Effectiveness of individualised Homoeopathy in hypertrophied adenoids in pediatric population: A single-arm, prospective pilot study

IntroductionAdenoid hypertrophy is a condition that presents itself as the chronic enlargement of adenoid tissues; it is frequently observed in the pediatric population. The Ugrp2 gene, a member of the secretoglobin superfamily, encodes a low-molecular weight protein that functions in the differentiation of upper airway epithelial cells. However, little is known about the association of Ugrp2 genetic variations with adenoid hypertrophy.ObjectiveThe aim of this study is to investigate the association of single nucleotide polymorphisms in the Ugrp2 gene with adenoid hypertrophy and its related phenotypes.MethodsA total of 219 children, comprising 114 patients suffering from adenoid hypertrophy and 105 healthy patients without adenoid hypertrophy, were enrolled in this study. Genotypes of the Ugrp2 gene were determined by DNA sequencing.ResultsWe identified four single nucleotide polymorphisms (IVS1-189G>A, IVS1-89T>G, c.201delC, and IVS2-15G>A) in the Ugrp2 gene. Our genotype analysis showed that the Ugrp2 (IVS1-89T>G) TG and (c.201delC) CdelC genotypes and their minor alleles were associated with a considerable increase in the risk of adenoid hypertrophy compared with the controls (p = 0.012, p = 0.009, p = 0.013, and p = 0.037, respectively). Furthermore, Ugrp2 (GTdelCG, GTdelCA) haplotypes were significantly associated with adenoid hypertrophy (four single nucleotide polymorphisms ordered from 5′ to 3′; p = 0.0001). Polymorfism–Polymorfism interaction analysis indicated a strong interaction between combined genotypes of the Ugrp2 gene contributing to adenoid hypertrophy, as well as an increased chance of its diagnosis (p < 0.0001). In addition, diplotypes carrying the mutant Ugrp2 (c.201delC) allele were strongly associated with an increased risk of adenoid hypertrophy with asthma and with allergies (p = 0.003 and p = 0.0007, respectively).ConclusionSome single nucleotide polymorphisms and their combinations in the Ugrp2 gene are associated with an increased risk of developing adenoid hypertrophy. Therefore, we tried to underline the importance of genetic factors associated with adenoid hypertrophy and its related clinical phenotypes.

The recent study by Yang et al 1 published in the Journal of Nat Sci Sleep has aroused my great interest. While Obstructive Sleep Apnea (OSA) has traditionally considered more prevalent in adults, recent research has revealed the alarming prevalence of OSA in the pediatric population. This study delved into the prevalence, severity, and associations between OSA and diverse conditions in the pediatric population, presenting timely and significant findings. While we commend the study for its valuable contribution, we offer some constructive suggestions for further improvement. In the study, 70.28% of children with OSA had a BMI < =18.5. Children with low BMI exhibited higher rates of OSA. This statistical outcome may appear contrary to the common understanding of the relationship between obesity and OSA, as it is generally believed that obesity (higher BMI) is more directly related to OSA. 2 Considering that this finding may have an important impact on the diagnosis and treatment strategies of Pediatric OSA, it is important to delve into the author's detailed methods and data processing procedures for statistical analysis. First, more detailed data analysis. The article could further analyze the differences between Pediatric OSA patients with lower BMI and those with higher BMI. This includes delving deeper into aspects of OSA's severity, accompanying conditions, and age, gender, etc. to determine whether there are other variables (such as tonsil enlargement, adenoid hypertrophy, etc.) that may influence this association. Second, Research can conduct subgroup analysis according to factors such as age, gender, region, etc., to observe whether the relationship between BMI and OSA is more significant in certain subgroups. The study has revealed that OSA has high severity in the ages of 3 to 12 years, peaking between 4 to 8 years, and declining after 12 years. 1 Further study on whether there are other influencing factors in children with low BMI or younger children (such as tonsil hypertrophy, adenoid hypertrophy, etc). Because there is evidence that obesity and adenoid hypertrophy are the two main established risk factors for Pediatric OSA, with the contribution of adenoidal size in younger children and excess weight is more important in adolescence (ie, older than 12 years). 2 Further analysis of the relationship between age groups and different risk factors could provide a more comprehensive understanding of OSA. Even children with lower body weight should be risk assessed and monitored for OSA, instead of low BMI having higher OSA. Third, the article conducted univariate statistical tests, such as the chi-square test, to study the association between OSA and other coexisting conditions. Considering the complexity of OSA and potential interactions with multiple factors, we recommend the use of more complex statistical models such as multivariable regression analysis. This can better handle the independent association strength between a specific coexisting condition and OSA while accounting the influence of other relevant variables (such as age, gender, adenoid hypertrophy, rhinitis, asthma, etc). Fourth, the potential confounding factors. The study has commendably analyzed the role of allergic rhinitis, tonsillar hypertrophy, adenoid hypertrophy, and obesity as a potential risk factor for Pediatric OSA events, contributing to a more nuanced understanding of this complex sleep disorder. However, it is essential to consider other potential confounders such as gender, nocturnal enuresis, otitis media, economic, regional and other factors to enhance the robustness of the

Adenoidal hypertrophy (AH) is a common disorder in the pediatric population, with common symptoms including mouth breathing, nasal congestion, hyponasal speech, snoring and obstructive sleep apnea. Although the pathogenesis of AH has not been fully elucidated, recent studies have indicated that immune responses may play an important role in AH. Tumor necrosis factor‐alpha (TNF‐α)‐induced protein‐8 like‐2 (TIPE2) is a newly identified protein that negatively regulates the activation of inflammatory pathways. Here, we investigated the effect of TIPE2 in AH in children. We observed that the levels of TNF‐α and interleukin‐6 were greater in the adenoid tissue of AH children than in healthy control subjects (P < 0.01), and this increase was positively correlated with the severity of AH. The level of TIPE2 expression was decreased compared with control and was negatively correlated with AH. TIPE2 overexpression in primary human monocytes (isolated from adenoid tissue of children with AH) inhibited the activation of nuclear factor‐κB and the expression of TNF‐α and interleukin‐6. These results suggest that overexpression of TIPE2 may attenuate AH through inactivation of the nuclear factor‐κB signaling pathway.

Adenoid hypertrophy (AH) is chronic enlargement of the adenoid tissue. The pathophysiology of the disease is unclear. We analyzed SCGB1D4 gene polymorphisms in order to determine the effect of the variants or their genetic combinations on AH. We genotyped the SCGB1D4 (IIS) gene in 167 participants (95 children with AH and 72 controls) by performing DNA sequencing in blood samples. We genotyped three single nucleotide polymorphisms (SNPs). In the analysis, we found that in the presence of those SNPs and the minor alleles of individual SNPs four haplotypes were associated with an increased risk of AH. In addition, those SNPs were significantly associated with asthma, allergy, sleep-disordered breathing, AH grade +4, and a high level of IgE. As indicated on multifactor dimensionality reduction analysis, single-locus (rs35328961), two-locus (rs35328961_rs56196602), and three-locus models (rs200327820_rs35328961_rs56196602) had the highest synergistic interaction effect on AH. The three-factor model was also significantly associated with some genotypes of rs35328961 and allergic-asthmatic AH. SNPs of SCGB1D4 and their combinations are associated with an increased risk for developing AH. We highlighted the importance of genetic factors on AH and AH-related clinical phenotypes.

Occult supraglottic lymphatic malformation presenting as obstructive sleep apnea

ABSTRACTBackgroundSnoring and OSA is very commonly seen among the pediatric population, most commonly due to adenoid and tonsil hypertrophy which requires adenotonsillectomy. The effect of this surgery on the immunity is controversial. This study was planned to see any alternative therapy which can delay or avoid the surgery by providing symptomatic relief to the patient.ObjectiveTo see the effect of intranasal mometasone on nasal obstruction due to adenoids, hence relieving the OSA and snoring.DesignProspective and observational study.Materials and methodsFifty-five children having snoring and or OSA due to adenoids were given intranasal mometasone. The symptoms before and after treatment were compared using OSA 18 questionnaire.ResultsThere was significant improvement in all the domains of OSA 18. The average total score showed improvement from 56.33 to 51.51 which is significant (p &lt; 0.001).ConclusionThe use of intranasal steroids is easy and effective method to improve nasal obstruction, snoring and OSA among children having adenoid hypertrophy.How to cite this articleGupta V, Gupta M, Matreja PS, Singh S. Efficacy of Mometasone Nasal Spray in Children with Snoring due to Adenoids. Clin Rhinol An Int J 2014;7(1):1-4.

BackgroundAllergic rhinitis (AR) and adenoidal hypertrophy (AH) are the most frequent causative disorders of nasal obstruction in children, leading to recurrent respiratory infections. Both nasal cavities are colonized by a stable microbial community susceptible to environmental changes and Staphylococcus aureus seems to play the major role. Furthermore, nasal microbiota holds a large number and variety of viruses with upper respiratory tract infections. This local microbiota deserves attention because its modification could induce a virtuous cross-talking with the immune system, with a better clearance of pathogens. Although AR and AH present a different etiopathogenesis, they have in common a minimal chronic inflammation surrounding nasal obstruction; hence it would be challenging to evaluate the effect of an immunomodulator on this minimal chronic inflammation with possible clinical and microbiological effects. The aim of this study is therefore to evaluate the efficacy of an immunomoldulator (Pidotimod) on nasal obstruction in children with AR and/or AH and whether its action involves a variation of nasal microbiota.MethodsWe enrolled 76 children: those with allergic rhinitis (AR) sensitized to dust mites entered the AR group, those with adenoidal hypertrophy (AH) the AH group, those with both conditions the AR/AH group and those without AR ± AH as controls (CTRL). At the first visit they performed: skin prick tests, nasal fiberoptic endoscopy, anterior rhinomanometry, nasal swabs. Children with.AR ± AH started treatment with Pidotimod.After 1 month they were re-evaluated performing the same procedures.The primary outcome was the evaluation of nasal obstruction after treatment and the secondary outcome was the improvement of symptoms and the changes in nasal microflora.ResultsAll patients improved their mean nasal flow (mNF) in respect to the baseline. In AR children mNF reached that one of CTRL. In AH children±AR the mNF was lower in respect to CTRL and AR group. We did not find any differences among all the groups at the two different time points in nasal microflora.ConclusionsPidotimod is able to give an improvement in nasal obstruction, especially in AR children but this effect seems to be not mediated by changes in nasal microbiota.

Adenoid hypertrophy (AH) is characterized by pathological hyperplasia of the nasopharyngeal tonsils, a component of Waldryer’s ring, which represents the first immune defense of the upper respiratory tract. The pathogenic factors contributing to AH remain to be comprehensively investigated to date. Although some studies suggest that environmental exposure to smoke and allergens, respiratory tract infections, and hormonal influences likely contribute to the development of AH, further research is necessary for fully elucidating the effects of these factors on the onset and progression of AH. AH is the most common cause of airway obstruction in the pediatric population, with a prevalence rate of 49.7%, and is frequently accompanied by various comorbidities. These patients often present with distinctive dental characteristics, including increased overjet, posterior crossbite, a high palatal plane, narrow dental arches, and facial features characterized by disproportionate alterations in facial height, commonly referred to as “adenoid facies.” Individuals with adenoid facies frequently display abnormal breathing patterns, especially mouth breathing. The present review summarizes the findings of research articles sourced from PubMed, IEEE, and Web of Science over the last 20 years up to September 2024. Several high-quality studies screened using the PICOPS framework reported that perioral muscle dysfunction, dental and skeletal malocclusions, and upper airway obstruction caused by AH are interdependent issues and mutually exacerbate one another. The review summarizes the potential associations and mechanisms linking AH, mouth breathing, and the subsequent development of adenoid facies in children.

Ear, nose and thorat disorders in pediatric patients at a rural hospital in Senegal

Introduction: Adenoid hypertrophy is one of the most common conditions encountered by Ear, Nose and Throat (ENT) surgeons in the paediatric age group. Clinical assessment of adenoid hypertrophy is the first step, but to confirm the degree of adenoid hypertrophy, both X-ray soft-tissue neck and endoscopy are needed. Aim: To correlate the clinical grading of adenoid hypertrophy with endoscopic and radiological findings. Materials and Methods: This was a hospital-based cross- sectional analytical study conducted at Chhatrapati Shivaji Subharti Hospital Meerut, Uttar Pradesh, India from August 2023 to January 2024. A total of 50 children aged between 4 and 15 years, who presented to the outpatient department of ENT with signs and symptoms of adenoid hypertrophy, were evaluated. These children underwent clinical evaluation, followed by endoscopy and X-ray lateral view of the soft-tissue neck. Adenoid hypertrophy was graded clinically, endoscopically and radiologically. Statistical analysis was performed using Kendall’s tau correlation analysis. Results: In the study population, the majority of children 17 (34%) were between the ages of 7 and 9 years, with a male predominance of 32 (64%). Grade-3 adenoid hypertrophy was the most common finding, observed in 21 (42%) based on clinical grading, 26 (52%) on endoscopy, and 19 (38%) on X-ray lateral view of the soft-tissue neck. There was a strong correlation between endoscopic and clinical grading (p-value=0.001), and the correlation between radiological and endoscopic grading was highly significant (p-value=0.001). Clinical grading and radiological findings also showed a significant correlation (p-value=0.002). Conclusion: All three modalities of adenoid grading are correlated and reliable. They can be used in different combinations for grading adenoid hypertrophy and determining the management plan.

Adenoidal hypertrophy (AH) and adenotonsillar hypertrophy are common disorders in the pediatric population and can cause symptoms such as mouth breathing, nasal congestion, hyponasal speech, snoring, and obstructive sleep apnea (OSA), as well as chronic sinusitis and recurrent otitis media. More serious long-term sequelae, typically secondary to OSA, include neurocognitive abnormalities (e.g. behavioral and learning difficulties, poor attention span, hyperactivity, below average intelligence quotient); cardiovascular morbidity (e.g. decreased right ventricular ejection fraction, left ventricular hypertrophy, elevated diastolic blood pressure); and growth failure. Adenoidectomy (with tonsillectomy in cases of adenotonsillar hypertrophy) is the typical management strategy for patients with AH. Potential complications have prompted the investigation of non-surgical alternatives. Evidence of a pathophysiologic link between AH and allergy suggests a possible role for intranasal corticosteroids (INS) in the management of patients with AH. This article reviews the epidemiology and pathophysiology of AH with a particular focus on evidence of its association with allergy and allergic rhinitis. Current treatment options are briefly considered with discussion on the rationale and evidence for the use of INS.

Background: Chronic otitis media with effusion (COME) and adenoid hypertrophy (AH) are common entities in the pediatric population. The conventional treatment approach (conventional medicine; COM) involved mainly surgery after a period of close observation. In this study, we aimed to introduce an integrative, non-invasive approach (integrative medicine; IM) for COME, AH, and associated episodes of recurrent acute otitis media, and compared outcomes with conventional treatment. Methods: We conducted a prospective, non-randomized study in an integrative primary care pediatric practice and a conventional pediatric otolaryngological clinic, where treatment modality was determined by patient preference. Out of a total 101 patients aged 1-8 years, integrative therapy was chosen by 46, and conventional treatment by 55. All patients had COME and AH diagnosed by an otolaryngologist and had moderate to severe hearing impairment. COM treatment was based on close observation over time, nasal decongestants and surgical intervention. In contrast, the IM involved a complex personalized approach with non-invasive interventions, non-allopathic medications, diet and patient education. Results: The number of surgical interventions (adenoidectomy, pressure-equalization tube insertion, myringotomy) was significantly less in the IM cohort (1 of 28 vs. 15 of 35 in the COM group, p < 0.001). The frequency of antibiotic use was significantly less in the IM group (p < 0.001). The frequency of analgesic use was also significantly less in the IM group (p = 0.029). Improvement in tympanometric measures (normal A-type curve) was higher in IM patients compared to expected spontaneous remission during the observation period. Improvement in audiometric measures (intact hearing) of IM patients was also higher than expected compared to spontaneous remission during the observation period. Conclusion: Compared to conventional treatment, integrative treatment of patients with COME and AH showed significantly lower invasive surgical intervention rates and significantly decreased antibiotic and analgesic use. The integrative treatment was effective, safe and well tolerated.

Background: Adenoidal hypertrophy (AH) is a common disorder in pediatric population with severe complications due to nasal air way obstruction. Adenoidectomy is a choice treatment for children with severe symptoms due to AH; however, it is accompanied by several side effects such as complication of surgery and emotional distress. We evaluated the efficacy of intranasal corticosteroid therapy in size and symptoms of Adenoid Hypertrophy especially in atopic patients.&#x0D; Methods: In this clinical trial 45 children aged 2 to 14 years old with AH were enrolled. All of them underwent 8-week course of intranasal Fluticasone therapy and their symptoms before and after treatment were scored and compared by questionnaires. Also they were divided into Atopic and non- Atopic groups based on history, physical examination and positive skin prick test. Then the two groups were compared after the treatment according to their response to therapy.&#x0D; Results: After 8 weeks’ treatment with intranasal corticosteroid, improvement in all symptoms score of AH including (Snoring, Sleep Apnea, Mouth breathing and Nasal congestion) was statistically significant (P = 0.000). The improvement in clinical symptoms of AH after treatment was observed in 92% of atopic patients in comparison with non-atopic patients was 50%, which was also statistically significant (P = 0.024).&#x0D; Conclusion: Our study demonstrated that 8-week intranasal corticosteroid was associated with a decrease in size of AH and all symptoms of obstruction. As a result, it can be suggested that intranasal corticosteroid therapy can prevent adenoidectomy especially in atopic patients.

Adenoid hypertrophy (AH) is a common condition among pediatric and adolescent populations. The clinical diagnosis primarily relies on rhinoscopy, with a notable absence of noninvasive early diagnostic methods. This study sought to identify potential biomarkers to facilitate the early diagnosis of AH. Ultra-high-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UHPLC-Q-TOF-MS/MS) was employed to analyze and compare urine samples from 40 patients with AH and 30 healthy controls. To validate and enhance the findings from untargeted metabolomics, targeted metabolomics was conducted using UHPLC-QqQ-MS/MS, aiming to elucidate the relationship between AH and metabolic pathways. The untargeted metabolomics analysis, utilizing multivariate techniques, identified significant differences in the levels of 20 endogenous metabolites in urine samples between the AH and healthy groups. Further investigation of metabolic pathways indicated that sphingolipid and riboflavin metabolism are implicated in the pathogenesis of AH. Riboflavin and phytosphingosine were identified as potential biomarkers using targeted metabolomics. In this study, a comprehensive approach involving both untargeted and targeted metabolomics was employed to investigate diagnostic biomarkers of AH. The abnormal expression levels of riboflavin and phytosphingosine may be related to inflammation, oxidative damage, and immunomodulatory dysfunction in the pathogenesis of AH. The results showed that the identified biomarkers may serve as a novel tool for early diagnosis and tracking of disease progression.

Adenoid hypertrophy (AH) is an extremely common condition in the pediatric and adolescent populations that can lead to various medical conditions, including acute rhinosusitis, with a percentage of these progressing to chronic rhinosinusitis (CRS). The relationship between AH and pediatric CRS has been extensively studied over the past few years and clinical consensus on the treatment has now been reached, allowing this treatment to become the preferred clinical practice. The purpose of this study is to review existing literature and data on the relationship between AH and CRS and the options for treatment. A systematic literature review was performed using a search line for “(Adenoiditis or Adenoid Hypertrophy) and Sinusitis and (Pediatric or Children)”. At the end of the evaluation, 36 complete texts were analyzed, 17 of which were considered eligible for the final study, dating from 1997 to 2018. The total population of children assessed in the various studies was of 2371. The studies were categorized as surgical-observational, microbiological, genetic-immunological, and radiological. The analysis of the studies confirms the relationship between AH and CRS and supports the existing consensus on medical and surgical therapy. Furthermore, these studies underline the necessity to adapt medical and surgical treatment considering age, comorbidities including asthma and, if present, the Computed Tomography (CT) score.