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Objective To compare the accuracy of lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy in assessment of adenoid size. Methods A cross-sectional study was conducted in 43 pediatric patients undergoing ENT surgery from July 2017 to December 2018. All patients underwent preoperative lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy. Results The average adenoidal-nasopharyngeal (A/N) ratio obtained from lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy was 72.9, 79.5, and 81.6, respectively. There was a moderate correlation between A/N ratio from lateral skull film and intraoperative rigid endoscopy (Pearson's correlation: 0.567, p˂0.001). Whereas, the A/N ratio from flexible endoscopy compared to intraoperative rigid endoscopy showed a stronger correlation (Pearson's correlation: 0.791, p˂0.001). From linear regression analysis, the intraoperative adenoid measurement was estimated from the results of flexible endoscopy (intraoperative rigid endoscopy: 0.72 [flexible endoscopy] +24.47) and lateral skull film (intraoperative rigid endoscopy = 0.65 [lateral skull film] + 34) Conclusion Flexible endoscopy yields the most accuracy in the assessment of adenoid size and nasopharynx visualization, without radiation exposure or anesthesia. Despite less accuracy, lateral skull film is more availability in every hospital. The correlation of adenoid size measurement in this study can also be applied for the actual size of adenoid.

Tonsillar surgery was, from the 19th century, the reference treatment for apneic patients. Adapting to the technical limitations of the time, surgeons devised ingenious procedures. The purpose of this historical note is to travel back to that time and rediscover one of the techniques favored by Chassaignac: “simultaneous enucleation” of the tonsils.

Developmental and growth retardation is a condition that is often encountered among children with adenotonsillar hypertrophy (ATH). Leptin, ghrelin and IGF-1 are important factors in growth and development for children. The aim of the study was to investigate serum leptin, ghrelin and IGF-1 levels in children with ATH compare with healthy controls.82 children between ages 6-12 were included in this study, divided into two groups. The first group being the study-group consisted of 42 children with obstructive adenotonsillar hypertrophy and the second group being the control-group consisted of 40 healthy children. At 08:30 a.m., peripheral blood samples were extracted from children from both groups to examine the serum levels, and kept in -40 °C until the Elisa test.Leptin serum level of the control-group was found to be statistically significantly higher than the serum leptin level of the ATH group (p = 0,049; p 0.05). Body mass indexes of the children with ATH were found to be statistically significantly lower than the body mass index (BMI) of the control group (p = 0,001; p 0.05). In contrast, there was no statistically significant difference between ghrelin and IGF-1 levels between the ATH and control group (p = 0.193, p 0.05 and p = 0.478, p 0.05, respectively).Upper airway infections are common in children with ATH. Increased airway infections and obstructive enlarged adenotonsillar lymphoid tissue which are caused swallowing difficulties can lead to reduced oral intake and fat tissue. It has led us to think that, ghrelin levels may be increasing secondary to these problems in children with ATH. Furthermore, BMI and leptin would be lower in children with ATH, considering adipose tissue was lesser and leptin was being synthesized and oscillated out of the fat cells of the tissue in these children.

The concept of personalised medicine is likely to revolutionise the treatment of adult obstructive sleep apnoea as a result of recent advances in the understanding of disease heterogeneity by identifying clinical phenotypes, pathophysiological endotypes, biomarkers and treatable traits. Children with the condition show a similar level of heterogeneity and paediatric obstructive sleep apnoea would also benefit from a more targeted approach to diagnosis and management. This review aims to summarise the adult literature on the phenotypes and endotypes of obstructive sleep apnoea and assess whether a similar approach may also be suitable to guide the development of new diagnostic and management approaches for paediatric obstructive sleep apnoea.

Objective to detect, analyze and discuss the different ear nose throat (ENT) manifestations those were reported in COVID19 positive patients in the reviewed and published literatures. Methods We performed a search in the PubMed databases, Web of Science, LILACS, MEDLINE, SciELO, and Cochrane Library using the keywords; COVID-19, Novel coronavirus, corona, 2019-nCoV, SARS-CoV-2, ENT, ear, nose, throat, otorhinolaryngology, ORL, pharynx, ORL, smell, larynx, different ENT related symptoms. We reviewed published and peer reviewed studies that reported the ENT manifestations in COVID-19 laboratory-confirmed positive patients. Results within the included 1773 COVID-19 laboratory-confirmed positive patients, the most common ENT manifestations of COVID-19 were sore throat (11.3%) and headache (10.7%). While the other reported ENT manifestations were pharyngeal erythema (5.3%), nasal congestion (4.1%), runny nose or rhinorrhea (2.1%), upper respiratory tract infection (URTI) (1.9%), and tonsil enlargement (1.3%). Conclusion ENT manifestations for COVID-19 are not common as fever and cough. But, a universal questionnaire using well-defined COVID-19 manifestations is needed to make the COVID-19 data precisely defined, complete and homogenous.

The use of mometasone furoate (MF) intranasal spray in treating adenoid hypertrophy (AH) has a variable outcome due the different methods of adenoid size evaluation. The aim of our study was to evaluate the effect of MF intranasal spray in children and adolescents with AH using a reliable and consistent endoscopic evaluation.A prospective interventional study was conducted. Evaluation took place during the first visit (week 0) and second visit (week 12). Symptoms of nasal obstruction, rhinorrhoea, cough and snoring were assessed, and an overall total symptoms score was obtained. A rigid nasoendoscopic examination using a four-grading system of adenoid size from 1 to 4 was performed. Patients were treated with MF intranasal spray for 12 weeks. Patients' aged 7-11-years old used 1 spray in each nostril once daily, while patients aged 12-17 used two sprays in each nostril once daily. Reassessment was carried out during the second visit (week 12).A total of 74 patients was recruited. There were significant improvements from week 0 to week 12 in the symptoms' score for nose obstruction, rhinorrhoea, cough, snoring including the total nasal symptoms' score (p0.001). AH significantly reduced in size from week 0 (2.89±.87) to week 12 (1.88±.83) (p0.001).MF intranasal spray is effective in improving the symptoms attributed to AH as well as reducing the adenoid size. MF intranasal spray is advocated as a treatment option before adenoidectomy is considered.

Evidence-based recommendations are constantly being updated for various pediatric surgical procedures, including the role for tympanostomy tubes, as well as indications for adenoidectomy and tonsillectomy. With a growing body of research available on some of the most prevalent pediatric conditions, an update on the current concepts surrounding management is warranted.

Objective To determine predictive fiberoptic findings of upper airway in children with allergic rhinitis. Method 129 children had fiberoptic evaluation of nasal cavity, pharynx and larynx. They were divided into allergic rhinitis group and normal group based on skin prick test results. All video recordings were randomly reviewed by three independent national board-certified otolaryngologists who were blinded to the clinical details and outcomes of the participants’ allergy testing. Each physician assessed and documented 10-item questionnaire. Intra-rater, inter-rater reliability and correlation between items and allergic status was calculated. Results Intra-rater reliability was moderate to perfect for all physicians on all items (kappa = 0.578–0.962). Inferior turbinate hypertrophy (κ = 0.714, p = 0.02), middle turbinate hypertrophy (κ = 0.728, p = 0.01), discoloration of inferior turbinate (κ = 0.685, p = 0.01), adenoid hypertrophy (κ = 0.662, p = 0.02) had good inter-rater reliability and these findings were predictive of allergic rhinitis. Adenoid hypertrophy was less encountered in allergic rhinitis. All other endoscopic findings beyond the nasal cavity were not predictive for allergic rhinitis in children. Conclusion Nasal cavity findings including inferior turbinate hypertrophy, middle turbinate hypertrophy, discoloration of inferior turbinate and adenoid tissue assessment rather than pharyngolaryngeal findings are predictive of allergic rhinitis in children.

Otitis media with effusion is common middle ear mucosa disease that can cause hearing loss in children. Adenoid hypertrophy can cause recurrent acute otitis media in addition to otitis media with effusion as a result of eustachian tube dysfunction and primary infection focus. The aim of this study was to investigate the effect of adenoid hypertrophy on the hearing threshold in children suffering from otitis media with effusion.Children of school age with otitis media with effusion were included in the study. The size and location of the adenoid tissue were determined by examination with a flexible endoscope. Four adenoid size groups were determined according to the percentage of choanal closure. The coverage was 0-25% in the first group, 26-50% in the second group, 51-75% in the third group and 76-100% in the 4th group. The location of the adenoid tissue in the nasopharynx was divided into three groups. In group A, the adenoid tissue was not in contact with torus tubarius. In group B, the adenoid tissue was in contact with the torus tubarius but did not cover it. In group C, the adenoid tissue covered the torus tubarius completely. Bone and air conduction thresholds were determined using standard procedures. The statistical relationship between the size and location of adenoid tissue and the hearing thresholds was investigated.The study was conducted with the 88 ears of 50 children aged 5-15 years. The median values of mean air conduction thresholds at 500 Hz, 1000 Hz, and 2000 Hz in the adenoid tissue size groups 1-4 were 22 dB HL, 20 dB HL, 15 dB HL, and 20 dB HL respectively. The median values of the mean air conduction thresholds were 20 dB HL, 20 dBHL and 18 dB HL in the adenoid location group A-C, respectively. No significant correlation was found between the groups (p:0.213) and the relevant hearing values (p:0.670). Type B tympanogram was identified in 46 ears and type C tympanogram in 42 ears. The mean hearing thresholds were significantly higher in the ears with a type B tympanogram in the otitis media with effusion cases. (P 0.001).There was no significant correlation between the duration of effusion and the adenoid size (p:0.931), adenoid location (p:0.626) and hearing threshold (p:0.815).We concluded that adenoid tissue size and location have no effect on hearing thresholds and the duration of effusion in otitis media with effusion. We suggest caution before deciding on adenoidectomy in otitis media with effusion cases. Adenoidectomy should not be performed in children over 4 years of age unless there is a definite indication such as nasal obstruction or chronic adenitis.

Objective Fractalkine, member of chemokine family, is involved in many inflammatory processes in the human body. The aim of this study is to compare expression levels of fractalkine ligand and its receptor in chronic tonsillitis and hypertrophic tonsil samples. Methods The study was conducted at Baskent University Departments of Otorhinolaryngology and Medical Genetics. It is designed as a prospective, non-randomized, controlled clinical study. Total 97 samples, obtained from adenotonsillectomy due to chronic tonsillitis or tonsillar hypertrophy, were participated in the study. Fractalkine and its receptor expression levels were determined and comparison was made between the tissue groups. c.839C > T (T280 M) polymorphism of fractalkine receptor was analyzed, then relationship between polymorphism and the expression level of fractalkine receptor was investigated. Results Fractalkine receptor expression was significantly higher in the hypertrophic tonsil group than chronic tonsillitis group (p Conclusion Fractalkine, member of chemokine family, and its receptor may play role in preventing chronic-recurrent tonsillitis.

Objective To evaluate the incidence of tonsil and adenoid malignancy in pediatric patients in Israel compared to the known literature and to revisit the common practice of routine histopathologic examination of tonsils and adenoids. Methods Analysis of the Israel National Cancer Registry data on pediatric tonsil and adenoid malignancies between the years 2005 and 2015, and a systematic literature review of all relevant articles that reported on malignancies amongst pediatric patients who underwent tonsillectomy with or without adenoidectomy. Results Only seven cases of tonsillar malignancies were documented out of 152,352 (0.0052%) surgeries in the pediatric population. All malignancies were lymphoproliferative and mainly Burkitt's lymphoma. In our medical center no malignancy was found in 2165 patients in the same age groups and time period. We found the incidence of tonsillar malignancy in Israel to be significantly lower (p = 0.013) compared to the previously described literature. Conclusion The incidence of malignancy in routine histopathological examination of tonsils and adenoids is Israel is very low when compared to the known literature. According to these results, we suggest that routine histopathological examination of all such samples is not clinically justified.

Children who undergo adenotonsillectomy have a range of symptoms. Some present with infective symptoms, others with obstructive symptoms, and many with a combination of both. The most common surgical indication has changed over the past several decades from infective symptoms to obstructive symptoms. However, there are few data available to differentiate these groups of children in terms of their clinical characteristics. This study aimed to determine the clinical characteristics of children with obstructive sleep apnea versus infectious adenotonsillar hyperplasia.Data were obtained from the medical records of two district health boards in Auckland, New Zealand. Extraction of clinical information was performed following the identification of all patients under the age of 16 years undergoing adenotonsillectomy between December 2015 and December 2017.A total of 1538 children were included in this study. There were 112 (7.3%) with recurrent tonsillitis (RT) symptoms only, 624 (40.6%) with RT and sleep-disordered breathing symptoms (SDB), and 802 (52.1%) with symptoms suggestive of obstructive sleep apnea (OSA). Children with OSA were more likely to be male (p 0.001), younger (p 0.001), and have lower body mass indexes at time of surgery (p 0.001). There was no difference between groups in the number of antibiotic courses prescribed in the year before surgery (p = 0.7). There was no significant difference in tonsil or adenoid grade between groups (p = 0.2). Children with OSA were more likely to have a diagnosis of asthma (p 0.001) and allergic rhinitis (p 0.001), but less likely than those with RT to have a diagnosis of eczema (p 0.001). Children with OSA were more likely to have otitis media with effusion requiring ventilation tube insertion (p 0.001) and a documented history of speech delay (p 0.001). Thirty-day readmission rates were higher in the OSA (8.5%) and SDB/RT (9.3%) groups when compared to those with RT (1.8%) (p = 0.03).Children with OSA have different perioperative characteristics than those with recurrent tonsillitis, including increased risk of postoperative bleeding and need for post op readmission. Therefore, management strategy may vary according to the indications for tonsillectomy and adenoidectomy.

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

Objective To investigate the safety of adenoidectomy and risk factors of re-adenoidectomy, and intend to provide evidence-based information to clinicians for further consideration. Methods and materials This study was based on data obtained from Taiwan’s National Health Insurance Research Database from the period 2002–2011. We utilized that data from the hospitalization group and collected information regarding those individuals who accepted adenoidectomy with or without tonsillectomy and post-adenoidectomy bleeding. Thereafter, we performed univariate and multi-variate analysis to explore the possible risk factors of re-adenoidectomy. Results A total of 5435 individuals who accepted a first adenoidectomy with or without tonsillectomy were collected. After further tracing treatment of these individuals, 107 (1.97%) accepted the revision adenoidectomy until 2011. Post-op bleeding was approximately 0.28%. The revision rate associated with patient age showed the following: 0–4 years (0.61%), 4–12 years (2.06%) and 12–18 years (2.56%). The revision rate associated with surgeon age showed: 28–41 years (1.42%), 41–50 years (2.96%), 50–65 years (2.74%); the surgeons’ surgery volume showed low (4.34%), medium (0.71%), and higher (1.02%). There are 4 diseases (otitis media with effusion, sinusitis, chronic pharyngitis, and sleep disorder) that showed a significant relationship with the revision rate when subject to univariate and multivariate analysis. The revision rate incorporating hospital locations, volumes and levels revealed no significant difference with each other. Conclusions Adenoidectomy is a generally safe surgical procedure, with low complication and low revision rate. Our study indicated that the revision rate of adenoidectomy might be lower when performed by young visiting staff with medium to higher surgical volume in the medium to higher volume hospital. If patients had diseases such as otitis media with effusion, sinusitis, chronic pharyngitis, and sleep disorder, they would be subject to higher rate of re-adenoidectomy. Surgeons should be aware and sufficiently explain this information to the parents before surgery.

AIMS This study compares the efficacy of adenoidectomy on otitis media with effusion (OME) in patients with different size of adenoids and the connection between differently sized adenoids and middle ear effusion. MATERIAL AND METHODS Children with a history of at least 3 months' OME underwent adenoidectomy and myringotomy without the insertion of a tympanostomy tube. Treatment assignment was stratified by adenoids' size causing choanal obstruction (grade I-III) and according to Eustachian tube ostium obstruction (grade A-C). The subjects were followed for 12 months. RESULTS Adenoidectomy was significantly more effective in children with adenoids in contact with torus tubarius (grade B, C) compared to those with small adenoids without contact (P

Respiratory infections, mainly in children, are a demanding challenge for physicians. Commonly, a relative immune-defect sustains their recurrence. At present, there is no standardized treatment for their prevention acting on the immune system. Citomix is a low-dose multicomponent medication largely used in this issue. The current study evaluated its ex vivo effect on adenoidal mononuclear cells recovered from children operated for adenoid hypertrophy. B cell phenotype, and IFN-γ, IL-6, IL-10, IgG, IgA, IgM in culture supernatants were evaluated. Citomix was able to significantly increase the expression of B memory cells, IFN-γ, IL-6, IgA and IgM, and significantly decrease IL-10 and IgG. The current outcomes could be consistent with a strategy deputed to improve the early immune response to pathogens. In conclusion, the present ex vivo study suggests that Citomix might be a promising medication in preventing and early treating respiratory infections.

Objectives To investigate the use of texture analysis to quantitatively distinguish nasopharyngeal carcinoma (NPC) from normal adenoid on CT. Methods In this IRB-approved, retrospective study, nasopharyngeal tissues in 13 patients with NPC and 13 control patients were manually contoured, segmented, and imported to an in-house developed texture analysis program, which extracted 41 texture features. Basic descriptive statistics were performed to evaluate for differences in texture parameters between NPC and controls. Results Statistically significant differences between NPC and controls were seen in 32 of 41 texture features. These significant differences were present in 11 of 12 histogram features, 4 of 5 gray-level co-occurrence matrix features, 7 of 11 gray-level run length features, 4 of 4 gray-level gradient matrix features, and 6 of 9 Laws features. Conclusion Significant differences in many texture features were seen between NPC and normal adenoids. CT texture analysis may aid in differentiating NPC from normal adenoid tissue.

Culture-independent methods, based on bacterial 16 S rRNA gene sequencing, have been used previously to investigate the adenotonsillar microbiota. However, these studies have focused on a single sampling site (usually a surface swab). We aimed to investigate potential differences in adenotonsillar microbiota according to sampling location, both on and within the adenoids and palatine tonsils.Pediatric patients (n = 28, mean age five years) undergoing adenotonsillectomy were recruited for this study. At the time of surgery, a mucosal adenoid surface swab and an adenoid tissue biopsy was collected. Immediately following surgery, the crypts of the right and left tonsils were swabbed, and a surface and core tissue sample from the right tonsil were also collected. Bacterial 16 S rRNA gene-targeted amplicon sequencing was used to determine the bacterial composition of the collected samples.There was no significant difference in diversity or composition of the adenoid microbiota based on sampling site. However, the Shannon-Wiener and Inverse-Simpson diversity indices differed significantly (p 0.05) between the microbial communities of the three different tonsil sampling sites. There was a higher average relative abundance of members from the genera Streptococcus, Actinobacillus, and Neisseria in the tonsil crypts when compared with surface and core tonsil tissue samples.Our results indicate that there is variation in bacterial diversity and composition based on sampling sites in the tonsils but not the adenoids. The difference in microbiota between the surface and the tissue may have implications for our understanding of the pathogenesis of recurrent tonsillitis and have treatment implications.

Objectives Mouth breathing is an important health problem, commonly encountered in children. In children, adeno-tonsillar hypertrophy is the main reason causing partial or complete upper airway obstruction and reduction in airflow. This study aimed to determine the oral health status of children aged 3–15 years, with mouth breathing who were due to have surgery for adeno-tonsillar hypertrophy and referred to the Department of Otorhinolaryngology at Children's Hospital of a University in Ankara, Turkey between January–July 2015. Methods The approval of the Non-Interventional Clinical Researches Ethics Board of Hacettepe University and written informed consents from the parents were obtained. The parents completed a questionnaire before the surgery. The children were examined using dental mirror and explorer under dental unit lighting. Oral health status was evaluated with DMFT/S, dmft/s, ICDAS II, dental plaque and gingival indices. The chi-square test, Kruskal Wallis and Mann Whitney U tests were used to statistically analyse the results, with statistical significance p Results Of the 170 children who had adenotonsillar hypertrophy with mouth breathing, 150 the parents agreed to participate the study. 77 of the children (51.3%) were male; the mean age was 5.9 ± 2.6. Mean dmft was 3.8 ± 3.6, dmfs 9.7 ± 1.1, DMFT 0.4 ± 1.0 and DMFS 0.6 ± 1.5 respectively. Among the children, 101 (67.3%) had cavitated dental caries, and according to ICDAS II, none had healthy teeth, 15 (10.0%) had initial, 42 (28.0%) had moderate and 93 (62.0%) had advanced caries. Of the children, 89.3% had gingivitis and the proportion of gingivitis in posterior region was found to be significantly higher than anterior region (p Conclusions The oral health status of mouth breathing in children with adeno-tonsillar hypertrophy was poor. To reduce the risk of dental caries and periodontal disease among these children, regular dental follow-up and preventive programmes for oral health are needed.

The immune reaction developing against Ebstein-Barr virus (EBV) infection may be one of the major determinants of severe adenoid hypertrophy (AH) and chronic otitis media with effusion (COME) needing surgery. In this study, we aimed to investigate the relationship between these antibodies and the need for surgery due to complications such as severe AH and COME.Sixty consecutive patients15 years old who were admitted to our outpatient clinics between January 2014 and December 2015 with severe AH ± COME and underwent adenoidectomy ± ventilation tube insertion and 129 control patients who had a history of EBV infection at least three months before the inclusion to the study without current symptoms of upper airway obstruction and middle ear disease were included in this study. Two groups of patients and a control group were studied: a) children who underwent adenoidectomy alone with no middle ear disease (group 1), b) children with COME and AH who underwent adenoidectomy and tympanostomy with ventilation tube insertion (group 2), and c) control group without adenoid hypertrophy or otitis media with effusion.Patients who needed surgery (Group 1 and 2) had significantly higher levels of anti-EBV VCA IgG antibodies than control patients (19.8 ± 16.4 vs. 1.7 ± 0.8 S/CO, p 0.001). Anti-EBV VCA IgM levels did not differ between groups. Group 2 patients had also higher levels of Anti-EBV VCA IgG antibodies than group 1 patients (35.8 ± 16.7 vs. 11.8 ± 8.5 S/CO, p 0.001). ROC curve analysis resulted in a cut-off point of 2.92 S/CO level for anti-EBV VCA IgG antibodies for need for surgery in EBV infected patients with 97% sensitivity and 98% specificity.Markedly increased serum anti-EBV VCA IgG antibodies in children who developed upper respiratory tract complications such as severe AH and COME may show the significant role of enhanced immune system reaction in the pathogenesis of these complications due to EBV infection.

We aim to determine average volumes of the upper airway, adenoids and tonsils in preterm and term infants and assess for the differences according to weight, sex and ethnicity. The volumes of the upper airways, tonsils and adenoids were measured from brain MR images in 96 (49 preterm and 47 term) infants and compared using a two-tailed t-test (significant at p

Previous reports have indicated the association of allergy with Waldeyer's ring. The aim of this prospective study was to evaluate the correlation between the allergy and the number of eosinophils in the adenoid and tonsil tissue.101 children who were underwent adenoidectomy and/or tonsillectomy were prospectively enrolled in this study. 46 children who had positive skin-prick test for at least one of the allergen panel were sensitized and 55 children were nonsensitized as a result of skin-prick test. Hematoxylin-eosin stained sections were examined under 400× magnification in a blinded fashion in 10 random sections for all samples and compared the groups.The number of eosinophils in adenoid and tonsil tissue was significantly higher in sensitized patients. The number of eosinophils in the adenoid and tonsil samples also were interrelated too (p 0.001, kappa coefficient: 0.617). As a result of ROC analysis, patients with a cut-off of ≥5 eosinophils was in the sensitized group for adenoid samples [Sensitivity value: 72.09 and specifity value: 91.84]. Patients with a cut-off of ≥3 eosinophils are in the sensitized group for tonsil samples [Sensitivity value: 52.94 and specifity value: 92.11].Presence of sensitization can be distinguished by looking at the number of eosinophils in the adenoid and tonsil tissue. It can be used to determine whether the patient is allergic or not. Examination of the routine hematoxylin-eosin stained adenotonsillary specimen for eosinophilia will guide us the diagnosis and treatment of allergic rhinitis and also reduce the cost considerably.

In the GRAPE study an analysis is made of postoperative pain sensation in children between 6 months and 6 years after adenotomy and placement of ear grommets. Intraoperative treatment with paracetamol versus placebo shows no statistically significant difference in pain between both groups indicating that this type of surgery causes little discomfort and does not require specific intraoperative analgesic treatment.

Introduction Innate immunity molecules are known to play a pivotal role in the homeostasis of the oral mucosa, permitting the presence of commensal microflora and, at the same time, providing a first line of defense against pathogens attempting to invade the oral cavity. Tonsils represent the local immune tissue in oral cavity, being able to provide a non-specific response to pathogens; however, in the presence of microbes or foreign materials present in the mouth tonsils could became infected and develop chronic inflammation, thus leading to hypertrophy. The etiology of the disease is multifactorial depending upon environmental and host factors, the latter including molecules of mucosal innate immunity. Methods Ninety-five children with adeno-tonsillar hypertrophy subjected to adeno-tonsillectomy were recruited at the pediatric otorhinolaryngology service of the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste (Italy). The specimen discarded from the surgery were used for genomic DNA extraction and genotyping, for mRNA extraction and gene expression analysis, finally the samples were cut and used to prepare slides to perform immunohistochemistry. Results Functional polymorphisms within DEFB1 gene, encoding the human beta defensin-1 (hBD-1), were analyzed finding association between DEFB1 rare haplotypes and susceptibility to adeno-tonsillar hypertrophy. DEFB1 mRNA expression was detected in the tonsils and the hBD-1 protein was localized at the epithelia of tonsils mainly in the proximity of the basal lamina. Conclusion Our findings lead us to hypothesize an involvement of hBD-1 mediated innate immunity in the modulation of the susceptibility towards adeno-tonsillar hypertrophy development.

Objective Clinical guidelines suggest adenoidectomy when enlarged adenoids are associated with nasal obstruction and other symptoms. Given that nasal obstruction is the leading symptom of adenoid hypertrophy, it should be thoroughly explored. However, there is no consensus regarding what could be the best approach. This systematic review is designed with the objective of exploring the extent to which adenoidectomy can decrease nasal resistance through rhinomanometry. Review methods 3 authors members of the YO-IFOS rhinology study group independently analyzed the data sources (Pubmed, the Cochrane Library, EMBASE, SciELO) for papers assessing the change in nasal resistance and/or nasal airflow in rhinomanometry after adenoidectomy in pediatric patients. Results A total of 9 studies with a total population of 423 participants (323 patients excluding healthy controls) met the inclusion criteria. All of them found decreased nasal resistance after adenoidectomy. 5 studies could be combined in a metanalysis, which revealed a statistically significant difference of 0.52 Pa in basal conditions, and 0.64 Pa in rhinomanometry under nasal decongestion. 4 authors explored changes in nasal airflow. All of them found a statistically significant increase in nasal airflow after adenoidectomy. However, their results could not be merged in a meta-analysis. Conclusion This systematic review and meta-analysis demonstrated the existence of a systematic decrease in nasal resistance and increase in nasal airflow with and without nasal decongestant after adenoidectomy. The available evidence suggests that rhinomanometry with nasal decongestant could help in intermediate cases of adenoid hypertrophy, in order to identify the presence of nasal obstruction and, when present, the possibility of other causes for it rather than enlarged adenoids, mainly turbinate hypertrophy.

To investigate the beneficial effect of adenotonsillectomy (AT) on nocturnal enuresis (NE) in children with adenotonsillar hypertrophy and evaluate the Modified Pediatric Epworth Scale (MPES).This was a prospective study comparing preoperative and postoperative evaluation of the frequency of NE and MPES in pediatric obstructive sleep apnea (OSA). A questionnaire on NE history was prepared based on the Turkish Enuresis Guidelines. NE histories were evaluated pre- and postoperatively on the first month and third month, respectively. MPES questions were asked to the parents of all the OSA patients pre- and postoperatively, and scores were noted.Eighty-four (84) pediatric OSA patients were involved in the study. Preoperatively, 19 patients (27%) complained about nocturnal enuresis. After the surgery, 52% of the patients with NE had complete resolution of NE (p 0.001). Postoperatively, the average Epworth scores of both groups significantly decreased (p 0.001).There is a strong correlation between OSA and NE. In the present study, enuresis in pediatric OSA patients significantly decreased after surgery. Also, Epworth scores decreased significantly after surgery. In children with nocturnal enuresis, the presence of OSA symptoms should be questioned.

Introduction Pharyngeal tonsil hyperplasia is the most frequent cause of nasal obstruction and chronic mouth breathing during childhood. Adenoidectomy is the procedure of choice for the resolution of these symptoms. It is not yet known, however, whether the conventional technique (“blind curettage”) has been surpassed by more modern adenoidectomy techniques (video-assisted, with the aid of instruments). This study aimed to compare the conventional adenoidectomy technique with two other emerging techniques, performed in a reference otorhinolaryngology center. Methods This is a prospective and observational study of 33 children submitted to adenoidectomy using 3 different techniques that were followed up for a period of 3 months after surgery. The patients were divided into 3 different groups, according to the adenoidectomy technique: Group A (conventional technique - "blind curettage”); Group B (video-assisted adenoidectomy with microdebrider); Group C (video-assisted adenoidectomy with radiofrequency – Coblation®). The surgical time of each procedure was measured, being considered from the moment of insertion of the mouth gag until complete hemostasis was achieved. The questionnaire for quality of life OSA-18 was applied to all caregivers on the day of the surgery and 30–90 days after the procedure. Postoperative complications were also analyzed. Results For the entire patient sample, there was an improvement in quality of life after the surgery (p 0.05). Regarding the duration of the procedure, the conventional technique showed the shortest surgical time when compared to the others (p Conclusions The adenoidectomy resulted in improvement of quality of life, and there were no major postoperative complications, for all operated children, regardless of the technique used. The conventional technique was faster when compared to the more modern adenoidectomy techniques.

Current grading systems may not allow clinicians to reliably document and communicate adenotonsillar size in the clinical setting. A validated endoscopic grading system may be useful for reporting tonsillar size in future clinical outcome studies. This is especially important as tonsillar enlargement is the cause of a substantial health care burden on children.To propose and validate an easy-to-use flexible fiberoptic endoscopic grading system that provides physicians with a more accurate sense of the three-dimensional relationship of the tonsillar fossa to the upper-airway.50 consecutive pediatric patients were prospectively recruited between February 2015 and February 2016 at a pediatric otolaryngology outpatient clinic. The patients had no major craniofacial abnormalities and were aged 1 to 16years. Each patient had data regarding BMI, Friedman palate position, OSA-18 survey results collected. For each child, digital video clips of fiberoptic nasopharyngeal, oropharyngeal and laryngeal exams were presented to 2 examiners. Examiners were asked to independently use the proposed Endoscopic tonsillar grading system, the Brodsky tonsillar grading scale, the Modified Brodsky tonsillar grading scale with a tongue depressor, and the Parikh adenoid grading system to rate adenotonsillar hypertrophy. Cohen's Kappa and weighted Kappa scores were used to assess interrater reliability for each of the four grading scales. The Spearman correlation was used to test the associations between each scale and OSA-18 scores, as well as Body Mass Index (BMI).50 pediatric patients were included in this study (mean age 6.1years, range of 1year to 16years). The average BMI was 20. The average OSA-18 score was 61.7. The average Friedman palate position score was 1.34. Twelve percent of the patients had a Friedman palate position score≥3, which made traditional Brodsky grading of their tonsils impossible without a tongue depressor. All four scales showed strong agreement between the two raters. The weighted Kappa was 0.83 for the Modified Brodsky scale, 0.89 for the Brodsky scale, 0.94 for the Parikh scale to 0.98 for the Endoscopic scale (almost perfect agreement). The Endoscopic scale showed the most consistent agreement between the raters during the study. There was a moderate association between the Parikh adenoid grading system with OSA-18 scores (Spearman's ρ=0.58, p0.001) compared to a low association of the tonsillar grading systems with OSA- 18 scores. None of the scales correlated with patient BMI.The proposed Endoscopic tonsillar grading system is as reliable of a method of grading tonsillar size as conventional grading systems. It offers the advantage of allowing for critical evaluation of the tonsils without any anatomic distortion which may occur with the use of a tongue blade. This new validated endoscopic grading system provides a tool for communicating the degree of airway obstruction at the level of the oropharynx regardless of Friedman palate position and may be used in future outcomes projects.

There is no standardized scheme for preoperative evaluation of adenoid hypertrophy or a consensus on surgical indications for adenoidectomy in children with otitis media with effusion (OME), especially for young children intolerant to nasal endoscopic assessment. The aim of this study was to evaluate the efficacy and reliability of acoustic rhinometry (AR) in evaluating benefits from adenoidectomy in children with OME.Children with OME who were scheduled for surgical intervention were reviewed and AR tests performed preoperatively and postoperatively. The patients were divided into two groups based on the surgical strategy (Group I: tympanostomy tube placement alone; Group II: tympanostomy tube placement plus adenoidectomy). Correlation and regression analyses were performed to assess the relationship between findings of AR and nasal endoscopy. AR parameters including minimal nasal cross-sectional area (MCA), and nasopharyngeal volume (NPV), as well as scores of subjective symptoms were obtained to evaluate the utility of AR pre- and post-surgery.Sixty-five children aged 4-10 years who met the inclusion criteria were included. No significant differences in gender or age distribution were observed between Group I and Group II. MCA, as well as NPV significantly decreased in Group II when compared with Group I (p = 0.000). A significant inverse correlation was observed between NPV and choanal obstruction ratio in both groups I (r = -0.625, p 0.001) and II (r = -0.570, p 0.001). A significant difference between preoperative and postoperative NPV and subjective symptom scores was observed in group II after adenoidectomy (p = 0.000).AR parameters showed a good clinical correlation with findings of nasal endoscopy and thus may be useful for evaluating candidacy for surgical adenoidectomy among children with OME, especially in whom preoperative nasal endoscopic examination is not feasible. Additionally, AR can reveal the changes occurring within the nasopharyngeal passage before and after adenoidectomy.

Carcinosarcoma and adenoid basal carcinoma (ABC) are both rare lesions in uterine cervix. There were only 5 cases of cervical carcinosarcoma combined with ABC and/without cervical intraepithelial neoplasia (CIN) reported in English literature. These limited studies showed that there was a strong association between HPV, carcinosarcoma, ABC and CIN, suggesting a common etiology for these lesions. Here, we present the case of a 65-year-old woman with cervical carcinosarcoma combined with ABC and CIN III. However, HPV-16, 18, 31 and 33 was negative in the cervical carcinosarcoma tissue by in situ hybridization detection. It indicated that there might be other subtype of HPV involved, or, HPV might play a role in some but not all cervical carcinosarcomas.

Objective To identify clinical characteristics of pediatric patients that failed nasal steroid therapy for management of chronic nasal obstruction and to evaluate the efficacy of adenoidectomy in this subset of patients. Design Retrospective chart review. Setting Tertiary care academic center. Subjects Analysis was performed on children that underwent adenoidectomy between 2011 and 2015 for chronic nasal obstruction refractory to nasal steroids. Results Seventy-four cases were identified. Average age of presentation was 3.6 years. Pre-operatively, 25.7% of patients had known asthma, 16.2% reported respiratory allergies, and 20.3% reported use of systemic antihistamines. The most common pre-operative symptoms included mouth breathing (82.4%), nasal congestion (81.1%), snoring (71.6%), and rhinorrhea (37.8%). Average adenoid size was 68% pre-operatively. Ninety-eight percent of patients experienced improvement or resolution of their symptoms following adenoidectomy. Conclusions This study demonstrates average rates of respiratory allergies, but high rates of asthma among patients that fail nasal steroid therapy for chronic nasal obstruction. Adenoidectomy is a highly efficacious intervention in this subset of patients.

Aim Pycnodysostosis is a rare autosomal, recessive, skeletal dysplasia caused by a mutation in the cathepsin k gene. Pycnodysostosis is characterized by short stature, characteristic facial appearance (delayed closure of fontanelles and cranial sutures, mandibular hypoplasia and angle disorder, blue sclera), and acroosteolysis of the distal phalanges. Our aim was to describe the otorhinolaryngologic findings, differential diagnoses, various treatment options, and followup in eight cases of pycnodysostosis. Method This retrospective clinical study used data from eight patients diagnosed with pycnodysostosis by a single pediatric endocrinologist primarily based on clinical and radiographic findings. All patients were referred to the otorhinolaryngology outpatient clinic by the pediatric endocrinology unit of the Marmara University between February 2013 and March 2015. Detailed medical histories were obtained in all cases and otorhinolaryngologic physical examination, blood assays, electrocardiogram, lateral skull X-rays, chest radiograph, cephalometric investigations, tympanograms, and audiograms were also carried out. Sleep videos of patients were recorded and those with upper airway problems were evaluated for sleep apnea by polysomnography. Informed consent form was obtained from the parents of all patients. Results Eight patients (7 females and 1 male) displaying proportionate dwarfism were included in the study. They had a mean age of 14.7 years (range: 13–16 y), the mean height of 141.3 cm (range 132–155 cm), and mean weight of 44.4 kg (range: 39.6–49.3 kg). All patients had facial dysmorphism with frontal bossing and the hands and feet had short digits with overlying cutaneous wrinkles that tapered off with large overriding nails. Midfacial hypoplasia and malocclusion were observed in seven of the eight patients (87.5%), four (50%) had micrognathia, and five (62.5%) had proptosis. Tympanograms and audiograms of all patients were type A and normal, and the mean of the pure tone audiogram was 13.3 dB (range: 10–16 dB). All patients had a narrow and grooved palate with disturbed dentition; two of them (25%) had mild markedness of the tongue base, five (62.5%) had grade 3 and three (37.5%) had grade 2 tonsillar hypertrophy, and five (62.5%) had adenoid hypertrophy. One patient (12.5%) had grade 3 Mallampati, four (50%) showed grade 2 Mallampati while three (37.5%) patients displayed grade 1 Mallampati score. Further, while six (75%) patients had no uvular pathology, one (12.5%) patient presented with uvular elongation and another patient had a bifid uvula. Cephalometric measurements such as PAS-UP (mean 5.67 mm; range: 5.0–7.6 mm) and PAS-TP (mean 9.61 mm; range: 8.5–12.2 mm) were lower than that of normal subjects. Video recordings showed that six of the eight patients (75%) had respiratory distress and four (50%) had sleep apnea. Polysomnography in these patients with sleep apnea showed that two had mild OSA (AHI: 18.2 and 20.1 events/hour) and two had severe OSA (AHI: 53.4 and 62.8 events/hour). For upper airway problems, an adenotonsillectomy was performed in two (25%) patients while two others required an adenoidectomy. Positive pressure ventilation was recommended in two patients with persistent sleep apnea after adeno/adenotonsillectomy. However, because of the parental objections, the follow-up polysomnographs could not be obtained. Conclusion Pycnodysostosis is a very rare form of bone dysplasia. Otorhinolaryngologically, proper follow-up of these patients and appropriate treatment of upper airway problems are important to achieve an acceptable quality of life. Adeno/adenotonsillectomy and positive pressure ventilation, used as conservative approaches in treating upper airway problems, are effective and could be used instead of an aggressive surgery such as tracheotomy or maxillomandibular advancement. This study, to the best of our knowledge, is the largest ENT case series on pycnodysostosis.

Pediatric OSAS and craniofacial malformations present challenges that require innovative approaches and comprehensive treatment strategies. Synchronous airway lesions, craniofacial malformations, obstructive anomalies of the tongue base, nasal vault and choanae are commonly addressed by subspecialists from various clinical and surgical academic traditions who practice variable levels of required communication. This is not a mere social requirement but an important requisite for intelligent and effective airway management. Membership of dedicated airway, aero digestive or craniofacial teams are desirable but not required. I expect this clinical brief to help many brilliant clinicians in their pursuit of perfection.

Background Airway obstruction due to enlargement of tonsils and adenoids is a common pediatric problem resulting in sleep disordered breathing. The cause for the relatively abnormal growth of tonsils and adenoids is poorly understood. Methods Non-acutely ill children undergoing tonsillectomy and adenoidectomy (T&A) for various reasons were enrolled prospectively in a study to determine the frequency of asymptomatic respiratory viral infections in each lymphoid tissue and to relate the number and types of virus to the degree of airway obstruction. Molecular techniques were used to detect 9 respiratory viruses while Brodsky scores and measurements of percentages airway obstruction were used to estimate the degree of airway compromise due to the tonsil and adenoid, respectively. Results Viruses were detected in 70.9% of tonsils and 94.7% of adenoids, p

There are many consequences of mold exposure related to respiratory system health of children This retrospective cohort study aims to find the association between adenoid hypertrophy and mold exposure in children living in damp environments.Children with history of recurrent respiratory tract infections were enrolled in the study between June 2012 and June 2013 and were followed up for adenoid hypertrophy from June 2013 to June 2016. One hundred and forty two children were residents of moldy houses and 242 were living in normal houses. Skin prick test results for 60 common allergens, vitamin D levels, IgE levels, age, presence of comorbidities such as urticaria, atopic dermatitis, allergic conjunctivitis, allergic rhinitis, asthma, frequency of upper respiratory tract infections and lower respiratory tract infections, were evaluated in both groups.A total of 384 children (mean age ± standard deviation = 53.37 ± 36 months; 198 males and 186 females) were included. The children were classified into 2 groups (1)Children living normal houses (n = 242) (2); Children living in damp houses (n = 142) according to mold exposure. Children with adenoid hypertrophy (p 0,001) and higher IgE levels (p 0,001) were more common in mold exposed group. Lower respiratory tract infections were more common in children with mold exposure (p 0,05). Bivariate correlation analysis showed no significant association between IgE levels and adenoid hypertrophy. Multiple linear regression analysis was performed to evaluate IgE levels, vitamin D levels, and presence of adenoid as independent variables; age as dependent variable among two groups and was found statistically significant (p 0,001). Dermatophagoid sensitive group living in damp houses had a significant increase in adenoid hypertrophy (p = 0,01). Housedustmite sensitive children with recurrent lower respiratory tract infection and upper respiratory tract infection were mainly residents of damp houses (p 0,001). Allergic comorbidities were significantly more in damp environment group (p 0,001), but there was no significant increase in any of the subgroups.Children with mold exposure had significantly increased adenoid hypertrophy regardless of their atopic nature, however, they may have become more sensitized due to other environmental triggers and genetic factors. In damp environments, sensitization to dermatophagoids, was significantly increased in children with adenoid hypertrophy. During the period of infancy, when children were mostly vitamin D supplemented, they were not sensitized and had normal adenoids. As children with recurrent respiratory tract infections grow, they tend to have lower vitamin D levels, become more atopic and tend to have adenoid hypertrophy.

Introduction The purpose of this study was to morphometrically investigate the growth pattern of the adenoids in growing subjects with hyperdivergent and hypodivergent vertical craniofacial features. Methods In this retrospective study, we used a longitudinal sample of lateral cephalometric radiographs of 28 hyperdivergent and 30 hypodivergent subjects from 4 to 13 years of age. The radiographs were obtained from the American Association of Orthodontists Foundation Craniofacial Growth Legacy Collection. Measurements were made using digital tracings of the lateral cephalograms and point distribution models. Mixed-model analyses were used for statistical analysis. Results The mean distance between the sphenoid bone and the posterior nasal spine increased up to 5.3 mm over a 9-year span (95% CI, 4.1-6.5 mm; P

Introduction Drug-induced sedation endoscopy is a valid tool to assess site obstruction of the upper airway responsible for children's obstructive Sleep Apnea. The aim is to show the experience of an ENT department with drug-induced sedation endoscopy in children selected for sleep apnea surgery. Methods Includes 56 cases between 2 and 12 years old (mean age: 59.13±27.29 months) presenting at the Otorhinolaryngology consultation clinic with snoring and apnea. Prior polysomnography had been practiced and mean AHI was 6.32±8.71. The distribution of cases was 10 persistent sleep apnea (17.85%), 15 clinical disproportion (26.78%), and 31 conventional (55.35%). All sleep endoscopies were performed in the operating room and Chan classification was used to assess the areas of collapse. Results In cases of residual disease the most affected regions were the side walls of the oropharynx (70%) and turbinate (70%) and the most frequently applied surgery was total tonsillectomy followed by second tongue tonsil reduction and turbinate radiofrequency. In clinical cases of desproportion, the most affected regions were the oropharyngeal side walls (93.3%) and adenoids (66.6%). The most frequently applied surgery in this group was adenoidectomy and radiofrequency tonsillotomy. Conclusion Drug-induced sedation endoscopy is a technique that can be incorporated easily into medical practice, mostly in children with residual sleep apnea syndrome or those suspected to have some cause other than adenotonsillar hypertrophy.

INTRODUCTION: Adenoid hypertrophy may play a role in velopharyngeal closure especially in patients with palatal abnormality; adenoidectomy may lead to velopharyngeal insufficiency and hyper nasal speech. Patients with cleft palate even after repair should not undergo adenoidectomy unless absolutely needed, and in such situations, conservative or partial adenoidectomy is performed to avoid the occurrence of velopharyngeal insufficiency. Trans-oral endoscopic adenoidectomy enables the surgeon to inspect the velopharyngeal valve during the procedure. OBJECTIVE: The aim of this study was to assess the effect of transoral endoscopic partial adenoidectomy on the speech of children with repaired cleft palate. METHODS: Twenty children with repaired cleft palate underwent transoral endoscopic partial adenoidectomy to relieve their airway obstruction. The procedure was completely visualized with the use of a 70° 4 mm nasal endoscope; the upper part of the adenoid was removed using adenoid curette and St. Claire Thompson forceps, while the lower part was retained to maintain the velopharyngeal competence. Preoperative and postoperative evaluation of speech was performed, subjectively by auditory perceptual assessment, and objectively by nasometric assessment. RESULTS: Speech was not adversely affected after surgery. The difference between preoperative and postoperative auditory perceptual assessment and nasalance scores for nasal and oral sentences was insignificant (p = 0.231, 0.442, 0.118 respectively). CONCLUSIONS: Transoral endoscopic partial adenoidectomy is a safe method; it does not worsen the speech of repaired cleft palate patients. It enables the surgeon to strictly inspect the velopharyngeal valve during the procedure with better determination of the adenoidal part that may contribute in velopharyngeal closure. Resumo Introdução: A hipertrofia da adenoide pode desempenhar um papel no fechamento velofaríngeo, especialmente em pacientes com anormalidade palatal; a adenoidectomia pode levar à insuficiência velofaríngea e fala hipernasal. Os pacientes com fenda palatina, mesmo após a correção, não devem ser submetidos a adenoidectomia, exceto quando absolutamente necessário e, em tais situações, a forma conservadora ou parcial é realizada para evitar a ocorrência de insuficiência velofaríngea. A adenoidectomia endoscópica transoral permite ao cirurgião inspecionar a válvula velofaríngea durante o procedimento. Objetivo: O objetivo deste estudo foi avaliar o efeito da adenoidectomia parcial endoscópica transoral na fala de crianças submetidas à correção de fenda palatina. Método: Um total de 20 crianças com fenda palatina previamente corrigida, foi submetida a adenoidectomia parcial endoscópica transoral, para desobstrução das vias aéreas,. O procedimento foi completamente visualizado com o uso de um endoscópio de 4 mm e ângulo de 70º; a parte superior da adenoide foi removida com uma cureta para adenoide e fórceps St. ClaireThompson, enquanto a parte inferior foi conservada para manter a competência velofaríngea. Avaliações da fala foram realizadas nos períodos pré e pós-operatório, de forma subjetiva pelaavaliação perceptivo-auditiva, e objetiva pela avaliação nasométrica. Resultados: A fala não foi prejudicada após a cirurgia. A diferença entre os escores da avaliação perceptivo-auditiva e nasalância para as sentenças nasais e orais nos períodos pré e pós-operatório foi insignificante (p = 0,231, 0,442, 0,118, respectivamente). Conclusões: A adenoidectomia parcial endoscópica transoral é um método seguro, e não piora a fala dos pacientes com fenda palatina operada. Ela permite que o cirurgião inspecione rigorosamente a válvula velofaríngea durante o procedimento, com melhor determinação da parte adenoide que pode contribuir para o fechamento velofaríngeo.

Objectives To propose a novel endoscopic adenoid grading system using a rigid nasal endoscope and to study its correlation with the clinical diagnosis. Methodology Prerecorded video clips of rigid nasal endoscopy taken during endoscopic adenoidectomy were retrieved. Otolaryngology consultants blinded to the clinical diagnosis of the child were presented these videos and asked to grade the adenoid hypertrophy as per the proposed endoscopic ACE ( A irway/ C hoana/ E ustachian tube) grading system. The clinical diagnosis was correlated with the different aspects of the descriptive endoscopic grading system. Results 152 video clips were presented to the otolaryngology consultants for grading. The average age was 8.6 years (SD—3.48), while the male female ratio was 3:2. The A subcomponent of the ACE grading showed significant correlation with the diagnosis of sleep disordered breathing and chronic adenotonsillitis, C subcomponent with sleep disordered breathing and the E subcomponent with the diagnosis of otitis media. Conclusion The proposed endoscopic grading is easily applicable and at the same time clearly describes the relation of the adenoids to the nasopharynx, choana and Eustachian tube. Different aspects of the grading system correlated differently with the clinical diagnosis emphasizing that a descriptive scoring rather than a comprehensive scoring is a more relevant clinical tool.

Tonsillectomy and adenoidectomy (T&A) is the primary surgical treatment for obstructive sleep apnea (OSA) in children with tonsillar and adenoid hypertrophy (TAH). We present the case of a 5-month old male with congenital neutropenia who developed severe TAH during treatment with granulocyte colony-stimulating factor (G-CSF). He had severe OSA, decreased oral intake, and failure to thrive (FTT) which all improved after undergoing a successful intracapsular T&A. We describe a successful procedure to help alleviate symptoms of OSA and FTT in this young infant with congenital neutropenia who developed TAH during treatment with G-CSF. It highlights the need for further research into the pathophysiology of TAH in immunocompromised children and the effects of G-CSF on Waldeyer's Ring.

Snoring/sleep apnea are usual symptoms of adenotonsillar hypertrophy, and adenotonsillectomy is usually recommended. In rare cases, symptoms remain after surgery, and tubal tonsil hypertrophy could be the cause. We experienced a pediatric patient whose symptoms were refratory snoring/sleep apnea although he previously underwent three times of adenotonsillectomy. We diagnosed tubal tonsil hypertrophy which was the cause of refractory symptoms, and decided to perform volume reduction with radiofrequency ablation. We suggest that tubal tonsil hypertrophy should be taken into account of the cause of refractory sleep apnea after adenotonsillectomy, and volume reduction with radiofrequency may be an effective method.

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

Childhood obstructive sleep apnoea syndrome (OSAS) secondary to adenoid hyperplasia is known to give rise to pulmonary hypertension. However, we present a case of a toddler with pulmonary hypertension (PH) and right heart failure due to OSAS, the cause of which is difficult to identify. After the patient underwent an adenotonsillectomy, OSAS disappeared and the PH eventually resolved. Both paediatricians and otolaryngologists should know that paediatric OSAS can occur even in the setting of mild, clinically insignificant palatine tonsil hypertrophy and adenoid hyperplasia. Surgical intervention should be considered without losing the opportunity if it could be the cause of PH.

Benign adenoidal hypertrophy is the most common cause of nasopharyngeal obstruction. However, depending on size and location, masses may cause nasopharyngeal obstruction. We present our experiences with a ten-year-old female who presented with what appeared to be a large nasopharyngeal mass that was initially favored to be malignant and was ultimately found to be adenoid hypertrophy related to acute infection with adenovirus.

Objectives Recent studies have suggested that the reflux of gastric contents can cause adenoid hypertrophy (AH). The frequency of gastro-oesophageal reflux disease (GERD) in this AH population is unknown, but according to studies using pH-metry it may be as high as 65%. The aim of this study was to estimate the frequency of GERD among children with AH. Methods This was a cross-sectional, multicentre, prospective study of children with AH selected for adenoidectomy. The diagnosis of AH was made by a single laryngologist using a flexible fiberscope. All children had 24-hr multichannel intraluminal pH-impedance (MII/pH) assessment. A GERD diagnosis was made using BioVIEW software analysis after manual review by a single investigator. Results 38 consecutive patients (21 males, mean age 6.58 years) were enrolled in the study. GERD was diagnosed in 5 (13.2%) patients. A total of 1462 gastro-oesophageal reflux events (GERs) were detected by MII/pH and the majority (60.9%) were acidic. The only significant differences between the GERD-positive and GERD-negative groups were the total number of GERs, and the number of acid GERs. Conclusion It is first study using MII/pH to assess the frequency of GERD in children with AH. The data suggest that GERD in children with AH seems to be not as common as it was previously raised. Further studies are needed to confirm these results.

Purpose By using preoperative parameters age, body mass index, nasopharyngeal obstruction as assessed using flexible videonasopharyngoscopy, and quality of life scores in patients undergoing adenoidectomy-alone because of adenoid hypertrophy causing sleep disordered breathing, we aimed to examine the relationship between the change in quality of life scores, and preoperative parameters and to develop a tool to predict the change. Materials and methods Patients who were scheduled for adenoidectomy-alone in a 12-month period were included. Flexible videnonasopharyngoscopy of the nasopharynx was performed. Nasopharyngeal obstruction was measured by using Image J software. Preoperative quality of life was evaluated using OSA-18 quality of life survey. OSA-18 survey has 5 subcategories consisting of sleep disturbance (O1), physical suffering (O2), emotional distress (O3), daytime problems (O4), caregiver concerns (O5). A question about the overall quality of life(O6) was added. Postoperative OSA-18 domain scores were obtained at the 3-month-follow-up. Preoperative OSA-18 subscores were compared to postoperative subscores. Linear regression analysis to predict the proportional change in OSA-18 subscores was performed. Results Our study group consisted of 94 cases. Mean postoperative O1, O2,O3, O4 and O5 scores were significantly lower compared to the preoperative scores. Mean postoperative O6 score was significantly higher. Linear regression analysis was carried out for predicting change in O1(r2 = 0.686; p = 0.006), O5(r2 = 0.711; p = 0.003) and O6(r2 = 0.757; p = 0.001). Conclusion Change in quality of life scores for sleep disturbance, physical suffering and general quality of life may be predicted by using preoperative parameters.

Aims To examine the potential risk factors for adenoid regrowth and the incidence of revision adenoidectomy. Methodology The English-language literature published from January 1995 to January 2020 regarding adenoid regrowth and revision adenoidectomy was reviewed. The keywords used were 'adenoids', 'adenoid regrowth' and 'revision adenoidectomy'. The inclusion criteria were English language, sample size greater than five and presentation of extractable data on risk factors for adenoid regrowth and rates of revision adenoidectomy. Random-effects modelling was used to estimate summary outcomes. Results Twenty studies met the inclusion criteria. There was a total of 143369 cases of baseline adenoidectomies. The mean age at primary surgery was 4.62 years (SD = 1.47 years, range of 2.3–7.3 years) and the mean age at revision adenoidectomy was 5.43 years (SD = 1.80 years, range of 2.5–7.6 years). Six studies reported on adenoid regrowth and a total of 4950 baseline adenoidectomies were examined. The prevalence of adenoid regrowth was 8%. Fifteen studies examined the rate of revision adenoidectomy and a total of 119369 baseline adenoidectomies were analysed. The revision adenoidectomy rate was 2%. Of the patients with revision adenoidectomy, 14% had allergic rhinitis and 9% had asthma. With regards to indications for revision adenoidectomy, 26% had OSA, 86% were snorers, 63% had nasal obstruction, 32% had recurrent AOM and 73% had OME. Conclusion The combined revision adenoidectomy rate from this study is 2%. Young age at first surgery was prevalent as well as co-morbidities of allergic rhinitis and asthma and indications for primary adenoidectomy like upper airway obstructive symptoms and middle ear disease. However, given the heterogeneity of these studies, direct cause and effect could not be concluded.

The study objective was to assess the levels of VEGF-A and TGF-β cytokines in the children with adenoid hypertrophy concomitant with exudative otitis media (OME) and in children with adenoid hypertrophy (HA) alone.The study material consisted of hypertrophic adenoids removed during adenoidectomy from 39 children (20 girls and 19 boys), aged 2-7 years suffering from OME. The reference group included 41 children (19 girls and 22 boys), aged from 3 to 9 years with adenoid hypertrophy. The levels of VEGF-A and TGF-β were determined in supernatants obtained from phytohemagglutinin-stimulated cell cultures of the adenoids using a commercial enzyme-linked immunosorbent assay kit.The median VEGF-A and mean TGF-β concentrations in the study group were significantly higher than those in the reference group (503 pg/mL versus 201 pg/mL, P 0.001 and 224 pg/mL versus 132 pg/mL, P 0.001, respectively). ROC analysis revealed that the area under the curve (AUC) for VEGF-A was 0.952 with diagnostic sensitivity and specificity of 95%, whereas for TGF-β it was 0.902 with 60% sensitivity and the same specificity as for VEGF-A. There was no significant difference between the AUC for VEGF-A and TGF-β (P = 0.573).The changes in the levels of VEGF-A and TGF-β may indicate bacterial pathogen as one of the causes of exudative otitis media in children. Determination of VEGF-A and TGF-β could be used as additional and objective tests to confirm the clinical diagnosis.

Objective: To test a feasible and reliable model for diagnosing obstructive sleep apnea (OSA) in children, based on the clinically relevant parameters, in comparison to a polysomnography. Methods: A total of 94 children with the suspected underlying OSA were included in the analyses. An association between clinical parameters (modified Mallampati score, tonsil size, adenoid size, age, gender, and body mass index) and apnea-hypopnea index (AHI) obtained following an overnight polysomnography was assessed, and significant variables were incorporated in the logistic regression model. Also, the sensitivity and specificity calculations of the model with the inclusion of ROC curve analysis were performed. Results: All tee local clinical parameters were significantly associated with AHI (P < 0.001). The most significant correlation with AHI was shown with the modified Mallampati score (r = 0.723), following with tonsil size (r = 0.673), and adenoid size (r = 0.502). The sensitivity of the tested model was 84%, and specificity was 74%. Conclusion: This study derived a model based on the local clinical findings that significantly overlapped with the results of an overnight polysomnography, in diagnosing OSA in children.

Introduction Adenoidectomy and adenotonsillectomy are very common operations in childhood. It is important to clarify their effects on this age group; in this study, we aimed to investigate the effects of the causative agent on children's mental health by using scales that help to screen for indications of mental disorders in children, who have had adenoidectomy or adenotonsillectomy, both before and after surgery. In this way, we aimed to investigate the effects of this factor on children's mental health. Materials and methods The study included 82 children aged 6–12 years with signs of upper respiratory tract obstruction or recurrent adenotonsilitis. Adenotonsillectomy was performed in 41 patients included in the study and adenoidectomy was performed in 41 patients included in the study. 40 healthy children matched with the patient groups in terms of age and gender were included in the control group. Patients, were divided into three groups, those who underwent adenoidectomy, patients undergoing adenotonsillectomy and those in the control group Preoperative and postoperative questionnaires were used to investigate the effect of tonsillectomy or adenoidectomy on the mental health of children. The Parents' Form for the Strengths and Difficulties Questionnaire, the Parental Form for the Children's Anxiety Screening Scale, the Sleeping Scale for Children and the Quality of Life Scale for Children were used in the screening. Results In children, who underwent adenoidectomy/adenotonsillectomy due to recurrent infection and adeno/adenotonsillar hypertrophy; it was seen that there was a significant decrease in the scores for the Strengths and Difficulties Questionnaire, the Anxiety Screening Scale in Children, and the Sleep Scale in Children, and a significant increase in Quality of Life Scale for Children scores. Outcome In conclusion, adenoidectomy/adenotonsillectomy in children with sleep apnea due to recurrent episodes of infection and adeno/adenotonsillar hypertrophy was thought to prevent further neurobehavioral problems, likely to become more complex in the future, and to improve quality of life.