The role of adenoids in pediatric rhinosinusitis

Risk factors and management countermeasures for obstructive sleep apnea hypoventilation syndrome in children

BACKGROUND

Obstructive sleep apnea hypoventilation syndrome (OSAHS) in children is a sleep respiratory disorder characterized by a series of pathophysiologic changes. Statistics in recent years have demonstrated an increasing yearly incidence.

AIM

To investigate the risk factors for OSAHS in children and propose appropriate management measures.

METHODS

This study had a case-control study design. Altogether, 85 children with OSAHS comprised the case group, and healthy children of the same age and sex were matched at 1:1 as the control group. Basic information, including age, sex, height, weight and family history, and medical history data of all study participants were collected. Polysomnography was used to detect at least 8 h of nocturnal sleep. All participants were clinically examined for the presence of adenoids, enlarged tonsils, sinusitis, and rhinitis.

RESULTS

The analysis of variance revealed that the case group had a higher proportion of factors such as adenoid grading, tonsil indexing, sinusitis, and rhinitis than the control group.

CONCLUSION

A regression model was established, and glandular pattern grading, tonsil indexing, sinusitis, and pharyngitis were identified as independent risk factors affecting OSAHS development.

Biologic Therapy in Pediatric Chronic Rhinosinusitis: A Systematic Review

OBJECTIVE

Provide clinicians with current evidence for biologic therapy in children with chronic rhinosinusitis with nasal polyposis (CRSwNP).

DATA SOURCES

PubMed, MEDLINE, Cochrane, and clinical trial registries.

REVIEW METHODS

Key search terms related to biologic therapy in pediatric CRSwNP were identified via a structured query of current medical literature and clinical trial databases.

CONCLUSIONS

There is a dearth of active clinical trials and research studies for biologics targeting pediatric CRSwNP. There is an ongoing compassionate-use clinical trial involving Dupilumab for children with nasal polyps as well as only 1 published work specifically focused on Dupilumab for pediatric CRSwNP in the setting of aspirin-exacerbated respiratory disease.

IMPLICATIONS FOR PRACTICE

For children with atopic dermatitis, asthma, and chronic idiopathic urticaria, biologic therapies such as Omalizumab, Dupilumab, and Mepolizumab have gained Food and Drug Administration approval. The role of biologic therapy in pediatric CRSwNP demonstrates significant promise in the comprehensive management of the unified airway. Additional Phase III trials are necessary to broaden clinical indications for children with comorbid conditions and complex sinonasal disease.

The role of adenoid immune phenotype in polysensitized children with allergic rhinitis and adenoid hypertrophy

BACKGROUND

There is increasing interest in elucidating the relationship between adenoid hypertrophy (AH) and allergic rhinitis (AR). However, the impact of aeroallergen sensitization patterns on children with AH and AR remains unclear.

METHODS

Patients aged 2-8 years (recruited from January 2019 to December 2022) with nasal symptoms were assessed for allergies, adenoid size, and respiratory viral infection history. The serum total immunoglobulin E (IgE) and specific IgE levels were measured, and flexible nasal endoscopy was performed. The relationship between AH, aeroallergen sensitization patterns, and lymphocyte subpopulations in adenoid samples was analyzed using flow cytometry.

RESULTS

In total, 5281 children were enrolled (56.5% with AR; and 48.6% with AH). AH was more prevalent in children with AR. Compared to nonsensitized individuals, those polysensitized to molds had a higher prevalence of AH (adjusted OR 1.61, 95% CI 1.32-1.96) and a greater occurrence of two or more respiratory viral infections, particularly in adenoidectomy patients. The percentages and corrected absolute counts of regulatory T (Treg) cells, activated Tregs, class-switched memory B cells (CSMBs), natural killer (NK) T cells, and NK cell subpopulations were reduced in the adenoid tissues of children with both AH and AR (AH-AR) compared to AH-nAR children. Polysensitization in AH-AR children correlated with lower CSMB percentages.

CONCLUSION

Polysensitivity to molds is associated with an increased risk of AH in children with AR. Fewer B cells, NK cells, and Treg cells with an effector/memory phenotype were detected in the adenoids of AR children, and these lower percentages of immune cells, particularly CSMBs, were closely linked to aeroallergen sensitization models and respiratory viral infection.

[Pediatric chronic rhinosinusitis]

Pediatric chronic rhinosinusitis (PCRS) differs from adult chronic rhinosinusitis (CRS) in several aspects. The confrontation with the environment takes place in the growing sinus system, and the immune system is also developing. The inflammatory mechanisms differ to some extent from those of adult CRS patients. The adenoid vegetations play an important role, particularly during the first 6 years of life. Other pathogenetic aspects are important (e.g., asthma, gastroesophageal reflux disease, immunodeficiency). Genetically determined systemic diseases such as cystic fibrosis cause specific challenges in diagnostics and treatment already in childhood. Consistent conservative therapy is often successful, but surgical procedures that have been proven to be effective and associated with few complications are also increasingly used.

An assessment of the effects of adenoid hypertrophy on mucociliary clearance and nasal cytology in children

AIM/OBJECTIVE

The aim of this study was to demonstrate the benefits of the systematic use of nasal cytology and mucociliary clearance in the diagnostic workup of nasal disorders in children with adenoid hypertrophy (AH) to reach a well-defined diagnosis, establish a rational therapeutic approach, avert from complications, and develop the patient's life quality.

MATERIALS/METHODS

In this prospective study, a total of 61 pediatric patients (aged 5-12 years) were evaluated. The case group consisted of 31 children with AH symptoms, while the control group comprised 30 children without AH symptoms.Exclusions included previous adenoidectomy/adenotonsillectomy, cardiovascular/neurological diseases, acute/allergic rhinitis, genetic disorders (e.g., Down syndrome), and immunodeficiency. The control group consisted of children without nasal obstruction symptoms and without AH, who admitted for various reasons. Medical history, examinations, fiberoptic nasopharyngoscopy, cephalometric evaluations, AST, and nasal cytology were conducted.

RESULTS

At the end of the study, a significant increase in the mucociliary clearance time was observed in the group with AH compared to the control group (p < 0.05). Although AH may disrupt MCC, there is no correlation between the size of the hypertrophy and MCC time.When the distribution of cells in the nasal cytology is evaluated, no difference was detected between the AH group and control groups.

CONCLUSION

Nasal mucociliary clearance has been found to be decreased, particularly in the presence of significant AH.

Adenoid Morphology and Other Prognostic Factors for Otitis Media with Effusion in School Children

Introduction

This study aimed to compare the children having enlarged adenoids with and without otitis media with effusion (OME) concerning clinical features like mouth breathing, snoring, recurrent episodes of cold, hearing impairment and specific morphology of adenoid. Further, the flora of adenoid tissue and middle ear fluid were also compared.

Methods

One hundred and twenty children having clinical features suggestive of enlarged adenoids with [Group A (n = 60)] or without [Group B (n = 60)] OME were included in this cross-sectional study. All patients underwent clinical examination, diagnostic nasal endoscopy, radiography of the nasopharynx, blood absolute eosinophil count and immittance. Core adenoid tissue was subjected to microbiological culture after adenoidectomy. OME fluid was subjected to microbial analysis after myringotomy.

Results

In group A patients, snoring was present in 90% (p = 0.011), adenoid facies in 76.6% (p < 0.001) and tubal tonsil enlargement in 86.7% (p < 0.001). The parts related to the development of OME were: behind the posterior cushion in 86%, touching the posterior end of septum in 76.7%, inside nasal cavity in 70% and completely covering the Eustachian tube orifices in 95% (p < 0.001 in all of them).

Conclusion

Specific morphology of adenoid enlargement and tubal tonsil enlargement was more critical in predicting the risk of developing OME and not just the grade of adenoid hypertrophy. The microbial flora in the adenoid core was similar in children with and without OME.

Risk factors and antibiotic sensitivity of aerobic bacteria in Chinese children with adenoid hypertrophy

BACKGROUND

Bacterial infection of adenoid is currently considered to be an important cause of adenoid hypertrophy (AH) in children. Although several bacteriology studies on adenoid diseases have been reported, the aerobic bacterial study regarding risk factors and antibiotic sensitivity of AH in Chinese children is lacking. This study aims to investigate the risk factors for aerobic bacterial colonization of AH in Chinese children and to elucidate aerobic bacterial profiles and antibiotic sensitivity.

METHODS

Samples were collected from the adenoid core and surface tissue of 466 children undergoing adenoidectomy. Aerobic cultures and antibiotic sensitivity were observed. The risk factors for bacterial colonization of adenoid were analyzed statistically.

RESULTS

A total of 143 children could be detected opportunistic pathogens in adenoid surface and/or core tissue, with a carriage rate of 30.7%. The presence of chronic rhinosinusitis, tonsillar hypertrophy and adenoidal size were the risk factors for aerobic bacterial colonization of adenoid in univariate analysis. Multivariate analysis showed that chronic rhinosinusitis and tonsil hypertrophy were significant variables associated with the aerobic bacterial colonization. The most frequently isolated aerobic bacteria were Haemophilus influenzae, followed by Staphylococcus aureus and Streptococcus pneumoniae. There was no statistically significant difference in bacterial species between the adenoid surface and core. The above common bacteria were more sensitive to cephalosporins and quinolones antibiotics, and significantly resistant to penicillin antibiotics and non-β-lactamase inhibitors.

CONCLUSION

Our results provide recent aerobic bacterial profiles for AH among Chinese children and confirm the risk factors and antibiotic sensitivity. This study contributes to understanding the role of different risk factors in the development of AH and will be helpful to the treatment of AH among Chinese children.

Chronic and Recurrent Sinusitis in Children, as Manifestation of Immune Dysfunction and Atopic Background

Rhinosinusitis in children, as in adults, can be classified by duration (acute, recurrent, and chronic) and by cause (viral, bacterial, and inflammatory) and needs to be treated accordingly after careful investigation which include through clinical history, laboratory tests, and, if necessary, nasal endoscopy and imaging studies.

Knowledge and Awareness Among Parents of Pediatric Patients Regarding the Complications of Recurrent Adenotonsillitis and Its Surgical Treatment

Background Given that parents act as both decision-makers and caregivers for their children, focusing on their experiences in managing their child's complex postoperative recovery is important. Objective To evaluate the parents' awareness regarding adenotonsillar diseases and post-adenotonsillectomy complications in their children. Methods This was a cross-sectional descriptive study involving parents and guardians of pediatric patients aged 1-14 years scheduled to undergo adenotonsillectomy according to Paradise Criteria at Ohud Hospital, Al Madinah. A well-constructed, self-administered questionnaire, including questions regarding sociodemographic characteristics and those assessing the knowledge of parents/guardians regarding adenotonsillar diseases and post-adenotonsillectomy complications, was distributed to all participants. Results This study included 294 parents (mean ± standard deviation of age, 33.0 ± 6.9 years; range, 18 and 55 years), more than half of whom were males (153, 52%). Overall, 127 parents (43.2%) had a poor level of knowledge regarding the complications of recurrent adenotonsillitis and its surgical treatment. University/postgraduate parents were more knowledgeable than lower educated parents (p < 0.001). Participants with a family history of recurrent adenotonsillectomy were more knowledgeable than those who had no such history (p < 0.001 ). Conclusion The parents/guardians of children scheduled to undergo adenotonsillectomy had insufficient knowledge regarding the complications of recurrent adenotonsillitis and its surgical treatment, necessitating health education among such a demographic.

Nasal Polyps in Children: The Early Origins of a Challenging Adulthood Condition

Nasal polyps (NPs) are benign inflammatory masses causing chronic nasal obstruction, usually associated with underlying chronic rhinosinusitis (CRS), which are rarely reported in childhood. The interest in NPs has recently increased due to new therapeutic options, namely biological agents, such as dupilumab, and an update of the European position paper on this topic was released in 2020, providing a detailed classification for these lesions and also discussing diagnostic and therapeutic approaches also in children. In childhood, NPs usually represent red flags for systemic diseases, such as cystic fibrosis and immunodeficiencies. This review outlines the recent data on NPs in childhood, focusing on predisposing factors for CRS as well as on the potential endotypes in this particular age group, for which further studies are required in order to better clarify their pathogenesis and to identify molecular biomarkers that could help achieve more personalized treatments.

Association between adenoid bacteriology and clinical characteristics of adenoid-related diseases in children

Introduction:

The aim of this research is to find the association between the pathogenic bacteria obtained from the adenoid culture and clinical characteristics of adenoid-related diseases in children.

Methods:

In this retrospective study, we reviewed the medical records of children who had adenoidectomy for adenoid-related diseases. Demographic data, diagnoses, indications for adenoidectomy and bacterial culture results were collected. The adenoid size was measured in the lateral skull X-ray as adenoid–nasopharyngeal ratio. Associations between the culture results and the demographic data, adenoid size, and the diagnoses were analyzed.

Results:

There were 407 children who had adenoidectomy for obstructive sleep-disordered breathing (75.2%), otitis media with effusion (19.2%), and chronic sinusitis (5.6%). Median age was 5.9 years. Common pathogenic bacteria in the adenoid were Haemophilus influenzae (26.2%), Staphylococcus aureus (23.5%), Streptococcus pneumoniae (18.2%), and Moraxella catarrhalis (12%). The patient’s age had significant association with the prevalence of pathogenic bacteria. S. pneumoniae was most prevalent in young children up to 7 years. S. aureus was more common in children over 7 years. H. influenzae had similar prevalence in all age groups. Size of the adenoid and type of adenoid-related diseases had no association with the outcome of bacterial culture.

Conclusion:

Age of the patients was the significant factor associated with the bacteriological findings of the adenoid while size and types of adenoid-related diseases were not associated with the outcome of bacterial culture.

Efficacy and safety of paranasal sinus balloon catheter dilation in pediatric chronic rhinosinusitis: a systematic review

Objective

Chronic rhinosinusitis (CRS) negatively affects quality of life (QoL), and balloon catheter sinuplasty (BCS) has shown good outcomes in adult patients. However, there has not been much research on the effects of BCS on pediatric patients. The objective of this review is to systematically assess the literature for studies demonstrating the effectiveness and safety of BCS in pediatric CRS patients.

Data sources

PubMed, Embase and Cochrane Library.

Study selection

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations (PRISMA) to conduct our study. Observational- and interventional-based studies reporting efficacy and/or side effects of BCS among pediatric populations were included. Efficacy was evaluated by clinically reliable measures including Sino-Nasal 5 (SN-5) QoL scale. Antibiotic usage and revision surgery were also evaluated.

Data extraction

Articles were screened, and data were obtained. Study design, sample size and demographics, treated sinuses, criteria of inclusion, adjunct procedure(s), follow-up time, and outcomes measured were reported.

Main findings

Out of 112 articles identified, 10 articles were included: two interventional controlled trials and eight observational studies. All studies evaluating QoL by SN-5 showed a remarkable reduction in SN-5 score postoperatively. Improvement in the computed tomography (CT) and endoscopic findings for up to 1 year after operation was reported. Furthermore, the majority of patinets treated with BCS did not recieve any course of sinusitis-indicated antibiotics during long-term follow-up, and they had low surgical revision rates. Minor side effects were reported, most commonly synechia.

Conclusion

Available evidence suggests that BCS is safe and effective for the treatment of CRS in pediatric patients. Future randomized controlled studies with large sample size are warranted. Such studies can further determine the efficacy of BCS in managing children with CRS.

Low-dose macrolides for treating pediatric rhinosinusitis: A retrospective study and literature review

The effects of low-dose macrolide (LDM) therapy on pediatric chronic rhinosinusitis (CRS) patients are unknown. This study aimed to assess the effectiveness of LDM for treating pediatric refractory CRS. A retrospective study was conducted by a medical chart review. Pediatric CRS patients (age <15 years) who received LDM after standard medical treatments failure between 2013 and 2019 were identified. The LDM treatments with any macrolide agents, doses, and regimens were included. Any co-interventions were allowed. Duration of the LDM therapy was ≥6 weeks. Outcomes were the total nasal symptoms by the visual analogue scale (TNS), presence of individual symptoms, physician-assessment nasal discharge and adverse events. Six patients (67% male, mean age 7±3.4 years) were assessed. All patients had failed to intranasal steroids and nasal saline irrigation but continued. The addition of LDM significantly improved TNS (mean difference ± standard deviation 5.83 ± 1.33; 95% confidence interval 4.44-7.23, p< 0.001). At the end of treatment, the numbers of patients with individual symptoms were decreased: nasal obstruction (100%-67%), rhinorrhea (83%-50%), hyposmia (50%-0%), cough (100%-33%), and physician-assessment thick mucoid discharge (33%-0%). No patients had facial pain. One patient reported mild tolerable nausea. Preliminary findings of this study showed some beneficial effects of LDM added to intranasal steroids and nasal saline irrigation in pediatric CRS after standard treatments failure. The beneficial effects included the improvements of the TNS and individual nasal symptoms and decrease in thick mucoid discharge.

The microbiome of pediatric patients with chronic rhinosinusitis

BACKGROUND

This study aimed to compare the microbiota of pediatric patients with chronic rhinosinusitis (CRS) who are undergoing adenoidectomy to treat their disease with that of healthy control patients.

METHODS

Patients undergoing adenoidectomy-only for obstructive sleep apnea (n = 50) and CRS (n = 37) were recruited. Preoperative 22-item Sino-Nasal Outcome Test (SNOT-22) or Sinus and Nasal Quality of Life Survey (SN-5) were collected. Each patient had samples collected from their nasopharynx (adenoid bed) and nasal cavity (sinus) at the onset of surgery. 16S ribosomal ribonucleic acid (rRNA) gene sequencing was subsequently performed to obtain per sample taxonomic abundances. Statistical analyses included permutational multivariate analysis of variance (PERMANOVA), alpha (within sample) diversity measures, and changes in taxonomic abundance.

RESULTS

Moraxella was the most abundant organism. Nasopharyngeal swabs demonstrated higher alpha diversity compared to the nasal cavity. The diversity was not different based on CRS vs obstructive history. There was an increase in diversity with increasing age, and eczema contributed to a greater difference in diversity between the nasopharynx and nasal cavity. Diversity was not affected by adenoid size; however, use of nasal steroids, inhaled steroids, and antihistamines influenced diversity in both the nasopharynx and nasal cavity. Nasopharyngeal samples were higher in relative abundance for Fusobacterium, Prevotella, Porphyromonas, and Campylobacter compared to the nasal cavity.

CONCLUSION

The nasopharynx and nasal cavity differed in both microbiota composition and diversity. In contrast, no significant difference in composition or diversity were found in CRS vs control patients. Ecological changes in the nasopharyngeal and sinus site may contribute to the etiology for adenoid hypertrophy in both healthy controls and CRS patients.

Pediatric Versus Adult Chronic Rhinosinusitis

PURPOSE OF REVIEW

Pediatric and adult chronic rhinosinusitis (CRS) have some similarities but a number of differences. This article reviews the similarities and differences between pediatric and adult CRS.

RECENT FINDINGS

Rhinosinusitis is an inflammatory disease of the nose and the paranasal sinuses. In adults, inflammation in CRS without polyps (CRSsNP) mainly manifests with T-helper 1 lymphocytes while in CRS with polyps (CRSwNP) manifests with T-helper 2 lymphocytes and eosinophilic inflammation. In children, CRS inflammation manifests with neutrophils, macrophages, and lymphocytes. The associations between the ostiomeatal complex occlusion and CRS are revealed in adults but are not so evident in children. Although the relationship between the CRS and allergic rhinitis is still controversial, recent findings have shown an association between allergen sensitization and a specific group of adults with rhinosinusitis. Intranasal corticosteroids and saline constitute the first-line of medical treatment for both pediatric and adult rhinosinusitis. Low-dose macrolides are used for immunomodulatory activities and beneficial effects to adult patients with CRSsNP were demonstrated by recent meta-analyses. For surgical treatment, adenoidectomy is a key strategy to eradicate mature biofilms in pediatric CRS and effective in treating children with CRS regardless of the adenoid size. Although endoscopic sinus surgery has been proven to improve quality of life outcomes in adult CRS, it should be only considered in the pediatric CRS after failure of adenoidectomy. Pediatric and adult CRS are different in many aspects, including immunopathogenesis and management. Investigations should be considered in specific cases. After failure of medical treatments, endoscopic sinus surgery is recommended for adults, while adenoidectomy is primarily considered for children.

Correlation Between Microbiological Profiles of Adenoid Tissue and Nasal Discharge in Children with Co-existent Chronic Adenoiditis and Chronic Rhinosinusitis

Chronic adenoiditis leading to adenoid hypertrophy is common in children. Many cases would also have co-existing chronic rhinosinusitis (CRS). Infact, long lasting bacterial infection of the adenoids has been hypothesized to be the cause for CRS in these children. A cross-sectional study was conducted in the departments of ENT and Micro-biology at Kasturba Hospital, Manipal, India between 2016 and 2017. 20 subjects who were diagnosed with CRS and adenoid hypertrophy took part in the study. Aerobic, anaerobic and fungal culture sensitivity of adenoid tissue was done along with aerobic and fungal culture sensitivity of nasal swabs from middle meatus. 2 out of 20 adenoid samples showed positive culture for aerobes and 19 adenoid samples grew anaerobic organisms. 7 out of 20 nasal swabs grew some aerobes and 2 were positive for fungal organisms. The correlation of microorganisms between adenoid hypertrophy and CRS was seen only in one patient in which methicillin resistant Staphylococcus aureus was grown. The present study showed mixed flora in the adenoid samples with anaerobic predominance. Aerobes were predominantly grown in nasal swabs from patients with CRS along with fungal colonizers. Though the study does not establish any bacteriological association with the CRS in our cohorts, the significant growth of the anaerobes from the core of the inflamed adenoids has prompted us to suggest the inclusion of the antibiotics against the anaerobes in the medical management of these children, whenever feasible. We think the addition of specific antibiotics to tackle anaerobes helps by hampering the further inflammatory hypertrophy of adenoid tissue.

Ciliary beat frequency in children with adenoid hypertrophy

BACKGROUND

Children with adenoid hypertrophy (AH) have impaired respiratory system defense mechanisms, such as mucociliary clearance. We hypothesized that AH negatively affects one of the most important aspects of mucociliary clearance-ciliary beat frequency (CBF) and that adenoidectomy could potentially restore this essential defence mechanism of the airways. This study evaluated the influence of AH and endoscopic adenoidectomy on the CBF of the nasal respiratory epithelium in children.

METHODS

This prospective study included 64 children with confirmed AH aged 3 to 18 years and 43 age- and sex-matched healthy controls. Nasal CBF was analyzed using a digital high-speed video microscope and the software application Ciliary Analysis (NI LabVIEW). The preoperative adenoid size was assessed according to Cassano. Clinical symptoms of chronic rhinosinusitis were evaluated using the SNOT-20 questionnaire.

RESULTS

Children with AH had a median CBF of 5.35 ± 1.06 Hz. Six months after surgery, the median CBF was significantly higher (6.48 ± 0.88 Hz; P < .001) and reached the values of healthy children (6.37 ± 0.71 Hz; P = .512). The size of the adenoid tissue did not correlate with the CBF. No influence of age or gender on the CBF was found. After adenoidectomy, a significant reduction of the mean total SNOT-20 score was recorded (P < .01).

CONCLUSION

Children with clinically symptomatic AH have impaired mucociliary clearance due to decreased nasal CBF. Removal of hypertrophic adenoid tissue normalizes the CBF and reduces the presence of clinical symptoms of rhinosinusitis.

Adenoidal Disease and Chronic Rhinosinusitis in Children-Is there a Link?

Adenoid hypertrophy (AH) is an extremely common condition in the pediatric and adolescent populations that can lead to various medical conditions, including acute rhinosusitis, with a percentage of these progressing to chronic rhinosinusitis (CRS). The relationship between AH and pediatric CRS has been extensively studied over the past few years and clinical consensus on the treatment has now been reached, allowing this treatment to become the preferred clinical practice. The purpose of this study is to review existing literature and data on the relationship between AH and CRS and the options for treatment. A systematic literature review was performed using a search line for "(Adenoiditis or Adenoid Hypertrophy) and Sinusitis and (Pediatric or Children)". At the end of the evaluation, 36 complete texts were analyzed, 17 of which were considered eligible for the final study, dating from 1997 to 2018. The total population of children assessed in the various studies was of 2371. The studies were categorized as surgical-observational, microbiological, genetic-immunological, and radiological. The analysis of the studies confirms the relationship between AH and CRS and supports the existing consensus on medical and surgical therapy. Furthermore, these studies underline the necessity to adapt medical and surgical treatment considering age, comorbidities including asthma and, if present, the Computed Tomography (CT) score.

The Role of the Adenoids in Pediatric Chronic Rhinosinusitis

There are several mechanisms by which the adenoids contribute to pediatric chronic rhinosinusitis (PCRS), particularly with children aged 12 years and younger. Understanding the role that the adenoids play in PCRS is crucial when attempting to treat these patients. A literature review was performed to address this problem and provide information surrounding this topic. This review will provide a better understanding of how adenoids contribute to PCRS, and also of the medical and surgical treatment options.

Clinical Guidelines on Chronic Rhinosinusitis in Children

PURPOSE OF REVIEW

Pediatric chronic rhinosinusitis (CRS) is a prevalent problem that can elude diagnosis. In addition, given the burgeoning interest in pediatric sinonasal disease, treatment modalities are constantly evolving.

RECENT FINDINGS

The diagnosis of pediatric CRS is primarily based on clinical history and signs supported by objective findings (i.e., nasal endoscopy and/or computed tomography (CT) imaging). Cultures are indicated in patients who have not responded to medical therapy or have significant comorbidities. Nasal saline irrigation, nasal saline spray, and oral antibiotics are currently recommended for initial medical management. In children with CRS who have failed medical therapy, a stepwise approach to surgical intervention can lead to significant improvements in quality of life. This review provides an overview of the current guidelines and recent literature regarding the diagnosis, microbiology, and treatment options of CRS in the pediatric population.

Risk factors associated with obstructive sleep apnea-hypopnea syndrome in Chinese children: A single center retrospective case-control study

Pediatric obstructive sleep apnea-hypopnea syndrome is caused by multiple factors. The present study aimed to investigate the potential risks of pediatric obstructive sleep apnea hypopnea syndrome (OSAHS) and their correlation with the disease severity. A total of 338 pediatric patients with OSAHS (polysomnography (PSG) diagnosis) were enrolled between June 2008 and October 2010. These pediatric patients were divided into mild, moderate and severe subgroups according to the obstructive apnea index (OAI) and/or apnea hypoventilation index (AHI). A total of 338 pediatric patients with vocal nodules who were without obstruction of the upper respiratory tract were enrolled as the control group. The patients were analyzed retrospectively. The average number of upper respiratory tract infections each year and tonsil hypertrophy, adenoid hypertrophy, positive serum tIgE, chronic sinusitis, nasal stenosis, craniofacial features and obesity were significantly higher in OSAHS compared with controls (P<0.01). The parameters the average number of upper respiratory tract infections each year (OR: 1.395, 95% CI: 1.256–1.550), adenoid hypertrophy (OR: 8.632, 95% CI: 3.990–18.672), tonsil hypertrophy (OR: 9.138, 95% CI: 4.621–18.073), nasal stenosis (8.023, 95% CI: 3.633–17.717) and chronic sinusitis (OR: 27.186, 95% CI: 13.310–55.527) were independent factors of pediatric OSAHS (P<0.01). The distribution of chronic sinusitis, nasal stenosis, craniofacial features and obesity indicated a gradual increasing trend in the severity of OSAHS (P<0.01). Number of upper respiratory tract infections per year, adenoid hypertrophy, tonsil hypertrophy, chronic sinusitis, nasal stenosis, infections, allergic reactions, craniofacial features and obesity may be potential risk factors of pediatric OSAHS.

Sinus and Upper Airway Surgery in Children

PURPOSE OF REVIEW

Chronic sinus and upper airway disease in children is a common health problem encountered every day. Its pathophysiology is complicated which leads to different treatment options and approaches. We seek to review the current literature and evidence to surgical treatments.

RECENT FINDINGS

Medical treatment with antibiotics and topical nasal sprays continues to be the first-line treatment. Surgical interventions include adenoidectomy, balloon catheter sinuplasty (BCS), and endoscopic sinus surgery (ESS). Each modality has proven to be safe; however, its effectiveness is widely variable. More research with higher level of evidence is needed to help in choosing the right surgical treatment with optimal benefit.

Adenoidectomy May Not Be Effective to Reduce the Number of Hospital Visits for Sinusitis

BACKGROUND

The objective of this study was to compare post-operative (post-op) visits for sinusitis between adenoidectomy and non-adenoidectomy participants (control).

METHODS

Using the national cohort study from the Korean Health Insurance Review and Assessment Service, we used 1:4 matching to select 2,593 adenoidectomy participants and 10,372 control participants. Post-op visits for sinusitis were measured from post-op 1 year through post-op 9 years. Equivalence testing was used. Margin of equivalence of difference was set as -0.5 to 0.5 in this study.

RESULTS

There were trivial differences between the two groups from post-op 1 to 2 years. However, there was no difference between the two groups from post-op 3 through 9 years. Visits for sinusitis gradually decreased in both groups. In the rare and frequent pre-operative sinusitis group, there were minor differences in both groups from post-op 1 to 2 years. In contrast, there were no differences between the two groups in rare and frequent pre-operative sinusitis groups from post-op 3 through 9 years. In the 0-4 years old group, there were minor differences between both groups from post-op 1 to 2 years. However, no differences in the number of visits for sinusitis were found between the two groups during follow up periods from post-op 3 through 9 years. Additionally, there were no differences between the two groups during the entire follow up period.

CONCLUSION

Adenoidectomy does not reduce post-op visits for sinusitis. Sinusitis decreased over time whether adenoidectomy was performed or not.

Adenoidectomy in Children: What Is the Evidence and What Is its Role?

Purpose of Review

Review the current state of the adenoidectomy procedure in the pediatric population with up-to-date indications for surgery, operative techniques, adverse events, non-surgical management of adenoid hypertrophy, and future directions.

Recent Findings

Adenoidectomy is indicated in children for the treatment of sleep-disordered breathing, nasal airway obstruction, recurrent acute otitis media, and chronic rhinosinusitis. A new recommendation was released in 2016, not supporting adenoidectomy for a primary indication of otitis media in children under 4 years old, including those with prior tympanostomy tubes, unless a distinct indication exists such as nasal obstruction or chronic adenoiditis. Although adenotonsillectomy is the mainstay of treatment for obstructive sleep apnea (OSA), recent studies have identified that non-obese patients with moderate OSA and small tonsils have comparable benefits with adenoidectomy alone with less complications. While conventional approaches such as indirect mirror-assisted curette and suction coagulation are still utilized, direct transnasal endoscope-assisted removal of the adenoids has proven to be a safe technique, with good short- and long-term outcomes. Novel non-surgical therapies including immunotherapy have been evaluated.

Summary

Adenoidectomy is a safe procedure in the pediatric population and leads to excellent outcomes. Adverse events are rare, and hospitalization is uncommon. Children with sleep disturbance from nasal airway obstruction, ear disease, or chronic rhinosinusitis are the best operative candidates for this procedure.

Post-adenoidectomy quality of life in children with refractory chronic rhinosinusitis

Objective:

This study aimed to evaluate post-adenoidectomy quality of life in children with refractory chronic rhinosinusitis.

Methods:

A prospective interventional study of children aged 4–12 years with chronic refractory rhinosinusitis was conducted. A total of 60 children completed follow up. Nasal endoscopy and non-contrast computed tomography of the paranasal sinuses were performed, and both symptoms and their effects on patient quality of life pre- and post-adenoidectomy were evaluated.

Results:

The most frequent symptoms were nasal obstruction, cough, fever and fatigue, which were experienced by 100 per cent, 90 per cent, 85 per cent and 81.7 per cent of children, respectively. Nasal endoscopy showed oedema and discharge were present in all children. A statistically significant post-operative improvement in sinus and nasal quality of life was seen in 53 children (88.3 per cent).

Conclusion:

Adenoidectomy is a simple, first-line surgical procedure for managing paediatric chronic rhinosinusitis refractory to maximal medical therapy and leads to an improved quality of life.

The effects of choanal atresia on development of the paranasal sinuses and turbinates

PURPOSE

The objective of this study was to evaluate the volume of paranasal sinuses (PNS) and turbinate in patients with unilateral choanal atresia (CA).

MATERIALS AND METHOD

Computed tomography images of PNS in 11 individuals with unilateral CA were evaluated retrospectively. Mucosal thickness and volume of the maxillary, frontal and sphenoidal sinuses were determined, in addition to the volume of the middle and inferior turbinate. The unaffected nasal side of patients was used as a control group for the measurements. The results comprised the measurements of the atresic side compared to those of the healthy side.

RESULTS

There was no significant difference between the atresic and healthy side of the nose in patients with CA with respect to mucosal thickness and volume of the PNS (the maxillary, frontal and sphenoidal sinuses) and the middle and inferior turbinate (p > 0.050).

CONCLUSION

The complete absence of nasal unilateral airflow had no effect on the development of the PNS and the middle and inferior turbinate. Moreover, mucosal thickness in the sinuses was similar to that in the control group.

Expression of Innate Immunity Genes in Epithelial Cells of Hypertrophic Adenoids with and without Pediatric Chronic Rhinosinusitis: A Preliminary Report

BACKGROUND

Adenoid hypertrophy (AH) is associated with pediatric chronic rhinosinusitis (pCRS), but its role in the inflammatory process of pCRS is unclear. It is thought that innate immunity gene expression is disrupted in the epithelium of patients with chronic rhinosinusitis (CRS), including antimicrobial peptides and pattern recognition receptors (PRRs). The aim of this preliminary study was to detect the expression of innate immunity genes in epithelial cells of hypertrophic adenoids with and without pCRS to better understand their role in pCRS.

METHODS

Nine pCRS patients and nine simple AH patients undergoing adenoidectomy were recruited for the study. Adenoidal epithelium was isolated, and real-time quantitative polymerase chain reaction (RT-qPCR) was employed to measure relative expression levels of the following messenger RNAs in hypertrophic adenoid epithelial cells of pediatric patients with and without CRS: Human β-defensin (HBD) 2 and 3, surfactant protein (SP)-A and D, toll-like receptors 1-10, nucleotide-binding oligomerization domain (NOD)-like receptors NOD 1, NOD 2, and NACHT, LRR and PYD domains-containing protein 3, retinoic acid-induced gene 1, melanoma differentiation-associated gene 5, and nuclear factor-κB (NF-κB). RT-qPCR data from two groups were analyzed by independent sample t-tests and Mann-Whitney U-tests.

RESULTS

The relative expression of SP-D in adenoidal epithelium of pCRS group was significantly lower than that in AH group (pCRS 0.73 ± 0.10 vs. AH 1.21 ± 0.15; P = 0.0173, t = 2.654). The relative expression levels of all tested PRRs and NF-κB, as well as HBD-2, HBD-3, and SP-A, showed no statistically significant differences in isolated adenoidal epithelium between pCRS group and AH group.

CONCLUSIONS

Down-regulated SP-D levels in adenoidal epithelium may contribute to the development of pCRS. PRRs, however, are unlikely to play a significant role in the inflammatory process of pCRS.

ACE grading-A proposed endoscopic grading system for adenoids and its clinical correlation

OBJECTIVES

To propose a novel endoscopic adenoid grading system using a rigid nasal endoscope and to study its correlation with the clinical diagnosis.

METHODOLOGY

Prerecorded video clips of rigid nasal endoscopy taken during endoscopic adenoidectomy were retrieved. Otolaryngology consultants blinded to the clinical diagnosis of the child were presented these videos and asked to grade the adenoid hypertrophy as per the proposed endoscopic ACE (Airway/Choana/Eustachian tube) grading system. The clinical diagnosis was correlated with the different aspects of the descriptive endoscopic grading system.

RESULTS

152 video clips were presented to the otolaryngology consultants for grading. The average age was 8.6 years (SD-3.48), while the male female ratio was 3:2. The A subcomponent of the ACE grading showed significant correlation with the diagnosis of sleep disordered breathing and chronic adenotonsillitis, C subcomponent with sleep disordered breathing and the E subcomponent with the diagnosis of otitis media.

CONCLUSION

The proposed endoscopic grading is easily applicable and at the same time clearly describes the relation of the adenoids to the nasopharynx, choana and Eustachian tube. Different aspects of the grading system correlated differently with the clinical diagnosis emphasizing that a descriptive scoring rather than a comprehensive scoring is a more relevant clinical tool.

Pediatric Severe Chronic Upper Airway Disease (P-SCUAD)

The term SCUAD (severe chronic upper airway disease) has been previously introduced to describe cases with upper airway disorders and symptoms not adequately controlled despite correct diagnosis and management. It has been so far applied mainly in adults and no specific focus has been given on the pediatric population. When the term SCUAD is considered for children specifically, a series of issues may arise. These issues involve accurate definition, epidemiology, clinical characteristics, pathophysiology, and socioeconomic implications. These issues seem to clearly differentiate adult from pediatric SCUAD. We attempt to shed light on these issues in an effort to provide directions for future guideline development and research. In this context, P-SCUAD (pediatric severe chronic upper airway disease) is hereby introduced.

Severe Chronic Upper Airway Disease (SCUAD) in children. Definition issues and requirements

OBJECTIVES

Upper airway diseases are extremely common, and a significant proportion of patients are not adequately controlled by contemporary treatment algorithms. The term SCUAD (Severe Chronic Upper Airway Disease) has been previously introduced to describe such cases. However, this term has not been adequately focused on children.

METHODS

This study aims to address the necessity of the term, as well as further details specifically for children. For this purpose, a review was performed of the current literature, with specific focus on issues regarding SCUAD in children.

RESULTS

Paediatric SCUAD represents a heterogeneous group of patients and has significant clinical and socioeconomic implications. Relevant literature is generally lacking and questions regarding definition and pathogenesis remain unanswered.

CONCLUSIONS

Accurate definition and acknowledgement of paediatric SCUAD cases may lead to better design of future clinical and molecular research protocols. This may provide improved understanding of the underlying disease processes, more accurate data regarding socioeconomic burden, and, above all, more successful treatment and prevention strategies.

Improvement in Allergic and Nonallergic Rhinitis: A Secondary benefit of Adenoidectomy in Children

Chronic rhinitis (CR) is a common disorder in children. Allergic rhinitis (AR) is a risk factor for CR, and children with AR tend to suffer more from hypertrophic adenoids than do patients with nonallergic rhinitis (NAR). Few studies have addressed the issue of alleviating symptoms of pediatric CR or AR following adenoidectomy alone. We conducted a retrospective chart review to determine whether CR in children improves after adenoidectomy and whether children with AR will benefit more than those with NAR. Charts of 47 children who had undergone adenoidectomy for nasal obstruction and chronic middle ear effusion were reviewed. AR and NAR subgroups were classified based on symptoms, signs, blood IgE, and nasal smear (allergic criteria). Hypertrophic adenoids were graded using the adenoid-to-nasopharyngeal ratio (ANr >0.8). A questionnaire was used to assess the change in chronic rhinitis postoperatively. Improvement in CR was reported in 37 of 47 (79%) children. Patients with AR improved to a higher extent than those with NAR (12 of 14 [86%] vs. 25 of 33 [76%], respectively), but the difference was not statistically significant. A total of 41 lateral postoperative nasopharyngeal x-rays were obtained. The x-rays revealed that 20 of 26 (77%) of patients with ANr >0.8 had complete and 4 of 26 (15%) had partial resolution of symptoms of CR for a total resolution rate of 92%, compared to only a 53% resolution in the ANr <0.8 subgroup (6 of 15 and 2 of 15 patients, respectively [p < 0.05]). The correlation between adenoid size and resolution of CR was not related to any of the AR/NAR subgroups. We conclude that symptoms of CR may improve after adenoidectomy in children who are experiencing nasal obstruction and chronic otitis media with effusion. Clinical improvement did not differ between AR and NAR patients, and was more prominent in children with hypertrophic adenoids (ANr > 0.8).

Relative etiological importance of adenoid hypertrophy versus sinusitis in children with persistent rhinorrhoea

Persistent rhinorrhoea is a common, yet often neglected, problem among Indian children. This study was designed to evaluate the relative etiological importance of adenoid hypertrophy versus sinusitis in children with persistent rhinorrhea. Additionally, the association between S. pneumoniae colonization and adenoid hypertrophy was studied. Children aged 1-14 years with persistent rhinorrhea underwent clinical evaluation, rigid nasal endoscopy and xrays of the nasopharynx and paranasal sinuses to ascertain the presence of adenoid hypertrophy and sinusitis using standard criteria. Nasopharyngeal swabbing to ascertain the presence of nasopharyngeal colonization with S. pneumoniae was also performed. Adenoid hypertrophy was more consistently associated with persistent rhinorrhea than sinusitis (p < 0.0001). Coincident adenoid hypertrophy and sinusitis occurred in 57 %. S. pneumoniae was cultured in only 29 % of children. Up to 47 % of patients had features of nasal allergy. There was no association between S. pneumoniae colonization and adenoid hypertrophy (p = 0.1). Adenoid hypertrophy is an important cause of persistent rhinorrhea in children. Measures to evaluate for and treat adenoid hypertrophy should be instituted early to alleviate the problem of persistent rhinorrhoea in children. S. pneumoniae colonization of the nasopharynx is not a major etiological factor for persistent rhinorrhoea in these children. Nasal allergy may be a cause of adenoid hypertrophy in roughly half the children.

Current utilization of balloon dilation versus endoscopic techniques in pediatric sinus surgery

OBJECTIVES

To study the utilization of balloon catheter dilation (BCD) compared to traditional endoscopic surgery (ESS) in pediatric patients.

STUDY DESIGN

Cross-sectional analysis.

SETTING

Hospital and freestanding ambulatory surgery centers in California, Florida, Maryland, and New York

SUBJECTS

Patients less than 18 years who underwent BCD(316) or ESS(2346), as identified by CPT codes from the State Ambulatory Surgery Databases 2011.

METHODS

Patient and facility demographics, mean charges, and operating room time were examined using bivariate and multivariate analyses.

RESULTS

A total of 2662 children underwent surgery, with BCD used in 10.6% of maxillary, 8.4% of sphenoid, and 11.8% of frontal procedures. Adjusted analysis found that children with asthma, allergic rhinitis (AR), GERD, or concomitant adenoidectomy were more likely to have BCD compared to patients without these comorbidities, asthma odds ratio (OR) = 1.94 (95% CI, 1.84-3.41), AR OR = 1.77 (95% CI, 1.03-3.07), GERD OR = 2.79 (95% CI, .59-4.90), or without adenoidectomy OR = 2.50 (95% CI, 1.84-3.41). Patients with cystic fibrosis were less likely to have BCD, OR = 0.33 (95% CI, 0.11-0.95). Median charges for patients undergoing maxillary antrostomy alone by BCD (P = .042) or with adenoidectomy (P < .001) were approximately $2100 and $4200 greater than the median of patients undergoing those procedures with ESS. However, operating room time was similar (P = .81) between patients undergoing maxillary antrostomy, regardless of whether BCD was used, but was longer (P < .001) in those undergoing maxillary antrostomy and adenoidectomy when BCD was utilized.

CONCLUSIONS

BCD was used in 11.9% of pediatric sinus surgery and had higher average charges with no decrease in OR time compared to procedures that only utilized ESS. Future research is necessary to evaluate whether BCD may lead to improved outcomes and eventually decreased operating room time for pediatric patients with chronic rhinosinusitis.

Nasopharyngeal vs. adenoid cultures in children undergoing adenoidectomy: prevalence of bacterial pathogens, their interactions and risk factors

Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus colonization of the adenoids and nasopharynx in 103 preschool children who underwent adenoidectomy for recurrent upper respiratory tract infections was examined. Bacterial interactions and risk factors for bacterial colonization of the nasopharynx and adenoids, separately, were analysed statistically. The prevalence of simultaneous isolation from both anatomical sites was 45·6% for S. pneumoniae, 29·1% for H. influenzae, 15·5% for M. catarrhalis and 18·4% for S. aureus. Three pathogens were significantly more frequent together from adenoid samples; nasopharyngeal swabs more often yielded a single organism, but without statistical significance. M. catarrhalis and S. aureus significantly more frequently co-existed with S. pneumoniae and H. influenzae than with each other and a positive association of S. pneumoniae and H. influenzae in adenoid samples was evident. Several differences between risk factors for nasopharyngeal and adenoid colonization by the individual pathogens were observed. We conclude that the adenoids and nasopharynx appear to differ substantially in colonization by pathogenic microbes but occurrence of H. influenzae and S. pneumoniae in the nasopharynx could be predictive of upper respiratory tract infections.

Chronic rhinosinusitis and age: is the pathogenesis different?

Chronic rhinosinusitis (CRS) is a common disease with a significant impact on quality of life, which is seen across all age groups. There are differences in symptomatology, histopathology and associated diseases when comparing pediatric versus adult patients with CRS. Nasal polyposis tends to be less commonly seen in pediatric CRS compared with adults except in children with cystic fibrosis or allergic fungal rhinosinusitis. The differences in histopathology of CRS in different age groups include higher cellularity and more prominent lymphocytic infiltration in children compared with adults who tend to have a stronger eosinophilic infiltration and more prominent glandular hyperplasia. There are data supporting a stronger association of gastroesophageal reflux disease and otitis media with CRS in children compared with adults. Adenoids may play a role in pediatric, but not adult CRS. Immunodeficiencies and asthma are strongly associated with CRS in all age groups. There is a paucity of data on pathophysiology of disease on elderly CRS.

The utility of nasopharyngeal culture in the management of chronic adenoiditis

OBJECTIVES

To examine the utility of nasopharyngeal culture in the management of children with chronic adenoiditis to determine if it results in a change in antibiotic therapy.

METHODS

Retrospective chart review of pediatric patients managed for chronic adenoiditis, being defined as cough, postnasal drip, and congestion for over three months with endoscopic evidence of nasopharyngeal purulence with normal anterior rhinoscopy and middle meati. Standard treatment was defined as amoxicillin clavulanate or amoxicillin clavulanate ES-600 in non-penicillin allergic patients, and cefuroxime or clarithromycin for penicillin allergic patients. Nasopharyngeal culture results and antibiotic prescriptions were reviewed to look for a change from the standard.

RESULTS

Of 207 patients diagnosed with chronic adenoiditis, 198 had nasopharyngeal cultures (119 male, 79 female, mean age 3.7 years). The most common organisms isolated were Streptococcus pneumoniae sensitive to penicillin in 40 cultures (20.2%), S. pneumoniae intermediate or resistant to penicillin in 26 (13.1%), Moraxella catarrhalis in 27 (13.6%), Haemophilus influenzae in 57 (28.8%), and Staphylococcus aureus intermediate or resistant to penicillin in 26 (13.1%). 13.3% of S. aureus isolated was methicillin resistant. 103 (52.0%) children required different antibiotics from the standard, and 26 (13.1%) had no antibiotics prescribed based on a negative culture. Of the 87 children suspected to have upper airway reflux, 25 (28.7%) had negative cultures. Of the 135 patients with follow-up, 50 (37.0%) reported resolution and 50 (37.0%) reported improvement of their symptoms.

CONCLUSION

Nasopharyngeal culture has significant utility in the choice of antibiotics for children with chronic adenoiditis.

Diagnosis of chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a rather common disease in children, but its symptoms are often subtle and non-specific and this may result in overlooking a correct diagnosis. In turn, a missed diagnosis of CRS prevents a correct management to be performed and is associated with uneffective investigations and improper treatments. Actually, when CRS symptoms, which are mainly nasal congestion and obstruction, nasal discharge, facial pain, cough, and halitosis, are correctly assessed, the clinical diagnosis of CRS may be achieved, and confirmation may be obtained by imaging criteria or nasal fibroendoscopy. In imaging, computed tomography (CT) is the first choice technique for the evaluation of CRS and is able to provide an anatomic road map when surgery is required. Magnetic resonance imaging (MRI) of the sinuses, orbits, and brain should be performed whenever extensive or multiple complications of sinusitis are suspected. Also for middle ear disorders, CT is the first choice because it detects opacification of the middle ear cavity and mastoid cells, presence of fluids or debris, and allows the ossicular chain and the cortical bone of the mastoid to be evaluated. Another important diagnostic issue is the need to look for disorders that are frequently associated with CRS, such as obstructive sleep apnea syndrome (OSAS), that has some recognized risk factors in adenotonsillar hypertrophy, craniofacial anomalies, obesity, and neuromuscular disorders. Other associated disorders requiring investigation are recurrent or persistent otitis media and difficult asthma.

Molecular characterization of Staphylococcus aureus isolated from children with adenoid hypertrophy: emergence of new spa types t7685 and t7692

OBJECTIVE

Adenoids have been associated with the pathogenesis of acute, recurrent and chronic infectious diseases of the upper respiratory system and their hypertrophy is one of the most common causes of upper airway obstruction affecting children. In this study, the characteristics of Staphylococcus aureus isolates from patients who had undergone adenoidectomy were investigated via spa typing method.

METHODS

A total of 113 children with adenoid hypertrophy who underwent adenoidectomy during September 2009 to November 2010, were included in the study. The isolates were identified to the species level as S. aureus using standard biochemical methods, following which the amplification and sequencing of the spa gene X region were carried out.

RESULTS

S. aureus was found in the adenoid tissue of 26 (23%) patients. Out of the 26 S. aureus isolates, 5 (19%), 3 (11.5%) and 3 (11.5%) were resistant to tetracycline, erythromycin and oxacillin respectively. All the isolates were susceptible to vancomycin, rifampin, ciprofloxacin, gentamicin, mupirocin and quinupristin-dalfopristin and were typed using spa typing method. All the isolates were found to include 21 spa types, including two previously unreported types (t7685 and t7692). The most prevalent spa types were t7685 (11.5%), t230 (8%), t325 (8%) and t1149 (8%).

CONCLUSION

This study demonstrates that the prevalence rate of S. aureus in the adenoid tissue of the children assessed was 23%. An interesting point to note was the dominance of the spa type t7685 that has not been previously reported by other studies.

Correlation of mucociliary clearance and symptomatology before and after adenoidectomy in children

OBJECTIVE

The goal of this study is to better understand the role of adenoid hypertrophy and its impact on mucociliary clearance as it relates to the symptoms of chronic sinusitis in children. More specifically, the goal is to better understand which symptoms of chronic rhinosinusitis might be most likely to improve in children undergoing an adenoidectomy.

METHODS

We conducted this study on 35 healthy children (>3 and <18 years of age), either male or female, who underwent adenotonsillectomy or adenoidectomy (with or without tympanostomy tube insertion). Eighteen patients completed pre- and postoperative surveys, with 10 also completing the Andersen's saccharine test (AST). The nasal mucociliary clearance will be evaluated with the AST, in which a saccharin particle (1.5mm diameter) is carefully placed on the floor of the nasal cavity approximately 1cm behind the anterior end of the inferior turbinate. The time taken by the subjects from placement of particle to the perception of the sweet taste will be taken as mucociliary clearance time (MCT). The length of the nasal cavity is measured intraoperatively as the distance between the upper medial incisor and the inferior edge of the soft palate. From these two values nasal mucociliary clearance velocity (MCV) (cm/min) can be calculated and assessed. This study took place at an academic institution.

RESULTS

Symptomatic improvement was seen in all categories, as measured by the mean score improvement postoperatively. The greatest improvements were seen in nasal obstruction (mean=2.67 points ± .59) on the symptom survey, and emotional distress (mean=2.56 ± .47) on the SN5 survey. Quality of life improved by a mean=2.61 ± .49. Both MCT and MCV improved postoperatively (mean 3.64 min ± .84 and mean 1.96 cm/min ±.90, respectively).

CONCLUSIONS

We believe this study has the potential to provide otolaryngologists across the country with a benchmark to communicate the specific symptomatic benefits from adenoidectomy.

Comparison of two minimally invasive techniques for treating chronic rhinosinusitis in the pediatric population

OBJECTIVE

To compare two minimally invasive techniques for the treatment of chronic rhinosinusitis in young children.

BACKGROUND

Chronic rhinosinusitis (CRS) is a common diagnosis in young children. Maxillary sinus aspiration & irrigation with adenoidectomy (MSI) followed by an extended course of oral antibiotics has been shown to be an alternative to functional endoscopic sinus surgery. However, since MSI is not performed under direct visualization, it has inherent risk. This study analyzes the techniques of MSI and endoscopically guided middle meatus cultures & antral biopsy with adenoidectomy (EGC) in the (1) diagnosis of bacterial infection by culture, (2) time to resolution using double antibiotic therapy, and (3) associated morbidity of the two procedures.

METHODS

The medical records at Wayne State University, Department of Otolaryngology Head & Neck Surgery were reviewed from 2004 to 2010. All children who presented with CRS who underwent MSI or EGC were included in this retrospective case series.

RESULTS

Patients presented with a history of cough, nasal discharge, and congestion. The mean age was 3.7 years. Symptom duration prior to treatment was 7.4 months in the 64 patients who underwent MSI and 9.1 months in the 46 patients who underwent EGC. MSI identified bacteria in 80% of patients compared to 73% in EGC patients (p=0.45). The MSI group underwent antibiotic treatment for 8.7 weeks and achieved symptom resolution in 8.7 weeks compared to 6.9 weeks and 4.9 weeks respectively in the EGC group (p=0.08 and 0.01). However, if patients presented with snoring or cough, time to resolution of symptoms was significantly lower in patients undergoing EGC versus MSI (p=0.02 and p=0.01, respectively). One patient who underwent MSI experienced epistaxis requiring nasal packing, and two patients had pseudoproptosis following irrigation that resolved spontaneously shortly thereafter. No complications were reported in the EGC group.

CONCLUSION

EGC is an effective treatment for young children with CRS. EGC and MSI are equally effective in obtaining diagnostic cultures. EGC decreases time to symptom resolution, and it lowers the risk of complication when compared to MSI.

The developmental relation between adenoid tissue and paranasal sinus volumes in 3-dimensional computed tomography assessment

OBJECTIVE

The aim of this study was to evaluate the developmental relationship between the volumes of paranasal sinuses and adenoid tissue by using a 3-dimensional (3D) reconstruction technique.

STUDY DESIGN

Cross-sectional study.

SETTING

Tertiary referral center.

SUBJECTS AND METHODS

Multislice computed tomography (MSCT) images were obtained using 3D reconstructions and a volume-rendering technique (VRT) in 69 boys and 35 girls aged 3 to 16 years, and bilateral maxillary, frontal, and sphenoid sinus volumes, as well as adenoid tissue volume marked in axial-coronal-sagittal planes, were calculated. The patients were grouped in 3 categories according to adenoid tissue volumes, and comparisons were made.

RESULTS

There was no significant difference between the right maxillary volume and left maxillary volume (P = .93). No significant difference was noted between the groups in terms of age and gender. There was no significant correlation between frontal, sphenoid, right and left maxillary, or total maxillary sinus volumes in all 3 groups of patients.

CONCLUSION

When classified according to adenoid tissue size, it was observed that increasing adenoid tissue volumes did not significantly affect the development of paranasal sinuses. Developmentally, there are no statistically significant correlations between the volumes of paranasal sinuses and adenoid tissues.