Tonsil Hypertrophy Research Articles

Photobiomodulation for Lowering Pain after Tonsillectomy: Low Efficacy and a Possible Unexpected Adverse Effect.

Background: Tonsillectomy is one of the most common surgical procedures performed in children as a treatment for obstructive sleep apnea due to tonsil hypertrophy or highly recurrent tonsillitis. Odynophagia, associated with food refusal for the first few days, is a common post-operative complaint. Available drugs for pain management, while efficacious, present some drawbacks, and a novel strategy would be welcome. Photobiomodulation (PBMT), in this context, can represent a possible choice, together with pharmacological therapy. The aim of this study was to evaluate PBMT effects compared to standard pain therapy on nociceptive sensation at different time points and administration of painkiller. Methods: A registered, controlled, randomized, double-blind clinical trial was performed. Twenty-two patients were recruited and divided into laser-treated (T) or untreated (UT) groups, based on random assignment. In T group, immediately after tonsillectomy, performed with cold dissection technique, laser light was applied to the surgery site (using a Cube 4 from Eltech K-Laser s.r.l., Treviso, Italy), and then hemostasis was performed using bismuth subgallate paste. In C group, the same procedure was performed, except that laser light was switched off. The primary outcome was the difference in pain scores between subject receiving photobiomodulation (PBMT) and subjects receiving standard care after 24 h; the secondary outcomes were pain scores at awakening and at 48 h together with distress (delirium) at awakening. Results: Two patients from the T group experienced a post-surgery bleeding, and one of them required revision of the hemostasis under general anesthesia. A preliminary analysis of pain sensation reported by the patients or caregivers did not show differences between treated and untreated subjects. Conclusion: These data suggest that PBMT could increase post-surgical bleeding.

Adenoid and Tonsil Hypertrophy in Zaria, North Western Nigeria: Review of Clinical Presentation and Surgical Outcome.

Background:Adenotonsillar hypertrophy is one of the most common childhood disorder that necessitates presentation to the ear nose and throat specialist. The disorder may be managed conservatively or by surgery.Aim:To highlight the clinical presentation and surgical treatment outcome of patients managed for adenoid and tonsillar hypertrophy at Ahmadu Bello University Teaching Hospital Zaria, Nigeria.Materials and Methods:The case records of patients managed for adenoid and tonsil hypertrophy were reviewed from January 2013 to December 2017 at the Division of Otorhinolaryngology, Department of Surgery Ahmadu Bello University Teaching hospital Zaria, - Northwestern Nigeria. Case notes with incomplete information and /or missing pages were excluded. The data were analyzed using IBM SPSS (for windows, version 23)Results:There were 56 (55.4%) males and 45 (44.6%) females with male to female ratio of 1.2:1. Their ages ranged from 2–16 years with a mean and standard deviation of 4.0 and 3.2 respectively. The most common symptom at presentation was snoring 85 (84.2%) followed by rhinorrhea 81(80.2%). Findings from the radiologic investigations revealed that majority of the patients had severely narrowed nasopharyngeal air column 83(82,2%) Adenotonsillectomy was the most common surgery performed on most of the patients 63(62.4%) who presented with adenotonsillar hypertrophy. Majority of the patients 95(94.1%) had resolution of symptoms within the period of follow up. Four (4.0%) of them had recurrent adenoidal growth.Conclusion:Snoring, rhinorrhea and mouth breathing were the most common symptoms of adenotonsillar hypertrophy. The outcome of adenotonsillar surgeries in our patients is good, with the majority having resolution of symptoms.

Микробиоценоз глоточной и небных миндалин при хронической воспалительной патологии глотки у детей

Chronic tonsillitis and adenoiditis in children is one of the unsolved problems in otorhinolaryngology. There are no specific pathogens of chronic adenotonsillitis, but there are still disputes about the viral, bacterial and fungal etiology of this disease. Chronic tonsillitis is a persistent chronic inflammation of the palatine tonsils, characterized in the vast majority of patients by recurrent exacerbations in the form of sore throats and a general toxic-allergic reaction, which is a frequently realized etiological factor of many local and general diseases and a catalyst for pathological processes in the body. Adenoid vegetations are pathological hypertrophy of the pharyngeal tonsil. Chronic adenoiditis is a chronic polyethological disease, which is based on a violation of the physiological immune processes of the pharyngeal tonsil. In children, it is impossible to talk about isolated inflammation of the pharyngeal tonsil, since as a result of exposure to antigens, an immune response occurs that involves all structures of the lymphoepithelial pharyngeal ring in the process, therefore some researchers use the term “adenotonsillitis”. With a pronounced violation of the microflora in the nasopharynx and oropharynx, the body's resistance to pathogenic microorganisms decreases, as a result, decay products and toxins lead to damage to the vascular endothelium, disrupt their permeability and, penetrating through the epithelial barrier, contribute to the development of chronic intoxication and sensitization of the body.

ANTIBODIES TO MICROBIAL ANTIGENS AND CYTOKINES IN THE CELLS OF THE PALATINE TONSILS AND SERUM OF CHILDREN WITH PALATINE TONSILS HYPERTROPHY AND CHRONIC TONSILLITIS

The aim: The aim of the study is to compare the class G antibody content in serum and tissue lysate from tonsils of children with hypertrophy and chronic tonsillitis to: streptolysin–O of Str. haemolyticus, protein–A of S. aureus, proteoglycans of Klebsiela spp., as well as to compare the content of interleukins 1β, 10, TNF-α, γ-IFN and lactoferrin in serum and tissue lysate from tonsils of children with hypertrophy and chronic tonsillitis. Materials and methods: We studied tonsils of 33 children aged 4-18 years with hypertrophy of palatine tonsils (HPT) and with chronic tonsillitis (CT). The content of interleukins 1β, 10, TNF-α, γ-IFN and lactoferrin in tonsil lysate and serum was determined by immunofluorescence assay. Antistreptolysin O was studied by neutralization test of micromethod; class G antibodies to protein A of S. aureus and proteoglycans of Klebsiela spp. were studied by treponema pallidum hemagglutination assay. All the results were statistically processed using U-test (Mann–Whitney–Wilcoxon test) and Fisher’s z-transformation. Results: The serum and tissue lysate from tonsils of patients with HPT showed significantly high level of antibodies to streptolysin O in comparison with similar studies of substrates from patients with CT. Anti-inflammatory cytokine IL-10 was detected only in the serum of patients with CT. The TNF-α concentration in the lysates of tonsils in the group of patients with HPT was 2 times higher than in the group of patients with CT. The γ-IFN concentration was significantly lower both in the serum and in the lysates of tonsils of patients with CT. The content of lactoferrin in the lysates of patients with CT was 3 times higher (P<0.05) than in the lysates of patients with HPT. Conclusions: The results indicate a significant difference in the state of antibodies to microbial antigens and cytokines production in case of HPT and CT. In tonsils with HPT, there predominate reactions of antibody production to bacterial antigens and antiviral reactions like a high-level cytokines TNF-α and γ-IFN in tissue lysate of palatine tonsils.

THE IMPORTANCE OF ALLERGIC FACTOR IN THE ETIOPATHOGENESIS OF CHRONIC ADENOIDITIS IN CHILDREN

The article presents the features of the course of chronic adenoiditis in children with allergic rhinitis. Allergic diseases of the upper respiratory tract and pathology of the pharyngeal tonsil today remain one of the most common diseases in pediatric practice and their pathogenetic mechanisms are often interrelated. The choice of treatment mode for this group of children is currently being actively discussed. The aim of the study is scientific-literary and practical consideration of the problem of the influence of an allergic factor on the pathogenesis of nasopharyngeal tonsil hypertrophy as a cause of chronic adenoiditis in children. The study examined 30 children with stage 2 adenoid hypertrophy, including 18 boys and 12 girls. A number of authors insist on the need to prioritize conservative management, while more and more evidence is emerging that there may often be indications for surgery. The prevalence of allergic diseases and adenoid vegetations in childhood has determined the relevance of studying the research problem. It is established that adenoids in allergic rhinitis become a kind of shock organ, on the surface of which inhaled allergens are delayed. It has been determined that in allergic rhinitis removal of adenoids has the ability to improve the general condition of the patient and relieve symptoms (including nasal congestion) and reduce the risk of various chronic pathologies (namely chronic otitis), and in obstructive sleep apnea — reduce the risk of suffocation. The algorithm of management of children with pathology of the pharyngeal tonsil in concomitant allergic diseases, where the first stage it is necessary to recommend treatment by an allergist, and only in the ineffectiveness of conservative therapy to perform surgery. It has been shown that most of the studied children (60–70%) with stage II nasopharyngeal tonsil hypertrophy showed allergic rhinitis and elevated levels of anti-inflammatory cytokines, which indicates the relationship of the disease with inflammatory diseases of the nasopharynx and immune system. It is determined that the problems of correct diagnosis of the causes of inflammation and hypertrophy of the nasopharyngeal tonsil and the strategy, tactics and correctness of their treatment deserve scientific attention.

Иммуномодулирующий эффект аденотомии у детей раннего и дошкольного возраста с высокими степенями гипертрофии глоточной миндалины и повторяющимися назофарингитами

It is known that 50% of children with constantly recurrent acute nasopharyngitis have high degrees of hypertrophy of the pharyngeal tonsil (2nd and 3rd degree). Adenoidectomy can remove obstruction of the nose and Eustachian tube. At the same time, it is assumed that the removal of the pharyngeal tonsil will also limit inflammation on the mucous membrane of the nose and pharynx. This effect may be positive both in terms of reducing the frequency of respiratory diseases and in preventing the early manifestation of chronic respiratory diseases. Materials and methods. 101 children were examined, in the age range of 2–6 years, who were in the children’s department of Otolaryngology of the Regional Children’s Clinical Hospital in Kemerovo for adenoidectomy. An objective examination of the ENT organs in the main group was carried out; biological material from the pharyngeal tonsil for PCR tests and DNA markers of viruses, bacteria, and fungi in the pharyngeal bioburden was collected; nasopharyngeal lavages for cytokine testing were collected. Results: Adenoidectomy significantly reduces the incidence of nasopharyngitis in children with high degrees of pharyngeal tonsil hypertrophy. The effect of adenoidectomy is associated with an immunomodulatory effect on the mucosal immunity of the nose and pharynx. After adenoidectomy, the level of topical cytokines that increase inflammation (IL-1b, IL-1Ra) decreases. Adenoidectomy effectively reduces the incidence of nasopharyngitis in infants and preschool children with elevated levels of IL-4 in the nasopharyngeal lavage. Adenoidectomy has a significant biodebridement effect for the nasopharyngeal bioburden through a decrease in the expression of DNA markers of bacteria (pyogenic streptococcus), viruses (Epstein–Barr virus), and fungi (Candida genus). The effect of adenoidectomy in relation to limiting the frequency of nasopharyngitis in children of early and preschool age is reduced with concomitant bronchial asthma and seasonal allergic rhinosinusitis; high concentration in the nasopharyngeal washout of TNF-α, a significant representation of the coccal bioburden according to rhinocytogram data, and increased expression of DNA markers of the Epstein–Barr virus in the cells of the nasopharyngeal mucosa.

Новые возможности терапии экссудативного среднего отита у детей

Anti-inflammatory therapy for otitis media with effusion (OME) in patients with chronic diseases of the Waldeyer's tonsillar ring is a key stage of treatment. Patients and methods. This observational study included 85 patients. Group 1 comprised 50 OME patients with grade I–II pharyngeal tonsil hypertrophy who were further divided into two subgroups: 1A (n = 30) and 1B (n = 20). Group 2 involved 35 OME patients on the second day after adenectomy; they were divided into subgroups 2A (n = 20) and 2B (n = 15). Children in subgroups 1A and 2A received standard OME therapy plus ammonium glycyrrhizinate (AG) for 30 days, whereas children in subgroups 1B and 2B received standard OME therapy alone. Results. Patients from the experimental subgroups (1A and 2A) who received AG demonstrated significantly lower VAS scores of both auditory symptoms (hearing loss and congestion/noise in the ear) and initial manifestations (rhinorrhea and nasal congestion) already by first follow-up visits compared to controls (subgroups 1B and 2B). Maximum differences were observed on day 30: the severity of symptoms in children from group 1A was 2.5 times lower than in children from subgroup 1B; patients from subgroup 2A also demonstrated a 2-fold reduction in symptom severity compared to children from subgroup 2B (p < 0.05). Tympanometry showed that 90% of patients in the experimental subgroups (1A and 2A) had complete restoration of auditory tube function by day 30, while in control subgroups 1B and 2B, the proportion of such patients was significantly lower (55% and 73%, respectively). Audiometry results suggest that complete hearing restoration by day 30 was more frequent in patients receiving AG than in controls (1A and 1B: 94% vs 70%; 2A and 2B: 100% vs 80%). Patients of the experimental subgroups were more satisfied with treatment results. Conclusion. The inclusion of AG into the treatment scheme for OME and auditory tube dysfunction after elective adenectomy increases treatment efficacy by normalizing drainage and ventilation functions of the middle ear, elimination of exudate, and ensuring hearing restoration. Key words: otitis media with effusion, children, auditory tube, Waldeyer's tonsillar ring, hearing loss, impedance audiometry, ammonium glycyrrhizinate

Prospects for the use of bacterial lysates in the complex therapy of chronic adenoiditis

Introduction. Adenotomy is a common surgical procedure in childhood. In children with recurrent infections of the respiratory tract, hypertrophy of the pharyngeal tonsil, a sign of lymphoproliferative syndrome of a secondary immunodeficiency state, is characterized by reduced adaptive abilities of mucosal immunity with impaired biocenosis in chronic inflammation. Pharyngeal tonsil surgery is considered stressful in frequently ill children and therefore requires preoperative preparation. In this context, it is relevant to study the nature of changes in the factors of mucosal immunity in terms of cell destruction in the nasal secretion in the complex treatment of children with hypertrophy of the pharyngeal tonsil and chronic adenoiditis, as prevention of complications in the postoperative period of adenotomy.Aim. To increase the effectiveness of the treatment of chronic adenoiditis in children with recurrent infections of the respiratory tract using the combined effect of low-frequency ultrasonic cavitation with monochromatic unpolarized light and bacterial lysates.Materials and methods. In order to test the hypothesis about the possibility of canceling adenotomy in 77 children aged 3-6 years with hypertrophy of the pharyngeal tonsil, accompanied by chronic inflammation. The effectiveness of the complex treatment was assessed by the functional and metabolic status of nonspecific resistance factors in the nasal lavage.Results and discussion. The combined effect of low-frequency ultrasonic cavitation with photochromotherapy and bacterial lysates leads to the normalization of pathophysiological changes on the surface of the mucous membrane, leading to a balance of the qualitative and quantitative composition of the functional-metabolic status of NG, which makes it possible to postpone adenotomy. The best clinical result is observed when bacterial lysates are used in complex therapy in combination with physiotherapy in children with chronic adenoiditis and, to a certain extent, substantiate the advisability of a combined effect as a non-invasive and effective method.Conclusions. Topical bacteriolysate in a complex treatment regimen for children with recurrent infections of the respiratory tract against a background of chronic inflammation eliminates bacterial antigens and enhances the intrinsic defenses of the mucous membrane of the pharyngeal tonsil.

Etiological aspects of chronic pathology of the lymphepithelial pharyngeal ring in children at the present stage

The lymphoepithelial pharyngeal ring is located in the entrance gate and is constantly exposed to infectious agents. Currently, chronic pathology of the lymphoepithelial pharyngeal ring remains one of the most common problems in the practice of a pediatric doctor. Hypertrophy of the pharyngeal tonsil, chronic adenoiditis, which occurs in 35.3% of children under the age of 7 years, and chronic tonsillitis, which occurs in 15-63% of cases, are among the most common diseases of childhood. Taking into account the wide range of infectious microbiota that contributes to the development of chronic pathology of the lymphoepithelial pharyngeal ring, the issue of differential diagnosis of the etiology of the disease and the selection of adequate treatment regimens remains relevant. In most cases, at the present stage, the approach to the treatment of patients with chronic inflammation of the lymphoid ring of the pharynx in children is reduced to replacing the surgical method with a conservative one with the appointment of immunocorrective and immunomodulatory drugs. The lack of a positive effect of the ongoing conservative treatment, clinical and laboratory signs of persistent streptococcal infection say us about the need for surgical treatment. At the same time, a group of frequently ill children requires special attention with the development of new regimens of the immunocorrecting and immunomodulating drugs usage.

Photobiomodulation for pediatric hypertrophic tonsils: a clinical case report

Photobiomodulation for pediatric hypertrophic tonsils: a clinical case report

Haematologic Markers and Tonsil-to-Body Weight Ratio to Assist Adenotonsillar Hypertrophy Diagnosis.

Aims Diagnosis of Adenotonsillar Hypertrophy (ATH), the leading cause of pediatric Obstructive Sleep Apnea (OSA), depends on physical exam via Brodsky's staging of tonsils. This study investigates the associations of ATH with patient parameters, and balances in-office tonsil hypertrophy appraisal against true organ mass. Materials and Methods A prospective cohort was formed of 103 children operated for ATH, and 31 matched controls. Demographic, clinical and tympanographic data, as well as Complete Blood Count (CBC) indices were compared. Absolute and relative to total body weight tonsil specimen mass were correlated with Brodsky's score. Results Tonsillar size indices were significantly raised in ATH patients. Elevated leukocytes (P = 0.012) and increased neutrophil percentage (P = 0.025) conveyed higher ATH risk. Subjective evaluation of tonsils graded 1 or 2 correlated significantly with absolute (P = 0.001) and relative (P = 0.006) objective measurements. Brodsky's score 3 and 4 displayed marginal significant association with relative (P = 0.050) but not with true (P = 0.989) mass. Conclusion An occult hematologic inflammatory response was detected in ATH children. Clinical estimation of severely hypertrophic tonsils should be adjusted for total body weight. Trial Registration Number: NCT03541434 (clinicaltrials.gov).

One-Stage Multilevel Surgery for Treatment of Obstructive Sleep Apnea Syndrome.

We report the results of one-stage multilevel upper airway surgery for patients who could not tolerate continuous positive airway pressure (CPAP). Patients treated with multilevel surgery at a University Hospital in 2015–2019 were identified from a prospectively maintained database. The inclusion criteria were aged 18–70 years, body mass index (BMI) < 35 kg/m2, apnea–hypopnea index (AHI) > 20, and lingual tonsil hypertrophy grade 3 or 4. Drug-induced sleep endoscopy was performed before surgery in all patients. Multilevel surgery was performed in one stage and included expansion sphincter pharyngoplasty (ESP), coblation tongue base reduction (CTBR), and partial epiglottectomy (PE) as required. The outcome measures were postoperative AHI, time percentage oxygen saturation < 90%, and Epworth Sleepiness Scale (ESS) score. A total of 24 patients were included: median age 49.1 years, average BMI 27.26 kg/m2, and 90% men. Ten patients received ESP plus CTBR plus PE, eight received ESP plus CTBR, and six received ESP plus PE. The mean preoperative AHI was 33.01 at baseline and improved to 17.7 ± 13 after surgery (p < 0.05). The ESS score decreased from 11 ± 5.11 to 7.9 ± 4.94 (p < 0.05). The surgical success rate according to Sher’s criteria was 82.3%. The median follow-up was 23.3 months (range 12–36). These findings suggest that multilevel surgery is a safe and successful treatment of OSAHS.

Prevalence and associated risk factors of recurrent otitis media with effusion in children in Upper Egypt.

ObjectiveWe conducted this study to determine the associations of possible risk factors and prevalence of recurrent otitis media with effusion (OME) in a cohort of children in Upper Egypt.MethodsThis was a cross-sectional study undertaken in two tertiary referral centers in Upper Egypt. Associations of possible risk factors with prevalence of recurrent OME were studied. Multi-factor logistic regression analysis was done to recognize the statistically significant risk factors associated with recurrent OME.ResultsWe collected the data of 2003 pediatric patients, of which 1016 were males (50.7%). A total number of 310 children have OME, including 159 males (51.3%). The prevalence rate of OME in our cohort was 15.5%. Multi-factor logistic regression analysis of the risk factors related to recurrent OME showed it was strongly associated with adenoid hypertrophy (P < 0.0001), tonsil hypertrophy (P < 0.0001), sinusitis (P < 0.0001), posterior nostril polyps (P = 0.009), allergic rhinitis (P < 0.0001), recurrent URTIs (P = 0.029) and gastroesophageal reflux (P = 0.031).ConclusionsOur study showed that recurrent OME in children in Upper Egypt is a common multifactorial problem, especially in young age. In our locality, allergic rhinitis, recurrent upper respiratory tract infections, gastroesophageal reflux, adenoid and tonsil hypertrophy were the most important associated factors related to the etiopathogenesis of OME.

Lymphoepithelial Carcinoma of the Palatine Tonsil

Abstract Lymphoepithelial carcinoma is an undifferentiated carcinoma with nonneoplastic lymphoplasmacytic infiltrate, mostly located in the nasopharynx, while it is extremely rare in the oropharynx. We present a rare case of lymphoepithelial carcinoma arising from palatine tonsil. A 81-year old male patient complained of dysphagia, hypersalivation and bloody sputum. Clinical examination revealed hypertrophy of the right palatine tonsil and ipsilateral cervical lymphadenopathy. Biopsy and histopathological analysis confirmed the diagnosis of lymphoepithelial carcinoma. Multi-slice computed tomography showed a 33x31x38 mm heterodense mass in the region of the right palatine tonsil, and 37x30 mm and 21x20 mm lymph nodes on the right side of the neck. The patient was reffered to an oncology council, which suggested radiotherapy and concurrent chemotherapy. Although rare in clinical practice, lymphoepithelial carcinoma should be considered in cases of tonsil cancer.

Ефективність алергенспецифічної імунотерапії пилковими алергенами в дітей із позиції молекулярної алергології

Мета роботи — встановити можливі причини неефективності алергенспецифічної імунотерапії (АСІТ) пилковими алергенами (бур’янів) у дітей із сезонним алергічним ринітом і/або бронхіальною астмою на підставі вивчення гіперчутливості до алергенів, аналізу анамнестичних даних. Матеріали та методи. Проведено алерготестування 192 дітей. 52 пацієнтам проведене анамнестичне опитування з акцентом на перехресну алергію та супутню патологію верхніх дихальних шляхів, а також на ефективність АСІТ. Статистична обробка результатів проведена в програмі Statistica for Windows 6.0. Результати. Серед хворих на поліноз переважала гіперчутливість до амброзії (56 %), циклахени (46 %) та соняшника (58 %). До злакових рослин (райграс, грястиця, вівсяниця) чутливі 10—20 % пацієнтів. 23 % дітей мають сенсибілізацію до 5 та більше алергенів (в середньому до 3,3 ± 0,4). 52 % дітей мають супутню харчову алергію, 15 % — синдром оральної алергії, третина дітей — аденоїдні вегетації, гіпертрофію глоткових мигдалин, у 13 % алергічний риніт ускладнювався синуситом. Незадовільний клінічний ефект АСІТ пилковими алергенами асоціювався з наявністю поєднаної пилково-грибкової сенсибілізації, перехресної харчової та пилкової алергії, із сенсибілізацією до 4 та більше пилкових алергенів, з полівалентною алергією, а також спостерігався при поєднанні алергічного риніту із синуситом (р &lt; 0,05). Висновки. Перед початком АСІТ дітям із полінозами необхідно визначити групу ризику стосовно можливої неефективності цього методу терапії та рекомендувати їм визначення специфічних імуноглобулінів класу Е до мажорних та мінорних алергенів для прогнозування ефективності АСІТ.

Assessment of event-related evoked potentials and China-Wechsler intelligence scale for cognitive dysfunction in children with obstructive sleep apnea

ObjectiveTo explore the relationship between obstructive sleep apnea (OSA) and cognitive impairment by combining event-related evoked potentials (ERPs) and China-Wechsler Younger Children Scale (C-WISC) in children with sleep-disordered breathing (SDB) with vs. without OSA. MethodsThis was a retrospective case-control study of all consecutive children (n = 148) with adenoid tonsil hypertrophy between July 2017 and March 2019 at the Hospital. ResultsThe children were divided into the OSA (n = 102) and non-OSA (n = 46) groups. The apnea-hypopnea index (AHI), obstructive apnea index (OAI), and obstructive apnea-hypopnea index (OAHI) in the OSA group were elevated compared with those of the non-OSA group (all P < 0.001). The mean oxygen saturation (SaO2) and SaO2 nadir were lower in the OSA group compared with the non-OSA group (both P < 0.001). The respiratory arousal index (RAI) values in the OSA group were larger than those of the non-OSA group (P < 0.001). The P300 and N100 latencies in the OSA group were longer than those of the non-OSA group (both P < 0.001). Pearson's correlation analysis revealed correlations of the P300 peak latency with full-scale intelligence quotient (FIQ) (P < 0.001 and r = −0.527), verbal intelligence quotient (VIQ) (P < 0.001 and r = −0.448), and performance intelligence quotient (PIQ) (P < 0.001 and r = −0.515). There was a correlation between the N100 peak latency and PIQ (P = 0.026 and r = −0.183). ConclusionERPs, as an objective measurement, might help assess cognitive impairment in children with OSA.

Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020).

Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020).

The relationship between adenoid and tonsil hypertrophy and asthma in children and analysis of changes in asthma after adenotonsillectomy

Adenoid and tonsil hypertrophy in children are closely related to asthma. Their pathogenesis and clinical symptoms are interacted on each other. The unified airway theory believes that the upper and lower respiratory tracts are connected through the release of systemic inflammatory factors. Studies have shown that adenoid and tonsillectomy surgery have a positive effect on the control and development of asthma. The symptoms of postoperative asthma, frequency of attacks, control medication and asthma severity related indicators in children were significantly reduced compared with those before surgery. It has been shown that asthma can increase the incidence of respiratory complications after adenoidectomy and tonsillectomy, so postoperative care after adenotonsillectomy is also important to control asthma. Understanding the relationship between diseases can help clinicians make a more comprehensive diagnosis and treatment.

The treatment progress of obstructive sleep apnea in children

Obstructive sleep apnea（OSA） is a common disease in otolaryngology in children, and its incidence rate is increasing gradually, which seriously endangers children's growth and development, behavior cognition and so on. There are many etiologies of OSA in children. Besides tonsil hypertrophy and/or adenoid hypertrophy, the most common one, there are many different levels of airway obstruction caused by inflammation, dysplasia, obesity and other reasons. Different individualized treatment plan should be taken according to different etiology. This paper summarizes the different treatment methods of children OSA.

Prevention measures of postoperative hemorrhage in children day surgery of tonsils and adenoids

Objective:To investigate the effect of preventive measures in reducing postoperative bleeding, which is made for children day surgery on tonsils and adenoids in our hospital, and to clarify its safety and feasibility. Methods:A retrospective analysis of 649 patients with children day surgery due to obstructive sleep apnea（OSA） caused by adenoid hypertrophy of tonsil was conducted. All of the patients were admitted to Shanghai Children's Hospital from February 2021 to April 2021. According to whether preventive measures were taken or not, they were divided into the control group and the observation group. The postoperative bleeding rate, bleeding time, and bleeding-related factors of the two groups were compared. Results:There were 4 cases（1.22%） in the observation group and 12 cases（3.74%） in the control group, the postoperative bleeding rate of the observation group was lower than that of the control group（χ²=4.28, P=0.039）. The postoperative bleeding in the observation group occurred（8.25±2.75） days after surgery while the control group（7.42±1.98） days, which shows no significant difference in postoperative bleeding time between the two groups（χ²=2.601, P=0.321）. There was no case of postoperative infection in the observation group while 7 cases（58.3%） in the control group（χ²=7.658, P=0.036）. Conclusion:For children with day surgery of tonsils and adenoids, appropriate optimization measures can be taken for hospital admission evaluation, infection prevention, postoperative observation, publicity and education, which can effectively reduce the incidence of postoperative complications and improve the treatment effect of day surgery.