Adenoid Hypertrophy In Children Research Articles

The role of adenoid immune phenotype in polysensitized children with allergic rhinitis and adenoid hypertrophy.

There is increasing interest in elucidating the relationship between adenoid hypertrophy (AH) and allergic rhinitis (AR). However, the impact of aeroallergen sensitization patterns on children with AH and AR remains unclear. Patients aged 2-8 years (recruited from January 2019 to December 2022) with nasal symptoms were assessed for allergies, adenoid size, and respiratory viral infection history. The serum total immunoglobulin E (IgE) and specific IgE levels were measured, and flexible nasal endoscopy was performed. The relationship between AH, aeroallergen sensitization patterns, and lymphocyte subpopulations in adenoid samples was analyzed using flow cytometry. In total, 5281 children were enrolled (56.5% with AR; and 48.6% with AH). AH was more prevalent in children with AR. Compared to nonsensitized individuals, those polysensitized to molds had a higher prevalence of AH (adjusted OR 1.61, 95% CI 1.32-1.96) and a greater occurrence of two or more respiratory viral infections, particularly in adenoidectomy patients. The percentages and corrected absolute counts of regulatory T (Treg) cells, activated Tregs, class-switched memory B cells (CSMBs), natural killer (NK) T cells, and NK cell subpopulations were reduced in the adenoid tissues of children with both AH and AR (AH-AR) compared to AH-nAR children. Polysensitization in AH-AR children correlated with lower CSMB percentages. Polysensitivity to molds is associated with an increased risk of AH in children with AR. Fewer B cells, NK cells, and Treg cells with an effector/memory phenotype were detected in the adenoids of AR children, and these lower percentages of immune cells, particularly CSMBs, were closely linked to aeroallergen sensitization models and respiratory viral infection.

Risk Factors, Clinical Profile and Association of Clinical Grading With Radiological Grading of Adenoid Hypertrophy in Children

BACKGROUND: Adenoid hypertrophy producing obstructive airway symptoms is the most commonly encountered pediatric ENT problem. Clinical symptoms in combination with lateral nasopharyngeal x ray is a reliable technique for selection of children requiring surgical intervention. METHODOLOGY: The current cross sectional prospective study was conducted among 250 children aged 3-12 years with clinical symptoms and radiological evidence suggestive of enlarged adenoids, at Pediatric outpatient department of a tertiary care center, Dhaka, during 1-year period. RESULT: In our current study, majority children (74%) with adenoid hypertrophy were 3-6 years old followed by 26% between 7-12 years. 66% children were male and 34% were female with a male to female ratio of 1.9:1. 44% children were from lower class family and history of atopy was present among 54% children. Clinical grading of adenoid hypertrophy was done on the basis of presenting symptoms (mouth breathing, snoring, sleep disturbances and adenoid facies) and radiological grading was done from calculating adenoid nasopharyngeal ratio. Correlation between clinical scoring and radiological grading of adenoid hypertrophy among study population was observed. Clinical score of 0-4, 5-8, 9-12 and 13-16 was graded clinically into Grade I, II, III and IV respectively. Highly significant p value (.000) was observed in Grade II clinical and radiological grade of enlarged adenoid. The remaining clinical and radiological grade of enlarged adenoids showed significant p value .031, .024 and .019 among grade I, III and IV respectively. CONCLUSION: Though various diagnostic modalities for detection of degree of obstruction caused by enlarged adenoids are available, clinical scoring in combination with radiological grading can be effectively used to select patients requiring surgical intervention for pediatric adenoid hypertrophy. J Shaheed Suhrawardy Med Coll 2022; 14(2): 11-17

The effects of adenoid hypertrophy and oral breathing on maxillofacial development: a review of the literature.

According to modern epidemiological surveys, the prevalence of adenoid hypertrophy in children and adolescents ranges from 42% to 70%. Adenoid hypertrophy can lead to airway obstruction; thus forces a child to breathe through their mouth, thus affecting the normal development of the dental and maxillofacial area, and can lead to malocclusion. Long-term mouth breathing can cause sagittal, vertical and lateral changes in the maxillofacial area. In this article, we review the current research status relating to the association between adenoid hypertrophy, oral breathing and maxillofacial growth and development in children and adolescents. We also discuss the personalized formulation of treatment plans.

Effects of oral cysteine leukotriene receptor antagonist-montelukast on adenoid lymphoid tissue: a histopathological study under light microscope.

Background: Adenoidal hypertrophy (AH) is one of the most common causes of upper airway obstruction in children. Drug and surgical treatment are the typical treatment of AH. The study on the inflammatory mechanism of AH in children provides a new idea for preoperative intervention and non-surgical treatment with anti-inflammatory drugs such as montelukast sodium (a cysteine leukotriene receptor antagonist). The aim of this study is to evaluate the effect of montelukast sodium on adenoidal lymphoid tissue pathology in children with AH under light microscope. Objective: To study whether there is any change in pathology of the adenoidal lymphoid tissue under the light microscope compared with the control group in children with moderate to severe simple AH treated with montelukast sodium for 1month before operation. Materials and methods: Twenty patients (8 males, 12 females, 3-8 years old) with moderate to severe AH who were prepared for surgical treatment were selected. All the patients were examined by Nasopharyngeal CT and hemocyte analysis before operation. 20 subjects were randomly divided into two groups: One group was given montelukast chewable tablets 5mg/d, qn, for 4 weeks; The control group was given placebo 5mg/d, qn, for 4 weeks. After 4 weeks, the adenoids were removed and examined histopathology. Results: Compared with the control group, the number of lymphocytes in the blood cell analysis of the study group was significantly reduced, with a statistically significant difference (p < 0.05). And the number of germinal centers in adenoid tissue of the study group was relatively reduced, no small cyst was found in the epithelium, and the degree of inflammatory cell infiltration was reduced, with a statistically significant difference (p < 0.05). Conclusion: Montelukast can reduce the number of reactive cells, the number of lymphocytes in blood cells and blood vessels in adenoid lymphoid tissue, which can provide a new idea for preoperative intervention and non-surgical treatment of adenoid hypertrophy in children. However, this is only a pilot study and a longer treatment period is needed to assess the long-term effects of montelukast sodium on adenoid lymphoid tissue. Clinical Trial Registration: www.Chictr.org.cn, identifier ChiCTR2300075040.

Automatic detection of adenoid hypertrophy on cone-beam computed tomography based on deep learning

This study proposed an automatic diagnosis method based on deep learning for adenoid hypertrophy detection on cone-beam computed tomography. The hierarchical masks self-attention U-net (HMSAU-Net) for segmentation of the upper airway and the 3-dimensional (3D)-ResNet for diagnosing adenoid hypertrophy were constructed on the basis of 87 cone-beam computed tomography samples. A self-attention encoder module was added to the SAU-Net to optimize upper airway segmentation precision. The hierarchical masks were introduced to ensure that the HMSAU-Net captured sufficient local semantic information. We used Dice to evaluate the performance of HMSAU-Net and used diagnostic method indicators to test the performance of 3D-ResNet. The average Dice value of our proposed model was 0.960, which was superior to the 3DU-Net and SAU-Net models. In the diagnostic models, 3D-ResNet10 had an excellent ability to diagnose adenoid hypertrophy automatically with a mean accuracy of 0.912, a mean sensitivity of 0.976, a mean specificity of 0.867, a mean positive predictive value of 0.837, a mean negative predictive value of 0.981, and a F1 score of 0.901. The value of this diagnostic system lies in that it provides a new method for the rapid and accurate early clinical diagnosis of adenoid hypertrophy in children, allows us to look at the upper airway obstruction in three-dimensional space and relieves the work pressure of imaging doctors.

Mometasone Furoate Use for Recurrent Adenoid Hypertrophy: Randomized Controlled Clinical Trial.

Background& Objective: Adenoid hypertrophy (AH) in children is one of the most causes of nasal obstruction and is associated with many nasal and respiratory symptoms. Till now, surgery is the main option for managing the associated symptom of AH. The intranasal steroid has an effective role in the control of allergic rhinitis and associated AH. This work aimed to assess the effects of local mometasone on recurrent AH in children. Patients& Methods: A randomized controlled trial enrolled 39 patients aged between 2 and 15 years with recurrent AH. Those patients were randomly subdivided into three groups; group (A) received topical mometasone furoate (MF), group (B) did not receive any medication, and group (C) received topical normal saline. All groups were followed up for 8 weeks. Results: Patients who received Mometasone furoate had temporary relief of adenoid hypertrophy-related symptoms (84.6%) in comparison to the control group and placebo group during the duration of treatment. After cessation of treatment with local steroids, all cases experienced symptoms caused by adenoid hypertrophy, and by the end of the third month of follow up all cases underwent adenoidectomy. Conclusion: Mometasone furoate can temporarily reduce the adenoid size, reducing symptoms related to adenoid hypertrophy.

&lt;i&gt;G-1082A&lt;/i&gt; IL-10 polymorphism as a predictor of adenoid hypertrophy in children with human herpes virus

Introduction. Adenoid hypertrophy (pharyngeal tonsil hypertrophy) is considered as one of the most common diseases of the ENT organs.Aim. To study the polymorphism of the IL-10 gene (interleukin 10) and infections caused by human herpesvirus 6 (HHV6), cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in children with AH.Materials and methods. The study included 106 children with adenoid hypertrophy and 38 healthy children aged 2 to 11 years. All children with adenoid hypertrophy were divided into three subgroups depending on the size of the pharyngeal tonsil. Viruses were determined by real-time quantitative polymerase chain reaction (PCR).Results. In patients with AH, HHV6 was detected more often than in CMV and EBV. Among the three subgroups of children with HGM, HHV6 and EBV infections prevailed in children with the maximum degree of pharyngeal tonsil hypertrophy. The frequency of the GG genotype was higher in the control group of children. Significantly higher frequencies of the G allele and GG and GA genotypes for IL-10 rs1800896 were found in the subgroup of children with the smallest size of the pharyngeal tonsil compared to other subgroups.Discussions. The frequencies of HHV-6 and CMV in the control group are significantly different. HHV-6 was the most frequently detected virus in patients with HGM compared with CMV and EBV. The frequency of the GG genotype was in the control group of children. A significantly higher frequency of the G allele and GG genotypes was found in the first subgroup of children compared to the second and exclusive subgroups. We found a lower frequency of the G allele and GG and GA genotypes in a significant subgroup of children compared to the second subgroup. Previous studies show a significant increase in the frequency of the A allele and the AA and IL-10 genotypes (rs1800896-1082G/A) in patients resistant to HHV-6 and CMV infections compared to those infected.Conclusions. The presence of HHV-6 and CMV infections contributes to the development of pharyngeal tonsil hypertrophy, and HHV-6 and EBV may contribute to the size of the pharyngeal tonsil.

Evaluation and grading progression of adenoid hypertrophy in children

儿童睡眠呼吸暂停患病率高，而腺样体和/或扁桃体肥大是造成其发生上气道阻塞的主要原因。临床上，对于扁桃体有明确的分级标准，但对于腺样体的分级标准尚未能统一。本文对内镜及影像学这2类分级方法的发展演进及新进展进行归纳总结，分析对比两者的优势与不足，探讨各种评估体系对于疾病转归及干预的指导意义。.

Role of neck radiography in assessing recurrent/residual adenoid hypertrophy in children with OSA and history of adenotonsillectomy: a sleep physician perspective.

Recurrent/residual adenoid hypertrophy after adenotonsillectomy in children can result in obstructive sleep apnea (OSA). We aimed to assess the role of soft tissue neck X-ray (STN-XR) in evaluating recurrent/residual adenoid tissue hypertrophy. This was a single-center retrospective study that included children with sleep study-confirmed OSA and a known history of adenotonsillectomy who underwent STN-XR to evaluate for recurrent/residual adenoid tissue hypertrophy. STN-XR nasopharyngeal obliteration and baseline polysomnographic data were analyzed. Multiple linear regression was used to assess the independent relationship between the results of STN-XR and the total apnea-hypopnea index, while controlling for relevant characteristics. The study included 160 participants with a median age of 10 years (quartile [Q] 1 = 7, Q3 = 12.25). More than half of the children were male (59.4%) and the median body mass index z-score was 2.11 (Q1 = 1.23, Q3 = 2.54). STN-XR was normal in 39.4%, and it showed mild, moderate, and complete nasopharyngeal obliteration in 20.6%, 32.5%, and 7.5% of the participants, respectively. Multiple regression analysis showed that moderate and complete nasopharyngeal obliteration was associated with an increase in the mean total apnea-hypopnea index by 109% (P = .0002) and 185% (P = .001), respectively, when compared with children without nasopharyngeal obliteration. However, mild nasopharyngeal obliteration, body mass index z-score, age, sex, and race were not significantly associated with an increase in the total apnea-hypopnea index. STN-XR was useful in assessing recurrent/residual adenoid tissue hypertrophy in children with OSA and a history of adenotonsillectomy. Moderate and complete nasopharyngeal obliteration were associated with significantly increased apnea-hypopnea index. Pediatric sleep physicians may consider STN-XR in the evaluation of children with OSA and previous history of adenotonsillectomy. Senthilvel E, Nguyen QL, Gunaratnam B, Feygin YB, Palani R, El-Kersh K. Role of neck radiography in assessing recurrent/residual adenoid hypertrophy in children with OSA and history of adenotonsillectomy: a sleep physician perspective. J Clin Sleep Med. 2023;19(6):1027-1033.

Topical nasal steroid for management of adenoid hypertrophy in children

Topical nasal steroid for management of adenoid hypertrophy in children

Efficacy of Topical Azelastine and Fluticasone Dipropionate Combination in Children With Adenoid Hypertrophy.

Adenoid hypertrophy (AH) is one of the common childhood diseases. Surgical and non-surgical treatment of AH in children is planned according to the severity of symptoms and associated complications. In recent years, treatment methods with intranasal sprays have been reported quite frequently in uncomplicated cases. We aim to evaluate the effectiveness of a new combination of azelastine - fluticasone (AZE-FLU) (137mcg azelastine and 50mcg fluticasone) nasal spray in children with uncomplicated AH. Sixty-five children diagnosed with AH were included in the study. The mean age of the children was 7.42 ± 2.26 (4-13years). The cohort consisted of 29 males and 36 females. All children were evaluated clinically and endoscopically. AZE-FLU nasal spray was applied to both nostrils twice a day for three months. Adenoid/choana ratio and symptom scores were evaluated before treatment and at the end of the 12th week. At the end of 24weeks of AZE-FLU application, there was a statistically significant decrease in both adenoid/choana ratio and symptom scores. While the initial adenoid/choana (A/C) score was 3.57 ± 0.58, it decreased to 1.74 ± 0.61 following treatment. A dramatic decrease in total symptom scores was observed. The total symptom score average was 15.63 ± 1.28 before treatment, while it was 2.31 ± 1.4 after the treatment with the difference being statistically significant (P < .01). In this study, the effectiveness of AZE-FLU nasal spray on AH was investigated for the first time. This treatment provides an effective alternative to the surgical approach in children with uncomplicated adenoid hypertrophy. Using this protocol, 96% of patients were removed from the surgery list. is IV.

Effectiveness of Evaluation of Adenoid Hypertrophy in Children by Flexible Nasopharyngoscopy Examination (FNE), Proposed Schema of Frequency of Examination: Cohort Study.

Objectives: To demonstrate the effectiveness of endoscopic assessment of the pharyngeal tonsil in defining the size of the adenoid hypertrophy in endoscopic examination that would be equivalent to intraoperative assessment as a large adenoid, and to determine the lowest necessary frequency of tests to assess the variability of its size. Methods: The study is based on an analysis of two groups of children diagnosed and treated in a children’s ENT outpatient clinic and ENT department. In the first group, adenoid size was assessed based on flexible endoscopy, and then with a consequent adenoid surgery with assessment of the intraoperative size of the adenoid, we compared the size of the adenoid. The second part of the study included a group of 81 children. We analyzed performed flexible nasopharyngoscopy examinations (FNE) of each child, and compared the change of adenoid size in a minimum of two subsequent examinations over a period of 1 year or more. Results: The sensitivity of flexible endoscopic examination in the assessment of the pharyngeal tonsil was determined at 97.3%, and specificity at 72.7%. The ROC curve shows the value of adenoid-to-choana (A/C) ratio as 75% or more in the preoperative FNE, indicating that the tonsil during surgery is assessed as large. Among the children, 26.3% had a change in adenoid size of more than 15% in the A/C ratio in 1 year of observation, and 45% of the children had A/C ratio changed above 15% in a period of 3 years of observation. Conclusions: FNE examination is highly effective in assessing the size of the pharyngeal tonsil. We proposed a schema for frequencies of FNE examinations and treatment dependent on A/C ratio and worsening of ailments.

Adenoid Hypertrophy Risk in Children Carriers of G-1082A Polymorphism of IL-10 Infected with Human Herpes Virus (HHV6, EBV, CMV).

Adenoid hypertrophy (AH) is considered one of the most common diseases in the ear, nose and throat (ENT) practice. The cause of adenoid hypertrophy in children is still unknown. The main aim of the current study was to investigate IL-10 (interleukin 10) gene polymorphisms and human herpesviruses 6 (HHV6), cytomegalovirus (CMV), and Epstein–Barr virus (EBV) infections in children with AH. A total of 106 children with adenoid hypertrophy and 38 healthy children aged 2–11 years were included in this study. All children with adenoid hypertrophy were divided into three subgroups depending on the adenoid size. The viruses were determined via quantitative real-time polymerase chain reaction (PCR) using commercially available kits (QIAGEN, Germany). HHV6 was more frequently detected in patients with AH compared with CMV and EBV. Among the three subgroups of children with AH, HH6 and EBV were prevalent in the children with the largest adenoid size. The frequency of genotype GG tended to be higher in the control group of children. We found significantly higher frequencies of the G allele and GG and GA genotypes for IL-10 rs1800896 in the subgroup of children with the smallest size of adenoid compared with other subgroups. In conclusion, HHV6 and EBV infection could contribute to the adenoid size. The genotype GG for IL-10 rs1800896 could contribute to the resistance to adenoid hypertrophy and the spread of the adenoid tissue.

Therapeutic Effect of Plasma Assisted Adenoidectomy on Otitis Media with Effusion

1.1. Background: This study aims to investigate the clinical efficacy of tympanostomy during plasma assisted adenoidectomy in children with adenoidal hypertrophy and OME. 1.2. Methods: A retrospective review of 2089 cases of childhood adenoid surgery assisted by low temperature and plasma in our hospital over the past 10 years showed that, of the 2089 cases, 245 cases with OME were treated with simultaneous intraoperative tympanometry, drug injection, suction, and external ear canal pressurization to the patency of the eustachian tube. 1.3. Results: The male to female ratio of the gender ratio in the 2089 cases was 2.08:1, with an average age of 5.87 ±3.12 years and a disease duration of 2.12±0.43 years; among these cases, 6 had adenoid I degree, 173 II degree, 642 III degree and 1268 IV degree. 2. Among 2089 cases, 245 cases with OME, the ratio of adenoid III-IV hypertrophy with OME (12.51%, 239/1910) was higher than that of I-II degree (3.35%, 6/179), P&lt;0.01. 3. Intraoperative tube placement was performed in 8 patients, while the rest of them were punctured, suctioned, infused, pressurized, and ventilated eustachian tubes. During more than 1 year of follow-up, the rate of non-tube placement, one cure, was 96.73% (237/245). 1.4. Conclusion and significance: The degree of adenoid hypertrophy in children correlates with the incidence of OME. OME with adenoid hypertrophy, the vast majority of whom do not undergo tube placement, can be cured by plasma assisted adenoidectomy with needle injection of slow-release hormonal agents and pressure flush through the eustachian tube, greatly reducing tympanostomy tube complications in children.

Clinical Study on the Treatment of Adenoid Hypertrophy in Children with Pneumatic Water Mist Nasal Washer

Clinical Study on the Treatment of Adenoid Hypertrophy in Children with Pneumatic Water Mist Nasal Washer

Grade- III Adenoid Hypertrophy treated with Individualized Homoeopathy – a Case Report

Adenoid is lymphoid tissue located at the portal of the upper respiratory tract. Snoring, mouth breathing, and recurrent upper respiratory tract infections, are the common presentations of Adenoid hypertrophy in children. Adenoids regress after 15 years of age. A case of Adenoid hypertrophy [AH], in a 3-year-old male child treated in the outpatient department of the National Homoeopathy Research Institute in Mental Health, is presented here, with an interim review at 11 months. Before and after values for the Clinical rating score, Mallampati score, Tonsillar score, and Adenotonsillar ratio [A/N] were calculated. The case reporting was done according to HOM-CASE guidelines. Homoeopathic medicines Tuberculinum Bovinum Kent (Tub-b)200c for the first five months, followed by Calcarea Carbonica (Calc-c)200c for the next three months and Mercurius Solubilis (Merc-sol) 200c for the last three months reduced the clinical rating score from 9 to 6, Tonsillar score from 3 to 2, and A/N ratio from 0.82 to 0.66. MONARCH scores for Tub-b, Calc-c, and Merc-sol were +6/13, +2/13, and +9/13, respectively. There was a clinically relevant improvement for the obstructive symptoms and the radiological findings before and after individualized homoeopathy.

Tissue Cytokine Adenoid Experssion in Hypertrophic Adenoid Gland in Children with Allergic Rhinitis.

To investigate the inflammatory pattern in terms of inflammatory cells and cytokines expression in children with adenoid hypertrophy (AH) and coexistent allergic rhinitis (AR). A cross-sectional analytical study. Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong P. R. China, from October 2018 to August 2020. A sample of 102 children with AH, who underwent adenoidectomy were enrolled. They were divided into two groups of AH, alone and AH with AR (AH+AR). A routine complete blood count, and the number of eosinophils in adenoid tissue was measured using hematoxylin-eosin staining. The tissue expression of cytokines was carried out using real-time quantitative PCR. Forty-eight children (47%) were diagnosed with AR. The number and percentage of eosinophils in peripheral blood and adenoid tissue were statistically (p <0.05) higher in the group of AH+AR than AH alone. Furthermore, in patients with AH+AR, the mRNA expression levels of IL-12 and IFN-γ decreased, while IL-4, IL-8, IL-18, IL-33, H2R, LTR1, LTR2 and GCR all increased in adenoid tissue. The pathological mechanism underlying adenoid hypertrophy in children with comorbid allergic rhinitis can be involved with predominant tissue eosinophilia and type 2 (or Th 2) inflammation. Key Words: Adenoid hypertrophy, Allergic rhinitis, Inflammatory features, Cytokines, Eosinophils.

The Microcephaly Epidemic Research Group Paediatric Cohort (MERG-PC): A Cohort Profile.

This cohort profile aims to describe the ongoing follow-up of children in the Microcephaly Epidemic Research Group Paediatric Cohort (MERG–PC). The profile details the context and aims of the study, study population, methodology including assessments, and key results and publications to date. The children that make up MERG–PC were born in Recife or within 120 km of the city, in Pernambuco/Brazil, the epicentre of the microcephaly epidemic. MERG–PC includes children from four groups recruited at different stages of the ZIKV microcephaly epidemic in Pernambuco, i.e., the Outpatient Group (OG/n = 195), the Microcephaly Case–Control Study (MCCS/n = 80), the MERG Pregnant Women Cohort (MERG-PWC/n = 336), and the Control Group (CG/n = 100). We developed a comprehensive array of clinical, laboratory, and imaging assessments that were undertaken by a ‘task force’ of clinical specialists in a single day at 3, 6, 12, 18 months of age, and annually from 24 months. Children from MCCS and CG had their baseline assessment at birth and children from the other groups, at the first evaluation by the task force. The baseline cohort includes 711 children born between February 2015 and February 2019. Children’s characteristics at baseline, excluding CG, were as follows: 32.6% (184/565) had microcephaly, 47% (263/559) had at least one physical abnormality, 29.5% (160/543) had at least one neurological abnormality, and 46.2% (257/556) had at least one ophthalmological abnormality. This ongoing cohort has contributed to the understanding of the congenital Zika syndrome (CZS) spectrum. The cohort has provided descriptions of paediatric neurodevelopment and early epilepsy, including EEG patterns and treatment response, and information on the frequency and characteristics of oropharyngeal dysphagia; cryptorchidism and its surgical findings; endocrine dysfunction; and adenoid hypertrophy in children with Zika-related microcephaly. The study protocols and questionnaires were shared across Brazilian states to enable harmonization across the different studies investigating microcephaly and CZS, providing the opportunity for the Zika Brazilian Cohorts Consortium to be formed, uniting all the ZIKV clinical cohorts in Brazil.

The P.E.A.N.U.T. Method: Update on an Integrative System Approach for the Treatment of Chronic Otitis Media with Effusion and Adenoid Hypertrophy in Children

Background and objectives: Based on our previous single-center study on optimization of treatment of chronic otitis media with effusion (COME) and adenoid hypertrophy (AH) in children using a noninvasive system approach to lower the necessity of antibiotics, analgesic use, and surgical interventions, we proceeded to perform a multicenter investigation in an outpatient setting. The purpose of the previous prospective study in 2013–2015 was to compare outcomes in the treatment of COME and AH using the noninvasive multimodal integrative method (IM) versus conventional treatment practice (COM). Materials and Methods: In this paper, we retrospectively analyze the data of patients treated with the integrative method between 2017 and 2020 in a multicenter setting and compared the outcomes with data from 2013–2015 in order to evaluate generalizability. In both periods, all eligible and willing participants were included and treated with the IM protocol under real-life conditions. The treatment involved pneumatization exercises, education, an antiallergic diet, nasal hygiene, useful constitutional therapy, and thermal interventions (P.E.A.N.U.T.). A total of 48 versus 28 patients, aged 1–8, were assessed, presenting with COME and AH, with moderate to severe hearing impairment at entry. Results: The significant improvement found in both audiometric measures (intact hearing) and tympanometric measures (normal A-type curve) was similar in both datasets with respect to conventional treatment. The new data confirms that the P.E.A.N.U.T. method results in a significant reduction of antibiotics, analgesic use, and surgical interventions. Conclusion: In this multicenter trial, we confirm the effectiveness of the noninvasive system approach for the treatment of COME in lowering the need for antibiotics and analgesic use and elective surgery. This could be especially important with respect to a generally observed increase in antibiotic resistance. The method is easy to perform in different clinical settings and is effective, safe, and well-tolerated.

The Prevalence of Adenoid Hypertrophy among Children with Zika Related Microcephaly.

Upper respiratory obstruction is a common sequela in children with Zika-related microcephaly (ZRM). As a cross-sectional analysis nested in a cohort study, this study aims to investigate the prevalence of adenoid hypertrophy (AH) in children with ZRM and symptoms of respiratory obstruction. The data were collected in the first three years of life from children with ZRM who were followed in two reference centers for otorhinolaryngological care of patients with congenital Zika syndrome. Out of 92 children with confirmed ZRM, 57 were evaluated by nasopharyngoscopy after presenting with upper respiratory obstruction symptoms. In this study, 31 of the 57 (54%) children with ZRM who were evaluated had obstructive AH. Thirteen children with obstructive AH were submitted to surgery, which resulted in the complete resolution of symptoms for 11, partial resolution in 1, and no improvement in 1. No evidence of direct involvement by Zika virus (ZIKV) infection in the adenoid tissues was demonstrated by histology or immunohistochemistry. Our results suggest that there is a high prevalence and early presentation of AH in children with ZRM, with consequent upper airway obstruction causing upper airway obstructive disorder, secretory otitis media, and dysphagia.