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Martin E, Frank M, Nguyen C, Bhatt J, Huoh K, Ahuja G, Pham N. Supplemental oxygen requirement after tonsillectomy in children >3 years of age. Int J Pediatr Otorhinolaryngol 2024; 178:111893. [PMID: 38382259 DOI: 10.1016/j.ijporl.2024.111893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION The indications for postoperative admission after tonsillectomy in children >3 years of age are less well defined than for children <3 years old, and typically include severe obstructive sleep apnea (OSA), obesity, comorbidities, or behavioral factors. Inpatient care after tonsillectomy typically consists of respiratory monitoring and support, as respiratory compromise is the most common complication after pediatric tonsillectomy. We aim to evaluate risk factors associated with postoperative oxygen supplementation and to identify high risk populations within the admitted population who use additional resources or require additional interventions. METHODS Retrospective chart review of patients between the ages of 3 and 18 years old who underwent tonsillectomy by four surgeons at a tertiary care children's hospital was performed. Data including demographics, comorbidities, surgical intervention, pre- and postoperative AHI, admission, postoperative oxygen requirement, and postoperative complications was collected and analyzed. RESULTS There were 401 patients included in the analysis. Of the patients in this study, 65.59% were male, 43.39% were Latino, and 53.87% were ages 3 to 7. Of the 397 patients with a record for supplemental oxygen, 36 (9.07%) received supplemental oxygen. The LASSO regression odds ratios (OR) found to be important for modeling supplemental oxygen use (in decreasing order of magnitude) are BMI ≥35 (OR = 2.30), pre-op AHI >30 (OR = 2.28), gastrointestinal comorbidities (OR = 2.20), musculoskeletal comorbidities (OR = 1.91), cardiac comorbidities (OR = 1.20), pulmonary comorbidities (OR = 1.14), and BMI 30 to <35 (OR = 1.07). Female gender was found to be negatively associated with risk of supplemental oxygen use (OR = 0.84). Age, race, AHI ≥15-30, neurologic comorbidities, syndromic patients, admission reason, and undergoing other procedures concomitantly were not found to be associated with increased postoperative oxygen requirement. CONCLUSION BMI ≥30, pre-op AHI >30, male gender, and gastrointestinal, musculoskeletal, cardiac, and pulmonary comorbidities are all associated with postoperative supplemental oxygen use. Age, race, AHI ≥15-30, neurologic comorbidities, syndromic patients, admission reason, and undergoing other procedures concomitantly were not found to be associated with increased postoperative oxygen requirement.
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Affiliation(s)
- Elaine Martin
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA.
| | - Madelyn Frank
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - Cecilia Nguyen
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - Jay Bhatt
- Department of Pediatric Otolaryngology - Head & Neck Surgery, Children's Hospital of Orange County, Orange, CA, USA
| | - Kevin Huoh
- Department of Pediatric Otolaryngology - Head & Neck Surgery, Children's Hospital of Orange County, Orange, CA, USA
| | - Gurpreet Ahuja
- Department of Pediatric Otolaryngology - Head & Neck Surgery, Children's Hospital of Orange County, Orange, CA, USA
| | - Nguyen Pham
- Department of Pediatric Otolaryngology - Head & Neck Surgery, Children's Hospital of Orange County, Orange, CA, USA
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Sagar M, Sagar P, Kabra SK, Kumar R, Mallick S. The concatenation of association between gastroesophageal reflux and obstructive adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2020; 139:110439. [PMID: 33068945 DOI: 10.1016/j.ijporl.2020.110439] [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: 07/29/2020] [Revised: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Gastroesophageal reflux (GER) is frequently seen in patients with adenotonsillar hypertrophy. However, the sequential association between GER and adenotonsillar hypertrophy is unknown. This leads to unpredictable outcomes while treating patients of adenotonsillar hypertrophy with GER. The objective of this study is to evaluate the prevalence of GER and gastroesophageal reflux disease (GERD) in paediatric patients with obstructive adenotonsillar hypertrophy (OATH), and to assess the effect of adenotonsillectomy (AT) on GER as well as GERD. METHODS In this prospective cohort study, consecutive pediatric patients with grade III/IV hypertrophy of adenoid or/and tonsillar tissue who were planned for AT were recruited after excluding comorbidities predisposing to GER. Symptoms of GERD using Gastro Esophageal Reflux Questionnaire for Young Children (GERQ-YC) and Reflux Indices (RI) obtained from 24-h ambulatory esophageal pH monitoring were evaluated in all patients pre-operatively and 12 weeks following AT. RESULTS A total of 49 patients with OATH with average age of 6 years were included in this study. With a RI of >4.3% as the threshold for making the diagnosis of GER on esophageal pH monitoring, the prevalence of GER was 20.4%. The average RI preoperatively was 15.7% which reduced to 1.7% following AT (p = 0.004). Among the 10 patients with preoperative GER, 80% of the patients had no evidence of GER after surgery. New incidences of GER was not observed post operatively in this cohort. As per the GER symptom scoring system, 31% of the parents reported GERD pre-operatively which resolved completely in all patients following surgery. CONCLUSIONS - In this study, the prevalence of GER proven by 24 h ambulatory esophageal pH monitoring is 20% in pediatric patients with OATH. Following AT, GER resolved in 80% of cases and was reduced substantially in the remaining cases in the subset of patients with pre-operative GER. The symptoms of GERD based on parents' recall of child's previous symptoms may not accurately represent presence of GER. Our results suggest that OATH can result in GER due to increased negative intra-thoracic pressure as a result of breathing against an obstructed upper airway and hence, GER subsides following surgical removal of the obstructive pathology. To establish this concatenational association of OATH and GER, larger studies are mandated.
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Affiliation(s)
- Milind Sagar
- Department of Otorhinolaryngology & Head Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Prem Sagar
- Department of Otorhinolaryngology & Head Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Rajeev Kumar
- Department of Otorhinolaryngology & Head Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Saumyaranjan Mallick
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Chorney SR, Zur KB, Buzi A. Reflux as a Risk Factor for Morbidity after Pediatric Tonsillectomy: A National Cohort of Inpatients. Laryngoscope 2020; 131:907-910. [PMID: 32681749 DOI: 10.1002/lary.28895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/27/2020] [Accepted: 06/11/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Gastroesophageal reflux (GER) has been identified as a risk factor for complications following pediatric tonsillectomy. The primary objective of this study was to examine outcomes after tonsillectomy among children with GER using a nationwide database. Secondary objectives included analyzing duration of hospitalization and total charges after admission. METHODS A cross-sectional review of the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Databases (KID) from 2012 and 2016. RESULTS A total of 21,232 children had a tonsillectomy with or without adenoidectomy, with 1683 (7.9%) diagnosed with GER. Average age for patients with reflux was 4.4 years and for those without was 5.6 years (P < .001). The rate of primary hemorrhage was not statistically different between groups (P = .87). Patients with reflux were more likely to have respiratory complications (P = .03), aspiration pneumonitis (P < .001), and hypoxemia (P < .001) during their hospital course. Noninvasive ventilation and reintubation also occurred more frequently in this population (P < .001). Children with reflux had a longer duration of postoperative admission (3.8 vs. 2.3 days, P < .001) and higher total hospital charges ($47,129 vs. $27,584, P < .001). Multivariable regression analysis determined that reflux remained a statistically significant indicator of aspiration pneumonitis, hypoxemia, invasive and non-invasive ventilation, as well as length of admission. CONCLUSION Children with GER were significantly more likely to experience inpatient complications following tonsillectomy. Further, length of admission was higher compared to children without reflux. These results suggest that children with GER experience poorer outcomes after tonsillectomy and highlight the role for appropriate preoperative counseling and planning in this patient population. Laryngoscope, 131:907-910, 2021.
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Affiliation(s)
- Stephen R Chorney
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.,Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Karen B Zur
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.,Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Adva Buzi
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.,Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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Galli J, Settimi S, Salonna G, Mele DA, De Corso E, Paludetti G. Narrow Band Imaging for lingual tonsil hypertrophy and inflammation, in laryngo-pharyngeal reflux disease. Eur Arch Otorhinolaryngol 2019; 277:819-825. [PMID: 31858222 DOI: 10.1007/s00405-019-05765-2] [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: 09/07/2019] [Accepted: 12/09/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE The objective of this study is to analyse the relationship between the endoscopic signs of laryngo-pharyngeal reflux, the lingual tonsil hypertrophy (LTH) and its inflammation, adopting Narrow Band Imaging (NBI) technology. METHODS We enrolled, as cases, patients with clinical diagnosis of laryngopharyngeal reflux disease (LPRD), a Reflux Symptom Index (RSI) ≥ 13, and a Reflux Finding Score (RFS) ≥ 7. Controls were enrolled among patients who underwent the same transnasal endoscopy, equipped with NBI, with a RSI < 13 and a RFS < 7. Nasopharynx, Lingual Tonsils (LT), Hypopharynx and Larynx were evaluated by two experienced otolaryngologists, who calculated the Reflux Finding Scale (RFS) score and focused their attention on the base of the tongue, observing its surface with NBI technology. RESULTS 82 patients with diagnosis of laryngopharyngeal reflux were enrolled as cases. Mean RFS was 11.7 (SD = 2.9). As controls, we enrolled 80 patients. Mean RFS was 2.7 (SD = 1.63). We found that RFS positivity was associated with a significant increase in LT dimension (2.5 vs 1.1, p < 0.001), with a higher LT crypt inflammation grading (1.8 vs 0.09, p < 0.001) and with a higher Roman Cobblestone pattern grading (1.48 vs 0.11, p < 0.001). A significant correlation between the crypt inflammation and the hyperemia subscore of RFS was present (r = 0.696, p < 0.0001), while it was not possible to find a correlation between crypt inflammation and either diffuse laryngeal edema (r = 0.166, p = 0.135) and posterior commissure hypertrophy (r = 0.089, p = 0.427). CONCLUSIONS NBI allowed us to identify endoscopically the presence of enlarged lingual tonsil, crypt inflammation and superficial mucosal changes, in patients affected by LPRD. LEVEL OF EVIDENCE 2 (prospective, case-control study).
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Affiliation(s)
- Jacopo Galli
- Institute of Otolaryngology, Head and Neck Surgery, School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Stefano Settimi
- Institute of Otolaryngology, Head and Neck Surgery, School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
| | - Giampiero Salonna
- Institute of Otolaryngology, Head and Neck Surgery, School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Dario Antonio Mele
- Institute of Otolaryngology, Head and Neck Surgery, School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Eugenio De Corso
- Institute of Otolaryngology, Head and Neck Surgery, Fondazione Policlinico Universitario "A.Gemelli" - IRCCS, Rome, Italy
| | - Gaetano Paludetti
- Institute of Otolaryngology, Head and Neck Surgery, School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
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Kim JH, Jang SJ, Yun JW, Jung MH, Woo SH. Effects of pepsin and pepstatin on reflux tonsil hypertrophy in vitro. PLoS One 2018; 13:e0207090. [PMID: 30408092 PMCID: PMC6224077 DOI: 10.1371/journal.pone.0207090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 10/24/2018] [Indexed: 12/18/2022] Open
Abstract
There is evidence that pepsin can aggravate tonsil hypertrophy. Pepstatin is a potent inhibitor of pepsin activity and could protect patients against reflux tonsil hypertrophy by inhibiting pepsin. We examined the effects of pepstatin on the development of tonsil hypertrophy to investigate pepsin’s role in the pathogenesis of tonsil lesions. We investigated whether pepstatin suppresses pepsin-mediated lymphocyte proliferation in tonsil hypertrophy. Forty-nine children with tonsil hypertrophy and twenty-two adults with tonsillitis were recruited to the study prior to surgery. Tonsil tissue from each patient was harvested and assessed for changes in the number of lymphocytes and macrophages in the presence of pepsin and pepstatin. We found that the proportions of CD4- and CD14-positive cells were significantly lower (p < 0.05), but that the proportions of CD19- and CD68-positive cells were significantly higher (p < 0.05), in children than in adults. There were significantly more CD4-positive cells after pepsin treatment, but these numbers were reduced by pepstatin. The levels of both interleukin-2 (IL-2) and interferon gamma (IFN-γ) increased significantly in response to pepsin, but were reduced when pepsin was inhibited by pepstatin. The level of IL-10 is reduced in pepsin-treated CD4 cells and the level is restored by pepstatin. IL-2 blocking reduced the increased CD4 cell number by pepsin. But, an additive or a synergic effect is not founded in combined with IL-2 blocking and pepstatin. Pepsin-positive cells did not co-localize with CD20 and CD45 cells, but they were found surrounding CD20- and CD45-positive hypertrophic tonsil cells. Pepsin-positive cells co-localized with CD68-positive cells. It is probable that pepsin from extraesophageal reflux aggravates tonsil hypertrophy and pepstatin exerts a protective effect by inhibiting pepsin activity.
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Affiliation(s)
- Jin Hyun Kim
- Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Si Jung Jang
- Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Korea
| | - Jeong Won Yun
- Department of Otorhinolaryngology-Head and Neck Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Myeong Hee Jung
- Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Korea
| | - Seung Hoon Woo
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Gyeongsang National University Hospital, Jinju, Korea
- Beckman Laser Institute, University of California, Irvine, California, United States of America
- * E-mail:
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Niu X, Wu ZH, Xiao XY, Chen X. The relationship between adenoid hypertrophy and gastroesophageal reflux disease: A meta-analysis. Medicine (Baltimore) 2018; 97:e12540. [PMID: 30313042 PMCID: PMC6203580 DOI: 10.1097/md.0000000000012540] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 09/04/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is believed to be associated with various manifestations in the otorhinolaryngology and has been found to be an additional risk factor for adenoid hypertrophy, but the causal relation between them is under controversial. We thus performed a meta-analysis to grade the strength of evidence and systematically explore whether adenoid hypertrophy correlates with GERD in the literature. METHODS A systematic literature search was performed using Medline via PubMed, Embase, CNKI, and Web of Science. Studies reporting the adenoid hypertrophy and GERD were identified for inclusion. RESULTS There were 6 studies that matched the selection criteria, and the total sample size of these studies was 548 cases. We identified a significant relationship between adenoid hypertrophy and GERD, with a pooled odds ratio of 4.12 (95% confidence interval [CI]: 1.32-12.93; P < .001). The results was significant in 24-hour pH monitoring subgroup analysis, with a corresponding value of 8.62 (95% CI: 4.06-18.27, P > .05) under the fixed-effects model. And the results was significant in Helicobacter pylori subgroup analysis, with a corresponding value of 2.39 (95% CI: 0.39-14.55, P < .05) under the random-effects model. Begg tests (P = .73) and Egger tests (P = .76) showed there were no obvious evidence to support publication bias in our study. CONCLUSION This meta-analysis provided a strong correlation between adenoid hypertrophy and GERD, the children with adenoid hypertrophy had a higher incidence of GERD than healthy children, but the pathogenesis of GERD in adenoid hypertrophy awaits more investigations and suggests that we should not overlook GERD in clinical practice and an appropriate evaluation for GERD may be needed.
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Shaker A, Magdy M. Frequency of obstructive sleep apnea (OSA) in patients with gastroesophageal reflux disease (GERD) and the effect of nasal continuous positive airway pressure. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2016.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kim JH, Jeong HS, Kim KM, Lee YJ, Jung MH, Park JJ, Kim JP, Woo SH. Extra-Esophageal Pepsin from Stomach Refluxate Promoted Tonsil Hypertrophy. PLoS One 2016; 11:e0152336. [PMID: 27058240 PMCID: PMC4825923 DOI: 10.1371/journal.pone.0152336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 03/11/2016] [Indexed: 11/24/2022] Open
Abstract
Background Gastroesophageal reflux is associated with numerous pathologic conditions of the upper aerodigestive tract. Gastric pepsin within reflux contributes to immunologic reactions in the tonsil. In this study, we aimed to find the relationships between pepsin and tonsillar hypertrophy. Methods and finding We explored the notion whether tonsillar hypertrophy was due to pepsin-mediated gastric reflux in tonsil hypertrophy. Fifty-four children with tonsil hypertrophy and 30 adults with tonsillitis were recruited before surgical treatment. Blood and tonsil tissues from each patient were harvested for analysis of changes in lymphocyte and macrophage numbers coupled with histological and biochemical analysis. Pepsin was expressed at different levels in tonsil tissues from each tonsillar hypertrophy. Pepsin-positive cells were found in the crypt epithelium, surrounding the lymphoid follicle with developing fibrosis, and also surrounding the lymphoid follicle that faced the crypt. And also, pepsin staining was well correlated with damaged tonsillar squamous epithelium and TGF-β1 and iNOS expression in the tonsil section. In addition, pepsin and TGF-β1-positive cells were co-localized with CD68-positive cells in the crypt and surrounding germinal centers. In comparison of macrophage responsiveness to pepsin, peripheral blood mononuclear cells (PBMNCs) were noticeably larger in the presence of activated pepsin in the child group. Furthermore, CD11c and CD163-positive cells were significantly increased by activated pepsin. However, this was not seen for the culture of PBMNCs from the adult group. Conclusions The lymphocytes and monocytes are in a highly proliferative state in the tonsillar hypertrophy and associated with increased expression of pro-inflammatory factors as a result of exposure to stomach reflux pepsin.
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Affiliation(s)
- Jin Hyun Kim
- Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Gyeongsangnamdo, Korea
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Kyung Mi Kim
- Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Gyeongsangnamdo, Korea
| | - Ye Jin Lee
- Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Gyeongsangnamdo, Korea
| | - Myeong Hee Jung
- Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Gyeongsangnamdo, Korea
| | - Jung Je Park
- Department of Otolaryngology, Gyeongsang National University Hospital, Jinju, Gyeongsangnamdo, Korea
| | - Jin Pyeong Kim
- Department of Otolaryngology, Gyeongsang National University Hospital, Jinju, Gyeongsangnamdo, Korea
| | - Seung Hoon Woo
- Department of Otolaryngology, Gyeongsang National University Hospital, Jinju, Gyeongsangnamdo, Korea
- Institute of Health Sciences, Gyeongsang National University Hospital, Jinju, Gyeongsangnamdo, Korea
- * E-mail:
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Banaszkiewicz A, Dembinski L, Zawadzka-Krajewska A, Dziekiewicz M, Albrecht P, Kulus M, Radzikowski A. Evaluation of laryngopharyngeal reflux in pediatric patients with asthma using a new technique of pharyngeal pH-monitoring. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 755:89-95. [PMID: 22826054 DOI: 10.1007/978-94-007-4546-9_12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
There is a debate about the association between asthma and gastroesophageal and/or laryngopharyngeal reflux (LPR). Pharyngeal pH-monitoring is a new technique that allows a physician to assess whether reflux passes the upper esophageal sphincter barrier. The aim of the study was to assess the prevalence of LPR in children with difficult-to-treat asthma. The present study was an open, prospective one. A total of 21 subjects of the mean age 12.7 years were enrolled in the study. All children were asked to fill out a Reflux Symptoms Index questionnaire and a 24-h pharyngeal pH monitoring was performed, using the Dx-pH Measurement System. The LPR was diagnosed in 13 (61.9%) children. There was a positive correlation between LPR diagnosis and the degree of asthma control. The LPR was more frequent in children treated with a higher than lower doses of fluticasone (p = 0.019, OR = 17.3) and in those using montelukast compared with non-users (p = 0.008, OR = 19.0). The mean Reflux Symptoms Index score was almost twice greater in children with LPR than in those without it (13.2 vs. 6.8, respectively, p = 0.003). We conclude that the prevalence of laryngopharyngeal reflux in children with difficult-to-treat asthma is substantial.
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Affiliation(s)
- A Banaszkiewicz
- Department of Pediatric Gastroenterology and Nutrition, Warsaw Medical University, Warsaw, Poland.
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Setabutr D, Patel H, Choby G, Carr MM. Predictive factors for prolonged hospital stay in pediatric tonsillectomy patients. Eur Arch Otorhinolaryngol 2012; 270:1775-81. [DOI: 10.1007/s00405-012-2188-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 09/07/2012] [Indexed: 11/30/2022]
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Respiratory response to proton pump inhibitor treatment in children with obstructive sleep apnea syndrome and gastroesophageal reflux disease. Sleep Med 2012; 13:824-30. [DOI: 10.1016/j.sleep.2012.04.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 04/08/2012] [Accepted: 04/25/2012] [Indexed: 11/23/2022]
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Mora R, Mora F, Crippa B, Santomauro V, Guastini L, Peretti G. Ribosomal therapy in patients with pharyngolaryngeal reflux. Acta Otolaryngol 2012; 132:651-6. [PMID: 22497598 DOI: 10.3109/00016489.2011.652310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Our data confirm the induction of specific and nonspecific immune responses of the upper respiratory tract mucosa and the consequent improvement of its physiology, through an oral ribosomal therapy in patients with pharyngolaryngeal reflux disease (PLRD). OBJECTIVES The aim of this study was to investigate the efficiency and applicability of oral ribosomal immunotherapy in adult patients with PLRD. METHODS One hundred adult patients with PLRD were enrolled. The patients were equally divided, at random, into two groups (A and B): group A patients underwent ribosomal prophylaxis with Immucytal® (one tablet daily, 8 days a month for 3 months), while group B received a placebo (same dosage for the same period). At the beginning, at the end, and 6 months after the beginning of the therapy, all patients underwent medical history, ENT examination, nasal-pharynx-laryngoscopy with optic fiber, plasma levels of immunoglobulins class E, A, G, M, subjective assessment of symptoms on a 10 cm visual analog scale (VAS), reflux symptoms index, and reflux finding score. RESULTS At the end and 6 months after the beginning of the treatment, all the patients in group A presented a significant (p < 0.05) improvement of almost all the different items analyzed.
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Affiliation(s)
- Renzo Mora
- ENT Department, University of Genoa, Italy.
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Iqbal FRW, Goh BS, Mazita A. The Role of Proton Pump Inhibitors in Adenoid Hypertrophy in Children. Otolaryngol Head Neck Surg 2012; 147:329-34. [DOI: 10.1177/0194599812444528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To establish the efficacy of proton pump inhibitors (PPI) in the treatment of adenoid hypertrophy in children. Design Randomized controlled double-blinded clinical trial. Population Forty children, aged 2 to 12 years, with adenoid hypertrophy fulfilling the inclusion and exclusion criteria. Methods Patients were randomly allocated into 2 groups: one to be treated with oral Losec MUPS for a period of 2 months (treatment group) and the other to be given a low-dose vitamin C tablet for the same period (control group). The patients were reviewed on 2 occasions during the 2-month study period, during which endoscopy was performed to examine the adenoid glands to assess their size and the larynx to assess signs of reflux disease. Examination of tonsillar size was also performed. Results There was a significant reduction in adenoid size in the treatment group, but the control group also demonstrated a significant reduction in adenoid size. Comparison between the 2 groups in terms of adenoid grade change between the first and second visits did not reveal any significant statistical difference. Conclusion The results of this study do not demonstrate any efficacy of PPIs for adenoid hypertrophy in children, and these drugs should not be used for this purpose.
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Affiliation(s)
- Farim Rizal Wong Iqbal
- Department of Otorhinolaryngology, Faculty of Medicine, National University of Malaysia, Bandar Tun Razak, Malaysia
| | - Bee See Goh
- Department of Otorhinolaryngology, Faculty of Medicine, National University of Malaysia, Bandar Tun Razak, Malaysia
| | - Ami Mazita
- Department of Otorhinolaryngology, Faculty of Medicine, National University of Malaysia, Bandar Tun Razak, Malaysia
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Aydın E, Aydoğan F, Taştan E, Arslan N, Karaca G. Does helicobacter pylori have a role in the etiology of adenoid hypertrophy? Indian J Otolaryngol Head Neck Surg 2011; 66:65-70. [PMID: 24533361 DOI: 10.1007/s12070-011-0310-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 09/05/2011] [Indexed: 01/04/2023] Open
Abstract
To investigate whether there is any association between nasopharyngeal reflux and adenoid hypertrophy in children by using 24-h pH monitoring with dual probe and to determine whether Helicobacter pylori simply colonises in adenoid tissue or it is present there temporarily due to extraesophageal reflux. A prospective study at a tertiary referral center. Thirty-two patients who underwent adenoidectomy, aged ranged between 4 and 13 were included. All children with adenoid hypertrophy underwent 24-h pH monitoring with a dual probe. Proximal probe was placed in the nasopharynx. The presence of nasopharyngeal reflux and gastroesophageal reflux were investigated by 24-h pH monitoring. The presence of H. pylori was investigated in adenoidectomy samples by HP-fast test. Of the 32 patients who underwent adenoidectomy, 5 had nasopharyngeal reflux positivity while 27 patients did not show nasopharyngeal reflux positivity with pH monitorisation. Helicobacter pylori could not be detected in 5 nasopharyngeal reflux positive children while 3 of 27 nasopharyngeal reflux negative children showed H. pylori positivity, one of them in the mucosa and others in the core. This study demonstrated the high incidence of nasopharyngeal reflux and gastroesophageal reflux in adenoid hypertrophy and the possible colonisation of H. pylori in the adenoid tissue. This may change the assesment of children with adenotonsillar hypertrophy in near future. However, more placebo controlled and double blind studies and larger series are still needed to support this hypothesis.
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Affiliation(s)
- Emine Aydın
- S.B. Ankara Eğitim ve Araştırma Hastanesi 2.KBB Kliniği Ulucanlar Caddesi Altındağ, Ankara, Turkey ; Department of Otolaryngology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Filiz Aydoğan
- Department of Otolaryngology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Eren Taştan
- Department of Otolaryngology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Necmi Arslan
- Department of Otolaryngology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Gökhan Karaca
- Department of General Surgery, Ankara Training and Research Hospital, Ankara, Turkey
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Wasilewska J, Kaczmarski M, Debkowska K. Obstructive hypopnea and gastroesophageal reflux as factors associated with residual obstructive sleep apnea syndrome. Int J Pediatr Otorhinolaryngol 2011; 75:657-63. [PMID: 21377218 DOI: 10.1016/j.ijporl.2011.02.004] [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: 11/22/2010] [Revised: 01/30/2011] [Accepted: 02/02/2011] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The mechanism of persisting obstructive sleep apnea (OSA) after adenotonsillectomy is not fully explained. The purpose of this study was to evaluate factors associated with residual OSA. The primary outcome measures were metabolic tests and polysomnographic respiratory indices in children with residual disease compared with children who were diagnosed with OSA but were untreated. Secondary outcome measures were acid gastroesophageal reflux indices recorded parallel to the sleep study. METHODS In the one-year study consecutive series of patients with sleep disordered breathing hospitalized in a tertiary pediatric center were evaluated. Following the study protocol a sleep interview, physical examination, metabolic blood tests (serum leptin and the homeostasis model assessment index for insulin resistance, HOMA-IR) and an overnight polysomnography with pH-metry recording were performed. Children diagnosed with OSA were analyzed in two groups: I - residual OSA (after surgery), II - non-residual OSA (newly diagnosed). Logistic regression analysis was applied to obtain significant risk factors for prediction of OSA. RESULTS Fifty-seven children (mean age ± SE, 6.9 ± 0.5 years; 66.7% boys) met the inclusion criteria and were enrolled in the study as residual (n=19) or non-residual OSA (n=38). The groups differed significantly in mean oxygen saturation, SpO₂ (94.3% vs. 96.2%; p=0.018 respectively), in the Apnea Hypopnea Index, (20.6/h vs. 9.1/h; p<0.03), the number of respiratory arousals with desaturation (2.2/h vs. 0.8/h; p<0.03); mean intraluminal esophageal pH (5.36 vs. 5.86; p=0.007) and the Reflux Index (9.61% vs. 4.35%; p=0.003). The groups did not differ in total sleep time, tonsil size, BMI z-score and blood metabolic indices. Logistic regression analysis showed that residual OSA was significantly predicted by two polygraphic findings: the obstructive hypopnea index (OR 1.15; 95% CI 1.02-1.28; p=0.014) and by the Reflux Index (OR 1.01; 95% CI 1.00-1.34; p=0.042). CONCLUSIONS 1. Obstructive hypopneas, rather than obstructive apneas, persist after adenotonsillar surgery resulting in residual OSA. 2. Children with residual OSA are at higher risk of acid gastroesophageal reflux and should be evaluated for gastroesophageal reflux disease.
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Affiliation(s)
- Jolanta Wasilewska
- Department of Paediatrics, Gastroenterology and Allergology, Medical University of Bialystok, Waszyngtona Street 17, 15-274 Bialystok, Poland
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Yousef E, Kung SJ, Malloy C. Risk Factors for Adenoidal Regrowth Among Patients in a Pediatric Allergy Practice. ACTA ACUST UNITED AC 2009. [DOI: 10.1089/pai.2009.0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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The impact of extra-esophageal reflux upon diseases of the upper respiratory tract. Curr Opin Otolaryngol Head Neck Surg 2008; 16:242-6. [PMID: 18475079 DOI: 10.1097/moo.0b013e3282fdc3d6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW The present paper examines the recent literature on extra-esophageal reflux and discusses how it affects patient testing and treatment of upper respiratory track inflammatory disease. RECENT FINDINGS Assays for pepsin have been developed casting more insight into the pathophysiology of extra-esophageal reflux as well as looking at the role of protective factors in upper respiratory mucosa. Similarities and differences in esophageal and extra-esophageal reflux continue to be explored. Acid suppression in extra-esophageal reflux improves symptoms before physical findings, but some patients do not respond. Mildly acidic (pH > 4) and alkaline reflux are being examined more in extra-esophageal reflux with impedance testing playing a more prominent role. Recent studies have also focused on whether extra-esophageal reflux could affect tissues of the nasopharynx, sinuses, or middle ear. Caution has been issued as acid suppressive therapies have been associated with hip fracture in older patients. SUMMARY Symptoms caused by reflux may reflect underlying weaknesses in mucosal resilience to acid and pepsin in addition to the variations in exposure to gastric contents. In some patients mildly acidic or alkaline reflux may be important and gastric contents may reach the nasopharynx or middle ear. Carefully designed placebo-controlled trials are needed.
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