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Kitamura T, Uegomori-Yokura A, Oku Y, Maeo K, Kohira W, Suzuki Y, Yamakawa Y, Ueda K, Sato H, Ishimaru H, Kanomi R, Yamasaki Y, Iwasaki T. Effects of adenoid hypertrophy on nasopharyngeal airway ventilation: A computational fluid dynamics study. Int J Pediatr Otorhinolaryngol 2024; 180:111961. [PMID: 38705134 DOI: 10.1016/j.ijporl.2024.111961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES Adenoid hypertrophy causes impaired nasopharyngeal airways (NA) ventilation. However, it is difficult to evaluate the ventilatory conditions of NA. Therefore, this study aimed to analyze the nasopharyngeal airway resistance (NARES) based on computational fluid dynamics simulations and the nasopharyngeal airway depth (NAD) and adenoid hypertrophy grade measured on cephalometric cone-beam computed tomography images and determine the relationship between NAD and grade and NARES to ultimately assess using cephalometric measurements whether NA has airway obstruction defects. METHODS Cephalogram images were generated from cone-beam computed tomography data of 102 children (41 boys; mean age: 9.14 ± 1.43 years) who received orthodontic examinations at an orthodontic clinic from September 2012 to March 2023, and NAD and adenoid grade and NARES values were measured based on computational fluid dynamics analyses using a 3D NA model. Nonlinear regression analyses were used to evaluate the relationship between NARES and NAD and correlation coefficients to evaluate the relationship between grade and NARES. RESULTS NARES was inversely proportional to the cube of NAD (R2 = 0.786, P < 0.001), indicating a significant relationship between these variables. The resistance NARES increased substantially when the distance NAD was less than 5 mm. However, adenoid Grade 4 (75 % hypertrophy) was widely distributed. CONCLUSIONS These study findings demonstrate that the ventilatory conditions of NA can be determined based on a simple evaluation of cephalogram images. An NAD of less than 5 mm on cephalometric images results in NA obstruction with substantially increased airflow resistance.
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Affiliation(s)
- Takamasa Kitamura
- Department of Pediatric Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | | | - Yoichiro Oku
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kei Maeo
- Department of Pediatric Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Wakana Kohira
- Department of Pediatric Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yukari Suzuki
- Department of Pediatric Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yoshihito Yamakawa
- Department of Pediatric Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Kimiko Ueda
- Department of Pediatric Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Hideo Sato
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | | | | | - Youichi Yamasaki
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Tomonori Iwasaki
- Department of Pediatric Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.
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Zwierz A, Domagalski K, Masna K, Burduk P. Maximal medical treatment of adenoid hypertrophy: a prospective study of preschool children. Eur Arch Otorhinolaryngol 2024; 281:2477-2487. [PMID: 38291243 DOI: 10.1007/s00405-024-08459-6] [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: 12/05/2023] [Accepted: 01/05/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE This study aimed to examine the effectiveness of the combined maximal medical treatment for adenoid hypertrophy in preschool children. METHODS Sixty-four children underwent one-year combined therapy with intranasal mometasone furoate, oral desloratadine, nasal saline irrigation, and bacteriotherapy. Additionally, decongestion drops were applied during scheduled breaks. RESULTS Of the 64 treated children, 72% showed clinical improvement in adenoid symptoms while 28% did not improve and underwent surgery. These groups differed significantly in terms of the overall reduction in ailments after treatment (p < 0.001), infection rate (p < 0.001), catarrh severity (p < 0.001) and nasal patency (p < 0.001). Endoscopic examination confirmed that responders experienced, on average, a decrease of 8.4% in the adenoid/choana ratio and an improvement in mucosal coverage of the adenoid. These effects were not observed in the group of children whose parents opted for surgery after nine months of conservative treatment. CONCLUSIONS The proposed new schema of long-term maximal medical treatment with the use of combined intermittent treatment of intranasal mometasone furoate and decongestion drops, oral desloratadine, nasal saline irrigation, and bacteriotherapy can be attempted in patients with adenoid hypertrophy symptoms, and responders may avoid the need for surgery. The applied treatment breaks resulted in a low number of therapeutic side effects.
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Affiliation(s)
- Aleksander Zwierz
- Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, University Hospital No 2, Ujejskiego Street 75, 85-168, Bydgoszcz, Poland.
| | - Krzysztof Domagalski
- Department of Immunology, Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University, 87-100, Torun, Poland
| | - Krystyna Masna
- Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, University Hospital No 2, Ujejskiego Street 75, 85-168, Bydgoszcz, Poland
| | - Paweł Burduk
- Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, University Hospital No 2, Ujejskiego Street 75, 85-168, Bydgoszcz, Poland
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Hu Z, Cheng S, Sun S, Wang Y, Lou M, Ma R, Gong M, Yang F, Zheng G, Zhang Y, Dong J. Numerical and experimental evaluation of nasopharyngeal aerosol administration methods in children with adenoid hypertrophy. Int J Pharm 2024; 653:123906. [PMID: 38365069 DOI: 10.1016/j.ijpharm.2024.123906] [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: 11/13/2023] [Revised: 02/03/2024] [Accepted: 02/13/2024] [Indexed: 02/18/2024]
Abstract
Administering aerosol drugs through the nasal pathway is a common early treatment for children with adenoid hypertrophy (AH). To enhance therapeutic efficacy, a deeper understanding of nasal drug delivery in the nasopharynx is essential. This study uses an integrated experimental, numerical modelling approach to investigate the delivery process of both the aerosol mask delivery system (MDS) and the bi-directional delivery system (BDS) in the pediatric nasal airway with AH. The combined effect of respiratory flow rates and particle size on delivery efficiency was systematically analyzed. The results showed that the nasopharyngeal peak deposition efficiency (DE) for BDS was approximately 2.25-3.73 times higher than that for MDS under low-flow, resting and high-flow respiratory conditions. Overall nasopharyngeal DEs for MDS were at a low level of below 16 %. For each respiratory flow rate, the BDS tended to achieve higher peak DEs (36.36 % vs 9.74 %, 37.80 % vs 14.01 %, 34.58 % vs 15.35 %) at smaller particle sizes (15 µm vs 17 µm, 10 µm vs 14 µm, 6 µm vs 9 µm). An optimal particle size exists for each respiratory flow rate, maximizing the drug delivery efficiency to the nasopharynx. The BDS is more effective in delivering drug aerosols to the nasal cavity and nasopharynx, which is crucial for early intervention in children with AH.
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Affiliation(s)
- Zhenzhen Hu
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China; School of Engineering, RMIT University, Bundoora, VIC 3083, Australia; Institute for Sustainable Industries & Liveable Cities, Victoria University, PO Box 14428, Melbourne, VIC 8001, Australia
| | - Shaokoon Cheng
- School of Engineering, Faculty of Science and Engineering, Macquarie University, Sydney, NSW 2109, Australia
| | - Siping Sun
- Zhejiang Cuize Pharmtech Co. Ltd., Hangzhou, Zhejiang 310000, China
| | - Yusheng Wang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Miao Lou
- Department of Otorhinolaryngology Head and Neck Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi 710068, China
| | - Ruiping Ma
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Minjie Gong
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Feilun Yang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Guoxi Zheng
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Ya Zhang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China.
| | - Jingliang Dong
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China; Institute for Sustainable Industries & Liveable Cities, Victoria University, PO Box 14428, Melbourne, VIC 8001, Australia; First Year College, Victoria University, Footscray Park Campus, Footscray, VIC 3011, Australia.
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Tamir SO, Schwarz Y, Hazan I, Cohen Michael O, Tshori S, Marom T. Medical treatment does not reduce surgery rates in children with adenoid hypertrophy. Int J Pediatr Otorhinolaryngol 2024; 176:111836. [PMID: 38154416 DOI: 10.1016/j.ijporl.2023.111836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/01/2023] [Accepted: 12/22/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE We sought to study adenoidectomy rates in children with adenoid hypertrophy (AH) who were either treated with medical therapy or not during a 2-year follow-up period in a longitudinal population-based study. METHODS We retrospectively identified healthy children aged 1-18 years between 2014 and 2020 with AH diagnosis from the Clalit Health Services database, the largest healthcare maintenance organization in Israel. The main outcome was adenoidectomy alone or in combination with other procedures performed within 2 years after diagnosis. The treatment group consisted of children who received medical therapy, defined as a pharmacy purchase of montelukast, nasal steroid sprays and/or antihistamines (medical therapy aimed to reduce AH) for ≥2 consecutive months, while the control group consisted of untreated children. RESULTS We identified 68,356 unique children with AH, of them 56 % were boys, with a mean age of 4.9 ± 3.3 years. Of them, 5310 (7.7 %) received medical therapy. Overall, 6633 (9.7 %) underwent adenoidectomy within 2 years following diagnosis. There was no significant difference in surgery referral rates between the treatment and the control groups, 10 % vs. 9.7 %, respectively (p = 0.3). When adjusted for age and sex, the likelihood of undergoing adenoidectomy was similar in both groups (HR = 0.98, 95 % CI = 0.90-1.07, p = 0.6). Among operated children, the average time from diagnosis to surgery was statistically significantly longer in the treatment group than in the control group, 346 ± 180 vs 311 ± 175 days (p < 0.001). CONCLUSION Prescribing montelukast, nasal steroids and/or oral antihistamines was not associated with a reduction in adenoidectomy rates and was associated with an average surgery delay of 35 days.
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Affiliation(s)
- Sharon Ovnat Tamir
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Yehuda Schwarz
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel; Clalit Health Services, Tel Aviv, Israel
| | - Itai Hazan
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel; Joyce and Irvin Goldman Medical School, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er-Sheva, Israel
| | - Ori Cohen Michael
- Joyce and Irvin Goldman Medical School, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er-Sheva, Israel
| | - Sagi Tshori
- Research Authority, Kaplan Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel; Clalit Health Services, Tel Aviv, Israel.
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Zwierz A, Domagalski K, Masna K, Walentowicz P, Burduk P. Impact of Breastfeeding Duration on Adenoid Hypertrophy, Snoring and Acute Otitis Media: A Case-Control Study in Preschool Children. J Clin Med 2023; 12:7683. [PMID: 38137751 PMCID: PMC10743536 DOI: 10.3390/jcm12247683] [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: 11/02/2023] [Revised: 12/03/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The aim of this study was to analyze the relationship between breastfeeding duration and adenoid size, snoring and acute otitis media (AOM). METHODS We analyzed the medical history of children admitted to the ENT outpatient clinic in 2022 and 2023, reported symptoms, ear, nose and throat (ENT) examination, and flexible nasopharyngoscopy examination of 145 children aged 3-5 years. RESULTS Breastfeeding duration of 3 and 6 months or more had a significant effect on the reduction of snoring (p = 0.021; p = 0.039). However, it had no effect on the adenoid size, mucus coverage and sleeping with an open mouth. Snoring was correlated with open mouth sleeping (p < 0.001), adenoid size with a 75% A/C ratio or more (p < 0.001), and adenoid mucus coverage in the Mucus of Adenoid Scale by Nasopharyngoscopy Assessment-MASNA scale (p = 0.009). Children who were breastfed for less than 3 months had more than a four-fold greater risk of snoring. There was a statistically significant correlation between AOM and gender (p = 0.033), breastfeeding duration in groups fed 1, 3 or 6 months or more (p = 0.018; p = 0.004; p = 0.004) and those fed with mother's breast milk 3 or 6 months or more (p = 0.009; p = 0.010). Moreover, a correlation was found between adenoid size and mucus coverage, tympanogram, and open-mouth sleeping (p < 0.001). Independent factors of snoring in 3- to 5-year-old children were breastfeeding duration of less than 3 months (p = 0.032), adenoid size with an A/C ratio of 75% or more (p = 0.023) and open mouth sleeping (p = 0.001). CONCLUSIONS Children breastfed for 3 and 6 months or more exhibited reduced rates of snoring. There was no effect of breastfeeding duration on adenoid size in children aged 3 to 5 years, suggesting that the link between breastfeeding duration and snoring is primarily associated with craniofacial development and muscle tone stimulation. A breastfeeding duration of 1 month or more plays a key role in reducing the rate of AOM. The mother's milk plays a protective role against AOM. The presence of mucus might be responsible for snoring in preschool children. A medical history of breastfeeding should be taken into consideration when snoring children are suspected of adenoid hypertrophy.
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Affiliation(s)
- Aleksander Zwierz
- Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, 75 Ujejskiego Street, 85-168 Bydgoszcz, Poland; (K.M.); (P.B.)
| | - Krzysztof Domagalski
- Department of Immunology, Faculty of Biological and Veterinary Sciences, Nicolaus Copenicus University, 87-100 Toruń, Poland;
| | - Krystyna Masna
- Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, 75 Ujejskiego Street, 85-168 Bydgoszcz, Poland; (K.M.); (P.B.)
| | - Paweł Walentowicz
- Department of Obstetrics, Gynecology and Gynecologic Oncology, Regional Polyclinical Hospital, 87-100 Toruń, Poland;
| | - Paweł Burduk
- Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, 75 Ujejskiego Street, 85-168 Bydgoszcz, Poland; (K.M.); (P.B.)
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Wang Y, She C, Wu X, Wang Z, Li B, Peng J, Liang Y, Liu D, Zhang Y, Wu Y, Wang Y. Significance of Nasopharyngeal Cavity Area in Individuals with Adenoid Hypertrophy Assessed by Cone Beam Computed Tomography. EAR, NOSE & THROAT JOURNAL 2023:1455613231212837. [PMID: 37997343 DOI: 10.1177/01455613231212837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
Objective: To determine the significance of the nasopharyngeal cavity area (S) in diagnosing and treating adenoid hypertrophy (AH) in children by measuring it with cone beam computed tomography (CBCT). Methods: A retrospective analysis was conducted on the clinical data of eighty-five 5- to 6-year-old children with AH admitted to the Department of Otorhinolaryngology at Dalian Central Hospital between January 2022 and April 2023. Of the 85 patients, 48 were male and 37 were female; all had been diagnosed with AH and underwent surgery. Sleeping with open-mouth breathing was frequently accompanied by clinical manifestations such as chronic sinusitis in most patients. Every patient was subjected to a CBCT examination of the nasopharynx and 3D airway reconstruction. The adenoid thickness (A) and nasopharyngeal cavity width (N) were measured in the sagittal plane, while the S was measured in the coronal plane. The factors that had a significant impact on S's size was analyzed using linear regression. Results: S and age, A, N, height, weight, BMI, allergic rhinitis, deviated nasal septum, and enlarged turbinate hypertrophy did not differ significantly (P > .05). However, there was a significant linear relationship between A/N and chronic sinusitis (R2 = 0.948, P < .01). Regression equation: S = -4.115 × A/N × 100-5.037 × 1/0 (with chronic sinusitis/without chronic sinusitis) +418. 097. The calculated S in individuals with A/N = 70% and no chronic sinusitis was 130 mm2. Conclusion: The S can be used as an important imaging index for diagnosing and evaluating the severity of AH in minors. When a child exhibits clinical signs of AH but A/N ≤ 70%, it is difficult to determine whether surgical intervention is necessary. At this time, CBCT is required to measure the nasopharyngeal cavity's size. When S ≤ 130 mm2, the patient should actively undertake surgical treatment.
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Affiliation(s)
- Yu Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Dalian Municipal Central Hospital, Dalian, Liaoning, China
- Dalian Medical University, Dalian, Liaoning, China
| | - Cuiping She
- Department of Otorhinolaryngology Head and Neck Surgery, Dalian Municipal Central Hospital, Dalian, Liaoning, China
| | - Xiuling Wu
- Department of Otorhinolaryngology Head and Neck Surgery, Dalian Municipal Central Hospital, Dalian, Liaoning, China
- Dalian Medical University, Dalian, Liaoning, China
| | - Zhengying Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Dalian Municipal Central Hospital, Dalian, Liaoning, China
- Dalian Medical University, Dalian, Liaoning, China
| | - Bo Li
- Department of Otorhinolaryngology Head and Neck Surgery, Dalian Municipal Central Hospital, Dalian, Liaoning, China
- Dalian Medical University, Dalian, Liaoning, China
| | - Jiaxin Peng
- Department of Otorhinolaryngology Head and Neck Surgery, Dalian Municipal Central Hospital, Dalian, Liaoning, China
- Dalian Medical University, Dalian, Liaoning, China
| | - Yunshi Liang
- Department of Otorhinolaryngology Head and Neck Surgery, Dalian Municipal Central Hospital, Dalian, Liaoning, China
- Dalian Medical University, Dalian, Liaoning, China
| | - Delong Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Dalian Municipal Central Hospital, Dalian, Liaoning, China
| | - Yue Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Dalian Municipal Central Hospital, Dalian, Liaoning, China
| | - Yan Wu
- Department of Otorhinolaryngology Head and Neck Surgery, Dalian Municipal Central Hospital, Dalian, Liaoning, China
| | - Yifan Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Dalian Municipal Central Hospital, Dalian, Liaoning, China
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