Enlarged Adenoids Research Articles

Typmpanometric Findings Pre and Post Adenoidectomy Amongst Children with Obstructive Adenoid Enlargement

Typmpanometric Findings Pre and Post Adenoidectomy Amongst Children with Obstructive Adenoid Enlargement

Cephalometric differences in grades II and IV adenoid hypertrophy: A cross-sectional study.

This study aims to determine whether there were cephalometric changes between grades II and IV adenoid hypertrophy. A cross-sectional study was conducted on 120 6-12-year-old patients selected from the ear, nose, and throat department at Imam Al-Hussein Medical City in Karbala. Patients were classified into three groups (each = 40) based on endoscopic findings: control, grade II, and grade IV. The findings were confirmed with cephalometric radiographs. Specific cephalometric points were identified to measure sella-nasion-point A (SNA), sella-nasion-point B (SNB), point A-nasion-point B (ANB), sella-nasion-pogonion (SNPog), sella nasion plane-palatal plane (SNPP), palatal plane-mandibular plane (PPMP), sella nasion plane-mandibular plane (SNMP), saddle, articular, gonial angles, and the y-axis. Additionally, superior-posterior airway space (SPAS), posterior air way space (PAS), mandibular plane-hyoid bone (MP-H), third cervical vertebra-hyoid bone (C3-H), total anterior facial height (TAFH), total posterior facial height (TPFH), upper anterior facial height (UAFH), lower anterior facial height (LAFH), and the Jarabak ratio were measured. Analysis of variance (ANOVA) and Welch tests indicated statistically significant differences (P < 0.05) among the three groups in SNA, SNB, SNPog, PPMP, SNMP, gonial angle, y-axis, SPAS, PAS, MP-H, and the Jarabak ratio. Tukey's honestly significant difference (HSD) and Games-Howell tests indicated a statistically significant difference between grade II and grade IV in SNA, SNMP, y-axis, SPAS, PAS, MP-H, and Jarabak ratio. The present study demonstrated that craniofacial changes start to occur at the moderate adenoid enlargement throughout the downward backward mandibular rotation. More changes would become evident at the severe stage; therefore, an urgent medical intervention and the establishment of nasal breathing by orthodontic treatment with breathing activity would be needed.

Clinical and Audiological Outcome of Surgical Treatment in Patients with Adenoid Hypertrophy

Background: Adenoid hypertrophy is a common condition in childhood, which may be associated with recurring acute otitis media, otitis media with effusion (OME), and obstructive sleep apnoea syndrome. There is close relationship between adenoids and possible middle ear pathology leading to conductive deafness. Objective: To find out the outcome of surgery regarding clinical features and hearing status in children with adenoids. Methods: This hospital based prospective study was conducted at the Department of Otolaryngology&amp; Head-Neck Surgery, Shaheed Suhrawardy Medical College &amp; Hospital, for a period of 6 months following approval from IRB. Patients having enlarged adenoids with or without OME of 3-12 years and both sex group were approached for inclusion of the study. Informed written consent was taken from the guardian. Proper surgical intervention was chosen according to condition of the child. Before and after intervention, data were collected by the researcher himself. Data were recorded into the case record form. Following collection, data were analyzed by the SPSS 26 (SPSS Inc, Chicago, IL, USA). Results: Among 100 patients, 66% were males and 34% were females. Mean age was 7.2±2.34 SD (years). Of all, 60% underwent adenoidectomy (AT), 20% underwent adenoidectomy with myringotomy (AM), and remaining 20% underwent adenoidectomy with myringotomy with grommet insertion (AMG). The PTA findings (baseline) of adenoidectomy, adenoidectomy with myringotomy, and adenoidectomy with myringotomy with grommet insertion group were 15.466±1.395, 37.8±3.349 and 38.2±3.548 db, respectively. Similarly, significant improvement was noticed in all of the three groups as evidenced by PTA value in three groups were 11.91±1.12, 18.65±.933 and 17.45±1.31 db, respectively (p&lt;0.05). Improvements in PTA among different groups also showed significant changes following operation (p&lt;0.05). Conclusion: Clinical improvement are noticed following surgical intervention in both ............

Risk Factors, Clinical Profile and Association of Clinical Grading With Radiological Grading of Adenoid Hypertrophy in Children

BACKGROUND: Adenoid hypertrophy producing obstructive airway symptoms is the most commonly encountered pediatric ENT problem. Clinical symptoms in combination with lateral nasopharyngeal x ray is a reliable technique for selection of children requiring surgical intervention. METHODOLOGY: The current cross sectional prospective study was conducted among 250 children aged 3-12 years with clinical symptoms and radiological evidence suggestive of enlarged adenoids, at Pediatric outpatient department of a tertiary care center, Dhaka, during 1-year period. RESULT: In our current study, majority children (74%) with adenoid hypertrophy were 3-6 years old followed by 26% between 7-12 years. 66% children were male and 34% were female with a male to female ratio of 1.9:1. 44% children were from lower class family and history of atopy was present among 54% children. Clinical grading of adenoid hypertrophy was done on the basis of presenting symptoms (mouth breathing, snoring, sleep disturbances and adenoid facies) and radiological grading was done from calculating adenoid nasopharyngeal ratio. Correlation between clinical scoring and radiological grading of adenoid hypertrophy among study population was observed. Clinical score of 0-4, 5-8, 9-12 and 13-16 was graded clinically into Grade I, II, III and IV respectively. Highly significant p value (.000) was observed in Grade II clinical and radiological grade of enlarged adenoid. The remaining clinical and radiological grade of enlarged adenoids showed significant p value .031, .024 and .019 among grade I, III and IV respectively. CONCLUSION: Though various diagnostic modalities for detection of degree of obstruction caused by enlarged adenoids are available, clinical scoring in combination with radiological grading can be effectively used to select patients requiring surgical intervention for pediatric adenoid hypertrophy. J Shaheed Suhrawardy Med Coll 2022; 14(2): 11-17

Risk Factors for Otitis Media with Effusion in Preschool and School Children in Calabar Municipality.

Predisposing factors for otitis media with effusion are multifactorial, ranging from genetic and anatomical abnormalities to environmental factors and inflammation of the nose and adjacent structures. The study determined the risk factors for otitis media with effusion (OME) among children in Calabar Municipality. This was a descriptive, cross-sectional, community-based study including children aged 1-10 years randomly selected from government and privately owned daycares, nurseries (preschool), and primary schools. The risk factors assessed included upper respiratory tract infection, allergic rhinitis, adenoid enlargement, acute otitis media, recurrent acute otitis media parental educational level, overcrowding (four children sleeping in a room), duration of breastfeeding, cleft palate, and Down's syndrome. Allergic rhinitis was diagnosed when a child had at least two of the rhinological symptoms: nasal congestion, running nose, sneezing, itching of the eye or nose, and at least one of the following: history of allergy, family history of allergy, and positive history of asthma. The questionnaire was the research instrument used to assess the risk factors for OME. OME diagnosis was made with otoscopy and tympanometry. Data were collected and analyzed with IBM SPSS version 25, and a P value <0.05 was considered statistically significant. A total of 24 daycare pupils, 141 nursery pupils, and 155 primary pupils were recruited into the study. The prevalence of otitis media with effusion was more in younger children than in older children and the relationship was statistically significant (P < 0.001). Female children were more statistically affected than male children (P = 0.007). Children with allergic rhinitis accounted for a higher proportion of those with OME than those without allergic rhinitis (26.7% vs. 11.6%), and the difference was statistically significant (P = 0.007). The association between OME and upper respiratory tract infection, acute otitis media, and recurrent acute otitis media was not statistically significant (P > 0.05). Multivariate binary logistic regression was used to identify predictors for the otitis media with effusion. There are many endogenous and exogenous risk factors for OME, but notable risk factors in our study were age 1-2 years, female sex, and allergic rhinitis.

Correlation between Fibreoptic Nasopharyngoscopy and Symptom Score in the Evaluation of Obstructive Adenoid Enlargement

Correlation between Fibreoptic Nasopharyngoscopy and Symptom Score in the Evaluation of Obstructive Adenoid Enlargement

Adenoid Hypertrophy Managed With Artemisia Cina Dilution: A Study of Two Cases

Adenoid hypertrophy, is the enlargement of adenoid tissues in the nasopharynx, a common concern among children and often exhibits with nasal congestion, mouth breathing, snoring, and sleep disturbances. Spontaneous healing of enlarged adenoid is common in adolescents and adults, however, in this case study, we present two instances of pediatric patients who demonstrated adenoid-related health issues. After a thorough evaluation, and based on the principle of symptom similarity Artemisia cina was prescribed; this treatment continued for three consecutive weeks, and a follow-up lateral x-ray of nasopharynx was obtained one more week later. The use of homeopathic preparation of Artemisia cina appeared to ease their symptoms. This outcome suggests that Artemisia cina may hold promise as a homeopathic option for managing adenoid-related concerns in pediatric patients. However, we acknowledge that further research and a larger sample size are necessary to establish the usefulness of this approach. Bioresearch Commu. 10(1): 1449-1452, 2024 (January)

Pathophysiological Effect of Enlarged Adenoid on Middle Ear in Children

Objective: To identify the incidence of otitis media with effusion (OME) in children with enlarged adenoid. Methodology: This is a cross sectional observational study was carried out at Department of Otolaryngology and Head Neck surgery of Sir Salimullah Medical College Mitford Hospital, Dhaka from July 2014 to June 2016. One Hundred and Fifty (150) children with enlarged adenoid were included in this study. All patients were subjected for history, local physical examination, evaluation of adenoid size by X ray of nasopharynx lateral view. Pure tone audiometry &amp; tympanometry were done in all patients. Informations were recorded in a specially designed data collection sheet. Result: Among 150 children with enlarged adenoid 30(20%) patient had OME, majority of patients (60%) were age group 7-9 years. Male were predominant (60%) than female (40%). Among 150 patients grade- I was 16%, grade II- was 26%, grade-III was 54% and grade IV was 4%.According to the grading of enlarged adenoid cases , grade I, grade II , grade III and grade IV had 8.33%,15.38% ,23.46% and 50% cases had OME respectively. Hearing loss was in 33(22%) children. According to tympanometry, type A curve was in 118(78.67%) children, type B 26(17.33%) and type C 6(4%) children. Conclusion: Enlarged adenoid is associated with otitis media with effusion. Incidence of Otitis media with effusion increases with the proportion of severity of nasopharyngeal obstruction by enlarged adenoid. Bangladesh J Otorhinolaryngol 2023; 29(1): 11-16

Knowledge and Awareness among Parents in the Aseer Region, Kingdom of Saudi Arabia, Regarding Complications of Recurrent Adenotonsillitis in Children and Its Surgical Treatment

Objective: The study emphasizes the importance of parental awareness regarding complications and surgical procedures associated with pediatric adenotonsillar hypertrophy. Methodology: A descriptive cross-sectional survey was used targeting parents of children aged 1–14 years in the Aseer region of Saudi Arabia. The sample size was 301 individuals. It includes parents of children between the ages of 1 and 14 years who are living in the Aseer region. Exclusion criteria involve anyone who does not live in the Aseer region, &lt;18 years, and nonparents of children between the ages of 1 and 14 years. Results: The data presented are based on 301 people who volunteered to participate in the survey; a considerable majority of participants, 71.4%, correctly identified that recurrent adenotonsillitis could induce tonsil and adenoidal enlargement. However, 28.6% of respondents answered this question incorrectly. Conclusions: Our findings emphasize the necessity of parental education on the risks and surgical procedures related to adenotonsillar hypertrophy in pediatric patients. While some areas of knowledge were well recognized, there is an obvious need for additional education.

Assessment Of Adenoid Nasopharyngeal Ratio In Children With Symptoms Suggestive Of Obstructive Adenoid Disease

Background: Adenoid hypertrophy (AH) is a common childhood illness that occurs due to obstruction of the nasopharynx by enlarged adenoids. Lateral nasopharyngeal X-ray is used for diagnosis and assessment of patency of the nasopharyngeal air column by assessing the Adenoid Nasopharyngeal Ratio (ANR). This study aims to assess the ANR of symptomatic patients with AH that presented to Ear, Nose and Throat/ Head and Neck Surgeon (ENT/HNS) Department of the University of Abuja Teaching Hospital (UATH).&#x0D; Methodology: This was a retrospective study conducted in the ENT/HNS Department of UATH, Gwagwalada from January 2019 to December 2021. The case notes and lateral nasopharyngeal xrays of 112 children aged between 3 months to 15 years, diagnosed with Adenoid Hypertrophy, were retrieved. Relevant information such as demographics, and Lateral Nasopharyngeal X-ray measurements were extracted.&#x0D; Results: A total number of 112 participants were enrolled into this study. Out of these, 77 (68.8%) were males and 35 (31.2%) were females. The mean age of participants was 3.86 0.27 years, and age range was 3 months to 15 years. Most participants were between 0 – 5 years. The mean ANR among participants was 0.69 0.02. The minimum ANR was 0.03, and the maximum ANR was 1.00 Majority of participants had ANR 0.69. None of the participants between 10 – 15 years had an ANR &gt; 0.79. Regression analysis showed statistically significant correlation between ANR and Age (p = 0.05).&#x0D; Conclusion: We observed an Adenoidal Nasopharyngeal Ratio that was lower than the benchmark of ANR considered for AH, this may probably be due to our inability to control the timing for obtaining the radiographs from clinic visit and some may have commenced treatment

Evaluation of risk factors and clinical presentation of adenoid hypertrophy among children attending the pediatric outpatient department of tertiary care hospital in Dhaka division

Background: Adenoid hypertrophy (AH), also known as enlarged adenoid, refers to the unusual growth of the adenoids. AH and its consequences are common in the entire childhood period. The adenoids are small masses of lymphatic tissue located in the upper airway, between the nose and the back of the throat.Methods: This cross-sectional study was conducted from January 2021 to December 2021 over a period of 12 months. All the children aged 1-18 years attending the pediatric outpatient department (OPD) who had known risk factors or sign-symptoms of AH underwent a lateral nasopharyngeal x-ray to confirm the presence of an enlarged adenoid. Those children who had enlarged adenoids were analyzed in this study.Results: A total of 1289 children aged 1-18 years attended the pediatric OPD over 1 year of the study period, out of them, 118 had evidence of enlarged adenoid on lateral nasopharyngeal x-ray, giving a prevalence of 2.3%. Among the 118 radiologically proved AH cases, 112 (95%) were symptomatic and 6 (5%) were asymptomatic having risk factors only. The peak age of diagnosis of AH in this study was between 12-72 months (43.4%). The mean age of presentation was 100.6±58 months. There was a male predominance with male to female ratio of 1.6:1. AH may be presented without symptoms in 5% of cases or may be presented with complications such as OSA (27%), adenoid facies (14%), and otitis media with effusion with or without hearing impairment (13%).Conclusions: The prevalence of AH among children attending the pediatric outpatient department was 2%, of them 18% had an indication for adenoidectomy. The most common two clinical presentations were mouth breathing and nasal obstruction and the most common complication was obstructive sleep apnea.

Effect of adenoidal enlargement on development of otitis media with effusion

Background Adenoid hypertrophy has a major effect on development of middle ear effusion not due to the large volume but through combination of factors including local immune regulation, biofilm, and immunoglobulin E allergic reaction. Aim To assess the correlation between adenoid tissue volume and development of middle ear effusion. Patients and methods This was a sequential analysis study including a sample size of 195 patients from 4 to 12 years. They were diagnosed with adenoid hypertrophy, confirmed by flexible nasopharyngeal endoscopy (FNE) and lateral neck radiographs. They were evaluated by tympanometry to assess otitis media with effusion. Results We found that 59 (29.2%) patients had FNE grade 1, 68 (35.4%) patients had FNE grade 2, 68 (35.4%) patients had FNE grade 3, and no patients had grade 4. A total of 101 (52.6%) patients had a tympanogram type A and 94 (47.4%) patients had a tympanogram type B. There was no statistically significant correlation between tympanogram groups in relation to the FNE (P=0.762). Conclusion We suggested that there was no valuable correlation between change in size or volume of adenoid tissue and development of middle ear effusion.

Changes of Impedance Audiometry before and after Adenoidectomy in a Clinically Normal Ear

Background: The nasopharyngeal tonsil, universally known as adenoids is to be found at the crossroads of roof along with posterior wall of nasopharynx. Adenoid is gift next to birth. Adenoid mass may block the eustachian tube, retracted tympanic membrane leads to conductive hearing loss. Impedance audiometry helps to assess the condition.&#x0D; Objective: To observe the changes of impedance audiometry before and after adenoidectomy in a clinically normal ear.&#x0D; Methods: This longitudinal study was done in Cumilla Medical College &amp; Hospital, Cumilla during a period of one year. 50 Cases of enlarged adenoids of 3-12 years admitted in ENT ward were included in this study. All cases underwent adenotonsillectomy. Impedance Audiometry was done before and one month after adenotonsillectomy. Collected data were classified, edited, coded and statistical analysis was done.&#x0D; Results: Total 50 cases, mean age was 6.95(±1.77) years. Majority 33(66%) were male and 17(34%) were female. Middle ear pressure of both ears was increased after adenotonsillectomy. After operation 40(80%) was type A curve and 09(18%) was type B in right ear and 42(84%) was type A curve and 08(16%) was B curve in left ear.&#x0D; Conclusion: Majority tympanometry was type B in both ears before adenotonsillectomy and after operation majority tympanometry curvature was type A in both ears&#x0D; Bangladesh J Otorhinolaryngol 2022; 28(1): 62-67

Middle Ear Pressure Changes after Adenotonsillectomy and Myringotomy in Patients with Otitis Media with Effusion

Background: Otitis media with effusion(OME) is a common ear problem among children characterized by accumulation of secretion in the middle ear. The pathophysiology of OME is negative pressure due to eustachian tube dysfunction. In children adenoid enlargement is associated with enlargement of the tonsils. Surgical treatment is advocated when conservative treatment fails. Surgical treatment consists of adenotonsillectomy with myringotomy. Negative middle ear pressure is expected to improve after surgical intervention.&#x0D; Objectives: To see the pressure changes after surgical treatment of OME.&#x0D; Methods: Among 68 subjects with OME, 88 ears were operated. Adenotonsillectomy was done in all subjects. In addition myringotomy was done in 65 ears and myringotomy with grommet insertion was done in 23 ears. In post-operative period all patient were followed up at end of 1 month, 3 month and 6 month with tympanometry.&#x0D; Results: Pre operatively type B tympanogram was 67(76.13%) whereas type Atympanogram was 0(0%). At end of 6 month type A curve was 49(61.27%) and type B tympanogram was 9(11.25%) that indicates improvement of middle ear function after operation.&#x0D; Conclusion: Tympanometric improvement was significant after 6 month of surgery.&#x0D; Bangladesh J Otorhinolaryngol 2022; 28(1): 22-28

Prevalence and clinical presentation of adenoid hypertrophy among children attending at pediatric outpatient department of a tertiary care general hospital of Dhaka

Background: Adenoid hypertrophy (AH) and it consequences are common in the entire childhood period. This study was aimed to estimate the prevalence, to enumerate the presence of risk factors and pattern of presentations of AH among children attending at pediatric outpatient department.&#x0D; Methods: This cross-sectional study was conducted at the general pediatric outpatient department (OPD) of BIRDEM General Hospital-2 (Women and Children), Dhaka from January 2017 to December 2020. All the children aged 1-18 years attending the OPD who had known risk factors or sign-symptoms of AH were underwent a lateral nasopharyngeal x-ray to confirm the presence of enlarged adenoid. Those children who had enlarged adenoid were analyzed in this study.&#x0D; Results: A total of 20234 children attended the general pediatric OPD during the study period, of them, 463 had evidences of enlarged adenoid on lateral nasopharyngeal x-ray, giving a prevalence of 2.3%. The mean age of presentation was 100.6±58 months. Among the AH cases 86% had allergic sensitivity to house dust, 60% had allergic rhinitis, 55.5% had history of recurrent tonsillitis and 55.3% children were exposed to cigarette smoke especially at home. Most common presentation of AH was mouth breathing especially during sleep time (90.5%). Other common presenting features were nasal obstruction (83.6%), nasal discharge (73%), drooling of saliva (72.4%), daytime somnolence (65.2%) and snoring during sleep (61.8%). According to our study AH may be asymptomatic in 5% cases. However, it may be presented with complications such as OSA (obstructive sleep apnea) (26.6%), adenoid facies (13.8%) and otitis media with effusion with or without hearing impairment (12.5%). Eighty two (17.7%) need referral to ENT OPD for adenoidectomy. Most common indication for adenoidectomy was obstructive sleep apnea (41.5%).&#x0D; Conclusion: Prevalence of adenoid hypertrophy among children attending at pediatric outpatient department was 2.3%, of them 17.7% had indication for adenoidectomy. Allergic sensitivity to house dust was the most common risk factors. Most common two clinical presentations were mouth breathing and nasal obstruction and most common complication was obstructive sleep apnea.&#x0D; BIRDEM Med J 2022; 12(2): 111-116

Assessing the ability of children and parents to rate their nasal patency. A cross sectional study

ObjectiveNasal obstruction is a common complaint in pediatric otolaryngology. There are several concerns about how nasal obstruction should be measured. This debate is even more important in children, as they can experience difficulties in being sensitive to their symptoms or even expressing them. In this research we aim to explore the ability of children (and their parents) to assess their nasal obstruction. ParticipantsAND METHODS: An observational cross-sectional study was performed. Four cohorts of children were consecutively selected from a third level referral Hospital. Cohort A (children suffering solely turbinate enlargement), B (adenoid enlargement only), and C (adenoid and turbinate enlargement), while cohort D were healthy controls. Children and parents were asked to rate nasal patency through a Likert scale from 0 (no patency, complete obstruction of the nose) to 10 (complete patency, it is easy to breathe through the nose). All participants underwent rhinomanometry. Results of nasal resistance were relativized according to pediatric reference values per each age subgroup. Results146 participants were included. Cohort A (54), B (40), C (28), D (24). There is a poor but significant correlation between parents’ assessment and nasal resistance (rho = −0.28; p = 0.004). In children, there is no significant correlation with nasal resistance (rho = −0.14; p = 0.17). Stratified by severity, only children (and their parents) with good nasal breathing demonstrated good correlation values with the visual analogue score (VAS). Stratified by age, the correlation is only significant for parents of children older than 12 years old. ConclusionsThis study has demonstrated a good ability to rate nasal patency by healthy children and their parents, but a poor ability for children suffering from impaired nasal breathing. We suggest combining subjective assessment of nasal patency with objective measurements such as rhinomanometry in children.

Otological Presentation of Obstructive Nasal Lesions: A Study of 50 Cases

Purpose: To analyze and realize the importance of the Eustachian tube dysfunction (ETD) in the pathogenesis of the middle ear infections as to raise the awareness amongst the Otolaryngologists consider the tubal dysfunctions in the management of the otitis media. Materials and methods: 50 patients of aural discharge, aural fullness, aural pain, hearing loss and tinnitus along with nasal obstruction were selected from July 2013 upto December 2013 in the outpatient department (OPD) of Otorhinolaryngology - Head and Neck Surgery dept. of Dhaka Medical College Hospital under a specific prospective study protocol. All patients of aural fullness, hearing loss, aural pain, tinnitus, aural discharge along with nasal obstruction with or without sore throat were included; patients of sensorineural hearing loss, primary external ear pathology, ear malignancy and congenital ear diseaseswere excluded. Results: 58% patients were below 20 years, 50% were children, 64% were male and 36% female. 62% patients got aural fullness, 60% hearing loss 40% mild, 14% moderate, 6% severe conductive and 8% mixed), 26% tinnitus, 32% aural discharge and 30% aural pain and amongst the patients of otitis media with effusion (OME), 100% got hearing loss, 73% aural fullness, 33% tinnitus, 27% aural pain and 13% dizziness. 78% patients got septal deviation, 58% hypertrophied inferior turbinates (HIT), 32% enlarged adenoids (EA), 62% allergic rhinitis, 26% acute upper respiratory tract infection (URTI), 4% nasal polyps and 48% sinusitis/mucosal thickening and amongst the children, 64% got enlarged adenoids, 56% HIT, 76% septal deviation (SD), 24% acute URTI, 4% antrochoanal polyp, 20% adenoid with HIT and 44% adenoid with SD. Regarding findings in the patients of enlarged adenoid, 37.5% patients got eustachian tube dysfunction (ETD) and 62.5% got hearing loss due to OME as well as acute otitis media (AOM), chronic otitis media (COM) and it showed that mild adenoid caused ETD occasionally on URTI but mild adenoid with HIT caused OME. Conclusion: The obstructive nasal lesions are intermingled with otitis media, so this association should be sought out and underlying nasal lesions must be managed if any as a part of treatment of the otitis media. Bangladesh J Otorhinolaryngol 2021; 27(2): 159-169

Study of montelukast in children with sickle cell disease (SMILES): a study protocol for a randomised controlled trial

BackgroundYoung children with sickle cell anaemia (SCA) often have slowed processing speed associated with reduced brain white matter integrity, low oxygen saturation, and sleep-disordered breathing (SDB), related in part to enlarged adenoids and tonsils. Common treatments for SDB include adenotonsillectomy and nocturnal continuous positive airway pressure (CPAP), but adenotonsillectomy is an invasive surgical procedure, and CPAP is rarely well-tolerated. Further, there is no current consensus on the ability of these treatments to improve cognitive function. Several double-blind, randomised controlled trials (RCTs) have demonstrated the efficacy of montelukast, a safe, well-tolerated anti-inflammatory agent, as a treatment for airway obstruction and reducing adenoid size for children who do not have SCA. However, we do not yet know whether montelukast reduces adenoid size and improves cognition function in young children with SCA.MethodsThe Study of Montelukast In Children with Sickle Cell Disease (SMILES) is a 12-week multicentre, double-blind, RCT. SMILES aims to recruit 200 paediatric patients with SCA and SDB aged 3–7.99 years to assess the extent to which montelukast can improve cognitive function (i.e. processing speed) and sleep and reduce adenoidal size and white matter damage compared to placebo. Patients will be randomised to either montelukast or placebo for 12 weeks. The primary objective of the SMILES trial is to assess the effect of montelukast on processing speed in young children with SCA. At baseline and post-treatment, we will administer a cognitive evaluation; caregivers will complete questionnaires (e.g. sleep, pain) and measures of demographics. Laboratory values will be obtained from medical records collected as part of standard care. If a family agrees, patients will undergo brain MRIs for adenoid size and other structural and haemodynamic quantitative measures at baseline and post-treatment, and we will obtain overnight oximetry.DiscussionFindings from this study will increase our understanding of whether montelukast is an effective treatment for young children with SCA. Using cognitive testing and MRI, the SMILES trial hopes to gain critical knowledge to help develop targeted interventions to improve the outcomes of young children with SCA.Trial registrationClinicalTrials.govNCT04351698. Registered on April 17, 2020. European Clinical Trials Database (EudraCT No. 2017-004539-36). Registered on May 19, 2020

The Impact of Adenoid Hypertrophy on Pediatric Chronic Maxillary Sinusitis

Background:The hypertrophied adenoids lay a role in rhinosinusitis, which is not fully unknown. The present view proposed that the hypertrophied adenoids perform as a bacterial pool and restricts the nasal mucociliary clearance. Obstructive adenoids may lead to stasis of nasal secretions with subsequent infection. Aim of the Work:The current work aimed to assess the impact of adenoid enlargement on pediatric chronic maxillary sinusitis [PCMS]. Patients and Methods:This study included 60 Children. The size of adenoid was graded through endoscopic examination. The Clemens grading system was used. Paranasal sinuses were radiologically investigated by computerized axial tomography scan. The radiological and endoscopic data were correlated. Additionally, all adenoid samples were cultivated for bacteriological growth. Result:The highest incidence of adenoid hypertrophy was seen in the age group 3-6 years old [60%], with similar male to female affection rate [1:1]. The positive computed tomography [CT] scan findings among children with hypertrophied adenoid were [55%]. The highest incidence of positive CT findings was found in grade-III adenoids, which is the highest grade of size [33.3%]. Adenoidectomy was performed for all patients and specimens were examined for bacteriological growth. 20% of adenoid tissue had multiple growth and 80.0% showed single organism. The frequency of isolated organism were H. Influenzae, S. Pneumoniae, S. Pyogenes, S. Aureus and Methicillin Resistant Staphylococcus Aureus. Conclusion: The endoscopically graded adenoid hypertrophy is significantly correlated to positive CT scan signs of rhinosinusitis in children. Isolation of bacteria from adenoid tissue supports the inflammatory mechanism of adenoid in pathogenesis of rhinosinutis in addition to its obstructive action. Early initiation of empirical antibiotic therapy is crucial and adenoidectomy provides a cure for adenoid hypertrophy and rhinosinusitis.

Effect of Rapid Maxillary Expansion on Upper Airway Morphology: A Retrospective Comparison of Normal Patients versus Patients with Enlarged Adenoid Tissue.

Objectives The present study evaluated the effect of rapid maxillary expansion (RME) on the morphology of the upper airway (UA) by calculating cross-sectional areas and volumes and comparing the effect in patients with a normal-sized adenoid with the effect in patients with an enlarged adenoid. Study design: Seventeen patients met the inclusion criteria. We constructed 3D models of the UA on cone-beam computed tomography images to calculate cross-sectional areas and volumes at the levels of the nasopharyngeal, retropalatal, and retroglossal airways. Patients were divided into two groups: group 1 was comprised of patients with an adenoidal nasopharyngeal (AN) ratio < 0.6 and group 2 with an AN ratio ≥ 0.6. Paired samples t-tests assessed any area and volumetric changes of the UA after RME. Changes in degree of nasal obstruction, calculated as the AN ratio, was then compared for the two groups. An independent samples t-test compared volumetric changes in the nasopharynx between the two groups before and after RME. Results Changes in cross-sectional areas and volumes of the UA due to RME were not significant. The effects of RME on AN ratio (11 % vs 0 %) and nasopharyngeal volume (36.8 % vs 5.97%) were somewhat larger in group 2 patients who had adenoid-associated nasal obstruction compared with group 1 patients with a normal-sized adenoid; however, the differences were not significant. Conclusions After RME, the patients with an enlarged adenoid had more increases in nasopharyngeal volume compared with those with normal adenoid, despite there was no significant difference.