Chronic Adenotonsillar Hypertrophy Research Articles

The impact of adenotonsillectomy on the acoustic parameters of voice

Background: The aim of the study was to evaluate and compare the changes in the acoustic parameters of voice and nasalance in individuals with chronic adenotonsillitis, before and after surgery. Methods: A pospective case-control study conducted in the department of ENT and HNS of a tertiary care centre from September 2014 to June 2016 with 120 patients aged between 5 to 16 years. 60 cases and 60 controls were assessed aged between 5 to 16 years. Cases included patients who underwent adenotonsillectomy in the inpatient department of ENT at Father Muller Medical College, Mangalore, India. Acoustic analysis of 5 parameters (fundamental frequency, jitter, shimmer, noise harmonic ratio and nasalance) was done 1day pre-operatively and at 4 weeks post-operatively by means of a VAGMI, Voice and Speech Systems, Bangalore, India, providing normative data for analysed measures. Results: The results of the study showed that pre-operative cases exhibited significant alterations in Jitter, Shimmer and NHR, compared to the control group. No significant differences were observed in the F0. Nasalance significantly reduced post-operatively and were almost normalized after the surgery. Conclusions: Chronic adenotonsillar hypertrophy causes transient changes in acoustic parameter of voice, which makes the voice disharmonic and harsh. Adenotonsillectomy eliminates the nasalance. Hence, parents should be warned for changes in voice after surgery.

Evaluation of Body Mass Index of 3–10-year-old Children with Adenotonsillar Hypertrophy, who Referred to Khatamolanbia Hospital during 2017–2018

BACKGROUND: Adenotonsillar hypertrophy is a common disorder in the children’s population that can lead to growth disorders. Chronic adenotonsillar hypertrophy can cause a break in the normal growth of children, weight loss, and decreased growth hormone secretion.
 AIM: The purpose of this study was to evaluate adenotonsillar hypertrophy in the growth rate of children with height, weight, and body mass index (BMI).
 METHODS: In this descriptive-analytical cross-sectional study, after examining 312, 3–10-year-old children with adenotonsillar hypertrophy, who met the inclusion criteria, growth scales were evaluated and entered into the patient evaluation form.
 RESULTS: There was a significant relationship between BMI, height, weight, and severity of tonsillar hypertrophy at Brodsky’s scale (P <0.001). Our studies showed well that with increasing severity of adenotonsillar hypertrophy disease, the growth indicators are also decreased in children.
 CONCLUSION: Adenotonsillar hypertrophy decreases growth indicators in children. There was also a relationship between growth indicators and severity of adenotonsillar hypertrophy in patients.

Effect of adenotonsillectomy on sleep problems, attention deficit hyperactivity disorder symptoms, and quality of life of children with adenotonsillar hypertrophy and sleep-disordered breathing.

Chronic adenotonsillar hypertrophy is the most common etiologic reason for upper airway obstruction in childhood and has been found to be associated with a variety of psychiatric disorders and poor quality of life. In the present study, we investigated the impact of adenotonsillectomy on attention deficit hyperactivity disorder symptoms, sleep problems, and quality of life in children with chronic adenotonsillar hypertrophy. The parents of children with chronic adenotonsillar hypertrophy filled out the Conners's Parent Rating Scale-Revised Short form (CPRS-RS), Children's Sleep Habits Questionnaire (CSHQ), and Pediatric Quality of Life Inventory, Parent version (PedsQL-P) before and six months after adenotonsillectomy. A total of 64 children were included in the study (mean age = 6.8 ± 2.4 years; boy:girl ratio= 1). The mean attention deficit hyperactivity disorder index and oppositionality subdomain scores of the CPRS-RS and all of the CSHQ subdomain scores (bedtime resistance, sleep-onset delay, sleep anxiety, night waking, parasomnias, sleep-disordered breathing, and daytime sleepiness) except for sleep duration significantly decreased after adenotonsillectomy ( p < 0.05). The PedsQL-P total score and both PedsQL-P physical health and psychosocial health subdomain scores were significantly higher at six months after adenotonsillectomy ( p < 0.001). Child and adolescent psychiatrists should check the symptoms of chronic adenotonsillar hypertrophy to identify children with chronic adenotonsillar hypertrophy who suffer from sleep disturbance, attention deficit hyperactivity disorder symptoms, and oppositionality. Adenotonsillectomy seems to be beneficial for coexisting attention deficit hyperactivity disorder and sleep disorder symptoms and quality of life in these children.

The Relationship between Colonization by Moraxella catarrhalis and Tonsillar Hypertrophy.

We sought to investigate the prevalence of potentially pathogenic bacteria in secretions and tonsillar tissues of children with chronic adenotonsillitis hypertrophy compared to controls. Prospective case-control study comparing patients between 2 and 12 years old who underwent adenotonsillectomy due to chronic adenotonsillar hypertrophy to children without disease. We compared detection of Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Pseudomonas aeruginosa, and Moraxella catarrhalis by real-time PCR in palatine tonsils, adenoids, and nasopharyngeal washes obtained from 37 children with and 14 without adenotonsillar hypertrophy. We found high frequency (>50%) of Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, and Pseudomonas aeruginosa in both groups of patients. Although different sampling sites can be infected with more than one bacterium and some bacteria can be detected in different tissues in the same patient, adenoids, palatine tonsils, and nasopharyngeal washes were not uniformly infected by the same bacteria. Adenoids and palatine tonsils of patients with severe adenotonsillar hypertrophy had higher rates of bacterial coinfection. There was good correlation of detection of Moraxella catarrhalis in different sampling sites in patients with more severe tonsillar hypertrophy, suggesting that Moraxella catarrhalis may be associated with the development of more severe hypertrophy, that inflammatory conditions favor colonization by this agent. Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and Moraxella catarrhalis are frequently detected in palatine tonsils, adenoids, and nasopharyngeal washes in children. Simultaneous detection of Moraxella catarrhalis in adenoids, palatine tonsils, and nasopharyngeal washes was correlated with more severe tonsillar hypertrophy.

Impact of adenotonsillectomy on hearing profile of children with chronic middle ear effusion

Background: Chronic middle ear effusion (CME) also known as otitis media with effusion (OME)/glue ear/secretory otitis media is the commonest cause of hearing loss in children, characterized by presence of sterile serous fluid within the middle ear, causing temporary and reversible hearing loss. The aim of present investigation was to determine the effect of adenotonsillectomy on hearing profile of children with persistent OME.Methods: This prospective study was conducted in the Department of ENT, Aarupadai Veedu Medical College, Pondicherry during the period of June 2014 to February 2016. 50 children, between the age group of 3-12 years, with features suggestive of OME, and adenotonsillar hypertrophy that underwent adenotonsillectomy during the study period was included in this study. Demographic details and clinical features were collected from the participants. Hearing evaluation was performed by pure tone audiometry (PTA) and tympanometry preoperatively at time of diagnosis and postoperatively at 6 weeks and 3 months after adenotonsillectomy. Data collected was plotted into master chart and analysed using paired t-test and chi square test to determine the improvement in hearing after 6 weeks and 3 months following surgery.Results: 46 children aged between 3 and 12 years with a mean age of 5.3 and standard deviation of 2.2 years. OME was most prevalent in age group was 5-7 years (34.78%) followed by 7-9 years (30.43%). There were 26 (56.52%) males and 20 (43.47%) females. Pre-operatively most of the subjects were having moderate conductive hearing loss (between 26dB to 40dB) with a mean hearing loss of 34.2dB and a standard deviation of 12.2dB. At 6 weeks postoperatively, hearing loss of children were within 16-25dB with a mean loss of 21.6dB and a standard deviation of 6.4dB. At 3 months postoperatively, 30 children were having only minimal hearing loss and 8 were having mild hearing loss.Conclusions: CME is a common cause of childhood hearing loss having a long-term sequel affecting the language development of the child. Adenoidectomy can improve the middle ear function and the hearing profile of child and can be considered as a practical management option in children with chronic adenotonsillar hypertrophy with established otitis media with effusion.

Study of adenotonsillectomy specimens: An institutional experience.

Objective:Waldeyer's lymphatic ring consists of group of tonsils located over the posterior oropharyngeal wall. The palatine tonsils are largest tonsil. The present study was aimed to evaluate the significance of lymphoid hyperplasia, lymphocyte infiltration with and without defect in the surface epithelium in chronic tonsillitis (CT) and chronic adenotonsillar hypertrophy (CAH) in resected tonsillectomy and adenotonsillectomy specimens.Materials and Methods:A total of 85 patients were included in the study. Fifty-one cases underwent bilateral tonsillectomy and 34 cases underwent adenotonsillectomy.Results:The lymphoid hyperplasia was higher in CAH (30/34; 88.24%) as compared to CT (26/50; 52%). Lymphocyte infiltration with or without defect in the surface epithelium was common in CT. The histopathologic criteria of lymphoid hyperplasia and lymphocyte infiltration with or without defect in the surface epithelium showed a statistically significant difference between CT and CAH.Conclusion:CT and CAH may be differentiated on the basis of reliable histopathological criteria. Punch biopsy can be performed to avoid CT complication if the clinical diagnosis is true. Choristomas can be clinically confused with true neoplasms, if large in size.

Effect of adenotonsillectomy on attention-deficit/hyperactivity disorder symptoms, sleep disturbance symptoms, and quality of life of children with adenotonsillar hypertrophy and sleep-disordered breathing

ObjectivesTo date, limited data has been available regarding the impact of adenotonsillectomy (AT) on the psychosocial well-being of chronic adenotonsillar hypertrophy (CAH) subjects.AimsIn the present study, we examined the impacts of AT on attention-deficit/hyperactivity disorder symptoms (ADHD) and sleep disturbance symptoms and quality of life of children with chronic adenotonsillar hypertrophy.MethodsParents of children with CAH filled in Conners Parent Rating Scale-Revised Short (CPRS-RS), children's sleep habits questionnaire (CSHQ), and the pediatric quality of life inventory, parent versions (PedsQL-P) before and six months after AT.ResultsA total of 64 children were included the study (mean age: 6.8 ± 2.4 years; 50% boys). Mean ADHD Index (11.98 ± 6.94 versus 10.35 ± 6.44) (before AT versus after AT) and oppositional scores (6.73 ± 3.72 versus 5.87 ± 3.52) improved statistically significantly after AT (P &lt; 0.05). All of the CSHQ subdomain scores, except sleep duration, significantly reduced after AT (P &lt; 0.05). Regarding to quality of life, both PedsQL-P physical health (64.20 ± 19.81 versus 69.84 ± 18.63) and psychosocial health subdomain scores (67.83 ± 12.89 versus 75.57 ± 13.16), and PedsQL-P total score (66.57 ± 12.94 versus 73.58 ± 12.46) of the patients were significantly higher six months after AT (P &lt; 0.001).ConclusionsIt is necessary for child and adolescent psychiatrists to query the symptoms of CAH to identify children with chronic adenotonsillar hypertrophy who suffer from ADHD symptoms, oppositionality, and sleep disturbance. To carry out AT seems to be beneficial for coexisting ADHD and sleep disorder symptoms and quality of life in these children.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Brain damage after general anesthesia

Background and objectiveS100B protein is a serum marker of cerebral damage. The objective was to evaluate the brain damage caused by general anesthesia, by determining the concentration of serum S100B protein before and after of general anesthesia. Patients and methodPatients with chronic adenotonsillar hypertrophy and indications for tonsillectomy were included. A venous blood sample was taken from the patients before general anesthesia (basal sample). The patients were anaesthetized using the following intravenous anesthetic drugs: midazolam, fentanyl and propofol; and inhaled sevoflurane. A second venous blood sample (postoperative sample) was taken from patients after the surgery, in the operating room. The concentration of serum S100B protein was determined in the basal sample (S100Bb) and postoperative sample (S100Bp) by immunoassay electro-chemiluminescence in MODULAR E-170 (Roche Diagnostics). ResultsSeventy-six patients were included, 46 males and 30 females, aged between 3 and 14 (median 5 years). In all the patients, serum S100B protein levels increased after general anesthesia. The values of S100Bp (median 164.0ng/l) were significantly higher than the values of S100Bb (median 94.5ng/l). The median of the difference between S100Bp and S100Bb was 58.0ng/l. There were statistically significant differences between S100Bb and S100Bp using the Wilcoxon test (p<0.0001). ConclusionsThe concentration of serum S100B protein increased significantly after general anesthesia. This indicates that general anesthesia may cause brain damage.

Daño cerebral postanestesia general

Background and objectiveS100B protein is a serum marker of cerebral damage. The objective was to evaluate the brain damage caused by general anaesthesia, by determining the concentration of serum S100B protein before and after of general anaesthesia. Patients and methodPatients with chronic adenotonsillar hypertrophy and indications for tonsillectomy were included. A venous blood sample was taken from the patients before general anaesthesia (basal sample). The patients were anaesthetised using the following intravenous anaesthetic drugs: midazolam, fentanyl and propofol; and inhaled sevoflurane. A second venous blood sample (postoperative sample) was taken from patients after the surgery, in the operating room. The concentration of serum S100B protein was determined in the basal sample (S100Bb) and postoperative sample (S100Bp) by immunoassay electro-chemiluminescence in MODULAR E-170 (Roche Diagnostics). ResultsSeventy-six patients were included, 46 males and 30 females, aged between 3 to 14 (median 5 years). In all the patients, serum S100B protein levels increased after general anaesthesia. The values of S100Bp (median 164.0ng/L) were significantly higher than the values of S100Bb (median 94.5ng/L). The median of the difference between S100Bp and S100Bb was 58.0ng/L. There were statistically significant differences between S100Bb and S100Bp using the Wilcoxon test (P<.0001). ConclusionsThe concentration of serum S100B protein increased significantly after general anaesthesia. This indicates that general anaesthesia may cause brain damage.

Echocardiographic Evaluation of Cardiac Functions in Children with Chronic Adenotonsillar Hypertrophy

Objective: Chronic adenotonsillar hypertrophy (ATH) causing upper airway obstruction may lead to pulmonary hypertension and other cardiac abnormalities. This study aimed at the clinical and echocardiographic evaluation of cardiac abnormalities in children with chronic ATH and evaluation of these abnormalities after adenotonsillectomy. Subjects and method: We studied 40 children with ATH indicated for adenotonsillectomy (group I) compared with another 35 sex and age matched normal children (Group II). Both groups were examined by otorhinolaryngologist and adenotonsillar hypertrophy was diagnosed with lateral neck x-ray. Clinical and echocardiographic examinations were compared in both groups. Adenotonsillectomy were performed in group I and reevaluation of clinical and echocardiographic findings were performed 6 months later in this group and results were compared with the preoperative findings in the same group. Results: Compared with group II, group I has a significantly higher pulmonary artery pressure, right ventricular size, Interventricular septal wall thickness, left ventricular end-diastolic dimension, and longer E-wave deceleration time. Postoperative echocardiographic findings showed statistically significant decrease only in pulmonary artery pressure and E-wave deceleration time. Significant improvement in clinical symptoms and growth parameters were also noted postoperatively in group II. Conclusion: Upper airway obstruction in children with ATH is associated with cardiac structural and functional abnormalities as demonstrated by echocardiography. Some of these abnormalities i.e. pulmonary hypertension and delayed LV diastolic relaxation are reversible after adenotonsillectomy.

Impact of adenotonsillectomy on ADHD and nocturnal enuresis in children with chronic adenotonsillar hypertrophy

ObjectiveChildren with chronic adenotonsillar hypertrophy (CAH) are more likely to have symptoms of attention deficit hyperactivity disorder (ADHD) and enuresis nocturna (EN) and benefit from surgery. The aim of this study was to evaluate the effect of adenotonsillectomy on ADHD and EN symptoms in children with CAH. Study designCross-sectional study was conducted. SettingParent-based questionnaires. MethodsParents of children with CAH were given Turgay DSM-IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale (T-DSM-IV) and Nocturnal Enuresis Questionnaire (NEQ) before and six months after adenotonsillectomy. Inattention (IA) and hyperactivity–impulsivity (HI) subscores of T-DSM-IV were used in the present study. The rates of ADHD and EN were compared before and after surgery. ResultsA total of 75 children between 5 and 16years of age and their families participated in the study. All 75 families completed T-DSM-IV and NEQ. Mean IA (5.69±4.88 versus 4.46±4.40) and HI (6.53±5.60 versus 5.93±5.45) scores as well as total ADHD scores (12.22±8.99 versus 10.42±8.70) improved significantly after surgery. This significance was found to be statistically important (p<0.05). Furthermore 26 of the subjects were diagnosed with primer EN before adenotonsillectomy and 14 of these enuretic children had total remission six months after surgery. The frequency of EN dropped from 34.7% to 16.0% and this remission rate was found to be statistically significant (p<0.05). ConclusionChildren with CAH had high frequency of ADHD and EN symptoms in the present study. Adenotonsillectomy was found to be effective in improvement of these symptoms.

The preoperative and postoperative oxidative status of children with chronic adenotonsillar hypertrophy.

This study aimed to evaluate the preoperative and postoperative oxidative status of children with chronic adenotonsillar hypertrophy. The study comprised 25 patients with indications for tonsillectomy and/or adenoidectomy following a diagnosis of chronic adenotonsillar hypertrophy and 25 age-gender matched control patients were included to the study. Blood samples were taken from the patients preoperatively and at four weeks postoperatively. Preoperative and postoperative serum total oxidant (TOS) and total antioxidant (TAS) levels were measured and the oxidative stress index (OSI) was calculated. The serum total oxidant level and oxidant stress index values in the preoperative and postoperative periods of the patients were found to be significantly high compared to those of the control group. While the preoperative serum total oxidant level values were found to be significantly high compared to the postoperative values, no statistical significance was found between the total antioxidant and oxidative stress index values. The development of chronic adenotonsillar hypertrophy plays a role in oxidative status and therefore, to neutralize high levels of oxidants in patients, the use of antioxidants for a period preoperatively and postoperatively is thought to be necessary.

Changes in growth pattern, leptin ghrelin and neuropeptide Y levels after adenotonsillectomy in prepubertal children

The purpose of this prospective study was to evaluate whether surgical treatment of adenotonsillar hypertrophy has an effect on growth patterns and circulating concentrations of leptin, ghrelin and neuropeptide Y, which are all significant in energy balance. The study group consisted of 20 children who underwent tonsillectomy with or without adenoidectomy due to chronic adenotonsillar hypertrophy. The ages ranged from 4.3 to 9.2 years with normal weight. The healthy control subjects consisted of 30 age- and sex-matched children (control group) with ages between 3.2 and 8.1 years. Serum levels of leptin ghrelin and neuropeptide Y were measured in the preoperative period and at the end of the postoperative period, which was 6 months in the study group, serum levels were only measured during the first examination in the control group. When the study group (preoperative) is compared with the control group, it is observed that the leptin and ghrelin levels were higher in the study group and that the neuropeptide Y levels were similar (p=0.01, p=0.005, p=0.19, respectively). When the preoperative and postoperative anthropometric data were compared, it was observed that weight, height, body mass index (BMI) and BMI-standard deviation score (SDS) values increased in the 6th month postoperatively (p<0.001, p<0.001, p=0.01, p=0.03, respectively). However, the leptin, ghrelin and neuropeptide Y levels were similar (p=0.70, p=0.12, p=0.60, respectively). Following adenotonsillectomy, an increase in weight and height occurred in the children. In the postoperative period, dietary and lifestyle suggestions as well as growth monitoring might be useful.

Exhaled Nitric Oxide Levels in Children with Chronic Adenotonsillar Disease

Exhaled nitric oxide (eNO) is a highly reactive biological mediator that has recently been associated with chronic tonsillar disease in adults, but there are no published data concerning eNO levels in their pediatric counterparts. The aim of this study is to measure mean eNO levels in children with chronic adenotonsillitis or adenotonsillar hypertrophy, and assess the effects of potential confounding factors. Children aged 3-17 years were divided into three groups (chronic adenotonsillitis, adenotonsillar hypertrophy and controls). Their eNO levels were measured in accordance with the international guidelines, and their other clinical and anamnestic characteristics were recorded. The mean eNO level in the children with chronic adenotonsillitis was slightly higher than that in the other groups, but there was no statistically significant between-group difference. Age (p=0.009), allergy (p=0.05) and body mass index (p=0.03), but not the mean grade of adenoidal or tonsil hypertrophy, were all statistically related to mean eNO levels. These preliminary results indicate the lack of an increase in mean eNO levels in children with chronic adenotonsillar disease, with no substantial difference between children with chronic adenotonsillitis and those with adenotonsillar hypertrophy.

CHRONIC TONSILLITIS CAN BE DIAGNOSED WITH HISTOPATHOLOGIC FINDINGS

Aim: The objective was to identify histopathologic findings of the chronic tonsillitis in the palatine tonsils. Methods: 480 palatine tonsillectomy specimens obtained from 240 patients were included in this study. 120 (66 males, 54 female) chronic tonsillitis patients and as control group 120 (60 males, 60 female) chronic adenotonsillar hypertrophy patients underwent bilateral tonsillectomy. Eight histopathologic criteria were investigated all palatine tonsils. Results: All histopathologic criteria showed a statistically significant difference between chronic tonsillitis and chronic adenotonsillar hypertrophy (p=0.0001 to p=0.006). Although seven criteria were more closely associated with chronic tonsillitis (p=0.0001 to p=0.001), only one criteria (the presence of lymphoid hyperplasia) was higher in chronic adenotonsillar hypertrophy compared chronic tonsillitis (p=0.006).Histopathological examination showed the presence of slight-moderate lymphocyte infiltration in the surface epithelium and the presence of Ugras's abscess and/or diffuse lymphocyte infiltration leading to the defect in the surface epithelium in 97and 93 vs 25 and 5 % in chronic tonsillitis and chronic adenotonsillar hypertrophy, respectively. Conclusion: Chronic tonsillitis may be diagnosed on tonsillectomy materials with fairly characteristic and reliable histopathologic criteria. Because three reliable histopathologic criteria were seen almost all of the patients with chronic tonsillitis. Slight-moderate lymphocyte infiltration and the presence of Ugras's abscess and/or diffuse lymphocyte infiltration leading to the defect in the surface epithelium not present in normal tonsils. These findings are observed in 97, 93% in chronic tonsillitis, respectively. Therefore, combination of these findings with other histopathological findings are fairly diagnostic for chronic tonsillitis.

The potential inflammatory role of arginase and iNOS in children with chronic adenotonsillar hypertrophy

Nitric oxide (NO) induced tissue damage has been implicated in the pathogenesis of several diseases. Although recurrent/chronic tonsillitis and hypertrophy are still the most frequent surgical procedures carried out on children in order to cure these pathologies, etiopathogenetic mechanisms underlying these entities are still unknown. We aimed to investigate the potential inflammatory role of NO regulatory enzymes, arginase and inducible nitric oxide synthase (iNOS), in children with adenotonsillar hypertrophy. The study consisted of 22 children with chronic adenotonsillar hypertrophy and 30 control subjects with similar age and sex. All the patients and/or their parents had complaints of snoring, mouth breathing and pausing of breathe during sleep at least 6 months. All patients underwent an adenotonsillectomy operation under general anesthesia with curettage and cold dissection methods. Venous blood samples were taken pre-operatively and 4 weeks post-operatively. iNOS activity was based on the diazotization of sulfanilic acid by nitric oxide at acid pH and subsequent coupling to N-(1-naphthtyl)-ethylenediamine. Arginase activity was measured by the spectrophotometric method. The mean pre-operative and post-operative arginase activities in patient group were 4283.7 +/- 1823.7 and 2754.5 +/- 889.3 IU/L, respectively. In the control group, mean arginase activity was 2254.7 +/- 903 IU/L. When pre-, post-operative and control arginase values were compared with each other, the mean activity in pre-operative activity was significantly different from the post-operative and control values (p < 0.001). In the patient group, the mean levels of pre- and post-operative iNOS were 2.84 +/- 1.16 and 1.99 +/- 0.78 IU/ml, respectively. The difference was statistically significant (p = 0.007). Similarly, post-operative and control values were not significantly different (p > 0.05). The results of the present study supports that L-arginine:NO pathway may be key the participant in the pathogenesis of chronic adenotonsillar disease; arginase and iNOS activities are altered in children with adenotonsillar hypertrophy and this alteration improves after tonsillectomy.

Reversible cardio-pulmonary changes due to adeno-tonsilar hypertrophy

Adeno-tonsillar hypertrophy, with signs of upper airway obstruction is a common presentation in ENT clinics. Recently it is identified as a major cause of sleep apnea syndrome. Several isolated case reports of pulmonary hypertension and corpulmonale appeared in the literature. The authors report two such children aged less than 2 years with cardio-pulmonary changes occurring secondary to chronic adeno-tonsillar hypertrophy that were successfully treated with the surgical removal.