Tonsil Hypertrophy Research Articles

Identifying Conditions With High Prevalence, Cost, and Variation in Cost in US Children’s Hospitals

Identifying high priority pediatric conditions is important for setting a research agenda in hospital pediatrics that will benefit families, clinicians, and the health care system. However, the last such prioritization study was conducted more than a decade ago and used International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. To identify conditions that should be prioritized for comparative effectiveness research based on prevalence, cost, and variation in cost of hospitalizations using contemporary data at US children's hospitals. This retrospective cohort study of children with hospital encounters used data from the Pediatric Health Information System database. Children younger than 18 years with inpatient hospital encounters at 45 tertiary care US children's hospitals between January 1, 2016, and December 31, 2019, were included. Data were analyzed from March 2020 to April 2021. The condition-specific prevalence and total standardized cost, the corresponding prevalence and cost ranks, and the variation in standardized cost per encounter across hospitals were analyzed. The variation in cost was assessed using the number of outlier hospitals and intraclass correlation coefficient. There were 2 882 490 inpatient hospital encounters (median [interquartile range] age, 4 [1-12] years; 1 554 024 [53.9%] boys) included. Among the 50 most prevalent and 50 most costly conditions (total, 74 conditions), 49 (66.2%) were medical, 15 (20.3%) were surgical, and 10 (13.5%) were medical/surgical. The top 10 conditions by cost accounted for $12.4 billion of $33.4 billion total costs (37.4%) and 592 815 encounters (33.8% of all encounters). Of 74 conditions, 4 conditions had an intraclass correlation coefficient (ICC) of 0.30 or higher (ie, major depressive disorder: ICC, 0.49; type 1 diabetes with complications: ICC, 0.36; diabetic ketoacidosis: ICC, 0.33; acute appendicitis without peritonitis: ICC, 0.30), and 9 conditions had an ICC higher than 0.20 (scoliosis: ICC, 0.27; hypertrophy of tonsils and adenoids: ICC, 0.26; supracondylar fracture of humerus: ICC, 0.25; cleft lip and palate: ICC, 0.24; acute appendicitis with peritonitis: ICC, 0.21). Examples of conditions high in prevalence, cost, and variation in cost included major depressive disorder (cost rank, 19; prevalence rank, 10; ICC, 0.49), scoliosis (cost rank, 6; prevalence rank, 38; ICC, 0.27), acute appendicitis with peritonitis (cost rank, 13; prevalence rank, 11; ICC, 0.21), asthma (cost rank, 10; prevalence rank, 2; ICC, 0.17), and dehydration (cost rank, 24; prevalence rank, 8; ICC, 0.18). This cohort study found that major depressive disorder, scoliosis, acute appendicitis with peritonitis, asthma, and dehydration were high in prevalence, costs, and variation in cost. These results could help identify where future comparative effectiveness research in hospital pediatrics should be targeted to improve the care and outcomes of hospitalized children.

Evolution of bronchial obstruction pattern in children of presсhool age

Introduction. The diagnosis of asthma presents objective difficulties in children aged less than 5 years. Not all children with recurrent virus-induced obstruction can further develop asthma.Aim. To assess the realization of different clinical and pathogenetic variants of bronchoobstructive syndrome in the child population.Materials and methods. Risk factors of 75 patients with bronchoobstructive syndrome in the first 5 years of life were retrospectively evaluated. 57 patients were surveyed using the “Asthma Prediction Tool” questionnaire. At the end of the follow-up period (one year), cases of bronchial asthma were evaluated.Results. A predictive contribution to the implementation of the recurrent variant of bronchoobstructive syndrome has a burdened hereditary allergic anamnesis (OR=5,4, CI 1,79-16,46, p<0,05) and the presence of atopic dermatitis (OR=7,7, CI 2,73-21,95, p><0,05). Symptoms of allergic rhinitis in combination with hypertrophy of the Palatine tonsils in 6,06 and 3,45 times, respectively, increase the risk of bronchial asthma (p><0.05). Conclusion. As a result of research, there are significant factors in the implementation of bronchial asthma such as concomitant allergic diseases in combination with a hereditary background and hypertrophy of the palatine tonsils. The>˂ 0,05) and the presence of atopic dermatitis (OR=7,7, CI 2,73-21,95, p˂ 0,05). Symptoms of allergic rhinitis in combination with hypertrophy of the Palatine tonsils in 6,06 and 3,45 times, respectively, increase the risk of bronchial asthma (p˂ 0.05).Conclusion. As a result of research, there are significant factors in the implementation of bronchial asthma such as concomitant allergic diseases in combination with a hereditary background and hypertrophy of the palatine tonsils. The “Asthma Prediction Tool” questionnaire allows you to predict the development of bronchial asthma in patients with episodic and recurrent bronchial obstruction. The article will be useful for both pediatricians and primary care professionals, as it allows to rationally influence the risks of bronchial asthma formation.

Diagnostic of lingual tonsil hypertrophy with lateral soft tissue cervical X-ray on laryngopharyngeal reflux

Background: Lingual tonsil hypertrophy (LTH) evaluation could be performed by flexible fiberoptic laryngoscopy, lateral soft tissue cervical roentgen, CT scan, and magnetic resonance imaging (MRI).Lateral soft tissue cervical roentgen examination was considered as substitutes for diagnostic testing of LTH, which, aside from being cheaper, the examination could also be conducted in all hospitals and easy to be performed on children. Objective: To compare the lingual tonsil enlargement with examination procedure using lateral soft tissue cervical roentgen as an LTH diagnosis measure compared to the flexible fiberoptic laryngoscopy examination as the gold standard examination. Methods: A cross-sectional design study on 30 respondents of laryngopharyngeal reflux (LPR) patients whose conducted routine ENT physical examination, followed by flexible fiberoptic laryngoscopy examination along with lateral soft tissue cervical roentgen. Results: The sensitivity level of 65.38% was acquired from the statistical tests, along with specificity level of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 30.37%. Conclusions: Based on sensitivity and specificity, lateral soft tissue cervical roentgen examination could already be used as a diagnostic measure and have an accurate capability to diagnose LTH.

A Rare Case of Eagle Syndrome Associated with Tonsil Hypertrophy: Case Report with Literature Review

Eagle’s syndrome, or stylohyoid complex syndrome, is a rare facial pain syndrome characterised by latero-cervical pain radiating to the face, pharyngeal pain increased by swallowing, linked to an abnormal enlargement of the styloid or calcification of the stylo-hyoid ligament. The incidence of the presentation is about 4 to 8 per 10,000 individuals. The establishment of the diagnosis is a challenge in itself as we need to differentiate it from the neuralgias of cranial nerve such as glossopharyngeal neuralgia and superior laryngeal neuralgias. The surgical management of the Eagle syndrome consists in the shortening of the elongated styloid process, with the surgical access by intra oral or cervical. We report a case of a 28-yearold men admitted to our otorhinolaryngology department with sharp neck pain and a sensation of having a foreign body in the throat. Physical examination found bilateral tonsilar hypertrophia, with palpation of a solid immobile structure. CT scan with 3D reconstruction revealed elongated styloid processes with ossification of the left stylo-hyoid ligament. The patient was treated by tonsillectomy with excision of styloid processes by intra oral approach.

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

Childhood obstructive sleep apnea (OSA) is a disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation during sleep and normal sleep patterns in children.1 OSA is one of the most serious sleep-disordered breathing (SDB) diseases in children. Because of its high prevalence and serious long-term complications, increasing numbers of families are affected by OSA. In 2012, the American Academy of Pediatrics (AAP) clinical practice guidelines reported that the prevalence of pediatric OSA was 1.2%–5.7%2; in 2010, the prevalence of pediatric OSA in Hong Kong was 4.8%.3 In contrast to OSA in adults, the main cause of upper airway obstruction in children is adenoid and/or tonsil hypertrophy. Obesity, craniofacial malformation, neuromuscular diseases, and other factors may also contribute to the onset of pediatric OSA.4 Without timely diagnosis and effective intervention, pediatric OSA can lead to a series of serious complications, such as maxillofacial dysplasia, behavioral abnormalities, learning disabilities, growth restriction, neurocognitive impairment, endocrine metabolic disorders, hypertension, and pulmonary hypertension; it can also increase the risk of cardiovascular events in adulthood.5, 6, 7, 8 Therefore, early detection and early diagnosis of pediatric OSA, as well as early intervention to correct this problem, are important considerations for improving patient prognosis. There have been some controversies in the clinical diagnosis and treatment of pediatric OSA in China, which have restricted clinical diagnosis and treatment strategies, while hindering progress regarding diagnosis and treatment. The diagnosis and treatment of pediatric OSA is increasingly hampered by the absence of multi-disciplinary cooperation and guidelines. The numbers of pediatric OSA diagnosis and treatment guidelines and expert consensuses are very limited, both in China and worldwide.1,2,5,9, 10, 11, 12, 13 The draft guidelines for diagnosis and treatment of pediatric obstructive sleep apnea hypopnea syndrome issued in 2007 were mainly established on the basis of expert consensus.1 In the past 10 years, there has been a lack of multi-disciplinary evidence-based diagnosis and treatment guidelines for pediatric OSA in China. Thus, evidence-based clinical practice guidelines are urgently needed. The purpose of the present guidelines is to standardize the clinical diagnosis and treatment decision-making concerning pediatric OSA in China, provide scientific evidence for the diagnosis and treatment of pediatric OSA, promote multi-disciplinary integration, guide clinical practice for relevant medical staff, and ensure the use of a scientific approach for management of pediatric OSA. Table 1 is the list of abbreviations. Table 1 List of abbreviations.

Does concurrent adenoidectomy or tonsillectomy affect the graft success rate of cartilage myringoplasty in adults?

BackgroundThe objective of this study was to evaluate the graft success and hearing outcomes of concurrent adenoidectomy or tonsillectomy and myringoplasty.MethodsMedical case notes were reviewed for all adult patients with dry perforations who had undergone myringoplasty, with or without concurrent throat surgery, from December 2015 to February 2018. The study population was divided into concurrent myringoplasty and throat surgery (Group A) and single myringoplasty (Group B) groups. The air–bone gap (ABG) and graft success rate were evaluated in both groups.ResultsA total of 131 ears of 131 patients were included in this study. In total, 33 ears of 33 patients were assigned to Group A and 98 to Group B. Of the 33 patients in Group A, adenoid residue was detected in 3, chronic tonsillitis in 21, and tonsil hypertrophy in 9. The graft success rate was 96.9 % in Group A and 96.9 % in Group B at 6 months postoperatively (p = 0.993). In addition, the graft success rate was 87.9 % in Group A and 92.8 % in Group B at 24 months postoperatively (p = 0.372). Reperforation occurred in three patients in Group A and four in Group B; the difference was not significant. No significant group differences were observed in preoperative (p = 0.654) or postoperative (p = 0.791) ABG values or mean ABG gain (p = 0.439). No patient in either group developed cholesteatoma of the middle ear.ConclusionsSimultaneous adenoidectomy or tonsillectomy and myringoplasty is feasible but does not improve the graft success rate or hearing outcome.

Оториноларингологична находка при пациенти с бета-таласемия

ENT finding by patients with P- thalassemia; Polina Nencheva, Petar Rouev, Mirela Rangelova, Denka Stoyanova, Dimitar Mihailov Introduction: The thalassemic syndromes are heterogeneous group of diseases. By this kind of haematological disorders the synthesis of p-polypeptid chains is decreased or missing. Except the thalassemic face and other symptoms of the P-thalassemia there are also some kinds of otorhinolaringological symptoms. Objective: The aim of this study is to determine the ENT status by patients with P-thalassemia under regular haemotransfusions and chelating therapy. Study design: Multicentre prospective research - ENT Clinic, Paediatric Clinic, Therapeutic Clinic, Medicine Faculty, Stara Zagora; 6-th Therapeutic Department, District Hospital "Prof. S. Kirkovich", Stara Zagora; Sector of Thalassemia, Paediatric Hospital, Sofia; Sector of Thalassemia, National Centre of Transfusiology, Sofia. Material and Methods: 63 patients with P-thalassemia under regular haemotransfusions and chelating therapy were examinated; ENT examination and audiometry. Results: I patient with chronic serous otitis media and hearing loss; 3 patients with hypertrophy of the pharyngeal tonsils; 16 patients with hypertrophy of the tonsils; 5 patients with septum deviation; 60 patients of the patients with hypohromic nasal mucosa.

Role of Tonsillar Chronic Inflammation and Commensal Bacteria in the Pathogenesis of Pediatric OSA.

Immune responses at the boundary between the host and the world beyond are complex and mucosal tissue homeostasis relies on them. Obstructive sleep apnea (OSA) is a syndrome suffered by children with hypertrophied tonsils. We have previously demonstrated that these tonsils present a defective regulatory B cell (Breg) compartment. Here, we extend those findings by uncovering the crucial role of resident pro-inflammatory B and T cells in sustaining tonsillar hypertrophy and hyperplasia by producing TNFα and IL17, respectively, in ex vivo cultures. Additionally, we detected prominent levels of expression of CD1d by tonsillar stratified as well as reticular epithelium, which have not previously been reported. Furthermore, we evidenced the hypertrophy of germinal centers (GC) and the general hyperplasia of B lymphocytes within the tissue and the lumen of the crypts. Of note, such B cells resulted mainly (IgG/IgM)+ cells, with some IgA+ cells located marginally in the follicles. Finally, by combining bacterial culture from the tonsillar core and subsequent identification of the respective isolates, we determined the most prevalent species within the cohort of OSA patients. Although the isolated species are considered normal oropharyngeal commensals in children, we confirmed their capacity to breach the epithelial barrier. Our work sheds light on the pathological mechanism underlying OSA, highlighting the relevance taken by the host immune system when defining infection versus colonization, and opening alternatives of treatment.

Impact of Isolation on Adenoid Size and Symptoms in Preschool Children Who Previously Qualified for Adenoidectomy: A Case-Control Study.

To analyze the role of factors that influence adenoid-related symptoms, and the influence of 3 months of isolation in preschool children who were qualified for adenoidectomy. This was a cohort study of the impact of 3 months of isolation on children aged 3 to 6 years with adenoid-related symptoms and endoscopically confirmed grade II and III adenoid hypertrophy. The children had previously qualified for adenoidectomy. After 3 months, 141 children were asked about their symptoms, 71 of whom were randomly chosen for medical examination, including endoscopic adenoid examination. Additionally, pre- and post-isolation tympanometry results were analyzed. In our study, significant or mild improvements in health were observed in approximately 73% of the children; 92% of the surveyed parents reported that their children exhibited improved nasal patency, 63% of children discontinued snoring, and 30% of children showed a decrease in snoring. Data collected through surveys correlated with endoscopic findings wherein the size of the adenoid decreased by an average of 5.4%, but the amount of mucus covering the adenoid decreased more significantly in 76% of patients, which may be the main problem determining symptoms reported before isolation. In addition, the amount of residual mucus in the nasopharynx significantly affected the middle ear effusion in adenoid hypertrophy. This study found that isolation in preschool children stabilizes the bacterial microbiome of the nose and nasopharynx, thereby having a significant effect not only on the number of recurrent infections of the upper respiratory tract but also on the patency of the nose. The only symptom that depended on the size of the pharyngeal tonsil hypertrophy was snoring. There was a weak correlation between prevalence of infections and adenoid size. During the isolation period, the adenoid size reduced by approximately 5.4% only, statistically more significant in the group with grade III adenoid hypertrophy, but the prevalence of infections rapidly decreased. Residual mucous in the nasopharynx found to be in correlation with middle ear effusion.

A rare case of difficult airway management in a Klippel-Feil syndrome pediatric patient with osseous torticollis undergone orthopedic surgery

BackgroundOrthopedic surgery for cervical torticollis poses potential threat to airway management both in tracheal intubation and extubation. Klippel-Feil syndrome (KFS) is a complex syndrome of osseous and visceral anomalies. The anatomical characteristics of KFS might have significant implications for airway management.Case presentationThis is a rare case of an 8-year-old boy presenting with osseous torticollis, congenital occipito-atlantal deformity, congenital basilar invagination and KFS undergone elective torticollis correction surgery. Though with difficulty, tracheal intubation was successfully performed. Extubation failed twice on postoperative day 2 and 10, and required tracheostomy. Based on radiological findings, we speculated that prolonged airway edema accounted for the main reason of the failed extubation, the hypertrophic tonsil and occipito-cervical fusion resulted in reduced oropharyngeal space and limited cervical range of motion. Moreover, the Chiari malformation and KFS complicated the airway condition and lead to prolonged airway obstruction. The tracheostomy casing was removed 1 month later.ConclusionsCautions should be taken in extubation of pediatric patients undergone major osseous torticollis surgery. Reintubation should be prepared in case of failed extubation. Severe post-operative airway edema, complicated with hypertrophic tonsil, the structural abnormalities in the oropharyngeal cavity, and occipito-cervical deformities constituted the decreased oropharyngeal space and resulted in failed extubation. For severe airway compromise and prolonged intubation, tracheostomy should be considered.

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 %.

Successfully Tracheostomy and Monobloc Advancement with External Frontofacial Distraction Followed by Simultaneous Adenoidectomy, Conchotomy, and Septoplasty in Severe Late Crouzon Syndrome

A 10-year-old male patient presented with Severe Late Crouzon Syndrome, with turri-brachycephaly, andsevere exorbitism of both eyes, visual loss, beaked nose and maxilla hypoplasia. The head circumference was54 cm and 90 precentile. Patient had a high arched palate, tonsil hypertrophy and type III malocclusion. Fromthe multidisciplinary meeting, in the first stage it was decided to first secure the airway with Tracheostomythen immediately followed by Monobloc Advancement with External Frontofacial Distraction. Then inthe second stage, after removal of the rigid external distractor, by 9 months after first surgery, the patientunderwent a simultaneous procedures of Adenoidectomy, Conchotomy, and Septoplasty. Thus, after patientgot stable in follow-up, Nasendoscopy and Tracheostomy devices was removed. After 11 months follow-up.Visual function still not getting better. However turri-brachycephaly, exorbitism of both eyes, beaked noseand maxilla hypoplasia, head circumference, arched palate, tonsil hypertrophy and the malocclusion weregetting much reduced, and the patient getting happier and more active.

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.

Primary and secondary postoperative hemorrhage in pediatric tonsillectomy.

BACKGROUNDTonsillectomy is the most common procedure for treatment of pediatric recurrent acute tonsillitis and tonsillar enlargement that contributes to obstructive sleep apnea hypopnea syndrome. Postoperative hemorrhage of tonsillectomy is a life-threatening complication.AIMTo identify the risk factors that may contribute to primary and secondary post-operative hemorrhage in pediatric tonsillectomy.METHODSThe clinical data from 5015 children, 3443 males and 1572 females, aged 1.92-17.08 years, with recurrent tonsillitis and/or tonsil hypertrophy who underwent tonsillectomy in our hospital from January 2009 to December 2018 were retrospectively collected. The variables including sex, age, time of onset, diagnosis, method of tonsillectomy, experience of surgeon, time when the surgery started and monthly average air temperature were abstracted. The patients with postoperative hemorrhage were classified into two groups, the primary bleeding group and the secondary bleeding group, and their characteristics were compared with those of the nonbleeding group separately. Statistical analysis was performed by chi-square test with SPSS 20.RESULTSNinety-two patients had post-tonsillectomy hemorrhage, and the incidence rate of post-tonsillectomy hemorrhage was 1.83%. The mean age was 5.75 years. Cases of primary hemorrhage accounted for approximately 33.70% (31/92), and cases of secondary hemorrhage occurred in 66.30% (61/92). The rate of reoperation for bleeding was 0.92%, and the rate of rehospitalization for bleeding was 0.88% in all patients. Multiple hemostasis surgery was performed in 6.52% (3/46) of patients. The method of tonsillectomy (coblation tonsillectomy) and experience of the surgeon (junior surgeon with less than 5 years of experience) were significantly associated with primary hemorrhage (χ2 = 5.830, P = 0.016, χ2= 6.621, P = 0.010, respectively). Age (over 6 years old) and time of onset (more than a 1-year history) were significantly associated with secondary hemorrhage (χ2= 15.242, P = 0.000, χ2=4.293, P = 0.038, respectively). There was no significant difference in sex, diagnosis, time when the surgery started or monthly average air temperature. There was a significant difference in the intervention measures between the primary bleeding group and the secondary bleeding group (χ2= 10.947, P = 0.001). The lower pole and middle portion were the common bleeding sites, followed by the upper pole and palatoglossal arch.CONCLUSIONThe incidence rate of post-tonsillectomy hemorrhage is low. Coblation tonsillectomy and less than 5 years’ experience of surgeon contribute to the tendency for primary hemorrhage. Age and time of onset are responsible for secondary hemorrhage.

Risk of dental malocclusion in children with upper respiratory tract disorders: A case-control study of a nationwide, population-based health claim database

ObjectivesThe aim of this study was to evaluate the association between different upper respiratory tract disorders and severe dental malocclusion in pediatric patients. MethodsNewly diagnosed patients (N = 773) with dental malocclusion aged 8–18 years and controls (N = 3865) were identified from the health claim records of the Longitudinal Health Insurance Database 2000 of Taiwan's National Health Insurance Research Database. Controls were frequency matched to the cases by sex, age group, and index year. Univariate and multiple logistic regression analyses were used to evaluate the association between severe dental malocclusion and six common upper respiratory tract disorders, including acute sinusitis, allergic rhinitis, chronic sinusitis, nasal septum deviation, nasal polyps, and hypertrophy of tonsil and adenoids. ResultsThe risk of severe dental malocclusion was significantly elevated in pediatric patients with three upper respiratory tract disorders, including acute sinusitis (adjusted odds ratio [aOR] = 1.66, 95% confidence interval [95% CI] 1.39–1.99), allergic rhinitis (aOR = 1.64, 95% CI 1.34–2.02), and chronic sinusitis (aOR = 2.01, 95% CI 1.27–3.19). When all the six upper respiratory tract disorders were simultaneously included in the multiple logistic regression analysis, acute sinusitis (aOR = 1.48, p < 0.001) and allergic rhinitis (aOR = 1.34, p < 0.010) were significantly and independently associated with an increased risk of severe dental malocclusion. ConclusionsFindings from this nationwide, population-based case-control study indicated that acute sinusitis and allergic rhinitis were independently and significantly associated with an increased risk of severe dental malocclusion in pediatric patients. Pediatricians should remain vigilant for the risk of dental malocclusion in their patients with these disorders.

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.

Adenoid Hypertrophy, Craniofacial Growth and Obstructive Sleep Apnea: A Crucial Triad in Children

Age-related (physiological) AH is an important problem in pediatric otorhinolaryngology. Since the beginning of the 70s, there has been an increase in the proportion of children with pharyngeal tonsil hypertrophy. Functional disorders of the oropharynx in children occupy the second place based on their incidence (after disorders of the musculoskeletal system). In previous years, there has been an increase in the incidence and prevalence of obstructive sleep apnea syndrome (OSAS) among children. In most cases of pediatric OSAS, upper airway obstruction occurs from the nasopharynx to the oropharynx, caused by upper airway stenosis. Consequences of untreated OSAS in children can be inattention and behavioral problems, daytime sleepiness, and in more severe cases are associated with a variety of comorbidities. The current review discusses the links between hypertrophied adenoids, craniofacial development and OSAS in children taking into account physiological and pathophysiological aspects as well as clinical evaluation of the problem.

Myeloid/lymphoid neoplasm with CEP110-FGFR1 fusion: An analysis of 16 cases show common features and poor prognosis

ABSTRACT Objectives: The 8p11 myeloproliferative syndrome (EMS) is an extremely rare, generally aggressive haematologic malignancies. This study provided the clinical outcomes and therapeutic strategies for EMS patients confirmed with CEP110-FGFR1 fusion. Methods: We report here a case of translocation (8;9) (p12;q33)/CEP110-FGFR1 who received allo-HSCT and achieved molecular remission. We searched the PubMed database for relevant medical literatures published between 1992 and 2018. We generalized the laboratory results, clinical features, therapeutic outcomes for EMS with confirmed CEP110-FGFR1 fusion. Results: We identified 16 EMS cases with CEP110-FGFR1 fusions including our patient. The observed common syndrome features were characterized as follows: a male predominance, fatigue (35.7%), tonsil hypertrophy (41.7%), lymphadenopathy (53.8%), hepatosplenomegaly (54.5%). leukocytosis (greater than 20.0 × 109/L, 71.4%), coexisting of eosinophilia and monocytosis (93.3%), and frequent progression to acute leukaemia. High incidence of tonsil hypertrophy and monocytosis may be a feature of EMS with CEP110/FGFR1 fusions. The CR rate for EMS was 23.1%. One patient treated with highly selective FGFR kinase inhibitor, INCB054828, achieved complete molecular remission rapidly. Allo-HSCT was performed in 8 patients. The median survival time for those patients was 9.0 (95%CI 5.599–12.601) months, with a range between 5 and 27 months. Allogeneic HSCT could improve survival in selected patients. Conclusion: FGFR1 and RUNX1 may be potential therapeutic targets for clinical trials. More accumulation of cases is also needed to determine whether allo-HSCT could be an optimal approach.

Clinical outcome of Montelukast Sodium in Children with Adenoid Hypertrophy.

Background & Objectives: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 complications like haemorrhage and recurrence of adenoid tissue. Consequently, therapeutic approach 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 objective of this study was to assess the impacts of Montelukast sodium in children with enlarged adenoids.Methods:A randomized controlled trail was performed from April 2018 to March 2019 in the Otorhinolaryngology clinic of Dr. Akbar Niazi Teaching Hospital, Islamabad. In this randomized, placebo treatment-controlled trial, 60 children aged 4-12 years meeting inclusion criteria were isolated into two groups. The study group was treated with Montelukast sodium 5mg consistently for three months while the control group got placebo treatment for a similar timeframe. A questionnaire was filled by parents/ guardians of every child before and after the intervention to evaluate the severity of sleep discomfort, snoring and mouth breathing.Results:Following 3 months of treatment, significant reduction in size of the adenoids was seen in 76% of study group compared with just 3% of control group getting placebo treatment.Conclusion:Montelukast sodium seems to be effective in the reduction of the size of adenoids and improvement in clinical manifestations. It can be viewed as a viable option in contrast to surgical treatment in children with hypertrophy of adenoids.

Occurrence of IL-1, IL-10, CD25, CD40, and CD69 in the tissue of palatine tonsils.

IntroductionPalatine tonsil disease often coexists with dermatological diseases. Correct diagnosis of inflammation of the palatine tonsil tissue and removal of the diseased palatine tonsils results in remission of the disease.AimTo determine similarities and differences in the immunohistochemistry profile of the palatine tonsil tissue between tonsillitis and hypertrophy, including location of the immunohistochemistry reactions in specific histological sites.Material and methodsA prospective analysis of 50 palatine tonsils that had undergone tonsillectomy due to tonsillitis (30 cases) and hypertrophy (20 cases) was performed. The collected material underwent immunohistochemistry staining for: IL-1, IL-10, CD25, CD40, and CD69, and subsequently phenotypic expression of the obtained results was performed including their histological location.ResultsStatistically significant differences (p < 0.05) between the tonsillitis and hypertrophy groups were found for almost all IHC reactions in the epithelium covering the tonsils for CD-25, CD-69, IL-1, IL-10. Furthermore, significant differences between these groups were found for IL-10 reaction in the subepithelial inflammatory infiltrate and follicular centres of lymphatic follicles as well as for CD-69 reaction between the follicles. When all the locations were summarized, significant (p < 0.05) differences were found for all IHC reactions except for CD-40.ConclusionsThe investigated markers and cytokines: CD25 and CD69, and IL-1 and IL-10 are more abundant in tonsillitis than in hypertrophy of the palatine tonsils.