Adenoid Hypertrophy Research Articles

PLATELET-TO-LYMPHOCYTE (PLR) RATİOS İN ADENOİDECTOMY PATİENTS

Objective: This study aimed to investigate Platelet-to-lymphocyte (PLR) ratios in adenoidectomy patients to determine whether this ratio can be a possible predictive factor in adenoidectomy. We also aimed to investigate whether PLR can help indicate ongoing systemic inflammation on patients with adenoid hypertrophy. Materials and Methods: A total of 100 boys aged 3-11 years, who had undergone adenoidectomy for adenoid hypertrophy between 2012 and 2018 at Suleyman Demirel University School of Medicine, Department of Ear Nose and Throat (ENT), were assigned to the study group. The control group consisted of 100 healthy boys who had been circumcised in the Urology or Pediatric Surgery Departments. Patients medical records were retrospectively reviewed. The results of preoperative complete blood counts were evaluated by reviewing the patient files. The PLR value is obtained by dividing absolute platelet count by absolute lymphocyte count. Results: PLR were 91,47 and 84,15 for control and study groups respectively with no statistically significant difference (Mann-Whitney U test, p = 0.062). The Mann-Whitney U test showed no significant difference between study and control groups among WBC, platelet and lymphocyte counts (p>0.05). PLR was higher in the control group as compared to the study group. Conclusion: We observed platelet and lymphocyte standard deviations are too high, therefore we beleive that PLR is not a reliable value in adenoidectomy.

0901 Role of Nasopharynx Radiography in Diagnosis of Sleep Disordered Breathing in Children

Abstract Introduction Sleep disordered breathing (SDB) in children comprises a wide spectrum of presentation ranging from primary snoring (prevalence 6-12%) to obstructive sleep apnea (OSA; prevalence 1-3%). In younger children, SDB is often secondary to adenotonsillar hypertrophy. Polysomnography is the gold standard test for evaluation of sleep disordered breathing. Yet, many providers order ancillary tests such as Radiography of Nasopharynx (NPX-ray) to assess for adenoidal hypertrophy. Previous studies evaluating efficacy of NPX-rays to diagnose airway obstruction have shown mixed results. Methods Retrospective chart review of 65 consecutive normally developed children who have had diagnostic polysomnography and NPX-rays over the past 3 years was performed. Data on age, sex, Obstructive Apnea Hypopnea Index (OAHI) and NPX-ray findings were collected. Our cohort mostly had the following diagnosis such as GERD, Asthma, Allergic rhinitis, ADHD and Obesity. Our cohort did not have neurological disorders or medications that could affect tone of upper airway. Standard pediatric AHI criteria was applied to categorize mild, moderate and severe OSA. Results Our cohort’s age ranged from 3-18 years (median age 10 years); 43 were males. Of the 24 children with normal sized adenoids with no obstruction; 6 had severe OSA and 4 had moderate OSA. 3 had hypertrophied adenoids on X-ray with occlusion of nasopharynx but only had mild OSA. Of the 15 children with prominent adenoids with some narrowing but no occlusion; 9 had severe OSA. Of the 9 children that had hypertrophied adenoids with no occlusion; 3 had moderate OSA and 3 had severe OSA. Of the 12 with mild enlargement, 4 had severe OSA. None of the 19 children with severe OSA showed airway occlusion by adenoids. Conclusion In our study, the size of the adenoids on X-ray of the Nasopharynx did not correlate with severity of SDB in children. Airway obstruction in OSA is dynamic and can occur at multiple sites affected by anatomical factors and upper airway collapsibility. As use of Nasopharyngeal radiography involves exposure to radiation, it should be used judiciously in diagnosis of SDB in children. Polysomnography is the gold standard test for evaluation of SBD in children. Support None.

1233 Mitochondrial Myopathy Making It Hard To Sleep! OSA management in Mitochondrial Myopathy with a variant in SNAPC4 and PURA genes

Abstract Introduction No standard of care exists for management of sleep disorders/sleep disordered breathing (SDB) and Mitochondrial myopathies. Our case report describes our experience with this condition in a pediatric patient. Report of Case A ten-year-old middle eastern male with PMH of Mitochondrial myopathy was referred to Sleep Medicine by ENT with reported snoring, witnessed apneic spells and daytime fatigue. Flexible Video Laryngoscopy did not reveal tonsillar or adenoid hypertrophy so it was postulated that his OSA was a result of his craniofacial abnormalities and global hypotonia. Genetic workup showed Mitochondrial complex II & III deficiency from a variant in SNAPC4 gene and PURA gene leading to failure to thrive, severe developmental delay, generalized muscle weakness, bradycardia requiring pacemaker, global hypotonia requiring nocturnal oxygen for chronic respiratory failure and G-tube placement due to difficulty with feedings. Diagnostic PSG showed severe OSA with AHI of 11.3, RDI 11.8, REM AHI 56.0, REM RDI 56, and minimum oxygen saturation 85%. Subsequent PAP titration led to initiation of BIPAP therapy with settings of Auto-BiPAP EPAP min 5, IPAP max 20; PSmin 4; PSmax 6 cm H2O and continuation of nocturnal home oxygen. Sleep fragmentation improved to an arousal index of 3.1 with BIPAP. The patient and caregiver presented to the Sleep Medicine clinic 1 month after the PAP titration study with objective report showing >4 hours use >70% of the time and subjective satisfaction with BIPAP therapy with improvement in snoring and apnea. Conclusion Mitochondrial disorders lead to a deficiency of ATP affecting all organ systems and is most recognizable in the form of neuromuscular impairments. Neuromuscular impairments can translate into SDB issues such as OSA. Patients with genetic conditions such as mitochondrial myopathy should be routinely screened and evaluated for SDB and treated if warranted to significantly improve morbidity, mortality and quality of life.

Sleep disordered breathing in children with trisomy 13 and trisomy 18.

While the prevalence of obstructive sleep apnea (OSA) is well documented in trisomy 21, there has been little published about the incidence in trisomy 13 (T13) and trisomy 18 (T18). Trisomies 13, 18, and 21 have overlapping clinical features that make patients prone to OSA. Because the literature regarding OSA in T13 and T18 children is limited, we performed a retrospective chart review to investigate the characteristics of these patients. We reviewed the medical records of children with T13 or T18 seen at seen at a single urban tertiary children's hospital for sleep disordered breathing from 1/1/10 to 5/1/18. Candidates were selected based on ICD-9 diagnosis and procedural codes. We identified 21 T18 patients that had documented symptoms of SDB, of which 3 were diagnosed with OSA, 11 had clinical SDB, and 7 had snoring. Of the T13 patients, 10 had documented symptoms of SDB, of which 1 patient was diagnosed with OSA, 7 with clinical SDB, and 2 with snoring. In both T13 and T18 patients, anatomical features included micrognathia/mandibular hypoplasia, small mouth/small airway, midface hypoplasia, abnormal/difficult airway, glossoptosis, hypotonia, and GERD. Endoscopic findings included laryngomalacia and/or tracheomalacia, adenoid and lingual tonsil hypertrophy, and inferior turbinate hypertrophy. Surgical interventions performed in T13 and T18 patients included adenoidectomy, lingual tonsillectomy, and tracheostomy. Of the 32 T13 and T18 patients, 15 had to be intubated for respiratory insufficiency. The results of our study suggest that T13 and T18 patients are at increased risk for OSA due to common features found in this population. These findings indicate a need for otolaryngologist intervention to increase both survival and quality of life in this population.

Vascular endothelial growth factor and transforming growth factor β in hypertrophic adenoids in children suffering from otitis media with effusion

ObjectivesThe study objective was to assess the levels of VEGF-A and TGF-β cytokines in the children with adenoid hypertrophy concomitant with exudative otitis media (OME) and in children with adenoid hypertrophy (HA) alone. MethodsThe study material consisted of hypertrophic adenoids removed during adenoidectomy from 39 children (20 girls and 19 boys), aged 2–7 years suffering from OME. The reference group included 41 children (19 girls and 22 boys), aged from 3 to 9 years with adenoid hypertrophy. The levels of VEGF-A and TGF-β were determined in supernatants obtained from phytohemagglutinin-stimulated cell cultures of the adenoids using a commercial enzyme-linked immunosorbent assay kit. ResultsThe median VEGF-A and mean TGF-β concentrations in the study group were significantly higher than those in the reference group (503 pg/mL versus 201 pg/mL, P < 0.001 and 224 pg/mL versus 132 pg/mL, P < 0.001, respectively). ROC analysis revealed that the area under the curve (AUC) for VEGF-A was 0.952 with diagnostic sensitivity and specificity of 95%, whereas for TGF-β it was 0.902 with 60% sensitivity and the same specificity as for VEGF-A. There was no significant difference between the AUC for VEGF-A and TGF-β (P = 0.573). ConclusionsThe changes in the levels of VEGF-A and TGF-β may indicate bacterial pathogen as one of the causes of exudative otitis media in children. Determination of VEGF-A and TGF-β could be used as additional and objective tests to confirm the clinical diagnosis.

Mometasone furoate intranasal spray is effective in reducing symptoms and adenoid size in children and adolescents with adenoid hypertrophy

IntroductionThe use of mometasone furoate (MF) intranasal spray in treating adenoid hypertrophy (AH) has a variable outcome due the different methods of adenoid size evaluation. The aim of our study was to evaluate the effect of MF intranasal spray in children and adolescents with AH using a reliable and consistent endoscopic evaluation. Material and methodA prospective interventional study was conducted. Evaluation took place during the first visit (week 0) and second visit (week 12). Symptoms of nasal obstruction, rhinorrhoea, cough and snoring were assessed, and an overall total symptoms score was obtained. A rigid nasoendoscopic examination using a four-grading system of adenoid size from 1 to 4 was performed. Patients were treated with MF intranasal spray for 12 weeks. Patients’ aged 7–11-years old used 1 spray in each nostril once daily, while patients aged 12–17 used two sprays in each nostril once daily. Reassessment was carried out during the second visit (week 12). ResultsA total of 74 patients was recruited. There were significant improvements from week 0 to week 12 in the symptoms’ score for nose obstruction, rhinorrhoea, cough, snoring including the total nasal symptoms’ score (p<0.001). AH significantly reduced in size from week 0 (2.89±.87) to week 12 (1.88±.83) (p<0.001). ConclusionMF intranasal spray is effective in improving the symptoms attributed to AH as well as reducing the adenoid size. MF intranasal spray is advocated as a treatment option before adenoidectomy is considered.

Age and Upper Airway Obstruction: A Challenge to the Clinical Approach in Pediatric Patients.

Upper airway abnormalities increase the risk of pediatric morbidity in infants. A multidisciplinary approach to obstructive sleep apnea syndrome (OSAS) poses challenges to clinical practice. The incidence and causes of OSA are poorly studied in children under 2 years of age. To fill this gap, we performed this retrospective observational study to determine the causes of obstructive sleep apnea (OSA) in children admitted to our hospital between January 2016 and February 2018, after a brief unexplained event (BRUE) or for OSA. We reviewed the medical charts of 82 patients (39 males; BRUE n = 48; OSAS n = 34) and divided them into two age groups: < 1 year old (1–12 months; n = 59) and >1 year old (>12–24 months; n = 23). Assessment included nap polysomnography, multichannel intraluminal impedance-pH, and nasopharyngoscopy. Sleep disordered breathing was comparable between the two groups. Omega-shaped epiglottis, laryngomalacia, and nasal septum deviation were more frequent in the younger group, and nasal congestion in older group. Tonsillar and adenoidal hypertrophy was more frequent in the older group, while laryngomalacia and gastroesophageal reflux was more frequent in the younger group. Tonsil and adenoid size were associated with grade of apnea-hypopnea index severity in the older group, and laryngomalacia and gastroesophageal reflux in the younger group. The main causes of respiratory sleep disorders differ in children before or after age 1 year. Our findings have potential clinical utility for assessing the pathophysiology of obstructive sleep disordered breathing in patients less than 2 years old.

Efficiency of Propolis and N-acetylcisteine on Reduction in Symptom Severity of Respiratory Infection in Children with Adenoid Hypertrophy

Efficiency of Propolis and N-acetylcisteine on Reduction in Symptom Severity of Respiratory Infection in Children with Adenoid Hypertrophy

Comparison of adenoid assessment by flexible endoscopy and mirror exam

ObjectiveAssessment of adenoid hypertrophy can be completed through various methods including flexible endoscopy and intraoperative mirror exam. The objective of this study was to compare the effect of adenoid size on the accuracy of these techniques. MethodsPatients younger than 18 years old who underwent adenoidectomy at Boston Medical Center from October 2012 to December 2018 and had documented preoperative and intraoperative adenoid sizes were included. Cases were identified through Current Procedural Terminology (CPT) codes 42,830 and 42,831 with exclusion of CPT 42820 for tonsillectomy and adenoidectomy. Patients who had less obstruction (75% or less obstruction) and more obstruction (>75%) were compared using Chi-square analysis and t-tests. ResultsOf 276 patients who underwent adenoidectomy from October 2012 to December 2018, 84 patients had adenoid size determined both preoperatively by flexible endoscopy and intraoperatively. Thirty-eight (45.2%) patients had intraoperative adenoids that were characterized as less obstructive hypertrophy and 46 (54.8%) had intraoperative adenoids that were characterized as more obstructive hypertrophy. In patients with less obstruction, the mean preoperative adenoid obstruction size of 72% was significantly higher than the mean intraoperative adenoid obstruction size of 63% (p = 0.0212). However, in patients with more obstruction, the mean preoperative adenoid size of 86% was not significantly different from the mean intraoperative adenoid size of 90% (p = 0.1237). ConclusionAdenoid assessment by flexible endoscopy and intraoperative mirror exam may not correlate as closely in patients who have less obstructive hypertrophy.

Impact of adenoidectomy or adenotonsillectomy on paediatric quality of life using obstructive sleep apnoea - 18 questionnaire

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Recurrent adeno-tonsillitis can lead to problems of secretory otitis media/OSA/sinusitis and thus adenotonsillectomy is one of the most frequent done surgery in children. The present study aimed to evaluate the impact of adenoidectomy or adenotonsillectomy on the quality of life of children using obstructive sleep apnoea- 18 score.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective study was conducted in the Department of Otorhinolaryngology, Head and Neck Surgery at Ananta Institute of Medical Science, Rajsamand between January 2017 to December 2019. A total of 60 patients of age group 4 to 15 years were included in study who were undergoing adenoidectomy or adenotonsillectomy. All patients were evaluated by using ‘obstructive sleep apnea - 18’ (OSA-18) preoperatively and 6 months post- operative period for impact on quality of life on children after surgery. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 60 children with a mean age of 8.6 years were evaluated. The most frequent indication for surgery was recurrent adeno-tonsillitis and obstructive sleep apnoea for adenoid hypertrophy. The total mean score of initial OSA-18 was 85.34, following surgery at 6 months, the total mean score was reduced to 31.23 (p value &amp;lt;0.001). Similarly, there was reduction in mean score of individual domains after surgery which was statically significant (p&amp;lt;0.001).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our study concludes that on evaluation of children with adenoid hypertrophy using OSA-18 pre-operative and 6 months post-operative period, showed adenoidectomy or adenotonsillectomy has positive impact on paediatric quality of life.&lt;/p&gt;

Clinical Outcomes of Montelukast Sodium in Children with Adenoid Hypertrophy

Clinical Outcomes of Montelukast Sodium in Children with Adenoid Hypertrophy

Clinical Outcomes of Montelukast Sodium in Childrenwith Adenoid Hypertrophy

Generally the blockage of upper respiratory tract in children is seen with the hypertrophy of adenoids and tonsils. Normally for patients with adenoid hypertrophy (AH), Adenoidectomy with or without Tonsillectomy is carried out, however it has its own genuine complications like haemorrhage and recurrence of adenoid tissue. Consequently, therapeutic treatment has increased extraordinary consideration rather than surgical procedure. The inflammatory process proposed for AH has prompted the utilization of anti-inflammatory drugs to treat this issue. The purpose of this study is to assess the impacts of Montelukast sodium in children with enlarged adenoids.

Detection of meningococcus, pneumococcus, Haemophilus influenzae, and group A streptococcus DNA in pediatric adenoid bioptats

Meningococcal, pneumococcal, streptococcal A and Haemophilus influenzae infections are manifested in different clinical forms, ranging from bacterial carriage to generalized life-threatening conditions. However, a connection between bacterial carriage and disease development has not been fully explored. A PCR assay was performed with adenoid biopsy samples collected from 112 children after planned adenotomy to detect Neisseria meningitidis, Streptococcus pneumoniae, Streptococcus pyogenes, H. influenzae carriage. A DNA specific to at least one of the four studied microbial species was found in 104 samples (92.86%) so that: meningococcal DNA was detected in one sample (0.9%), pneumococcal — in 98 (87.5%), H. influenzae — in 19 (16.96%), and streptococcal A — in 42 (37.5%) samples. However, none of these species was found in 8 children (7.14%). A sole S. pneumoniae was detected in 54 samples (48.2%), whereas S. pyogenes — in 5 samples (4.5%). Moreover, two bacterial species were simultaneously as follows: N. meningitidis and S. pneumoniae — in 1 sample (0.9%), S. pneumoniae and H. influenzae — in 7 samples (6.3%); H. influenzae and S. pyogenes — in 1 sample (0.9%); S. pneumoniae and S. pyogenes — in 25 samples (22.3%). A triple combination consisting of S. pneumoniae, H. influenzae and S. pyogenes bacteria were detected together in 11 patients (9.8%). Meningococcal serogrouping revealed no connection with any of the 6 most common global serogroups responsible for epidemic incidence rise (A, B, C, W-135, X, Y). A clear tendency for prevalence of S. pyogenes DNA in adenoid pediatric biopsies in children diagnosed with “Adenoids and tonsils hypertrophy” vs. “Adenoids hypertrophy” was observed. It is noteworthy, a high relative prevalence of pneumococcal carriage (87.5%), found by us was of special importance. Pediatric carriers serving as a reservoir for virulent pneumococcal species pose a threat both for themselves and surrounding people. Thus, PCR-based data of adenoid biopsies may be a promising approach for future studies, as a potential to identify live viable but nonculturable bacteria in clinical specimens will contribute to a more accurate assessment of carriage rate of meningococci, pneumococci, H. influenzae and group A streptococci.

Risk factors for otitis media with effusion in children with adenoid hypertrophy.

SUMMARYThe aim of this study was to determine the most important risk factors in the development of otitis media with effusion (OME) in children with adenoid hypertrophy. A total of 539 patients undergoing surgery for adenoid hypertrophy (AH Group) (n = 429) or adenoid hypertrophy and otitis media with effusion (AH + OME Group) (n = 110) between February 2012 and February 2018 constituted the study group. Data were obtained on neonatal history (breastfeeding, bottle feeding), past health and medical history (presence of atopy or allergic rhinitis, snoring at night, cough, tonsillitis in the past 12 months), environmental factors (presence of pets, attending to daycare centers, district of school), family history (passive smoking at home, number of siblings, family size, parental education), and family income. The groups did not differ from each other for age (p = 0.684) and gender (p = 0.728). Our data support the presence of atopy or allergic rhinitis (p < 0.001), frequent (> 5) tonsillitis (p < 0.001), attending to daycare centers (p < 0.001), exposure to smoke (p < 0.001), having 3 or more siblings (p < 0.001), and 4 or more people in the household (p < 0.001) as the main risk factors for OME. Comprehensive knowledge of modifiable risk factors found in this study could help to minimise the complications of OME in children.

Approach to the snoring child.

Sleep is an important component in a child's growth and development. Snoring is common in children and often perceived as benign, but habitual snoring may be an indication of obstructive sleep apnoea (OSA). OSA can have health, developmental and cognitive consequences. The three common risk factors for paediatric OSA are tonsillar and/or adenoidal hypertrophy, obesity and allergic rhinitis. Primary care providers are well-placed to identify children at risk by screening for habitual snoring and associated OSA risk factors during routine consultations. Physician awareness of OSA symptoms/signs facilitates diagnosis, management and referral decisions. A trial of medical treatment may be considered for habitual snoring with mild symptoms/signs before referral. Overnight polysomnography is the gold standard investigation utilised by paediatric sleep specialists to diagnose OSA. Adenotonsillectomy is the first-line management for OSA with adenotonsillar hypertrophy, but residual/recurrent OSA may occur, so follow-up by primary care providers is important after surgery.

Correlation between clinical grading of adenoid or tonsil hypertrophy and adenoid or tonsil volume post adenotonsillectomy: a prospective cohort study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Measuring adenoid or tonsil volume in surgically removed specimens is likely the most accurate method for quantifying adenotonsillar hypertrophy severity which may predict the extent of surgery to curtail post tonsillectomy haemorrhage a potential lethal complication.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; All patients with adenoid or tonsil hypertrophy were graded clinically while the objective grading by volumetric saline displacement in accordance with Archimedes’ principle; between August 1, 2017 to July 31, 2019 at the Jos University Teaching Hospital, Plateau State, Nigeria. Data analysis was by the SPSS version 21.0 Chicago IL, USA. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The study had 96 participants with a M:F=1.7:1. Age range was 9 months to 51 years, median was 3 yrs, mean was 9.5 yrs±15.5 yrs with 83 (86.5%) who were ≤18 yrs. Main features of this study, no. of patients in snoring was 83 (86.5%), nasal obstruction 71 (74.0%), rhinorrhoea 32 (33.3%), noisy breathing 23 (24.0%), dysphagia- 18 (18.8%), mouth breathing 18 (18.8%). Grading of this study was 78 (81.2%) were Brodsky grade III &amp;amp; IV while 72 (75.0%) had ANR of ≥0.5. Blood loss was range 10 ml to 250 ml, median 35 ml, mean 52.7±46.9 ml while 51 (63.0%) had blood loss of ≤50 ml. Volume of surgical specimen of adenoid; range 0.20-4.50 ml, mean 1.56±0.83 ml while tonsil; (Rt)-range 1.00-12.50 ml, mean 3.18±1.97 ml. There was a positive correlation between adenoid or tonsil grade and volume at 99% CI; (r)=0.409, (p=0.000) and grade (mean) 3.11±0.78, volume (mean) 3.18±1.96.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study establishes a positive correlation between clinical grading of adenoid or tonsil and volume with a certain level of accuracy which may predict extent of surgery to avoid post tonsillectomy hemorrhage, a life-threatening/lethal complication from excessive, partial or suboptimal surgery commonly.&lt;/p&gt;

Down-regulation of anti-inflammatory TIPE2 may aggravate adenoidal hypertrophy in children.

Adenoidal hypertrophy (AH) is a common disorder in the pediatric population, with common symptoms including mouth breathing, nasal congestion, hyponasal speech, snoring and obstructive sleep apnea. Although the pathogenesis of AH has not been fully elucidated, recent studies have indicated that immune responses may play an important role in AH. Tumor necrosis factor‐alpha (TNF‐α)‐induced protein‐8 like‐2 (TIPE2) is a newly identified protein that negatively regulates the activation of inflammatory pathways. Here, we investigated the effect of TIPE2 in AH in children. We observed that the levels of TNF‐α and interleukin‐6 were greater in the adenoid tissue of AH children than in healthy control subjects (P < 0.01), and this increase was positively correlated with the severity of AH. The level of TIPE2 expression was decreased compared with control and was negatively correlated with AH. TIPE2 overexpression in primary human monocytes (isolated from adenoid tissue of children with AH) inhibited the activation of nuclear factor‐κB and the expression of TNF‐α and interleukin‐6. These results suggest that overexpression of TIPE2 may attenuate AH through inactivation of the nuclear factor‐κB signaling pathway.

Evaluation of Adenoid Hypertrophy with Ultrasonography.

To determine the reliability of ultrasound in the diagnosis of adenoid hypertrophy in children. The subjects were divided into three groups: Group A: Pre-experiment group: 30 children who were hospitalized for adenoidal hypertrophy were selected, and preoperative ultrasound was used to measure adenoid thickness. Their re-confirmed Adenoidultrasound measurementthickness was obtained during surgeryunder the guidance of metal instruments; Group B: Ultrasound screening group: 1898 children aged 3-12 y were selected, and their adenoids were examined by ultrasonography to observe the size, shape, echo and blood flow of adenoids and the thickness of adenoids; Group C: Surgical resection group: 133 hospitalized patients were selected, and their adenoid ultrasound measurement thickness (AUT), the adenoid-nasopharynx (A/N) ratio was calculated based on nasopharyngeal lateral radiographs and obstruction ratio was obtained in electronic nasopharyngoscopy [extent of adenoid-posterior nostril occlusion (EANC)] were compared. In Group A, there was no statistical difference in the measurements of the adenoids between the preoperative ultrasound and the ultrasound measurements under the guidance of intraoperative metal instruments (P > 0.05). In Group B, the adenoids of 1898 children aged 3-12 y were measured and were found thickest at 6 y, with an average of 5.035 ± 0.0609mm. There was no statistical difference in adenoid thickness between boys and girls (P > 0.05). In Group C, there was a linear correlation between AUT and A/N ratio (r = 0.999, P = 0.01) and between AUT and EANC (r = 0.950, P = 0.000). In children between 3 and 12 y of age, AUT greater than 6mm may be considered for surgical resection of adenoid hypertrophy.

The effects of adenoidectomy of serum insulin-like growth factor-1 (IGF-1) and ghrelin in hypertrophied adenoids in children with otitis media with effusion.

&lt;b&gt;Aim:&lt;/b&gt; The aim of the current study was to assess the serum levels of insulin-like growth factor-1 (IGF-1) and ghrelin in hypertrophied adenoids in children suffering with or without otitis media with effusion before and after adenoidectomy. &lt;br&gt;&lt;b&gt;Material and methods:&lt;/b&gt; Serum IGF-1 and ghrelin concentrations were measured with specific enzyme-linked immunoassay (ELISA) methods. The study was carried out in 20 children with otitis media with effusion. The reference group comprised 24 children with hypertrophied adenoid, while control group included 19 children. &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; This mean values of IGF-1 in children with otitis media with effusion and children with hypertrophied adenoid before adenoidectomy were significantly lower than those found in healthy children. Serum levels of IGF-1 were higher after adenoidectomy. There was a significant difference of serum ghrelin levels between both examined groups and the control group. &lt;br&gt;&lt;b&gt;Conclusion:&lt;/b&gt; Our results suggest that adenoidectomy in children with hypertrophied adenoids and in children with otitis media with effusion significantly increases the level of IGF-1 in serum compared to before surgery through the effect of the GH-IGF-1 axis, which could contribute to children's growth.

Metabolic changes in peripheral blood lymphocytes from children with recurrent respiratory infections

Objective: to examine activity and correlative relations for peripheral blood lymphocyte NAD (P)-dependent dehydrogenases in young children with recurrent respiratory infections with hypertrophy of the pharyngeal tonsils and bronchial obstructive syndrome. Methods. 89 children, aged 1–3 years, with recurrent respiratory infections were examined, including 35 children with hypertrophy of pharyngeal tonsils (HPT) and 54 children — with bronchial obstructive syndrome (BOS). Control group contained 20 age-matched healthy children. Activity and relations for peripheral blood lymphocyte for NAD(P)-dependent dehydrogenases were assessed by using bioluminescent method proposed by А.А. Savchenko and L.N. Suntsova (1989). Results. It was found that children with recurrent respiratory infections displayed altered enzyme status in peripheral blood lymphocytes. In particular, activity ribose-5-phosphate- and NAD(P)-dependent metabolic events as well as substrate flux via the tricarboxylic acid cycle were elevated that was paralleled with decreased lactate dehydrogenase anaerobic reaction, thereby implicating a role for malate-aspartate shunt in the energy turnover, substrate efflux from the tricarboxylic acid cycle into amino acid metabolic pathways as well as activity of glutathione reductase. Moreover, features of altered enzymatic profile in peripheral blood lymphocytes were uncovered, which depended on type of complication related to respiratory infection. In addition, children with hypertrophy of pharyngeal tonsils were featured with increased influx of lipid catabolism products into glycolysis, elevated level of malic enzyme activity and decreased pyruvate production. However, children with bronchial obstructive syndrome were found to have decreased glycerol-3-phosphate dehydrogenase activity resulting in lowered shunting activity of slow reactions in Krebs cycle and increased influx of amino acid metabolism intermediates into the tricarboxylic acid cycle. Reshaping of enzymatic profile in peripheral blood lymphocytes depended on type of complications coupled to respiratory infections (ENT-pathology or BOS syndrome). A correlation analysis revealed features of relationship between parameters of NAD(P)-dependent dehydrogenase activity in peripheral blood lymphocytes found in children with hypertrophy of pharyngeal tonsils and bronchial obstructive syndrome marked by quantity, modality and power of correlative links. Conclusion. Children with the recurrent respiratory infections require metabolic therapy aimed at restoring intracellular pathology-driven metabolic processes in immune cells.