Hypertrophy Of Palatine Tonsils Research Articles

Laryngopharyngeal Reflux Scoring in a Pediatric Population

In recent years, the prevalence of laryngopharyngeal reflux has risen, especially among pediatric patients. The diagnosis of laryngopharyngeal reflux relies on patient history and clinical assessment using the Reflux Finding Score and Reflux Symptom Index as crucial diagnostic tools. Some studies have proposed a link between pepsin and laryngopharyngeal reflux, potentially triggering palatine tonsil hypertrophy. Our study aimed to investigate the correlation between laryngeal and pharyngeal manifestations of laryngopharyngeal reflux through two questionnaires and the presence of pepsin in saliva and palatine tonsils in a pediatric population. Pepsin in saliva was detected using a Western blot method, while immunohistochemistry assessed its presence in palatine tonsils. Although no statistically significant differences in Reflux Finding Score and Reflux Symptom Index were found between the immunohistochemistry-positive (IHC-positive) and immunohistochemistry-negative (IHC-negative) groups, median reflux symptom index and Reflux Finding Score values consistently trended higher in the IHC-positive group. This suggests a potential connection between elevated index values and pepsin presence in tonsillar tissue. Further investigations are essential to fully comprehend the clinical implications of these findings.

Incompetent lip seal and nail biting as risk factors for malocclusion in Japanese preschool children aged 3–6 years

BackgroundMalocclusion is a multifactorial condition associated with genetic and environmental factors. The purpose of this study was to investigate the prevalence of occlusal traits, oral habits, and nose and throat conditions by age and to assess the association between malocclusion and its environmental factors in Japanese preschool children.MethodsA total of 503 Japanese children (258 boys and 245 girls aged 3–6 years) were recruited. Occlusal traits were assessed visually to record sagittal, vertical, and transverse malocclusion, and space discrepancies. Lip seal was recorded by an examiner, and oral habits (finger sucking, lip sucking or lip biting, nail biting, chin resting on a hand) and nose and throat conditions (tendency for nasal obstruction, allergic rhinitis, palatine tonsil hypertrophy) were assessed by a questionnaire completed by the parents. The prevalence of each item was calculated, and binary logistic regression was used to examine the factors related to malocclusion.Results62.0% of preschool children in the present study exhibited malocclusion, and 27.8% exhibited incompetent lip seal. Nail biting was the most frequent oral habit with a prevalence of 18.9%. Nasal obstruction was recorded in 30.4% of children. The results of binary logistic regression showed that incompetent lip seal was significantly related to malocclusion, and that nail biting was significantly negatively related.ConclusionsIncompetent lip seal is significantly associated with malocclusion, but nail biting may not necessarily be a deleterious habit for the occlusion in Japanese preschool children.

Features of innate immunity in children with hypertrophy of the palatine tonsils

Hypertrophy of pharyngeal lymphoid tissue is among the most common problems in pediatric otorhinolaryngology, in particular, hypertrophy of the palatine tonsils. This disorder is characterized by increased size of a single or both palatine tonsils combined with various clinical symptoms. The principles of treatment in children with this pathology remain debatable, since the long-term effects of bilateral tonsillotomy are still not fully understood. The aim of the study was to assess the expression levels of genes encoding the innate immunity molecules (TLR4, HBD1, HBD2, IL1β) in the mucous membranes of palatine tonsils in children with palatine tonsillitis before and after treatment.We conducted a study of 78 patients divided into three independent groups. The 1st group (comparison) included 20 somatically healthy children. The 2nd group included 28 children with grade 2 palatine tonsil hypertrophy who underwent local treatment. The 3rd group included 30 children with grade 3 hypertrophy of the palatine tonsils, who, by clinical indications, underwent bilateral tonsillotomy. Determination and evaluation of innate immunity indices was carried out both before starting the treatment, and one month later, using the real-time PCR method.In children with hypertrophy of palatine tonsils, the initial values of TLR4 gene expression and antimicrobial peptides differed from those of healthy children. A decreased expression of HBD1 and HBD2 genes, which provide immediate protection against pathogens, was revealed. The values of TLR4 gene expression differed in groups of children with varying degrees of palatine tonsillar hypertrophy. In patients with bilateral tonsillotomy, an increased expression of TLR4 gene and a decreased expression of antimicrobial peptide genes (HBD1, HBD2) were revealed, which may indicate a readiness for development of tonsillar inflammation in response to pathogens. One month after surgical treatment, the indices of innate immunity were comparable with those of healthy children thus confirming the validity of surgical treatment. In the 2nd group of patients, the TLR4 gene expression one month after conservative treatment remained reduced, the expression of β-defensin HBD1 gene increased and exceeded the indicators of the group of healthy children, the expression level of the IL-1β gene was reduced.The revealed imbalance between the TLR4, HBD1 and HBD2 expression levels confirms an important role of innate immunity mechanisms in pathogenesis of palatine tonsillitis. The assessment of innate immunity indices may be used as an additional criterion in administration of therapy for hypertrophy of palatine tonsils and evaluation of its efficiency.

Effect of palatine tonsil hypertrophy on tongue posture and maxillofacial dentition: A pharyngeal airway computational fluid dynamics study

This study aimed to clarify the effect of palatine tonsil hypertrophy-induced ventilation obstruction on maxillofacial dentition morphology using computational fluid dynamics (CFD) to represent tongue posture and maxillofacial dentition three dimensionally. We analyzed data of 20 patients with tonsil hypertrophy (tonsil hypertrophy group (TG); 9.0 years old, seven boys) and a comparison group (CG) of 20 patients without tonsil hyperplasia (comparison group; 9.4 years old, 10 boys). Cone-beam computed tomography and CFD data were used to assess the effects of palatine tonsil hypertrophy on pharyngeal airway ventilation, tongue posture, and morphology of the maxillofacial dentition. The TG exhibited significantly greater depth, narrower width, smaller cross-sectional area of the pharyngeal airway, and narrower maxillary dental arch with Class II than the CG. Additionally, the tongue was positioned significantly more anteriorly and inferiorly in the TG than that in the CG. Our data suggest that hypertrophy of the palatine tonsils narrows the pharyngeal airway, resulting in a smaller cross-sectional area. Widening of the pharyngeal airway may occur due to compensatory anterior displacement of the tongue to prevent ventilation obstruction. This may decrease palatal support, disturbing the pressure balance of the maxillary molar region between the buccal and palatal sides and resulting in lateral undergrowth of the maxillary bone and narrowing of the maxillary dental arch.

Перспективы использования иммуностимулирующих средств с неспецифической противовирусной активностью в комплексном лечении детей с хроническим аденоидитом

The article presents the results of studies on using inosine pranobex in children with pharyngeal tonsils hypertrophy of the 3rd degree after surgical intervention to prevent the development of pharyngeal tonsillitis relapses and compensatory hypertrophy of palatine tonsils in the postoperative period. 355 children aged 3 to 7 years old with a diagnosis of pharyngeal tonsil hypertrophy of the 3rd degree were examined. Laboratory methods of examination included qualitative studies to detect DNA of lymphotropic herpesviruses (EBV, CMV, HHV-6) in flushes from the nasopharyngeal mucosa. As a result of the conducted research, it was revealed that the inclusion of inosine pranobex in the complex treatment of children with chronic adenoiditis with verified herpesvirus infection is clinically effective and helps to reduce the risk of recurrence of pharyngeal tonsil hypertrophy and compensatory palatine tonsil hypertrophy.

Efficacy of the extract of marshmallow root, chamomile flowers, horsetail herb, walnut leaves, yarrow herb, oak bark, and dandelion herb in preschool children with pharyngeal and/or palatine tonsil disorders and frequent recurrent respiratory infections

Background. Acute upper respiratory tract infections (AURTIs) are common in children and can become recurrent, especially in patients with pharyngeal and/or palatine tonsil disorders.
 Aim. To evaluate the efficacy and safety of the herbal medicine of marshmallow root, chamomile flowers, horsetail herb, walnut leaves, yarrow herb, oak bark and dandelion herb (Tonsilgon N) in preschool children with adenotonsillar disorders.
 Materials and methods. The study included 1876 children aged 2 to 5 years with a history of pharyngeal and/or palatine tonsil disorders and frequent recurrent respiratory infections. The subjects were randomized into two groups: Group 1 (n=940) received herbal medicine (10 drops 56 times daily) for 30 days, and Group 2 (n=936) received no additional medication. Efficacy and safety were evaluated after the therapy course and during the follow-up (3, 6, and 12 months after the treatment started). The assessment included nasopharyngeal endoscopy, cytological examination of nasal mucosa smears, measurement of soluble immunoglobulin A (sIgA) levels and lysozyme activity in nasal secretion.
 Results. After a course of therapy, a significant decrease in the incidence of AURTIs (p0.05), associated with a local immunity improvement, estimated by sIgA levels and lysozyme activity (p0.001 for both values versus the control group), was noted. By the end of the study, in 86.5% of patients of Group 1, the pharyngeal tonsil volume decreased from grade 2 to grade 1 of hypertrophy (p=0.000). The pharyngeal and palatine tonsil hypertrophy worsened in 83.6% of Group 2 patients.
 Conclusion. The study results showed that Tonsilgon N significantly reduced the incidence of AURTIs in children with pharyngeal and/or palatine tonsil disorders and frequent recurrent respiratory infections. This effect was associated with an increase in sIgA and lysozyme levels in the nasal secretion and a decrease in neutrophil counts, indicating an improvement in local immunity.

Clinical and histopathological correlation in patients with chronic tonsillitis

<p class="abstract"><strong>Background:</strong> Chronic tonsillitis is diagnosed when an individual has 7 episodes of tonsillitis in 1 year, 5 episodes in 2 consecutive years, or 3 episodes each year for 3 years consecutively. There is correlation of clinical and histopathological findings in patients with chronic tonsillitis.</p><p class="abstract"><strong>Methods:</strong> It is prospective study which is aimed at correlation of clinical and histopathological findings in chronic tonsillitis patients underwent tonsillectomy. This was carried out in tertiary care hospital, Pune, Maharashtra, India. In our study, 25 patients of chronic tonsillitis underwent tonsillectomy were included. In this we have examined the histopathology of tonsillar tissue section in correlation with the clinical manifestations of tonsillar diseases that were due to infection. </p><p class="abstract"><strong>Results:</strong> In pathological examination of palatine tonsil, underlying subepithelial tissue showed many lymphoid follicles with prominent germinal centres comprising of centrocytes, centroblasts, immunoblasts, small and large lymphocytes in 19 patients (76%). 13 patients (52%) showed prominent germinal centres with bites of salivary gland and muscle tissue. 6 patients (24%) showed prominent germinal centre with mild lymphoplasmocytic inflammatory cell infiltrate. In 4 patients (16%), tissue lined by stratified squamous epithelium showed focal ulceration. 3 patients (12%) showed stratified squamous epithelium with granulation tissue. Crush artifact were noted in 3 patients (12%). 2 patients (8%) had small granules with actinomycotic species colonies within the palatine tonsilar crypts. Only 1 patient (4%) showing keratin impacted in tonsilar tissue.</p><p class="abstract"><strong>Conclusions:</strong> There is strong correlation between histopathological examination suggestive of lymphoid hypertrophy and grading of palatine tonsil hypertrophy.</p>

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.

EFFICACY OF CAPNOMETRY IN PATIENTS WITH RESPIRATORY DYSFUNCTION

Резюме. Згідно з зарубіжними та вітчизняними джерелами розповсюдженість зубощелепних аномалій у дітей віком 6-9 років сягає 63-80 % у різних регіонах [1, 4]. Потужним етіопатогенетичним чинником виникнення патології є порушення носового типу дихання. Причиною виникнення дисфункції дихальних шляхів нерідко є гіпертрофія піднебінних та глоткових мигдалин чи респіраторні алергози. Перехід від нормального типу дихання до змішаного чи ротового призводить до зміни міодинамічної рівноваги та провокує формування патології прикусу; за наявності інших функціональних порушень відхилення лише посилюються та поглиблюються [2, 11].
 Метою дослідження є своєчасне та більш детальне вивчення дихальної дисфункції у пацієнтів віком 6-9 років, створення комплексного плану лікування, зменшення термінів лікування, забезпечення більш стабільного результату.
 Нами було прийнято на лікування 92 дитини віком 6-9 років з дистальним прикусом, пацієнти були розподілені на 2 групи відповідно до проведених методик лікування. В І основну групу увійшли пацієнти, лікування яких проводили за допомогою міофункціональної апаратури; в ІІ – діти, яких лікували за допомогою механічно діючої апаратури.
 Кожному пацієнту було проведено стандартну ортодонтичну діагностику: збір анамнезу, фотопротокол, виготовлення КДМ, ортопантомограму та запропонований нами метод обстеження – капнометрію. Всі дані були зафіксовані та підкріплені до особистої ортодонтичної картки пацієнта.
 У ході дослідження ми проводили оцінку проміжних результатів капнометрії та розширеного фотопротоколу. У результаті, відсоток успішного лікування в групі, де корекцію патології проводили за допомогою запропонованої методики, становив 93,5 %, у групі стандартної методики лікування – 86,2 %.

Correlation between the transverse dimension of the maxilla, upper airway obstructive site, and OSA severity.

Acquiring a better comprehension of obstructive sleep apnea physiopathology can contribute to improving patient selection for surgical treatments. We hypothesize that maxillary transverse deficiency restricts the space available for the tongue, leading to upper airway obstruction during sleep. Our primary hypothesis was that maxillary transverse deficiency increases the prevalence of tongue collapse during drug-induced sleep endoscopy (DISE). The secondary hypothesis was that maxillary transverse deficiency will also increase the prevalence of circumferential collapse at the velopharynx. The exploratory hypothesis was that maxillary transverse deficiency is associated with increased obstructive sleep apnea severity. The objectives of this study were to correlate maxillary morphometric measurements with (1) the anatomic level of obstruction during DISE and (2) the apnea-hypopnea index on polysomnography. We made a cross-sectional analysis of patients with obstructive sleep apnea undergoing DISE in search of positive airway pressure alternative treatment. Maxillary measurements were collected from a computed tomography scan (interpremolar distance, intermolar distance [IMD] and sella-nasion A point angle), findings from DISE, and sleep study variables from polysomnography. Correlation between computed tomography, DISE, and polysomnography data was assessed using Pearson's correlation, and receiver operating characteristic curves were determined for each facial measurement. Sixty-nine patients were included in the study. The group with velopharyngeal circumferential collapse had mean IMD = 26.30 mm (25.5-31.45), and the group with anteroposterior collapse had mean IMD = 29.20 mm (26.8-33.10; P = .040). The group with complete tongue-base obstruction had mean interpremolar distance = 26.40 mm (25.1-28) and IMD = 26.30 mm (25.6-28.4), and the group without obstruction had mean interpremolar distance = 28.7 mm (27.2-30; P = .003) and IMD = 34.06 mm (32.1-37; P < .001). The receiver operating characteristic curve determined an IMD cutoff of 29.8 mm for predicting tongue-base obstruction. The maxillary transverse deficiency, identified by reduction in interpremolar distance and IMD, predicted the occurrence of complete tongue-base obstruction, complete concentric collapse at the velopharynx, and multilevel obstruction during DISE. We did not find an association between the maxillary measurements and obstructive sleep apnea severity. These associations hold some promise in ultimately supplanting insights previously available only through DISE.

Adenoidectomy and adenotonsillotomy in patients treated in the Department of Paediatric Otorhinolaryngology of the Medical University of Warsaw in 2018 – a retrospective analysis

Introduction. Adenoidectomy and adenotonsillotomy are among the most common surgical procedures worldwide. Sleep-related breathing disorders and recurrent upper respiratory tract infections are two primary categories of indications for adenoidectomy and adenotonsillotomy. Aim. The aim of this study was to analyse selected adenoidectomy and adenotonsillotomy procedures performed in the Department of Paediatric Otorhinolaryngology of the Medical University of Warsaw in 2018. Material and methods. A total of 474 patients aged between 11 months and 18 years, who underwent adenoidectomy and adenotonsillotomy in the Department of Paediatric Otorhinolaryngology of the Medical University of Warsaw in 2018, were included in the study. Data on age, gender, length of hospital stay, as well as additional diagnoses in adenoid hypertrophy or adenoid and palatine tonsil hypertrophy were collected. Minor surgeries performed in addition to tonsillectomy were also evaluated. Results. A total of 472 patients underwent adenoidectomy and adenotonsillotomy in 2018. Adenotonsillotomy was almost twice more common. Tonsillar hypertrophy was accompanied by exudative otitis media in almost 1/3 of children, and ear ventilation tubes were needed in almost 1/5 of children. Mean hospital stay equaled 4.19 ± 1.44 days. Conclusions. We have shown that adenotonsillotomy was the most common procedure in the Department of Paediatric Otorhinolaryngology. Exudative otitis media was the most common concomitant diagnosis, and middle ear ventilation was the most common additional procedure. Hospital stay usually lasted 3 days.

Hypertrophy of palatine tonsils - possible treatment approaches

To evaluate the effectiveness of different approaches to the treatment of patients with hypertrophy of the palatine tonsils (HPT). 90 children with HPT of II-III degree and 20 healthy children (group 1) aged from 3 to 7 years were included in the study. Children with HPT were divided into three groups: group 2 - children who underwent tonsillotomy (n=30), group 3 - children who underwent conservative treatment, including only topical use of Polyoxidonium (n=30), group 4 - children who underwent complex treatment (tonsillotomy with subsequent local use of Polyoxidonium), (n=30). The severity of nasal breathing disturbances on a visual analogue scale, the average number of acute respiratory viral infections 6 months before and after treatment, the level of gene expression of antimicrobial peptides before and after treatment, the degree of hypertrophy of the palatine tonsils and spleen with an assessment of the echostructure and determination of the spleen mass coefficient using Ultrasound were evaluated in the study. In children receiving only Polyoxidonium, there was a decrease in the severity of nasal breathing disorders, a decrease in the frequency of acute respiratory viral infections, an increase in the expression of antimicrobial peptide genes compared to the initial level of these indicators. Comprehensive treatment of children with HPT (group 4) showed a significant decrease in the severity of nasal breathing disorders, a decrease in the average number of acute respiratory infections within 6 months, an increase in the expression of antimicrobial peptide genes compared to children who underwent only tonsillotomy (group 2) or only conservative therapy (group 3). It is proved that the use of Polyoxidonium in the complex treatment of HPT is clinically effective and safe.

CYTOKINE AND IMMUNOGLOBULIN SPECTRA OF TISSUE EXTRACTS FROM TONSILS OF CHILDREN WITH HYPERTROPHY AND CHRONIC TONSILLITIS

The aim: To compare the content of α and γ-interferons, interleukins 1β ,4, 10, IgA, IgG, as well as the level of the general forms of immune complexes in tissue extracts from tonsils of children with hypertrophy and chronic tonsillitis. Results: In tissue extracts from tonsils with CT, there is a predominance of inflammation factors, potential sensitization, and the development of immunopathological reactions. The presence of inflammation is indicated by elevated levels of interleukin-1β, immunoglobulin G. High levels of interleukin-4 may indicate that both HPT and CT have a tendency to increase sensitization to microbial and other antigens. Conclusion: The results indicate a significant difference in the qualitative and quantitative state of inflammation factors and allergy in case of HPT and CT. In tonsils with CT, there predominate both simple and allergic inflammations, as well as immunopathological reactions.

Оптимизация лечения гипертрофии органов лимфоглоточного кольца у детей, инфицированных герпесвирусами

The aim of the work is to evaluate the prevalence of herpes virus infection of nasopharynx mucosa in children with hypertrophy of adenoid and palatine tonsils to improve the complex treatment methods. An open continuous prospective analytical study was carried out, which included examination and treatment of 186 patients with chronic adenoiditis. The patients were divided into three groups. The first group included 146 children with a diagnosis of adenoids grade 3 – 90 people; adenoids grade 3, hypertrophy of the tonsils grade 2-3 – 56 people. Endoscopic adeno- or adenotonsillotomy was performed in patients of the first group. Patients of the second group had adenoids grade 1–2 and received conservative treatment. Patients of the third group were children with compensatory hypertrophy of the palatine tonsils and recurrences of adenoids, who had a history of endoscopic anesthetic adenotomy. All patients were examined for the presence of Epstein-Barr and cytomegaloviruses DNA in swabs from the nasopharynx and oropharynx by PCR. The result was positive in 63.3% of patients with pharyngeal tonsil hypertrophy and in 76.8% of patients with pharyngeal and tonsil hypertrophy. The calculation of the odds ratio indicated that the probability of hypertrophy of these tonsils in children infected with herpes viruses is 3.3 times higher (OR 3.3; 95% CI 1.2-9.1) than in uninfected ones. Patients from the first group with a positive test result for herpes viruses, in addition to surgical and basic therapy, received a drug with antiviral and immunomodulatory activity. The results of endoscopic adenotomy and adenotonzillotomy in combination with the administration of etiotropic therapy indicated a high treatment efficiency.

Общность патогенеза хронического тонзиллита и острого аппендицита

For many decades, the problem of chronic tonsillitis still does not lose its relevance. However, some aspects of the etiology and pathogenesis of chronic tonsillitis remain unexplored. This article presents the results of a study of the bacterial flora and structural components of the tissues of the palatine tonsils in chronic decompensated tonsillitis and appendix in patients with acute tonsillitis, as well as a comparison of some indicators of the general clinical analysis of peripheral blood in patients with these types of pathology. Chronic tonsillitis occurred in the history of patients with acute appendicitis in 78% of cases, which is ten times the frequency of its detection in the urban population. In all patients with acute appendicitis, palatine tonsil hypertrophy was detected, mainly of the III degree, as well as the presence of liquid or thick caseous pus in the gaps. In chronic decompensated tonsillitis, an increase in the seeding of the palatine tonsils of Streptococcus pyogenes occurs, and in acute appendicitis, Staphylococcus aureus and Streptococcus pyogenes appear on the background of Escherichia coli. Unidirectional changes in the areas of structural components of palatine tonsils in patients with chronic decompensated tonsillitis and appendix in patients with acute appendicitis were revealed. Based on the data obtained, we can assume the similarities and interconnections of the pathogenesis of chronic decompensated tonsillitis and acute appendicitis.

Comparison Between Radiological Versus Endoscopic Assessment of Adenoid Tissue in Patients of Chronic Adenoiditis.

The adenoids are a common cause for morbidity in pre-school and school going children. Adenoid hypertrophy is common cause of nasal obstruction in pediatric population. The assessment of the size of palatine tonsil hypertrophy is quiet easy to perform, however, measuring the size of nasopharyngeal tonsil and establishing its connection with the given symptoms is more difficult. This is basically due to the location of a tonsil in the nasopharyngeal cavity. Since the cavity is inaccessible directly and cannot be examined visually, many direct and indirect methods of adenoid size evaluation have been developed. The objective of this study is to compare the diagnostic efficacy of both X-ray soft tissue nasopharynx lateral view and nasoendoscopy in evaluation of adenoid size in patients having chronic adenoiditis. Our study included 50 children in age group of 3-14years who had signs and symptoms of adenoiditis clinically. After comparing X-ray and endoscopic findings we found that there was good agreement between X-ray and endoscopic method. Sensitivity of X-ray was 79.41% and specificity of 75% whereas sensitivity of nasoendoscopy was 87.10% and specificity was 63.16%. Nasal endoscopy is good screening method and more accurate method to assess the size of adenoids in patients of chronic adenoiditis.

Relationship between mouth breathing etiology and maximum tongue pressure.

To verify the relationship between maximum tongue pressure and the etiology of oral breathing in oral breathing children attended at the Oral Respiratory Outpatient Clinic. A descriptive and analytical cross-sectional study was accomplished with 59 mouth breathing children aged 3 to 12 years (mean age 6.5 years and SD: standard deviation= 2.4). To collect tongue pressure, the Iowa Oral Performance Instrument (IOPI) was used and data regarding the etiology of oral breathing and dental occlusion were collected in the records of these patients for analysis. The associations between the maximum tongue pressure and the etiology of oral breathing, age, gender and dental occlusion were verified by the T test, ANOVA, Spearman's coefficient and Tuckey's test, using a significance level of 5%. There was a moderate and positive correlation between age and maximum pressure, it was verified that there was a statistically significant difference between the maximum tongue pressure and the variables pharyngeal tonsil hypertrophy and palatine tonsil hypertrophy. There were no statistical differences between the other variables. It was concluded that mechanical obstructions, among them the pharyngeal and palatine tonsil hypertrophy alter the maximum tongue pressure in oral breathing children.

The Value of the Muller maneuver during endoscopic evaluation of OSAS patients

The Muller maneuver is a forced inspiration with both the nose pinched and mouth closed, after a forced expiration, so as to simulate the colapse of pharyngeal walls, similar to what happens at night during deep sleep (atonia of the pharyngeal muscles during REM sleep). When diagnosing patients with obstructive sleep apnea syndrome (OSAS) the nasofibroscopy-assisted Muller maneuver (NMM) is indispensable to identifying the site of obstruction[1] and thus properly establishing the surgical indication [2]. This patient was overweight (BMI of 29.4) and had documented severe OSAS with 4 channel ambulatory polygraphy and the apnea-hypopnea index (AHI) of 83.7 events\hour. Objective E.N.T. assessment shown Mallampati 3 with moderate-severe (Brodsky 3+) palatine tonsil hypertrophy. The images show (clockwise) the initial aspect ("helicopter view") of the oropharynx as seen from the rhinopharynx, the beginning of the Muller maneuver and the total closure of the oropharynx during the maneuver. Thus the patient was classified in the Fujita I class of OSAS, and was later operated, by way of tonsillectomy and modified uvulo-palatal-pharyngoplasty (UPPP) with expansion-sphincter construction. The NMM is a easy-to-use technique that provides valuable information in patients with OSAS and thus help establish the proper surgical indication.

Otolaryngological features in a cohort of patients affected with 22q11.2 deletion syndrome: A monocentric survey.

Otorhinolaryngologic manifestations are common in 22q11.2 deletion syndrome (22q11.2DS), but poorly described. This study aimed to better define the ear-nose-throat (ENT) phenotype of 22q11.2DS patients, in the attempt to best detect subjects requiring subspecialist intervention. We enrolled 25 patients affected with 22q11.2DS. Anatomic and functional ENT findings were investigated using clinical, laboratory, and instrumental data. Immunophenotype and frequency of infections were evaluated. Univariate and multivariate analyses were performed. ENT anomalies were found in 88% of patients, and in 20% congenital palate defects required surgery. Adenoid or palatine tonsil hypertrophy was noted in 80% and 48%. Forty-eight percent of subjects had rhinolalia/phonia, severe in half of these. We also found nasal regurgitation or laryngeal penetration/aspiration in 20% and 16%, respectively. Instrumental exams revealed a mild conductive hearing loss in 32% (bilateral in most cases), tympanometric anomalies in 28%, and swallowing abnormalities in 16%. Statistical univariate analysis showed a direct association between rhinolalia/phonia and episodes of laryngeal aspiration (p = .016) and between tympanometric anomalies and increased adenoid volume (p = .044). No association between episodes of food aspiration and palatal anomalies was found. Moreover, no statistically significant association was observed between the number of airway infections and the ENT findings. This study contributes to better define the ENT phenotype in patients with 22q11.2DS, helpful to prevent potential complications. Furthermore, the identification of a subcategory of patients may allow the early adoption of specific speech therapy programs to improve the clinical outcome of 22q11.2DS patients.

Morphofunctional Characteristics of Palatine Tonsils in Children by the Results of Tonsillotomy

The aim was to study the morphofunctional features of palatine tonsils of children aged 2-14 years with hypertrophy of palatine tonsils of 2 nd and 3 rd degree. Material and methods . The palatine tonsils obtained after tonsilotomy in 34 children aged 2-14 years with hypertrophy of palatine tonsils of 2nd and 3rd degree served as a subject of the study. The material was examined using histological, histochemical and morphometric methods. Results . Lymphoid tissue in the examined tonsils is represented by both lymphoid nodules (follicles) and diffusely located lymphoid tissue. In tonsils, the presence of a marked inflammatory process in most of the children examined, despite the absence of a history of angina. Against the background of moderate edema in the vessels of the microcirculatory bed, the stasis of the formed blood elements, focal destruction of the capillary wall, the release of the formed elements of blood into the surrounding connective tissue were noted. All children showed marked lymphoid infiltration of the epithelium and connective tissue, focal destruction of the epithelial layer in the crypts and on the surface of the tonsils. Destructive changes in epithelial cells were mainly manifested in the form of vacuolization of the cytoplasm of epitheliocytes and karyorexis. Among the leukocytes, lymphocytes predominated, in addition to them, plasmocytes, single macrophages, mast cells, and neutrophils were detected. The height of the epithelial layer on the surface and in the crypts increased with increasing age of the children. Thus, in the crypt region, the height of the epithelium in children aged 3 years was 32-37 μm and in children 13 to 14 years, 60 to 70 μm. The proportion of interfollicular connective tissue increased insignificantly with increasing age of children. In children 2-8 years old, hyperplasia of lymphoid tissue was accompanied by an increase in the number and size of lymphoid follicles. Later, the size of follicles decreased with increasing age of children. A significant feature of follicles was the significant development of reactive centers centers of reproduction), in which numerous mitoses were recorded, which indicates the activation of the B-system of immunity.