Adenoid Vegetations Research Articles

Hypertrophy of adenoid vegetation in modern treatment conditions

We present data on the hypertrophy of adenoid vegetation in modern treatment conditions. Actual aspects of the etiology of hypertrophy of adenoid vegetation and chronic adenoiditis are discussed, and mechanisms of the formation of local immunity and the effect of immunomodulating therapy are also described. Data on the morphology of adenoids, immunity condition after exposure to modern drugs and the rationality of treatment in frequently ill children are presented.

Отдельные аспекты патогенетически обоснованного подхода в лечении хронического аденоидита с применением физических методов воздействия

Introduction. The relevance of using nondrug methods of influence on inflamed lymphoid tissue in the complex therapy of chronic adenoiditis in children is determined by the possibility of obtaining positive results in a shorter time. Objective. To study the effect of low-frequency ultrasonic cavitation in combination with photochromotherapy on the course of the inflammatory response in chronic adenoiditis in children. Patients and methods. There were 84 patients with chronic adenoiditis and adenoid hypertrophy of the second and the third grades with absolute indications for adenotomy in the prospective study. Adenotomy was used in every research. There were three groups for study clinical, morphological, and biochemical parameters in the tissues of adenoid vegetations under the influence of low-frequency ultrasonic cavitation in combination with photochromotherapy. The first group is the control group (n = 32). This group did not receive physical methods of exposure in the preoperative period. The second group (n = 27) received low-frequency ultrasonic cavitation irrigation of the nasopharynx in combination with photochromotherapy. The third group (n = 25) was not exposed to photochromotherapy. The course of the treatment lasted for 7 days. Results. Under the influence of a combination of low-frequency ultrasonic cavitation in combination with photochromotherapy, the content of the end products of lipid peroxidation – Schiff bases, which are a marker of irreversible dystrophic changes in the cell, decreases. An increase in the level of activity of the antioxidant catalase in the tissues was noted, which inhibits the processes of oxidative stress. Conclusion. Treatment of chronic adenoiditis with low-frequency ultrasonic cavitation with photochemotherapy reduces the inflammatory process in the tissues of adenoid vegetations, which greatly decreases the severity of illness and, as a result, surgery frequency.

СТАН ІМУНІТЕТУ В ДІТЕЙ ДОШКІЛЬНОГО ВІКУ, ХВОРИХ НА ГОСТРІ РЕСПІРАТОРНІ ВІРУСНІ ІНФЕКЦІЇ НА ФОНІ АДЕНОЇДНИХ ВЕГЕТАЦІЙ

Introduction. Acute respiratory infections are the most common infectious diseases worldwide among children of different age groups. Materials and methods. 59 children between the ages of 3 and 7 participated in the study. The first group included 22 patients with an acute respiratory viral infection, the second one consisted of 23 patients with acute respiratory viral infections associated with adenoid vegetation, and 14 apparently healthy children were included in the control group. Immunology research was conducted during the acute period of the disease. Statistical processing of received data was done with the standard statistical software EZR 1.41. Results. After the research, most of the patients with acute respiratory viral infections were identified an actual increase in CD3+, CD4+, CD8+, CD22+- cells and IgA, IgM in the blood serum. Simultaneously, in patients with acute respiratory viral infections associated with adenoid vegetation during the acute period, the increase in total lymphocytes was identified due to CD4+, CD8+, CD22+ cells and IgG. A comparative analysis of the study results of both groups of patients showed that children from the second group had a significantly higher level of CD3+- cells, while the CD22+- lymphocytes, IgA, IgM and IgG were significantly lower from the similar indicators of the first group. Conclusions. The acute period of the disease in children with acute respiratory viral infections, associated with adenoid vegetation, had an imbalance in both the cell and the immune system's humoral component

Nasal Steroids Use in the Prevention of Symptomatizing Adenoid Regrowth after Adenoidectomy

Abstract Background Regrowth of the adenoids is a well-recognized entity. Intranasal steroids for children with adenoid vegetation can provide an alternative to revision surgery. Objective To assess the ol' using nasal steroids to prevent recurrence of adenoid hypertrophy and related symptoms after adenoidectomy. Methods Controlled clinical trial. One hundred patients after adenoidectomy were divided randomly into 2 groups. Group I were patients performing surgery on odd days of the month received postoperative intranasal steroid [fluticasone propionate (50 mcg/metered dose per nostril per day)] and Group Il were patients performing surgery on even days of the month received intranasal saline spray starting at postoperative week 2 after wound healing. Both medications will be adninistrated for 8 weeks postoperatively. Patients will be followed up for minimum of 6 months by using modified SNOT Score to suit children in reporting the degree of the symptoms and i!' needed nasopharyngeal lateral X-rays. Results Highly significant difference between both groups after 6 months postoperatively. Conclusion The use of intranasal steroids may obtain successful results in children to prevent adenoid regrowth and recurrence of related nasal symptoms after adenoidectomy. The most appropriate drug, the most efficient dose, and optimal treatment duration need to be investigated and determined.

Protracted otitis media with effusion in an adult patient with adenoid vegetation. Clinical case presentation

Background Otitis media with effusion (OME) is characterized by the accumulation of non-purulent discharge in the middle ear cavity, with no signs or symptoms of acute ear infection. If the effusion persists for 3 months or more, this is considered a case of chronic otitis media with effusion (COME). The main pathogenetic mechanism for the occurrence of serous otitis is the dilatory dysfunction of the Eustachian tube. This dysfunction can be due to a number of reasons, the main one being an external obstruction resulting from the constriction of the opening of the Eustachian tube by adenoid vegetation or tumors. We present a case of protracted otitis media with effusion and adenoid vegetation in a 24-year-old man– with bilateral combined hearing loss, upper airway obstruction, and chronic sinuitis– successfully treated by bilateral tympanostomy and adenoidectomy. Materials and methods In our clinical case we have described chronologically the investigations and chosen tactics of treatment, applied to our patient, some immediate results, but also the long-term consequences of the management of this disease. Results In our opinion, the outcomes in this patient’s case were prompted not only by the specifics of this disease, but also by the interpretation of the instrumental examination and the decision-making regarding the initial treatment.

Treatment of adenoid inflammation in children

Topicality: Inflammation of the adenoid tonsil is one of the common causes of ENT diseases in children. Among the causes of adenoiditis (nasopharyngitis) are infectious - viral and bacterial, allergic and gastric acid irritation in laryngopharyngeal reflux. The aim of our research was to study the effectiveness of topical application of a combination of xylometazoline hydrochloride 0.05% and miramistin 0.01% in the treatment of pediatric patients with pharyngeal tonsillitis. Materials and methods: We selected 60 patients aged 5 to 14 years with endoscopically confirmed adenoid vegetations of I-II stage with inflammation. Patients were divided into 2 groups – main and control. Patients in the control group received saline irrigation therapy 4 times a day, patients in the main group received saline lavage 4 times a day and intranasal administration of a combination of xylometazoline hydrochloride 0.05% and miramistin 0.01% three times a day for 7 days. Patient status was analyzed using a Likert scale questionnaire and objective endoscopic examination. Results: During treatment, a positive effect was observed in both groups. However, starting from the second visit (on the 3rd day of treatment) there was a faster decrease in symptoms in children of the main group compared to the control, on the 7th day the difference between the groups was subjective – 5.9 points, and objective – 2.5 points in favor of the main group. Therefore, intranasal administration of a combination of xylometazoline hydrochloride 0.05% and miramistin 0.01% helps reduce edema, redness, exudation, improves nasal breathing and in combination with saline irrigation therapy is an effective means for topical treatment of children with inflammatory diseases of the pharynx.

Risk Factors for Postoperative Bleeding after Adenoidectomy.

IMPORTANCE: Postoperative bleeding is a common and potentially life-threatening complication. Precise identification of risk factors in addition to the basic ones, such as coagulation parameters, is certainly very desirable. OBJECTIVE: The aim of this study was to identify other possible risk factors for bleeding after adenoidectomy in children. DESIGN: This observational prospective study enrolled children undergoing adenoidectomy from October 2019 to February 2020, then evaluated the influence of possible risk factors for bleeding. SETTING: Tertiary pediatric otorhinolaryngology center. PARTICIPANTS: A total of 288 children aged 0–18 years undergoing adenoidectomy for recurrent upper respiratory tract infections, recurrent acute otitis media, secretory otitis media, and obstructive sleep apnea syndrome. MAIN OUTCOMES AND MEASURES: Increased blood pressure and time of surgery were identified as risk factors for bleeding after adenoidectomy. RESULTS: Elevated systolic (p = 0.046), diastolic (p = 0.012), and mean arterial blood pressure (p = 0.007) (Mann–Whitney U test) as adjusted for age-specific distributions and with corrections for height and weight, as well as time length of surgery (p < 0.001) (Fisher’s exact test) were revealed as statistically significant risk factors for postoperative bleeding. Atmospheric pressure, surgeon’s level of experiences, chronic inflammatory content in adenoid vegetation (AV), size of AV, recidivism of AV, recurrent infections of the upper respiratory tract, type of anesthesia, long-term using of drugs, and positive coagulation questionnaire or pathology in standard coagulation tests were not found to be risk factors for bleeding after adenoidectomy. CONCLUSIONS AND RELEVANCE: In this prospective study within a well-defined population of children, we evaluated increased blood pressure and time of surgery as risk factors for bleeding after adenoidectomy. These data bring new information that complements current knowledge in this field.

Effect of montelukast treatment on adenoid hypertrophy and sleep quality in pediatric patients

Adenoid vegetation is part of lymphoid tissue located in the upper respiratory tract. When adenoid tissue becomes hypertrophied, it may cause narrowing of the respiratory tract and complications. Generally, treatment of adenoid hypertrophy is surgical; however, currently reducing the size of adenoid hypertrophy with the leukotriene receptor blocker of montelukast is evaluated among treatment choices apart from surgery. The aim of the study was to assess whether montelukast treatment is an alternative to surgical treatment or not. The study included a total of 50 pediatric patients. Adenoid tissue size was evaluated endoscopically and radiographically. Patients were divided into two groups based on closure of the nasopharynx by adenoid tissue. Group 1 comprised adenoid hypertrophy cases with the choana blocked by less than 50%, with Group 2 comprising children with adenoid hypertrophy and more than 50% closure of the choana. All patients began 5 mg montelukast treatment for 12 weeks. Patients had the pediatric sleep questionnaire applied before and after treatment. Tests and radiographic results were compared. In both groups, it was identified that montelukast treatment had no effect on adenoid tissue size (p=0.286, 0.304, respectively). Contrary to this, patients in Group 1 were identified to have statistically significant improvement in sleep quality with montelukast treatment (p=0.006). In Group 2 patients, there was no such improvement in sleep quality identified (p=0.91). Montelukast treatment increased sleep quality in children with less than 50% obstruction of the choana.

Эндогенная интоксикация при хронической патологии глотки у детей

A review of scientific Russian and foreign articles devoted to the development of endogenous intoxication in chronic inflammatory pathology of the lymphoepithelial pharyngeal ring is carried out. Chronic tonsillitis and adenoiditis in children are one of the unsolved issues in otorhinolaryngology. Chronic tonsillitis is a chronic inflammation of the palatine tonsils characterized by recurrent exacerbations in the form of tonsillitis and a general toxic-allergic reaction. Adenoid vegetation is a pathological hypertrophy of the pharyngeal tonsil. Chronic adenoiditis is a chronic polyetiologic disease, which is based on a violation of the physiological immune processes of the pharyngeal tonsil. In children, one cannot talk about an isolated inflammation of the pharyngeal tonsil, since as a result of exposure to antigens, an immune response arises, which involves all structures of the lymphoepithelial pharyngeal ring in the process, therefore some authors distinguish the term «adenotonsillitis». With pronounced activation of microflora in the nasopharynx and oropharynx, the body’s resistance to pathogenic microorganisms decreases, as a result of which decay products and toxins damage the vascular endothelium, disrupt their permeability and, penetrating through the epithelial barrier, contribute to the development of chronic intoxication and sensitization of the body. Endogenous intoxication is a polyetiologic and polypathogenetic syndrome characterized by the accumulation of endogenous toxins in tissues and biological fluids. Diagnostics of the endogenous intoxication severity includes a number of clinical and laboratory indicators and immunological markers. But, despite the constant improvement of the research methods, the issue of endotoxicosis diagnosis in chronic tonsillitis and adenoiditis remains insufficiently studied. As a result of the inadequate diagnosis, there is often a simultaneous removal of the pharyngeal and palatine tonsils, which in turn can lead to irreversible consequences.

Expression of terminal deoxynucleotidyl transferase in the pharyngeal and palatine tonsils in local infectious and inflammatory diseases of the upper respiratory tract and pharynx in childhood

Along with central immune organs, the peripheral lymphoepithelial organs of the pharynx are actively involved in protecting the body from infections. Adaptive, or induced, immunity occurs during the postnatal ontogenesis of immunocompetent lymphocytes, which includes the secondary somatic recombination of the V genes with the participation of recombination-activating gene (RAG) and terminal deoxynucleotidyl transferase (Tdt) proteins. This publication discusses the results of detection of Tdt-positive cells in the pharyngeal and palatine tonsils of children of different ages, who had been operated on for adenoid vegetations and chronic tonsillitis. Attention is drawn to the localization of Tdt+ cells, the level of Tdt expression, an attempt to clarify the phenotype, destination, and place in the diagnostic arrays of functional markers when an adaptive immunity is generated in children.

Monozygous twins with Epstein-Barr infection in the nasopharynx

The article describes a clinical case of monozygotic twins with hypertrophy of the organs of the lymphopharyngeal ring. The examination revealed IgG to the Epstein-Barr virus capsid antigen in both patients. One twin had Epstein-Barr virus DNA in the sample from the oropharynx. It was this child who had complaints typical of patients with adenoid vegetation, and he required surgical treatment (endoscopic shaver adenotomy and radio wave bilateral tonsillotomy). At the time of the initial examination and in the absence of complaints the second twin revealed no DNA of Epstein-Barr virus in the oropharynx. This patient was diagnosed with adenoids of 1-2 degree. Due to the complaints of the second twin that appeared during the following year of observation, with previously negative results on active Epstein-Barr virus markers served as the reason for a repeated specific laboratory examination. Epstein-Barr virus DNA was found in a sample from this child’s oropharynx. This case using the twin control method by partner enabled us to demonstrate the significance of Epstein-Barr virus in the pathogenesis and clinic manifestations of chronic diseases of the lympho-pharyngeal ring organs in children.

Experience of Use of the Drug Nasomer® After Adenectomy in Children

Adenectomy is the most common surgical procedure in children. After successful adenectomy, proper care of the nasal cavity and nasopharynx in the postoperative period is important.The objective: of the clinical study was to study the effectiveness of the drug Nasomer® after adenectomy in children.Materials and methods. We observed 60 patients with adenoid vegetations aged 2 to 12 years in the clinic. There were 26 girls and 34 boys. Adenoid vegetations of the second degree took place in 26.7 %, third degree – in 73.3 %. Children were randomly divided into two groups, comparable in age, sex, clinical diagnoses. The 1st group (main) included 30 children after adenotomy who received standard therapy with the inclusion of the drug Nasomer® for 14 days in age doses. The 2nd group (control) included 30 children after adenotomy who did not use the drug Nasomer®.Results. The use of the drug Nasomer® in the complex treatment of children after adenectomy helped reduce redness and swelling of the nasal mucosa, cessation of mucous secretions from the nasal cavity, faster healing of postoperative wounds, restoration of nasal breathing in a shorter time compared to the control group. No side effects were detected when using the drug Nasomer® in any case.Conclusions. The use of Nasomer® after adenotomy improves mucociliary transport, improves the evacuation of infectious agents from the nasal cavity and increases the effectiveness of rehabilitation of children in the postoperative period.

Analysis of the Microorganism’s Sensitivity in Patients with Chronic Adenoiditis to Pharmacotherapy with Antibacterial Drugs

Introduction: The prevalence of chronic pathology of the pharyngeal lymphatic system in preschool children reaches 45% and is mainly manifested by hypertrophy of adenoid vegetations, which in half of cases are combined with chronic inflammation, which, with repeated periods of exacerbation, leads to the development of severe chronic pathology of the upper respiratory tract. The role of microorganisms toleranceto pharmacological agents is widely proven in formation of chronic inflammatory disorders and demand correction of therapeutic schemes. Research tasks: The aim of this research was to study the microbial landscape of oropharynx in children who received surgical for adenoiditis and determine the sensitivity of the identified microorganisms to the pharmacotherapy with antibiotics. Material and Methods: We conducted a study of 1577 children aged from 1 year to 17 years and 11 months who received inpatient treatment at the otorhinolaryngological Department of the OO “Scientific and clinical multidisciplinary center named after Z. I. Kruglaya” in the city of Oryol in the period from 2015 to 2017 for hypertrophy of adenoid vegetations. The patients were divided into three groups based on the years of the study. The study of the oropharyngeal microbial association was performed by preparing a smear followed by Gram staining and bacterioscopy. Determination of the sensitivity of microorganisms to antibacterial drugs was performed by discdiffusion method. Results: We found in patients oropharynx microbial landscape with hypertrophy of chronic vegetation in dynamics over the period from 2015 to 2017, an increase in the number of opportunistic saprophytic flora was detected, which was observed against the background of a clear increase in the number of patients with this pathology an increase in the number of cases associated with saprophytic MRCA flora, represented mainly by Staphylococcus aureus, leads to a decrease in the effectiveness of conservative treatment of chronic adenoiditis, which is expressed in an increase in the number of adenotomies. Conclusion: The study revealed negative consequences of uncontrolled use of antibiotic therapy at the pre-hospital stage and irrational schemes of chemotherapy in hospital units, which is manifested in the growing resistance of microorganisms to both “old” antibacterial drugs and a decrease in sensitivity to pharmacotherapy with the latest generation of antibiotics and requires active revision of the schemes of antibiotic therapy and prevention.

«Атипова» аденотомія у дітей

With the spread of adenoid vegetation into the nasal cavity, their removal and restoration of the respiratory and auditory function in full is significantly difficult. The objective: of the study was to increase the effectiveness of adenotomy in children. Materials and methods. Under our supervision in the clinic were 239 children with adenoid vegetation II-III degree, aged 2 to 15 years. In the main group, there were 175 children, in the comparison group – 64. In 10 (4.2%) patients, lymphoid tissue from the nasopharynx spread through the choana into the nasal cavity. All children were operated on under endotracheal anesthesia with endoscopic control. Atypical adenotomy was performed in 83 (47.4%) patients of the main group and in 30 (46.9%) patients of the comparison group. Results. 239 children with adenoid vegetation were operated on. In all children of the main group, physiological respiration was restored, hearing was restored or improved, and disease recurrence was not observed. In the comparison group, relapse of adenoid vegetation was detected in 4 (6.25%) cases. In 29.3% of cases, an increased density of adenoid vegetation was revealed. In 13.8% of patients, hypertrophy of the tubular and lateral ridges is observed. Blood loss when using high-frequency current decreased 4.7 times. Conclusions. 1. In 29.3% of pediatric patients, an increased density of adenoid vegetation is detected, and in 4.2%, adenoid vegetation spreads to the nasal cavity, which makes it difficult or sometimes impossible to remove Beckman’s adenotome and requires an «atypical» adenotomy. 2. Atypical location of adenoid vegetation, their increased density and the use of traditional tools for adenotomy can cause a relapse of the disease. Key words: adenoid vegetation, «atypical» adenotomy, children.

Стан слухової функції у дітей з аденоїдними вегетаціями

Стан слухової функції у дітей з аденоїдними вегетаціями

Topical therapy drugs containing silver in acute adenoiditis sinusitis in children

The article presents the results of Russian authors’ research aimed at studying the clinical efficacy of topical drugs containing silver in treating acute serous adenoiditis and sinusitis in children. The authors noted the efficacy and safety of the drug (silver proteinate and polyvinyl-N-pyrrolidone) in the complex treatment of inflammatory diseases of the nose and paranasal sinuses in children. Clinical observation was carried out – comparison of two groups of 30 patients aged from 5 to 14 years, average age 6 years 3 months, the groups included: 17 boys (56.7%) and 13 girls (43.3%), all children had adenoid vegetations of the 1st-2nd degree. To assess the clinical efficacy of the drug, a control group of children with similar pathology was recruited, comparable in age and sex (14 boys and 16 girls). The main group received the drug Sialor and irrigation therapy. The control group received local antibacterial drugs and decongestants according to age. At the beginning of treatment normal values of mucociliary transport were not observed in any patient (0%) of the main and control groups. Disorder of the 1st degree mucociliary transport function was determined in 6 children (20%) of the main group and 7 children (23.3%) of the control group, 2nd degree – in 21 children (70%) of the main group and 19 children (63.3%) of the control group, 3rd degree – in 3 (10%) patients of the main group and 4 children (13.4%) of the control group. In 7 days from the beginning of treatment normal values of MCT were observed in 28 patients (93.3%) of the main group and 9 patients (30%) of the control group, the disorder of MCT function of the 1st degree had 3 patients (9%) of the main and control groups, the 2nd degree was not in the main group and was revealed in 18 patients (60%) of the control group, no disorder of MCT function of the 3rd degree was revealed (neither in the main nor control groups). The average time of MCT was: before treatment – 49 minutes (main group) and 47 minutes (control group), the 3rd day of treatment – 28 minutes (main group) and 36 minutes (control group). On the 7th day of the drug intake – 14 minutes (main group) and 21 minutes (control group). Thus, normalization of MCT time was noted only in patients of the main group. On the 7th day of treatment with Sialor in the main group of children under examination, nasal mucosa edema, nasal excretion and adenoid tissue size decreased, mucociliary transport parameters normalized, nasal breathing improved. Sialor has a pronounced anti-inflammatory and anti-edema effect, is well tolerated by patients and can be recommended for inclusion in standard treatment protocols of patients with diseases of the nasal cavity, paranasal sinuses.

Neutrophil-to-lymphocyte and basophil-to-lymphocyte ratios in children with adenoid vegetation: Can they be prognostic markers?

Aim: Adenoid vegetation often causes open-mouth sleeping, snoring, breathing difficulties and it is also associated with many inflammatory diseases. In the treatment, adenoidectomy is performed to get rid of these symptoms and to prevent the future complications. In recent years, it has been reported that the neutrophil-to-lymphocyte ratio (NLR) is a prognostic factor in various diseases. Researches on the basophil-to-lymphocyte (BLR) ratio have been increasing. The aim of our study is to compare NLR and BLR before and after adenoidectomy and to determine whether these markers can be used as prognostic factors. Material and Methods: The patients 2 to16 years old who underwent adenoidectomy in our clinic from January 2016 to June 2019 were included in our study. The postoperative hospital application data of them were analyzed. Routine hemograms for surgery and postoperative hemograms (except inflammatory conditions) were used for calculating the NLR and BLR. Results: One hundred and twelve patients were included in the study. When the preoperative and postoperative NLR values (1.3335 and 1.1152, respectively) were compared, there was a statistically significant decrease in the postoperative period (p = 0.02). However, when the BLR values were compared preoperatively and postoperatively (0.0054 and 0.0050, respectively), there was no statistically significant difference in the postoperative period (p = 0.59). Conclusion: There are very few studies in the literature that evaluates NLR before and after adenoidectomy. To our knowledge, our research is the first study to evaluate BLR before and after adenoidectomy. In contrast to the literature, a significant difference in NLR was found out in our study. It has been determined that NLR can be used as a prognostic marker in adenoidectomy. More researches are needed for BLR in this area.

Роль родительских и персональных факторов риска в формировании гипертрофии глоточной миндалины у детей раннего и дошкольного возраста

Pharyngeal tonsil hypertrophy of the second and higher degree occurs in infants and preschool children with the frequency of 5% and higher. The issue of exogenous and endogenous factors contributing to the formation of pharyngeal tonsil hypertrophy in infants and preschool children remains relevant for the modern pediatrics. Adenotomy surgery cannot be performed with the same frequency, because it has intraoperative, early post-operative and long-term complications and consequences. The search for parental and personal controlled risk factors of formation of the pharyngeal tonsil hypertrophy is an urgent task for pediatrics and pediatric otorhinolaryngology. The objective of the study was to assess the role of parental and personal risk factors on the occurrence of pharyngeal tonsil hypertrophy in infants and preschool children. Materials and methods. The authors studied the extended medical history and DNA markers of pharyngeal biotope microorganisms in children with adenoid vegetations (228 children) and healthy children (63 children). The associations of social, medical, and microbiome predictors with the pharyngeal tonsil hypertrophy were studied using multi-analysis. Results. It was revealed that the formation of the pharyngeal tonsil hypertrophy is associated with integrative parental and personal risk factors, as well as with the high expression of Streptococcus pyogenes and Epstein–Barr virus in the pharyngeal biotope. The prescription of antibacterial and antiviral therapy in the treatment of acute respiratory disease in children with the pharyngeal tonsil hypertrophy should be made taking into account the expression of Streptococcus pyogenes and Epstein–Barr virus.

Treatment of exudative (secretory) otitis media in young children taking into account the anatomical features of the auditory tube

To study the efficacy and safety of treatment of exudative (secretory) otitis media (EOM) in children of early age taking into account the anatomical features of the auditory tube. We examined and treated 30 children (51 ears) by balloon dilatation (BD) at the age of 1 to 3 years, with recurrent EOM (more than 6 months). The 21st child was diagnosed with a 2-sided process, and 9 with a one-sided process. All patients have previously unsuccessfully used conservative methods of treatment. According to the results of the examination and treatment, the children were divided into 2 groups. In group 1 (16 children, 30 ears) included children suffering from ESR in combination with hypertrophy of adenoids 2-3 art. with a block of pharyngeal mouths of auditory tubes, which at stage 1 of treatment was carried out endoscopic adenotomy and shunting of the tympanic cavities. In follow-up, this group of children after shunt loss was diagnosed with relapse of EOM (type B was registered on tympanometry). In this group, balloon dilation of auditory tubes was performed in the second stage after adenotomy and bypass surgery. In group 2 (14 children, 21 ear) included children with relapsing course of EOM, the adenoid vegetation 1 degree without block the pharyngeal orifices of the auditory tubes, which in the first phase was conducted on bypass the tympanic cavity. After the loss of shunts, during the control examination, a relapse of EOM was diagnosed, in connection with which, the children underwent balloon dilation of the auditory tubes. During tympanometry in 1 month. complete restoration of middle ear function in 17 children (56.7%, 28 ears) (tympanograms type A) was revealed. 4 children (13.3%, 6 ears) were diagnosed with partial recovery of middle ear function (tympanograms type C). 9 children (30%, 17 ears) retained exudate in the tympanic cavity, these patients underwent a second course of conservative therapy, after which the function of the middle ear was restored. 9 children after BD with persistent exudate in the middle ear cavities underwent tympanostomy (in this case, long-term wearing shunts were used). Balloon dilation of the cartilaginous part of the auditory tube is minimally invasive, effective in 70% of cases and a safe approach to the treatment of children suffering from a recurrent course of EOM.

Rhinolithiasis, a Rare Entity: Analysis of 31 Cases and Literature Review

OBJECTIVE:Rhinolithiasis is a rare condition which results from deposition of salt around a endogenous or exogenous nidus. In the literature, most of the reports are single case studies. In this study, we aimed to present the characteristics, symptoms, diagnosis, and treatment methods of 31 rhinolithiasis cases and to focus on the current literature.METHODS:We retrospectively reviewed 31 rhinolithiasis cases which have been diagnosed and treated in a tertiary care center between January 2014 and December 2018. Patient characteristics, presenting symptoms, concomitant sinonasal disorders, and type of surgery were noted. Descriptive statistics were carried out.RESULTS:Mean age was 25.4±15.7. The cases were comprised 14 female patients (45.2%) and 17 male patients (54.8%). The most common presenting symptom was nasal obstruction (71%). Malodorous unilateral rhinorrhea was present in 17 patients (54.8%). Epistaxis snoring and sleep apnea were other rare symptoms. In 21 of the cases (67.7%), rhinolith was located between inferior turbinate and septum which was the most common location seen in our series. The number of patients who were under the age of 18 was 13, in 2 of them, rhinolith was found to be formed around a plastic bead, and in 2 of them, fruit seeds were the nidus. The most common concomitant sinonasal pathology was septal deviation which was detected in 20 of the patients (64.5%), adenoid vegetation and nasal polyposis were other disorders. In 20 of the patients (64.5%), simple removal of the rhinolith using a forceps with the help of a rigid nasal endoscope was performed. Eight of the 17 patients had severe deviation and septoplasty was performed at the same time, which was the most common concomitant surgical intervention (25.8%). In 3 patients (9.6%), functional endoscopic sinus surgery was performed at the same time.CONCLUSION:Our series is one of the largest series in the literature. The most common presenting symptom was nasal obstruction followed by malodorous rhinorrhea. Accompanying sinonasal disorders should be addressed to improve the outcome. Rigid or flexible endoscopic examination should be used to detect a rhinolith. Computed tomography scan can diagnose a hidden rhinolith in a patient with nasal obstruction.