Adenoid ciliostimulation in children with chronic otitis media

The effect of tonsillectomy with adenoidectomy on medical services used in association with otitis media based on Korean national sample cohort data

Background

The effect of tonsillectomy with adenoidectomy (T&A) on otitis media has been investigated, but there have been no reports of the relationship between T&A and medical services used in association with otitis media. We investigated the effect of T&A on otitis media with regard to the number and cost of medical services used.

Methods

From the National Health Insurance Service National Sample Cohort data in Korea, we selected patients 7 years old or younger in 2002 who had T&A in 2005 while between the ages of three and ten. A control group was established matching the patient group with similar propensities of demographic characteristics. The number and cost of medical services used in association with otitis media were analyzed for 3 years before T&A through 8 years after T&A.

Results

The total number of patients was 1,338, with 227 in the T&A group and 1,111 in the non-T&A group. The number of medical services used was not significantly different between the T&A and non-T&A groups before and after surgery. The cost of medical services used was significantly higher in the T&A group than in the non-T&A group one year before surgery. The cost of medical services used was not significantly different between the two groups after surgery.

Conclusions

There were no significant differences between the T&A and non-T&A groups in the number and cost of medical services used in association with otitis media after surgery.

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.

Relation between adenoid size and otitis media with effusion

AIMS

This study compares the efficacy of adenoidectomy on otitis media with effusion (OME) in patients with different size of adenoids and the connection between differently sized adenoids and middle ear effusion.

MATERIAL AND METHODS

Children with a history of at least 3 months' OME underwent adenoidectomy and myringotomy without the insertion of a tympanostomy tube. Treatment assignment was stratified by adenoids' size causing choanal obstruction (grade I-III) and according to Eustachian tube ostium obstruction (grade A-C). The subjects were followed for 12 months.

RESULTS

Adenoidectomy was significantly more effective in children with adenoids in contact with torus tubarius (grade B, C) compared to those with small adenoids without contact (P<0.001). The volume of the adenoids was irrelevant (P=0.146). The size of adenoids did not affect the viscosity of the middle ear secretion. The distribution of mucous and serous secretion was not dependent on the size of adenoids; the efficacy of adenoidectomy was 82% in mucous as well as serous secretion.

CONCLUSION

The relation between adenoids and torus tubarius is more important than the volume of the adenoids. The viscosity of middle ear fluids (serous or mucous) did not influence the rate of treatment efficacy.

Nasal Mucociliary Clearance in Adenoid Hypertrophy and Otitis Media with Effusion

Mucociliary clearance (MCC), which exists in many systems, is the first defensive mechanism of the human body. Nasal MCC has an important role in transporting the secretions of the nasal cavity and paranasal sinuses along with the trapped inhaled pathogens to the nasopharynx. Physiologic or pathologic situations that effect nasal MCC, such as temperature, humidity, nasal obstruction, allergic rhinitis, chronic infections, etc., lead to impaired MCC and related local or circumjacent system disorders. With this perspective, when a unified airway with a multiple disease principle is considered, investigating the relationship between adenoid hypertrophy (AH), otitis media with effusion (OME) and nasal MCC is logical. In this review, histological and physiologic properties of nasal MCC and its possible role involving pathologic situations such as AH and OME is discussed together with recent literature findings.

Tonsillectomy and adenoidectomy

Adenotonsillectomy (AT) is one of the most common pediatric surgical procedures performed in the United States; more than 530,000 are performed annually in children younger than 15 years of age. AT was traditionally performed for recurrent tonsillitis and its sequelae but in recent times, sleep-disordered breathing/obstructive sleep apnea in children has emerged as the primary indication for surgical removal of adenoids and tonsils. The new guidelines used by clinicians to identify children who are appropriate candidates for AT address indications based primarily on obstructive and infectious causes.