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Hu L, He W, Li J, Miao Y, Liang H, Li Y. The role of adenoid immune phenotype in polysensitized children with allergic rhinitis and adenoid hypertrophy. Pediatr Allergy Immunol 2024; 35:e14166. [PMID: 38822736 DOI: 10.1111/pai.14166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 04/04/2024] [Accepted: 05/13/2024] [Indexed: 06/03/2024]
Abstract
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.
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Affiliation(s)
- Lanye Hu
- Department of Otolaryngology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenjun He
- Department of Otolaryngology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Junyang Li
- Department of Otolaryngology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Miao
- Department of Hematology/Oncology, National Health Committee Key Laboratory of Pediatric Hematology and Oncology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Huanhuan Liang
- Department of Hematology/Oncology, National Health Committee Key Laboratory of Pediatric Hematology and Oncology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Youjin Li
- Department of Otolaryngology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Sant'Ana JP, Mastrandonakis ICF, Silva RSB, Duprat ADC, Floriano CG, Miyake MM. Reliability of nasofibroscopy for the evaluation of adenoid hypertrophy and its correlation with clinical symptoms. Braz J Otorhinolaryngol 2023; 89:101307. [PMID: 37690427 PMCID: PMC10493505 DOI: 10.1016/j.bjorl.2023.101307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/14/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
OBJECTIVE To analyze the reliability of estimating the percentage of rhinopharyngeal obstruction by the adenoid using nasofibroscopy and its correlation with clinical symptoms. METHODS Cross-sectional observational study was conducted, involving 80 patients between 4 and 14 years old, recruited from Santa Casa of São Paulo general otorhinolaryngology outpatient service during the years of 2020 and 2021. All patients underwent nasal endoscopy examination, and the recorded videos were randomly assigned to four evaluators in two different sessions, with a minimum interval of 1 month. The evaluators estimated the percentage of rhinopharyngeal obstruction caused by the adenoid. Intra- and inter-evaluator correlations were established by comparing the reports from each evaluator. The data were compared to the Pro Image J Software report, that also estimates a percentage of obstruction by computer graphics. To correlate the grading of obstruction with clinical symptoms, all patients completed the OSA (Obstructive Sleep Apnea) 18 questionnaire, a validated tool for assessing sleep apnea in children. The questionnaire data were then compared to the average scores assigned by the evaluators. RESULTS Satisfactory intra- and inter-rater correlations were observed, and the results were consistent with the Pro Image J Software. However, no correlation was found between the percentage of obstruction and the severity of clinical symptoms. CONCLUSION Nasofibroscopy demonstrates good reliability in assessing a percentage of rhinopharyngeal obstruction caused by adenoids. However, there is no correlation between the degree of obstruction of the rhinopharynx and the clinical symptoms. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | | | | | | | - Caio Gomes Floriano
- Santa Casa de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Marcel Menon Miyake
- Santa Casa de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
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Peedikakkal NT, Prakash DRS, Chandrakiran C, Patil SB, Reddy HN. Endoscopic Grading, Radiological Grading and Clinical Features in Children with Chronic Adenoid Hypertrophy: A Correlational Study. Indian J Otolaryngol Head Neck Surg 2023; 75:725-731. [PMID: 37274952 PMCID: PMC10235224 DOI: 10.1007/s12070-022-03438-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023] Open
Abstract
To obtain a correlation between endoscopic findings, radiological findings and clinical features in children with symptomatic Chronic Adenoid hypertrophy. A cross sectional study was conducted in 42 pediatric patients (3-14 years) who visited the Department of Otorhinolaryngology in a tertiary care centre from November 2019 to April 2021 (18 months). The patients were subjected to complete history taking; ENT examination, Rigid nasal endoscopic examination, a lateral X-ray nasopharynx were performed prior to surgery after obtaining consent from the parents of the patients. The endoscopic findings were assessed using ACE grading system and the X-ray nasopharynx was assessed using Adenoid- Nasopharyngeal ratio. A male predominance was noted with mouth breathing, snoring, nasal obstruction and recurrent rhinitis as common presentation. Grade 3 hypertrophy was the most common finding in X-ray Nasopharynx (Mean ANR-0.682). Children with Grade 3 adenoid hypertrophy with more than 50% choanal obstruction and Eustachian tube abutment in nasal endoscopy were noted to be the most symptomatic clinically. A positive correlation between reduced hearing (p value-0.004) and blocked ear sensation (p value- < 0.01) with eustachian tube abutment was noted. The children with more symptoms did not show higher-grade adenoid hypertrophy radiographically in our study. The adenoid- nasopharyngeal ratio on X-ray correlated with endoscopic grading of adenoid hypertrophy (p value-0.006) and degree of choanal obstruction (p value-0.003) but not with the abutment of the eustachian tube. The endoscopic grading correlated with clinical grading, but not the X-ray grading. Hence, endoscopic grading appears to be more accurate in assessing the adenoid size and endoscopic grading is nearer to clinical grading than X-ray grading. Though, the digital X-ray nasopharynx lateral view is a more convenient method, nasal endoscopy is the gold standard method to determine whether the adenoid hypertrophy is clinically significant or not.
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Affiliation(s)
- Nawal Thazhathe Peedikakkal
- Department of Otorhinolaryngology and Head and Neck Surgery, Ramaiah Medical College Hospital, Bangalore, Karnataka 560054 India
| | - D. R. Surya Prakash
- Department of Otorhinolaryngology and Head and Neck Surgery, Ramaiah Medical College Hospital, Bangalore, Karnataka 560054 India
| | - C. Chandrakiran
- Department of Otorhinolaryngology and Head and Neck Surgery, Ramaiah Medical College Hospital, Bangalore, Karnataka 560054 India
| | - Sanjay B. Patil
- Department of Otorhinolaryngology and Head and Neck Surgery, Ramaiah Medical College Hospital, Bangalore, Karnataka 560054 India
| | - Harshavardhan N. Reddy
- Department of Otorhinolaryngology and Head and Neck Surgery, Ramaiah Medical College Hospital, Bangalore, Karnataka 560054 India
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Bi M, Zheng S, Li X, Liu H, Feng X, Fan Y, Shen L. MIB-ANet: A novel multi-scale deep network for nasal endoscopy-based adenoid hypertrophy grading. Front Med (Lausanne) 2023; 10:1142261. [PMID: 37122318 PMCID: PMC10140414 DOI: 10.3389/fmed.2023.1142261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/23/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction To develop a novel deep learning model to automatically grade adenoid hypertrophy, based on nasal endoscopy, and asses its performance with that of E.N.T. clinicians. Methods A total of 3,179 nasoendoscopic images, including 4-grade adenoid hypertrophy (Parikh grading standard, 2006), were collected to develop and test deep neural networks. MIB-ANet, a novel multi-scale grading network, was created for adenoid hypertrophy grading. A comparison between MIB-ANet and E.N.T. clinicians was conducted. Results In the SYSU-SZU-EA Dataset, the MIB-ANet achieved 0.76251 F1 score and 0.76807 accuracy, and showed the best classification performance among all of the networks. The visualized heatmaps show that MIB-ANet can detect whether adenoid contact with adjacent tissues, which was interpretable for clinical decision. MIB-ANet achieved at least 6.38% higher F1 score and 4.31% higher accuracy than the junior E.N.T. clinician, with much higher (80× faster) diagnosing speed. Discussion The novel multi-scale grading network MIB-ANet, designed for adenoid hypertrophy, achieved better classification performance than four classical CNNs and the junior E.N.T. clinician. Nonetheless, further studies are required to improve the accuracy of MIB-ANet.
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Affiliation(s)
- Mingmin Bi
- Department of Otolaryngology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Siting Zheng
- College of Computer Science and Software Engineering, Shenzhen University, Shenzhen, China
- AI Research Center for Medical Image Analysis and Diagnosis, Shenzhen University, Shenzhen, China
| | - Xuechen Li
- College of Computer Science and Software Engineering, Shenzhen University, Shenzhen, China
- AI Research Center for Medical Image Analysis and Diagnosis, Shenzhen University, Shenzhen, China
| | - Haiyan Liu
- Department of Otolaryngology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Xiaoshan Feng
- Department of Otolaryngology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Yunping Fan
- Department of Otolaryngology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
- *Correspondence: Yunping Fan, ; Linlin Shen,
| | - Linlin Shen
- College of Computer Science and Software Engineering, Shenzhen University, Shenzhen, China
- AI Research Center for Medical Image Analysis and Diagnosis, Shenzhen University, Shenzhen, China
- *Correspondence: Yunping Fan, ; Linlin Shen,
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Dange PS, Bhat VK, Yadav M. Adenoid Morphology and Other Prognostic Factors for Otitis Media with Effusion in School Children. Indian J Otolaryngol Head Neck Surg 2022; 74:3649-3653. [PMID: 36742487 PMCID: PMC9895436 DOI: 10.1007/s12070-020-02332-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/14/2020] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Prajwal Shrirang Dange
- Department of Otolaryngology, Head and Neck Surgery, Mysore Medical College, Mysore, India
| | - Vikram Kemmannu Bhat
- Department of Otolaryngology, Head and Neck Surgery, Karnataka Institute of Medical Sciences, Hubli, India
| | - Mona Yadav
- Department of Otolaryngology, Head and Neck Surgery, Karnataka Institute of Medical Sciences, Hubli, India
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YILDIZ MG, KARAKAYA AE, GÜLER AG, ORHAN İ, KARA İ, SAĞIROĞLU S, BİLAL N, DOĞANER A. THE EFFECT OF ADENOTONSİLLECTOMY SURGERY İN PEDİATRİC ENUREZİS NOCTURNA PATİENTS. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1025885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective: The aim of this study was to investigate the effect of tonsillectomy and adenoidectomy on EN in patients with tonsil hypertrophy and adenoid hypertrophy.
Material and Method: Data of 94 patients was retrospectively valuated. The frequency of EN of the patients and whether they improved after the operation were investigated.
Results: The mean age was 9.59 ± 2.04. EN patients was higher in the group with Adenoid Vegetation. EN was detected in 73 of the patients before surgery. There was a complete improvement in 63 patients and partial improvement in 10 patients after the operation. There was no statistically significant difference in EN improvement between the groups.
Conclusion: In a multidisciplinary approach, the surgical procedures can be effective in the treatment of EN. Therefore the patients admitting with EN symptomsshould be questioned for complaints about upper airway obstruction and The correct surgical procedure for children with symptoms may constitute an important step in their treatment.
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Affiliation(s)
| | | | | | - İsrafil ORHAN
- KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNİVERSİTESİ, TIP FAKÜLTESİ
| | - İrfan KARA
- KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNİVERSİTESİ, TIP FAKÜLTESİ
| | | | - Nagihan BİLAL
- KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNİVERSİTESİ, TIP FAKÜLTESİ
| | - Adem DOĞANER
- KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNİVERSİTESİ, TIP FAKÜLTESİ
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Naina P, Pokharel A, Syed KA, John M, Varghese AM, Kurien M. A Three Point Assessment Protocol for Tympanoplasty Outcomes: A Retrospective Analysis. Int Arch Otorhinolaryngol 2020; 24:e438-e443. [PMID: 33101508 PMCID: PMC7575394 DOI: 10.1055/s-0039-3402432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 10/15/2019] [Indexed: 10/31/2022] Open
Abstract
Introduction The surgical outcome of chronic otitis media (COM) of the mucosal type in the pediatric population with high rates of recurrent tympanic membrane perforation is indeed a concern for the attending surgeon. Objective The present study was done to evaluate the outcome of tympanoplasty in children with chronic otitis media mucosal type. Methods A retrospective analysis of the medical records of all children, aged < 16 years old, who underwent tympanoplasty for COM of the mucosal type was performed. These patients were addressed by a three-point assessment, for predicting outcome of tympanoplasty, which included the age of the patient, addressing the nasal/pharyngeal issues, and the status of the COM (discharging or dry). Surgical success was assessed in terms of graft uptake and improvement of hearing. Factors affecting the surgical outcome were also analyzed. Results A total of 90 children underwent type 1 tympanoplasty; 7 were lost to follow-up and 10 had incomplete audiometric results. In the 73 tympanoplasties analyzed, graft uptake was seen in 91.7% of the patients. Children with longer duration of ear discharge (> 8 years) had greater hearing loss. Children aged > 8 years old showed statistically significant higher chance of graft uptake ( p = 0.021). Five of the six children who had graft rejection had bilateral disease. Conclusion A three-point assessment in the management of pediatric COM of the mucosal type offers good outcomes with post-tympanoplasty graft uptake rates > 90%.
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Affiliation(s)
- P Naina
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu, India
| | - Apar Pokharel
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu, India
| | - Kamran Asif Syed
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mary John
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Mary Kurien
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu, India.,Department of ENT, Pondicherry Institute of Medical Sciences, Puduchery, India
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Cohen O, Betito HR, Adi M, Shapira‐Galitz Y, Halperin D, Lahav Y, Warman M. Development of the nasopharynx: A radiological study of children. Clin Anat 2019; 33:1019-1024. [DOI: 10.1002/ca.23530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/16/2019] [Accepted: 11/19/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery Kaplan Medical Center Rehovot Israel
- Hebrew University‐ Hadassah Medical School Jerusalem Israel
| | - Hadar Rotem Betito
- Department of Otolaryngology, Head and Neck Surgery Kaplan Medical Center Rehovot Israel
- Hebrew University‐ Hadassah Medical School Jerusalem Israel
| | - Meital Adi
- Department of Radiology Kaplan Medical Center Rehovot Israel
- Hebrew University‐ Hadassah Medical School Jerusalem Israel
| | - Yael Shapira‐Galitz
- Department of Otolaryngology, Head and Neck Surgery Kaplan Medical Center Rehovot Israel
- Hebrew University‐ Hadassah Medical School Jerusalem Israel
| | - Doron Halperin
- Department of Otolaryngology, Head and Neck Surgery Kaplan Medical Center Rehovot Israel
- Hebrew University‐ Hadassah Medical School Jerusalem Israel
| | - Yonatan Lahav
- Department of Otolaryngology, Head and Neck Surgery Kaplan Medical Center Rehovot Israel
- Hebrew University‐ Hadassah Medical School Jerusalem Israel
| | - Meir Warman
- Department of Otolaryngology, Head and Neck Surgery Kaplan Medical Center Rehovot Israel
- Hebrew University‐ Hadassah Medical School Jerusalem Israel
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A Case–Control Study on the Association Between Endoscopic ACE Grade of Adenoid Hypertrophy and Hearing Loss in Children and Its Impact on Speech and Language Development. Indian J Otolaryngol Head Neck Surg 2019; 71:150-154. [DOI: 10.1007/s12070-018-1506-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 09/26/2018] [Indexed: 11/25/2022] Open
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