Obstructive Adenoids Research Articles

Ultrasonographic evaluation of effectiveness of circumoral muscle exercises in adenotonsillectomized children

Mouth breathing due to obstructive adenoids and tonsils has deleterious effects on craniofacial morphology especially on dentition and dental arches. Reports confirm that removal of nasal obstruction, adenoids and tonsils has not given beneficial development of circumoral musculature. Use of muscles to correct malocclusion was first recommended by Alfred Paul Rogers. This study highlights the imaging of circumoral musculature using ultrasound to evaluate the effectiveness of muscle exercises in adenotonsillectomized children. Definite changes in muscle thickness were noted in subjects, who were given muscle exercises.

The effects of tonsillectomy and adenoidectomy on pulmonary arterial pressure in children

Purpose It is well known that hypertrophic tonsils and adenoids may cause upper-airway obstruction. The aim of this study is to determine the mean pulmonary arterial pressure (mPAP) in children with hypertrophic tonsils and adenoids and to clarify whether tonsillectomy and adenoidectomy (T&A) has any effect on mean pulmonary arterial pressure of these children. Materials and methods Fifty-two randomly selected children (36 male, 16 female) aged between 4 and 11 (mean 7.7 ± 2.5) a with a diagnosis of upper-airway obstruction resulting from hypertrophied tonsils and adenoids were included in our study. Thirty-three children were assigned as controls with similar age and sex distrubution with the study groups. Mean pulmonary arterial pressure was measured by using Doppler echocardiography preoperatively and mean 5.4 ± 2.9 months postoperatively in all subjects. Results When the mean pulmonary arterial pressure values of study and control group compared preoperatively, the mean pulmonary arterial pressure levels of the children in the study group were significantly higher than the mean pulmonary arterial pressure levels of the children in the control group ( P < .05) (study group mean PAP = 23.13 ± 7.68, control group mean PAP = 16.11 ± 7.24) (Levene’s test, P < .05). When the preoperative and postoperative results were compared, it was found that there was a statistically significant decrease in mean pulmonary arterial pressures in these 52 children (preoperative mean PAP = 23.13 ± 7.68, postoperative mean PAP = 17.00 ± 6.99) (paired sample t test, P < .05). Twenty-seven of the 52 subjects in the study group were pulmonary hypertensive preoperatively. mPAPs of 18 of these children decreased to normal range yielding 9 subjects, and this was also found ststistically significant (McNemar test, P < .001). Conclusion This study showed that obstructive adenoid and tonsillar hypertrophy causes higher mPAP values in children and revealed that T&A is an effective therapeutic measure in such patients.

Abundance of intraepithelial gamma delta T cells in hypertrophic obstructive but not in chronically infected adenoids.

Using quantitative morphometric analysis of immunohistochemically stained tissue sections we compared hypertrophic obstructive adenoids (HOA, n = 10) from children without middle ear disease with chronically infected adenoids (CIA, n = 10) from children with middle ear disease. gamma delta T cell receptor (TCR)+ cells constituted the dominating T cell population in the surface epithelium of HOA, while alpha beta TCR+ cells were the dominating intraepithelial T cell population in CIA. Intraepithelially CD8+ cells dominated over CD4+ cells in both diseases. Intraepithelially B cells were not detected. The cellular composition of follicles, with B cells dominating followed by activated CD4+ alpha beta TCR+ cells, was the same in both groups. However, the number of follicles in CIA was twice as many as in HOA. In the deeper interfollicular areas granulocytes were more abundant in CIA than in HOA. The latter two findings suggest a more pronounced inflammatory response in the adenoids of patients with middle ear disease. There was no significant difference with regard to pathogenic bacterial strains colonizing the adenoid surface when comparing the two patient groups. These results suggest that in patients with HOA gamma delta TCR+ T cells help to maintain the integrity of the surface epithelium, thereby preserving its protective function. On the basis of our results we speculate that CIA have a malfunctioning defence, thereby facilitating long-standing infections deep in the adenoid. This may be the main reason for development of middle ear disease and an indication for adenoidectomy in patients with CIA.

Estudo clínico, randomizado, duplo-cego, em crianças com adenóide obstrutiva, submetidas a tratamento homeopático

OBJETIVO: Avaliar a eficácia e segurança do tratamento homeopático em crianças com adenóide obstrutiva, com indicação cirúrgica. FORMA DE ESTUDO: Clínico prospectivo. Material e método: Estudo prospectivo, duplo-cego, randomizado, em que foram incluídas 40 crianças com idade variando de 3 a 7 anos, 20 crianças foram tratadas com medicação homeopática individualizada (Simillimum), baseada no princípio da similitude e 20 crianças receberam placebo. Todas as crianças do grupo medicação homeopática foram medicadas diariamente com Agraphis nutans 6 CH, Thuya 6 CH e Adenóide 21CH; e as do grupo placebo receberam diariamente medicamentos sem o princípio ativo. A duração do estudo de cada paciente foi de 4 meses. A avaliação dos resultados foi clínica, por meio de questionário padrão, de exame otorrinolaringológico e nasofaringoscopia direta com fibroscópio flexível, no primeiro e no último dia de tratamento. Utilizou-se como critério de inclusão a adenóide que ocupou mais do que 70% da luz coanal. RESULTADOS: Das 20 crianças tratadas com medicamento homeopático, 13 não apresentaram alteração no tamanho da adenóide nos exames nasofaringoscópicos e 7 tiveram diminuição da adenóide; das 20 crianças que receberam placebo por 4 meses, 11 não apresentaram alterações no tamanho da adenóide, 4 tiveram diminuição da adenóide e 5 crianças tiveram aumento. Não houve diferença estatística significante entre os grupos (P= 0,069). Na avaliação clínica da evolução dos pacientes, dos 20 pacientes tratados com medicamento homeopático, 17 se mantiveram inalterados, com respiração oral e ronco, um paciente melhorou, ficando sem ronco e dois foram curados, isto é, a respiração alterou-se de oral para nasal e sem ronco. Dos 20 pacientes tratados com placebo, 17 pacientes se mantiveram inalterados, um paciente melhorou do ronco e dois foram curados, não tendo havido diferença estatística significante entre os grupos (P&gt;0,999). CONCLUSÕES: O tratamento homeopático não foi eficaz nas crianças com adenóide obstrutiva, mantendo-se a indicação cirúrgica em 85% dos pacientes. O medicamento homeopático não provocou eventos adversos nas crianças.

Endoscopic partial adenoidectomy for children with submucous cleft palate.

Children with submucous cleft palate who suffer from chronic nasal obstruction because of hypertrophic adenoids usually are not subjected to adenoidectomy because of the fear of postoperative velopharyngeal insufficiency. These patients present a therapeutic challenge because we are aware more than ever of the importance of normal nasal breathing and nocturnal respiration, especially during childhood. Our hypothesis was that transnasal endoscopic horizontal limited adenoidectomy may relieve nasal obstruction while preserving the function of the velopharyngeal valve. The objective of this study was to evaluate the efficacy of transnasal endoscopic horizontal partial adenoidectomy in patients with submucous cleft palate and adenoidal hypertrophy. Patients were either referred to the outpatient clinic of the Palate Surgery Unit (seven patients) or were patients referred to the senior author's (Y.F.) private clinic. All the patients had been operated on by this senior author (Y.F.). Ten children aged 3.5 to 13 years (six girls and four boys) with submucous cleft palate and hypertrophic adenoids were included in the study. All the patients were hyponasal and suffered nasal obstruction, loud snoring, and episodes of apnea. Endoscopic partial adenoidectomy was accomplished to open the lower third of the choanae. Nasal breathing was achieved in all the patients, and only mild snoring remained in two patients. The hyponasality disappeared and speech intelligibility normalized. Mild hypernasality developed in two patients but was still perceived as an overall improvement in speech. Transnasal endoscopic horizontal partial adenoidectomy may be an effective surgical method for relief of nasal obstruction while preserving velopharyngeal valve function in patients with submucous cleft palate who suffer from obstructive adenoids.

Combined transoral and transnasal power‐assisted endoscopic adenoidectomy by a StraightShot® microdebrider and Endoscrub® device

Objective:To describe a combined transoral and transnasal approach power‐assisted endoscopic adenoidectomy by StraightShot® microdebrider and Endoscrub® device in children.Method:Transoral power‐assisted endoscopic adenoidectomy using a 45°‐curved cutting visor of a StraightShot® microdebrider (Medtronic Xomed, Jacksonville, FL, USA) is performed with an Endoscrub, irrigation device (Medtronic Xomed) attached to the rigid endoscope. The oscillating mode (1500 r.p.m.) of the microdebrider is selected. The dissection begins at the inferior pole of the adenoids and swifted upwards to the roof of the nasopharynx. Transnasal dissection of the choanal extension of the adenoids is achieved using a straight‐cutting visor with the aid of a 0° rigid endoscope.Results:The technique was performed in 11 consecutive patients (six male and five female) in a 6‐month period. The mean age of the patients was 6.9 years (range, 3–9 years). The main indication for surgery was obstructive sleep apnoea with huge obstructive adenoids and with choanal extension. The mean operative time was 4.8 min (range, 2–11 min). The mean blood loss was 12.8 mL (range, 4–16 mL). No intraoperative or postoperative complications were recorded.Conclusion:The described technique for dissection of adenoids in children is safe and is recommended for patients with large adenoids and with choanal extension. Chinese Abstract imageimageimageimageimage

Obstructive adenoid tissue: an indication for powered-shaver adenoidectomy.

To quantify the incidence of intranasal extension of adenoid tissue and residual adenoidal obstruction of the posterior choanae following traditional curette adenoidectomy to determine the efficiency of adenoid curettage and the usefulness of intraoperative endoscopic examination and powered-shaver adenoidectomy in achieving better postnasal patency. Prospective intraoperative endoscopic evaluation of the posterior choanae and nasopharynx of a case series of 130 patients before and after curette and powered-shaver adenoidectomy. Tertiary referral center. One hundred thirty consecutive pediatric patients with obstructive adenoidal hypertrophy undergoing adenoidectomy. The degree of residual postnasal obstruction due to adenoid tissue was assessed endoscopically (grades 0-3) after curette and adjuvant powered-shaver adenoidectomy. The presence of intranasal adenoid tissue was also recorded. Following traditional curette adenoidectomy, 51 (39%) of 130 patients had residual obstructive adenoid with 42 patients (32%) having occlusive intranasal adenoid tissue. Having determined the presence of remaining obstructive tissue with intraoperative nasal endoscopy in these 51 patients, complete airway patency was achieved with powered-shaver adenoidectomy. The presence of intranasal extension of adenoids obstructing the posterior choanae is common in children with adenoid hypertrophy. Traditional adenoidectomy is ineffective in removing this tissue and may also leave obstructive tissue high in the nasopharynx. Intraoperative nasal endoscopy allows assessment of the completeness of surgery. Powered-shaver adenoidectomy enables complete removal of obstructive adenoid tissue thereby ensuring postnasal patency.

The effects of tonsillectomy and adenoidectomy on serum IGF-I and IGFBP3 levels in children.

Obstructive adenoid and tonsillar hyperplasia may present with retardation of growth. Interruption of growth hormone-insulin-like growth factor I axis resulting from abnormal nocturnal growth hormone secretion is among the postulated causes. Growth hormone (GH) mediates its anabolic effects on tissues through insulin-like growth factor I (IGF-I). Most of the circulating IGF-I is bound to insulin-like growth factor binding protein 3 (IGFBP3). The objective of this study is to determine blood serum levels of IGF-I and IGFBP3 in patients with adenoid and tonsillar hypertrophy. Furthermore, we want to investigate the effect of tonsillectomy and adenoidectomy (T&A) on these levels. The blood serum levels of IGF-I and its binding protein IGFBP3 were examined in 41 randomly selected children with a diagnosis of upper airway obstruction resulting from hypertrophic tonsils and adenoids. Blood samples were taken preoperatively and repeated at 3 to 6 months (mean, 4.3 mo) following T&A operation. Coated-tube immunoradiometric assay (IRMA) method was used to analyze IGF-I and IGFBP3 levels. Thirty-two of 41 children were eligible for the analysis. When the preoperative and postoperative results were compared, it was found that there was a statistically significant increase in serum IGF-I and IGFBP3 levels in these 32 children (P <.001). In 7 of the 32 patients, the preoperative serum IGF-I levels were below normal. Postoperatively these levels increased within normal range. This was also statistically significant (P = .016). These findings revealed that obstructive adenoid and tonsillar hypertrophy may cause decreased serum IGF-I levels by affecting the GH-IGF-I axis, and T&A is an effective therapeutic measure in these patients.

Analysis of epsilon germline transcripts and IL-4 mRNA expression in the adenoids suggests local IgE switching.

We have previously observed more frequent occurrence of IgE+ and FcepsilonRI+ cells in adenoids of atopic than nonatopic children. To investigate the hypothesis that the adenoids are involved in IgE production, we analyzed the levels of epsilon germline (epsilonGL), IL-4, and IFN-gamma transcripts in the adenoids in relation to atopy and presence of ear disease. Adenoidectomy was performed on 19 atopic and 18 nonatopic children (median age 5 years, range 2-12 years) suffering from otitis media with effusion (OME) (n = 16) or obstructive adenoids hyperplasia (AH) (n = 21). The levels of epsilonGL transcripts, IL-4, and IFN-gamma mRNA were analyzed by competitive reverse transcriptase-PCR. EpsilonGL transcript levels in the adenoids were found to be dependent on IL-4 mRNA expression (P < 0.01) and serum IgE levels (P < 0.05) (R2 = 0.32, n = 37). IL-4 mRNA expression was associated with epsilonGL transcript levels (rs = 0.32, P = 0.05, n = 37), especially among patients with AH (rs = 0.53, P = 0.01, n = 21). No significant differences in IL-4 and IFN-gamma mRNA levels were observed between the groups. This study supports an IL-4-induced class switch to IgE production in the adenoids that might be of importance for inflammatory reactions in the upper respiratory tract.

Surgical modalities other than ethmoidectomy

When medical management fails to control the symptoms of chronic sinusitis, surgical intervention is frequently considered. The more commonly recommended procedures include tonsilectomy and adenoidectomy, adenoidectomy alone, maxillary sinus irrigation, and nasal antral windows. These procedures have not undergone meticulous prospective evaluation or documentation of chronic sinusitis. It has only recently become known that plain sinus x-ray films are frequently misleading, and there has been a tendency to completely ignore ethmoid disease. Adenoidectomy has been frequently recommended; however, these studies have not documented the duration of symptoms or the extent of disease. Approximately 20% of the patients treated with tonsilectomy and adenoidectomy do not have resolution of symptoms of chronic sinusitis. It is prudent, however, to remove an enlarged obstructive adenoid pad as a first course of therapy. Irrigation has been proposed, but it treats only the maxillary sinus, and the ethmoid sinuses are involved approximately 70% of the itme. One irrigation rarely clears the symptoms. Nasal antral windows in children require well-developed maxillary sinuses and do not maintain their patency. Therefore they are not an effective mechanism for treating chronic sinusitis. Other surgical modalities must therefore be sought.

Current Indications for Tonsillectomy and Adenoidectomy

Tonsillectomy and adenoidectomy are currently the most common pediatric surgical procedures performed in the United States. Tonsillectomy may be effective in recurrent acute throat infection (acute tonsillitis), chronic tonsillitis, tonsillar hypertrophy, and peritonsillar abscess. Antimicrobial therapy may also be beneficial. Clinical trials evaluating children with obstructive adenoids are currently being evaluated; anecdotal evidence points to improvement in development and quality of life after surgery. The efficacy of adenoidectomy in paranasal sinusitis has not been evaluated in clinical trials; antimicrobial therapy or the possibility of upper respiratory tract allergy should be considered in such cases. For acute otitis media, recommendations range from no treatment in cases that will abate with time, to anti-microbial prophylaxis, to myringotomy with tympanostomy tube insertion, adenoidectomy with or without tonsillectomy, or a combination of adenoidectomy with myringotomy and/or tympanostomy tubes. The decision for or against otic and/or pharyngeal surgery should be individualized on the basis of severity, duration, and frequency of illness; previous treatment; and risk.

Transnasal fiberoptic endoscopy in children with obstructive apnea.

Eight children with obstructive apnea were evaluated by transnasal fiberoptic endoscopy. Three children had obstructive adenoids and tonsils, 2 had pharyngeal collapse, 1 had an obstructive tongue, and 1 had a subglottic cyst. The remaining patient had no abnormality. The results of transnasal endoscopy influenced therapeutic interventions.

Obstructive Adenoids in Relation to Otitis Media

Obstructive Adenoids in Relation to Otitis Media

Obstructive adenoids in relation to otitis media.

Obstructive adenoids in relation to otitis media.