Obstructive Adenotonsillar Hypertrophy Research Articles

Adenotonsillar Hypertrophy and Cardiopulmonary Status: A Correlative Study.

Introduction Adenotonsillar hyperplasia in childhood is a common phenomenon. It has been reported in the literature that increased upper-airway resistance resulting from hypertrophied tonsils and adenoids can cause intermittent airway obstruction, chronic alveolar hypoventilation, and even lead to severe cardiopulmonary complications such as right ventricular (RV) failure and cor-pulmonale, a near-lethal culmination of pulmonary artery hypertension (PAH). This study was undertaken to explore and examine the association of adenotonsillar hypertrophy and cardiopulmonary status in patients with complaints of upper airway obstruction below the age of 20 yearsandto analyze the effect of adenotonsillar enlargement on pulmonary function tests and cardiac aberration reflectedin the electrocardiography (ECG) changes. Methods This study included patients visiting or admitted to the Otolaryngology/Ear, Nose, and Throat (ENT) and Paediatrics department of Acharya Vinoba Bhave Hospital, Sawangi (Meghe), Wardha, Maharashtra, India. It is anObservational Prospective Study conducted on 75 Patients (50 cases and 25 controls) below the age of 20 years. Inclusion criteria for cases included all patients of adenoid hypertrophy (AH) and adenotonsillar hypertrophy (ATH). Inclusion criteria for controls comprised all patients with a history and clinical examination not suggestive of any upper airway and pulmonary disease. All the patients were subjected to pulmonary function tests (PFT) and electrocardiography (ECG), and thevalues were compared. Results It was found that there was a decrease in the value of the parameters of the pulmonary function tests (PFT), which includesforced expiratory volume in the first second (FEV1), forced vital capacity (FVC), the ratio of the forced expiratory volume in the first one second to the forced vital capacity of the lungs (FEV1/FVC) and peak expiratory flow rate (PEFR) with increasing severity of theendoscopic grades of adenoid hypertrophy. This was found to be statistically significant. All the PFT parameters were significantly lower in the subset of patients with ATH compared to those with AH only, emphasizing the compounding effect of tonsillar volume. Between case and control subjects also, these differences were statistically significant. Seventeen (34%) out of the 50 patients studied in the present work were found to have abnormalities in their ECG, while no subject in the control group had any departure from normal. Nine of these 17 patients had AH, and eight had the adenotonsillar disease. In the 9 patients (18%) with AH, sinus arrhythmia was seen in 5 (10%), sinus tachycardia in 3 (6%), and Mobitz type 1 block in 1 (2%) patients. In 8 patients (16%) with AH, sinus arrhythmia was seen in 4 (8%), sinus tachycardia in 3 (6%), and Mobitz type 1 block in 1 (2%) patients. Overall, sinus arrhythmia was the commonest finding seen in 9 patients (18%). Conclusion Chronic obstructive adenotonsillar hypertrophy causes significant cardiovascular and pulmonary changes, which is often overlooked in the clinical setting. Symptoms of progressive pulmonary hypertension are minimal until the rapid onset of severe cardiac decompensation occurs. These entire cascades of events are reversible in the early stages and thus mandate early detection and treatment. Performing PFT and ECGin children with adenotonsillar disease is not mandatory but profitable even in the absence of obvious symptoms of upper airway obstruction.

The Relationship Between Oxidative Stress and Adenotonsillar Hypertrophy in Children

Objective: In this study, it was aimed to evaluate the preoperative and postoperative oxidative stress levels of children with obstructive adenotonsillar hypertrophy and to compare the obtained data with healthy children. Material and Methods: 25 patients and 25 healthy controls were included in the prospective study conducted between March and September 2015. In the study sample, children who were diagnosed with adenotonsillar hypertrophy due to chronic tonsillitis, snoring and mouth breathing and who were planned for adenotonsillectomy were included in the patient group. Control group included 25 healthy volunteers with the same demographic characteristics. Serum and urine samples were collected from the patient group twice, before and after surgery, and once from the control group. 8-hydroxy-2-deoxyguanosine levels of all samples were determined by EIA method, protein carbonyl levels were determined by ELISA method and malondialdehyde levels were determined by manual spectrophotometric method. Results: In the study, it was found that the serum malondialdehyde levels of children with adenotonsillar hypertrophy were significantly higher than the control group (p=0.003) and that there was no difference in terms of other parameters (p>0.05). After the operation, it was determined that the levels of all three parameters evaluated significantly decreased compared to before (p<0.05). It was determined that there was a statistically significant and weak correlation between malondialdehyde and 8-hydroxy-2-deoxyguanosine values before the operation (p=0.003, r=0.566). Conclusion: Hypertrophic adenotonsillar, which is common in the pediatric population, causes many clinical conditions and adversely affects the health and quality of life of children. In line with our findings, we can say that serum and urine MDA levels and tissue PCO levels are useful markers in the evaluation of oxidative damage in children with obstructive ATH and may help to elucidate the etiopathogenesis of the disease. Considering the effects of ATH on health, it is recommended to be considered as an important health problem and to examine the clinical, biochemical and histopathological studies of the disease in a larger sample group.

Is adenotonsillectomy safe in covid-19 era? Investigation of sars-cov2 in adenoid and tonsil tissues

ObjectivesCOVID-19 has seriously altered physicians' approach to patients and diseases, with a tendency to postpone elective procedures. Tonsillectomy, alone or with adenoidectomy, is one of the most common surgeries performed by otolaryngologists. Although they are generally accepted as elective surgeries, they significantly improve the quality of life, and postponing these surgeries for a long time can have deteriorative effects on the patients. We aimed to investigate the presence of SARS CoV-2 in the adenotonsillectomy materials to find out if performing adenotonsillectomy is safe during the COVID-19 pandemic. MethodsForty-eight tissue samples from 32 patients that underwent tonsillectomy with or without adenoidectomy were investigated whose SARS-CoV-2 RT-PCR test in the samples obtained from nasopharyngeal (NP) and oropharyngeal (OP) swabs were negative within 24 h before the operation. While 16 patients underwent only tonsillectomy and one of their tonsils was investigated, 16 of the patients underwent adenotonsillectomy and their adenoid tissues were sent along with one of their tonsils. SARS-CoV-2 viral RNA was investigated with Real-Time PCR in tissue samples. ResultsTwo (4.2%) tissue samples had positive PCR tests for SARS-CoV-2, while 46 of them were negative. One of the positive patients had undergone tonsillectomy with the indication of chronic recurrent tonsillitis, and the other patient had undergone adenotonsillectomy for obstructive adenotonsillar hypertrophy. PCR test was positive in the adenoidectomy specimen and negative in the tonsillectomy specimen in this patient. ConclusionsAdenotonsillectomy can be done safely in asymptomatic patients without a history of Covid-19, with a negative PCR test result obtained within the last 24 h.

Evaluation of Choroidal Thickness of Children with Advanced Obstructive Adenotonsillar Hypertrophy

Amaç: Adenotonsiller hipertrofiye bağlı obstrüktif uyku apne sendromu (OUAS) olan çocuklarda koroid kalınlığındaki değişiklikleri normal kontrol grubundaki değerlerle karşılaştırıp değerlendirmek.

Auditing adenotonsillectomy: The Makurdi, North Central Nigeria, experience

Background: Adenoidectomy, tonsillectomy, or both are a leading cause of surgical admission, especially in children, in otolaryngological practice in the world. This study aimed to audit the demography, symptoms/signs, indications, types of surgery, postoperative outcome, and histopathological evaluation of adenotonsillectomy in Makurdi, Nigeria. Methods: This was a 3-year retrospective study. Record of total surgical procedures was taken and data of patients who had adenoidectomy, tonsillectomy, or both were retrieved. The data extracted included study population demography, symptoms/signs, indication and surgery carried out, postoperative care, and histopathological reports of specimens. The primary outcomes were symptoms/signs, indication, and type of surgery, whereas postoperative management and histopathological examination findings were secondary consideration. Ethical clearance was obtained. The data were analyzed. Results: Two hundred and twenty different types of surgeries were done within the study period. Seventy-two patients (32.7%) underwent adenoid and tonsil surgeries, comprising 46 males and 26 females; age ranged from 1 to 38 years with mean age of 6.63 ±7.78 years. Majority (68.0%) of the patients were ≤5 years old. Snoring and noisy breathing were common presentations. Obstructive adenotonsillar hypertrophy at 63.9% was the most frequent indication for surgery and adenotonsillectomy constituted the most performed procedure. Postoperatively, all the patients had routine antibiotics, analgesics, and were commenced on graded oral feeds. Nine (12.5%) and six (8.3%) patients had postoperative vomiting and fever, respectively. There were no complications of hemorrhage or fatality. The patients were kept for 2 to 3 days. Histopathology results showed follicular hyperplasia (61.1%) and chronic inflammation (38.9%). Conclusion: Adenoid and tonsillar surgeries still constitute common procedures among children in Makurdi and obstructive adenotonsillar hypertrophy and its surgery is commonly encountered with satisfactory outcome. Routine histopathological examination of nonsuspicious adenoid and tonsil specimens should be discouraged.

The concatenation of association between gastroesophageal reflux and obstructive adenotonsillar hypertrophy

ObjectivesGastroesophageal reflux (GER) is frequently seen in patients with adenotonsillar hypertrophy. However, the sequential association between GER and adenotonsillar hypertrophy is unknown. This leads to unpredictable outcomes while treating patients of adenotonsillar hypertrophy with GER. The objective of this study is to evaluate the prevalence of GER and gastroesophageal reflux disease (GERD) in paediatric patients with obstructive adenotonsillar hypertrophy (OATH), and to assess the effect of adenotonsillectomy (AT) on GER as well as GERD. MethodsIn this prospective cohort study, consecutive pediatric patients with grade III/IV hypertrophy of adenoid or/and tonsillar tissue who were planned for AT were recruited after excluding comorbidities predisposing to GER. Symptoms of GERD using Gastro Esophageal Reflux Questionnaire for Young Children (GERQ-YC) and Reflux Indices (RI) obtained from 24-h ambulatory esophageal pH monitoring were evaluated in all patients pre-operatively and 12 weeks following AT. ResultsA total of 49 patients with OATH with average age of 6 years were included in this study. With a RI of >4.3% as the threshold for making the diagnosis of GER on esophageal pH monitoring, the prevalence of GER was 20.4%. The average RI preoperatively was 15.7% which reduced to 1.7% following AT (p = 0.004). Among the 10 patients with preoperative GER, 80% of the patients had no evidence of GER after surgery. New incidences of GER was not observed post operatively in this cohort. As per the GER symptom scoring system, 31% of the parents reported GERD pre-operatively which resolved completely in all patients following surgery. Conclusions– In this study, the prevalence of GER proven by 24 h ambulatory esophageal pH monitoring is 20% in pediatric patients with OATH. Following AT, GER resolved in 80% of cases and was reduced substantially in the remaining cases in the subset of patients with pre-operative GER. The symptoms of GERD based on parents' recall of child's previous symptoms may not accurately represent presence of GER. Our results suggest that OATH can result in GER due to increased negative intra-thoracic pressure as a result of breathing against an obstructed upper airway and hence, GER subsides following surgical removal of the obstructive pathology. To establish this concatenational association of OATH and GER, larger studies are mandated.

Association between adenotonsillar hypertrophy and leptin, ghrelin and IGF-1 levels in children

ObjectiveDevelopmental and growth retardation is a condition that is often encountered among children with adenotonsillar hypertrophy (ATH). Leptin, ghrelin and IGF-1 are important factors in growth and development for children. The aim of the study was to investigate serum leptin, ghrelin and IGF-1 levels in children with ATH compare with healthy controls. Material method82 children between ages 6–12 were included in this study, divided into two groups. The first group being the study-group consisted of 42 children with obstructive adenotonsillar hypertrophy and the second group being the control-group consisted of 40 healthy children. At 08:30 a.m., peripheral blood samples were extracted from children from both groups to examine the serum levels, and kept in −40 °C until the Elisa test. ResultsLeptin serum level of the control-group was found to be statistically significantly higher than the serum leptin level of the ATH group (p = 0,049; p < 0.05). Body mass indexes of the children with ATH were found to be statistically significantly lower than the body mass index (BMI) of the control group (p = 0,001; p < 0.05). In contrast, there was no statistically significant difference between ghrelin and IGF-1 levels between the ATH and control group (p = 0.193, p > 0.05 and p = 0.478, p > 0.05, respectively). ConclusionUpper airway infections are common in children with ATH. Increased airway infections and obstructive enlarged adenotonsillar lymphoid tissue which are caused swallowing difficulties can lead to reduced oral intake and fat tissue. It has led us to think that, ghrelin levels may be increasing secondary to these problems in children with ATH. Furthermore, BMI and leptin would be lower in children with ATH, considering adipose tissue was lesser and leptin was being synthesized and oscillated out of the fat cells of the tissue in these children.

Effectiveness of adenotonsillectomy in resolution of enuresis in children with sleep-disordered breathing: a hospital based prospective cohort study in Dar es Salaam, Tanzania

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Adenotonsillar hypertrophy remains to be the commonest causes of sleep disordered breathing in paediatric patients and has been implicated as a cause of primary and secondary enuresis. The aim of this study was to determine the effectiveness of adenotonsillectomy in resolution of enuresis in children with sleep-disordered breathing.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A hospital based prospective cohort study was conducted at Ekenywa Specialised Hospital in Dar es Salaam, from May 2018 to February 2019. Two hundred children aged 3 to 15 years with obstructive adenotonsillar hypertrophy who were admitted ready to undergo adenotonsillectomy were evaluated. Upon such evaluation, the primary outcome was the number of bedwetting incidents (nocturnal enuresis) post-operatively compared with pre-operative incidents. Patients were kept under follow-up for 3 months. Data were collected using structured questionnaires regarding number of bedwetting incidents, type of enuresis (primary or secondary) and family history of enuresis. Data was analyzed using SPSS version 21 and p-values &amp;lt;0.05 were considered to be statistically significant. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Of 200 children admitted for adenotonsillectomy, 80 (40%) had a positive history of preoperative enuresis, including 35 (43.8%) girls and 45 (56.2%) boys. All parents for the children consented to participate in the study. Three months after adenotonsillectomy, enuresis had resolved completely in 50 (62.5%) children and had shown relative improvement in 25 (31.3%) children. Enuresis had not improved in the remaining 5 (6.3%) children (p&amp;lt;0.05).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Findings from this study indicates that adenotonsillectomy can improve nocturnal enuresis and day-time incontinence in the majority of children with adenotonsillar hypertrophy.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Impact of emotional distress on caregivers burden among Nigerian children with Obstructive Adenotonsillar hypertrophy

BackgroundDespite the significance of the role of caregivers among children with Obstructive Adenotonsillar hypertrophy (OAT), their caregiving experience and emotional well-being are given poor attention in research, policy and service design. This study represents a novel effort sought to investigate the burden experienced by caregivers of children with OAT and the impact of emotional distress on their caregiving burden. MethodologyA total of one hundred consecutive caregivers of children with OAT were interviewed with designed socio-demographic questionnaire. This was subsequently followed by administration of General Health Questionnaire-12 (GHQ-12) to ascertain emotional distress using cut-off score ≥3 and Zarit Caregivers Burden of care scale was used to characterize the pattern of burden experienced by these caregivers. ResultsIn this study, the mean ages of children with OAT and their caregivers were 36.7(±21.8) months and 34.4(±5.4) years, respectively. The affected children were mainly males (68%), while their caregivers were predominantly females (84%). Fifty-seven percent of children with OAT were schooling but 13% of them had academic delay. Majority of the caregivers (66%) had a tertiary level of education. Of the total participants, up to 43% reported various degrees of burden of care, with majority (34%) of them reporting mild to moderate burden of care. In the same vein, 48% were emotionally distressed. Following regression analyses, emotional distress was independently associated with burden of care among participants (Odds ratio [OR]=0.108; 95% Confidence Interval [95% CI]=0.043–0.272; p<0.001). ConclusionCaregivers of children with OAT reported the experience of various degrees of burden, and worse among caregivers with emotional distress. Overall, the level of distress and burden observed in this study were many-fold what has been reported among caregivers of other populations of children. The results of this study support the proposal of proactive measures to address the psychosocial needs of caregivers as integral to the care of children with OAT. Further research on the well-being of caregivers is also justified.

DNA damage in children with obstructive adenotonsillar hypertrophy.

The objective of this prospective, controlled study was to evaluate oxidative DNA damage in children with obstructive adenotonsillar hypertrophy. This study included 30 patients with obstructive adenotonsillar hypertrophy (male/female ratio, 3:2; age range, 3-9 y) scheduled to undergo tonsillectomy and adenoidectomy and 25 control subjects of similar age and sex with no adenotonsillar disease or airway obstruction. Urine and blood samples were obtained from each child for 8-hydroxy 2-deoxyguanosine (8-OhdG) and malondialdehyde (MDA) concentrations. There were significant differences in leukocyte (3.28 [0.69/10] vs 0.70 [0.15/10] dG) and urine 8-OhdG (8.22 [2.27/10] vs 5.26 [1.3/10] dG) levels in patients with obstructive adenotonsillar hypertrophy and healthy subjects (P < 0.001 for both). Plasma (2.98 [1.31] vs 1.14 [0.64] μM) and urine (1.77 [0.84] vs 0.56 [0.32] μM) MDA levels were also different (P < 0.001 for both). There were positive correlations between 8-OhdG in leukocyte DNA and plasma MDA (r = 0.648, P < 0.001) and between levels of urine 8-OhdG excretion and urine MDA (r = 0.588, P < 0.001). The DNA damage in children with adenotonsillar hypertrophy should be kept in mind, but further studies must be done with larger patient groups.

Insulin-like growth factor alpha changes after tonsillectomy for obstructive and nonobstructive causes

Abstract To assess the effect of tonsillectomy, weather performed for obstructive or nonobstructive causes, on the serum levels of insulin-like growth factor alpha (IGF-1). This prospective study was carried out on 60 children who underwent tonsillectomy or adenotonsillectomy at Zagazig University Hospitals. The children were divided into two groups: the first group included 30 children who underwent tonsillectomy because of obstructive symptoms and the second group included 30 children who underwent tonsillectomy because of recurrent tonsillitis with no manifestations of upper-airway obstruction. Preoperative and 3 months’ postoperative blood levels of IGF-1 were estimated and the data were statistically analyzed. Six children from the first group (24 children) and four children from the second group (26 children) did not follow-up after surgery and were excluded from the study. Both study groups were matched for age and sex. In the first (obstructive) group, there was a statistically significant increase in the mean level of IGF-1 from 119.08109 ± 27.81797 preoperatively to 222.395 ± 6.62559 postoperatively and the difference was significant (P < 0.0001). However, in the second (infection) group, the mean IGF-1 values increased from 155.0715 ± 89.83015 preoperatively to 191.4075 ± 57.38667 postoperatively, and the difference was not significant (P = 0.0883). Insufficient weight and height gain in children who had obstructive adenotonsillar hypertrophy could be attributed to low IGF-1, and this can be corrected after surgery. This is not the case in patients with chronic tonsillitis without upper-airway obstruction, and other factors may explain the retarded growth in these patients. Study design A prospective study.

Polysomnographic findings of obstructive sleep apnea in children with adenotonsillar hypertrophy

Serous Background: There are few studies assessing the clinical manifestations of sleep breathing disorders and polysomnograms in several pediatric age ranges. This studied aimed to assess polysomnography results such as apnea-hypopnea index, mean oxygen saturation and sleep efficiency in children presenting with airway obstruction and adenotonsillar hypertrophy complaints, and to establish whether they are correlated to age and sex. Methods: A retrospective study with children of both sexes, aged between 2 and 12 years, with clinically suspected obstructive sleep apnea syndrome and adenotonsillar hypertrophy, who underwent polysomnography before surgery. The children were allocated to groups according to their age range (Group I: 2 to 4 years old; Group II: 5 to 8 years old; Group III: 9 to 12 years old). Apnea-hypopnea index, mean oxygen saturation and sleep efficiency data were compared between sexes and among the three groups (Student’s t test, p

DNA Damage in Children with Snoring

Objective: Learning the levels of oxidative DNA damage in children with obstructive adenotonsillar hypertrophy. We determined the 8-hydroxy 2-deoxyguanosine levels in leukocyte DNA and in urine samples as a specific marker of oxidative damage to DNA, and the plasma and urine malondialdehyde levels as an index of lipid peroxidation in children. Method: Prospective, randomized controlled study conducted between 2010 and 2011. The study consisted of 30 patients and 25 healthy controls. Patients had snoring and pauses of breathing during sleep. We obtained blood and urine samples from each child to measure 8-hydroxy 2-deoxyguanosine and malondialdehyde levels in their initial visit. Results: A significant difference was observed in leukocyte and urine 8-hydroxy 2-deoxyguanosine levels in patients with obstructive adenotonsillar hypertrophy compared to controls (P &lt; .001 for both). Similarly, a significant difference was observed in plasma and urine malondialdehyde levels in patients with obstructive adenotonsillar hypertrophy compared to controls ( P &lt; .001 for both). In addition, significant correlations were observed between the levels of 8-hydroxy 2-deoxyguanosine in leukocyte DNA and plasma malondialdehyde ( r = 0.648, P &lt; .001), and between the levels of urine 8-hydroxy 2-deoxyguanosine excretion and urine malondialdehyde ( r = 0.588, P &lt; .001). Conclusion: 8-hydroxy 2-deoxyguanosine in leukocyte DNA and urine levels in children can be useful as an indicator for obstructive adenotonsillar hypertrophy screening.

Outcome of Adenotonsillectomy for Sleep and Breathing Difficulties in Nigerian Children with Obstructive Adenotonsillar Enlargement

The aim of this study was to examine improvements or otherwise, in sleep disturbance and breathing difficulties after adenotonsillectomy (AT) for chronic upper airway obstruction in children. In a prospective clinical study and tertiary referral center setting, the study population included consecutive children aged 1.5 through 12years who underwent AT for chronic upper airway obstruction due to adenotonsillar enlargement, without any history of previous AT. The validated "Symptomatology score" (SS) parameters were used to grade the symptoms before and after AT. The extent of improvement of the symptoms after surgery were estimated by a standardized response mean (SRM). The study included 59 children, 40 of whom were males (68%). Their ages ranged from 1.5 to 12years with a mean of 3.3years and 63% were <4years. The results showed that tonsillar size was correlated significantly with a high preoperative SS (P≤0.001). The mean preoperative SS for the study population was 7.2, whereas the mean postoperative SS was 1.7. This change was highly significant (P<0.001). The symptom domain with the greatest change in mean score was snoring, which improved by 2 points with SRM of 2.2. The changes in total score and in the scores for each symptom domain were highly significant (P<0.002). We concluded that adenotonsillectomy is associated with remarkable improvement in breathing difficulties and sleep disturbances in children with obstructive adenotonsillar hypertrophy regardless of the condition whether it is mild or severe.

Identification and Immunolocalization of the Innate Immune Receptor CD14 in Hypertrophic Adenoids and Tonsils

The purpose of this study is to determine the expression of CD14 as a marker of the innate immunity in hypertrophic adenoids and tonsils. Twenty-four pediatric patients (age <12 years) with obstructive adenotonsillar hypertrophy, confirmed by sleep study were included in this study. Intensity and expression of positive CD14 infiltrating cells was assessed by immunohistochemistry in specific histologic areas. In tonsils, CD14 immunoreactivity was demonstrated in intraepithelial lymphocytes located in the basal layer of the stratified squamous mucoepithelium. CD14 expression was significantly higher in mucosal layers and inter-follicular areas of tonsils than adenoid tissues [(p < 0.001), (p = 0.021), respectively]. CD14 expression was significantly higher in the submucosal layers of adenoids than tonsil tissues (p = 0.002). Hypertrophic adenoids and tonsils from children with OSA are prominent sites of innate defense, with over expression of CD14. The enhanced expressions of CD14 cells in adenoids and tonsils may be an important factor for the development and persistence of adenoids and tonsils enlargement causing OSA in children. CD14 expression in adenoids and tonsils illustrates an important immunological sentinel function of the innate immunity of the upper airway.

Do children with adenotonsillar hypertrophy have lower IGF-1 and ghrelin levels than the normal children?

Objectives We aimed to determine serum IGF-1 levels and plasma ghrelin levels in male children with adenoid and tonsillar hypertrophy and compare with healthy controls. Methods Forty-four male children with obstructive adenotonsillar hypertrophy between the ages of 8 and 11.9 years (mean 9.98 ± 0.98 years) and age matched 40 healthy male children (between 8 and 12 years old, mean 9.83 ± 0.85 years) as control group were enrolled in this study. In both the groups plasma ghrelin and serum IGF-1 levels were measured at 08.30, in the morning. Results Male children with adenotonsillar hypertrophy had significantly depressed serum IGF-1 levels (227.29 ± 83.11 ng/ml) and plasma ghrelin levels (389.67 ± 170.94 pg/ml) compared to control group (389.67 ± 170.94 ng/ml and 629.76 ± 263.62 pg/ml respectively, p < 0.05). Body mass indexes of children with adenotonsillar hypertrophy were significantly lower than those of their healthy peers (15.72 ± 2.08 kg/m 2 and 19.12 ± 2.79 kg/m 2 respectively, p < 0.05). Conclusions Delayed growth in male children with adenotonsillar hypertrophy may be related to the lower serum IGF-1 and plasma ghrelin levels compared to that of normal male controls. Since ghrelin increases hunger and food intake and its levels increase before the meals, lower levels lead to decreased appetite and also swallowing difficulties in children with adenotonsillar hypertrophy may lead to suboptimal nutrition. Lower serum levels of IGF-1 in children with adenoid and tonsillar hypertrophy may be secondary to deficient growth hormone stimulation by ghrelin.

Parental satisfaction with post-adenotonsillectomy in the developing world

Tonsillectomy with or without adenoidectomy is one of the most commonly performed surgical procedures by the otolaryngologists in the pediatric population. The aim of this study is to evaluate parental expectation and satisfaction following tonsillectomy with or without adenoidectomy. Hospital-based prospective study of all consented parents whose children had tonsillectomy with or without adenoidectomy over a period of 13 months (February 2008 to February 2009) using a cross-sectional method. Pre- and post-surgical questionnaire-based Interview was conducted for them and information retrieved included biodata, pre- and post-surgical symptoms on follow-up in the clinic of obstructive sleep apnoea, snoring, mouth breathing and rhinorrhea, parental expectation and satisfaction after surgery. All data were entered into statistical data using SPSS version 11 and analyzed and the results are presented in tables and figures. A total of 29 patients had adenotonsillar surgery, who were within the age range of 1.50-14 years with a mean age of 5.50 (SD=4.06+/-0.75). M:F ratio was found to be 3:1 (22 males and 7 females). Parents were satisfied with the expected outcome in terms of symptoms post-operatively in 96.6% while only one 3.4% were not satisfied. Majority of the parents (96.6%) were satisfied with the expectation of immediate resolution of symptoms; however, obstructive adenotonsillar hypertrophy remains an important problem to be solved to achieve total parental satisfaction in adenotonsillar operations.

Associação entre hipertrofia adenotonsilar, tonsilites e crises álgicas na anemia falciforme

OBJETIVOS: Determinar a prevalencia da hipertrofia adenotonsilar obstrutiva em criancas e adolescentes portadores de anemia falciforme; investigar possivel associacao entre presenca de mais de cinco episodios de tonsilite nos ultimos 12 meses e episodios de crise algica no mesmo periodo; e comparar a hemoglobina anual media entre os que apresentam e os que nao apresentam hipertrofia adenotonsilar obstrutiva. METODOS: Trata-se de estudo prospectivo, observacional do tipo corte transversal, com 85 criancas e adolescentes com anemia falciforme. Todos responderam questionario e avaliacao otorrinolaringologica, incluindo endoscopia nasossinusal. Para o diagnostico da hipertrofia adenotonsilar obstrutiva foram adotados os criterios de Brodsky. RESULTADOS: A prevalencia da hipertrofia adenotonsilar obstrutiva foi de 55,3%. A hipertrofia adenotonsilar obstrutiva associou-se a historia de dificuldade para alimentar-se (76,7 versus 23,5%; p = 0,003), presenca de mais de cinco episodios de tonsilites nos ultimos 12 meses (70,6 versus 29,4%; p = 0,021), roncar alto (73,0 versus 27,0%; p = 0,004) e apneia do sono assistida (71,8 versus 28,2%; p = 0,005). Portadores de hipertrofia adenotonsilar obstrutiva apresentaram maior numero de infeccoes das vias aereas superiores (62,5 versus 37,5; p = 0,010). Tambem foi observada associacao entre presenca de mais de cinco episodios de tonsilite nos ultimos 12 meses e episodios de crise algica no mesmo periodo (mediana = 12 versus 2; p = 0,017). Nao houve diferenca significante da hemoglobina anual media entre portadores de hipertrofia adenotonsilar obstrutiva versus hipertrofia adenotonsilar nao-obstrutiva (7,6 versus 8,2 g/dL; p = 0,199). CONCLUSAO: A prevalencia da hipertrofia adenotonsilar obstrutiva foi de 55,3% em criancas e adolescentes com anemia falciforme. A presenca de mais de cinco episodios de tonsilite nos ultimos 12 meses associaram-se com episodios de crise algica no mesmo periodo; e nao houve diferenca quanto ao valor da hemoglobina anual media entre os que apresentaram e os que nao apresentaram hipertrofia adenotonsilar obstrutiva.

Association between adenotonsillar hypertrophy, tonsillitis and painful crises in sickle cell disease

To determine the prevalence of obstructive adenotonsillar hypertrophy in children and adolescents with sickle cell anemia; to investigate possible association between the presence of more than five episodes of tonsillitis in the last 12 months and episodes of painful crises in the same period; and to compare the mean annual hemoglobin level in children and adolescents with and without obstructive adenotonsillar hypertrophy. Prospective, observational, cross-sectional study involving 85 children and adolescents with sickle cell anemia. All patients answered a questionnaire and underwent a standard otolaryngology examination, including endoscopic endonasal approach. The diagnosis of obstructive adenotonsillar hypertrophy was made according to the Brodsky scale. The prevalence of obstructive adenotonsillar hypertrophy was 55.3%. Obstructive adenotonsillar hypertrophy was associated with history of difficulty in eating (76.7 vs. 23.5%, p = 0.003), presence of more than five episodes of tonsillitis in the last 12 months (70.6 vs. 29.4%, p = 0.021), loud snoring (73.0 vs. 27.0%, p = 0.004), and sleep apnea (71.8 vs. 28.2%, p = 0.005). Patients with obstructive adenotonsillar hypertrophy had more episodes of recurrent upper airway tract infection (62.5 vs. 37.5; p = 0.010). The presence of more than five episodes of tonsillitis in the last 12 months was associated with episodes of painful crises (median = 12 vs. 2, p = 0.017). There was no significant difference between mean annual hemoglobin levels of patients with obstructive adenotonsilar hypertrophy vs. nonobstructive adenotonsillar hypertrophy: 7.6 vs. 8.2 g/dL, p = 0.199. The prevalence of obstructive adenotonsillar hypertrophy was 55.3% in children and adolescents with sickle cell anemia; the presence of more than five episodes of tonsillitis in the last 12 months was associated with episodes of painful crises in the same period; and there was no difference in the mean annual hemoglobin value among those with or without obstructive adenotonsillar hypertrophy.

A prospective multi-centre randomised controlled trial comparing PlasmaKnife with bipolar dissection tonsillectomy: Evaluating an emerging technology

To clinically evaluate and compare the PlasmaKnife to bipolar electrocautery in paediatric tonsillectomy. A prospective, multi-centred, double-blinded randomised controlled trial, conducted in central London teaching hospitals. The participants were 100 patients aged 2-16 years with recurrent tonsillitis or obstructive adenotonsillar hypertrophy awaiting a tonsillectomy were recruited in to the study. The primary outcome measures were throat, ear and swallowing pain scores over two weeks. Secondary outcome measures were return to normal diet, return to normal activity, analgesic requirements, operation time and intra-operative blood loss. Surgical dissection was similar between the two groups with minimal blood loss and comparable overall operative times. We found that PlasmaKnife tonsillectomy caused more throat pain at 24 h (p=0.02). There was a tendency for a higher proportion in the bipolar dissection group to return to a normal diet, at day 3 (p=0.05) and at day 7 (p=0.04). The bipolar dissection returned to normal activities in a larger proportion than the PlasmaKnife group at day 3 (p=0.02) and at day 7 (p=0.01). There is some evidence of an association between use of analgesia at day 14 and method of tonsillectomy (p=0.03); the PlasmaKnife group tended to use less analgesia. During the study, four secondary bleeds occurred in the PlasmaKnife group and one in the bipolar dissection group, and all were managed conservatively. Our study has found no significant advantage to PlasmaKnife over bipolar diathermy tonsillectomy. However, this preliminary study finds PlasmaKnife to be an interesting instrument and may warrant a larger randomised study to evaluate the potential advantages.