Adenotonsillar Hyperplasia Research Articles

Extracapsular Tonsillectomy versus Intracapsular Tonsillotomy in Paediatric Patients with OSAS.

The objective of our study was to compare our experience of intracapsular tonsillotomy performed with the help of a microdebrider usually used for adenoidectomy with results obtained from extracapsular surgery through dissection and from adenoidectomy in cases of people affected with OSAS, linked to adeno-tonsil hypertrophy, observed and treated in the last 5 years. 3127 children with adenotonsillar hyperplasia and OSAS-related clinical symptoms (aged between 3 and 12 years) underwent tonsillectomy and/or adenoidectomy. A total of 1069 patients (Group A) underwent intracapsular tonsillotomy, while 2058 patients (Group B) underwent extracapsular tonsillectomy, from January 2014 to June 2018. The parameters considered in order to evaluate the effectiveness of the two different surgery techniques taken into consideration were as follows: the presence of possible postoperative complications, represented mainly by pain and perioperative bleeding; the level of postoperative respiratory obstruction compared with the original obstruction through night pulse oximetry, performed 6 months before and after the surgery; tonsillar hypertrophy relapse in Group A and/or the presence of residues in Group B with clinical evaluation performed 1 month, 6 months, and 1 year after the surgery; and postoperative life quality, evaluated through submitting to parents the same survey proposed before the surgery 1 month, 6 months, and 1 year after the surgery. Regardless of the technique used (extracapsular tonsillectomy or intracapsular tonsillotomy), there was a clear improvement in both the obstructive respiratory symptomatology and quality of life in both patient groups, as highlighted by the pulse oximetry and the OSA-18 survey submitted later. Intracapsular tonsillotomy surgery has improved in terms of a reduction in postoperative bleeding cases and pain reduction, with an earlier return to patients' usual lifestyle. Lastly, using a microdebrider with the intracapsular technique seems to be particularly effective in removing most of the tonsillar lymphatic tissue, leaving only a thin border of pericapsular lymphoid tissue and preventing lymphoid tissue regrowth during one year of follow-up.

Modified dindo-clavien system for registration of perioperative complications in children undergoing adenotonsillectomy.

Surgical procedures in children are among the most commonly performed procedures in otolaryngology. Perioperative safety and documentation of complications are becoming increasingly important. This study investigates perioperative complications in a clinical cohort of children with adenotonsillar hyperplasia undergoing adenotonsillectomy using the standardized Dindo-Clavien reporting system. Retrospective evaluation of 402 children who underwent adenotonsillectomy between 2009 and 2015. Patient parameters including all perioperative complications were investigated. In the study, 124 complications were found (106 mild, 16 severe). According to the Dindo-Clavien classification, 93 grade I, 15 grade II, 5 grade III, 11 grade IV and 0 grade V complications were documented. Complications were associated with additional diagnoses (p = 0.001), long-term medication intake (p = 0.003), duration of hospitalization (p < 0.001) and duration of surgery (p < 0.001), undergoing tonsillotomy (p = 0.022) or tonsillectomy (p < 0.001), differences in ASA score (p = 0.005) and differences in OSA-18 score (p = 0.011). Severe complications, classified as grade III and IV, were associated with premature birth (p = 0.026), additional diagnoses (p = 0.017), long-term medication intake (p < 0.001) and differences in ASA score (p =< 0.001). The Dindo-Clavien classification is a standardized reporting system which can also be used for surgical procedures in children with adenotonsillar hyperplasia. The system shows associations with clinical parameters and thus can help to identify subgroups at risk of severe complications.

Neurocognitive and psychiatric effects of pediatric sleep apnea-hypopnea syndrome secondary to adenotonsillar hyperplasia and postsurgical outcomes

article: Neurocognitive and psychiatric effects of pediatric sleep apnea-hypopnea syndrome secondary to adenotonsillar hyperplasia and postsurgical outcomes - Otorhinolaryngology 2022 December;72(4):204-10 - Minerva Medica - Journals

Association Between Social Disadvantage and Otitis Media Treatment in US Children With Commercial Insurance

It is well established that social disadvantage is associated with earlier, more frequent, and more severe otitis media in children. Appropriate medical and surgical treatment of otitis media can prevent hearing loss and other complications, which may affect future academic and employment opportunities in socially disadvantaged populations. Clinical treatment patterns for otitis media in the US are unclear. To describe and quantify social disparities in the treatment patterns of otitis media in children in the US. This cross-sectional study included claims data from the Optum Clinformatics Data Mart Database between January 1, 2003, and March 31, 2021, with linked inpatient, outpatient, and pharmaceutical claims for 4 831 408 children with otitis media. Age at first otitis media diagnosis, sex, environmental allergies, gastroesophageal reflux, adenotonsillar hyperplasia, zip code, social deprivation index score, social vulnerability index score. Treatment of recurrent and suppurative otitis media in children, insertion of tympanostomy tubes, and treatment for severe complications of undertreated otitis media. The principal measure of social disadvantage was the social deprivation index. The social vulnerability index was used for sensitivity analyses to ensure external validity. Multiple logistic regression analyses were used to quantify the association of all projected variables with the study outcomes. Among 4 831 408 US children with otitis media (median [IQR] age, 4 [1-8] years; 2 491 557 boys [51.57%]), 994 921 (20.59%) were treated for recurrent otitis media, 717 978 (14.86%) were treated for suppurative otitis media, 335 949 (6.95%) received tympanostomy tubes, and 10 975 (0.23%) had severe complications of otitis media. In multivariable regression models including patient factors and social indices, earlier age at diagnosis, male sex, environmental allergies, gastroesophageal reflux, and adenotonsillar hyperplasia were associated with increased treatment for otitis media, whereas social deprivation index was associated with lower odds of medical treatment for recurrent otitis media (odds ratio [OR], 0.86; 95% CI, 0.85-0.87), suppurative otitis media (OR, 0.61; 95% CI, 0.60-0.62), and insertion of tympanostomy tubes (OR, 0.76; 95% CI, 0.75-0.78) but higher odds of having severe complications (OR, 1.28; 95% CI, 1.19-1.37). The findings of this cross-sectional study suggest that children with otitis media who were socially disadvantaged were less likely to receive treatment and more likely to experience complications for undertreated otitis media. As otitis media is a modifiable risk factor for hearing loss, efforts need to be made to ensure equitable access to treatment for all children.

Adenotonsillar Hypertrophy and Cardiopulmonary Status: A Correlative Study.

Introduction Adenotonsillar hyperplasia in childhood is a common phenomenon. It has been reported in the literature that increased upper-airway resistance resulting from hypertrophied tonsils and adenoids can cause intermittent airway obstruction, chronic alveolar hypoventilation, and even lead to severe cardiopulmonary complications such as right ventricular (RV) failure and cor-pulmonale, a near-lethal culmination of pulmonary artery hypertension (PAH). This study was undertaken to explore and examine the association of adenotonsillar hypertrophy and cardiopulmonary status in patients with complaints of upper airway obstruction below the age of 20 yearsandto analyze the effect of adenotonsillar enlargement on pulmonary function tests and cardiac aberration reflectedin the electrocardiography (ECG) changes. Methods This study included patients visiting or admitted to the Otolaryngology/Ear, Nose, and Throat (ENT) and Paediatrics department of Acharya Vinoba Bhave Hospital, Sawangi (Meghe), Wardha, Maharashtra, India. It is anObservational Prospective Study conducted on 75 Patients (50 cases and 25 controls) below the age of 20 years. Inclusion criteria for cases included all patients of adenoid hypertrophy (AH) and adenotonsillar hypertrophy (ATH). Inclusion criteria for controls comprised all patients with a history and clinical examination not suggestive of any upper airway and pulmonary disease. All the patients were subjected to pulmonary function tests (PFT) and electrocardiography (ECG), and thevalues were compared. Results It was found that there was a decrease in the value of the parameters of the pulmonary function tests (PFT), which includesforced expiratory volume in the first second (FEV1), forced vital capacity (FVC), the ratio of the forced expiratory volume in the first one second to the forced vital capacity of the lungs (FEV1/FVC) and peak expiratory flow rate (PEFR) with increasing severity of theendoscopic grades of adenoid hypertrophy. This was found to be statistically significant. All the PFT parameters were significantly lower in the subset of patients with ATH compared to those with AH only, emphasizing the compounding effect of tonsillar volume. Between case and control subjects also, these differences were statistically significant. Seventeen (34%) out of the 50 patients studied in the present work were found to have abnormalities in their ECG, while no subject in the control group had any departure from normal. Nine of these 17 patients had AH, and eight had the adenotonsillar disease. In the 9 patients (18%) with AH, sinus arrhythmia was seen in 5 (10%), sinus tachycardia in 3 (6%), and Mobitz type 1 block in 1 (2%) patients. In 8 patients (16%) with AH, sinus arrhythmia was seen in 4 (8%), sinus tachycardia in 3 (6%), and Mobitz type 1 block in 1 (2%) patients. Overall, sinus arrhythmia was the commonest finding seen in 9 patients (18%). Conclusion Chronic obstructive adenotonsillar hypertrophy causes significant cardiovascular and pulmonary changes, which is often overlooked in the clinical setting. Symptoms of progressive pulmonary hypertension are minimal until the rapid onset of severe cardiac decompensation occurs. These entire cascades of events are reversible in the early stages and thus mandate early detection and treatment. Performing PFT and ECGin children with adenotonsillar disease is not mandatory but profitable even in the absence of obvious symptoms of upper airway obstruction.

Obstructive sleep apnea syndrome in children

Pediatric obstructive sleep apnea syndrome (OSAS) has ahigh prevalence in the general population. Risk factors are adenotonsillar hyperplasia, preterm birth, obesity, and craniofacial dysmorphia. Aspecial feature of pediatric OSAS is that it can manifest in behavioral problems. These patients also have an increased risk of perioperative anesthesiologic complications. Diagnostic and therapeutic options should be defined individually using the "Snoring in childhood" algorithm of the German Sleep Research and Sleep Medicine Society (DGSM). Diagnosis based on polysomnography (PSG) is reserved for specialized pediatric sleep centers. The most common surgical treatment for pediatric OSAS is adenoidectomy with tonsillotomy. Positive airway pressure (PAP) therapy in children is only indicated in individual cases. Monitoring of treatment success is important after OSAS therapy.

Application of intraoperative hypothermic saline to relieve postoperative pain for pediatric coblation tonsillectomy

ObjectivesTo evaluate the effect of hypothermic saline application for pediatric coblation tonsillectomy on postoperative pain. MethodsForty-eight children with adenotonsillar hyperplasia underwent tonsillectomy ± adenoidectomy. 24 children were in the HTS group (which used hypothermic saline as the coblation medium in operation), the other 24 children with the same age were in the control NTS group (who use normothermic saline as the coblation medium). All children and their parents were asked to complete a daily questionnaire for 7 days following their surgery. ResultsSignificant differences were observed when comparing the two outlet water temperatures of the coblation wand both at ablation power and at coagulation power (p = 0.000). Children in HTS group got lower scores than those in the NTS group (p < 0.05). No side effects were observed. ConclusionsUsing hypothermic normal saline as the media of coblation wand is potential for reduce postoperative pain in pediatric patients while also having no detrimental financial or medical effects on said patients.

0881 Clinical Evaluation of Adeno-Tonsillar Hyperplasia in Non-Syndromic Children and Adolescents During Growth Hormone Treatment

Abstract Introduction Recombinant human Growth Hormone (rhGH) is an important pharmacological agent for linear growth stimulation and body composition in children with growth hormone deficiency (GHD). However, reports indicate that treatment with rhGH can be associated with adeno-tonsillar hyperplasia. This condition can lead to occurrence of obstructive sleep apnea (OSA) and worsening of sleep and life quality. Nonetheless, studies assessing this outcome in non-syndromic children are scarce. Methods We evaluated the difference in size of pharyngeal and palatine tonsils in patients aged between 5 and 17 being treated with recombinant human Growth Hormone (rhGH). We conducted a prospective longitudinal observational study. Twelve patients in treatment with rhGH were evaluated by otorhinolaryngological physical examination, nasofibrolaryngoscopy and obstructive sleep apnea (OSA)-18 questionnaire in two different time-points: when selected (T0) and after 6 months (T1). Results No significant associations were found regarding palatine and pharyngeal tonsil size with rhGH treatment. In relation to OSA 18 questionnaires, there was no statistically significant result in the absence of covariables for the general score as well as for the five domains that it comprises. When covariables were included in the analyses, controlled by the patients age, we observed statistically significant increases in the general score and in the domains relating to sleep disorders, emotional suffering, diurnal problems and the caretaker′s concerns. Conclusion In the present study, pharyngeal or palatine tonsils hyperplasia were infrequent during treatment with rhGH in the non-syndromic children and adolescents. However, the impact on sleep and quality of life that may arise warrant careful monitoring during therapy. Support Associação Fundo de Incentivo à Pesquisa (AFIP).

Comparison of Functional Outcomes after Powered Intracapsular Tonsillectomy with Adenoidectomy and Conventional Extracapsular Tonsillectomy with Adenoidectomy for Pediatric Obstructive Sleep Apnea

Background and Objectives This study was investigated to compare the clinical outcomes and complications of powered intracapsular tonsillectomy and adenoidectomy (PITA) with those of conventional extracapsular tonsillectomy and adenoidectomy (ECTA) in treatment of pediatric obstructive sleep apnea (OSA).Subjects and Method Eighty-one children with adenotonsillar hyperplasia underwent tonsillectomy and adenoidectomy (46 PITA and 35 ECTA) from December 2016 to July 2017 for OSA. The choice of surgical procedure (PITA vs. ECTA) was determined by the number of episodes of acute tonsillitis. The quality of life measurement was performed using Korean Obstructive Sleep Apnea Survey (KOSA-18) score. Postoperative bleeding was assessed as number of revisit or readmission. Postoperative pain was evaluated by visual analog scale (VAS) at postoperative day 1, 3, and 7.Results PITA and ECTA significantly reduced KOSA-18 scores postoperatively (p＜0.01, p＜0.01, respectively) and were equally effective in pediatric OSA treatment. Postoperative bleeding was lower in the PITA group, but there was no statistical difference due to small number of cases. VAS score for postoperative pain was significantly lower in the PITA group at day 1, 3, and 7 (p=0.03, p＜0.01, and p＜0.01, respectively).Conclusion PITA is effective in pediatric OSA treatment with less morbidity, and less complications.

The KINDL questionnaire for assessment of general quality of life inadenotonsillar hyperplasia

There are few systematic studies on the general quality of life of children before and after adenoidectomy and adenotonsillotomy, although interventions on adenoids and tonsils are the most frequent operations in childhood in Germany. For this reason, the established KINDL questionnaire was used to assess the quality of life of children for the first time. Study participants (n = 111) and a waiting design control group (n = 35) were recruited consecutively from children (3-6 years) receiving adenoidectomy (66 %) or adenotonsillotomy (34 %). The Kiddy-KINDL® questionnaire was answered by parents on the day of surgery and 3.5 months postoperatively. Parents of the control group were interviewed, when the date of operation was scheduled and on the day of operation. Total scale score of the Kiddy-KINDL of max. 100 points improved slightly in the intervention group from preoperatively 75.9 ± 10.8 (95 %-KI [73.8-77.9]) to postoperatively 77.2 ± 9.2 points (95 %-KI [75.1-79.0]; p = 0.365). Also in the comparison group there was no significant change over time (77.9 ± 9.7; 95 % CI [74.1-81.7] vs. 77.3 ± 11.3; 95 % CI [72.8-81.8]; p = 0.949) or compared to the preoperative score of the intervention group (p = 0.894). The subscales scores for "physical well-being" (p < 0.01), "school" (p = 0.034) and "parents" (p < 0.01) showed significant improvements for the intervention group. Children with additional tonsillotomy also showed a significant postoperative increase of the total scale score (p = 0.049). The version of the Kiddy-KINDL we used is therefore not fully suitable for recording the general QOL in adenotonsillar hyperplasia, since an improvement in QOL could only be recorded in subscales. However, since tonsillotomy in particular seems to have a relevant influence on QOL, it should be performed in children with significant hyperplasia.

Clinical characteristics of obstructive sleep apnea versus infectious adenotonsillar hyperplasia in children

IntroductionChildren who undergo adenotonsillectomy have a range of symptoms. Some present with infective symptoms, others with obstructive symptoms, and many with a combination of both. The most common surgical indication has changed over the past several decades from infective symptoms to obstructive symptoms. However, there are few data available to differentiate these groups of children in terms of their clinical characteristics. This study aimed to determine the clinical characteristics of children with obstructive sleep apnea versus infectious adenotonsillar hyperplasia. MethodsData were obtained from the medical records of two district health boards in Auckland, New Zealand. Extraction of clinical information was performed following the identification of all patients under the age of 16 years undergoing adenotonsillectomy between December 2015 and December 2017. ResultsA total of 1538 children were included in this study. There were 112 (7.3%) with recurrent tonsillitis (RT) symptoms only, 624 (40.6%) with RT and sleep-disordered breathing symptoms (SDB), and 802 (52.1%) with symptoms suggestive of obstructive sleep apnea (OSA). Children with OSA were more likely to be male (p < 0.001), younger (p < 0.001), and have lower body mass indexes at time of surgery (p < 0.001). There was no difference between groups in the number of antibiotic courses prescribed in the year before surgery (p = 0.7). There was no significant difference in tonsil or adenoid grade between groups (p = 0.2). Children with OSA were more likely to have a diagnosis of asthma (p < 0.001) and allergic rhinitis (p < 0.001), but less likely than those with RT to have a diagnosis of eczema (p < 0.001). Children with OSA were more likely to have otitis media with effusion requiring ventilation tube insertion (p < 0.001) and a documented history of speech delay (p < 0.001). Thirty-day readmission rates were higher in the OSA (8.5%) and SDB/RT (9.3%) groups when compared to those with RT (1.8%) (p = 0.03). ConclusionChildren with OSA have different perioperative characteristics than those with recurrent tonsillitis, including increased risk of postoperative bleeding and need for post op readmission. Therefore, management strategy may vary according to the indications for tonsillectomy and adenoidectomy.

Bipolar-destekli tonsil küçültme: Basit ve düşük maliyetli bir tonsillotomi tekniği

Objective: This study aims to investigate the novel use of a simple and inexpensive bipolar-assisted tonsil reduction (B-TR) technique in pediatric cases with adenotonsillar hyperplasia by evaluating long-term results, possible complications, need for reoperation and incidence of recurrence. Methods: We present our long-term retrospective data from 78 consecutive pediatric cases undergoing B-TR combined with adenoidectomy from April 2013 to January 2017. The tonsillar sizes were recorded using the Brodsky grading scale from I to IV, and the patients only with prominant tonsillar sizes (III and higher) and adenoidal sizes exceeding 50% were included in the study group. The tonsil sizes were noted preoperatively, and during the latest follow-up visit after tonsillotomy (min. 9 months postoperatively). Results: With a mean follow-up period of 18.3 months, the mean tonsillar size preoperatively was 3.47 (±0.50) and mean tonsillar size postoperatively was 1.35 (±0.48). A significant difference (p<0.001) was observed between these two groups, excluding the only case who later had undergone tonsillectomy. Minimal uvular edema was noted in 27 children (34.6%), which did not cause any upper airway obstruction in these patients. Conclusion: We describe herein our B-TR technique in details so that it can be learned relatively quickly and used in pediatric cases with adenotonsillar hyperplasia as a treatment option.

Pediatric coblation total tonsillectomy: intracapsular or extracapsular?

Objectives: To compare the results of coblation intracapsular total tonsillectomy (CITT) with those of conventional coblation extracapsular total tonsillectomy (CETT) in the treatment of tonsillar hypertrophy in children with regards to efficacy and complications.Methods: Ninety children with adenotonsillar hyperplasia underwent tonsillectomy ± adenoidectomy (48 CITT and 42 CETT). Intraoperative situation was observed and recorded. Patients were reexamined regarding recovery condition and tonsil regrowth, and were followed for at least one year.Results: Significant differences were observed in four clinical features when the CITT group was compared with the CETT group: intraoperative bleeding score, intraoperative tonsillar fossa score, color of white membrane one day postoperatively, and visual analogue scale (VAS) value one week postoperatively (p < .05). There were statistical correlations between intraoperative bleeding score and age, course of disease, surgery method, number of acute tonsillitis attacks per year, and intraoperative tonsillar fossae score (p < .05). Two significant differences were noted when the tonsil hypertrophy group was compared with the chronic tonsillitis group: color of white membrane at one day and one week postoperatively (p < .05). No regrowth of tonsil was found.Conclusions: Compared with conventional extracapsular tonsillectomy, CITT has the advantages of decreased pain and bleeding, and promote healing of wounds. No tonsillar regrowth was observed after at least one year of follow-up.

Expression of cysteinyl leukotriene receptor 1 and 2 (CysLTR1 and CysLTR2) in the lymphocytes of hyperplastic tonsils: comparison between allergic and nonallergic snoring children.

Cysteinyl leukotriene receptor 1 and 2 (CysLTR1 and CysLTR2) are involved in allergic processes and play a role in adenotonsillar hyperplasia (AH). Clinically, only CysLTR1 may be blocked by montelukast. Our objective was to compare the expression of CysLTR1 and CysLTR2 in the B and T cells of hyperplasic tonsils of sensitized (SE) and control (NS) snoring children. Sixty children, 5 to 10 years of age, referred for adenotonsillectomy, were divided into SE and NS groups, according to their responses to the skin-prick test. Cells from the removed tissues were stained for CysLTR1, CysLTR2, CD19, and CD3 and counted via flow cytometry. messenger RNA (mRNA) expression of the CysLTRs genes was measured real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR). The SE group showed reduced expression of the small CD3+/CysLTR1+ lymphocytes (4.6 ± 2.2 vs 6.5 ± 5.0; p = 0.04). Regarding the large lymphocytes, the SE group showed lower expression of CD3+/CysLTR1+ (40.9 ± 14.5 vs 47.6 ± 11.7; p = 0.05), CD19+/CysLTR1+ (44.6 ± 16.9 vs 54.1 ± 12.4; p = 0.01), and CD19+/CysLTR2+ (55.3 ± 11.3 vs 61.5 ± 12.6; p = 0.05) lymphocytes. Considering the total number of lymphocytes, the SE group had fewer CD3+/CysLTR1+ lymphocytes (11.1 ± 5.5 vs 13.7 ± 6.2; p = 0.04). All other cell populations exhibited reduced expression in the SE group without statistical significance. The expression of CysLTR2 was significantly higher (p < 0.05) than CysLTR1 in most studied cell populations. The mRNA expression did not show significant differences between the groups. The expression of CysLTR is higher in the lymphocytes of the NS children, and CysLTR2 shows greater expression than CysLTR1 Respiratory allergies do not appear to be a stimulus for AH occurrence. Newer drugs capable of blocking both CysLTRs warrant further study.

Powered intracapsular tonsillotomy vs. conventional extracapsular tonsillectomy for pediatric OSA: A retrospective study about efficacy, complications and quality of life

ObjectivesTo compare the results of powered intracapsular tonsillectomy and adenoidectomy (PITA) with that of conventional extracapsular tonsillectomy and adenoidectomy (ECTA) in treatment of pediatric obstructive sleep apnea (OSA) as regard efficacy, complications including postoperative pain and bleeding, and quality of life. MethodsFour hundred fifty children with adenotonsillar hyperplasia (with age range from 3 to 14 years) underwent tonsillectomy±adenoidectomy (251 PITA and 199 ECTA) from January 2012 till October 2014 for OSA. Outcome measures included Obstructive Sleep Apnea Survey (OSA-18), the number of cases treated for post tonsillectomy bleeding with particular regard to the number of cases that needed readmission, the need for analgesics, the visual analog scale (VAS) for post-operative pain, the perceived satisfaction assessed by post tonsillectomy quality of life questionnaire (QOL). ResultsOSA-18 scores proved that both PITA and ECTA were equally effective in curing upper airway obstructive symptoms as reflected by the targeted questionnaire. Postoperative bleeding was significantly lower in the PITA group (P<0.01). Postoperative pain and number of needed analgesic doses were significantly lower in the PITA group (P=0.01, P<0.01, respectively). Satisfaction and quality of life were significantly higher in the PITA group (P<0.01). ConclusionPITA is proved to be effective in treating pediatric OSA with less morbidity, less complications in terms of postoperative bleeding mainly with better satisfaction and lower incidence of regrowth.

Medicinal treatment of breathing disorders in adenotonsillar hyperplasia

Adenotonsillar hyperplasia (ATH) can lead to severe breathing disorders, such as impaired nasal breathing, mouth breathing, snoring and obstructive sleep apnea. In such cases ATH should be treated mostly by performing adenoidectomy and/or adenotonsillectomy. There is increasing evidence that anti-inflammatory medication (AIM) is effective in treating ATH-related breathing disorders. The aim of this study was to provide evidence and recommendations for the use of AIM in the treatment of ATH-related breathing disorders. In this study 12 national pediatric sleep experts were included into a Delphi process and formulated indications and recommendations. The use of AIM in the treatment of ATH-related breathing disorders is sufficiently supported by the results of randomized controlled trials and systematic reviews. Nasal beclometason and nasal mometason have been studied for the treatment of enlarged adenoids and nasal fluticason and oral montelukast for the treatment of obstructive sleep apnea. The use of AIM for first-line treatment should be restricted to selected indications, such as a characteristic patient age and exclusion of an acute upper respiratory tract infection. Evidence-based recommendations are given concerning indications, dosage, treatment duration and correct administration of AIM. Anti-inflammatory medications are simple and effective alternatives for the treatment of ATH-related breathing disorders. These guidelines are intended to promote the use of AIM by pediatricians in ambulatory care settings.

Increased incidence of adenoidectomy and tonsillectomy in children with renal transplantation

Previous studies have found that pediatric solid organ transplant recipients suffer from adenotonsillar hyperplasia. However, as this condition is also common in normal children, it remains unclear whether the incidence is truly increased. The aim of this study was to compare the incidences of surgery on the adenoids and tonsils of normal children with those receiving renal transplants and to define risk factors in the transplant population. Data on 49 consecutive children from a single renal transplant unit were compared to data from a large governmental survey of healthy German children (KiGGS). For analysis of 'survival without operation', controls were matched for gender, region and immigration status (n = 8,650), as well as for age to compare incidence rates (n = 637). The age-matched solid organ transplant recipients had a higher incidence of adenoidectomies [2.3-fold, [95 % confidence interval (CI) for relative risk 1.6-3.3) and a higher incidence of tonsillectomies/tonsillotomies (3.5-fold, 95 % CI 2.1-5.7). The normal peak of adenoidectomies was delayed by 2 years in the pre-school group, and transplanted teenagers showed an extra peak for both operations. Boys and those transplanted at a younger age were significantly more likely to need adenoidectomies. Ciclosporin levels, Epstein-Barr virus and cytomegalovirus infections did not influence the incidence of operations. Children receiving renal transplants are at markedly increased risk of adenotonsillar hyperplasia requiring surgery, especially males and young recipients.

Medicinal treatment of breathing disorders in adenotonsillar hyperplasia

Medicinal treatment of breathing disorders in adenotonsillar hyperplasia

Quality of life in children with sleep-disordered breathing

Children may present sleep-disordered breathing (SDB) and suffer with adverse effects upon their quality of life. ObjectiveThis study assessed the quality of life of children with SDB, compared subjects with obstructive sleep apnea syndrome (OSAS) and primary snoring (PS), and identified which areas in the OSA-18 questionnaire are more affected. MethodsThis is a historical cohort cross-sectional study carried out on a consecutive sample of children with history of snoring and adenotonsillar hyperplasia. The subject's quality of life was assessed based on the answers their caregivers gave in the OSA-18 questionnaire and on diagnostic polysomnography tests. ResultsA number of 59 children participated in this study with mean age of 6.7 ± 2.26 years. The mean score of the OSA-18 was 77.9 ± 13.22 and the area most affected were “caregiver concerns” (21.8 ± 4.25), “sleep disturbance” (18.8 ± 5.19), “physical suffering” (17.3 ± 5.0). The impact was low in 6 children (10.2%), moderate in 33 (55.9%) and high in 20 (33.9%). PS was found in 44 children (74.6%), OSAS in 15 (25.6%). OSAS had higher score on “physical suffering” area than PS (p = 0.04). The AI (r = 0.22; p = 0.08) and AHI (r = 0.14; p = 0.26) were not correlated with OSA-18. ConclusionSleep disordered breathing in childhood cause impairment in quality of life and areas most affected the OSA-18 were: “caregiver concerns”, “sleep disturbance” and “physical suffering”. OSAS has the domain “physical suffering” more affected than primary snorers.

Childhood obstructive sleep apnea syndrome: an interdisciplinary approach

Population-representative data on sleep disorders in children is scarce. The aim of this epidemiological study was to determine the prevalence of various sleep-related breathing disorders (SRBD) and any correlations with occlusion and jaw abnormalities in preschool children. The study material consisted of 4,318 children (5.5 years old) whose parents completed the Pediatric Sleep Questionnaire (PSQ); 60 out of 140 children (6.3 ± 0.78 years old) with a positive questionnaire score (> 0.33) were examined by an orthodontist and ENT specialist. From this cohort, 15 children who presented a dental occlusion and jaw abnormality but no indication for surgical reduction of adenotonsillar tissue underwent polysomnography in a sleep laboratory. According to the PSQ, 3.3% of the 5.5-year-olds showed evidence of a SRBD. Boys were affected significantly more frequently. Lack of concentration, hyperactivity, morning fatigue, mouth breathing, loud snoring, and breathing interruptions were indicators of SRBD. The SRBD children more frequently presented with jaw abnormalities such as mandibular retrognathia, lateral cross-bite, and increased overjet. The SRBD cohort showed a higher rate of orofacial dysfunctions. Adenotonsillar hyperplasia still played a significant role in the development of SRBD. In contrast to previous reports in the literature, the frequency of SRBD in our group of 5- to 6-year-olds was lower (3%). Boys with adenotonsillar hyperplasia and/or mandibular retrognathia, lateral cross bite, and an enlarged overjet require special attention.