Tonsil Size Research Articles

Predictors of Obstructive Sleep Apnea Severity in Adolescents

Untreated obstructive sleep apnea has severe health consequences, yet little is known about predictors of sleep apnea severity in the adolescent population. To evaluate clinical and demographic factors associated with obstructive sleep apnea severity in adolescents. A retrospective case series of 224 children (53% male), ages 12 to 17 years who underwent polysomnography from January 1, 2013, to June 4, 2015. The study was carried out in a large tertiary referral children's hospital associated with an academic medical center in Dallas, Texas. Children were excluded if they were missing clinical data (eg, tonsil size), had major comorbidities (eg, chromosomal abnormalities), or had previously undergone tonsillectomy and adenoidectomy. The mean (SD) age was 14.6 (1.7) years (range, 12.0-17.9 years), and the patients were 55% Hispanic, 30% African American, 13% white, and 2% other. Electronic medical records were reviewed for demographic, clinical, and polysomnographic parameters. Correlation between demographic and clinical characteristics and the apnea hypopnea index. In 224 adolescents (53% male) aged 12 to 17 years, the mean (SD) apnea hypopnea index was 14.9 (28.7) (range, 0.0-187.7) and was positively correlated with CDC-defined weight categories (P = .04) and tonsillar hypertrophy (P < .001). Sex, ethnicity, and age were not associated with the apnea hypopnea index. Severe obstructive sleep apnea (apnea hypopnea index >10) was more common in males (OR, 1.8; 95% CI, 1.0-3.2), patients with tonsillar hypertrophy (OR, 3.2; 95% CI, 1.8-5.8), and patients in a heavier CDC weight class (OR, 2.0; 95% CI, 1.3-3.2). Age and ethnicity did not predict severe obstructive sleep apnea. Obstructive sleep apnea in adolescents is associated with obesity and tonsillar hypertrophy in this study. Severe obstructive sleep apnea is more likely in adolescents who are male or obese, or who have tonsillar hypertrophy. This study supports routine polysomnography in obese male adolescents with tonsillar hypertrophy and symptoms of sleep-disordered breathing to screen for and treat severe obstructive sleep apnea.

Histomorphological comparison of tonsil of Large WhiteYorkshire and indigenous pigs of Kerala, India

The present study was undertaken to compare the distribution and histomorphology of the tonsil of soft palate in Large White Yorkshire and indigenous pigs of Kerala. Tissue samples were collected from12 apparently healthy adult male animals. In both the groups of pigs, the tonsil of soft palate was located in the oropharynx and was found to be larger in Large White Yorkshire. Histological structure of tonsil of soft palate revealed that the average number of lymphatic nodules per microscopic field and lymphocyte count per nodule was maximum in indigenous pigs. Statistically significant differences were recorded in the average size of tonsils, crypt depth, number and size of lymphatic nodules and lymphocyte count per nodule in Large White Yorkshire and indigenous pigs.

Transcervical ultrasonographic examination of palatine tonsil size and its correlation with age, gender and body-mass index in healthy children

ObjectiveOur aim was to assess the palatine tonsil size with transcervical ultrasonography in healthy children and to analyze whether the palatine tonsil size is correlated with age, gender and body-mass index (BMI). MethodsThis series consisted of 680 healthy children (340 females, 340 males) who underwent transcervical ultrasonography for evaluation of palatine tonsil size. A total of seventeen age groups (range: 1–17 years) comprised of 40 children (20 females, 20 males) were constituted. Demographic data including gender, height, weight and BMI were noted. Correlation between baseline descriptive data and tonsil volume was investigated. ResultsThe average age was 102.51 ± 59.24 months (range: 12 to 204) and body-mass index was 17.50–5.16 kg/m2 (min: 12.4-max:25.8). The average tonsil volume was 1819.5–2023.5 mm3 (min:601, max: 4007). The tonsil volume did not differ significantly between females and males (p = 0.108). However, there was a significant difference between tonsil volumes of various age groups (p < 0.001). Tonsil size seemed to be greater in parallel with advancement of age (p < 0.001) and increased BMI (p < 0.001). ConclusionTranscervical ultrasonography can be an accurate, safe, cheap, non-invasive and accessible measure for evaluation of the size of tonsils objectively. There were strongly positive correlations between age, BMI and palatine tonsil size in healthy children and variability with respect to descriptive characteristics must be considered during diagnostic procedures and preoperative evaluation. Advances in knowledgeIn our study, we suggest that transcervical ultrasonography can be an accurate, safe, cheap, non-invasive and accessible measure for evaluation of the size of tonsils. There were positive correlations between age, BMI and palatine tonsil size in healthy children.

Ultrasonographic assessment of tonsillar volume in children

ObjectivesAdenotonsillar hypertrophy in children is the most common anatomical abnormality associated with obstructive sleep apnoea. Perioperative complications associated with adenotonsillectomy are more common in children with severe obstructive sleep apnoea. An objective preoperative method to determine the size of tonsils is missing. This study assessed the validity of ultrasound as a tool for measuring tonsillar size in children. MethodsSingle-institution prospective study of twenty-six children aged 2–6 years who underwent elective bilateral tonsillectomy. Trans-cervical ultrasonographic assessment of tonsillar size prior to tonsillectomy operation was performed. We assessed correlation of ultrasonographic and actual tonsillar volume. ResultsA total of 52 tonsils from 26 patients were measured. Actual and ultrasonographic mean tonsillar volume (±SD) was 3.9 (±2.1) ml and 3.6 (±2.5) ml, respectively (P = 0.24). Ultrasonographic and actual measurements correlated well (r = 0.89). ConclusionsThis is the first study to show that ultrasound is a suitable objective method for determining tonsillar volume in paediatric patients. Preoperative ultrasound assessment of tonsillar anatomy and size may be an additional and suitable, objective method in the development of a risk stratification system in children with obstructive sleep apnoea undergoing tonsillar surgery.

The size of palatine tonsils cannot be used to decide the indication of tonsillectomy for IgA nephropathy.

Background. Tonsillectomy is one of the treatment strategies for immunoglobulin A nephropathy (IgAN). The relationship between the indication of tonsillectomy and the size of palatine tonsils (PTs) in patients with IgAN remains controversial. Methods. This retrospective cohort study investigated 57 patients with IgAN who underwent tonsillectomy combined with steroid pulse therapy (SPT). They were classified into two groups, the hypertrophy group and the nonhypertrophy group, according to the weight of their excised PTs. The effects of tonsillectomy combined with SPT on clinical remission (CR) and the histopathological findings of PTs were compared between the two groups. Results. During the mean follow-up period of 45.5 (range 6–133) months, 78.9% of the patients achieved CR (79.3 versus 78.6%, P = 0.945) and the baseline serum creatinine doubled only in one patient in the nonhypertrophy group (0 versus 3.6%, P = 0.491). No significant difference was observed in the incidence of CR between the two groups by the Kaplan–Meier method (P = 0.839). The predictor for CR, identified in Cox proportional hazards models, was baseline proteinuria [hazard ratio 0.14 (95% CI 0.032–0.621) P = 0.010]. Although macroscopic pus plugs were observed on the surface of PTs in almost 60% of patients in each group, microscopic pus plugs in the crypt and the enlarged interfollicular area were observed in all patients. Conclusions. The treatment effect of tonsillectomy combined with SPT and the pathological features of PTs in IgAN were equal, regardless of the size of the PTs. Therefore, the size of PTs should not be included as a factor when deciding the indication of tonsillectomy for IgAN.

The frequency of sleep-disordered breathing in children with asthma and its effects on asthma control

ABSTRACTBackground: The presence of sleep-disordered breathing (SDB) in children with asthma may cause difficult to control asthma. Objectives: The aim of this study was to determine the frequency of SDB in children with asthma, to evaluate its effects on asthma control and to assess the risk factors associated with the presence of SDB. Methods: Parents of children who Sleep Questionnaire (PSQ) and the Childhood Asthma Control Test (C-ACT). Asthma control level was assessed according to Global Initiative for Asthma (GINA). Same ear–nose–throat (ENT) specialist evaluated all patients. A 4-point tonsil grading method and adenoid-nasopharynx ratio were used to categorize tonsil and adenoid size, respectively. Results: A total of 408 children (275 male, 67.4%) with a mean age of 8.1 ± 3.2 years were included. Nearly 40% of asthmatic children were not-well-controlled according to GINA and 34.6% of all patients had SDB according to PSQ. Multivariate logistic regression analysis revealed that coexistence of SDB [OR: 6.62, 95% CI (4.21–10.41); p < 0.001)] and tonsillar hypertrophy [OR: 3.47; 95% CI (1.05–11.5); p < 0.041] were independent risk factors for not-well-controlled asthma in asthmatic children after other established contributors to asthma control were adjusted. Conclusions: Our study showed that SDB is a strong risk factor for not-well-controlled asthma in asthmatic children independent of other confounders. In addition, tonsillar hypertrophy may have a role in the association between SDB and not-well-controlled asthma in childhood.

Predictors of failure of DISE-directed adenotonsillectomy in children with sleep disordered breathing

BackgroundAdenotonsillectomy (AT) is the most commonly performed procedure for sleep disordered breathing (SDB) in pediatrics. However, 20-40% of patients will have persistent signs and symptoms of SDB after AT. Drug-induced sleep endoscopy (DISE) has the potential to individualize surgical treatments and avoid unnecessary or unsuccessful surgeries. The objective of this study was to determine the predictors of failure of DISE-directed adenoidectomy and/or tonsillectomy in otherwise healthy children with SDB.MethodsWe retrospectively reviewed a prospective database of children who presented with SDB. All patients underwent preoperative pulse oximetry (PO), followed by DISE with T ± A, The variables documented included demographics, ethnicity, co-morbidities, family history, McGill Oximetry Score (MOS) on PO, as well as findings of collapse and or obstruction on DISE and symptom resolution based on modified Pediatric Sleep Questionnaire (PSQ). The primary outcome was the independent predictors of treatment failure based on multivariate binary logistic regression.ResultsThree hundred eighty-two patients satisfied the inclusion criteria. Based on post-operative modified PSQ, SDB resolved in 259 patients (68%), whereas 123 (32%) had persistent symptoms. On bivariate analysis, neuropsychiatric diagnosis (r = 0.286, p = 0.042), history of sleepwalking or enuresis (r = 0.103, p = 0.044), MOS (r = 0.123, p = 0.033), presence of DNS (r = 0.107, p = 0.036), and presence of laryngomalacia (r = 0.122, p = 0.017) all positively correlated with treatment failure. Small tonsil size on DISE correlated with treatment failure (r = −0.180, p < 0.001). Multivariate analysis identified age greater than 7 years (OR = 1.799, [95% CI 1.040–3.139], p = 0.039), obesity (OR = 2.032, [95% CI 1.043–3.997], p = 0.040), chronic rhinitis (OR = 1.334, [95% CI 1.047–1.716], p = 0.025), deviated nasal septum (OR = 1.745, [95% CI 1.062–2.898], p = 0.031) and tonsil size (OR = 0.575, [95% CI 0.429–0.772], p < 0.01) as independent predictors of treatment failure.ConclusionsObese, asthmatic, and children older than seven years are at increased risk of treatment failure after DISE-directed AT. Several DISE findings can independently predict AT failure, including tonsil size, degree of chronic rhinitis, and the presence of a deviated nasal septum, and can be addressed at a second stage. Further research is needed into the role of DISE in surgically naïve patients with SDB, and to compare DISE-directed surgery with the current standard of care.

Does drug-induced sleep endoscopy change the surgical decision in surgically na\xefve non-syndromic children with snoring/sleep disordered breathing from the standard adenotonsillectomy? A retrospective cohort study

BackgroundAdenotonsillectomy is the most commonly performed operation for pediatric snoring/sleep disordered breathing (S/SDB). However, 20–40% of patients will fail to improve. Drug-induced sleep endoscopy (DISE) may provide a more individualized surgical plan and limit unsuccessful surgeries. The aim of this study was to assess the impact of DISE on surgical decision-making in surgically naïve children with S/SDB.MethodsA retrospective observational cohort study was undertaken at the Stollery Children’s Hospital. Patients 3–17 years of age who underwent DISE-directed surgery for S/SDB between January 2009 and December 2015 were eligible. We excluded other indications for tonsillectomy and syndromic children. The primary outcome was the level of agreement between a DISE-based surgical decision and the reference standard based on the American Academy of Pediatrics (AAP) guidelines via un-weighted Cohen’s kappa. Secondary outcomes included the frequency and type of alternate surgical targets identified by DISE. The agreement on tonsil size between in-office physical assessment and DISE was also calculated. The effectiveness of DISE-directed surgery on postoperative S/SDB was not investigated.ResultsFive hundred fifty-eight patients were included. DISE changed the surgical plan in 35% of patients. Agreement between DISE-based and AAP clinical practice guidelines-based management was low (κ = 0.354 +/- 0.021 [95% CI 0.312–0.395]). An alternate diagnosis or surgical target was identified by DISE in 54% of patients. There was moderate agreement on tonsil size (κ = 0.44 [0.33–0.55]) between DISE and in-office clinical assessment.ConclusionsThis is a first phase diagnostic study, which demonstrates that DISE affects decision-making in surgically naïve children with S/SDB in up to 35% of patients. It has utility in individualizing first stage surgical treatments as well as identifying alternate targets for further surgical or medical therapy, while potentially limiting unsuccessful surgeries. Further studies to examine the effect of DISE on surgical outcomes are required.

Primary mantle cell lymphoma of tonsil: Case report

Introduction: Mantle cell lymphoma is rare type of the mature B cell lymphoma. It includes 4% - 6% of all Non Hodgkin's Lymphomas. Compared to the other subtypes of lymphoma it develops more often in older men, and the median age of patients is 65 years. Primary tonsillar lymphoma accounts for less than 1% of head and neck malignancies. Method: Data obtained from medical records of the patient. Objective: Emphasize the importance of early and accurate diagnosis and early treatment of malignant diseases. Case report: Patient RP, 63 years old, presents with difficult swallowing, hoarseness, enlarged tonsils, snoring. Left tonsil almost sets into the right tonsillar vine, displaces the uvula and covers the isthmus. Respiratory sound is normal, with rhythmic action of the heart and soft abdomen. Good general condition. Echo: enlarged and actively altered lymph glands of the middle right jugular chain, the largest 148x77 mm, on the left side lymph nodes are enlarged, the largest is 143x72 mm. Echo of the abdomen inconspicuous. Lab: WBC 5.9, RBC 5.2, Hb 152, Hct 0.44, SE 10, CK 129, LDH 331, CRP 4.6, ALP 61, fibrinogen 2.4, Ca2+ 2.3, phosphate 0.8; BK, HCV, HBsAg, EB, HIV negative. X-ray of the chest inconspicuous. Admitted to the hematology department of the General Hospital. PH: Immunoproliferative disease. Immunohistochemistry, at the institute of Pathology: IHH CK AE1-AE3, PAX5 +, CD20 +, CD3, bcl2 +, bcl6-, CyklinD1 +, CD23-, CD43 +, MUM1 - / +, Ki67 + in about 20% of the tumor cells. Morphological and immunohistochemical findings: Mantle cell lymphoma. MSCD of the neck, chest and upper abdomen: Left tonsil diameter is 28x32 mm and length is 36mm, with lobular contour and heterogeneous structure, asymmetrically narrowing lumen of the airways to 7 mm. pathologically enlarged submandibular and par jugular lymph nodes (10-15 mm diameter) on the left. There were no pathological findings in the lung parenchyma. Abdominal and retroperitoneal lymph nodes are not enlarged. Abdominal organs in the normal range. Bone marrow biopsy: No signs of lymphoproliferative disease. Haematological consulting team: NHL Mantle cell lymphoma CS IIAE. Chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) according to the protocol. Administered six cycles. After the second cycle of chemotherapy the size of the left tonsil was reduced and patient's breathing and swalowing were less troublesome. Patient completed the therapeutic regimen. and regulary attends follow-ups. Conclusion: Differential diagnosis of unilateral tonsillar swelling should include possibility of a rare type of lymphoma with primary extranodal localization. The role of general practitioner is crucial in establishing the diagnosis.

Ultrasonographic measurement of palatine tonsil size and its correlation with body-mass index and hepatosteatosis in adolescents

Aim: To research the correlation between body-mass index (BMI) and hepatosteatosis with palatine tonsil size measured using transcervical ultrasonography (TCU) in adolescents.

Characteristics and risk factors of snoring and the prevalence of suspected obstructive sleep apnea in children

Background Snoring as a consequence of upper airway obstruc-tion is common in children. Snoring can be considered as normal,but might also reflect a disease such as obstructive sleep apnea(OSA), which is associated with serious morbidities. In Indonesia,data on the characteristics and risk factors of snoring and obstruc-tive sleep apnea is limitedObjectives The aims of this study were to find out the character-istics and risk factors of snoring in children and to determine theprevalence of suspected OSA in snoring children.Methods A cross-sectional study was carried out on children aged5-13 years using parental questionnaires scored according to theBrouilette formula. All children underwent physical examination forweight, height and tonsil size. Adenoid radiology was performedon part of the samples.Results Of the 917 questionnaires distributed, only 658 were com-pleted. The ratio of boys to girls was equal. Obesity was detectedin 18.3% of children, among whom 54.2% snored. Obese childrenwere 2.1 times more likely to snore. Besides obesity, rhinitis andatopy were found to be associated with snoring (PR= , 95%CI ;and PR= , 95%CI ; respectively). Asthma and tonsil hypertrophywere shown not to be predisposing factors of snoring. Childrenwith adenoid hypertrophy were 1.8 times more likely to snore ha-bitually. The prevalence of snoring and suspected OSA in childrenaged 5-13 years were 31.6% and 5.9%, respectively.Conclusion Risk factors of snoring were obesity, adenoid hyper-trophy, atopy and rhinitis. Prevalence of snoring in children age 5-13 years was 31.6% and that of suspected OSA cases was 5.9%.

Comparison of treatment outcomes between intracapsular and total tonsillectomy for pediatric obstructive sleep apnea

BackgroundIntracapsular tonsillectomy (IT) has been advocated as a treatment for pediatric obstructive sleep apnea (OSA). However, evidence in the literature utilizing polysomnography (PSG) is limited. ObjectiveTo examine the experience at a tertiary children's hospital to evaluate the effectiveness and risks of intracapsular tonsillectomy compared to total tonsillectomy (TT) for treating pediatric OSA. MethodsA retrospective study was undertaken of pediatric tonsillectomy cases performed for OSA at a tertiary children's hospital from 2005 to 2010. Patients with recurrent tonsillitis, craniofacial abnormalities, chromosomal abnormalities, neuromuscular disease, and congenital malformations were excluded. Main outcome measures were apnea-hypopnea index (AHI), minimum oxygen saturation (minO2), and surgical complications. ResultsOf the 1583 patients reviewed in this study, there were 75 IT and 93 TT patients with pre- and post-operative PSG results. The IT patients were younger, had lower BMI, larger tonsil size, lower pre-operative (AHI) and lower post-operative AHI (p < 0.05). There was a similar percentage of patients that showed improvement in AHI and minimum oxygen saturation between the IT and TT groups. There were statistically similar average change in AHI and minimum oxygen saturation between the IT and TT groups at 5.6 ± 8.6 and 8.6 ± 12.9, respectively (p = 0.8) as well as similar improvement in minimum oxygen saturation between the two groups at 3.3% ± 4.3% and 3.0% ± 5.2%, respectively (p = 0.66). Of TT patients, 2.9% experienced post-operative bleeding with 1.6% requiring OR for control of hemorrhage. Of IT patients, 2.2% were found to have tonsillar regrowth with 2.0% returning to the OR for secondary tonsillectomy. ConclusionsIntracapsular tonsillectomy, like total tonsillectomy, is effective in improving polysomnogram results in appropriately selected children. Intracapsular tonsillectomy is a suitable option for the surgical treatment of pediatric OSA consequent to its demonstrated efficacy in relieving OSA and its favorable safety profile.

Adenoidectomy for Obstructive Sleep Apnea in Children.

Adenotonsillectomy is the recommended treatment for children with obstructive sleep apnea (OSA). Since adenoidectomy alone may be associated with significantly lower morbidity, mortality, and cost, we aimed to investigate whether adenoidectomy alone is a reasonable and appropriate treatment for children with OSA. Five-hundred fifteen consecutive children diagnosed with moderate-to-severe OSA (apnea-hypopnea index > 5) based on polysomnography and who underwent adenoidectomy or adenotonsillectomy were reevaluated after 17-73 months (mean 41) for residual or recurrent OSA using a validated questionnaire (Pediatric Sleep Questionnaire, PSQ). Failure of OSA resolution was defined as a positive mean PSQ score ≥ 0.33. Contribution of age, obesity, tonsil size, and OSA severity at baseline to adenoidectomy or adenotonsillectomy failure was examined. Positive PSQ score occurred in 15% of the entire sample and was not influenced by age or gender. No difference in failure rate was observed between adenoidectomy and adenotonsillectomy for children who were not obese with apnea-hypopnea index < 10 and had small tonsils (< 3). Children with apnea-hypopnea index ≥ 10 and/or tonsil size ≥ 3 showed a higher failure rate after adenoidectomy compared to adenotonsillectomy (20% versus 9.8%, p = 0.028). We suggest that subjective, long term outcomes of adenoidectomy are comparable to those of adenotonsillectomy in non-obese children under 7 years old with moderately OSA and small tonsils. Hence, adenoidectomy alone is a reasonable option in some children. Future prospective randomized studies are warranted to define children who may benefit from adenoidectomy alone and those children in whom adenoidectomy alone is unlikely to succeed.

Variation trend and significance of adult tonsil size and tongue position

Objective:The aim of this study is to explore the changing trend and significance of adult tonsil size and tongue position by observing adults in different age groups. Method:Oropharyngeal cavities of 1 060 adults who undergoing health examination and had no history of tonsil surgery were observed. Friedman tongue position (FTP) and tonsil size (TS) were scored according to Friedman's criteria and results were statistic analyzed to evaluate their changing law and significance. Result: Mean FTP scores increased with age significantly（P <0.01）; FTP score in male was lower than that in female（P <0.01）. TS score significantly decreased with age（P <0.05）.The average score of TS had no statistical significance in different gender. Although there was no statistical significance, total score of FTP show an increasing trend with age（P >0.05）;Total scores of FTP were different between sexes（male 4.12±0.67，female 4.23±0.68，P <0.05）.BMI was not found to be statistically different when FTP scores, TS scores and total scores changed (P >0.05); but it showed an increasing trend with age（P <0.01）. Conclusion:Width of pharyngeal cavity in normal adults is always kept in certain stability, while it proves to be narrower in obese people. TS score and FTP score, which appear the opposite trend with age, can be thought as a major factor to keep a stable width of oral pharyngeal cavity.

MR Image Analytics to Characterize the Upper Airway Structure in Obese Children with Obstructive Sleep Apnea Syndrome.

PurposeQuantitative image analysis in previous research in obstructive sleep apnea syndrome (OSAS) has focused on the upper airway or several objects in its immediate vicinity and measures of object size. In this paper, we take a more general approach of considering all major objects in the upper airway region and measures pertaining to their individual morphological properties, their tissue characteristics revealed by image intensities, and the 3D architecture of the object assembly. We propose a novel methodology to select a small set of salient features from this large collection of measures and demonstrate the ability of these features to discriminate with very high prediction accuracy between obese OSAS and obese non-OSAS groups.Materials and MethodsThirty children were involved in this study with 15 in the obese OSAS group with an apnea-hypopnea index (AHI) = 14.4 ± 10.7) and 15 in the obese non-OSAS group with an AHI = 1.0 ± 1.0 (p<0.001). Subjects were between 8–17 years and underwent T1- and T2-weighted magnetic resonance imaging (MRI) of the upper airway during wakefulness. Fourteen objects in the vicinity of the upper airways were segmented in these images and a total of 159 measurements were derived from each subject image which included object size, surface area, volume, sphericity, standardized T2-weighted image intensity value, and inter-object distances. A small set of discriminating features was identified from this set in several steps. First, a subset of measures that have a low level of correlation among the measures was determined. A heat map visualization technique that allows grouping of parameters based on correlations among them was used for this purpose. Then, through T-tests, another subset of measures which are capable of separating the two groups was identified. The intersection of these subsets yielded the final feature set. The accuracy of these features to perform classification of unseen images into the two patient groups was tested by using logistic regression and multi-fold cross validation.ResultsA set of 16 features identified with low inter-feature correlation (< 0.36) yielded a high classification accuracy of 96% with sensitivity and specificity of 97.8% and 94.4%, respectively. In addition to the previously observed increase in linear size, surface area, and volume of adenoid, tonsils, and fat pad in OSAS, the following new markers have been found. Standardized T2-weighted image intensities differed between the two groups for the entire neck body region, pharynx, and nasopharynx, possibly indicating changes in object tissue characteristics. Fat pad and oropharynx become less round or more complex in shape in OSAS. Fat pad and tongue move closer in OSAS, and so also oropharynx and tonsils and fat pad and tonsils. In contrast, fat pad and oropharynx move farther apart from the skin object.ConclusionsThe study has found several new anatomic bio-markers of OSAS. Changes in standardized T2-weighted image intensities in objects may imply that intrinsic tissue composition undergoes changes in OSAS. The results on inter-object distances imply that treatment methods should respect the relationships that exist among objects and not just their size. The proposed method of analysis may lead to an improved understanding of the mechanisms underlying OSAS.

Total analysis of clinical factors for surgical success of adenotonsillectomy in pediatric OSAS.

The objective of this study is the total evaluation of most common clinical factors influencing the successful rate of adenotonsillectomy for pediatric obstructive sleep apnea syndrome (OSAS). Retrospectively, 63 pediatric patients ranged from 2 to 16 years old were included. Syndromics and patients who had received orthodontic treatment or orthognathic surgery were excluded. All patients received pre-operative and postoperative polysomnography and cephalometry. Each patient received adenotonsillectomy by single surgeon. Surgical success was defined as apneahypopnea index (AHI) decreased ≧50% or post-operative AHI <5. Total evaluated clinical factors related to success of adenotonsillectomy for pediatric OSAS include age, gender, body mass index (BMI), tonsil size, adenoid/nasopharynx ratio (A/N Ratio), pre-operative data of polysomnography, including AHI, apnea index (AI), hypopnea index (HI), mean O2 saturation and nadir O2 saturation, and 18 cephalometry parameters. Mean age of the total 63 patients was 7.78 years old. Mean BMI of the patients was 19.02. The proportion of obese patients was 25.4% (16/63). Surgical success was achieved in 42 out of 63 patients (66.7%). The surgical success was not statistically significant related to all pre-operative cephalometric parameters, age, gender, BMI and adenoid size by multiple logistic regression model. However, the surgical success was significantly related to pre-operative AHI and tonsil size. In addition, all patients who received adenotonsillectomy showed improved polysomnography parameters, including AHI, AI, HI, mean O2 saturation and nadir O2 saturation which all reached statistically significant improvement. Although adenotonsillectomy cannot cure pediatric OSAS in our research, all patients showed significant improvement of polysomnography parameters after this procedure. Pre-operative cephalometry parameters, BMI and age did not show significant correlation with surgical success, however, pre-op AHI and tonsil size correlated with surgical success. Higher pre-op AHI value and higher tonsil grade showed higher rate of surgical success. Based on the total evaluation of clinical data, surgical success after adenotonsillectomy might be predicted by pre-op AHI severity and tonsil grade.

The clinical and radiological predictors of pulmonary hypertension in children with adenotonsillar hypertrophy.

Unrelieved upper airway obstruction from highly prevalent adenotonsillar hypertrophy (ATH) has the potential of producing structural remodelling of the pulmonary vascular bed with resultant pulmonary hypertension (PH) and cor pulmonale. This cross-sectional study aimed to determine the local prevalence of PH and examine its clinical and radiological pointers among children with ATH. The airway obstruction was evaluated clinically by grading the nocturnal and daytime symptoms of ATH. A Brodsky scale and adenoid-nasopharynx ratio (AN ratio) were used to categorize tonsil and adenoid size, respectively. Mean pulmonary artery pressure (mPAP), was measured noninvasively for each child using Doppler echocardiography and PH was defined by mPAP ≥25mmHg. Comparison of symptom scores, tonsil and adenoid size and demographic factors was made between children with mPAP ≥25mmHg and those mPAP <25mmHg using univariate and multivariate analysis. There was 22.8% (18/79) prevalence of PH among the 26 children with only adenoid hypertrophy and 53 with ATH. Significant risk factors identified by logistic regression analysis associated with PH were daytime mouth breathing, daytime stertor, and AN ratio >0.75 (P=0.002, 0.018, and 0.04, respectively), with more than sixfold and fourfold increase risk for daytime mouth breathing and daytime stertor, respectively. Obstructive breathing during sleep was significant only on univariate analysis. Prolonged symptom duration ≥24months, large tonsils (grades 3 and 4), snoring and mouth breathing during sleep were not significant. This study demonstrated that pulmonary hypertension remains prevalent in children with ATH. Daytime mouth breathing and stertor as well as AN ratio >0.75 are the prime predictors of pulmonary hypertension, with an AN ratio cut-off point of 0.73 on ROC analysis.

Palatine tonsil volume estimation using different methods after tonsillectomy.

This study was carried out to measure the volume of the palatine tonsil in otorhinolaryngology outpatients with complaints of adenotonsillar hypertrophy and chronic tonsillitis who had undergone tonsillectomy. To date, no study has investigated palatine tonsil volume using different methods and compared with subjective tonsil size in the literature. For this purpose, we used three different methods to measure palatine tonsil volume. The correlation of each parameter with tonsil size was assessed. After tonsillectomy, palatine tonsil volume was measured by Archimedes, Cavalieri and Ellipsoid methods. Mean right-left palatine tonsil volumes were calculated as 2.63±1.34cm3 and 2.72±1.51cm3 by the Archimedes method, 3.51±1.48cm3 and 3.37±1.36cm3 by the Cavalieri method, and 2.22±1.22cm3 and 2.29±1.42cm3 by the Ellipsoid method, respectively. Excellent agreement was found among the three methods of measuring volumetric techniques according to Bland-Altman plots. In addition, tonsil grade was correlated significantly with tonsil volume.

Is obstructive sleep apnea syndrome in children season dependent?

The most common cause of obstructive sleep apnea (OSA) in children is an enlargement of tonsils and/or adenoids. Previous studies have shown that the size of adenoids and tonsils is influenced by upper respiratory tract infections and exposure to allergens. The rate of exposure to bacteria, viruses, and allergens fluctuates from season to season. Therefore, we hypothesized that the rate of polysomnograms positive for OSA may vary according to season. The objective of this study is to determine whether the prevalence of OSA in children, as determined by polysomnography, is affected by the season during which the study was performed. We retrospectively reviewed polysomnography tests of 296 children, ages 0-12years, referred for suspected OSA. We compared the Obstructive Apnea Hypopnea Index (OAHI) between the seasons and the rates of abnormal tests in each season according to the degree of severity. The mean OAHI did not significantly differ among the seasons (winter, 3.0 ± 5.0; spring, 3.0 ± 4.9; summer, 4.0 ± 6.3; fall, 3.4 ± 5.7, p = 0.183). When dividing the OAHI by levels of severity, no seasonality was found in moderate (winter, 13.8%; spring, 6.7%; summer, 11.7%; fall, 14.1%, p = NS) and severe OSA (winter, 8.8%; spring, 11.2%; summer, 10%; fall, 7.8%, p = NS). There was a small increase in the frequency of mild OSA diagnoses in the summer compared to the other seasons. In this study, season does not appear to affect the rate of diagnosis of significant OSA in children. Re-evaluation during a different season is unlikely to provide different results and may postpone surgery unnecessarily.

Efficacy of Coblation Endoscopic Lingual Lightening in Multilevel Surgery for Obstructive Sleep Apnea.

Multilevel obstruction is involved in the pathogenesis of obstructive sleep apnea (OSA). Coblation endoscopic lingual lightening (CELL) is a variation of glossectomy to reduce tongue collapse and can be considered in the surgical management of adults with OSA. To evaluate the clinical and polysomnographic outcomes of tongue base reduction using CELL in multilevel surgery for OSA. A retrospective case-control study was performed to review the medical records of adults with OSA (apnea-hypopnea index [AHI], >20) and Friedman stage III (tongue position III and tonsil size I-II) who underwent combined CELL and relocation pharyngoplasty (group 1) or relocation pharyngoplasty alone (group 2) for OSA between January 1, 2012, and December 31, 2013, at a tertiary referral sleep center. The groups were matched by age, sex, body mass index, and AHI at baseline. The dates of the analysis were May 30 to June 29, 2014. Coblation endoscopic lingual lightening. The primary outcome measure was change in AHI after surgery (after ≥6 months). Other outcomes were differences in surgical response rates, perioperative apnea index, lowest oxygen saturation, and Epworth Sleepiness Scale score. The study cohort comprised 90 participants. Their mean (SD) age was 40.7 (9.2) years, and 96% (86 of 90) were male. Group 1 patients (n = 30) underwent combined CELL and relocation pharyngoplasty, and group 2 patients (n = 60) underwent relocation pharyngoplasty only. The mean (SD) AHI decreased from 48.4 (16.9) to 16.5 (11.2) (P < .001) in group 1 and from 44.2 (19.3) to 20.1 (15.6) (P < .001) in group 2 . Percentage change in AHI was significantly different between group 1 and group 2 (mean [SD], -65.5 [20.5] vs -53.2 [30.3]) (P = .047). The surgical response rate was greater in group 1 (73% [22 of 30]) than in group 2 (50% [30 of 60]) (P = .04). Without increasing complications, combined CELL and relocation pharyngoplasty achieved greater AHI reduction and a higher surgical response rate among adults with OSA and Friedman stage III compared with relocation pharyngoplasty alone.