Tonsillar Size Research Articles

Predictive values of Mallampati score, tonsillar size, and BMI z-score in the presence and severity of obstructive sleep apnea in pediatric population.

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder in children. Determination of risk factors for the development of OSA is essential for early diagnosis and treatment of the disease and decreases the risk of negative consequences. This study aimed to investigate the predictive values of Mallampati score, tonsillar size, and BMI z-score in the presence and severity of OSA in children. This prospective cross-sectional study included 114 children with OSA symptoms. All children were assessed by BMI z-score, Mallampati score, and tonsillar size and underwent overnight polysomnography. They were consecutively selected and assigned to 4 groups as follows: Group 1 included normal-weight with a low Mallampati score; Group 2 involved normal-weight with a high Mallampati score; Group 3 included obese with a low Mallampati score; and Group 4 involved obese with a high Mallampati score. Of the 114 included children, 58 were female and 56 were male, with a mean age of 13.1 ± 2.9 years. OSA frequency and apnea-hypopnea index were significantly higher in group 4 compared with other groups (p = 0.003 and p < 0.0001, respectively), whereas average and minimum spO2 were significantly lower (for both, p = 0.001). Mallampati score and BMI z-score were found to be significant for predicting OSA (odds ratio = 4.147, 95% CI: 1.440-11.944; p = 0.008 and odds ratio = 1.760, 95% CI: 1.039-2.980; p = 0.035, respectively). Among OSA patients, the Mallampati score, tonsillar size, and BMI z-score were found to be significant for predicting OSA severity (odds ratio = 4.520, 95% CI: 1.332-15.335, p = 0.015, odds ratio = 9.177, 95% CI: 2.513-33.514, p = 0.001, and odds ratio = 2.820, 95% CI: 1.444-5.508; p = 0.002, respectively). The coexistence of the Mallampati score and BMI z-score significantly increases the presence of OSA in children. Mallampati score, tonsillar size, and BMI z-score are promising parameters for predicting OSA severity.

Obstructive sleep apnea in type 2 diabetes mellitus patients

Abstract Objective The study aims to identify the prevalence and risk factors for OSA in a group of Egyptian patients with type 2 diabetes. Methods 125 type 2 diabetes mellitus patients visited Mansoura University Hospital (Diabetes Mellitus Outpatient Clinic (OPC) at Specialized Medical Hospital and the Sleep Disordered Breathing Unit of the Chest Department), all of them exposed to history taking, the patients underwent anthropometric measurements (weight, height, body mass index, neck circumference), a test of their tonsillar size, Malampati score, Friedman OSA score, Epworth sleepiness scale (ESS), Berlin questionnaire, STOP BANG questionnaire, full-night polysomnography, fasting, and postprandial blood sugar. Results The study included 125 T2DM Egyptian patients with a mean age of 54.63 ± 9.47 years. Males accounted for 35.2 percent of patients, while females accounted for 64.8%. According to the study of co-morbidity, hypertension constituted 77 (61.1%), ischemic heart disease 28 (22.4%), other cardiac diseases 11 (8.8%), bronchial asthma 6 (4.8%), liver diseases 6 (4.8%), hypothyroidism 3 (2.4%), and renal diseases 3 (2.4%). A total of seven patients (5.6%) had no OSA symptoms, 87 had borderline symptoms, and 31 had positive symptoms. There were 51 (40.8%) normal patients, 12 (9.6%) borderline patients, and 62 (49.6%) sleepy patients on the Epworth scale. According to the Stop-Bang questionnaire, 121 (96.8%) patients answered positively. It was determined that 122 patients (97.6%) were at high risk based on the Berlin questionnaire. There were 17 patients (13.6%) with OSA on polysomnography, of which six were moderate (35.3%) and 11 were severe (64.7%). Among moderate and severe OSA patients, glycosylated hemoglobin levels differed significantly. Multivariate logistic regression analysis for independent predictors of OSA, chronic renal disease patients is the most common associated risk factor (OR = 14.3, CI = 1.2–67) then hypertension (OR = 5.6,CI=1.2–25.5) and heart failure (OR = 4.4). Conclusions OSA affects 13.6% patients with type 2 diabetes patients who are hypertensive are at higher risk of OSA, chronic renal failure is considered another risk factor Furthers studies are needed on a big scale of Egyptian diabetic patients to detect the prevalence of OSA

Evaluation of Serum 25(OH) Vitamin D as a Risk Factor in Adult Recurrent Tonsillitis.

Background Studies have reported that the rate of upper respiratory tract infections in children and adults is inversely related to serum vitamin D levels and supplementation with vitamin D reduces the incidence of this infection. This study aimed to examine if vitamin D serum levels were a risk factor for recurrent tonsillitis among adult patients. Methods Retrospective comparative analysis was carried out on 100 patients diagnosed with recurrent tonsillitis with 100 age- and sex-matched individuals as controls between June 2016 and May 2022. Tonsillar size was assessed based on Brodsky grading system. Serum levels of 25-hydroxy (25(OH)) vitamin D, total calcium, iron, hemoglobin, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were analyzed. Results There was a statistically significant low vitamin D levels in tonsil size grades III+IV compared to grade I+II (p <0.001) among cases. There was a significantly lower serum value for 25(OH) vitamin D in the cases as compared to the control group (p <0.001). A high percentage (68%) of cases had vitamin D deficiency (<20 ng/mL) and this was statistically significant (p <0.001). There were statistically significant higher values of CRP and ESR among cases compared to the control group (p <0.001). At a cut off (≤21.2), serum vitamin D levels achieved 78% sensitivity, 65% specificity (p <0.001) to differentiate cases from controls. Following logistic regression analysis, the level of vitamin D was the only significant risk factor. Conclusion Findings from our study also suggest an association between recurrent tonsillitis among our adult cohorts and low serum 25(OH) vitamin D levels. Therefore, we opine that serum vitamin D levels should be considered in the management of adult patients with tonsillitis.

Obstructive sleep apnea and anatomical structures of the nasomaxillary complex in adolescents.

The aim of the present study was to reveal the associations between skeletal and soft tissue features of the nasomaxillary complex and development and severity of obstructive sleep apnea (OSA) in adolescents. A total of 100 adolescents (mean age, 14.9 ± 1.4 years; age range, 13–17 years) were enrolled. All participants underwent full-night polysomnography and had an assessment of size and position of the tongue, tonsillar size, body mass index (BMI), and circumference of the waist, neck, and hip. The skeletal features of the nasomaxillary complex, including the zygomatic arch width, nasal cavity width, nasal base width, intercanine width, intermolar width, maxillary dental arch length, palatal vault angle, palatal depth, and SNA were measured on the three-dimensional images constructed with computed tomography data. Participants with an apnea and hypopnea index (AHI) of lower than 5 (AHI ≤ 5) were classified as control and participants while those with an AHI of greater than 5 were classified as OSA group. Each variable with a significant outcome in the independent T-test and age and sex factors were integrated into the multivariate linear regression and the dependent variable was AHI. There were significant differences in the BMI and hip circumference between two groups. The width of nasal base, palatal vault angle and SNA also showed significant differences between groups. The results from multivariate linear regression demonstrated that the BMI, width of the nasal base, and SNA showed significant contributions to the severity of OSA in adolescents. The features of the nasomaxillary complex seemed to have significant influences on development and severity of OSA.

0544 Polysomnography characteristics of children with obesity: A single center retrospective study

Abstract Introduction The constellations of symptoms known as obstructive sleep apnea (OSA) results from either partial or complete airway obstruction during sleep. This affects effective gas exchange and disrupts sleep architecture resulting in sleep fragmentation with downstream immediate and long-term adverse effects. Obesity is a significant risk factor in childhood OSA, especially in post-pubertal children. Obese/overweight children have been found to have significantly higher rates of OSA than their normal-weight counterparts, independent of tonsillar size. Polysomnography characteristics (PSG) comparing children with obesity with and without comorbidities (Hypertension, Diabetes or Pre-diabetes) has not been previously described. Methods Retrospective analysis of 190 obese children (BMI&amp;gt;95th centile), age between 7-18 years with AHI ≥5/hour met the criteria for the data analysis. Clinical, demographic and PSG parameters of children with obesity with and without co-morbidities were compared using Wilcoxon rank sum test. Correlation (Spearman non-parametric) and regression model was employed to explore associations between demographic and PSG characteristics. Results Majority of the obese children (mean BMI 33.2) had mild OSA, with no significant difference in AHI between the two groups. Children with obesity and comorbidities were older with higher BMI. There was no difference in BMI between the two groups after adjusting for BMI z scores. AHI increased with increasing BMI centiles. In our regression model, peak ETCO2 was associated with Black race, AHI, rhinitis and inversely associated with asthma. Peak ETCO2 increased with BMI. Oxygen at baseline, nadir and desaturation duration inversely correlated with BMI-centiles. Older children had lower O2 nadir. Black race was associated with higher desaturation, supine AHI, and arousal index. Supine AHI was higher with rhinitis. Average heart rate when awake, NREM and REM increased with higher BMI. Conclusion In our study, majority of the children had mild OSA with no significant difference in AHI between obese children with and without comorbidities. AHI, average heart rate and peak ETCO2 increased with BMI. O2 nadir was lower in older children and with higher BMI. Black race was associated with higher peak ETCO2, higher desaturation and supine AHI. Children with obesity and comorbidities were older with higher BMI suggesting synergistic effect of BMI and duration of obesity. Support (If Any)

Using clinical data to predict obstructive sleep apnea.

BackgroundObstructive sleep apnea (OSA) is a common disorder and associated with motor vehicle accidents, reduced quality of life and various comorbidities. It is necessary to identify clinical parameters that may predict the presence and severity of OSA.MethodsSubjects with suspected OSA were consecutively recruited for development and validation of the models. Clinical data collected from participants included general information, OSA-related symptoms, questionnaire responses, and physical examination. Logistic and linear regressions were used to develop models to determine the presence and severity of OSA.ResultsAll 202 subjects (157 men, 45 women; age range, 18–68 years) underwent polysomnography (PSG) and clinical assessment, of whom 62.3% were diagnosed with OSA. The presence of OSA was defined using the equation, 1.00 × central obesity + 2.05 × snoring + 1.80 × witnessed nocturnal apnea + 1.73 × lateral narrowing – 3.25; and apnea-hypopnea index (AHI) was defined using, 12.5 × central obesity + 17.1 × witnessed nocturnal apnea + 6.2 × tonsillar size + 9.0 × lateral narrowing – 19.7. The model demonstrated a sensitivity of 81.1% (95% CI: 73.2–87.5%) and a specificity of 76.0% (95% CI: 64.7–85.1%) at the optimal cut-off value for OSA detection. The positive and negative likelihood ratios were 3.4 (95% CI: 2.2–5.1) and 0.3 (95% CI: 0.2–0.4), respectively. The area under the receiver operating characteristic curve for the predictive model (83.7%) was significantly greater than that of the Berlin Questionnaire (53.5%), Epworth Sleepiness Scale (61.1%), and STOP-BANG questionnaire (73.8%). 101 subjects were recruited as the validation group. The models to determine the presence and severity of OSA had an accuracy of 0.812 and 0.416 in the validation group.ConclusionsResults of the present study suggest that a combination of clinical data may be helpful in identify patients who are at increased risk for OSA.

Potential Role of Obstructive Sleep Apnea on Pain Sensitization and Jaw Function in Temporomandibular Disorder Patients.

BackgroundThe relationships between obstructive sleep apnea (OSA) and diverse types of pain disorders have been reported. However, the interaction between OSA and pain-related temporomandibular disorder (TMD) remains obscure.MethodsA total of 60 adults (male/female, 48/12; mean age, 41.7 ± 13.2 years) with pain-related TMD were enrolled. All participants underwent overnight full-channel polysomnography and had assessment of size and position of the tongue, tonsillar size, height, and weight. Diagnostic Criteria/TMD criteria was applied to diagnose TMD. Myofascial trigger points (TrPs) were bilaterally evaluated in the two masticatory and four cervical muscles including the temporalis, masseter, trapezius, sternocleidomastoid, occipitalis, and splenius capitis muscles. Participants were divided into three groups in accordance with their levels of OSA.ResultsThe significantly higher number of active TrPs were detected in participants with severe OSA. The number of active TrPs in the masticatory muscles significantly interacted with diverse types of apneic and arousal indices.ConclusionThe myofascial pain modulating mechanisms and jaw function could have interactions with nocturnal hypoxia and sleep fragmentation in chronic pain-related TMD patients.

Clinical correlations to distinguish severe from milder forms of obstructive sleep apnoea syndrome using overnight oximetry for prioritising adenotonsillectomy in a limited-resource setting

BackgroundIn resource-poor settings with limited surgical services, it is essential to identify and prioritise children with severe and very severe obstructive sleep apnoea syndrome (OSAS) to expedite surgery. McGill's Oximetry Score (MOS) has been validated against polysomnography for OSAS and is affordable and easy to use. AimsThe aim of this study was to assess the correlation of tonsillar size and clinical symptoms with MOS grade 3 or 4, to identify who requires overnight oximetry and who to prioritise for adenotonsillectomy. MethodsChildren with suspected OSAS were recruited from the otolaryngology clinic at the Red Cross War Memorial Children's Hospital. Demographics, symptom screening scores (SSS), patient characteristics, overnight oximetry (OO), echocardiography and MOS scores (graded 1–4) were recorded. Multivariate modified-Poisson regression models were used to examine correlations of patient characteristics ‘with grade 3 or 4 MOS. ResultsOne-hundred-and-three children were analysed, 38% were female, and median (IQR) age was 3.8 (2.5–5.3) years. Increased tonsil size was associated with a 60% increased risk of grade 3 or 4 MOS, risk ratio (RR) 1.59, 95% CI 1.10–2.29 (p = 0.014). Children with witnessed apnoeic events during sleep had 1.3 times increased risk of MOS Grade 3 or 4, RR 1.31, 95% CI (p = 0.033). A significant correlation was shown with grade 3 or 4 MOS, RR 1.15, 95% CI 1.03–1.27 (p = 0.010) by combining tonsillar size with the following symptoms: apnoeic events; struggling to breathe during sleep and needing to stimulate the child to breathe. ConclusionIdentifying children with suspected OSAS who require overnight oximetry can be performed using a simple 3-question screening tool: witnessed apnoeic events, struggling to breathe and the need to shake them awake to breathe. This is more precise with an additional clinical finding of grade 3 or 4 tonsils. These children should have surgery expedited. Any child with a MOS 3 or 4 score on OO needs to have expedited surgery.

Haematologic Markers and Tonsil-to-Body Weight Ratio to Assist Adenotonsillar Hypertrophy Diagnosis.

Aims Diagnosis of Adenotonsillar Hypertrophy (ATH), the leading cause of pediatric Obstructive Sleep Apnea (OSA), depends on physical exam via Brodsky's staging of tonsils. This study investigates the associations of ATH with patient parameters, and balances in-office tonsil hypertrophy appraisal against true organ mass. Materials and Methods A prospective cohort was formed of 103 children operated for ATH, and 31 matched controls. Demographic, clinical and tympanographic data, as well as Complete Blood Count (CBC) indices were compared. Absolute and relative to total body weight tonsil specimen mass were correlated with Brodsky's score. Results Tonsillar size indices were significantly raised in ATH patients. Elevated leukocytes (P = 0.012) and increased neutrophil percentage (P = 0.025) conveyed higher ATH risk. Subjective evaluation of tonsils graded 1 or 2 correlated significantly with absolute (P = 0.001) and relative (P = 0.006) objective measurements. Brodsky's score 3 and 4 displayed marginal significant association with relative (P = 0.050) but not with true (P = 0.989) mass. Conclusion An occult hematologic inflammatory response was detected in ATH children. Clinical estimation of severely hypertrophic tonsils should be adjusted for total body weight. Trial Registration Number: NCT03541434 (clinicaltrials.gov).

Oral Physical Findings in Patients with Chronic Nasal Obstruction

Background: Although chronic nasal obstruction causes mouth breathing, it causes changes in orofacial anatomy to compensate reduced airflow and facilitate breathing. As a result there is a mismatch between growth and evolution of orofacial structures.The aim of this study is to find oral physical findings in patients with chronic nasal obstruction. Methods: All patients referred to the clinic and ward in Imam Reza Hospital during 2019-2020, who suffered from chronic nasal obstruction, were examined and the findings of the examination included Tonsil size, tongue size, mallampati, tonsillar pillars size, palate height, palate thickness, ovula length, hypertrophy of nasal turbines,septal deviation, long face, neck circumference were compared among case and control groups.And also STOP-BANG score was calculated and risk of OSAS was shown. Results: In this study, the average age of people with nasal obstruction was 42.89±14.30. In physical examinations of the mouth, the size of the tonsils and the size of the neck did not differ significantly between two groups, but other positive examinations were significantly higher in patients with chronic nasal obstruction and there was no significant difference in blood pressure, diabetes, hypercholesterolemia, IHD, fatty liver in the control group. Only patients with nasal obstruction complained significantly more than the control group of hearing loss. Conclusion: The frequency of tongue enlargement, soft palate, and thick palate and Malapmati score were significantly higher in people with chronic nasal obstruction.

Otorhinolaryngological Management in Taiwanese Patients with Mucopolysaccharidoses.

Background: Mucopolysaccharidoses (MPSs) are lysosomal storage disorders wherein glycosaminoglycans accumulate because the enzymes that degrade them are insufficient. The earliest symptoms, which are the main reasons for seeking consultation, are otorhinolaryngological and commonly occur in MPS I, II, IV, and VI. This retrospective study aimed to determine the occurrence of otorhinolaryngological manifestations in MPS patients in Taiwan and to analyze the prognosis of surgical intervention, including its effect on symptoms.Methods: We reviewed 42 patients (30 males and 12 females), with a median age of 20.5 years, who had MPS (16.7% type I, 35.7% type II, 19.0% type IIIB, 21.4% type IVA, and 7.2% type VI). The following otorhinolaryngological manifestations were collected: annual number of upper respiratory tract infections (URTIs) and otitis media with effusion (OME) episodes, adenoid size, tonsillar size, and apnea-hypopnea index (AHI).Results: Among 42 patients, we found recurrent otitis media in 42.9% of the patients, hearing loss in 83.3% (mixed: 52.4%, conductive: 21.4%, and sensorineural: 9.5%), frequent URTIs in 47.6%, and obstructive sleep apnea syndrome in 35.7%. Moreover, 76% of the patients underwent ear, nose, and throat (ENT) surgery, including adenoidectomy, tonsillectomy, tympanostomy with ventilation tube insertion, tracheotomy, and supraglottoplasty.Conclusions: MPS patients had a high incidence of ENT problems. ENT surgery reduced the severity of hearing loss, degree of symptoms related to upper airway obstruction, and severity of respiratory tract and otological infections of patients with MPS.

Assessment of Friedman Classification by Measuring Actual Tonsil Size During Surgery

Background and Objectives: Adenotonsillar enlargement is a common cause of pediatric illnesses, including obstructive respiratory disease and recurrent airway infection. The current tonsil grading systems evaluate tonsil size, but the correlation with actual tonsillar size in a clinical setting has not been established.Materials and Method: Between May and July of 2018, we recruited 31 children who underwent adenotonsillectomy with no major craniofacial abnormalities. The actual size of the palatine tonsils, the long (L1) and short (S1) axes of the tonsil beyond the anterior pillar, and the real axes (L2 and S2) after tonsil extraction from the fossa were measured during surgery. Adenoid size was determined by measuring the adenoid-nasopharynx (AN) ratio through lateral view x-ray of the neck.Results: Though S1 was related to the Friedman scale (p&lt;0.001), measured real axes were not (L2: p=0.058, S2: p=0.056). Also, adenoid size and AN ratio did not relate statistically to the Friedman scale (p=0.565). One of the measured real tonsil size parameters (S2) was related to AN ratio (p=0.048).Conclusion: For pediatric patients undergoing tonsillectomy and adenoidectomy, the Friedman grading scale based on physical examination may not reflect the actual size of the tonsils. Therefore, for children with obstructive sleep disorder or recurrent tonsillitis, intraoperative measurement of tonsil size can be helpful.

Karakteristik Pasien Tonsilitis pada Tonsilektomi di Rumah Sakit Pertamina Bintang Amin Bandar Lampung

Tonsillitis is an inflammation of the palatine tonsils originating from the Waldeyer ring. Eustachian tubal tonsils, lingual tonsils, palatine tonsils, and pharyngeal tonsils are the composition of the lymph glands in the oral cavity and are the waldayer ring's composition. Tonsillectomy is one type of ENT (Ear Nose and Throat) surgery most often performed on children, adolescents, and adults. Tonsillectomy is also a procedure that can be done if there is a chronic infection or a recurring infection. This study aims to determine the characteristics of age, sex, tonsillar size of Tonsillitis patients in Tonsillectomy at Pertamina Bintang Amin Hospital in Bandar Lampung. Method: The research method used is a quantitative descriptive analysis method with data taken retrospectively. The source of the research data is secondary data obtained from medical records of patients diagnosed with Tonsilitis in Tonsillectomy at Pertamina Bintang Amin Hospital in Bandar Lampung. A total of 92 patients. Data collection in November 2019 - finished. Analysis through univariate analysis. The results show the characteristics of Tonsillitis Patients in Tonsillectomy in Pertamina Bintang Amin Hospital are 12-25 years of age (52.5%) and 6-11 years of age 30 (3 2.6%) and ages 26-45 5 years (5.4%) and ages 46 - 65 years 3 (3.3%), with 50 (54.3%) female and 42 (45.3%) men, with T3 tonsil size was 47 (51.1%), and T2 size was 27 (29.3%), and T4 was 18 (19.6), and T1 was 0 (0%). Characteristics of Tonsillitis Patients in Tonsillectomy at Pertamina Bintang Amin Hospital in Bandar Lampung, the most age was 12-25 years old, and the most sex is in women, the most tonsil size in T3 size was 47 people.

Anti-inflammatory medications for obstructive sleep apnoea in children.

Anti-inflammatory medications for obstructive sleep apnoea in children.

Obstructive sleep apnea in 2-6year old children referred for adenotonsillectomy.

Adenotonsillectomy is one of the most common surgical procedures performed in children. The indications for surgery are either frequent recurrent throat infections or hypertrophy of the tonsils/adenoid vegetation, which can cause obstructive sleep apnea (OSA). There is disagreement regarding the need for sleep studies before adenotonsillectomy to confirm a diagnosis of OSA. Several studies have evaluated questionnaires and physical examination as tools to identify OSA, with conflicting results. The aim of this study was to evaluate the prevalence of OSA among children referred for adenotonsillectomy and whether questionnaires or physical examination can help identify OSA. This is a prospective cohort study of children aged 2-6 years, referred for adenotonsillectomy. Polysomnography and an otorhinological examination were performed. Tonsillar size and the oral cavity were graded using Friedman's classification and Mallampati score, respectively. The Pediatric Sleep Questionnaire (PSQ) and OSA-18 were also completed. 100 children were included. The prevalence of OSA was 87%, with 52% having moderate to severe OSA. The usefulness of the PSQ and OSA-18 for detecting OSA was evaluated using multiple cutoff points, but none yielded acceptable values for both sensitivity and specificity. In logistic regression analyses predicting different levels of OSA severity, age, Friedman tonsillar size and Mallampati score were weakly associated with OSA. The prevalence of OSA is high among children referred for adenotonsillectomy and questionnaires and clinical characteristics are not sensitive enough to detect the presence or severity of OSA.

High-Frequency Ultrasound: A Novel Diagnostic Tool to Measure Pediatric Tonsils in 3 Dimensions.

A wide variety of pathologies can affect the palatine tonsils. Ultrasound is a commonly used modality for assessing head and neck masses in children; however, its use in tonsillar evaluation has not been widely explored. The objective of this study was to measure 3-dimensional tonsillar size with ultrasound, in centimeters, and correlate these measurements with actual ex vivo dimensions on pathology specimens. We performed a prospective cohort study. The study was set in a tertiary care children's hospital. Children undergoing tonsillectomy were included in the study. Transcervical high-frequency ultrasonography (HFU) was performed prior to surgery to obtain 3-dimensional measurements of the right and left palatine tonsils. Mean sizes were compared to ex vivo tonsil measurements and correlations were obtained. Seventy-five consecutive children underwent a transcervical HFU, with a total of 150 tonsils analyzed. The mean differences between HFU and pathology measurements were -0.08 cm and -0.24 cm for the right and left craniocaudal axes, -0.19 cm and -0.18 cm for the right and left mediolateral axes, and 0.05 cm and 0.03 cm for the right and left anteroposterior axes. Correlation coefficients between ultrasound and pathology measurements were all above 0.5. HFU can accurately measure the size of pediatric tonsils in 3 dimensions.

Obstructive sleep apnea in children and adolescents with and without obesity.

To investigate the prevalence of obstructive sleep apnea (OSA) in children referred for obesity treatment, and to compare the prevalence with that of a normal-weight group. Moreover, we examined the association between Body Mass Index Standard Deviation Score (BMI SDS) and the Apnea-Hypopnea Index (AHI). This cross-sectional study included 139 children aged 7-18years with overweight/obesity (BMI SDS >1.28) recruited from an obesity treatment clinic. The normal-weight group consisted of 33 children (BMI SDS ≤ 1.28) aged 7-18years recruited from schools. Sleep examinations were performed using a type 3 portable sleep monitor (Nox T3). OSA was defined as AHI ≥ 2. Height and weight were measured and the tonsillar size was clinically estimated using the Brodsky scale. The OSA prevalence was 44.6% in children with overweight/obesity compared with 9.1% in the normal-weight group (p = 0.0002), and the relative risk of OSA was 4.9 (95% CI 1.6-14.7). In a logistic regression, a one-unit increase in the BMI SDS increased the odds of having OSA by a factor of 1.92 independent of age, sex, tonsillar hypertrophy, and asthma (95% CI 1.33-2.76, p = 0.0005). A generalized linear regression adjusted for the same variables revealed an association between BMI SDS and AHI (a one-unit increase in the BMI SDS equaled an average increase in the AHI of 35% (95% CI 19-53%, p < 0.0001)). In this study, children with overweight/obesity had a significantly higher prevalence of OSA compared with a normal-weight group. Increased BMI SDS was associated with increased AHI.

Bipolar-destekli tonsil küçültme: Basit ve düşük maliyetli bir tonsillotomi tekniği

Objective: This study aims to investigate the novel use of a simple and inexpensive bipolar-assisted tonsil reduction (B-TR) technique in pediatric cases with adenotonsillar hyperplasia by evaluating long-term results, possible complications, need for reoperation and incidence of recurrence. Methods: We present our long-term retrospective data from 78 consecutive pediatric cases undergoing B-TR combined with adenoidectomy from April 2013 to January 2017. The tonsillar sizes were recorded using the Brodsky grading scale from I to IV, and the patients only with prominant tonsillar sizes (III and higher) and adenoidal sizes exceeding 50% were included in the study group. The tonsil sizes were noted preoperatively, and during the latest follow-up visit after tonsillotomy (min. 9 months postoperatively). Results: With a mean follow-up period of 18.3 months, the mean tonsillar size preoperatively was 3.47 (±0.50) and mean tonsillar size postoperatively was 1.35 (±0.48). A significant difference (p<0.001) was observed between these two groups, excluding the only case who later had undergone tonsillectomy. Minimal uvular edema was noted in 27 children (34.6%), which did not cause any upper airway obstruction in these patients. Conclusion: We describe herein our B-TR technique in details so that it can be learned relatively quickly and used in pediatric cases with adenotonsillar hyperplasia as a treatment option.

Pediatric Tonsil Cancer: A National and Institutional Perspective

To evaluate childhood and adolescent tonsil cancer incidence and to identify the clinical characteristics indicative of those patients who would benefit from urgent operative intervention. The Surveillance, Epidemiology and End Results 18 database, inclusive of national cancer statistics from 1973 to 2013, provided quantitative tonsil cancer incidence data. An institutional retrospective chart review of pediatric patients diagnosed with tonsil malignancy from January 2013 to January 2017 identified supplementary qualitative clinical presentation information. The Surveillance, Epidemiology and End Results 18 database included 138 pediatric patients with tonsil cancer with an age-adjusted incidence rate of 0.021/100 000 patients per year. The majority of cases were unilateral (79.7%), and there was both a male and Caucasian predominance. Non-Hodgkin lymphoma (84.1%) was the most common malignancy, of which Burkitt lymphoma (31.1%), diffuse large B-cell lymphoma (26.8%), and follicular lymphoma (10.1%) were the most common subtypes. Five tonsillar malignancy patients were identified upon institutional chart review. The majority likewise had non-Hodgkin lymphoma and all shared a history of rapid tonsillar enlargement over ≤12 weeks. Significant tonsillar asymmetry was present in 4 patients. Four patients additionally exhibited prominent cervical lymphadenopathy. Pediatric tonsil cancer is rare, with non-Hodgkin lymphoma accounting for the majority of pediatric tonsillar malignancies. A high index of suspicion is appropriate in children who present with relatively rapid tonsil enlargement, tonsillar asymmetry characterized by a difference in tonsillar size of ≥2 degrees on the Brodsky scale, or concurrent prominent cervical lymphadenopathy.

Normative Values for Tonsils in Pediatric Populations Based on Ultrasonography.

Pediatric tonsillar infections are common, particularly in adolescents. Ultrasonography (US) has high sensitivity and specificity for diagnosing peritonsillar abscesses and can diagnose tonsillitis by enlargement of the gland. In this study, we established normal tonsillar measurements and volumes according to age in pediatric populations. Transcervical US of the peritonsillar region to measure tonsillar size and volume was performed in patients who had undergone neck US without throat symptoms from October 2016 to May 2017. Transverse and anteroposterior diameters, length, and volume were measured. In total, 161 patients (age range, 1 month-18 years) were enrolled in the study. The mean tonsillar volumes ± SD were 1.58 ± 1.26 (total), 0.30 ± 0.14 (<1 year), 1.27 ± 0.57 (1-<5 years), 2.06 ± 1.09 (5-<10 years), and 2.19 ± 1.48 (>10 years) cm3 . Mean measurements for the sums of both tonsils for the transverse diameter, anteroposterior diameter, and length were 1.98 ± 0.61, 2.17 ± 0.66, and 2.28 ± 0.69 cm, respectively. Tonsillar size and volume increased according to age. Simplified models for volume estimation showed that anteroposterior diameters had the highest coefficients of determination (R2 = 0.71 and 0.74). Regression models for the tonsillar volume of 6 measurements in the multiple linear regression models showed an R2 of 0.89. Regression models for log(volume) showed an improved coefficient of determination (R2 = 0.96). These normal tonsillar sizes on transcervical ultrasound in pediatric patients can be used to diagnose tonsillar lesions.