obstruction was underlined in 52 (73.2%). These patients were tested also with rhinomanometry after ND which confirmed the presence of nasal obstruction in 29 (55.7%) of patients. All patients included in the study underwent a NFE: 34 (47.8%) of them presented severe AH with an occlusion >75% of the choanal opening (grade ≥ 3) and 37 (52.2%) presented no or a mild form of AH (grade < 3). When compared to NFE, rhinomanometry test after ND had 82.7% sensitivity and 82.6% specificity. Positive predictive value and negative predictive value were 85.7% and 79.2%, respectively. Two receiver operating characteristic (ROC) curves were derived using data related to rhinomanometry vs NFE, and to rhinomanometry after ND vs NFE. CONCLUSIONS Rhinomanometry after ND, compared to rhinomanometry, is more specific and useful to evaluate nasal obstruction due to AH in children, and it may be helpful to avoid unnecessary surgical procedures in children with temporary nasal obstruction.
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Affiliation(s)
- A M Zicari
- Department of Pediatric Science, University La Sapienza, Rome, Italy.
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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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Marseglia G, Caimmi D, Pagella F, Matti E, Labò E, Licari A, Salpietro A, Pelizzo G, Castellazzi A. Adenoids during Childhood: The Facts. Int J Immunopathol Pharmacol 2011; 24:1-5. [DOI: 10.1177/03946320110240s401] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Adenoids are constantly exposed to viral and bacterial agents as well as to allergens. They play a major role in the upper airways immunity, being effector organs in both mucosal-type and systemic-type adaptive immunity. Because of both their immunological function and their specific location, adenoids are considered to be as reservoirs of viruses and bacteria. Reiterative infections may therefore contribute both to Eustachian tube dysfunction and to tissue hypertrophy. Nasal endoscopy is a key diagnostic tool to detect both adenoid hypertrophy and adenoiditis. Moreover, such a procedure may be very helpful in detecting bacterial biofilms that could justify the concomitant presence of recurrent episodes of otitis media, chronic and occult sinusitis in children. Even though the connection between allergies and adenoidal diseases is not completely clear, allergic diseases cause an inflammatory state that influences adenoidal tissue as well, configuring the picture of allergic adenoiditis, a condition in which adenoid tissue exhibit numerous IgE positive mast cells. Several studies are still needed to better understand the relationship between allergies and infections and the influence they play on adenoids during childhood.
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Affiliation(s)
- Gl Marseglia
- Department of Pediatrics, University of Pavia - Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - D Caimmi
- Department of Pediatrics, University of Pavia - Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - F Pagella
- Department of Otorhinolaryngology - Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - E Matti
- Department of Otorhinolaryngology - Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - E Labò
- Department of Pediatrics, University of Pavia - Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Licari
- Department of Pediatrics, University of Pavia - Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Salpietro
- Department of Pediatrics, Unit of Pediatric Genetics and Immunology, University of Messina, Italy
| | - G Pelizzo
- Department of Pediatric Surgery, University of Pavia - Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Am Castellazzi
- Department of Pediatrics, University of Pavia - Foundation IRCCS Policlinico San Matteo, Pavia, Italy
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Saedi B, Sadeghi M, Mojtahed M, Mahboubi H. Diagnostic efficacy of different methods in the assessment of adenoid hypertrophy. Am J Otolaryngol 2011; 32:147-51. [PMID: 20392530 DOI: 10.1016/j.amjoto.2009.11.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 10/24/2009] [Accepted: 11/16/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study was designed for better understanding of the role of different methods of nasal endoscopy in the assessment of adenoid hypertrophy and comparing them with lateral neck radiography and patients' symptoms. SUBJECTS AND METHOD From August 2007 until January 2009, in the otolaryngology ward of a tertiary referral center, 89 patients who had symptoms related to chronic mouth breathing participated in this study. History of the symptoms related to adenoid hypertrophy was obtained from them. In addition, all patients underwent nasal endoscopy and lateral nasopharynx x-ray. The clinician who did nasal endoscopy was blinded to information about clinical data and x-ray and vice versa. Afterward, the relationship between symptoms and each diagnostic procedure was evaluated. RESULTS Patients had a mean age of 9.47 ± 4.68 years. In the evaluation of the relationship between symptoms grading and grading in lateral neck radiography, this relationship was significant about snoring. Furthermore, there was a significant relationship between the endoscopic size of adenoid and number of the episodes of acute otitis media. The sum of symptoms grading had a significant relationship with the size of adenoid in lateral neck x-ray, but not in nasal endoscopy. CONCLUSION The results of the present study indicated that both radiography and nasal endoscopy could define the relationship between adenoid hypertrophy and associated symptoms and therefore are complementary. Between them, despite the popularity of nasal endoscopy, radiography can serve as a better planning tool.
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Affiliation(s)
- Babak Saedi
- ENT Research Center, Tehran University of Medical Sciences, Imam Khomeini Medical Center, Tehran, Iran.
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Diagnostic accuracy of the nasal obstruction index in detecting adenoid hypertrophy in children without allergy. Int J Pediatr Otorhinolaryngol 2011; 75:57-61. [PMID: 21035875 DOI: 10.1016/j.ijporl.2010.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Revised: 09/23/2010] [Accepted: 10/01/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We have previously compared the capacity of the nasal obstruction index (NOI) and nasal fiberoptic endoscopy (NFE) to detect adenoid hypertrophy (AH) in children and found no agreement between them. However, the prevalence of false positive results was significantly higher in children with allergic rhinitis (AR), thus suggesting that AR may be a possible causative factor. The aim of this study was to verify the diagnostic accuracy of the NOI in detecting AH by comparing NOI scores with NFE findings in a selected series of non-allergic children affected by nasal obstruction. METHODS This prospective study was carried out at the Outpatient Clinics of the Departments of Specialist Surgical Sciences and Maternal and Pediatric Sciences of the University of Milan, Italy, and involved 154 non-allergic children aged 3-12 years in whom otological diseases and/or perceived nasal obstruction led to the suspicion of adenoid obstruction. The diagnostic accuracy of NOI was tested at all of the thresholds obtained by combining all of the cut-off points of NFE and NOI. RESULTS Sixty-two percent of the children had otological diseases. The choanal opening was completely blocked by the adenoids in 40% of the children, whereas NOI indicated severe clinical obstruction in only 16%. The analysis of diagnostic accuracy showed that sensitivity and specificity were respectively 17-96% and 15-91% depending on the threshold, with no simultaneously acceptable sensitivity and specificity values at any threshold and AUC values of ≤0.7 at all thresholds. CONCLUSIONS In comparison with NFE, the NOI seems to be inaccurate in detecting AH in non-allergic children with nasal obstruction.
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Feres MFN, Hermann JS, Cappellette M, Pignatari SSN. Lateral X-ray view of the skull for the diagnosis of adenoid hypertrophy: a systematic review. Int J Pediatr Otorhinolaryngol 2011; 75:1-11. [PMID: 21126775 DOI: 10.1016/j.ijporl.2010.11.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 10/30/2010] [Accepted: 11/01/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Many studies have been developed aiming to reveal the usefulness of cavum X-rays and telerradiographies as diagnostic tools for the detection of upper airway obstruction due to adenoid hypertrophy. However, the scientific literature is diverse and controversial. Therefore, a systematic review is proposed; with the objective to determine the diagnosis value of lateral X-ray view of the skull regarding adenoid hypertrophy. METHODS Searching was conducted on Pubmed, Lilacs, Cochrane Library, Embase, and Web of Knowledge databases; and was restricted to studies published in English, Portuguese or Spanish languages, carried out on humans under 18 years of age. All the obtained publications were first submitted to a pre-selection, and then, full-texts (n=66) were analyzed and selected by independent examiners. The resultant studies (n=11) were systematically and critically analyzed, and qualified according to QUADAS (Quality Assessment of Diagnostic Accuracy Studies) questionnaire, an assessment tool designed to qualify diagnostic tests accuracy studies. RESULTS Searching and selection procedures generated 11 studies which were considered adequate to be systematically analyzed. Accordingly, large variation was observed concerning the evaluation methods of radiographic and fibronasoendoscopic exams, and the sample characteristics. Additionally, little amount of scientific evidences could be provided, since few radiographic variables were analyzed simultaneously. Moreover, assessment methods were, at most, subjective or poorly described. QUADAS application revealed other significant limitations related to the sampling, such as inadequate spectrum of the investigated "disease" (adenoid hypertrophy), and poor report of the subjects' enrollment and participation process. Further, QUADAS revealed inadequacies regarding methodological features, including poor description of the radiographic exams and assessment methods. In addition, it was also shown that most of the studies did not specify the moment in clinical time when both exams were performed; neither reported a strategy of "blindness" by the examiners. CONCLUSIONS Despite such limitations, the majority of the resultant data indicates that lateral X-rays might be considered somewhat useful, even though it could not be clearly demonstrated. Future research should then adhere to greater methodological rigor, in order to investigate the significance of radiographies as a screening test.
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Affiliation(s)
- Murilo Fernando Neuppmann Feres
- Division of Pediatric Otolaryngology, Department of Otolaryngology, Head and Neck Surgery, Federal University of São Paulo, Sorocaba, SP, Brazil.
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Clinical assessment of adenoidal obstruction based on the nasal obstruction index is no longer useful in children. Otolaryngol Head Neck Surg 2010; 142:237-41. [PMID: 20115981 DOI: 10.1016/j.otohns.2009.10.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 09/17/2009] [Accepted: 10/20/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the accuracy of clinical assessment of adenoidal obstruction based on a standardized score of the degree of mouth breathing and speech hyponasality (nasal obstruction index [NOI]) in comparison to nasal fiberoptic endoscopy. STUDY DESIGN Cross-sectional study with planned data collection. SETTING Outpatient clinics of the Departments of Maternal and Pediatric Sciences and Specialized Surgical Sciences, University of Milan, Italy. SUBJECTS AND METHODS Children aged three to 12 years with adenoidal obstruction suspected on the grounds of persistent/recurrent otitis media or perceived obstructive nasal breathing were eligible. Ear, nose, and throat examination, allergy testing, NOI measurement, and nasal fiberoptic endoscopy to assess the degree of adenoidal hypertrophy were performed. Agreement between the NOI and adenoidal hypertrophy grade was assessed in the patients as a whole and by clinical subgroups. RESULTS A total of 202 children were enrolled: 54.9 percent had otological diseases and 45.1 percent had perceived obstructive nasal breathing. Most of the children (79.2%) showed mild or moderate clinical nasal obstruction. Adenoidal hypertrophy ranged from no obstruction (18%) to severe obstruction (38%). There was no substantial agreement between the NOI and the degree of adenoidal obstruction in the population as a whole and in all the clinical subgroups. False positive findings were significantly more frequent among allergic children (50%) than non-allergic children (22.4%, P = 0.009). CONCLUSION Clinical assessment based on the NOI is incapable of accurately predicting the degree of adenoidal obstruction. In children with clinical nasal obstruction not explainable by adenoidal size, the clinician should consider, among causes of more anterior obstruction, nasal allergy.
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Correlation between adenoid-nasopharynx ratio and endoscopic examination of adenoid hypertrophy: a blind, prospective clinical study. Int J Pediatr Otorhinolaryngol 2009; 73:1532-5. [PMID: 19732970 DOI: 10.1016/j.ijporl.2009.07.018] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2009] [Revised: 05/19/2009] [Accepted: 07/21/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the reliability of adenoid-nasopharynx (A/N) ratio that is calculated on lateral cephalometric graphies for measuring the adenoid tissue size. METHODS 85 patients that had been examined in our clinic with a prediagnosis of adenoid hypertrophy between June 2007 and March 2008 were included in the study. Local ethics committee approved the study protocol. Patients who had a previous adenoidectomy history and anatomic anomaly or acute infection in nose, palate or nasopharynx were excluded. Endoscopic nasal examination was done in all patients in addition to the routine ear nose throat examination. Lateral cephalometric graphs were obtained from all patients. Digital images obtained during endoscopic examination were evaluated on computer and obstruction ratios of adenoid tissue to choanal opening were calculated. Each cephalometric graph was evaluated by a blinded author. A/N ratio was calculated by dividing the distance from the outermost point of convexity of adenoid shadow to basiocciput to the distance between sphenobasiocciput and posterior end of hard palate (Fujioka Method). A/N ratio of each patient was then compared with the obstruction ratio obtained in nasal endoscopy. Pearson correlation test was used for statistical analysis and a p-value of <0.05 was accepted as significant. RESULTS There were 52 male and 33 female patients between the ages of 2 and 12 years (mean age, 5.0+/-2.2; median, 4.5). In nasal endoscopy, adenoid tissue was determined to obstruct the choanal opening as 88.5+/-12.0% (range, 51-99%) in an average. Mean adenoid nasopharynx ratio was found to be 0.87+/-0.1. There was a statistical significant correlation between A/N ratio and nasal endoscopic examination findings (r=0.511; p<0.0001). CONCLUSIONS A/N ratio is an easily applicable, noninvasive method that can correctly measure the size of the adenoid tissue in patients who are suspected to have adenoid hypertrophy.
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Chadha NK, Zhang L, Mendoza-Sassi RA, César JA. Using nasal steroids to treat nasal obstruction caused by adenoid hypertrophy: does it work? Otolaryngol Head Neck Surg 2009; 140:139-47. [PMID: 19201278 DOI: 10.1016/j.otohns.2008.11.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Revised: 11/05/2008] [Accepted: 11/05/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To systematically review the evidence for the usage of nasal steroids to improve symptoms of nasal airway obstruction in children with adenoidal hypertrophy. DATA SOURCES Published studies indexed in the MEDLINE (1951 to 2008), EMBASE (1974 to 2008), and the Cochrane databases (Issue 3, 2008). REVIEW METHODS Data from the included trials were extracted and trial quality was assessed. Meta-analysis was not applicable and data were summarized in a narrative format. Evidence from excluded studies was also discussed. RESULTS Seven studies (six randomized controlled trials and one cohort study) met the inclusion criteria of the review, including a total of 493 patients. Six of these studies demonstrated significant efficacy of various nasal steroids (mometasone, beclomethasone, flunisolide) in improving nasal obstruction symptoms and in reducing adenoid size, as measured with symptom scores and fiber-optic nasopharyngeal endoscopy, respectively. The response appeared to be a group effect and may be maintained longer-term by continuing nasal steroids at a lower maintenance dose. The treatment was safe and well-tolerated with few minor adverse events. CONCLUSION The available evidence suggests that nasal steroids may significantly improve nasal obstruction symptoms in children with adenoid hypertrophy. This improvement appears to be associated with a reduction of adenoid size. Evidence of long-term efficacy is limited but suggests that in many children maintenance therapy is needed if symptom-relief is to persist. Further studies are required to support the use of nasal steroids as a first-line approach in these children.
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Affiliation(s)
- Neil K Chadha
- Department of Otolaryngology, Hospital for Sick Children, Toronto, Ontario, Canada.
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Kindermann CA, Roithmann R, Lubianca Neto JF. Obstruction of the eustachian tube orifice and pressure changes in the middle ear: are they correlated? Ann Otol Rhinol Laryngol 2008; 117:425-9. [PMID: 18646438 DOI: 10.1177/000348940811700604] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We performed a cross-sectional study to investigate whether the obstruction of the eustachian tube orifice due to adenoid hyperplasia changes the pressures in the middle ear. METHOD Fifty consecutive children 2 to 12 years of age with nasal obstruction were examined from May to October 2005. Adenoid size and status of the eustachian tube orifice were assessed with nasal flexible fiberoptic endoscopy. Tympanometry was used to evaluate the middle ear. RESULTS In children with occlusion of the eustachian tube orifice by adenoid tissue, 87% had abnormal pressure in the middle ear according to tympanograms. When orifices were not occluded, 86% of the tympanograms were normal (p < .001). CONCLUSIONS Obstruction of the eustachian tube orifice by adenoid tissue was associated with tympanograms suggestive of abnormal pressure in the middle ear. Future studies with a larger sample size are necessary to clarify this association.
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