Sleep disordered breathing in children in a general population sample: prevalence and risk factors

STUDY OBJECTIVES

Assess the prevalence based on clinically meaningful criteria (i.e., blood pressure) and identify risk factors of sleep disordered breathing (SDB) in a representative sample of elementary school children.

DESIGN

A random sample of the local elementary school children (K-5) were assessed using a two-phased strategy. In phase I a brief questionnaire was completed by a parent of each child in local elementary schools (N = 5,740), with a response rate of 78.5%. In phase II, randomly selected children and their parent spent a night in our sleep laboratory (N = 700) with a response rate of 70.0%.

SETTING

University sleep laboratory.

PARTICIPANTS

Children enrolled in local elementary schools.

INTERVENTION

None.

MEASUREMENT & RESULTS

Each child was assessed with a full polysomnogram and completed a history/physical examination including an electrocardiogram, otolaryngology examination, and pulmonary evaluation. The prevalence of moderate SDB (apnea-hypopnea index > or = 5) was 1.2%. The independent risk factors included nasal abnormalities and minority associated only with mild (1 < AHI < 5) SDB and snoring and waist circumference associated with all levels of SDB. Tonsil size, based on visual inspection, was not an independent risk factor.

CONCLUSION

The prevalence of AHI > or = 5 was 1.2% in a representative sample of elementary school children. Risk factors for SDB included waist circumference, nasal abnormalities (e.g., chronic sinusitis/rhinitis), and minority. The strong linear relationship between waist circumference and BMI across all degrees of severity of SDB suggests that, as in adults, metabolic factors may be among the most important risk factors for SDB in children.

Nasal obstruction as a risk factor for sleep-disordered breathing. The University of Wisconsin Sleep and Respiratory Research Group

Nasal obstruction frequently has been associated with sleep-disordered breathing as a potential etiologic factor. Nasal obstruction results in pathologic changes in airflow velocity and resistance. Experimentally produced nasal obstruction increases resistance and leads to sleep-disordered breathing events, including apnea, hypopnea, and snoring. Clinical research examining the correlation between nasal obstruction and sleep-disordered breathing is limited, especially in regard to patients with conditions that increase nasal resistance, such as rhinitis and sinusitis. To further identify risk factors for sleep-disordered breathing, the role of chronic and acute nasal congestion was investigated in a population-based sample. Data on nasal congestion history and sleep problems were obtained by questionnaire (n = 4927) and by objective inlaboratory measurement (n = 911). Participants who often or almost always experienced nighttime symptoms of rhinitis (5 or more nights a month) were significantly (p < 0.0001) more likely to report habitual snoring (3 to 7 nights a week), chronic excessive daytime sleepiness, or chronic nonrestorative sleep than were those who rarely or never had symptoms. Habitual snorers had significantly (p < 0.02) lower air flow than nonsnorers, although a linear relation between decreased airflow and sleep-disordered breathing severity did not exist. Participants who reported nasal congestion due to allergy were 1.8 times more likely to have moderate to severe sleep-disordered breathing than were those without nasal congestion due to allergy. Men and women with nasal obstruction, especially chronic nighttime symptoms of rhinitis, are significantly more likely to be habitual snorers, and a proportion also may have frequent episodes of apnea and hypopnea, indicative of severe sleep-disordered breathing. Because allergic rhinitis is a common cause of nasal obstruction and it is a modifiable risk factor, further study of this association is warranted.

Prevalence of nasal polyposis in France: a cross-sectional, case-control study

BACKGROUND

The prevalence of nasal polyposis (NP) has never been established in France due to the lack of diagnostic tools for population-based studies.

METHODS

Using a recently validated questionnaire/algorithm (90% specificity and sensitivity) in a population-based random sample, the present cross-sectional, case-control study allowed to determine NP prevalence and describe the principal aspects of NP epidemiology. A total of 10 033 subjects (>/=18 years) were screened. After identification of subjects with NP and those without, another questionnaire was submitted to NP patients only for further data collection. Controls were individuals without NP, matched by gender and age to NP patients.

RESULTS

Nasal polyposis prevalence was 2.11% (95% CI 1.83-2.39). NP patients (n = 212, 45% males) were aged 49.4 +/- 17.6 years. No gender preponderance was observed, but NP tended to increase with age. Mean duration of nasal symptoms was 22.4 +/- 15.7 years. Among the 145 patients having already seen a doctor for their symptoms, 77.2% have been referred to a specialist, and 18.6% had a diagnosis of NP. Rhinorrhoea was reported by 39.9% of NP patients, blocked nose by 30.8%, and anosmia by 28.9%. Only 6.9% reported facial discomfort while 24.6% complained about general discomfort. Most NP patients (61.3%) had a pharmacological treatment, a nasal spray for the major part (76.9%).

CONCLUSION

The present study provides valuable and reliable information on NP epidemiology in France; the collected information are in accordance with most published international data.

Chronic nasal congestion at night is a risk factor for snoring in a population-based cohort study

BACKGROUND

Nasal congestion at night is thought to have a role in snoring and sleep apnea, but this hypothesis has not previously been tested in a population-based study.

METHODS

Baseline and 5-year follow-up data on self-reported nocturnal nasal congestion and snoring frequency were collected from a population-based sample of 4916 men and women (age range, 30-60 years at baseline) enrolled in the ongoing Wisconsin Sleep Cohort Study. In-laboratory polysomnography was performed on a subset (n = 1032) of the study population to determine the frequency of apnea and hypopnea episodes during sleep. Logistic regression was used to estimate odds ratios for snoring with chronic nasal congestion at night.

RESULTS

Nocturnal nasal congestion frequency was independently associated with snoring frequency in cross-sectional analyses. The odds ratios (adjusted for sex, age, body habitus, and smoking) for habitual snoring with severe (always or almost always) nasal congestion vs none was 3.0 (95% confidence interval, 2.2-4.0). This association was not explained by habitual snorers with frank sleep apnea (ie, >/=5 apnea and hypopnea episodes per hour of sleep). Prospective analyses showed that persons with chronic severe nasal congestion had a high risk of habitual snoring according to the data from the 5-year follow-up survey: the odds ratio for habitual snoring and reporting congestion always or almost always at both baseline and follow-up was 4.9 (95% confidence interval, 2.8-8.8).

CONCLUSIONS

Nocturnal nasal congestion is a strong independent risk factor for habitual snoring, including snoring without frank sleep apnea. Intervention studies are needed to determine if snoring can be reduced with treatment of nasal congestion.

Prevalence of Taste and Smell Dysfunction in Coronavirus Disease 2019

Importance

Early diagnosis of coronavirus disease 2019 (COVID-19) may help control the diffusion of the disease into the population.

Objective

To investigate the presence of sinonasal manifestations at the onset of COVID-19 to achieve an earlier diagnosis.

Design, Setting, and Participants

This retrospective telephone survey study investigated patients diagnosed with COVID-19 from March 5 to March 23, 2020, who were hospitalized or discharged from a single referral center. Patients who were unable to answer (intubated, receiving noninvasive ventilation, or deceased) or unreachable by telephone were excluded. Of 359 consecutive patients, 204 fulfilled the inclusion criteria; 76 were unable to answer, 76 were unreachable by telephone, and 3 refused.

Exposures

Sinonasal manifestations reported before COVID-19 diagnosis were studied with a validated questionnaire: Italian Sino-Nasal Outcome Test 22 (I-SNOT-22). If reduction of taste and/or smell was documented by item 5 of the I-SNOT-22, further inquiries were made to score them separately on a scale from 0 to 5, with 0 indicating no problem and 5 indicating problem as bad as it can be.

Main Outcomes and Measures

The prevalence of sinonasal manifestations preceding COVID-19 diagnosis.

Results

Among the 204 patients enrolled (110 [53.9%] male; mean [SD] age, 52.6 [14.4] years), the median I-SNOT-22 total score was 21 (range, 0-73). I-SNOT-22 identified 116 patients (56.9%) with reduction of taste and/or smell, 113 (55.4%) with taste reduction (median score, 5; range, 2-5), and 85 (41.7%) with smell reduction (median score, 5; range, 1-5). Eighty-two patients (40.2%) reported both. Severe reduction of taste was present in 81 patients (39.7%), and severe reduction of smell was present in 72 patients (35.3%). Only 12 patients (14.8%) with severe taste reduction and 12 patients (16.7%) with severe smell reduction reported severe nasal obstruction. Severe reduction of taste and smell was more prevalent in female vs male patients (odds ratios, 3.16 [95% CI, 1.76-5.67] vs 2.58 [95% CI, 1.43-4.65]) and middle-aged vs younger patients (effect sizes, 0.50 [95% CI, 0.21-0.78] vs 0.85 [95% CI, 0.55-1.15]). No significant association was observed between smoking habits and severe reduction of taste (odds ratio, 0.95; 95% CI, 0.53-1.71) and/or smell (odds ratio, 0.65; 95% CI, 0.35-1.21).

Conclusions and Relevance

The findings of this telephone survey study suggest that reduction of taste and/or smell may be a frequent and early symptom of COVID-19. Nasal obstruction was not commonly present at the onset of the disease in this study. The general practitioner may play a pivotal role in identifying potential COVID-19 in patients at an early stage if taste and/or smell alterations manifest and in suggesting quarantine before confirmation or exclusion of the diagnosis.

Inverting papilloma of the head and neck: the UCLA update

Inverting papilloma of the nose and paranasal sinuses is a benign disease with malignant potential. This disease is characterized by multiple recurrences, especially after minimal operative therapy. Controversy exists over the most appropriate treatment for this rare tumor. This review presents an update of the UCLA experience with inverting papilloma over the past four decades along with a review of the literature. A retrospective study of 61 patients seen at the UCLA Medical Center was conducted. The mean age at presentation was 63 years, with a male-to-female ratio of 2:1. The most common symptom at presentation was nasal obstruction (71%), followed by epistaxis (27%). Seventeen percent of the patients in this series either had concurrent squamous cell carcinoma of the nose or paranasal sinuses, or it developed. Patients treated with a lateral rhinotomy and medial maxillectomy had a recurrence rate of 30 percent. Those treated with a less aggressive operation had a recurrence rate of 71 percent. Despite a trend for a more conservative sinus operation in recent literature, we continue to advocate a lateral rhinotomy and medial maxillectomy as the treatment of choice for inverting papilloma of the head and neck.

Long term results following nasal septal surgery. Focus on patients' satisfaction

OBJECTIVE

The patient selection for septoplasty usually relies on clinical judgement alone. It is not clear, if surgeons' selection criteria are able to accurately anticipate patients' long term satisfaction as only a few studies exist on the outcome of nasal septal surgery. In this study, we analyze patients' long term satisfaction following septoplasty based on their subjective opinion.

MATERIALS AND METHODS

In this prospective study, 67 consecutive patients, who underwent septoplasty during one year in a District General Hospital, were included. We used the fairley nasal symptom questionnaire (FNQ) preoperativeiy and postoperatively and the Glasgow benefit inventory (GBI) postoperatively to assess the outcome. Patients were mailed two questionnaires 2-3 years postoperatively, to evaluate their perception of the procedure's long term results. As a criterion to measure the success of the operation we used the median postoperative FNQ score and patients were divided into two groups, consisting of patients with more and less successful result, respectively.

RESULT

Fifty-one patients responded (76%). Analysis of the outcomes revealed significant improvement of total nasal symptom score (FNQ) postoperatively (from mean score 13.25 to 9.09) with significant benefit in the nasal obstruction, sore throat and the sense of smell but not for headaches. Significant improvement in nasal breathing was recorded mainly from patients with anterior septal deviation. Patients in the below criterion group (49%) had a mean GBI total score of 6.3, reporting no satisfaction after surgery, whereas patients in the above criterion group (51%) had a mean of 23.8, which is also not a satisfactory result. Social and physical components of GBI had no difference between groups having considerably low scores.

CONCLUSION

The principal benefits of septal surgery are related to improvement in nasal symptoms. In this study GBI results did not reflect a significant change in health status from septoplasty even in the above criterion group. The significant percentage of patients who did not report satisfaction in the long term, questions the objectivity of surgeons' criteria regarding nasal septal surgery. It also indicates that positive evaluation by patients of septal surgery outcome tends to be attenuated with time.

Oxidant stress and inflammation in the snoring child: confluent pathways to upper airway pathogenesis and end-organ morbidity

Snoring in children is increasingly being recognized as a highly prevalent condition, and indicates the presence of heightened upper airway resistance during sleep. In this paper, we present evidence to support the hypothesis that local inflammatory processes within the upper airway contribute to the pathophysiology of adenotonsillar hypertrophy and altered reflexes potentially leading to increased propensity for upper airway obstruction during sleep. Furthermore, the cumulative evidence supporting multiorgan morbidity for sleep-disordered breathing (SDB) is reviewed, and a unified hypothesis of a triple risk model proposing oxidative-inflammatory mechanisms as mediating the morbid consequences of SDB is presented. This hypothetical working model incorporates both dose-dependent disease severity components, as well as environmental and genetic elements of susceptibility.

Nasal stuffiness during pregnancy

OBJECTIVE

To investigate the occurrence of nasal stuffiness during pregnancy.

STUDY DESIGN

Prospective longitudinal study, with collection of data during 1 year in a cohort of 2,264 pregnant women.

METHODS

Self-reported nasal stuffiness in gestational weeks 12, 20, 30, and 36 was correlated to age, parity, body mass index, and smoking habits.

RESULTS

The prevalence of nasal stuffiness increased during pregnancy and occurred in 27% of the women at 12 weeks of gestation, in 37% at 20 weeks, in 40% at 30 weeks and in 42% at 36 weeks. Sixty-five percent of the women reported stuffiness at some time when asked. It was commoner in multiparous than in nulliparous women. Age, body mass index, and smoking habits were not associated with nasal stuffiness.

CONCLUSION

Self-reported nasal stuffiness for 3 or more weeks was common during pregnancy and could occur at any time in two thirds of the women. Treatment regimens to alleviate this symptom should be developed.

Relationship of nasal congestion with sleep, mood, and productivity

OBJECTIVE

To explore the impact of nasal congestion alone relative to a full set of allergic rhinitis (AR) symptoms on sleep, fatigue, daytime somnolence, and work and school productivity in a 15-day prospective, naturalistic study.

RESEARCH DESIGN AND METHODS

Patients (N = 404) received a clinical exam to confirm congestion and assess its possible causes, including confirmed allergic rhinitis. They completed a battery of patient-reported outcomes (PROs) that assess the impact of nasal congestion and morning AR symptoms on patients' reports of sleep, daytime sleepiness, fatigue, and work, school, and activity impairment. Data were analyzed using multiple regression. Each PRO was regressed separately on congestion and morning AR symptoms, controlling for patient demographics.

RESULTS

Nasal congestion has a significant (p < 0.05), negative impact on patients' lives. Nasal congestion alone had only a slightly smaller negative impact on sleep adequacy relative to AR symptoms more broadly (congestion: beta = 0.137-0.534; AR: beta = 0.123-0.642). Congestion increases the likelihood of sleep problems, fatigue, shortness of breath, headache, and daytime somnolence.

CONCLUSIONS

A single congestion item by itself is a statistically and substantively significant predictor of patient-relevant outcomes. Although the sample was not randomly drawn from clinics or physician offices, the consistency and strength of the findings suggest the salience of this single symptom for patients' experiences.

Anatomic correlates of normal and diseased adenoids in children

In order to better understand the pathogenesis and sequelae of obstructive adenoid hyperplasia in children, the anatomic relationships of the adenoids to the hard and soft palates, oropharynx, and nasopharynx were studied in vivo in 94 children. Direct, intraoperative palatal, nasopharyngeal, and oropharyngeal measurements were performed in 19 children with normal, nondiseased adenoids (controls [C]) and compared to 75 children undergoing adenoidectomy for obstructive adenoid hyperplasia (OAH) (n = 44) or chronic adenoid infection (CAI) (n = 31). As expected, the weight and volume of the adenoids removed were significantly greater in the OAH vs. CAI group (P < .001). Before adenoidectomy, the volume of the nasopharynx was significantly smaller in the OAH group; however, nasopharyngeal volumes after adenoidectomy were quite similar in all three groups and ranged from 5.4 to 6.2 cc. Only the change in the volume of the nasopharynx after adenoidectomy for obstruction was significant (2.5 +/- 1.2 cc, P < .01). Differences in oropharyngeal and palatal dimensions were not associated with longstanding obstruction from adenoid hyperplasia. These data indicate that the nasal obstruction from adenoid hyperplasia is due to an absolute increase in adenoid size rather than a relatively smaller nasopharynx. Differences in palatal and oropharyngeal dimensions usually described and attributed to longstanding nasal obstruction could not be demonstrated in this study.

Increased prevalence of perennial allergic rhinitis in patients with obstructive sleep apnea

BACKGROUND

Impaired nasal breathing is a risk factor for obstructive sleep apnea syndrome (OSAS).

OBJECTIVES

The aim of this study was to determine whether atopy to perennial allergens and existence of perennial allergic rhinitis was a risk factor for OSAS.

METHODS

In a case-control study, we compared the proportions of OSAS patients with atopy to perennial allergens and perennial allergic rhinitis to the proportions in patients with chronic obstructive pulmonary disease (COPD). Seventy-two OSAS patients (mean age 60.7 years; 79.4% male) and 44 COPD patients (mean age 63.6 years; 88.6% male) were selected from a hospital outpatients' clinic in Switzerland. All patients completed a respiratory symptom questionnaire, performed spirometry and had a skin prick test for atopy.

RESULTS

OSAS patients were significantly heavier than COPD patients (BMI 32.4 +/- (SD) 6.6 vs. 29.2 +/- 6.6 kg/m2, p = 0.04) and had a better lung function than COPD patients (FEV1% predicted 91.3 +/- 19.2 vs. 51.6 +/- 18.9%, p < 0.001). Patients with OSAS were more likely to be sensitized to perennial allergens such as house dust mite (23.6 vs. 4.5%, p = 0.009) and dog (18 vs. 4.5%, p = 0.04) than the COPD patients. Perennial allergic rhinitis (having nose problems [nasal obstruction and/or runny nose and/or sneezing] all year and being atopic to at least one perennial allergen) was reported in 11% of OSAS patients but in only 2.3% of COPD patients (p = 0.15).

CONCLUSION

We conclude that subjects with OSAS may have an increased risk of being allergic to perennial allergens and suffer from perennial rhinitis. Awareness of this risk may have important consideration in the clinical situation.

Acoustic Reflection for Nasal Airway Measurement in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome

STUDY OBJECTIVE

To measure nasal dimensions and explore relationships between these and patients' use of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).

DESIGN

Prospective single-blind study.

SETTING

A tertiary-care, sleep disorders referral center.

PATIENTS

Sixty OSAHS patients (52 men, mean age 51 years, body mass index (BMI) 36.1 +/- 9.4 kg/m2).

MEASUREMENTS

After in-vitro validation, acoustic reflection was used to measure the nasal minimal cross-sectional area (MCSA), mean area, and volume in OSAHS patients receiving CPAP treatment. Variables from sleep studies included the apnea-hypopnea index (AHI), titration pressure, and CPAP use (hours per night) after 3 months. Median MCSA was used to categorize subjects into small and large MCSA groups. Correlation and regression analyses were conducted to investigate the relationship between results of polysomnography and nasal acoustic reflection.

RESULTS

At baseline the small and large MCSA groups were not different (P > .05) in BMI, age, mask type, or previous nasal stuffiness, but there were more women in the smaller MCSA group (P = .02). CPAP use was significantly lower in the small MCSA group (P = .007), but apnea-hypopnea index and titration pressure were indistinguishable between the 2 groups. Furthermore, CPAP use correlated significantly and positively with MCSA (r = 0.34, P = .008), mean area (r = 0.27, P = .04), and volume (r = 0.28, P = .03). Step-wise multiple regression models revealed that MCSA was a predictor of the CPAP compliance (R2 = 0.16, P = .002), and MCSA (P = .001) and age (P = .04) were predictive factors of CPAP compliance (R2= 0.22). Nasal dimensions were not related to subjective nasal stuffiness.

CONCLUSIONS

CPAP use in patients with smaller nasal passages was lower than in those with larger passages. Objective measurement of nasal dimension may be more reliable than subjective self-report of nasal symptoms in identifying patients with OSAHS who might struggle with CPAP therapy.

How septum deformations in newborns occur

The authors have examined the nasal septum in 273 newborns. Nasal septal deformations have been divided into anterior, posterior and anterior-posterior groups. Newborns have been divided into age groups within 12-h time sections. The incidence of nasal septal deviations in the group of newborns born by spontaneous labour has been compared with the incidence of nasal septal deviations in the group of newborns born by Caesarean section. A much more frequent occurrence of anterior nasal septal deviation has been found in children born by spontaneous labour. It testifies to the importance of birth injury, which leads to anterior nasal septal deformation. The incidence of nasal septal deviations in the particular 12-h age groups has been compared. It has been proved by means of linear and exponential regression that the septum is straightened spontaneously in its anterior section during the first 3 days of life. Therefore a decision about surgical intervention should be taken in the case of older newborns.

A community based questionnaire study on the association between symptoms suggestive of otitis media with effusion, rhinitis and asthma in primary school children

OBJECTIVES

To evaluate the association between symptoms suggestive of otitis media with effusion (OME), rhinitis and asthma in an unselected population of primary school children and investigate whether our previous observation of such an association in a secondary care setting was valid in the community.

METHODOLOGY

A specifically designed questionnaire was administered to 332 new entrant primary school children across 11 state and independent primary schools in the East Berkshire district between March and June 1996. It had six sections, to ascertain symptoms suggestive of OME, rhinitis, asthma, other atopic features, treatment for any of these, and a possible family history of atopy. Within the first three sections, each question was scored and weighted depending on the importance of each in establishing the possible diagnoses, with three scoring bands: '0' indicating the absence; '1-5' the possibility and '> or =6' a strong likelihood that the above conditions were present. The outcome measures were the number of children with or without symptoms suggestive of OME, rhinitis, asthma, and the correlation of these symptom scores with each other and OME with eczema, other atopic manifestations, family history of atopy and educational system.

RESULTS

Thirty two point eight percent, thirty six point six percent and twenty four percent had symptoms suggestive of OME, rhinitis and asthma, respectively with scores of either 1-5 or > or =6. There was a highly significant correlation between otological (OME) and nasal scores (p=0.00000), particularly obstructive nasal symptoms (p=0.00000) and > or =6 upper respiratory tract infections/year (p=0.00000); otological and chest scores suggestive of asthma (p=0.00001), and a family history of asthma (p=0.00178). No association was found between scores for OME and eczema, urticaria, food or drug allergies. No differences were noted between the sexes or educational systems.

CONCLUSION

The highly significant association between the symptom scores suggestive of OME and rhinitis in this unselected population, indicates the importance of enquiring about nasal symptoms in children with chronic OME, as appropriate treatment of rhinitis may improve the child's quality of life, reduce health care utilisation and possibly reduce the need for OME surgery.

Perceived stress, common health complaints and diurnal patterns of cortisol secretion in young, otherwise healthy individuals

Research has frequently linked perceived stress with changes in subjective and objective measures of ill health; however, additional assessment should consider the physiological mechanisms mediating these effects. This study investigated whether differential patterns of cortisol secretion might partially mediate perceived stress related disparities in common health complaints in young, otherwise healthy individuals. To capture the kinds of health complaints commonly reported in this population, the Pennebaker Inventory of Limbic Languidness (PILL) was selected. To capture important parameters of the diurnal profile, cortisol was sampled at waking, 30 minutes post waking, 1200 h and 2200 h on three consecutive weekdays. Results revealed flatter diurnal cortisol slopes and elevated mean diurnal output (characterised by HPA hyperactivity in the evening) for participants in the higher stress group. Participants that reported higher perceived levels of stress also reported experiencing common health complaints with markedly greater frequency; however, these disparities were abolished when mean diurnal output of cortisol was statistically controlled. While dysregulation of basal HPA activity has been implicated in the aetiologies of chronic illness, findings reported here implicated hypersecretion of cortisol as one physiological pathway, partially mediating perceived stress related disparities in the kinds of common health complaints that typically affect young, otherwise healthy individuals.

The effect of adenotonsillectomy on children suffering from obstructive sleep apnea syndrome (OSAS): the Negev perspective

OBJECTIVE

To present the Negev perspective in recent decades as to the effect of adenotonsillectomy regarding clinical and polysomnographic features, cardiopulmonary morbidity, growth, neurocognitive function, health care services utilization, and enuresis by reviewing current related literature.

METHODS

All relevant published data by the Soroka University Medical Center and related community medical services were reviewed and compared to MEDLINE linked literature regarding aspects of childhood obstructive sleep apnea published through November 2005.

RESULTS

Published data support a significant effect of adenotonsillectomy on the associated co morbidities: adenotonsillectomy resulted in the reduction of pulmonary hypertension, improved growth as a result of an increase in growth hormone secretion, improvement of neurocognitive function to the normal range, reduction in nocturnal enuresis, as well as reducing general morbidities, as reflected by the reduction in health care utilization. However, there are still uncertainties relating to major aspects. There is no specific definition for OSAS grading, or for generating a guideline for surgical treatment and refinement of the indications of T&A.

CONCLUSIONS

Adenotonsillectomy has a beneficial effect on children with OSAS, however, further research is required before recommendations for the treatment of OSAS in children can be formulated.

Perioperative airway complications following pharyngeal flap palatoplasty

This study was performed to determine the incidence and types of perioperative airway complications after pharyngeal flap palatoplasty. We conducted a retrospective chart review of 88 patients who underwent correction of velopharyngeal insufficiency between April 30, 1983, and April 30, 1997, in a tertiary care hospital. Some degree of airway obstruction developed in 7 patients. One child developed laryngobronchospasm and required immediate endotracheal intubation. He was successfully extubated without sequelae. Another patient developed severe obstructive sleep apnea and required flap revision. A third patient was found asystolic and apneic. She was immediately intubated; however, she subsequently died. Two patients aspirated blood, presumably resulting in pneumonia. They were managed with parenteral antibiotics. Another child developed worsening sleep apnea and required flap revision. One patient developed nasal obstruction that resolved with time. Airway compromise in patients who undergo pharyngeal flap palatoplasty can be a potentially fatal complication. Careful surveillance should be maintained over patients with underlying neurologic, craniofacial, or cardiopulmonary disorders.

Prevalence of sinonasal symptoms in patients with HIV infection

Infection with the human immunodeficiency virus (HIV) is increasing in prevalence, and disease patterns are changing as patient survival lengthens. The purpose of this cross-sectional epidemiological study was to assess the prevalence and severity of self-reported symptoms of otolaryngologic disease in a group of patients attending a general HIV outpatient clinic (n = 203), and to compare the prevalence of self-reported symptoms with a sample of patients without HIV infection (n = 100). Of the HIV-infected patients, 65% of patients had AIDS, 35% were HIV-positive, and the median CD4 count was 135. Although only 11% of patients had seen an otolaryngologist in the prior 6 months, the majority of patients (66%) reported the presence of sinonasal disease during that time. Allergic rhinitis (80%) and sinusitis (54%) were the most commonly reported sinonasal symptoms, and 44% regularly used nasal or sinus medications. Sinonasal disease severity was significantly higher than the self-reported severity of mouth/throat disease (p = 0.01), ear disease (p = 0.03), and neck/salivary disease (p = 0.01). Although patients' self-reported overall health status was associated (p = 0.02) with CD4 count, the severity of sinonasal symptoms was not associated (p = 0.93) with CD4 count. Similarly, sinonasal symptom severity did not differ between HIV-positive and AIDS patients (p = 0.45). In other words, sinonasal disease severity did not improve as general health status improved.

Categorization of patients with allergic rhinitis: a comparative profile of "sneezers and runners" and "blockers"

BACKGROUND

The recent Allergic Rhinitis and Its Impact on Asthma (ARIA) workshop report classified patients into "sneezers and runners" and "blockers" and described a new disease severity categorization.

OBJECTIVE

To sketch the profile of these 2 groups and to evaluate the relevance of categorization.

METHODS

Patients were categorized as "sneezers and runners" (group 1) or "blockers" (group 2). The patients responded to a questionnaire that sought information on symptoms and associated factors. They were then categorized into seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR) groups and "intermittent" and "persistent" disease groups and compared.

RESULTS

A total of 114 patients (72 in group 1 and 42 in group 2) participated in the study. The significant features in group 1 were age at onset younger than 20 years (90%); birth date between June and September (61%); family history of atopy (88%); itching of skin (26%), eye (43%), ears (43%), and throat and palate (67%); and aggravation with dust (93%). History of breathlessness (90%), mouth breathing (81%), loss of smell (36%), and prior nasal surgery (31%) were significant in group 2. Significantly more patients in group 1 had SAR (54%) and moderate-severe intermittent disease (60%), whereas group 2 had PAR (81%) and mild persistent (69%) disease (P = .03). Patients classified as having SAR had intermittent disease (40, 83%) (P = .005), and those with PAR had persistent disease (51, 76%) (P < .001). Sixteen patients (24%) classified as having PAR were in the intermittent category, whereas 7 (17%) classified as having SAR were in the persistent category.

CONCLUSIONS

This study demonstrated that the 2 groups had distinct clinical profiles and that it is important to categorize patients, according to the ARIA report, into intermittent and persistent allergic rhinitis groups.

Influence of allergy on the symptoms and treatment of nasal polyposis

CONCLUSION

Allergy does not modify the symptoms of nasal polyposis, either initially or after a 1-year medical treatment.

OBJECTIVES

To assess the role of allergy in the symptoms and treatment of patients presenting with the diagnosis of nasal polyposis.

PATIENTS AND METHODS

Two simultaneous studies were carried out. In the first study, 180 consecutive patients with nasal polyposis (60% males, mean age = 48.4 years) were analyzed to detect whether the severity of their symptoms correlated with the presence of positive allergic tests. In the second study, 74 consecutive patients (57.5% males, mean age = 48.3 years) were analyzed to detect whether the results of a 1-year medical treatment of nasal polyposis were influenced by the presence of positive allergic tests (Phadiatop). Five nasal criteria were scored: nasal obstruction, anterior and posterior rhinorrhea, facial pain, and the loss of sense of smell. The frequency of asthma was evaluated. Treatment of nasal polyposis consisted of washing of the nasal cavities, steroid spray, and oral steroid administration. The amount of steroid consumption (prednisolone and beclomethasone) was studied.

RESULTS

In the first study, mean scores of nasal symptoms did not differ between the two groups of patients with and without allergy. The prevalence of asthma (p = 0.03) was higher in the group with than without allergy. In the second study, decrease of all nasal symptoms was not statistically different in the two groups. Cumulative consumption of prednisolone and beclomethasone between baseline and year 1 were similar in the two groups.

Prevalence of non-allergic nasal complaints in an urban and a rural population in Sweden

By questionnaire, 1469 randomly selected persons between 16 and 82 years of age were asked whether they had suffered from such nasal complaints as obstruction, sneezing and discharge, at least during the previous 6 months. Seventy-five per cent answered the questionnaire, two thirds of whom were city dwellers and one third lived in a rural district. No difference was found between the urban and the rural populations regarding the prevalence of symptoms. Twenty-one per cent suffered from non-allergic nasal complaints, and 5% from allergic nasal complaints. The prevalence of non-allergic nasal complaints was highest in the 20-30-year age group, and lowest in the 50-60-year age group. Contributory factors were of greater importance among the younger individuals than among the more elderly.

Endonasal geometry changes in elderly people: acoustic rhinometry measurements

BACKGROUND

Skeletal nasal changes in elderly people have been extensively investigated, but data on variation of the endonasal architecture with age do not exist. We evaluated endonasal parameters in an elderly population as compared with those in a young group.

METHODS

Acoustic rhinometry measurements were performed on 165 participants in the age range of 20-93 years. The rhinograms provided the endonasal volume from the nostril entrance to a 7.0 cm cephalic point (V0-7) and the minimal cross-sectional areas (MCA1 and MCA2). Statistical analysis was performed by Pearson correlation and one-way analysis of variance, using age as a continuous or categorical variable.

RESULTS

There was no statistical difference in gender distribution within each age group. The results obtained for the left and right nostrils were similar. Endonasal volume V0-7 and the narrowing areas MCA1 and MCA2 significantly increase with age, except for men over 80 years in which a relative decrease was observed.

CONCLUSION

Acoustic rhinometry examination of the endonasal architecture in a healthy young and elderly population demonstrated a gradual increase of endonasal volumes and minimal cross-sectional areas with age.