Adenoid Size Research Articles

Adenoidal-Nasopharyngeal Ratio in Healthy Adults on Cone Beam Computed Tomography.

This study aimed to quantify the adenoidal-nasopharyngeal ratio (ANR) in a cohort of healthy adults on cone beam computed tomography (CT) using the Fujioka method, which is a reproducible measure of adenoid size and nasopharyngeal patency. Electronic health records and maxillofacial cone beam CT in 202 consecutive patients aged 16 years and older were retrospectively reviewed. Patients with a history of adenoidectomy, sinonasal disease, lymphoproliferative disorders, and cleft palate were excluded from the study. The midsagittal reconstructed cone beam CT image was used to determine the ANR. Statistical analysis was conducted using 1-way analysis of variance. Of the 202 subjects, 131 were female and 71 were male. The mean ± SD subject age was 45.43 ± 20.79 years (range, 16-91 years). The mean ± SD ANR in all subjects was 0.22 ± 0.13 (range, 0.03-0.75) and in each decade of adult life was as follows: younger than 21 years, 0.39 ± 0.12; 21 to 30 years, 0.29 ± 0.11; 31 to 40 years, 0.21 ± 0.09; 41 to 50 years, 0.20 ± 0.07; 51 to 60 years, 0.16 ± 0.10; 61 to 70 years, 0.13 ± 0.05; 71 to 80 years, 0.12 ± 0.05; 81 to 90 years, 0.11 ± 0.04; and 91 years or older, 0.10 ± 0. The differences in mean ANR among the age subgroups were statistically significant ( P < 0.001). The mean ANR gradually decreased from 0.39 in the second decade of life to 0.16 in the sixth decade of life and plateaued at approximately 0.10 thereafter.

Evaluation of the associations between maxillary sinus dimensions and adenoid hypertrophy using multislice computed tomography

IntroductionAdenoid hypertrophy is especially common in childhood, raising the concern that such growth might affect maxillary sinus volumes during the developmental period. This study evaluated the developmental relationships between maxillary sinus volumes and adenoid hypertrophy via computed tomography. Materials and methodsIt was examined computed tomographic images of 118 individuals: 61 boys and 57 girls. The participants were divided into a healthy control group (n = 59) and an experimental group (with adenoid hypertrophy) (n = 59). Raw data were recorded in DICOM format and analysed using the ITK-SNA algorithm; it was measured the right, left, and total maxillary sinus volumes and adenoid tissue sizes. ResultsIt was found significant between-group differences in the three maxillary sinus volumes and adenoid tissue dimensions (linear maximum anterior and posterior depth; maximum upper and lower height, and maximum width to the right and left) (all p<0.001). On the contrary, there was no significant difference according to sex in terms of either maxillary sinus volumes or linear adenoid tissue measurements. Maxillary sinus volumes increased significantly according to age in both groups. ConclusionAdenoid hypertrophy decreases the maxillary sinus volumes, regardless of sex. The impacts of adenoid growth on maxillary sinus aeration and sinus disease should be further investigated.

Reply to Kalfert, D. Comment on "Zwierz et al. The Long-Term Effects of 12-Week Intranasal Steroid Therapy on Adenoid Size, Its Mucus Coverage and Otitis Media with Effusion: A Cohort Study in Preschool Children. J. Clin. Med. 2022, 11, 507".

We wish to thank the author for raising the issues of how we performed the adenoid size classification and why we did not classify the condition of the nasopharyngeal orifice of the Eustachian tube [...].

Comment on Zwierz et al. The Long-Term Effects of 12-Week Intranasal Steroid Therapy on Adenoid Size, Its Mucus Coverage and Otitis Media with Effusion: A Cohort Study in Preschool Children. J. Clin. Med. 2022, 11, 507.

I read with great interest the article entitled "The Long-Term Effects of 12-Week Intranasal Steroid Therapy on Adenoid Size, Its Mucus Coverage and Otitis Media with Effusion: A Cohort Study in Preschool Children" by Zwierz et al. [...].

Improved diagnostic accuracy for pediatric obstructive sleep apnea using an out-of-center sleep test

ObjectivePolysomnography (PSG) is considered the gold standard for diagnosing obstructive sleep apnea syndrome (OSA) in children. However, many hospitals do not carry out PSG evaluations, and use out-of-center sleep test (OCST) devices for diagnosis instead. The aim of this study was to confirm the reliability of OCSTs for the diagnosis of pediatric OSA. We also investigated the factors influencing diagnostic reliability of OCST for the severe OSA patients who should be treated earlier. MethodsThis was a retrospective study using the Ota Memorial Sleep Center database. We analyzed the data of children who underwent Type 4 OCST at home and Type 1 PSG in the sleep lab between April 2006 to April 2015. Cephalometric parameters and anthropometric findings such as enlarged tonsils were also evaluated. We compared the 3% oxygen desaturation index (ODI3%) measured by OCST with the apnea-hypopnea index (AHI) measured by PSG. We used Receiver Operator Curve (ROC) to calculate the optimal OCST- ODI3% value to diagnose PSG-AHI ≥10 per hour. In order to determine which factors increase the accuracy of OCST, we calculated the accuracy, sensitivity and specificity in regard to the predicted values using multiple logistic regression analysis. The Ethics Committee of Ota General Hospital approved the study (approval no. 21018). ResultsA total of 191 children were enrolled in this study. The study included 127 boys and 64 girls, with a mean age of 5.4 years (range: 3-8 years), BMI of 15.7 kg/m² (range: 11.5-35.7 kg/m²), PSG-AHI of 17.4 per hour (range: 0.3-89.8 per hour). The sensitivity, specificity and accuracy with an OCST-ODI cutoff of 6.3 per hour were 64.4%, 70.3% and 67.5%, respectively, to detect PSG-AHI ≥ 10 per hour for children with suspected OSA. Multivariable stepwise regression revealed that increases of sensitivity, specificity and accuracy with an OCST-ODI cutoff of 6.3 per hour were independently predicted by facial axis, which is cephalometric angle of 81° or less, and tonsil hypertrophy, which is Brodsky +3 or +4, showing increases to 73.3%, 71.3%, and 72.3%, respectively, whereas age, gender, body mass index, adenoid size and other cephalometric parameters were not significant predictors. ConclusionThe results of the statistical analyses suggest that it would be useful to add the assessment of tonsil size and facial axis as well as OCST to determine whether the threshold of PSG-AHI ≥ 10 per hour has been crossed.

The hemostatic efficacy of hydrogen peroxide in adenoidectomy

OBJECTIVE: This study aimed to investigate the effect of hydrogen peroxide, on the extent of intraoperative bleeding and operation times in pediatric patients undergoing adenoidectomy. METHODS: Data of 86 adenoidectomy patients (47 males, 39 females; mean age 5.2±1.9 years; range 3 to 11 years) collected from patient files were retrospectively evaluated. The patients’ age, sex, and adenoid tissue size, as well as anesthetic technique, operation time, amount of bleeding during the operation, were reviewed. Among the patients, 45 were administered hydrogen peroxide for hemostasis (study group) and 41 patients were not administered hydrogen peroxide during operation (control group). RESULTS: No statistically significant difference was found between groups in terms of age, sex and, adenoid tissue size (p&gt;0.05). The operation times of the study group were significantly lower than those of the control group (p=0.001; p&lt;0.01). There was also a statistically significant difference between groups in terms of bleeding amount (p=0.001; p&lt;0.01). Bleeding amount was significantly lower in the study group than in the control group. CONCLUSION: In this study, we determined that administration of hydrogen peroxide with nasopharyngeal packing significantly decreases operation time and intraoperative bleeding in adenoidectomy patients.

Versatility and Benefits of 4.0mm Flexible Nasal Endoscopy in 118 Children up to 10 Years of Age.

PurposeThis retrospective study looked at the feasibility of using adult 4.0 mm flexible nasendoscopes (FNE) examination under local anesthetic (LA) in children three to 10 years old to diagnose adenoid hypertrophy (AH) and other conditions. We also looked for a correlation between the adenoid size on FNE and a) tonsil size, b) the typical symptoms of snoring, mouth breathing, impaired hearing, and apnoeic episodes c) the management options of otitis media with effusion (OME) and d) the adenoid size intraoperatively.MethodsA retrospective, observational study of 118 children in an NHS pediatric otolaryngology clinic led by a single consultant. One hundred ten consecutive patients with suspected AH were divided into two groups of three to five years and six to 10 years. We compared the acceptance rate to FNE in two subgroups (three to five years and six to 10 years old) and examined the correlation between various parameters as outlined above, using the Chi-square test. Eight children underwent FNE for other reasons of change of voice and epistaxis.ResultsFNE was successfully performed in 86% of the patients without restraint. Thirty-three percent of patients had non-obstructive adenoids (OA) and did not require surgical intervention. The intraoperative adenoid size, symptoms of snoring, mouth-breathing, and apnoeic episodes positively correlated with OA; however, no correlation was seen with the tonsil size (p=0.1143). All patients with OA and type B tympanogram needed adenoidectomy and grommet insertion (p=0.0119), and those with type C curves recovered with adenoidectomy alone.Conclusions4.0 mm adult scope helped reach a definitive diagnosis for AH in most children above three years of age, thus proving cost-effective. The symptoms of snoring, mouth-breathing, and apnoeic episodes had a positive correlation to the presence of OA; however, the tonsil size was seen to be independent of adenoid size.Primary surgical management can be considered the treatment of choice for all patients with OA and type B tympanogram without a trial of conservative therapy.

Impact of rapid palatal expansion on the size of adenoids and tonsils in children

IntroductionAdenoid and tonsillar hypertrophy in children often leads to adverse respiratory symptoms and obstructive sleep apnea (OSA). Current clinical guidelines from the American Academy of Pediatrics and American Academy of Otolaryngology–Head and Neck Surgery recommend tonsillectomy as the first line of pediatric OSA treatment for children with tonsillar hypertrophy. Rapid palatal expansion (RPE) performed by orthodontists improves obstructive sleep apnea in children by reducing nasal airway resistance, increasing nasal volume, raising tongue posture, and enlarging pharyngeal airway. However, the role of RPE in alleviating adenoid and tonsillar hypertrophy remains elusive. In this study, we aim to evaluate the changes in adenoid and palatine tonsil sizes following RPE using 3D volumetric analysis of cone beam computational tomography (CBCT) imaging. Materials and methodsIn this retrospective cohort study, a total of 60 pediatric patients (mean age: 8.00, range: 5–15, 32 females and 28 males) who had tonsillar hypertrophy (size 3 and 4) were included and divided into the control group (n = 20) and expansion group (n = 40). The control group did not undergo any treatment. The expansion group underwent RPE using a conventional Hyrax expander, activated 0.25 mm per day for 4–6 weeks. Final CBCT scans (T2) were performed 13.8 ± 6.5 months after the initial scan (T1). Pediatric sleep questionnaire (PSQ) and BMI were obtained at each timepoint. Volumetric analysis of adenoid and palatine tonsils was performed using a combination of bony and soft tissue landmarks in CBCT scans through Anatomage Invivo 6 imaging software. Paired t-tests were used to evaluate the difference between the initial and final adenoid and tonsil volumes. p values less than 0.05 were considered statistically significant. ResultsCompared to the control group, the expansion group experienced a statistically significant decrease in both adenoid and tonsil volume. There was non-statistically significant increase in volume from T1 to T2 for the control group. For the expansion group, 90.0% and 97.5% of patients experienced significant reduction in adenoid and tonsil volume, respectively. The average volume decrease of adenoids was 16.8% while that of tonsils was 38.5%. The patients had up to 51.6% and 75.4% reduction in adenoid and tonsil size, respectively, following RPE orthodontic treatment. Pearson correlation ranged from 0.88 to 0.99 for each measurement, representing excellent internal consistency. There was a significant reduction in the PSQ scores from 5.81 ± 3.31 to 3.75 ± 2.38 in expansion group (p < 0.001). ConclusionsOur results demonstrated that RPE significantly reduced the size of both adenoid and palatine tonsils and revealed another long-term benefit of RPE treatment. To our knowledge, this is the first study to quantify the changes of adenoids and tonsils following RPE. RPE treatment can be considered as a valid and effective treatment option for pediatric OSA population with narrow high arch palate and adenotonsillar hypertrophy.

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.

The Long-Term Effects of 12-Week Intranasal Steroid Therapy on Adenoid Size, Its Mucus Coverage and Otitis Media with Effusion: A Cohort Study in Preschool Children.

Background: The purpose of this study is to analyse the long-term effects of a 12-week course of topical steroids on adenoid size and its mucus using endoscopy and on middle ear effusion measured by tympanometry. Methods: The study presents an endoscopic choanal assessment of the change in adenoid size (adenoid to choanae ratio, A/C ratio) and its mucus coverage in 165 children with Grade II and III adenoid hypertrophy three to six months after finishing a 12-week course of intranasal steroid treatment with mometasone furoate. Additionally, tympanometry was performed to measure middle ear effusion. Changes in the tympanograms were analysed. Results: The mean A/C ratio before treatment was 65.73%. Three to six months after finishing a 12-week course of intranasal steroid treatment, the mean A/C ratio decreased to 65.52%, although the change was not statistically significant (p = 0.743). There was no change in adenoid mucus according to the MASNA scale before and three to six months after the end of the steroid treatment (p = 0.894). Long-term observations of tympanograms before and three to six months after the end of the treatment did not show improvement (p = 0.428). Conclusions: The results indicate that there was no effect of topical steroids on adenoid size, its mucus and otitis media with effusion (OME) three to six months after finishing a 12-week course of treatment. In the light of performed study, decision of adenoidectomy and tympanostomy should not be procrastinated.

Pediatric turbinate radiofrequency ablation improves quality of life and rhinomanometric values. A prospective study

Objectiveturbinate surgery in pediatric patients is gradually increasing in popularity amongst pediatric otolaryngologists. However, despite this, there is scarce information regarding this surgical procedure in children. The present research is designed with the aim of assessing changes in nasal resistance, nasal airflow and quality of life in pediatric patients undergoing turbinate radiofrequency ablation. MethodsA prospective uncontrolled intervention clinical trial design was followed. Children between 4 and 15 years old undergoing turbinate radiodiofrequency ablation (TRA) were consecutively selected. Children were examined preoperatively and 1, 3, 6 and 12 months after turbinate surgery. Anterior active rhinomanometry with and without nasal decongestant and examination of the turbinates and adenoid size were carried out in each follow-up visit. The SN5 quality of live survey was answered by parents. Results81 children were included, 28 with associated adenoidectomy. A significant improvement in quality of life was demonstrated since the first month after TRA. Regarding nasal resistance, there was an improvement 1 month after surgery, but it only reached statistical significance for the whole sample (p < 0.001)) and for the cohort of isolated turbinate surgery (p < 0.001) at 3 months, while the values for the cohort of children who underwent adenoidectomy reached significance at 6 months after surgery (p = 0.04). The difference in nasal resistance before and after decongestant was compared to the change in nasal resistance after surgery. It demonstrated a strong correlation with the change in nasal resistance at 1 month (R = 0.985; p < 0.001), 3 months (R = 0.995; p < 0.001), 6 months (R = 0.98; p < 0.001) and 12 months (R = 0.98; p < 0.001) after surgery. Conclusionsturbinate surgery in pediatric patients seems to be a safe procedure which objectively and subjectively improves the symptoms of children suffering from nasal obstruction.

Prevalence of Asymptomatic Otitis Media with Effusion in Children with Adenoid Hypertrophy and its Relation to Adenoid Size: A Cross-sectional Study

Introduction: Otitis Media with Effusion (OME) occurs as a sequela of adenoid hypertrophy. But most often hearing loss due to OME goes unnoticed in children. This causes poor cognitive development, inattention and thus poor scholastic performance. Aim: To estimate the frequency of asymptomatic OME in children with adenoid hypertrophy and to find the association between adenoid size and occurrence of OME and hearing loss. Materials and Methods: The present study was a prospective cross-sectional study conducted in a tertiary care centre in South India from November 2019 to November 2021. Children of 5-12 years of age, with symptoms suggestive of adenoid hypertrophy and with no complaints of hearing loss, were selected. A detailed ear, nose, throat examination, Pure Tone Audiometry (PTA) and tympanometry were done in all patients. Adenoid size was graded by nasal endoscopy using Mc Murray and Clements scale and also based on radiographs (comparing the distance between maximum convexity of adenoid and line drawn along basiocciput (A) and posterior part of hard palate and sphenobasioccipital synchondrosis (N)) using A/N ratio. All patients subsequently underwent adenoidectomy. Myringotomy was done along with adenoidectomy in cases with bilateral OME. All OME patients were followed-up with tympanometry, one month and three months postoperatively. The frequency of OME was presented as percentage. The association between adenoid size and asymptomatic OME as well as hearing loss was done using Fisher's exact test. Results: A total of 150 children between 5-12 years with adenoid hypertrophy were analysed. The mean age was 9 years. On analysing the association between adenoid size (both radiographically and endoscopically) and OME, 30 (20%) had bilateral effusion and 18 (12%) had unilateral effusion and prevalence of asymptomatic OME was calculated as 32%. Most of the patients had Grade 2 adenoids radiographically, and Grade 3 adenoids as per nasal endoscopy. Majority of patients had Type B Tympanogram. There was significant association between OME and adenoid size. Association between adenoid size with hearing loss showed significant association between the two with p=0.001 on right ear and p&lt;0.001 on left ear (radiographically), and p=0.0027 on right ear and p=0.043 on left ear (as per nasal endoscopy). About 93% of children with bilateral Type B tympanogram and all children with unilateral Type B and bilateral Type C returned to normal on three months follow-up. Conclusion: There was association between adenoid size, and occurrence of OME and hearing loss. About 32% of the study population were detected to have asymptomatic OME.

Association between Adenoid-Nasopharyngeal Ratio and Tympanogram Width in Adenoid Hypertrophy Patients

IntroductionAdenoid hypertrophy is a change in adenoid size that can lead to obstruction the Eustachian tube and become a risk factor for otitis media effusion (OME) in children. Standard objective examination of adenoid hypertrophy uses adenoid-nasopharyngeal ratio (A-N ratio) based on correct lateral skull radiography. Adenoid hypertrophy is one of the factors causing OME in children. There is still much debate about the association between A-N ratio and tympanogram width (Tw). Determining the association of A-N ratio and Tw in adenoid hypertrophy patients.MethodsParticipants performed a true lateral radiographic examination using Fujioka method to determine A-N ratio, and Tw to determine middle-ear pressure. The distance between examination of A-N ratio and tympanogram examination was at maximum of ∼1 week. The association between A-N ratio and Tw in patients with adenoid hypertrophy used the Pearson correlation test. This research employed significance levelp&lt; 0.05.ResultsMost participants were aged between 6 and 10 years (38.10%), male patients (57.14%), and the symptom most participants complained of was snoring during sleep (38.10%). Most participants had A-N ratio of 0.53 to 0.70 (61.90%) with an average of 0.60 ± 0.05. The average value of Tw measurement was 102.83 ± 50.03 daPa (r= 0.605;p&lt; 0.001).ConclusionThere is a significant association between A-N ratio base on true lateral radiographic examination and Tw in adenoid hypertrophy patients.

Efficacy and safety of fluticasone propionate nasal spray in treatment ofadenoidal hypertrophic snoring in children

This study investigatedthe efficacy and safety offluticasone propionate nasal spray in treatment of adenoidal hypertrophic snoring in children.Fifty-six children with adenoidal hypertrophic snoring were enrolled. According to adenoidal-nasopharyngeal ratio (ANR) in lateral nasal X-ray examination,the children were assigned in moderategroup (23 cases) and severegroup (33 cases).The fluticasone propionate nasal spray was used for all patientsfor 4 weeks.In 56 patients, after treatment, compared with before treatment, the snoring, sleep apneaand nasal obstruction scores in moderategroupand the nasal obstruction score in severegroupwere significantly decreased,respectively (P < 0.05).The decreases of snoring, sleep apnea, mouth breathing and nasal obstruction scores after treatment in moderate group were significantly higher than those in severe group, respectively (P <0.001).After treatment, in 18 patients with ateral nasal X-ray examination,the adenoid size was obviously reduced, and the nasopharynx airway was obviously enlarged. The meanANRdropped from 0.76±0.10 to 0.72±0.09(P <0.001).Duringtreatment, only 2 of 56 patients were reported with intranasal dryness and occasional epistaxis, which were self-healed without treatment.Fluticasone propionate nasal spray is effective and safe for treatment of children’s snoring caused by adenoidal hypertrophy.

Status of the mastoid antrum and the eustachian tube function in cases of chronic otitis media

Introduction: Chronic otitis media (COM) is now synonymous with chronic suppurative otitis media, which is not actively used since COM is seldom associated with “the collection of pus.” Acute suppuration of the ear which transcends 6 weeks is considered to be COM which suggests an abnormality of the ear drum. With a prevalence incidence of 1%, Eustachian tube (ET) dysfunction is among the most important factors in the development of COM. Recently, mastoid air cells have been acknowledged as an essential compounding factor for the pathogenesis of middle ear disease. Since ET, mastoid air cell system, and nasopharyngeal mass like adenoids can play a pivotal role in the causation and persistence of COM, the current study will be taken to observe the status of ET, mastoid air cells system, nasopharynx in general, and adenoids in particular in patients of COM. Aim: This study aims to study the status of the mastoid antrum on surgical exploration, the status of ET, and nasopharynx for adenoids in patients of large, subtotal perforation, and posterosuperior retraction pockets (PSRPs). Study Design: This study was an observational, cross-sectional study. Study Setting: All the patients with large, subtotal perforation, and PSRPs visiting the Outpatient Department and Inpatient Department of ENT in Acharya Vinoba Bhave Rural Hospital (AVBRH) between 2022 and 2023 will be studied. Methods: All the selected patients of large, subtotal perforation, and posterosuperior retraction pocket (PSRP) in the age bracket of 15–65 years and satisfying the inclusion criteria will be considered and accrued in this study. We plan to look at a sample size of 50 patients (50 ears). Diagnostic nasal video endoscopy to get insight into ET function, size, and grade of adenoids by grading system given by Cassano et al. and pure-tone audiometry by ALPS AD2000 to know the type and amount of hearing loss will be carried out. Status of the mastoid antrum, the extent of the disease, status of ossicles, and associated abnormalities of temporal bone along with any other incidental findings will be noted intraoperatively. Expected Results: The data will be tabulated, analyzed statistically, and will be discussed in the context of existing research. Conclusion: The purpose of the present study is to help the surgeon have a better insight into the status of the mastoid antrum, ET in cases of large and subtotal perforation, and PSRP and nasopharynx in general with significance to adenoids in patients of COM in rural area.

Evaluation of Eustachian tube function in children with adenoid hypertrophy by nasopharyngeal digital photography and ETDQ-7 scores

Objective:To evaluate the Eustachian tube function of children with simple adenoid hypertrophy and adenoid hypertrophy with secretory otitis media（OME） by using the A/N value of lateral radiograph of nasopharyngeal X-ray and EDQ-7 scale scores. Methods:Sixty cases of children with adenoid hypertrophy admitted from February 2019 to August 2021 were all underwent nasopharyngeal X-ray lateral radiographs to determine the adenoid/nasopharyngeal cavity ratio（A/N ratio） and then determine the size of adenoids. The Eustachian tube function ETDQ-7 survey was used to evaluate the patient's self-evaluation of the severity of the disease and ear symptoms, and the degree of influence were scored. Subsequently, the correlation between adenoid hypertrophy with OME and ETDQ-7 scores was statistically analyzed by using the Spearman rank correlation statistical method. Results:In adenoid hypertrophy with OME group, the ETDQ-7 scores of A/N≤0.60, A/N 0.61-0.70 and A/N≥0.71 were 4.15±1.75, 14.55±6.67 and 23.95±6.63, respectively. The higher the grade of adenoid hypertrophy, the higher the ETDQ-7 scores. In adenoid hypertrophy with OME group, the degree of adenoid hypertrophy was positively correlated with the ETDQ-7 scores（P<0.05）. Conclusion:Adenoid hypertrophy is also one of the potential factors causing OME in children.

The Impact of the Thermal Seasons on Adenoid Size, Its Mucus Coverage and Otitis Media with Effusion: A Cohort Study.

Background: The purpose of this study is to analyze seasonal differences in adenoid size and related mucus levels via endoscopy, as well as to estimate changes in middle ear effusion via tympanometry. Methods: In 205 children with adenoid hypertrophy, endoscopic choanal assessment, adenoid hypertrophy assessment using the Bolesławska scale, and mucus coverage assessment using the MASNA scale were performed in two different thermal seasons, summer and winter. The study was conducted in two sequences of examination, summer to winter and winter to summer, constituting two separate groups. Additionally, in order to measure changes in middle ear effusion, tympanometry was performed. Results: Overall, 99 (48.29%) girls and 106 (51.71%) boys, age 2–12 (4.46 ± 1.56) were included in the study. The first group, examined in summer (S/W group), included 100 (48.78%) children, while the group first examined in winter (W/S group) contained 105 (51.22%) children. No significant relationship was observed between the respective degrees of adenoid hypertrophy as measures by the Bolesławska scale between the S/W and W/S groups in winter (p = 0.817) and in summer (p = 0.432). The degrees of mucus coverage of the adenoids using the MASNA scale and tympanograms were also comparable in summer (p = 0.382 and p = 0.757, respectively) and in winter (p = 0.315 and p = 0.252, respectively) between the S/W and W/S groups. In the total sample, analyses of the degrees of adenoid hypertrophy using the Bolesławska three-step scale for seasonality showed that patients analysed in the summer do not differ significantly when compared to patients analysed in the winter (4.39%/57.56%/38.05% vs. 4.88%/54.63%/40.49%, respectively; p = 0.565). In contrast, the amount of mucus on the adenoids increased in winter on the MASNA scale (p = 0.000759). In addition, the results of tympanometry showed deterioration of middle ear function in the winter (p = 0.0000149). Conclusions: The obtained results indicate that the thermal seasons did not influence the size of the pharyngeal tonsils. The increase and change in mucus coverage of the adenoids and deterioration of middle ear tympanometry in winter may be the cause of seasonal clinical deterioration in children, rather than tonsillar hypertrophy. The MASNA scale was found to be useful for comparing endoscopy results.

Study of montelukast in children with sickle cell disease (SMILES): a study protocol for a randomised controlled trial

BackgroundYoung children with sickle cell anaemia (SCA) often have slowed processing speed associated with reduced brain white matter integrity, low oxygen saturation, and sleep-disordered breathing (SDB), related in part to enlarged adenoids and tonsils. Common treatments for SDB include adenotonsillectomy and nocturnal continuous positive airway pressure (CPAP), but adenotonsillectomy is an invasive surgical procedure, and CPAP is rarely well-tolerated. Further, there is no current consensus on the ability of these treatments to improve cognitive function. Several double-blind, randomised controlled trials (RCTs) have demonstrated the efficacy of montelukast, a safe, well-tolerated anti-inflammatory agent, as a treatment for airway obstruction and reducing adenoid size for children who do not have SCA. However, we do not yet know whether montelukast reduces adenoid size and improves cognition function in young children with SCA.MethodsThe Study of Montelukast In Children with Sickle Cell Disease (SMILES) is a 12-week multicentre, double-blind, RCT. SMILES aims to recruit 200 paediatric patients with SCA and SDB aged 3–7.99 years to assess the extent to which montelukast can improve cognitive function (i.e. processing speed) and sleep and reduce adenoidal size and white matter damage compared to placebo. Patients will be randomised to either montelukast or placebo for 12 weeks. The primary objective of the SMILES trial is to assess the effect of montelukast on processing speed in young children with SCA. At baseline and post-treatment, we will administer a cognitive evaluation; caregivers will complete questionnaires (e.g. sleep, pain) and measures of demographics. Laboratory values will be obtained from medical records collected as part of standard care. If a family agrees, patients will undergo brain MRIs for adenoid size and other structural and haemodynamic quantitative measures at baseline and post-treatment, and we will obtain overnight oximetry.DiscussionFindings from this study will increase our understanding of whether montelukast is an effective treatment for young children with SCA. Using cognitive testing and MRI, the SMILES trial hopes to gain critical knowledge to help develop targeted interventions to improve the outcomes of young children with SCA.Trial registrationClinicalTrials.govNCT04351698. Registered on April 17, 2020. European Clinical Trials Database (EudraCT No. 2017-004539-36). Registered on May 19, 2020

Impact of adenoidectomy alone or with ventilation tube for treatment of secretory otitis media in children

Background: Adenoid surface in patients suffering from secretory otitis media is usually associated with bacterial biofilm. Adenoidectomy is thought to be effective in treatment of cases associated with secretory otitis media. Objective: Evaluating the role of adenoidectomy alone or in combination with ventilation tube insertion in improving the outcome of OM with effusion associated with adenoid hypertrophy. Patients and methods: This study included 40 children with recurrent or persistent secretory OM despite proper medical treatment for 3-6 months. They were divided into 2 equal groups. Group A treated by adenoidectomy with ventilation tube insertion and the group B was treated by adenoidectomy alone. These patients were evaluated preoperatively by plain X-ray nasopharynx lateral view and audiological assessment, adenoid specimen was taken for scanning by electron microscope for adenoid surface biofilm detection and grading. Postoperatively, we followed up the patients for 1 year to assess improvement and post-operative complications. Results: At the 1st follow up visit, Group A had higher rate of improvement than those who had adenoidectomy alone. Long term follow up (1 year) show significant higher rate of complications in those who were treated by adenoidectomy with ventilation tube 5 cases in comparison to only 2 cases of in Group B. There is no significant association between adenoid size and biofilm formation. Adenoid size and biofilm extension grade had no significant relation to postoperative outcome. Conclusion: Removal of adenoid was associated with relieve of OM with significant higher rate of complications in those undergoing adenoidectomy with ventilation tube insertion.

Adenoid measurement accuracy: A comparison of lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy (gold standard)

ObjectiveTo compare the accuracy of lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy in assessment of adenoid size. MethodsA cross-sectional study was conducted in 43 pediatric patients undergoing ENT surgery from July 2017 to December 2018. All patients underwent preoperative lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy. ResultsThe average adenoidal-nasopharyngeal (A/N) ratio obtained from lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy was 72.9, 79.5, and 81.6, respectively. There was a moderate correlation between A/N ratio from lateral skull film and intraoperative rigid endoscopy (Pearson's correlation: 0.567, p˂0.001). Whereas, the A/N ratio from flexible endoscopy compared to intraoperative rigid endoscopy showed a stronger correlation (Pearson's correlation: 0.791, p˂0.001). From linear regression analysis, the intraoperative adenoid measurement was estimated from the results of flexible endoscopy (intraoperative rigid endoscopy: 0.72 [flexible endoscopy] +24.47) and lateral skull film (intraoperative rigid endoscopy = 0.65 [lateral skull film] + 34) ConclusionFlexible endoscopy yields the most accuracy in the assessment of adenoid size and nasopharynx visualization, without radiation exposure or anesthesia. Despite less accuracy, lateral skull film is more availability in every hospital. The correlation of adenoid size measurement in this study can also be applied for the actual size of adenoid.