Adenoid Tissue Research Articles

Naive and memory T cells in hypertrophied adenoids in children according to age

The anatomic location of the adenoid implies that this organ is the first site of contact with inhaled antigens. Depending on the expression of different isoforms of the CD45 molecules, T cells can be divided into naive (CD45RA +) and memory (CD45R0 +) cells, the latter representing T cells that have already been exposed to antigens. The purpose of this study was to analyse the lymphoid cells’ subsets in adenoids and relate the findings to the age. The analysed material was adenoid tissue removed on the grounds of hypertrophy from 22 children. The patients were divided into two groups: up to 5 and above 5 years of age. The analyses of the lymphocytes subpopulations in the adenoid were performed in an EPICX XL (Coulter) flow cytometry. The results are expressed as the percentage of positively labeled cells (CD4 +, CD8 +, CD4 +/CDB +, CD4 +CD45RA +, CD8 +CD45RA +, CD4 +CD45R0 +, CD8 +CD45R0 +). The percentage of CD4 +/CD45R0 + in children up to 5 years of age was significantly lower than in older children. We found the positive regression between age and the percentage of CD4 + cells was CD45R0 + ( r=0.64). There were no statistically significant differences between study subgroups for the other parameters. The positive regression for CD4 +/CD45R0 + cells and age may result from increased stimulation by bacterial, viral and other antigens. Our results indicate that the adenoid have an important role in the development of an immunological memory among younger children.

Adenoid Bacteriology in Otitis Media Children With Effusion

Objectives: The relationship between the adenoids and otitis media has been well documented. The purpose of this study was to document the current trends in the bacteriology of the adenoids in children with otitis media with effusion (OME). Comparisons of bacteriology of the adenoids with that of the middle ear fluid are made, and the role of adenoidectomy in treating otitis media with effusion is discussed. Methods: A prospective investigation of 44 patients with adenoid hyperplasia and OME was performed. All patients received transoral endoscopic adenoidectomy and insertion of tympanostomy tubes. The core adenoid tissue and middle ear fluid were cultured. Presumptive pathogens were identified using standard methods. Results: The age range of the patients was 3 to 14 years with a mean age of 6.95years; 31 patients were male and 13 were female. Microorganisms were isolated in the core adenoid tissue in 84% (37/44) of the patients and more than two microorganisms were isolated in 41% (20/44) of the patients. Possible pathogenic microorganisms were present in 41% (29/70) of the samples. The most common pathogenic microorganisms were Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae and Pseudomonas aeruginosa. Possible nonpathogenic microorganisms were present in59% (41/70) of the samples. Streptococcus viridans, Neisseria species and coagulase(-) Staphylococcus were the most common. Only one isolate of Neisseria species(2.9%) was cultured from the middle ear effusion. Conclusions: Our results suggest that the adenoidal reservoir of bacteria may be associated with otitis media with effusion. Although we did not find a significant association between bacteriology of the adenoids and that of middle ear effusion, a significant portion of the reservoir bacteria were pathogenic microorganisms and some of them were oxacillin-resistant or β-lactamase positive. The clinical benefits of adenoidectomy in the health management of children with otitis media with effusion should not be overlooked.

Detection of Epstein–Barr virus and subsets of lymphoid cells in adenoid tissue of children under 2 years of age

Epstein–Barr virus (EBV) has been closely associated with undifferenciated nasopharyngeal carcinoma (NPC) and T/NK nasal non Hodgkin lymphoma. Nevertheless, the presence of EBV in non neoplastic lymphoid tissue of the nasopharynx has been rarely investigated. In a previous study by our group, using in situ hybridization to detect EBV in adenoids of children (2–13 years old) resected because of nasal obstruction due to hypertrophy, we found EBV genome in 72% of the cases. It was now intended to study the frequency of EBV expression in adenoids from children that underwent surgical removal, belonging to a lower age group (1–2 years old). It was also intended to establish which lymphoid subsets are involved in this infection. Adenoidal paraffin sections from 21 patients aged 1–2 years old (mean 1.6 years), 15 males and six females were submitted to double labeling: in situ hybridization with EBER 1/2 probes to detect EBV and immunohistochemistry to determine the lymphocyte typing of EBV-positive cells (CD20 for B-lymphocytes, CD3 for T-lymphocytes and CD56 and CD57 for NK-cells). Among 21 patients, seven showed positive lymphoid cells for EBV (33%). In almost all cases, EBV-positive cells were also CD20-positive. Some EBV-positive cells showed no labeling with any of the lymphoid markers, but in no instance they were positive for CD3, CD56 or CD57. This study confirms the preferential infection of B-lymphocytes by EBV, which in some instances can down regulate the expression of CD20.

Prevalence and quantitation of species C adenovirus DNA in human mucosal lymphocytes.

The common species C adenoviruses (serotypes Ad1, Ad2, Ad5, and Ad6) infect more than 80% of the human population early in life. Following primary infection, the virus can establish an asymptomatic persistent infection in which infectious virions are shed in feces for several years. The probable source of persistent virus is mucosa-associated lymphoid tissue, although the molecular details of persistence or latency of adenovirus are currently unknown. In this study, a sensitive real-time PCR assay was developed to quantitate species C adenovirus DNA in human tissues removed for routine tonsillectomy or adenoidectomy. Using this assay, species C DNA was detected in Ficoll-purified lymphocytes from 33 of 42 tissue specimens tested (79%). The levels varied from fewer than 10 to greater than 2 x 10(6) copies of the adenovirus genome/10(7) cells, depending on the donor. DNA from serotypes Ad1, Ad2, and Ad5 was detected, while the rarer serotype Ad6 was not. When analyzed as a function of donor age, the highest levels of adenovirus genomes were found among the youngest donors. Antibody-coated magnetic beads were used to purify lymphocytes into subpopulations and determine whether viral DNA could be enriched within any purified subpopulations. Separation of T cells (CD4/8- expressing and/or CD3-expressing cells) enriched viral DNA in each of nine donors tested. In contrast, B-cell purification (CD19-expressing cells) invariably depleted or eliminated viral DNA. Despite the frequent finding of significant quantities of adenovirus DNA in tonsil and adenoid tissues, infectious virus was rarely present, as measured by coculture with permissive cells. These findings suggest that human mucosal T lymphocytes may harbor species C adenoviruses in a quiescent, perhaps latent form.

Rhinovirus RNA in children with longstanding otitis media with effusion

Background: Earlier studies indicate that respiratory viruses may play a role in the pathogenesis of otitis media with effusion (OME). Objectives: To study the presence of rhinovirus RNA in middle ear mucosa in children with OME without signs of present acute infection. Methods: Eighteen children scheduled for tympanostomy tube placement due to longstanding OME were recruited and a biopsy of the promontory mucosa was obtained. In addition, adenoidectomy was performed for eight of these children and a biopsy of adenoid tissue was taken as well. The samples were collected from December to May. Rhinovirus RNA was studied by in situ hybridization (ISH). Results: Seven out of eight adenoid biopsies were positive for rhinovirus by ISH. However, rhinovirus RNA was not found in any of the 18 middle ear biopsies. Conclusions: These results show that children with longstanding OME do not have a rhinovirus infection in the middle ear mucosa, although the same children frequently harbor large amounts of rhinovirus RNA in their adenoid tissue.

A combined method of transoral and transnasal endoscopic adenoidectomy

Objective: Conventional adenoidectomy is usually performed with either a curette or an adenotome under blind or indirect visualization. The possibility of injury to the Eustachian tube or posterior choanae can not be excluede during surgery. We present a safe and more effective technique, which can be performed using endoscopic direct visualization during the whole procedure. Patients and Methods: Between January 1995 and December 1999, 105 children underwent this new surgical procedure under general anesthesia. All procedures were performed under endoscopic direct visualization. Using guidance via a 4.0 mm or 2.7 mm 70 endoscope, there was a clear operative field transorally. The adenoid curette was applied transorally to the nasopharynx to remove the main bulk of the adenoids and a 90 Blakesley forceps was also used to perform a peritubal adenoidectomy under intraoral visualization. To remove any residual adenoid tissue obstructing the orifice of the Eustachian tube or posterior choanae, we adopted a transnasal approach with a 45 or straight Blakesley forceps using a 4.0 mm or 2.7 mm 0 or 30 endoscope for guidance. Epinephrine-and H2O2-rinsed gauze was packed in the nasopharynx for post-operative hemostasis. Results: The method was successfully applied in all patients. None of the 105 patients had complications, such as post-operative nasopharyngeal hemorrhage or injury to the Eustachian tube or posterior choanae.Conclusions: the combined method of a transoral 70 and transnasal 0 or 30 endoscopic approach offered a clear and stable operative field. The surgical procedures were all performed under direct visualization. Damage to the Eustachian tube or posterior choanae was not a problem. This method has the potential to become the procedure of choice for adenoidectomy.

Comparison of the sizes of adenoidal tissues and upper airways of subjects with and without cleft lip and palate

The purpose of this retrospective study was to compare 2-dimensionally the sizes of the adenoidal tissues and the upper airways in juvenile and adolescent males with and without cleft lip and palate (CLP). Two paired groups of age-matched boys were used: (1) 90 juveniles with CLP (CLP/j) and without CLP (control/j) and (2) 40 adolescents with CLP (CLP/a) and without CLP (control/a). Measurements of adenoidal tissues and upper airways were determined by using lateral cephalograms. The adenoidal tissue was significantly larger in the CLP/j group than in the control/j group, but there was no significant difference between the CLP/a and control/a groups. The adenoidal tissue was significantly smaller in the CLP/a group than in the CLP/j group. The upper airway in the CLP/j group was significantly smaller than that in the control/j group, and that in the CLP/a group was also significantly smaller than that in the control/a group. Moreover, the upper airway in the CLP/a group was significantly larger than that in the CLP/j group, and that in the control/a group was significantly larger than that in the control/j group. However, the upper airway in the CLP/a group was significantly smaller than that in the control/a group. These results suggest that the larger adenoidal tissues in the CLP/j group, compared with those in the control/j group, decreased to a similar size with aging. However, the more restricted upper airway in the CLP/j group, compared with that in the control/j group, appeared to persist until adolescence. (Am J Orthod Dentofacial Orthop 2002;122:189-95)

Commentary

Commentary

Obstructive adenoid tissue: an indication for powered-shaver adenoidectomy.

To quantify the incidence of intranasal extension of adenoid tissue and residual adenoidal obstruction of the posterior choanae following traditional curette adenoidectomy to determine the efficiency of adenoid curettage and the usefulness of intraoperative endoscopic examination and powered-shaver adenoidectomy in achieving better postnasal patency. Prospective intraoperative endoscopic evaluation of the posterior choanae and nasopharynx of a case series of 130 patients before and after curette and powered-shaver adenoidectomy. Tertiary referral center. One hundred thirty consecutive pediatric patients with obstructive adenoidal hypertrophy undergoing adenoidectomy. The degree of residual postnasal obstruction due to adenoid tissue was assessed endoscopically (grades 0-3) after curette and adjuvant powered-shaver adenoidectomy. The presence of intranasal adenoid tissue was also recorded. Following traditional curette adenoidectomy, 51 (39%) of 130 patients had residual obstructive adenoid with 42 patients (32%) having occlusive intranasal adenoid tissue. Having determined the presence of remaining obstructive tissue with intraoperative nasal endoscopy in these 51 patients, complete airway patency was achieved with powered-shaver adenoidectomy. The presence of intranasal extension of adenoids obstructing the posterior choanae is common in children with adenoid hypertrophy. Traditional adenoidectomy is ineffective in removing this tissue and may also leave obstructive tissue high in the nasopharynx. Intraoperative nasal endoscopy allows assessment of the completeness of surgery. Powered-shaver adenoidectomy enables complete removal of obstructive adenoid tissue thereby ensuring postnasal patency.

Resistant bacteria in the adenoid tissues of children with otitis media with effusion

Objective: To investigate the relationship between the resistant bacteria in the adenoid tissue and the middle ear effusion of children who underwent myringotomy and adenoidectomy with the diagnosis of otitis media with effusion (OME). Methods: This study was performed in the ENT Clinic, Firat University between January 2001 and June 2001. Forty-one subjects who were enrolled in the study were diagnosed as OME, their age ranged from 1 to 11 years, and they underwent a myringotomy together with an adenoidectomy because of adenoid hyperthrophy. Bacteriological cultures were performed on the samples obtained from adenoid tissues and middle ear fluids, in the bacteria that were cultured; the resistance to oxacilline sodium and beta-lactamase were investigated. The resistance of penicillin was confirmed by MIC test. The control group composed of individuals who did not have OME but who underwent adenotonsillectomy due to adenotonsillary hyperthrophy. Results: In the adenoid tissue cultures; Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis species were isolated from the 70% (29/41) of the study group and 40% (20/41) of the control group ( P<0.01). In the isolated bacteria, the resistance rates for oxacilline or beta-lactamase were found to be 48% (20/41) in the study group and 16% (4/25) in the control group ( P<0.05). We observed that bacterial growth in 29% (9/31) of the middle ear cultures of the study group and resistant bacteria were isolated in 77% (7/9) of them. The same pathogens which have grown in the middle ear cultures were also present in the adenoid tissue cultures. Conclusion: The isolation of resistant bacteria in most of the adenoid tissue samples of the children with OME, makes us to consider the possible role of these bacteria in the development of OME.

Tumor necrosis factor-alpha and interleukin-1beta levels in recurrent and persistent otitis media with effusion.

Based on interleukin (IL)-1beta and tumor necrosis factor (TNF)-alpha levels in effusions, our goals were to specify either recurrent or persistent otitis media with effusion (OME) is a mid stage in the development of chronic disease and to identify the factors that have an influence on cytokine levels. Samples from groups with recurrent (n = 15) and persistent (n = 39) OME were assayed for IL-1beta and TNF-alpha. Children were also grouped with respect to age, sex, quality of effusion, and the presence of pharyngeal adenoid tissue. Tertiary referral center. In recurrent and persistent OME groups, IL-1beta was higher than TNF-alpha (P < 0.01). IL-beta was higher in recurrent OME than in persistent OME (P < 0.05). Recurrent OME seems to be closer to the chronic stage of the disease relative to persistent OME in terms of higher IL-1beta levels. Each exacerbation of acute disease in recurrent otitis media is likely to be mediated by IL-1beta. We were able to clarify that recurrent OME is a stage that occurs before chronic OME. Therefore, the prevention of acute attacks in recurrent disease would also impede long-term damage to the middle ear.

超音波切開凝固装置を用いたアデノイド手術

Ultrasonically activated scalpel was developed to concomitantly achieve cutting and coagulation, and thereby has a potential to reduce bleeding. We introduced this instrument (Harmonic Scalpel ®, Johnson and Johnson Medical Co., Cincinnati, OH, USA) for adenoidectomy in 14 patients under direct visualization by endoscope.After the patient was intubated, a sandbag was placed under the shoulders and Davis mouth gag was inserted. Small rubber catheters were introduced to retract the soft palate and a 4-mm 70° rigid endoscope was used transorally to visualize the nasopharynx. The adenoid tissue was initially shaved mostly using a KATANA blade. Thereafter, the residual tissue, especially the choanal adenoid and peritubal tonsil, was removed with a ball coagulator. Finally the nasopharyngeal wound was smoothed for complete hemostasis using the latter blade.The mean blood loss was 31.6g (range 0-70g) and the mean surgical duration was 37.6 minutes (range 19-57 minutes). Neither postoperative hemorrhage nor regrowth of adenoid tissue was encountered. There were no other complications such as otitis media, hemotympanum and local infection observed.We concluded that ultrasonically activated instrument combined with endoscopic visualization facilitated a more adequate adenoidectomy.

Perfil oxidativo de la infección amigdalar. Estudio de las enzimas antioxidantes en amígdala y sangre

In order to investigate the effect of oxidative damage due to free radicals on ent infectious diseases, levels of superoxide dismutase (sod), glutathione-peroxidase (gpx) and reductase (grt) and the total antioxidant status (tas) were measured by spectrophotometry on tonsillar tissue obtained from tonsillectomy in 538 patients, who were divided in three groups according to their surgical indication: tonsillar hypertrophy (n=235), recurrent tonsillitis (n=280) or peritonsillar abscess (n=23). sod concentration were also measured on adenoid tissue and middle ear exudate in 75 patients from the first two groups. erythrocite and tonsillar sod levels were significantly greater in the abscess group, and lower in the hypertrophic one. these differences were similar for gpx and tas. for grt, its level in abscess were lower than in the other two groups in a statistically significant way. there were strong correlations between erythrocyte and tonsillar sod, tonsillar sod and gpx, tonsillar sod and tas, and tonsillar gpx and tas. sod concentrations from adenoid tissue an middle ear exudate did not affect its blood level. so, we can conclude that tonsillar oxidative damage is determined by the frequency or the severity of local infections, and it can be evaluated by measuring the sod concentration in the tonsillar tissue or in the peripheral blood. so, it can be considered a good marker of tonsillar damage

Investigation of Helicobacter pylori colonization in adenotonsillectomy specimens by means of the CLO test.

Investigation of Helicobacter pylori (HP) colonization in adenoid and tonsil tissues by using the CLO (Campylobacter-like organism) test. Prospective clinical study. Included in the study were 19 patients aged 4 to 38 who had undergone an adenoidectomy, tonsillectomy, or adenotonsillectomy procedure under local or general anesthesia. Tissue pieces with diameters of 2 mm, which had been obtained from each adenoid and tonsil specimens in the early postoperative stage, were placed in kits specially prepared for HP (CLO test). Color changes were noted after 20 minutes and after periods of 1, 3, and 24 hours. Eleven (57.89%) of the 19 patients included in the study were shown to be HP positive, and 8 (42.11%) were negative, regardless of the type of specimen. It was shown that there was a high rate of HP colonization in tonsil and adenoid tissues.

Radiofrequency tonsil and adenoid ablation

We describe our experience with 2 new techniques for tonsil and adenoid reduction after experience with 150 procedures. Both techniques are based on low-temperature radiofrequency energy to reduce tonsil and adenoid size rather than excision of tonsil or adenoid tissue. The advantages are almost complete elimination of pain and postoperative bleeding risk. Tonsil ablation is performed by applying radiofrequency energy to the tonsil tissue, which causes posttreatment shrinkage and scarring. Tonsil coblation is based on tonsil reduction by surface application radiofrequency until 90% of the tonsil is eliminated. The disadvantage is that both procedures do not accomplish complete tonsillectomy and some residual tonsillar tissue is left. With tonsil ablation, approximately 40% of the tonsil remains, whereas with tonsil coblation, only 10% of the tonsil remains. Tonsil coblation is more predictable because the surgeon controls the amount of reduction at the time of surgery. Both procedures result in minimal pain, and over 90% of the patients resume a solid diet within 48 hours.

Current techniques of adenoidectomy

The presence of the adenoids remained undiscovered until the mid 1800s. Today, adenoidal pathology is recognized as a very common cause of morbidity in children. Surgical removal of the adenoids remains one of the most common procedures performed within our specialty. The location of the adenoids within the nasopharynx has led to the development of many instruments and techniques to facilitate their removal. All are premised on the adequate removal of the adenoidal tissue without damage to surrounding structures. The authors present a review of traditional and more recent approaches to adenoidectomy.

Experimental model of invasion and metastasis by orthotopic transplantation of oral squamous and adenoid cystic carcinomas into the tongue of nude mice

Three squamous cell carcinoma (SCC) cell lines established from oral cancer, seven specimens of SCC and three of adenoid cystic carcinomas taken from the oral cavity during operations were transplanted into the tongues of nude mice. Metastases to the regional lymph nodes and the lungs were examined histologically. We were able to transplant every cell line or specimen of tissue into the tongue of nude mice, and found that cancer transplanted in the tongue invaded diffusely to the surrounding tissues without forming a capsule, and that the mode of invasion of the transplanted SCC was similar to that of the biopsy specimen of the patient from whom the material had been obtained. We also found that all three of the SCC cell lines, 3 of the 7 SCC specimens and 2 of the 3 adenoid cystic carcinoma tissues metastasized to the regional lymphnode. SCC did not metastasize to the lung, but in two of the three adenoid cystic carcinomas we did see micrometastases to the lung. The study indicates that this method can be used as a model of metastasis in oral squamous cell carcinoma and adenoid cystic carcinoma to show the stages of metastasis in cancer.

Pediatric allergic rhinitis and comorbid disorders

Allergic rhinitis (AR) is rarely found in isolation and needs to be considered in the context of systemic allergic disease associated with numerous comorbid disorders, including asthma, chronic middle ear effusions, sinusitis, lymphoid hypertrophy with obstructive sleep apnea, disordered sleep, and consequent behavioral and educational effects. The coexistence of AR and asthma is complex. First, the diagnosis of asthma may be confounded by symptoms of cough caused by rhinitis and postnasal drip. This may lead to either inaccurate diagnosis of asthma or inappropriate assessment of asthma severity with over treatment of the patient. The term “cough variant rhinitis” is therefore proposed to describe rhinitis that manifests itself primarily as cough that results from postnasal drip. AR, however, also has a causal role in asthma; it appears both to be responsible for exacerbating asthma and to have a role in its pathogenesis. Postnasal drip with nasopharyngeal inflammation leads to a number of other conditions. Thus sinusitis is a frequent extension of rhinitis and is one of the most frequently missed diagnoses in children. Allergen exposure in the nasopharynx with release of histamine and other mediators can cause Eustachian tube obstruction possibly leading to middle ear effusions. Chronic allergic inflammation of the upper airway causes lymphoid hypertrophy with prominence of adenoidal and tonsillar tissue. This may be associated with poor appetite, poor growth, and obstructive sleep apnea. AR is therefore part of a spectrum of allergic disorders that can profoundly affect the well being and quality of life of a child. Prospective cohort studies are required to assess the disease burden caused by AR in childhood and to further assess the potential educational impairment that may result. Because AR is part of a systemic disease process, its management requires a coordinated approach rather than a fragmented, organ-based approach. (J Allergy Clin Immunol 2001;108:S9-15.)

The importance of a beta-glucan receptor in the nonopsonic entry of nontypeable Haemophilus influenzae into human monocytic and epithelial cells.

Previous reports showed that nontypeable Haemophilus influenzae (NTHi) reside in macrophage-like cells in human adenoid tissue. This study investigated the ability of nonopsonized NTHi and encapsulated H. influenzae type b (Hib) to enter human monocytic and epithelial cells. The number of intracellular bacteria was determined by a viability assay and flow cytometry. To characterize the mechanisms responsible for the internalization of NTHi, different inhibitors of surface molecules, receptor turnover, and the cytoskeleton were used. Hib were found in monocytic cells at very low numbers (<100 bacteria/2x105 cells). In contrast, a great variation in intracellular numbers was detected between the different NTHi isolates (range, 0.0007%-0.28% of the inoculum for monocytes and 0.053%-3.5% for epithelial cells). NTHi entered human monocytic and epithelial cells via a receptor-mediated endocytosis involving mainly a beta-glucan receptor that could be blocked by laminarin.

Ectopic adenoid tissue in the choanae.

A series of 19 patients with often long-lasting nasal stenosis despite repeated treatment attempts, including in many cases repeated adenoidectomy, were found to have ectopic adenoid tissue in the choanae which could only be removed transnasally by forceps. It did not emerge from the rhinopharynx but from the roof of the choanae, the posterior part of the nasal septum and in some cases also from the lateral wall of the choanae. The diagnosis was established by anterior rhinoscopy using a flexible rhinopharyngo-laryngoscope. The treatment was successful in all 19 patients, many of whom had had symptoms for years. It is estimated that about two per cent of patients with adenoid symptoms have such ectopic choanal adenoid tissue, that cannot be removed by the usual oral approach. In young patients with long-lasting nasal stenosis attention should be focused on the bottleneck of the nasopharyngeal airway formed by the choanae, primarily by fibre-optic endoscopic examination.