Enlarged Adenoids Research Articles

Evaluation of adenoidal obstruction in children: clinical symptoms compared with roentgenographic assessment

Obstructive adenoid enlargement is commonly implicated as the major cause of chronic nasal obstruction in children. Although clinical assessment is considered essential, there is little consensus over its reliability. This study was conducted to determine the correlation between graded symptomatology assessment and roentgenographic assessment of adenoidal obstruction. Symptoms assessed included snoring, mouth-breathing and obstructive breathing during sleep. Each symptom was rated on a four-point scale (absent = zero, mild = one, moderate = two and severe = three). We summed the ratings for each child to obtain the symptomatology score. We used an adenoidal-nasopharyngeal ratio parameter to classify roentgenographic assessment into minimal, moderate or marked obstruction. Sixty-four children, 42 boys and 22 girls, aged one to 12 years were enrolled. The clinical symptomatology scores correlated significantly with the roentgenographic ratings of nasopharyngeal airway obstruction (r = 0.419; p = 0.001). The correlation was significant at roentgenographic ratings of minimal obstruction (p < 0.05) and gross obstruction (p < 0.001). Both the symptomatology score and the roentgenographic rating showed significant correlations with patient age (r = -0.657, p < 0.01 and r = -0.340, p < 0.01, respectively). Clinical rating of adenoidal symptoms in children provides a reasonably reliable assessment of the presence and severity of nasopharyngeal airway obstruction. This technique of assessment is easy to use and is particularly valid when obstruction is either minimal or gross.

Anaemia, weight loss, and round shadows in the lungs

In February, 2007, a 70-year-old man visited his general practitioner after 6 weeks of weight loss, shortness of breath on slight exertion, and night sweats. 3 weeks previously, he had had a tooth extracted, and subsequently developed sinusitis, left-sided tinnitus, and reduced hearing in the left ear. In the week before his appointment, the tinnitus and hearing loss had become bilateral. On examination, the patient was pale and looked tired. He had mouth ulcers, a palpable left supraclavicular lymph node, and a hard mass on the right side of the abdomen. Blood tests showed a microcytic anaemia (haemoglobin concentration 50·9 mmol/L), and an ESR and C-reactive-protein concentration of more than 120 mm/h and 250 mg/L, respectively. Renal and liver function tests gave normal results. Blood, but no protein, was found in the urine. Chest radiography revealed shadows consistent with metastases (fi gure). An otolaryngologist ascribed the tinnitus to temporomandibular dysfunction caused by dental extraction, and the hearing loss to adenoid enlargement; he also postulated that the mouth ulcers represented paraneoplastic pemphigus. CT of the abdomen showed cancer in the ascending colon. Histopathological examination of a biopsy sample obtained by colonoscopy revealed a moderately diff erentiated adenocarcinoma. We therefore told the patient that his life was threatened by disseminated cancer. However, CT of the chest then indicated that the lesions in the lungs were likely to be vasculitic rather than metastatic. Further blood tests showed a high concentration of antineutrophil cytoplasmic antibody specifi c for serine proteinase 3 (PR3-ANCA) (0·08 U/L, normal <0·006 U/L). We realised that a diagnosis of Wegener’s granuloma tosis, as well as explaining this result, could account for the vasculitis, sinusitis, tinnitus, hearing loss, and even lymphadenopathy. Moreover, fi breoptic rhinos copy revealed nasopharyngeal ulcers, consistent with Wegener’s granulomatosis. Bronchoscopy, to confi rm the origin of the pulmonary lesions, was not done because the patient was deemed too frail. The patient was treated for Wegener’s granulomatosis with immunoglobulin and methylprednisolone, and then with oral prednisolone. Since he had cancer, we did not prescribe cytotoxic drugs. Within 3 weeks, the pulmonary lesions resolved. The colonic tumour was subsequently resected, and staged as T4 N0 M0; the patient was relieved to learn of his revised prognosis. After the resection, we treated Wegener’s granulomatosis with cyclo phosphamide. However, the patient developed pulmonary aspergillosis, so treatment with cyclophosphamide was stopped. The patient then developed ulcers in the mouth and nasopharynx, digital infarctions, and mononeuritis multiplex. The PR3-ANCA concentration increased to 0·152 U/L. Plasma exchange substantially reduced the symptoms; the patient was then treated with rituximab. When last seen, in November, 2007, the patient continued to improve, albeit slowly; his cancer had not recurred. Wegener’s granulomatosis causes infl ammation of small blood vessels, characteristically aff ecting the upper respiratory tract, lungs, and kidneys. Other features can include mononeuritis multiplex, polyneuropathy, skin nodules, purpura, and infl ammation of the eye. Although high levels of PR3-ANCA can be found in Churg-Strauss syndrome or microscopic polyangiitis, this fi nding is more strongly associated with Wegener’s granulomatosis, being present in over 80% of people at the time of diagnosis. Unlike other causes of pulmonary vasculitis, Wegener’s granulomatosis causes nodular or cavitating lesions, which can be mistaken for metastases. Ironically, Wegener’s granulomatosis, and other causes of smallvessel vasculitis, are associated with an increased risk of cancer.

Relationship between Sinusitis and Adenoid Size in Pediatric Age Group

We sought to examine the relationship between adenoid volume and the stage of rhinosinusitis, as well as the relationship between age and adenoid size. Forty-two children complaining of nasal discharge, whose paranasal sinus computed tomographic scans had been obtained, were involved in the study. The patients with adenoid enlargement underwent adenoidectomy. The volumes of adenoid vegetation were measured in square centimeters, and paranasal sinus computed tomographic scans were classified according to the Lund-Mackay staging system. No statistically significant difference existed between patients whose Lund-Mackay scores were 0 and those with scores greater than 0. There seems to be no correlation between the Lund-Mackay score and the degree of adenoid vegetation. Adenoid vegetation may cause nasal discharge that is not necessarily due to sinusitis. We could not find any supportive data for the statement "The greater the adenoid tissue, the more extensive the sinusitis."

Case 1: Sounds like trouble

A two-year-old boy was brought to his paediatrician for noisy respiration and difficulty breathing during sleep. He had a history of loud snoring and difficulty breathing, which had worsened over the past six to eight months. His sleep was described as restless, and the parents indicated they had observed obstructive apneas in which breathing efforts continued but the snoring stopped for a few seconds. Trials of oral antibiotics and nasal steroids had not resolved the problem. The child was born at 29 weeks’ gestation as the second of triplets. He had had bilateral inguinal herniorrhaphies, but no long-term sequelae of preterm birth had become apparent. Physical examination performed during wakefulness revealed a child in no distress but was remarkable for tonsillar hypertrophy and mouth breathing. There was nasal congestion, and breath sounds were equal and clear. The cardiac examination was normal, with weight just above the 5th percentile for corrected age. A lateral neck radiograph documented adenoidal enlargement. A test was performed that confirmed the child’s diagnosis.

Adenoidectomy: Long-term follow-up

To assess the long-term (3-5 years) success of adenoidectomy and reasons for unsatisfactory results. The parents of all children who underwent adenoidectomy alone at a major tertiary center from 1998 to 2000 were asked to complete a questionnaire assessing their child's well-being and symptomatology 3-5 years after surgery; some were invited for follow-up. Symptom improvement, persistent symptoms, and adenoid regrowth were evaluated. Among the 206 parents who complied, 74%-87% reported improvement in all main symptoms: nasal obstruction, snoring, chronic rhinorrhea, hyponasal speech, and obstructive sleep disorder. At follow-up (n = 36), the symptomatic patients had significantly more anatomic nasal abnormalities (P = 0.01) and a higher rate of significant adenoid enlargement (P = 0.08), 3 patients (19%) vs none (0%). Adenoidectomy alone is satisfactory treatment for nasal obstruction and obstructive sleep apnea in selected children. Though some adenoid regrowth is not rare, clinically significant adenoid regrowth is infrequent. Persistent or recurrent symptoms are attributable mainly to nasal pathology.

The Effect of Volume Reduction Surgery by Radiofrequency for Enlarged Adenoid Causing Recurrent Otitis Media with Effusion

We studied the effect of volume reduction surgery by a radiofrequency (ENTec coblator) for enlarged adenoid causing recurrent otitis media with effusion. The effect of volume reduction surgery by radiofrequency for enlarged adenoid was studied in 50 children with enlarged adenoid causing recurrent otitis media with effusion from June 2002 to September 2004, while a group of 50 children with tympanostomy-tube placement alone from April 2001 to September 2004, was used as the control group. Volume reduction surgery by radiofrequency system for enlarged adenoid was done with tympanostomy-tube placement under general anesthesia by laryngeal mask. We compared two groups in following 5 different aspects: (1) tympanostomy-tube replacement, (2) remyringotomy, (3) total visits to our clinic after surgery, (4) total days with antibiotics, (5) absence of effusion and normal middle ear function as seen on the tympanogram after tympanostomy-tubes loss. We evaluated the reduction of enlarged adenoid by using the pre-and postoperative obstructive rate of the choana through the nasopharyngoscope. The volume of enlarged adenoid was reduced an average of 52.2% by radiofrequency. The pharyngeal opening of the eustachian tube and the choana could be opened widely. No severe intra or postoperative complications occurred. Compared to the control group treated with tympanostomy tubes alone, postoperative tympanostomy-tube replacement, postoperative remyringotomy, total postoperative visits to our clinic, total postoperative days with antibiotics, and tympanogram types C2 and B after tympanostomy-tubes loss decreased notably in cases with volume reduction surgery by radiofrequency for enlarged adenoid and tympanostomy-tube placement. Volume reduction surgery by radiofrequency for enlarged adenoid is considered very safe, effective one-day surgery technique for recurrent otitis media with effusion.

Adenoidectomy techniques for sleep disordered breathing

Adenoidectomy is routinely performed in children with adenoid enlargement and sleep disordered breathing (SDB). An adenoidectomy can be performed as an isolated procedure or as part of an adenotonsillectomy. This article describes a number of transnasal and transoral techniques that can be used successfully for removal of the adenoids in children with SDB. Adenoidectomy is routinely performed in children with adenoid enlargement and sleep disordered breathing (SDB). An adenoidectomy can be performed as an isolated procedure or as part of an adenotonsillectomy. This article describes a number of transnasal and transoral techniques that can be used successfully for removal of the adenoids in children with SDB.

Prophylactic or Therapeutic Adenoidectomy?

To the Editor .— As a practicing pediatric otolaryngologist, I read with interest the article about adenoidectomy and tympanostomy tube insertion by Hammaren-Malmi et al.1 As usual, the problems start with the title, which states that adenoidectomy performed at the time of tympanostomy tube insertion does not significantly reduce the incidence of acute otitis media (AOM). This sounds like a great conclusion until one reads that they excluded patients with adenoid enlargement (precisely the ones we would expect to benefit …

Prophylactic or Therapeutic Adenoidectomy?: In Reply

In Reply.—We thank Dr Carron for his comments on our study.1 His main concern was the accuracy of the diagnosis of otitis media. Although it was not explicitly stated in our report, all the children had tympanostomy tubes, which made the diagnosis straightforward because it invariably involved discharge from the tympanostomy tube. Some children had lost their tympanostomy tubes during the follow-up period, but adenoidectomy did not prevent the need for reinsertion of tympanostomy tubes.Dr Carron suggested that children who have had adenoidectomy because of obstructive symptoms should have been included in our study. Such children, however, benefit from adenoidectomy irrespective of middle ear disease, because adenoidectomy will enable normal nasal breathing. Therefore, these children were excluded from our study. Comparisons of such children with our study children with recurrent otitis media would have been difficult, because they have different diseases.In some children, adenoids may be infected chronically and serve as a source of pathogenic bacteria, presumably predisposing to otitis media. This may explain why adenoidectomy was beneficial in earlier studies of children who were mainly older than 4 years and who had previously received tympanostomy tubes2 and in children who suffered from persistent middle ear disease.3,4 It may be presumed that these children had had infections starting from their infancy, which allowed a chronic infection to develop in their adenoids. However, this is entirely hypothetical, and it is quite vague to call adenoidectomy “therapeutic” without gross adenoid enlargement.Dr Carron also questioned what would happen to the child when the tympanostomy tubes fall out and the child is reliant on his or her own ventilation system again. The focus of such a study should involve only those children who have middle ear disease after the initial or even secondary insertion of tympanostomy tubes, as has been evaluated in an earlier study.2 He stated that “tympanostomy tubes are great for preventing ear infections.” This certainly is not an evidence-based fact at all, because the effect of tympanostomy tubes for preventing otitis media is at its best quite modest5 and is not “preventing most ear infections anyway.”Because children who are younger than 4 years and who do not suffer from gross adenoid enlargement comprise the vast majority of children with middle ear infections, it is especially important to evaluate the effect of adenoidectomy in this very population. As our study showed, adenoidectomy failed to produce any additional benefit in preventing otitis media.

Medical Treatment for Rhinosinusitis Associated with Adenoidal Hypertrophy in Children: An Evaluation of Clinical Response and Changes on Magnetic Resonance Imaging

The association between adenoidal hypertrophy and rhinosinusitis with upper airway inflammation is increasingly recognized; however, no study has used magnetic resonance imaging (MRI) to assess the changes in adenoid size after medical treatment of rhinosinusitis. Thirteen children referred to a tertiary allergy clinic with symptoms of rhinosinusitis received medical treatment over a 4-month period. All underwent MRI before and after treatment. The medical treatment regimen comprised a short course of oral antibiotics and oral steroids and a longer course of oral antihistamines and intranasal steroids. The pretreatment MRI demonstrated enlarged adenoids and rhinosinusitis in all 13 children, with evidence of extensive rhinosinusitis in 9 of the 13. The treatment resulted in an improvement in overall symptom score; the most significant improvement was seen in mouth breathing. The posttreatment MRI showed a statistically significant reduction in adenoid size and adenoid/nasopharynx ratio, which was associated with a significant decrease in sinus involvement on MRI. There is a high association between adenoidal hypertrophy and rhinosinusitis in the context of an allergy clinic. Magnetic resonance imaging can document the changes in adenoid size associated with resolution of rhinosinusitis. Further studies are necessary to validate these pilot data and further assess the effects of medical treatment and the role of MRI in adenoidal hypertrophy.

Association between adenoidal–nasopharyngeal ratio and right ventricular diastolic functions in children with adenoid hypertrophy causing upper airway obstruction

Adenoid hypertrophy causing upper airway obstruction can cause cardiovascular complications, including pulmonary hypertension and right heart failure in children. Adenoidal-nasopharyngeal ratio (ANR) is a practical, non-invasive and reliable method to evaluate adenoid enlargement. Our aim was to evaluate a possible association between ANR and echocardiographic parameters of right ventricle. Twenty-one children who were affected by upper respiratory obstruction symptoms due to adenoid hypertrophy were included in this study (male/female: 12/9; mean age was 6.0 +/- 1.5 years). ANRs were calculated as the ratio of adenoidal depths to the nasopharyngeal depths on lateral cephalometric radiographs. Pulmonary arterial pressures, right ventricular diastolic filling parameters (peak E, peak A, E/A ratio), right ventricular end-diastolic diameters, and left ventricular ejection fractions were measured using echocardiography both preoperatively and also 3 months after the operation. Preoperative pulmonary arterial pressure, E/A ratio, right ventricular end-diastolic diameter, and left ventricular ejection fraction values were 23.10 +/-3.43 mmHg, 1.01 +/- 0.20, 1.95 +/- 0.16 cm, and 69.43 +/- 3.68%, respectively. Postoperative pulmonary arterial pressure, E/A ratio, right ventricular end-diastolic diameter, and left ventricular ejection fraction values were 16.94 +/- 1.45 mmHg, 1.24 +/- 0.14, 1.72 +/- 0.15 cm, and 69.77 +/- 2.17%, respectively. There were significant differences between preoperative and postoperative pulmonary arterial pressures, E/A ratios, and right ventricular end-diastolic diameters (p < 0.01 for each), while left ventricular ejection fraction values did not significantly change after the operation (p > 0.05). There was a negative correlation between E/A ratio and ANR-Ba (p < 0.05, r = -0.44). ANR can give information about the right ventricular functions in children with enlarged adenoids causing obstructive symptoms.

Adenoidectomy Does Not Significantly Reduce the Incidence of Otitis Media in Conjunction With the Insertion of Tympanostomy Tubes in Children Who Are Younger Than 4 Years: A Randomized Trial

To evaluate the efficacy of adenoidectomy in reducing the incidence of otitis media among children who are younger than 4 years and receive tympanostomy tubes. A randomized trial was conducted at a tertiary center clinic. A total of 217 children who were aged 12 to 48 months and had recurrent acute otitis media (>3 episodes during the past 6 months) or chronic otitis media with effusion, no obstructive symptoms as a result of adenoid enlargement, and no previous surgical intervention were enrolled in the study. Adenoidectomy in conjunction with the insertion of tympanostomy tubes or insertion of tympanostomy tubes without adenoidectomy was studied. The number of otitis media episodes during the follow-up period of 12 months was measured. During the follow-up, the mean number of otitis media episodes was 1.7 among children who underwent adenoidectomy with concurrent insertion of tympanostomy tubes and 1.4 among children who received tympanostomy tubes only. The risk for recurrent otitis media (>or=3 episodes) could not be reduced by adenoidectomy (odds ratio: 1.66; 95% confidence interval: 0.80-3.46). Adenoidectomy does not significantly reduce the incidence of acute otitis media in otitis prone children who are younger than 4 years and receive tympanostomy tubes.

Effects of adenoidectomy and immediate orthodonthic treatment on jaw relations and naso-respiratory rehabilitation

To determine if adenoidectomy itself could provide spontaneous relation of the transverse growth of jaws as well as an adequate mode of breathing or if there is a need for an additional orthodontic treatment to solve the problem. The study included one hundred and one patients aged 6-17 yrs., divided into three groups: group K--patients with oral respiration caused by adenoidal enlargement; group 1--patients with adenoidectomy done 5 or more years before; group 2--patients with orthodontic treatment done immediately after adenoidectomy. Transverse occlusion relation, the frequency of crossbite, and the intensity of nasal respiration were measured in all three groups of patients. The obtained results have shown that in the patients with adenoidal enlargement and oral respiration, there was an evidence of maxillary width reduction as opposed to mandibular width. Of the patients, 14% were with unilateral or bilateral crossbite. In the patients with adenoidectomy done 5 or more years before, transverse maxillary growth compared to mandibular one in the region of the front width, showed statistically significant increase (p < 0.05) as opposed to the patients with adenoidal enlargement. The effect of adenoidectomy on transverse maxillary growth was not satisfactory anyway, which was also indicated by the increase of frequency of crossbite in 24% of the patients with adenoidectomy done 5 or more years before. In operated on and in the patients one month after orthodontic treatment, transverse maxillary growth compared to mandibular growth in all the regions of both front and back width, there was statistically highly significant increase (p < 0.01) as opposed to the patients with adenoidal enlargement and adenoidectomy done many years before. Significant maxillary and mandibular transverse relation was obtained without the presence of crossbite. Nasal respiration prevailled. Orthodontic therapy one month after adenoidectomy was necessary for solving the orthodontic problems caused by adenoidal enlargement and significantly contributed to the rehabilitation of nasal respiration.

Effects of orthodontic treatment after adenoidectomy on jaw relations in the sagittal plane

To evaluate the orthodontic treatment effects, performed immediately after adenoidectomy, on lips relation, overjet and class (Angle). Three groups of patients, aged 6-17 years, were observed: group K--patients with oral respiration caused by adenoidal enlargement; group 1--patients with adenoidectomy performed five and more years previously; group 2--patients with one year of orthodontic treatment performed immediately after adenoidectomy. Lips and overjet status and class (Angle) was measured in the examined patients. In all of the three examined groups, there was a statistically highly significant increase (p<0.01) of competent lips. In the patients of group K, the overjet values ranged from 1 mm up to 12 mm where 90% of them had overjet > 4 mm and 6% < 1 mm. The front open bite, low overbite and reversed overjet was found in the patients with low overjet in this group, as well. Overjet values in the patients of group 1 ranged from -2 mm up to 12 mm where 86% had overjet > 4 mm and 10% < 1 mm. Significantly higher increase (p<0.01) of overjet values (1-4 mm in 94% of patients) was observed in the patients of group 2 in comparison to the values found in the patients from groups 0 and 1. Class II (Angle) was recorded in 81% of the patients in group 0, and 79% in group 1, while class I (Angle) was observed 100% only in the patients of group 2. Orthodontic treatment immediately after adenoidectomy was necessary for achieving the competition lips relation, normal overjet and class I (Angle).

X-Rays in the evaluation of adenoid hypertrophy: It's role in the endoscopic era.

To evaluate the reliability of X-rays in the diagnosis of adenoid hypertrophy and to validate this with flexible nasopharyngoscopy which is the existing gold standard. Lateral radiograph of the neck and a flexible nasopharyngeal endoscopy was done to evaluate adenoid enlargement in children aged 3-12 years who were included in a S week randomized double-blind placebo controlled study for the effect of beclomethasone in adenoid hypertrophy. These were graded independently by both the co-investigor and investigator X-ray and nasal endoscopy for reevaluation of adenoid size was done at the completion of the study. Variables of both the procedures were scored at the beginning and end of the study. The agreement between the two groups was assessed using weighted kappa statistic. There were 26 patients in the study, 17 of them had complete correlation between the X-ray and endoscopy findings. The agreement between these findings was statistically significant (p<01) with the weighted kappa 0.51. This study shows that lateral X-rays of the neck, besides being a noninvasive procedure, still remains a very reliable and valid diagnostic test in the evaluation of hypertrophied adenoids.

Long-term follow-up and mechanisms of Obstructive Sleep Apnea (OSA) and related syndromes through infancy and childhood

Background: Although tonsil and adenoid (T&A) enlargement in children is a leading cause of it, Obstructive Sleep Apnea (OSA) may occur at any age. But even after T&A surgery, some children experience recurrent apneic episodes. The reasons for possible recurrence are unclear. Objective: To quantify the prevalence of recurrent OSA after T&A surgery and find out a common cause of OSA in children from the neonatal period to adulthood. Method: A retrospective report of apneic patients followed in a tertiary-care center is presented. Telephone interviews of parents were performed 3 years after T&A surgery. The questionnaire included night and day symptoms related to sleep-disordered breathing (SDB). A literature review was performed about associated causes of upper airway stenosis. Results: Out of 59 children who were included to follow up, 5 (8.5%) experienced residual or recurrent symptoms of SDB. The literature suggests the role of skeletal abnormalities in this process through nasal or pharyngeal stenosis. Major craniofacial anomalies are a well-known cause of obstruction. Thickened soft tissue has to be ruled out. Minor stenoses or neuromuscular disorders are less often diagnosed although they seem to be involved as well. Conclusion: A longitudinal follow-up of apneic children is able to reveal recurrence of SDB after adenotonsillectomy and often allows the understanding of mechanisms of upstream-induced recurrent pharyngeal obstructions.

Long-term follow-up and mechanisms of Obstructive Sleep Apnea and related syndromes through infancy and childhood

Background: Although tonsil and adenoid (T&A) enlargement in children is a leading cause of it, OSA may occur at any age. However, even after T&A surgery, some children experience recurrent apneic episodes. The reasons for possible recurrence are unclear. Objective: To quantify the prevalence of recurrent OSA after T&A surgery and find out a common cause of OSA in children from the neonatal period to adulthood. Method: A retrospective report of apneic patients followed in a tertiary-care center is presented. Telephone interviews of parents were performed 3 years after T&A surgery. The questionnaire included night and day symptoms related to sleep-disordered breathing (SDB). A literature review was performed about associated causes of upper airway stenosis. Results: Out of 59 children who were included to follow up, 5 (8.5%) experienced residual or recurrent symptoms of SDB. The literature suggests the role of skeletal abnormalities in this process through nasal or pharyngeal stenosis. Major craniofacial anomalies are a well-known cause of obstruction. Thickened soft tissue has to be ruled out. Minor stenoses or neuromuscular disorders are less often diagnosed although they seem to be involved as well. Conclusion: A longitudinal follow-up of apneic children is able to reveal recurrence of SDB after adenotonsillectomy and often allows the understanding of mechanisms of upstream-induced recurrent pharyngeal obstructions.

Open-mouth versus closed-mouth radiographs of the nasopharynx in the evaluation of nasopharyngeal airway obstruction

The open-mouth and closed-mouth nasopharyngeal airway radiographs of 53 children, whose symptomatology score was concordant with nasopharyngeal airway obstruction that may be due to adenoidal enlargement, were taken and, for each radiograph, nasopharyngeal airway/soft palate (NA/SP) ratio was measured and graded using the method of Cohen and Konak. According to the statistical analysis, since closed-mouth views correlated better with the symptomatology score than the open-mouth views, if a radiological measurement is needed to evaluate the nasopharyngeal airway obstruction, closed-mouth views can be chosen.

Otitis media with effusion and histopathologic properties of adenoid tissue

Objective: Adenoidectomy is being generally used for the treatment of otitis media with effusion (OME). The purpose of current study was to determine objectively the significance of the histopathology of adenoid tissue on the development of otitis media with effusion. Methods: The records of all the patients operated on with the diagnosis of adenoid enlargement with or without OME were reviewed and pathologic specimen were re-evaluated regarding histopathological properties by one pathologist unfamiliar with the diagnosis. Sixty-one patients with adenoid hyperplasia were enrolled in the study group, 38 males and 23 females. Age ranged between 3 and 13 years (mean age was 7.03±3.26 years). All the patients of study group were those operated on due to the adenoid hyperplasia and uni- or bilateral OME. Control group was composed of 39 male and 26 female patients (age range was between 3 and 13 years, and mean age was 7.06±3.04 years) with solely adenoid hyperplasia. Results: The squamous metaplasia was present in 47 (77%) and 14 (22%) patients of study and control groups, respectively. The fibrosis of connective tissue interspersed follicles of adenoid was present in 29 (48%) and 6 (9%) patients of study and control groups, respectively. The statistical analysis revealed a significant prevalence of squamous metaplasia ( P<0.001) and fibrosis of connective tissue interspersed follicles of adenoid ( P<0.001) for a surgical indication of adenoid hyperplasia with OME than for without OME. The prevalence of other parameters was not significantly different between two groups. Conclusions: Adenoid tissue not only exerts an obstructive influence on the eustachian tube lumen when enlarged, but also impedes (hinders) mucociliary drainage of the middle ear by the way of non-ciliated metaplastic epithelium and fibrosis of connective tissue.

Perioperative adenotonsillectomy management in children: current practices.

To determine the current practices of preoperative evaluation, surgical techniques, and postoperative treatment of pediatric adenotonsillectomy. Forty-one-item survey measuring the frequency of different evaluations, procedures, and treatments performed, including selected case scenarios, with all items scored on a five-point ordinal scale ranking frequency. The entire membership of the American Society of Pediatric Otolaryngology (ASPO) and active fellows and members of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) residing in New York state were anonymously surveyed through mail-in questionnaires. History alone was the most frequent modality for diagnosing both adenoid enlargement and obstructive sleep apnea. The most common preoperative laboratory test ordered before an adenotonsillectomy is a complete blood cell count; ASPO members ordered fewer preoperative laboratory tests than AAO-HNS members. Unipolar cautery is the most frequently used tonsillectomy technique, and curettage followed by cautery is the most popular adenoidectomy technique. Steroids are the most common intraoperative medication administered during an adenotonsillectomy, and office visits remain the most frequently used methods of assessing adenotonsillectomy patients postoperatively. Although there are statistically significant trends uncovered by the survey, the results reflect a lack of consensus regarding adenotonsillectomy management. Further randomized controlled trials or large-scale outcomes projects are much needed to evaluate critically the current practices of pediatric adenotonsillectomies. Additional efforts may also be required to use the information from these studies in effecting changes in actual practice patterns, moving us toward a more evidence-based paradigm of treating pediatric adenotonsillar disease.