Tonsillar Hypertrophy Research Articles

Biomarkers of pediatric obstructive sleep apnea syndrome and the assessment of quality of life before and after adenotonsillectomy.

The study aims to explore the inflammatory cytokines and oxidative stress in children with obstructive sleep apnea syndrome (OSAS) triggered by adenoids and/or tonsillar hypertrophy and their changes after adenotonsillectomy (AT) and to investigate the associated behavioral disorders in OSAS, before and after AT. Thirty patients with OSAS and 20 healthy children, aged 3 - 13 years were included in the study. According to apnea-hypopnea index (AHI), OSAS children were classified into 3 groups: mild (n = 19), moderate (n = 5), and severe OSAS (n = 6). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor (TNF)-α, malondialdehyde (MDA) and antioxidant enzymes activities were assessed in serum, preoperative and 6 weeks after AT. TNF-α, IL-6 and malondialdehyde levels were also estimated in adenoid and tonsils tissues. A Pediatric Sleep Questionnaire was completed by the parents before and after AT. As a result of the study, we obtained the following results: TNF-α, IL-6 and malondialdehyde evaluated preoperative increased in serum and tissues in OSAS, especially in severe disease compared to mild and moderate forms. Six weeks after AT, AHI diminished significantly in OSAS, as well as the inflammatory markers and malondialdehyde, in parallel with significant improvement of antioxidant enzymes activities. Daytime sleepiness, hyperactivity and attention deficit in OSAS, even in mild disease were present, with significant improvements of obstructive symptoms after AT. We conclude that OSAS caused by adenoids and/or tonsillar hypertrophy led to changes in the blood parameters, with significant improvement after AT. Postoperatively, a significant improvement in sleep quality and behavior in OSAS patients was also observed.

Clustering upper airway physicals, otitis media with effusion and auditory functions in children

ObjectiveAdenoid hypertrophy (AH) has been identified as a cause of otitis media with effusion (OME), which is the most common cause of childhood hearing loss. Indeed, there may be other upper airway-related predisposing factors such as, location of the adenoid, accompanying tonsillar hypertrophy (TH) and nasal septal deviation (NSD) for the development of OME. In this study, we aimed to evaluate the associations between the upper airway physicals and OME with auditory functions. MethodsEighty-six ears of 43 children, aged 3–11 years were included in this prospective clinical study. Findings of otolaryngologic examinations were noted. Data of pure tone audiometry (PTA), traditional tympanometry (TT) and wideband tympanometry (WBT) parameters were collected. Cluster analysis was performed to the following variables: age, sex; the adenoid choana percentage (ACP), the presences of adenoid around torus tubarius (AATT), TH, NSD and OME; peak pressure (PP) values on TT, resonance frequencies (RF) on WBT, ambient pressure absorbance ratios (APAR) and PTA hearing thresholds. ResultsTwo groups of ears revealed by clustering; cluster-1 (n = 46) and cluster-2 (n = 40), at the similarity level of 0.662. The presences of AH, AATT, OME and the medians of ACP, PP, RF, WBT APARs at all frequencies except 5656 Hz and 8000 Hz, all PTA thresholds were significantly different between two clusters (p < 0.05). The lower WBT APARs and higher PTA thresholds were associated with higher levels of ACP and higher frequencies of the presence of AATT and OME in cluster-1. ConclusionThere are associations between AH, AATT and OME together with decline in hearing and SEA. Whereas, TH and NSD are not related to the formation of clusters and they are insignificant factors.

Effect of Adenotonsillectomy on Peak Expiratory Flow Rate Among Children.

Cross sectional, prospective, observational study. Department of otorhinolaryngology in tertiary care centre. Included 40 children aged between 5 and 15years, who had adenotonsillar hypertrophy and underwent adenotonsillectomy. Diagnostic nasal endoscopy and X-ray, nasopharynx, was done to assess the grade of adenoid hypertrophy endoscopically and radiologically respectively. Peak expiratory flow rate was assessed using Mini Wright peak expiratory flow meter pre-operatively and 1month post-operatively and both the readings were compared. Subjective improvement was also compared pre-operatively and post-operatively using visual analogue score. This study included 40 patients with male to female ratio of 1.6:1, 92.5% presented with mouth breathing. 92.5% presented with grade III tonsillar hypertrophy and 70% with grade III adenoid hypertrophy endoscopically. After adenotonsillectomy, improvement in Peak expiratory flow rate ranged from 16 to 25.3% which was statistically significant. Patients with grade III tonsillar and grade IV adenoid hypertrophy showed 25.3% improvement. Subjective improvement was 98.8% in the complaint of snoring. Adenotonsillectomy significantly improves pulmonary functions. This may help to improve physical and cognitive development in children and decrease chances of getting cardiopulmonary problems in later life.

Tonsil Hipertrofisinde Bağ Dokusu ve Lenfoid Dokunun Rolü

Objective: This study aimed to investigate connective tissue and lymphoid tissue ratios in tonsillectomy specimens to determine differences between microanatomical structure.&#x0D; &#x0D; Methods: Tonsillectomy materials were collected from patients aged 3-13 years and three groups were created. Patients with larger tonsils than 3 cc and had recurrent tonsillitis history were included to the Group 1, larger tonsils than 3 cc without recurrent tonsillitis history were included to the Group 2 and tonsil sizes less than 2 cc with recurrent tonsillitis history were included to the Group 3. Masson’s Trichrome stained slides were evaluated to determine the connective and lymphoid tissues. We use Python programming language and count pixels to calculate the approximate ratio of the connective tissue area. &#x0D; &#x0D; Results: The mean connective tissue percentages were 5.45±2.50 in group 1, 5.45±2.42 in group 2 and 10.90±3.41 in group 3. There was significantly higher connective tissue ratios in group 3 compared to group 1 and group 2 (p=0.001). Lymphoid tissue was significantly higher in group 1 and group 2 compared to group 3 (p=0.001). Follicle numbers were significantly different among 3 groups (p=0.032).&#x0D; &#x0D; Conclusion: The mechanism of the tonsillar hypertrophy has not been elucidated, yet. We found that; as long as the tonsil volume increases, lymphoid tissue ratio increases to. Relationship between recurrent inflammation and microanatomical structures of the palatine tonsil seem to be more complicated than previously supposed knowledge.

Relationship of endoplasmic reticulum stress with the etiopathogenesis of chronic tonsillitis and tonsillar hypertrophy in pediatric patients: a prospective, parallel-group study.

Tonsil tissue is a very important component of the human immunity system, contributing to the functioning of the cellular and humoral defence system, especially in childhood. The endoplasmic reticulum (ER) is an organelle that has a very important function in the balanced functioning of cells, in which the accumulation of a cellular protein called ER stress occurs in case of dysfunction. ER stress influences the pathogenesis of many diseases and immune system functions. We aimed to investigate the relation between the diseases of tonsil tissue and ER stress response to elucidate the mechanisms of diseases related with the immune system. A prospective study was conducted in 46 children aged between 2 and 16years who underwent tonsillectomy for chronic tonsillitis or tonsillar hypertrophy. Tonsil tissue was separated into two groups according to their size and evaluated in terms of ER stress markers and apoptosis markers by Real-time PCR and Western blot analysis. The ΔCT levels of ER stress markers (ATF4, ATF6, CHOP, GRP78, EIF2AK3, ERN1, GRP94) were greater in children with chronic tonsillitis (p < 0.005). In contrast, the tonsillar hypertrophy group had greater ΔCT levels of apoptosis markers (BAX, BCL-2) according to the Real-time PCR method (p < 0.005). According to the Western blot analysis, the normalized levels of ATF4, ATF6, CHOP, GRP78, and ERN1 genes were found greater in the chronic tonsillitis group than the tonsillar hypertrophy group. There was no difference between the two groups in terms of normalized BCL-2 and BAX levels by Western blot analysis. This is the first study in the literature investigating the effect of the ER stress pathway on the etiopathogenesis of tonsil diseases. It was concluded that the ER stress pathway plays a role in the etiopathogenesis of chronic tonsillitis. Investigating the relationship between ER stress and structures such as the tonsil tissue that make up the immune system can help create new treatment strategies. Trial Registration ClinicalTrials.gov Identifier: NCT04653376.

Preoperative screening for obstructive sleep apnea in cardiovascular patients - How useful is STOP-BANG questionnaire in the Indian context?

Background:Obstructive sleep apnea (OSA) is reported in a high proportion of cardiac surgical patients, up to 73%. STOP-BANG is a validated questionnaire for screening of outpatients for OSA with high sensitivity. There is sparse literature from India regarding the prevalence of OSA in preoperative cardiovascular patients and the utility of screening tools.Aims:We sought to study the utility of the STOP-BANG questionnaire as a screening tool for OSA in cardiovascular patients validating it with ambulatory level 3 polysomnography.Materials and Methods:It was a prospective study where consecutive patients getting admitted for coronary artery bypass surgery (CABG) from August 2017–February 2019 were recruited. All the patients were screened with the STOP-BANG questionnaire. 53 patients underwent overnight level 3 polysomnography using Apnea-Link. Correlations were made between clinical symptoms, STOP-BANG score, and OSA severity, measured using Apnea hypopnea index (AHI).Results:We had 120 patients(103 males) with a mean age 60 years. Snoring was the most common sleep complaint. Our cohort had a high prevalence of vascular risk factors (DM 72.3%, hypertension 59.2%, dyslipidemia 60%) and 11.7% were obese (BMI >30). The median STOP-BANG score was 3 (IQR 2) with 83 having scores ≥3. Median AHI was 5.6 with AHI ≥5 in 28 patients and AHI 15 or above in 14 patients. Among the clinical parameters, arousals with respiratory difficulty at night, higher neck circumference, and tonsillar hypertrophy showed a significant association with PSG-proven OSA.STOP-BANG scores 3 or above had a sensitivity of 75% in predicting OSA.Conclusions:Our study shows that in cardiovascular patients less symptomatic for sleep complaints, the STOP-BANG questionnaire is a useful screening tool for OSA in outpatient settings. Among clinical parameters, airway narrowing and neck circumference can predict OSA.

Predictive Risk Factors for Post Tonsillectomy Hemorrhage in Children

Objective: To assess the risk factors which determine the magnitude of post-tonsillectomy hemorrhage. &#x0D; Study Design: Prospective cross sectional study.&#x0D; Setting: A study carried out at otolyrangical unit at a tertiary care Isra University hospital Hyderabad, from June 2018 to April 2019.&#x0D; Materials and Methods: 110 pediatric patients age 5-17 years were included in this study. We administrated a structured questionnaire to parents of the patients. We selected cases for tonsillectomy as per criteria of the American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS). Those patients with a history of recurrent tonsillitis presented at the otolaryngology department were included. Patients with a history of use of anticoagulant therapy, obstructive sleep apnea, patients with a history of a bleeding disorder, and patients not giving consent were excluded. We diagnosed patients selected for tonsillectomy included with recurrent tonsillitis, peri-tonsillar hypertrophy, and tonsillar hypertrophy. Patients were observed and followed for postoperative hemorrhage. Data were analyzed by using Statistical Package for Social Sciences version 21 (SPSS 21).&#x0D; Results: Among 110 children included in the study, 41.8% patients were in the age group of 5-10 years, 30% were in the age group of 11-15 years and 28.2% were over 15 years. Among 110 patients 21.8% underwent tonsillectomy were diagnosed as recurrent tonsillitis, 19% were diagnosed as having tonsillar hypertrophy, 40.0% were suffering from both recurrent tonsillitis and tonsillar hypertrophy and 19.2% had peritonsillar hypertrophy. This shows that 14.5% were admitted to the hospital after 1-5 days, 58.1% developed post-tonsillectomy hemorrhage after 6-10 days and 27.2% developed post-tonsillectomy hemorrhage after 10 days.&#x0D; Conclusion: We conclude that age &gt;10 years was significant predictive risk factors for post-tonsillectomy hemorrhage among children who undergo tonsillectomy.

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

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

Symptoms: are they correlated with Centor/McIsaac Score in the diagnosis of pharyngotonsillitis?

Objective: Group A beta hemolytic streptococcus (GABHS) is identified in 20-40% of cases of childhood pharyngitis. The Centor/McIsaac score is an important scoring method used in the early diagnosis of patients presenting with symptoms of Group A beta hemolytic streptococcus (GABHS) pharyngitis. In this study, we aimed to determine the relationship between Centor/McIsaac score and patients’ symptoms, and to investigate any conformity between Rapid Antigen Test positivity and high Centor/McIsaac score. Materials and methods: Data were obtained retrospectively by scanning the files of patients (age 2 to 18 years) diagnosed with GABHS who were hospitalized between May and December 2017. Inclusion criteria were, being between the ages of 2 and 18 years and to be diagnosed with group A beta hemolytic streptococcal pharyngitis. Receiving antibiotic treatment within the last 14 days, being under 2 years of age and over 18 years of age are exclusion criteria. Daily clinical findings and test results (complete blood count, neutrophil and lymphocyte percentages, rapid antigen test, throat culture) were collected from medical records. The Centor/McIsaac scores calculated according to symptoms and rapid antigen test results used for GABHS antigen detection from throat swab samples, used for the initiation of effective treatment and to shorten hospitalization, were recorded from patient files. Student's t test was used to analyze the data that showed normal distribution among independent groups. The chi-square test was used for the analysis of categorical variables. P<0.05 was considered statistically significant. Results: A total of 236 patients were included in the study. The average age of the patients was 7 years. The frequency of pharyngitis symptoms was similar in patients younger and older than 7 years of age. There was no statistically significant difference between those younger and older than 7 years of age in terms of throat culture positivity (p=0.059). There was no statistically significant difference between Centor/McIsaac scores of the two age groups (p=0.063). The Centor/McIsaac score (3.62±1.01) of those with positive rapid antigen test was significantly higher than that of those with negative rapid antigen test (2.78±1.28) (p=0.001). Centor/McIsaac scores of those with and without fever, those with and without tonsillar hypertrophy, those with and without cough were also compared. Centor/McIsaac scores of those with fever (3.53±1.02) were higher compared to those without (1.63±0.89) (p=0.001), scores were higher in those with tonsillar hypertrophy (3.68±1.01) compared to those without (2.10±0.97) (p=0.001), and scores were again higher in those without cough (3.67±1.07) compared to those with cough (2.22±0.99) (p<0.001). Conclusion: The intensity of symptoms seen in GABHS infection leads to higher Centor/McIsaac scores. The correlation between rapid antigen test results and Centor/McIsaac score shows the increasing importance of Centor/McIsaac score in early diagnosis of GABHS pharyngitis.

Obstructive Sleep Apnea in Children Under 3 Years of Age.

To identify predictors of severe obstructive sleep apnea (OSA) in children under 3 years of age and to compare demographics, comorbidities, and polysomnographic characteristics of infants and toddlers with OSA. Retrospective case series. We examined children under 3 years of age who had polysomnogram between August 2012 and March 2020. Demographics, clinical, and polysomnographic parameters were compared in children age 0-1 versus 1-3 years and 0-2 versus 2-3 years and severe versus mild-moderate OSA. Univariate analysis was used to compare age groups; multiple logistic regression for predictors of severe OSA. Significance was set at P < .05. Of the 413 children, 267 (65%) were male and 131 (32%) obese. The population included Hispanic (41%), African American (28%), and Caucasian (25%) children. A total of 98.5% had OSA and 35% had severe OSA. Children under 1 year of age more commonly had gastroesophageal reflux disease (GERD) (38% vs. 23%; P=.014); tonsillar hypertrophy was more common in children over 2 years of age (56% vs. 34%, P=.001). Down syndrome (odds ratio (OR): 3.16, 95% confidence interval (CI)=1.14-8.68, P=.026) and tonsillar hypertrophy (OR: 1.97, 95% CI=1.28-3.02, P=.002) were predictors of severe OSA. Children under 3 years of age with OSA are more likely to be male and have GERD. Down syndrome and tonsillar hypertrophy are predictors of severe OSA, and children with these conditions should be prioritized for polysomnography. 4 Laryngoscope, 131:E2603-E2608, 2021.

Selection of Screening Tool for Sleep-Disordered Breathing or Obstructive Sleep Apnea in Pediatric Patients in the Perianesthesia Setting

PurposeThis study was undertaken to select an appropriate tool to predict risk of obstructive sleep apnea (OSA) among pediatric patients in the preoperative setting. Design/MethodsA retrospective chart review and a survey of nursing staff to compare two tools that were determined to be valid in assessing risk of OSA and postanesthesia complications in pediatric patients aged 6 months to 18 years was conducted. About 300 pediatric patients presenting for elective surgery were screened for OSA using STBUR (Snoring, Trouble Breathing during sleep, struggling to Breathe during Sleep, and waking UnRefreshed) and ST(1)OP-BANG (Snoring, Tonsillar hypertrophy, sleep Obstruction, BMI, Age, Neuromuscular disorders, and Genetic/congenital deformities) concurrently. Six preoperative nurses were then surveyed to compare ease of use and time to complete the screening tools. FindingsThe STBUR tool was found to predict complications in 37.5% patients versus 22.7% patients with the pediatric ST(1)OP-BANG. Nursing staff found that although both tools were quick and easy to use, the STBUR tool was easier for parents to answer. ConclusionsUse of a screening tool to help predict risk of OSA and postanesthetic complications also helps to dictate anesthesia technique, nursing staffing requirements, and plans of care for postoperative management of pediatric patients.

Adenoidectomy and adenotonsillotomy in patients treated in the Department of Paediatric Otorhinolaryngology of the Medical University of Warsaw in 2018 – a retrospective analysis

Introduction. Adenoidectomy and adenotonsillotomy are among the most common surgical procedures worldwide. Sleep-related breathing disorders and recurrent upper respiratory tract infections are two primary categories of indications for adenoidectomy and adenotonsillotomy. Aim. The aim of this study was to analyse selected adenoidectomy and adenotonsillotomy procedures performed in the Department of Paediatric Otorhinolaryngology of the Medical University of Warsaw in 2018. Material and methods. A total of 474 patients aged between 11 months and 18 years, who underwent adenoidectomy and adenotonsillotomy in the Department of Paediatric Otorhinolaryngology of the Medical University of Warsaw in 2018, were included in the study. Data on age, gender, length of hospital stay, as well as additional diagnoses in adenoid hypertrophy or adenoid and palatine tonsil hypertrophy were collected. Minor surgeries performed in addition to tonsillectomy were also evaluated. Results. A total of 472 patients underwent adenoidectomy and adenotonsillotomy in 2018. Adenotonsillotomy was almost twice more common. Tonsillar hypertrophy was accompanied by exudative otitis media in almost 1/3 of children, and ear ventilation tubes were needed in almost 1/5 of children. Mean hospital stay equaled 4.19 ± 1.44 days. Conclusions. We have shown that adenotonsillotomy was the most common procedure in the Department of Paediatric Otorhinolaryngology. Exudative otitis media was the most common concomitant diagnosis, and middle ear ventilation was the most common additional procedure. Hospital stay usually lasted 3 days.

Serum C-reactive protein and erythrocyte sedimentation rate changes in children after adenotonsillectomy

Background: Sleep-disordered breathing is a common problem in children and is associated with increased cardiovascular morbidity. The circulating level of C-reactive protein, a pro-inflammatory protein, is associated with increased risk for atherosclerosis. The aim of this study was the comparison of C-reactive protein level and erythrocyte sedimentation rate in children with tonsillar hypertrophy before and after adenotonsillectomy. Methods: All patients aged between 4 to 10 years who had underwent adenotonsillectomy due to obstructive sleep apnea were enrolled. Serum C-reactive protein and erythrocyte sedimentation rate were measured before and after adenotonsillectomy. Data were analyzed with SPSS version 19. Results: In this study, 384 patients were enrolled. The average age of the patients was 6.7 years. The C-reactive protein level in 91 patients (23.7 %) was decreased and in 286 patients (74.5%) did not change and in 7 patients (1.8%) it was increased. Decreasing serum C-reactive protein level and erythrocyte sedimentation rate was statistically significant after adenotonsillectomy (P-value &lt; 0.05). Conclusion: Obstructive sleep apnea induces a systemic inflammatory response so frequently associated with an increase in serum C-reactive protein and erythrocyte sedimentation rate that is reversible with surgery and if left untreated may lead to cardiovascular morbidity.

Role of Adenoidectomy in Adenotonsillectomy: An Observational Study

ABSTRACT The present study is an observational case series study of 50 cases of patients in the age group of 5–15 years for a period of 2 years. The age range was chosen, where issue of tonsillar and adenoid hypertrophy is very common. The objective of this case series is to establish that adenoidectomy is not a requirement while performing adenotonsillectomy unless and until the patient suffers from genuine adenoid hypertrophy symptoms. How to cite this article: Vinayak ES. Role of Adenoidectomy in Adenotonsillectomy: An Observational Study. Clin Rhinol An Int J 2019;12(2 and 3):45–48.

Monopolar electrocautery tip vs plasma ablation in tonsillotomy: A randomized case-control study comparing outcomes in pediatric population

BackgroundThe objective of this study was to compare the low-priced monopolar electrocautery to the high-priced, worldwide used, plasma ablation in tonsillotomy among children aged between three and twelve years, suffering from obstructive breathing disorders (OBD), with respect to post-operative pain, bleeding and related morbidities. MethodsA randomized case-control study was conducted in the Eye and Ear Hospital International- Lebanon. 103 children aged between three and twelve years suffering from OBD secondary to tonsillar hypertrophy were randomly assigned into two groups. Post-operative pain was evaluated using age-adequate validated scales: “FLACC-R” (Face, Legs, Activity, Cry, Consolability-Revised) for children aged less than five years, and “Wong Baker faces” for older children. Additional post-operative outcomes were evaluated using Pain-PROM (Patient reported Pain-Related Outcome Measures) and TAHSI (Tonsil and Adenoid Health Status Instrument) scales. ResultsSignificantly, higher rates of patients who underwent tonsillotomy via plasma ablation technique used analgesics and had severe pain compared to the monopolar electrocautery group. A longer operative duration was significantly associated with higher pain scores, and the plasma ablation technique yielded significantly higher operative mean durations. 10 days post-operatively, a significantly higher percentage of children reported an overall high pain severity and more than expected overall pain when using the plasma ablation technique compared to the monopolar electrocautery one. Overall bleeding rates were similar. No difference was reported one month post-operatively. ConclusionWhen compared to plasma ablation, monopolar electrocautery, can provide the same efficiency in relieving OBD in healthy children, with equal overall bleeding rates, but significantly lower cost, operating time, pain scores and need for analgesics.

Modified Uvulopalatopharyngoplasty with Tonsillectomy in Treatment of Obstructive Sleep Apnoea.

Obstructive sleep apnoea is a common problem with many long-term consequences if left untreated. The purpose of this study is to find the efficacy of modified uvulopalatopharyngoplasty with tonsillectomy in the treatment of OSA symptoms, apnoea-hypopnoea index, Epworth sleepiness scale and its effect on blood pressure and cardiac status. Patients with obstructive sleep apnoea with apnoea-hypopnoea index more than 15 with tonsillar hypertrophy, Friedman stage < 3 and palatal collapse or obstruction at the level of velum as diagnosed by DISE were included in this prospective analytical cross-sectional study. Modified uvulopalatopharyngoplasty with tonsillectomy was done in all patients. History of nocturnal and daytime OSA symptoms, Epworth sleepiness scale, snoring score, polysomnogram, drug induced sleep endoscopy, blood pressure, echocardiogram to measure velocity across pulmonary and aortic valve and ECG were taken preoperatively and 6months postoperatively. A total of 129 participants were recruited. 82 of the 129 patients (63.5%) were men; mean (SD) age was 44.2 (6.78) years. The patients were post operatively classified as responders and non-responders by the DISE finding. 107 patients (82.9%)-responders, had no narrowing and 22 patients (17.1%)-non-responders, had persistent narrowing of velum. Non-responders had increased baseline BMI when compared to responders. All the parameters were statistically improved in responders (p < 0.001). In non-responders, there was no statistical improvement in any of the parameters. Modified uvulopalatopharyngoplasty provides significant improvement in sleep parameters like AHI, Epworth sleepiness scale and other polysomnographic parameters. It significantly reduces the cardiac burden in OSA patients without any complications. Trial registration www.ctri.nic.in identifier: CTRI/2020/06/025759.

Prevalence of Post Tonsillectomy Haemorrhage at a Tertiary Care Centre in Nepal

Introduction: Tonsillectomy is one of the common ENT surgical procedures. Post-tonsillectomy haemorrhage remains a frequent complication which can be potentially life-threatening. The objective of the present study was to calculate the prevalence of haemorrhage following a tonsillectomy at a tertiary care centre.&#x0D; Methods: It was a descriptive cross-sectional study performed by medical chart review of the patients who underwent tonsillectomy from January 2018 to December 2019 at the department of ENT- Head and Neck Surgery of Tribhuvan University Teaching Hospital. Ethical approval was obtained from the institutional review committee (Ref:-282(6-11) E2 076/077). Convenient sampling method was used. All patients of any age who had tonsillectomy for recurrent tonsillitis or tonsillar hypertrophy with or without obstructive sleep apnoea and no missing information on chart review were included in the study. Data were entered in MS-Excel 2007 and analyzed in rate and percentage.&#x0D; Results: Ten (5.18%) out of a total of 193 patients who underwent tonsillectomy had a post tonsillectomy haemorrhage. All 10 (100%) were adults patients, operated for recurrent tonsillitis, and used electrocautery. It was common in male patients 7 (70%). All of the haemorrhages was between a third and sixth postoperative day and were mild in severity.&#x0D; Conclusions: The prevalence of post-tonsillectomy haemorrhage was high at our centre during the study period of two years. It was common in adults, males and surgery done for recurrent tonsillitis using electrocauterization.

Programmed cell death 1 positive lymphocytes at palate tonsils in the elder patients with chronic tonsillitis

Circulating lymphocytes infiltrate into local foci at the inflammatory phase of acute wound healing for activation of the immune system and express an immune checkpoint protein programmed cell death 1 (PD-1) at the resolution phase for inactivation of the immune system. Conversely, the PD-1 expression was still found even on circulating lymphocytes of the elder patients with chronic tonsillitis at the palliative stage. Recently, an adhesion G protein coupled receptor 56 (GPR56) was reported to at least work as a proliferation factor for infiltrated lymphocytes into local foci at the resolution phase of acute wound healing. To preliminary examine a similar role of PD-1 and GPR56 at local foci at chronic inflammation, palate tonsils were prepared from small amounts of patients with chronic tonsillitis and tonsillar hypertrophy. A positive relationship of RNA expression might be observed between PD-1 and GPR56 in the elder patients with chronic tonsillitis. In regard to immunohistopathological findings, there were huge and small amounts of PD-1 and GPR56 expression at the marginal zone of lymphoid follicles of palate tonsils with chronic tonsillitis. Moreover, the positive relationship of RNA expression between PD-1 and GPR56 confirmed in large numbers of the elder patients with chronic tonsillitis. Probably, GPR56 participates in a supplement of PD-1+ lymphocytes to circulating bloods of the elder patients with chronic tonsillitis through a lymphocyte cell maintenance system at the marginal zone of the lymphoid follicles of palate tonsils.

Perioperative care of obstructive sleep apnea patients: A survey of European anesthesiologists.

Background:Obstructive sleep apnea (OSA) is prevalent in the surgical patient population and is associated with high risk of perioperative complications. There are limited guidelines and wide practice variations regarding the perioperative care of obese and OSA patients. This is a study of European anesthesiologists' clinical practice of perioperative care of OSA patients.Methods:This survey evaluated United Kingdom anesthesiologists' clinical practice of the perioperative care of OSA patients. Outcomes and variables were compared between 4100 anesthesiologists of different clinical experience and hospital settings.Results:Approximately 45% of respondents manage OSA patients rarely, 42% occasionally, and 13% regularly. Most respondents order OSA screening tests if patients have tonsillar hypertrophy, head/neck tumor, BMI >35, increased neck circumference, craniofacial anomaly, and right-sided electrocardiography (ECG) anomaly. Majority request preoperative polysomnography, ECG, overnight pulse oximetry, and arterial blood gas analysis. Majority recommend preoperative weight loss, optimisation, smoking cessation, reduction of substance use, and regular mask-CPAP use. Majority consider endoscopy, and ophthalmology as appropriate day case procedures, but not laparoscopy. Majority postpone elective airway, laparoscopic, laparotomy, and head/neck surgery; if patients are not optimized preoperatively. For major surgery, combined general + neuraxial anesthesia was ranked as 3rd option. For major limb surgery, neuraxial anesthesia without sedation was ranked as 1st option, nerve block without sedation was ranked 2nd, and general anesthesia + nerve block was ranked 3rd or 4th. At anesthesia emergence, majority ensure that patients have normal consciousness, respiration and neuromuscular function. Majority ensure postoperative oximetry, telemetry, and oxygen supplementation.Conclusion:This study highlights variations in anesthesiologists' perioperative care of OSA patients; even in developed countries with advanced medical training and standards. The study outcomes will improve perioperative care of OSA patients.

Immunoglobulin E level in children with chronic hypertrophied tonsils either symptomatized or not symptomatized

Background Hypertrophy of tonsils is common in the pediatric population, primarily affecting younger children, aged 3–6 years. Tonsillar hypertrophy symptoms are among the most common causes for pediatric or ENT visits in children. Hence, doctors also need to be informed of the potential complications of tonsillar hypertrophy and the surgical indications. Therefore, the physiology of tonsils, their function for the immune system, and the early and late effects of tonsillar hypertrophy also need to be understood. Objective The aim was to measure the total serum and tonsillar tissue immunoglobulin E (IgE) level in children with chronic hypertrophied tonsils who will undergo for tonsillectomy (symptomatized children) and serum IgE level in nonsymptomatized children. Patients and methods This is a prospective comparative study that was carried out at the Otorhinolaryngology Department at Al-Zahraa University hospital and Al Mataria General Hospital. The study included 40 children, and their ages ranged from 5 to 15 years. Overall, 19 were males and 21 were females diagnosed with chronic hypertrophied tonsils. Half of them were symptomatized and underwent tonsillectomy, and the rest were not symptomatized. Results There was no significant difference in the serum IgE level in symptomatized and nonsymptomatized children. A statistically significant difference was found between the serum IgE level and the grades of tonsillar hypertrophy in both symptomatized and nonsymptomatized children. Tonsillar IgE level was also increased with increase in the grade of tonsillar hypertrophy. The relation between the serum and the tonsillar IgE levels in symptomatized children was found to be significant. Conclusion The authors observed a strong relationship between the serum IgE level and the grade of tonsillar hypertrophy in the two groups. Regarding the tonsillar IgE level in symptomatized children, there was an increase with increase in the grade of tonsillar hypertrophy, and there was also a positive correlation between serum and tonsillar IgE levels.