1
|
Han Y, Guo R, Feng Z, Wang H, Li Y, Zou J, Wang Y. Associations of systemic inflammation markers with myocardial enzymes in pediatric adenotonsillar hypertrophy: A cross-sectional study. Heliyon 2023; 9:e17719. [PMID: 37483768 PMCID: PMC10359822 DOI: 10.1016/j.heliyon.2023.e17719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 07/25/2023] Open
Abstract
Objective The present study aimed to investigate the relationship between systemic inflammation markers and myocardial enzymes in children with adenotonsillar hypertrophy (ATH). Methods The levels of myocardial enzymes were detected and the systemic inflammatory biomarkers including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and systemic immune inflammation index (SII) were calculated. Regression analyses were performed and a prediction model for screening myocardial injury was established by receiver operating characteristic (ROC) curve. Results Finally, a total of 804 children with ATH were included. After adjusting for age, BMI, fasting blood glucose and lipid profiles, both NLR and SII were significantly associated with CK-MB (p = 0.041 and 0.034, respectively) and LDH (p = 0.002 and 0.001, respectively), and PLR was associated with CK-MB (p = 0.008). In addition, NLR, SII were independently associated with hyper-LDH [OR = 1.447, 95%CI (1.063, 1.968); OR = 1.001, 95%CI (1.000, 1.002), respectively] and the associations were more significant in girls. A prediction model for hyper-LDH based on SII was developed with the area under the ROC curve of 0.715 (0.682, 0.746). Conclusion Systemic inflammation markers were only independently associated with serum hyper-LDH in children with ATH, especially in girls. Further investigation was needed to determine the relationship between systemic inflammation with myocardial enzymes in ATH children.
Collapse
Affiliation(s)
- Yingying Han
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| | - Ruixiang Guo
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| | - Ziyu Feng
- School of Basic Medical Sciences, Shandong University, Jinan, China
| | - Haipeng Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Zibo Central Hospital, Zibo, China
| | - Yanzhong Li
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| | - Juanjuan Zou
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| | - Yan Wang
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| |
Collapse
|
2
|
Uysal P, Güleç Köksal Z, Gönenli Z, Doğan M, Şahin M. The impact of adenoid hypertrophy on pulmonary functions measured using impulse oscillometry in preschool-age children. Eur Arch Otorhinolaryngol 2023; 280:207-217. [PMID: 35907002 DOI: 10.1007/s00405-022-07521-5] [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: 01/31/2022] [Accepted: 06/20/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE To assess pulmonary impedance [resistance (zR5, zR20, R5-20, Fres, and AX) and reactance (zX5 and zX20)] using impulse oscillometry (IOS) in children with adenoid hypertrophy (AH) and its association with the degree of AH, and to evaluate subsequent changes in pulmonary function 3 months after adenoidectomy. METHODS This prospective cross-sectional study was conducted with 170 preschool-age children [110 with AH and 60 sex- and age-matched healthy controls (HCs)]. Pulmonary function was analyzed using IOS at baseline (1st visit) in all participants and 3 months after adenoidectomy (2nd visit) in patients who underwent the operation. RESULTS The IOS parameters of zR5, zR20, R5-20, Fres, and AX were higher, but zX20 was lower, in children with AH compared to the HCs (p < 0.05 for all). The parameters of zR5, Fres, and AX were higher in children with grade IV AH than in those with grade I (p < 0.001). zR5, zR20, R5-20, Fres, and AX decreased, but zX20 increased, after adenoidectomy (2nd visit) compared to baseline (1st visit) (p < 0.05). Post-adenoidectomy (2nd visit) zR5, AX, Fres values were higher in children with AH compared to baseline values in the HCs (1st visit) (p < 0.05). The area under the ROC curve (AUC) value for estimating adenoidectomy was 0.741 for zX20 (CI 0.648-0.834, p < 0.001) with a cut-off value of ≤ -3.21, sensitivity of 68.8%, and specificity of 70%. CONCLUSION This study shows that IOS is a useful method for demonstrating subclinical bronchial obstruction in preschool-age children with AH with greater pulmonary impedance (resistance and reactance). Pulmonary impedance decreased 3 months after adenoidectomy, but remained higher than in the HCs. The IOS parameter of X20 may be predictive of adenoidectomy. This study evaluated the pulmonary functions of children with adenoid hypertrophy (AH) using impulse oscillometry (IOS) and the association with the scale of AH. Pulmonary functions were analyzed using IOS. The main IOS parameters include resistances (zR5 and zR20), reactance (zX5 and zX20), R5-20 (resistance at 5 Hz minus resistance at 20 Hz), resonant frequency (Fres), and AX. Fres is the point at which reactance is zero and is measured in Hz (1/s). The Reactance Area (AX - "Goldman Triangle") represents the integrated low-frequency respiratory reactance magnitude between 5 Hz and Fres. Faster frequencies of R (~ 20 Hz) reflect larger airways, regarded as resistance around the central airways. Lower frequencies of R (~ 5 Hz) providing information around the entire (small and large) airways. Peripheral (small) airway resistance is defined by R5-20. IOS parameters of zR5, zX20, Fres, and AX differed among AH grades I-IV and compared to the HCs (p < 0.001 for all).
Collapse
Affiliation(s)
- Pınar Uysal
- Division of Allergy and Immunology, Department of Pediatric Allergy and Immunology, School of Medicine, Aydin Adnan Menderes University, 09010, Aydin, Turkey.
| | - Zeynep Güleç Köksal
- Division of Allergy and Immunology, Department of Pediatric Allergy and Immunology, School of Medicine, Aydin Adnan Menderes University, 09010, Aydin, Turkey
| | - Zeynep Gönenli
- Department of Pediatrics, School of Medicine, Aydin Adnan Menderes University, Aydin, Turkey
| | - Murat Doğan
- Department of Otorhinolaryngology, School of Medicine, Aydin Adnan Menderes University, Aydin, Turkey
| | - Mustafa Şahin
- Department of Otorhinolaryngology, School of Medicine, Aydin Adnan Menderes University, Aydin, Turkey
| |
Collapse
|
3
|
Deshmukh P, Lakhotia P, Gaurkar SS, Ranjan A, Dash M. Adenotonsillar Hypertrophy and Cardiopulmonary Status: A Correlative Study. Cureus 2022; 14:e31175. [DOI: 10.7759/cureus.31175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022] Open
|
4
|
Role of Adenotonsillectomy and Tonsillectomy in Children with Down Syndrome Who Develop Obstructive Sleep Apnea by Obesity as a Risk Factor. Int J Pediatr 2022; 2022:8074094. [PMID: 35574039 PMCID: PMC9106504 DOI: 10.1155/2022/8074094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 12/17/2022] Open
Abstract
Down syndrome (DS) or trisomy 21 is caused due to the presence of additional chromosome 21 in humans. DS can exist either as free trisomy 21 (nondisjunction), Robertsonian translocated DS, or as mosaic DS. Obstructive sleep apnea (OSA) is a complex condition with serious health implications for pediatric individuals with DS. OSA is common in DS, and when it is present, it appears to be extreme. Obesity and snoring are some of the OSA risk factors for children associated with DS and OSA. Adenotonsillectomy is one of the surgical protocols applied in children, which is useful in lowering the OSA in which obesity is commonly connected within normal and DS children. Tonsillectomy is the alternative procedure of surgery connected with postoperative respiratory complications, and adenotonsillectomy was found to be a safe surgical method in children and improves the quality of life. The main aim of this review is to bridge the gap between the role of OSA in normal children (46, XX/XY) and DS children (47, XX/XY+21) characterized by the presence of chromosomes and exactly what is the involvement with adenotonsillectomy and tonsillectomy when obesity is a risk factor. The treatment for OSA and obesity is rehabilitative and reversible; however, DS can be managed but not resolved because the disorder occurs from the existence of an extra chromosome during the failure of homologous chromosomal pairing separation during maternal meiosis I. This review concludes that there is a treatment for OSA and obesity and that DS children can be prevented from being obese or experiencing OSA but cannot be turned to normal chromosomes due to an extra trisomy 21. According to this review, children with DS and OSA/OSAS, as well as concomitant complications, can be treated.
Collapse
|
5
|
Ozbilgic T, Suslu AE, Aykan HH, Pehlivanoglu B, Onal D, Kasikci M, Duzova A, Emiralioglu N, Yalcin EE, Ersoz DD, Kiper EN, Ozcelik HU. The impact of the Adenotonsillectomy on cardiac functions and oxidative stress. Int J Pediatr Otorhinolaryngol 2022; 154:111039. [PMID: 35091202 DOI: 10.1016/j.ijporl.2021.111039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/06/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Obstructive sleep apnea syndrome (OSAS) causes cardiovascular comorbidities and increased oxidative stress. Adenotonsillectomy is the first treatment option for OSAS secondary to adenotonsillar hypertrophy (ATH). This study evaluated the presence of cardiovascular changes, hypertension and oxidative stress before and after adenotonsillectomy in patients with OSAS secondary to ATH. METHODS Patients with ATH diagnosed with OSAS by polysomnography (PSG) were included. All participants received an Echocardiography (ECHO) and 24-h ambulatory blood pressure measurement (ABPM). Serum malonyldialdehyde (MDA) and total oxidant activity (TOS) levels of oxidant parameters; total antioxidant activity (TAS), catalase (CAT), superoxide dismutase (SOD) and glutathione (GSH) levels of antioxidant parameters were measured. All patients received an adenotonsillectomy. Postoperative evaluation was performed at the 6th month. In the postoperative period, PSG, ECHO, ABPM and the oxidant-antioxidant parameter levels in the serum was repeated. RESULTS Twenty-eight patients (13 males, 15 females; mean age 8.2 ± 2.06 years) were included in the study. In the preoperative period, concentric remodeling was observed in 14,8% of the patients, although they had no cardiovascular system complaints. The apnea-hypopnea index (AHI) scores were classified as mild in 39.3% (n = 11), moderate in 21.4% (n = 6) and severe in 39.3% (n = 11) preoperatively. In the postoperative period, 22 patients were evaluated. It was observed that the severity of OSAS decreased, ventricular functions improved, oxidant parameters decreased and antioxidant parameters increased postoperatively. CONCLUSION Adenotonsillectomy provides a positive change in cardiovascular system parameters and an antioxidant change in the oxidative balance in patients with OSAS.
Collapse
Affiliation(s)
- Tugce Ozbilgic
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Ahmet E Suslu
- Department of Otolaryngology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - H Hakan Aykan
- Department of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bilge Pehlivanoglu
- Department of Physiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Onal
- Department of Physiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Merve Kasikci
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ali Duzova
- Departments of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nagehan Emiralioglu
- Departments of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - E Ebru Yalcin
- Departments of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz D Ersoz
- Departments of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - E Nural Kiper
- Departments of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - H Ugur Ozcelik
- Departments of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
6
|
Felemban WA, Alhussaini R, Essa AF, Felemban AA, Fallatah JM. Knowledge and Awareness Among Parents of Pediatric Patients Regarding the Complications of Recurrent Adenotonsillitis and Its Surgical Treatment. Cureus 2021; 13:e20402. [PMID: 34926095 PMCID: PMC8671063 DOI: 10.7759/cureus.20402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 11/29/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Walaa A Felemban
- Otolaryngology-Head and Neck Surgery, Ohud Hospital, Medina, SAU
| | - Rayan Alhussaini
- Otolaryngology-Head and Neck Surgery, Prince Mohammed Bin Abdulaziz Hospital, National Guard Health Affairs, Medina, SAU
| | - Abdullah F Essa
- Family Medicine, Prince Mohammed Bin Abdulaziz Hospital, National Guard Health Affairs, Medina, SAU
| | - Alaa A Felemban
- Family Medicine, Eastern al-Jarf Primary Healthcare Center, Medina, SAU
| | | |
Collapse
|
7
|
Sun YL, Yuan B, Kong F, Li XM. Effects of adenoidectomy or adenotonsillectomy on the cardiovascular system in children: a meta-analysis. Eur Arch Otorhinolaryngol 2021; 279:1147-1156. [PMID: 34269887 DOI: 10.1007/s00405-021-06986-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/06/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Adenoid or adenotonsillar hypertrophy (AATH) causes upper airway obstruction, leading to cardiovascular complications. This meta-analysis was conducted to evaluate the efficacy of adenoidectomy or adenotonsillectomy (AATE) on the cardiovascular system. METHODS Using the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases, we identified studies involving a comparison of preoperative and postoperative cardiovascular function in children with AATH. The Cochrane Collaboration's Review Manager 5.3 software was used for meta-analysis. RESULTS A total of 13 studies with 706 participants were included. The meta-analysis demonstrated a significant reduction in mean pulmonary artery pressure (mPAP) of patients after AATE compared with preoperative values. The left ventricular myocardial function index (LVMPI) and the right ventricular myocardial function index (RVMPI) showed a significant decrease after the operation. Moreover, AATE prominently increased left ventricular ejection time (LVET) and right ventricular ejection time (RVET) and reduced the left ventricular interventricular septum diameter (LVIVSD) and the right ventricular end-diastolic diameter (RVedD). There was no significant difference in mPAP, LVMPI, RVMPI, LVET, RVET, LVIVSD, and RVedD between postoperative patients and healthy children (P > 0.05). CONCLUSION AATE can improve cardiovascular function in pediatric patients with AATH. Specifically, it reduces mPAP and LVMPI/RVMPI in pediatric patients. Furthermore, AATE increases LVET and RVET and reduces LVIVSD and RVedD.
Collapse
Affiliation(s)
- Ya-Lei Sun
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Qinhuai District, Nanjing, 210000, Jiangsu, China
| | - Bin Yuan
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Qinhuai District, Nanjing, 210000, Jiangsu, China.
| | - Fei Kong
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Qinhuai District, Nanjing, 210000, Jiangsu, China
| | - Xin-Min Li
- Basic Medicine College, Henan University of Chinese Medicine, Zhengzhou, 450000, China
| |
Collapse
|
8
|
Lima MS, Nader CMFF, Franco LP, Meira ZMA, Capanema FD, Guimarães RES, Becker HMG. Pulmonary hypertension evaluation by Doppler echocardiogram in children and adolescents with mouth breathing syndrome. Braz J Otorhinolaryngol 2017; 83:292-298. [PMID: 27388953 PMCID: PMC9444763 DOI: 10.1016/j.bjorl.2016.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/20/2016] [Accepted: 03/31/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Adenotonsillar hyperplasia (ATH) and allergic rhinitis (AR) are the most common causes of upper airway obstruction in children. Such diseases, by affecting the upper airways, can cause chronic alveolar hypoventilation, pulmonary vasoconstriction and pulmonary hypertension, which in some cases, are irreversible. OBJECTIVE This cross-sectional study aimed to evaluate the prevalence of pulmonary hypertension in two groups of mouth-breathing (MB) 2-12 years old children with ATH and isolated allergic rhinitis, through Doppler echocardiography. METHODS 54 patients with ATH and indications for adenoidectomy and/or tonsillectomy and 24 patients with persistent allergic rhinitis were selected and submitted to Doppler echocardiography. The Systolic Pulmonary Artery Pressure (SPAP) was determined by tricuspid regurgitation and the Mean Pulmonary Artery Pressure (MPAP) was calculated from the SPAP. Similar measurements were carried out in 25 nasal breathing (NB) individuals. RESULTS The mean MPAP and SPAP were higher in the MB than in the NB group (17.62±2.06 [ATH] and 17.45±1.25 [AR] vs. 15.20±2.36 [NB] mmHg, p<0.005, and 25.61±3.38 [ATH] and 25.33±2.06 [AR] vs. 21.64±3.87 [NB] mmHg, p<0.005, respectively) and the mean acceleration time of pulmonary flow trace (Act) was higher in the NB than in the MB group (127.24±12.81 [RN] vs. 114.06±10.63ms [ATH] and 117.96±10.28 [AR] MS [AR]; p<0.0001). CONCLUSION None of the MB children (ATH and AR) met the PH criteria, although individuals with both ATH and isolated AR showed significant evidence of increased pulmonary artery pressure by Doppler echocardiography in relation to NB individuals. No differences were observed between the ATH and AR groups.
Collapse
Affiliation(s)
- Marcela Silva Lima
- Universidade Federal de Minas Gerais (UFMG), Departamento de Cirurgia e Oftalmologia, Belo Horizonte, MG, Brazil.
| | - Carolina Maria Fontes Ferreira Nader
- Faculdade de Saúde e Ecologia Humana (FASEH), Vespasiano, MG, Brazil; Faculdade de Saúde e Ecologia Humana (FASEH), Fundação de Amparo a Pesquisa do Estado de Minas Gerais (FAPEMIG), Programa Institucional de Bolsas de Iniciação Científica e Tecnológica (PROBIC), Vespasiano, MG, Brazil
| | - Letícia Paiva Franco
- Universidade Federal de Minas Gerais (HC-UFMG), Hospital das Clínicas, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Belo Horizonte, MG, Brazil
| | - Zilda Maria Alves Meira
- Universidade Federal de Minas Gerais (UFMG), Departamento de Pediatria, Belo Horizonte, MG, Brazil
| | - Flavio Diniz Capanema
- Núcleo de Inovação Tecnológica, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Santa Efigênia, MG, Brazil
| | - Roberto Eustáquio Santos Guimarães
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Oftalmologia, Otorrinolaringologia e Fonoaudiologia, Belo Horizonte, MG, Brazil
| | - Helena Maria Gonçalves Becker
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Oftalmologia, Otorrinolaringologia e Fonoaudiologia, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (HC-UFMG), Hospital das Clínicas, Centro Multidisciplinar de Atenção ao Respirador Oral, Belo Horizonte, MG, Brazil
| |
Collapse
|
9
|
Orji FT, Ujunwa FA, Umedum NG, Ukaegbe O. The impact of adenotonsillectomy on pulmonary arterial pressure in West African children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2017; 92:151-155. [PMID: 28012518 DOI: 10.1016/j.ijporl.2016.11.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/19/2016] [Accepted: 11/23/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the improvement or otherwise, in the mean pulmonary arterial pressure (mPAP) among children with adenotonsillar hypertrophy (ATH) after adenotonsillectomy (AT), and to examine the impact of timing of surgery as well as the patients' characteristics on the mPAP changes. METHODS We included 39 children with ATH in this study. The adenoidal enlargement was evaluated radiologically with adenoid nasopharyngeal ratio (ANR) parameter from lateral neck radiograph, whereas the clinical assessment of adeno-tonsillar obstruction was conducted with the 'symptom score'. Pulmonary arterial pressure (PAP) measurement was performed noninvasively by Doppler echocardiography. All patients underwent adenotonsillectomy (AT). After 6 weeks, they were subjected again to clinical and echocardiographic assessments, and the mean pulmonary arterial pressures (mPAP) were then compared. The mPAP changes after AT were further related to the grades of ANR, symptom scores, tonsillar size, and timing of AT. RESULTS The preoperative mPAP was 23.46 mmHg and was 18.98 mmHg post-operatively (P = 0.003). Seventeen of subjects (43.6%) had pulmonary hypertension (PH) (mPAP ≥ 25 mmHg) preoperatively, out of which 14 (82%) decreased to normal range 6 weeks after AT. Non-reversal of pulmonary hypertension was associated with ANR > 0.75 (P = 0.043), but was not related to the timing of surgery, tonsillar size, and symptom score. Significant reduction in mPAP was more likely with ANR ≤ 0.75 and pre-operative mPAP ≥ 25 mmHg. All the symptoms also improved significantly after AT. CONCLUSION Elevated PAP due to ATH in children was mostly reversible by AT irrespective of the timing of surgery, symptom severity, and tonsillar size, but gross enlargement of adenoids seem to be associated with non-reversal of PH.
Collapse
Affiliation(s)
- Foster T Orji
- Department of Otolaryngology, University of Nigeria Enugu Campus, Nigeria.
| | - Fortune A Ujunwa
- Department of Pediatric Cardiology, University of Nigeria Teaching Hospital Enugu, Nigeria
| | - Nnaemeka G Umedum
- Department of Otolaryngology, University of Nigeria Teaching Hospital Enugu, Nigeria
| | - Onyinyechi Ukaegbe
- Department of Otolaryngology, University of Nigeria Enugu Campus, Nigeria
| |
Collapse
|
10
|
Orji FT, Adiele DK, Umedum NG, Akpeh JO, Ofoegbu VC, Nwosu JN. The clinical and radiological predictors of pulmonary hypertension in children with adenotonsillar hypertrophy. Eur Arch Otorhinolaryngol 2016; 274:1237-1243. [DOI: 10.1007/s00405-016-4207-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 07/11/2016] [Indexed: 11/30/2022]
|
11
|
Derin S, Erdogan S, Sahan M, Topal H, Sozen H. Neutrophil-Lymphocyte Ratio in Patients with Adenoidectomy. J Clin Diagn Res 2016; 10:MC03-5. [PMID: 27134905 DOI: 10.7860/jcdr/2016/16549.7360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 12/20/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Obstructive Sleep Apnea syndrome (OSA) is the most serious consequence of adenoid hypertrophy (AH) and it is one of the most common reasons of nocturnal hypoxia in children. There is some information about the relationship between childhood OSA and atherosclerosis or cardiac diseases. In this study, we evaluated the relationship between, neutrophil-lymphocyte ratio (NLR) and AH which is the most frequent cause leading OSA in children. AIM Thus we aimed to contribute about subject of preoperative and postoperative NLR values in patients undergoing adenoidectomy that there is limited information. MATERIALS AND METHODS The study group comprised 76 children undergoing adenoidectomy. A preoperative and 3(rd)-month postoperative complete blood cell count was performed to calculate the NLR values in all patients. The NLR values were calculated as the ratio of neutrophils to lymphocytes in peripheral blood. Data analysis was performed using SPSS 15. RESULTS The mean NLR (min - max) was 1.0 (0.16-3.57) preoperatively and 1.06 (0.35-4.95) 3 months postoperatively (p = 0.052> 0.05). Haemoglobin 12.9 ± 0.95 (preop) 12.94 ± 0.91 (postop) (p= 0.522), WBC (min-max) 7.75 (3.90-14.99) 7.8 (4-15.64) (p= 0.297 <0.005), platelet 344.5 ± 98.7 328.4 ± 68.9 (p<0,005). CONCLUSION There is limited information in the English literature. This study has investigated the association between the NLR and adenoidectomy. The results of the present study demonstrate that the NLR is not a statistically significant inflammatory factor. So, NLR values do not appear related to stage of upper airway obstruction.
Collapse
Affiliation(s)
- Serhan Derin
- Faculty, Department of Otorhinolaryngology, Mugla Sitki Kocman University, School of Medicine , Mugla/Turkey
| | - Selvet Erdogan
- ENT Clinic, Kocaeli University, Medical Faculty , Kocaeli, Turkey
| | - Murat Sahan
- Faculty, Department of Otorhinolaryngology, Mugla Sitki Kocman University, School of Medicine , Mugla/Turkey
| | - Hatice Topal
- Faculty, Department of Peadiatrics, Mugla Sitki Kocman University, School of Medicine , Mugla, Turkey
| | - Hamdi Sozen
- Faculty, Department of Infectious Disease, Mugla Sitki Kocman University, School of Medicine , Mugla/Turkey
| |
Collapse
|
12
|
Effects of Obstructive Sleep Apnea in Children as a Result of Adenoid and/or Adenotonsillar Hypertrophy on Maternal Psychologic Status. J Craniofac Surg 2015; 26:2364-7. [DOI: 10.1097/scs.0000000000002086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
13
|
Abstract
Adenoid hypertrophy (AH) is a common disorder in children, resulting in chronic nasal congestion. This chronic congestion should be evaluated carefully because it can lead to chronic upper airway obstruction. Many authors have suggested that increased nasal resistance to respiration may cause disturbances in the pulmonary ventilation and carry the risk of cardiopulmonary diseases. Mean platelet volume (MPV) is a marker of platelet function and is positively associated with indicators of platelet activity. Mean platelet volume is an indicator of larger and more reactive platelets and has been shown to be increased in patients with vascular disease, including peripheral, pulmonary, and coronary artery disease. Recently, MPV levels have also been shown to be increased in patients with severe obstructive sleep apnea, and marked nasal septal deviation. Moreover, increased MPV has also been shown to have a prognostic role in cardiovascular disease. We investigated whether MPV is higher in patients with AH and whether higher MPV levels can be reduced by adenoidectomy. To the best of our knowledge, this is the first study to investigate MPV in patients with AH. Our results suggest that MPV, a determinant of platelet activation, is elevated in patients with AH and adenoidectomy is an effective therapeutic measure in such patients. Increased platelet activation may be related to an increase of cardiopulmonary risk in patients with AH.
Collapse
|
14
|
Wilson SE, Chinyere UC, Queennette D. Childhood acquired heart disease in Nigeria: an echocardiographic study from three centres. Afr Health Sci 2014; 14:609-16. [PMID: 25352879 PMCID: PMC4209661 DOI: 10.4314/ahs.v14i3.16] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Acquired heart diseases (AHD) are not uncommon in children. The current multi-center study aims to provide a more representative data of AHD in Nigeria. METHODS Over 42 months, children referred for echocardiographic evaluation who had confirmed AHD in three centers in Nigeria were recruited. The data was collected on biodata and types of AHD. RESULTS There were 116 children with 132 cases of AHD, with a mean age of 6.7 ± 5.7 years. The males were 63(54.3%). Myocarditis/ dilated cardiomyopathy (DCM) 38(28.8%) was the commonest AHD followed by pericarditis 34 (25.8%), rheumatic heart disease (RHD) 23 (17.4%) and hypertrophic cardiomyopathy 18(13.6%). Endomyocardial fibrosis (EMF) 3(2.3%) was uncommon. CONCLUSION Nigerian children face a quadruped of AHD namely, myocarditis, DCM, pericardial disease and RHD. As other types of AHD other than RHD are becoming prevalent, there is need to improve the scope of intervention facilities in the country to meet with the demands of the growing afflictions.
Collapse
Affiliation(s)
- Sadoh E Wilson
- Department of Child Health University of Benin Teaching Hospital, Benin Nigeria
| | | | | |
Collapse
|
15
|
Marangu D, Jowi C, Aswani J, Wambani S, Nduati R. Prevalence and associated factors of pulmonary hypertension in Kenyan children with adenoid or adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2014; 78:1381-6. [PMID: 24969347 DOI: 10.1016/j.ijporl.2014.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 05/29/2014] [Accepted: 06/05/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Adenotonsillar hypertrophy is a common condition in childhood, whose serious complications of pulmonary hypertension and cor pulmonale are devastating but local prevalence is unknown. This study determined the prevalence and associated factors of pulmonary hypertension in children with adenoid or adenotonsillar hypertrophy at Kenyatta National Hospital, Kenya. METHODS This was a cross sectional hospital based survey conducted among children below 12 years of age with clinical and radiological adenoid hypertrophy attending the ear, nose and throat (ENT) outpatient clinic and general pediatric wards. Doppler echocardiography was used to determine pulmonary hypertension defined as a mean pulmonary arterial pressure (mPAP) of ≥ 25 mm Hg using the Chemla equation. Children with mPAP of ≥ 25 mm Hg were compared to those with lower pressures and clinical and radiological factors associated with pulmonary hypertension determined using multivariate logistic regression analysis. RESULTS Of the 123 eligible children in the study, 27 had pulmonary hypertension giving a prevalence of 21.9% (95% CI 14.64%-29.27%). Independent factors associated with pulmonary hypertension included nasal obstruction (OR=3.0 [95% CI 1.08-8.44] p=0.035) and hyperactivity on history (OR=0.2 [95% CI 0.07-0.59] p=0.003) and adenoid-nasopharyngeal ratio (ANR) >0.825 on lateral neck radiography (OR=5.0 [95% CI 1.01-24.37] p=0.048). CONCLUSION One in five children with adenoid or adenotonsillar hypertrophy had pulmonary hypertension with a 3-fold and 5-fold increased odds in those with nasal obstruction on history and ANR >0.825 on lateral neck radiography respectively and an 80% reduced odds in reportedly hyperactive children.
Collapse
Affiliation(s)
- Diana Marangu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
| | - Christine Jowi
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Joyce Aswani
- Department of ENT Surgery, University of Nairobi, Nairobi, Kenya
| | - Sidika Wambani
- Radiology Department of Kenyatta National Hospital (KNH), Nairobi, Kenya
| | - Ruth Nduati
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| |
Collapse
|