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Background: Adenotonsillar hypertrophy is the most frequent cause for obstructive sleep apnea (OSAS) in children. In patients with small tonsils and where adenoid size cannot be assessed, the indication for adenoidectomy often relies on clinical symptoms. However, data on the association of clinical parameters and adenoid hypertrophy with OSAS severity in children undergoing an adenoidectomy is sparse. Aim: To investigate the correlation of patient characteristics, adenoid hypertrophy, and clinical symptoms with OSAS severity in pediatric patients indicated for an adenoidectomy. Methods: We performed a retrospective chart review of all pediatric patients at our tertiary referral center between 2018 and 2023 who underwent polygraphy (PG) for OSAS diagnostics. Adenoid hypertrophy was assessed as adenoid-choanal ratio (AC-ratio) via nasal endoscopy and clinical symptom score (CS) via physical examination and parental survey. We included all symptomatic children with mild to severe OSAS (apnea–hypopnea index (AHI) ≥ 1). Exclusion criteria were obesity according to BMI and/or the presence of systemic diseases. The patients were divided according to age in a preschool and school cohort. Patient characteristics and PG data were compared between both groups. Linear regression analysis was used to investigate the association of AC-ratio, CS and BMI with the AHI. Results: A total of 121 patients were identified of which 81 were included in our study, resulting in 42 and 39 patients from 3–5 and 6–14 years of age, respectively. We observed a significant correlation between CS and BMI (p = 0.026) and the CS and AC-ratio (p < 0.001). Univariable regression analysis showed significant association of the AC-ratio and CS with AHI-score for the total (p < 0.001), the preschool (p < 0.001), and the school cohort (p < 0.001). In multivariable regression analysis, the significant association of AC-ratio and CS remained in the total (p = 0.014; p < 0.001), and the preschool cohort (p = 0.029; p = 0.002). However, only the CS remained as positive predictor in the school cohort. Conclusion: AC-ratio and clinical symptoms seem to be reliable predictors for OSAS severity in patients between 3–14 years of age. Moreover, only clinical symptoms were associated with OSAS severity in schoolchildren. Future investigation should contribute to the validation of our results [ABSTRACT FROM AUTHOR]

Background: Since monocytes secrete cytokines, high monocyte counts may indicate subclinical inflammation. HDL-C, a significant component of total cholesterol, may reduce inflammation. Objectives: This study investigated whether the monocyte/HDL ratio (MHR) could be an independent predictive marker in patients with adenoid vegetation, both with and without otitis media with effusion (OME). Methods: This cross-sectional study included patients diagnosed with adenoid vegetation, with or without OME, who underwent surgery. The groups consisted of patients who underwent adenoidectomy alone for adenoid vegetation and those who underwent adenoidectomy + ventilation tube for adenoid vegetation with OME (Group 2). Monocyte counts, HDL-C levels, and MHR values were calculated for both groups. Results: The mean age of Group 1 was 6.95 ± 2.77 years, while Group 2 had a mean age of 6.61 ± 2.98 years. No significant difference was found in monocyte count or percentage between the groups. The HDL-C ratios were lower in Group 2, which OME accompanied, and the difference between the groups was significant (p: 0.027). The MHR was not significantly different between Groups 1 and 2, with values of 10.47 (4.22–29.23) and 12.29 (5.43–99.6), respectively. Conclusion: Reduced MHR ratios may indicate elevated inflammatory levels in the body and may be linked to certain medical conditions. However, we found no significant difference in the parameters' ability to predict OME in children with adenoid vegetation. Therefore, a simple, low-cost marker to predict middle ear effusion in children is needed. Key points: • Recurrent infections are thought to play a role in the pathogenesis of OME in chronically infected hypertrophic adenoid tissue. • Diagnosing OME is important because it negatively impacts the child's functional listening abilities, auditory perception, and attention. • A simple, low-cost marker is needed to measure disease activity and severity in children. • Macrophages and monocytes are the most important cell types that mainly secrete pro-inflammatory and pro-oxidant cytokines. • In our study, we aimed to see whether the recently discovered and popular monocyte/HDL ratio could predict the development of OME in cases with adenoid vegetation. [ABSTRACT FROM AUTHOR]

Purpose: Speech disorders associated with velopharyngeal dysfunction (VPD) are common. Some require surgical management, while others are responsive to speech therapy. This is related to whether the speech error is obligatory (passive) or compensatory (active). Accurate identification of speech errors is necessary to facilitate timely and appropriate intervention. Recent studies have supported the role of magnetic resonance imaging (MRI) in the assessment process for VPD. The purpose of this study was to utilize MRI to support differential diagnosis and treatment planning in a child presenting with inconsistent nasal air escape, mild hypernasality, and compensatory speech errors. Method: A nonsedated, fully awake, velopharyngeal (VP) MRI protocol was implemented to acquire anatomic data at rest and during phonation. Segmentations and visualization of the tongue, palate, adenoids, and nasopharyngeal airway were completed. Anatomic linear measurements were obtained for VP variables to assess VP function, establish a baseline, and monitor change over time. Results: VP anatomy was successfully visualized on MRI in multiple imaging planes. All anatomic measurements fell within normative expectations. Elevation and retraction of the soft palate occurred against the adenoid pad. A pharyngeal fricative was documented, resulting a small VP gap during speech. In contrast, adequate VP closure was obtained for vowels and other oral consonant sounds. Conclusions: Quantitative assessment and visualization of the anatomy demonstrated adequate VP closure capabilities and a pharyngeal fricative substitution that had not been adequately perceived during routine clinical assessments. This study suggests a promising additive role for VP MRI for enhanced differential diagnosis and therapeutic monitoring in children with VPD and concomitant speech disorders. Supplemental Material: https://doi.org/10.23641/asha.27905451 [ABSTRACT FROM AUTHOR]

Background: Adenoidectomy is a frequently done ENT procedure. The purpose of the current article is to assess endoscopic powered adenoidectomy as a potential replacement for the traditional curettage approach. Methods: Two hundred forty consecutive adenoidectomy cases were randomly divided into two groups of one hundred twenty each. Between August 2020 to February 2023 after getting ethical clearance from Institutional Ethical Committee, Group I underwent Conventional Curettage Adenoidectomy (CA), while Group II underwent Endoscopic Micro-debrider Adenoidectomy (EMA). Results: Average operative time in CA Group was 31.4 min and in EMA group was 55.7 min. In CA group, mean intraoperative blood loss was 64.4 mL, however, in EMA group, mean blood loss was 86.7 mL (p 0.001). In EMA Group, the resection was consistently complete, with 112 out of 120 cases having an adenoid grade of less than I in post-op. However in the CA group, in 44 (36.7%) of the patients, there was more than 25% remaining adenoid tissue postoperatively and more than 50% remnant adenoid tissue was found in 12 cases (10%) post-op. Post-operative pain was studied with the CA Group demonstrating an average 7 days' postoperative pain score of 3.90 whereas EMA Group demonstrating an average 7 days' postoperative pain score of 0.9. Conclusions: It was observed that EMA was a secure and reliable tool for adenoidectomy. Endoscopic powered adenoidectomy performed better in the completion of resection, accuracy of resection under vision, collateral damage, and post-operative pain. Contrarily, conventional Curettage adenoidectomy scored higher in terms of shorter surgery times and less intraoperative hemorrhage. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the correlation between cephalometric parameters and apnea–hypopnea index (AHI) after controlling gender, body mass index (BMI), and adenoid size in children with obstructive sleep apnea (OSA). Methods: Sixty-four children with OSA (40 males, 24 females, 8.72 ± 0.899 years) were chosen by simple random sampling for a cross-sectional study from January 2018 to March 2022. They were diagnosed with OSA, assessed by Obstructive Sleep Apnea-18 questionnaire and home polysomnography and underwent lateral cephalograms. Results: Hierarchical regression analysis indicated that cephalometric parameters (except adenoid size) were associated with OSA severity, explaining 18.1% of the AHI variance. Among cephalometric measurements, AHI was positively associated with H-RGn and N-Go-Me angle (p< 0.05) and negatively associated with NP (p< 0.05). Conclusion: The sagittal diameter of the oropharynx, lower gonial angle, and hyoid position are significant AHI predictors in children with OSA, independent of demographic characteristics and adenoid size. [ABSTRACT FROM AUTHOR]

Purpose: Smell ability is associated with nasopharyngeal obstruction. Herein, we evaluated the effect of nasopharyngeal obstruction by adenoid hypertrophy on the olfactory bulb (OB) volume and olfactory sulcus (OS) depth in children. Methods: A total of 135 children who were candidates for brain magnetic resonance imagining scanning were enrolled in the study. The olfactory disorder-negative statements questionnaire was utilized to assess the patient-reported olfactory status. A validated sleep questionnaire was used to assess sleeping status. According to the adenoidal/nasopharyngeal (A/N) ratio, the children were divided into two groups: those with an A/N ratio ≤ 0.5 (n = 70) and those with an A/N ratio > 0.5 (n = 65). OB volume and OS depth measurements were performed on coronal T2-weighted images using planimetric manual contouring. The mean OB volumes and OS depths on the right and left sides were used for the evaluation. Results: The mean OB volume of the group with an A/N ratio > 0.5 was significantly lower than that of the group with an A/N ratio ≤ 0.5 (P = 0.003), while there was no difference in the mean OS depth between groups (P = 0.061). In those with an A/N ratio > 0.5, the mean OB volume in older children (aged 9–12 years) was significantly lower than that in younger children (aged 5–8 years) (P = 0.012). In terms of laterality, the OS depth on the right side was significantly larger than that on the left side in both groups (P = 0.039 and P = 0.001). In the group with an A/N ratio ≤ 0.5, the OB volume on the right side was also significantly larger than that on the left side (P = 0.040); however, no such difference was observed in the group with an A/N ratio > 0.5 (P = 0.630). No sex-based differences were evident for any variable. Conclusions: Children with nasopharyngeal obstruction greater than 50% have a significantly smaller OB volume. Our results suggest that morphological alterations in OB may contribute to the pathogenic mechanism of olfactory dysfunction related to nasopharyngeal obstruction. [ABSTRACT FROM AUTHOR]

Background: Adenoid hypertrophy alters the posture of the oro-facial structures by obstructing the upper airways and restricting nasal breathing. These postural changes may eventually have an impact on facial skeletal development and dental occlusion. The postural adjustments may negatively impact a child's life by affecting a number of speech-production factors. Objective: This study aimed to detect the speech sound disorders in school aged Egyptian children with adenoid hypertrophy and if they were related to structure changes in the airway that caused by adenoid hypertrophy. Methodology: 300 school-aged Egyptian children aged from (5–15) years old with speech sound disorders (SSD). They were divided into 2 groups; Group 1 consisted of 150 children with speech (SSD) and adenoid hypertrophy, and Group 2 consisted of 150 children complained from (SSD) without adenoid hypertrophy. All children were evaluated by protocol of language assessment and articulation test used in Assiut University Hospital. Results: Speech sound disorders (SSD) mainly the omission and distortion are more frequent in (group 2) while, the substitution errors are more prominent in (group 1). The interdental sigmatism was the most frequent speech sound disorder in (group 1) especially those with adenoid hypertrophy occupying more than 50% of the airway, whereas, devoicing, gliding and back to front are more frequent in (group 2). Conclusion: Adenoid hypertrophy can affects only the /s/ sound production which needs precise placements of the articulators especially the tongue, and seems to be vulnerable due to the structural alteration of the oral cavity caused by adenoid hypertrophy. [ABSTRACT FROM AUTHOR]

Introduction: Adenoid hypertrophy is one of the most common conditions encountered by Ear, Nose and Throat (ENT) surgeons in the paediatric age group. Clinical assessment of adenoid hypertrophy is the first step, but to confirm the degree of adenoid hypertrophy, both X-ray soft-tissue neck and endoscopy are needed. Aim: To correlate the clinical grading of adenoid hypertrophy with endoscopic and radiological findings. Materials and Methods: This was a hospital-based cross-sectional analytical study conducted at Chhatrapati Shivaji Subharti Hospital Meerut, Uttar Pradesh, India from August 2023 to January 2024. A total of 50 children aged between 4 and 15 years, who presented to the outpatient department of ENT with signs and symptoms of adenoid hypertrophy, were evaluated. These children underwent clinical evaluation, followed by endoscopy and X-ray lateral view of the soft-tissue neck. Adenoid hypertrophy was graded clinically, endoscopically and radiologically. Statistical analysis was performed using Kendall’s tau correlation analysis. Results: In the study population, the majority of children 17 (34%) were between the ages of 7 and 9 years, with a male predominance of 32 (64%). Grade-3 adenoid hypertrophy was the most common finding, observed in 21 (42%) based on clinical grading, 26 (52%) on endoscopy, and 19 (38%) on X-ray lateral view of the soft-tissue neck. There was a strong correlation between endoscopic and clinical grading (p-value=0.001), and the correlation between radiological and endoscopic grading was highly significant (p-value=0.001). Clinical grading and radiological findings also showed a significant correlation (p-value=0.002). Conclusion: All three modalities of adenoid grading are correlated and reliable. They can be used in different combinations for grading adenoid hypertrophy and determining the management plan.

The main difficulty in the diagnosis of atypical in situ adenocarcinoma lies in the distinction between true and false stromal invasion. Moreover, how to identify local alveolar wall collapse in situ lung adenocarcinoma and how to identify whether the trapped adenoid structure around scar is an invasion component have become the key points for accurate diagnosis of lung adenocarcinoma. In the present study, we detected 40 cases of lung adenocarcinoma in situ and 40 cases of invasive adenocarcinoma by using immunohistochemical techniques. We found FAP-α had not immunreactivity in the stroma of adenocarcinoma in situ. However, it stained in the stroma of invasive areas in lung adenocarcinoma. FAP-α staining pattern could represent hyperplastic myofibroblast and demonstrated the true invasion of stroma. This study provides strong evidence that FAP-α is an effective tool to evaluate the presence or absence of stroma invasion of lung adenocarcinoma. Our findings will contribute to the accurate diagnosis of lung invasive adenocarcinoma. [ABSTRACT FROM AUTHOR]

Background Although polioviruses (PVs) replicate in lymphoid tissue of both the pharynx and ileum, research on polio vaccine–induced mucosal immunity has predominantly focused on intestinal neutralizing and binding antibody levels measured in stool. Methods To investigate the extent to which routine immunization with intramuscularly injected inactivated polio vaccine (IPV) may induce nasal and pharyngeal mucosal immunity, we measured PV type-specific neutralization and immunoglobulin (Ig) G, IgA, and IgM levels in nasal secretions, adenoid cell supernatants, and sera collected from 12 children, aged 2–5 years, undergoing planned adenoidectomies. All participants were routinely immunized with IPV and had no known contact with live PVs. Results PV-specific mucosal neutralization was detected in nasal and adenoid samples, mostly from children who had previously received 4 IPV doses. Across the 3 PV serotypes, both nasal (Spearman ρ ≥ 0.87, P ≤.0003 for all) and adenoid (Spearman ρ ≥ 0.57, P ≤.05 for all) neutralization titers correlated with serum neutralization titers. In this small study sample, there was insufficient evidence to determine which Ig isotype(s) was correlated with neutralization. Conclusions Our findings provide policy-relevant evidence that routine immunization with IPV may induce nasal and pharyngeal mucosal immunity. The observed correlations of nasal and pharyngeal mucosal neutralization with serum neutralization contrast with previous observations of distinct intestinal and serum responses to PV vaccines. Further research is warranted to determine which antibody isotype(s) correlate with polio vaccine–induced nasal and pharyngeal mucosal neutralizing activity and to understand the differences from intestinal mucosal immunity. [ABSTRACT FROM AUTHOR]

Background: Adenotonsillar hypertrophy (ATH) is a major cause of pediatric obstructive sleep apnea (OSA), potentially impacting craniofacial growth and development. Currently, whether children with ATH exhibit distinctive hyoid bone position and upper airway morphology remains uncertain. This research aimed to compare the hyoid bone position and upper airway morphology of children with and without ATH. Methods: A total of 199 children aged 6–8 years were recruited for the study, and their pre-treatment lateral cephalograms were obtained. The size of the adenoids and tonsils on the lateral cephalogram was assessed based on Fujioka's and Baroni's methods for classification into groups: adenoid hypertrophy only (AHO) group, tonsillar hypertrophy only (THO) group, adenoid and tonsillar hypertrophy (AH + TH) group, and control group (CG). The position of the hyoid bone and upper airway morphology was analyzed using Dolphin Image Software. Results: The distance between the hyoid bone and mentum was greater in the THO group compared to the AHO group (P = 0.005). Children in the AHO group exhibited a longer soft palate (SPL) compared to the THO group (P = 0.014), whereas the THO group displayed a reduced SPL in comparison to healthy controls (P = 0.008). The THO group showed a more inferior tongue position compared to children in the AHO group (P = 0.004). Subjects in the THO group exhibited significantly wider inferior airway space compared to healthy children (P < 0.001). Conclusions: Adenotonsillar hypertrophy may be associated with hyoid bone position and upper airway morphology in children seeking for orthodontic treatment. In children with enlarged tonsils, the hyoid bone was positioned farther from the mentum than in those with enlarged adenoids. Conversely, children with enlarged adenoids had a longer soft palate compared to those with enlarged tonsils. [ABSTRACT FROM AUTHOR]

To investigate the effect of adenoid hypertrophy on the morphological development of the mandible in adolescents with different vertical facial types of Class II malocclusion, 104 patients who met the inclusion criteria were selected. Cone Beam Computed Tomography (CBCT) was used to measure the angle and linear parameters before and after treatment, and a total of 23 related parameters were measured in all three-dimensional models using Invivo5.0 software. Independent-samples t-test was conducted to observe whether there was a statistically significant difference between the groups' data, P-values < 0.05 were considered statistically significant. Experimental results confirmed that adenoid hypertrophy had a significant effect on mandibular morphogenesis in Class II malocclusion high angle adolescents (P<0.05) and a lesser effect on mandibular morphogenesis in Class II malocclusion homogeneous adolescents (P>0.05). The differences in the horizontal, coronal and vertical openness of the mandible in relation to the skull were statistically significant (P<0.05) in the hypertrophic hypergoniacal cases compared to the non-hypertrophic Class II malocclusion hypergoniacal cases, while mandibular Angle width GoR-GoL, mandibular volume length Co-Pog, mandibular body length L-a and mandibular branch length L-b, chin height B-Me and chin thickness C-C' index difference were statistically significant (P<0.05); The differences in the development of mandibular opening relative to the cranium, mandibular length and width, and mandibular ascending length and width were not statistically significant (P>0.05) compared with non-adenoidal hypertrophy in Class II malocclusion homogeneous cases, the difference of chin thickness C-C' in chin morphology was statistically significant (P < 0.05). This study provides a theoretical basis for the clinical treatment of patients with various skeletal facial types affected by adenoid hypertrophy. [ABSTRACT FROM AUTHOR]

The case of a 75‐year‐old man with a glioblastoma of the right frontal lobe showing features of adenoid glioblastoma is reported. The tumor consisted of two components: the adenoid component, in which large, cohesive, polygonal cells with vesicular nuclei and abundant basophilic cytoplasm showed nest‐like, trabecular, or tubular growth on the myxoid matrix and formed a multinodular configuration; and the subsidiary component, in which short spindle cells showed compact fascicular growth. The features of ordinary glioblastoma were also found in a small area. Tumor cells were immunoreactive for S‐100 protein, glial fibrillary acidic protein, and Olig2, and some tumor cells in the adenoid component showed immunoreactivity for cytokeratins and E‐cadherin. A marked regional decrease in microvascular density, approaching almost complete absence of microvessels, was demonstrated in the adenoid component. In contrast, microvascular density was well preserved in the spindle cell component and the area of ordinary glioblastoma. Tumor cells in the adenoid component showed cytoplasmic expression of chondromodulin‐I, one of the cytokines that strongly inhibit angiogenesis, whereas the expression of this protein was very weak or only faint in the spindle cell component and the area of ordinary glioblastoma. A marked regional decrease in microvascular density was associated with myxoid change of the stroma and considered to be caused by the secretion of chondromodulin‐I by tumor cells. Stromal hypovascularity with myxoid change might play an important role in the morphogenesis of adenoid features. [ABSTRACT FROM AUTHOR]

Background: Radiology, endoscopy, and clinical evaluation are the three most used diagnostic modalities for adenoids. This research aimed to evaluate the most accurate method for assessment of adenoid hypertrophy (radiological versus endoscopic Assessment). Patients and methods: We carried out this cross-sectional study on 60 children with chronic adenoid hypertrophy recruited from the ENT outpatient clinic in Zagazig university hospital for management their problem. During the initial assessment, a diagnostic nasal endoscopy was conducted utilizing both rigid and flexible endoscopes.X-ray nasopharynx lateral view was done for all patients. Results: By X ray 30% of the cases were Grade I, 31.7% were Grade II, 18.3% were Grade III and 20 % were Grade IV. By endoscope 30% of the cases were Grade I, 31.7% were Grade II, 28.3 were Grade III and 10% were Grade IV. Statistically significant agreements were revealed between the clinical grading and X ray (p<0.001), the clinical grading and endoscope (p=0.003), X ray and endoscope (p<0.001). Statistically significant positive correlation was found between grading by clinical examination and both X ray and endoscope (p<0.001). The sensitivity of X ray in diagnosis of the adenoid obstruction was 83.3%, specificity was 94.4%, PPV 62.5%, NPV 98% and Accuracy was 93.33% in comparison to endoscope as gold standard. Conclusion: The X-ray alone can rule out adenoidal hypertrophy, but alone it could be insufficient for assessment of the degree of adenoidal obstruction. Endoscopy was found to be more reliable, convenient, correlate well with the volume of adenoid tissue and allow estimation of adenoidal hypertrophy with degree of obstruction. This study demonstrates that combining clinical grading with endoscopy and radiology is important for the evaluation of adenoid hypertrophy. [ABSTRACT FROM AUTHOR]

To determine the association of adenoid hypertrophy with allergic rhinitis in pediatric patients based on Simplified Visual Analog Scale and serum IgE levels. The present study was conducted in our tertiary care centre on 130 patients planned for adenoidectomy from May 2022 to June 2023. Children were divided into two groups based on IgE levels and Allergic history- Group I: who had raised immunoglobulin E levels with allergic rhinitis (according to ARIA guidelines) before adenoidectomy (n = 69) and Group II: who had normal immunoglobulin E levels pre-operatively (n = 72). VAS scoring was done in both groups and compared pre and post operatively. In our study it was found that the adenoid volume was more in patients with allergic history and increased IgE levels as compared to those with normal IgE levels (p < 0.05) pre-operatively. Also, the difference between pre-operative VAS score among Group I and Group II was statistically significant (p = 0.046). Also, the difference between postoperative VAS score among Group I and group II was also statistically significant (p = 0.043). There was statistically significant higher change in VAS score in Group II post-operatively (p = 0.027). sOur study demonstrates that children with allergic rhinitis tend to present earlier with symptoms of adenoid hypertrophy. In addition, children without allergic history show better post-operative VAS scores as the allergic component still prevails in children with allergic history. [ABSTRACT FROM AUTHOR]

Objective: Adenoid hypertrophy is a prevalent pediatric condition, often necessitating surgical intervention. Intranasal steroid administration shows promise as a conservative treatment, particularly by inducing apoptosis in adenoidal cells, leading to a reduction in adenoid size and inflammation. This study aims to characterize the expression profile of caspase-3 as an apoptotic inducer protein in inflammatory and epithelial adenoid tissues and explore its association with steroid administration. Methods: We performed immunohistochemical staining for caspase-3 proteins in adenoid tissues obtained from 51 pediatric patients aged between 2.5 and 12 years (mean age: 6.09 ± 2.1 years) who underwent adenoid surgery. A retrospective analysis of clinical data was conducted, categorizing participants into steroid treatment receivers (n = 25) and non-receivers (n = 26). Subsequently, the lymphoid inflammatory tissue and epithelial tissue from the adenoid were compared in terms of caspase-3 protein expression, and associated clinical variables were assessed. Results: Immunohistochemical analysis revealed significant caspase-3 expression in inflammatory tissues. The expression levels were scored, and no significant correlation was observed between inflammation and epithelium based on caspase-3 expression (correlation coefficient = 0.143; p > 0.05). Furthermore, demographic and clinical characteristics did not show a statistically significant difference in caspase-3 expression levels. Conclusion: Caspase-3 expression was significant in inflammatory adenoid tissue, but it showed no association with nasal steroid administration. [ABSTRACT FROM AUTHOR]

The aim of the study was to evaluate and compare the efficacy of Endoscopic Adenoidectomy with Microdebrider over Conventional technique by Curettage using Impedance Audiometry findings. In this prospective, randomised, comparative study patients were divided into two groups to undergo one of the above adenoidectomy surgeries. Patients with symptoms of Adenoid hypertrophy after failed maximal medical therapy (12 weeks) were selected after due consideration of the inclusion and exclusion criteria. Baseline Impedance Audiometric assessment was done one week prior to surgery which was compared to Impedance Audiometric values 12 weeks post operatively in each group. This study enrolled 50 patients with adenoid hypertrophy, 25 patients of group A underwent Conventional adenoidectomy and the other 25 patients of group B underwent Endoscopic Adenoidectomy with Microdebrider. Significant difference in type of tympanogram before and after adenoidectomy was found in both the groups (p = 0.0008 in group A & p < 0.0001 in group B). In Group A Percentage of abnormal tympanograms becoming normal (Type A), 12 weeks after adenoidectomy was 80%. In Group B Percentage of abnormal tympanograms becoming normal (Type A), 12 weeks after adenoidectomy was 88%. A statistically significant improvement (p < 0.0001 in both the groups) in the percentage of ears with absent stapedial reflex was observed in both groups postoperatively, with no difference between the two groups suggestive of improvement in eustachian tube function. Association of Preoperatively & Postoperatively Eustachian tube function in each group undergoing adenoidectomy was statistically significant (p < 0.0001). Both forms of adenoidectomy are effective in managing adenoid hypertrophy with tubal dysfunction causing mild conductive hearing loss and prone for OME. However, the audiological and endoscopic evaluation seems to favor Endoscopic Adenoidectomy with microdebrider over conventional adenoidectomy, and it should be therefore considered in the therapeutic management of young patients with adenoidal disease. [ABSTRACT FROM AUTHOR]

The aim of this study was to study the prevalence of obstructive sleep apnea syndrome in patients with nasal and nasopharyngeal pathologies. A total of 60 consenting patients between the age of 14 to 60 years with primary nasal and nasopharyngeal pathologies were taken up for the study. These patients underwent history taking, detailed clinical examination including BMI, diagnostic nasal endoscopy and overnight polysomnography. The polysomnography results of people with different pathologies were compared and analysed. Based on the analysis it was arrived that isolated pathologies like septal deviation, nasal polypi and adenoid hypertrophy provided a statistically significant association with occurrence and severity of OSA. Also, that patients with combined pathologies were more proportionately affected by OSA than those with isolated pathologies. Nasal and nasopharyngeal pathologies have significant association with obstructive sleep apnea syndrome and all patients with these pathologies need to undergo polysomnography along with other routine investigations. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate the relationship between adenoid hypertrophy, the most common cause of obstructive sleep apnea (OSA) in children, with the systemic immune inflammation index (SII) and the pan-immune inflammation value (PIV), and to evaluate the clinical utility of SII and PIV in prognostic and predictive aspects. Materials and Methods: The retrospective data from 29 patients presenting to the otorhinolaryngology clinic with dyspnea and undergoing adenoidectomy for OSA between June, 2022 and June, 2023 were reviewed. Thirty age- and sex-matched healthy subjects were included as the control group. The preoperative and postoperative 6-month SII and PIV values of both groups were compared. Results: There was no significant difference between the groups in terms of age and gender (p>0.05). Platelet SII and PIV were statistically significantly higher in patients in the preoperative period compared to the control group (p<0.05). No significant differences were found in the preoperative neutrophil, lymphocyte, and monocyte counts between the patients and the control subjects (p>0.05). Postoperative neutrophil, platelet, and monocyte counts, as well as the SII and PIV values of the patients, were significantly higher than of those in the control group (p<0.05). Conclusion: Our study highlights the potential utility of SII and PIV in assessing systemic inflammation in adenoid hypertrophy-related OSA. However, the unexpected increase in postoperative SII and PIV values underscores the need for further research into their clinical implications. [ABSTRACT FROM AUTHOR]

Introduction: Hypertrophy of adenoids is a common condition in childhood, resulting in obstructive symptoms such as sleep apnea, snoring, and rhinosinusitis. Adenotonsillectomy is recommended to improve prognosis and quality of life. This case-control study compared facial angles and lip position related to dentofacial and mouth growth in symptomatic children with adenoid hypertrophy and asymptomatic control groups. Materials and Methods: The study included children aged 5 to 7 who presented with obstructive symptoms and confirmed severe adenoid hypertrophy in lateral neck radiography. Standard lateral photography was taken. The Nasofacial and Nasomental angles, and upper and lower lip positions and their distance behind the Ricketts line, were measured and compared with the normal control group. Results: This study included 54 children with severe adenoid hypertrophy and 66 normal children. Facial angles were not significantly different between the two groups, but the mean horizontal position of the upper and lower lip in children with adenoid hypertrophy was significantly lower than in the control group (P value = 0.05). The lips were too close to the Ricketts line compared with the control group. Conclusions: This research demonstrates that children with severe adenoid hypertrophy have more dentofacial disorders than others. Adenotonsillectomy surgery is necessary for children with obstructive symptoms caused by tonsil enlargement, and if symptoms like snoring persist post-surgery, complementary orthodontic treatments should be considered. [ABSTRACT FROM AUTHOR]

Objective: Even though pathologies of palatine tonsils are common, the mechanisms leading to these pathologies are not clearly understood. The main objective of this study is to investigate the effect offibroblast growth factor receptor-1 (FCFR1) on tonsillar hypertrophy. Material and Method: Children who underwent total tonsillectomy were included in the study. Subjective tonsil size, tonsil weight and volume were measured for all patients. The tonsil samples were than homogenized and their FGFR1 concentrations were measured with enzyme- linked immunoassay (ELISA) method. The correlations between tonsil measurements and FGFR1 concentrations were analyzed. Results: 59 patients were included in the study. Tonsil size and weight was found to be positively correlated to the patient age. No significant correlation was found between subjective tonsil size and objective tonsil measurements. The FGFR1 concentration of the tonsil tissue showed significant negative correlation with the tonsil volume (r:-0.22, p: 0.04) and weight (r:-0.28, p: 0.01). Subjective tonsil size showed no correlation with the FGFR1 concentration. Conclusion: There is a negative correlation between tonsil size and tonsillar FGFR1 concentration. This finding might indicate that FGFR1 plays a role in the mechanisms which determine the tonsil size. [ABSTRACT FROM AUTHOR]

Diseases of the tonsils and adenoids are extremely common in children and make up a significant part of the paediatric ENT surgeon's practice, as well as presenting frequently to paediatric and primary care teams. The majority of adenotonsillar pathology in children is either infective or obstructive in nature. This article discusses the anatomy and pathophysiology of acute and chronic adenotonsillar disease and discusses how to evaluate a child with suspected adenotonsillar pathology clinically, in both the outpatient and emergency scenario. Surgical management and the adenoidectomy and tonsillectomy techniques are described. The current multidisciplinary working group guidelines regarding surgery for obstructive sleep apnoea in children are also highlighted. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This study aims to determine whether there were cephalometric changes between grades II and IV adenoid hypertrophy. METHODS AND MATERIALS: A cross-sectional study was conducted on 120 6–12-year-old patients selected from the ear, nose, and throat department at Imam Al-Hussein Medical City in Karbala. Patients were classified into three groups (each = 40) based on endoscopic findings: control, grade II, and grade IV. The findings were confirmed with cephalometric radiographs. Specific cephalometric points were identified to measure sella-nasion-point A (SNA), sella-nasion-point B (SNB), point A-nasion-point B (ANB), sella-nasion-pogonion (SNPog), sella nasion plane-palatal plane (SNPP), palatal plane-mandibular plane (PPMP), sella nasion plane-mandibular plane (SNMP), saddle, articular, gonial angles, and the y -axis. Additionally, superior-posterior airway space (SPAS), posterior air way space (PAS), mandibular plane-hyoid bone (MP-H), third cervical vertebra-hyoid bone (C3-H), total anterior facial height (TAFH), total posterior facial height (TPFH), upper anterior facial height (UAFH), lower anterior facial height (LAFH), and the Jarabak ratio were measured. RESULTS: Analysis of variance (ANOVA) and Welch tests indicated statistically significant differences (P < 0.05) among the three groups in SNA, SNB, SNPog, PPMP, SNMP, gonial angle, y -axis, SPAS, PAS, MP-H, and the Jarabak ratio. Tukey's honestly significant difference (HSD) and Games-Howell tests indicated a statistically significant difference between grade II and grade IV in SNA, SNMP, y -axis, SPAS, PAS, MP-H, and Jarabak ratio. CONCLUSION: The present study demonstrated that craniofacial changes start to occur at the moderate adenoid enlargement throughout the downward backward mandibular rotation. More changes would become evident at the severe stage; therefore, an urgent medical intervention and the establishment of nasal breathing by orthodontic treatment with breathing activity would be needed. [ABSTRACT FROM AUTHOR]

Copyright of Bagcilar Medical Bulletin / Bağcılar Tıp Bülteni is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To investigate the expression characteristics of cysteamine leukotriene receptor 1 (CysLTR1) in the adenoid tissue of children with adenoid hypertrophy (AH), as well as the mechanism of action of CysLTR1 in the formation of AH and the influencing factors for CysLTR1 expression. Methods A total of 71 children who underwent adenoidectomy in Department of Otolaryngology, Weihai Municipal Hospital, from October 1, 2020 to October 1, 2021 were enrolled. Immunohistochemical staining was performed for CysLTR1 in the resected specimens, and according to the results of staining, the children were divided into high CysLTR1 expression group and low CysLTR1 expression group. The two groups were compared in terms of the data including sex, age, degree of adenoid hypertrophy, presence or absence of allergic rhinitis, and presence or absence of other comorbidities (secretory otitis media, chronic sinusitis, and sleep apnea syndrome), and a multivariate logistic regression analysis was used to identify the influencing factors for the expression of CysLTR1 in children with AH. Results Immunohistochemistry showed that CysLTR1 was expressed in the adenoid tissue of all 71 children with AH, and there were significant differences between the high and low expression groups in the degree of adenoid hypertrophy, the presence or absence of allergic rhinitis, and the presence or absence of other comorbidities (χ2=9.003-49.196,P

In the majority of cases, pediatric obstructive sleep apnea (OSA) is associated with adenotonsillar hypertrophy. Therefore, adenotonsillectomy is typically considered as the first line of treatment. However, the severity of pediatric OSA is not always directly correlated with the size of the adenoids and tonsils. Other factors, such as upper airway anatomy or obesity, may interact in a multifactorial manner to contribute to its occurrence. For these reasons, sleep apnea in obese children may resemble the condition in adults. Furthermore, in these cases, if adenotonsillar hypertrophy is present, adenotonsillectomy is likely to be prioritized. Reevaluation should be conducted 6 to 8 weeks post-surgery, and additional treatment for residual sleep apnea should be performed thereafter when necessary.

Background: The adenoids act as a reservoir of bacterial pathogens and immune molecules, and they are significantly involved in children with otitis media with effusion (OME). As an essential carrier of intercellular substance transfer and signal transduction, exosomes with different biological functions can be secreted by various types of cells. There remains significant uncertainty regarding the clinical relevance of exosomes to OME, especially in its pathophysiologic development. In this study, we will seek to determine the biological functions of exosomes in children with adenoid hypertrophy accompanied by OME (AHOME). Methods: The diagnostic criteria for OME in children aged 4–10 years include a disease duration of at least 3 months, type B or C acoustic immittance, and varying degrees of conductive hearing loss. Adenoidal hypertrophy is diagnosed when nasal endoscopy shows at least 60% adenoidal occlusion in the nostrils or when nasopharyngeal lateral X-ray shows A/N > 0.6. Children who meet the indications for adenoidectomy surgery undergo adenoidectomy. Peripheral blood, nasopharyngeal swab, and adenoid tissue will be collected from patients, and the exosomes will be isolated from the samples. Following the initial collection, patients will undergo adenoidectomy and peripheral blood and nasopharyngeal swabs will be collected again after 3 months. Expected results: This study aims to identify differences in exosomes from preoperative adenoid tissue and peripheral blood samples between children with AHOME and those with adenoid hypertrophy alone. Additionally, it seeks to determine changes in microbial diversity in adenoid tissue between these groups. Conclusions: The findings are expected to provide new insights into the diagnosis and treatment of OME, to identify novel biomarkers, and to enhance our understanding of the pathophysiology of OME, potentially leading to the development of innovative diagnostic and therapeutic approaches. [ABSTRACT FROM AUTHOR]

Aim: The study aims to investigate the correlation between grade of adenoid hypertrophy and severity of hearing loss and to profile tympanometric findings in children with Adenoid Hypertrophy. Materials and methods: A within group comparison study was carried out in Father Muller College, Department of Speech and Hearing, Mangalore where 123 patients diagnosed with Adenoid Hypertrophy (86 males and 37 females; mean age 7.146; range 2 to 12 years) were analyzed using detailed case history, Pure tone audiometry (PTA) and Tympanometry. Results: The most prevalent presenting problems with adenoid hypertrophy were snoring (68.29%), mouth breathing (57.72%) and reduced hearing (35.77%). PTA results showed majority had bilateral hearing loss (60.27%). In the 230 ears that were tested, 50.85% had hearing loss. Majority of these ears had a minimal loss (23.91%), followed by mild loss (18.69%), moderate loss (7.82%), and moderately severe loss (0.43%). No correlation was found between the grade of Adenoid hypertrophy and the severity of hearing loss noted (p > 0.05). According to tympanometric findings, the most common tympanogram pattern was 'B' type (39.15%), 'A' type (31.60%), and 'C' type (18.39%). A small proportion of the population had 'As' (4.71%), 'Cs' (5.66%), and 'Ad' (0.47%). No correlation was found between the grade of adenoid hypertrophy and the type of tympanogram obtained (p > 0.05). Conclusion: In a significant percentage of cases, Adenoid hypertrophy affects the middle ear leading to conductive hearing loss. If left untreated it can lead to delayed speech and language development, auditory processing disorders, mental retardation, and physical and social complications. These are avoidable through primary health care education, accurate diagnosis, and effective treatment. [ABSTRACT FROM AUTHOR]

The development and deployment of single-cell genomic technologies have driven a resolution revolution in our understanding of the immune system, providing unprecedented insight into the diversity of immune cells present throughout the body and their function in health and disease. Waldeyer's ring is the collective name for the lymphoid tissue aggregations of the upper aerodigestive tract, comprising the palatine, pharyngeal (adenoids), lingual, and tubal tonsils. These tonsils are the first immune sentinels encountered by ingested and inhaled antigens and are responsible for mounting the first wave of adaptive immune response. An effective mucosal immune response is critical to neutralizing infection in the upper airway and preventing systemic spread, and dysfunctional immune responses can result in ear, nose, and throat pathologies. This review uses Waldeyer's ring to demonstrate how single-cell technologies are being applied to advance our understanding of the immune system and highlight directions for future research. [ABSTRACT FROM AUTHOR]

Background: The adenoids, primary sites of microbial colonization in the upper airways, can influence the development of various conditions, including otitis media with effusion (OME). Alterations in the adenoid microbiota have been implicated in the pathogenesis of such conditions. Aim: This study aims to utilize 16S rRNA genetic sequencing to identify and compare the bacterial communities on the adenoid surfaces of children with OME and children with healthy middle ears. Additionally, we seek to assess the differences in bacterial diversity between these two groups. Materials and Methods: We collected adenoid surface swabs from forty children, divided into two groups: twenty samples from children with healthy middle ears and twenty samples from children with OME. The V3-V4 hypervariable region of the bacterial 16S rRNA gene was amplified and sequenced using the Illumina MiSeq platform. Alpha and beta diversity indices were calculated, and statistical analyses were performed to identify significant differences in bacterial composition. Results: Alpha diversity analysis, using Pielou's index, revealed significantly greater evenness in the bacterial communities on the adenoid surfaces of the healthy ear group compared with the OME group. Beta diversity analysis indicated greater variability in the microbial composition of the OME group. The most common bacterial genera in both groups were Haemophilus, Fusobacterium, Streptococcus, Moraxella, and Peptostreptococcus. The healthy ear group was primarily dominated by Haemophilus and Streptococcus, whereas the OME group showed higher abundance of Fusobacterium and Peptostreptococcus. Additionally, the OME group exhibited statistically significant higher levels of Alloprevotella, Peptostreptococcus, Porphyromonas, Johnsonella, Parvimonas, and Bordetella compared with the healthy ear group. Conclusion: Our study identified significant differences in the bacterial composition and diversity on the adenoid surfaces of children with healthy middle ears and those with OME. The OME group exhibited greater microbial variability and higher abundances of specific bacterial genera. These findings suggest that the adenoid surface microbiota may play a role in the pathogenesis of OME. Further research with larger sample sizes and control groups is needed to validate these results and explore potential clinical applications. [ABSTRACT FROM AUTHOR]

Introduction: Leukotrienes play a significant role in the pathogenesis of adenoid hypertrophy (A.H.). Therefore, we aimed to analyse the role of montelukast, a leukotriene receptor antagonist, alone or in combination with mometasone, a potent local intranasal steroid, for the treatment of A.H. Methods: Participants were children with A.H. were treated with montelukast alone or montelukast and mometasone furoate. The main outcome measures were effect of montelukast on clinical symptoms of A.H. A literature review was conducted using online search engines, Cochrane Library, PubMed, Web of Science and Scopus, for randomized clinical trials assessing children with A.H. treated with montelukast alone or montelukast and mometasone furoate. Seven randomized clinical trials (RCTs) were included with 742 children. Results: Our study reveals that montelukast alone or in combination with intranasal mometasone furoate significantly improves clinical symptoms of adenoid hypertrophy such as snoring, sleeping disturbance, mouth breathing and A/N ratio. Montelukast was superior to placebo in decreasing snoring (SMD = −1.00, 95% CI [−1.52, −0.49]), sleep discomfort (SMD = −1.26, 95% CI [−1.60, −0.93]), A/N ratio (MD = −0.11, 95% CI [−0.14, −0.09]) and mouth breathing (SMD = −1.36, 95% CI [−1.70, −1.02]). No difference was detected between montelukast and mometasone versus mometasone alone in snoring (SMD = −0.21, 95%CI [−0.69, 0.27]); however, the combination group was superior to the mometasone alone in mouth breathing (SMD = −0.46, 95% CI [−0.73, −0.19]). Conclusions: The limitation of studies included a small sample size, with an overall low to medium quality. Thus, further larger, higher‐quality RCTs are recommended to provide more substantial evidence. [ABSTRACT FROM AUTHOR]

Introduction Adenoidectomy is one of the most common procedures performed by otolaryngologists. Traditional adenoid curettage is performed blindly, which can result in inadequate removal of the adenoid and injury to the surrounding structures. Objective To perform transnasal endoscopic examinations to assess the nasopharynx after conventional curettage adenoidectomy. Methods The present prospective study included 100 children with a mean age of 4.2 ± 3.07 years. It is composed of two steps: conventional curettage adenoidectomy by a resident trainee; and endoscopic evaluation of the nasopharynx through a 0° telescope to assess adenoidal remnants, injury to the surgical field or adjacent structures, and bleeding points. Results Adenoid remnants were observed in 42% of the cases after conventional adenoid curettage in multiple locations, such as the roof of the nasopharynx over the choana (24%), the tubal tonsil (12%), the posterior pharyngeal wall (4%), and the posterior end of the nasal septum (2%). Injury to the surgical field and adjacent structures was observed in 46% of the cases (posterior pharyngeal wall: 23%; lateral pharyngeal wall: 11%; Passavant ridge: 10%; and the Eustachian tube orifice: 2%). Endoscopic bleeding was observed in 29% of the cases; 13% of the cases were from adenoid remnants, 10%, from the mucosa, and 6%, from the pharyngeal muscles. Bleeding was mild in 19% of the cases, moderate in 9%, and severe in 1%. Conclusion Endoscopic evaluation of the nasopharynx following conventional adenoid curettage provides important data regarding adenoid remnants, injury to the surgical field or nearby structures, and bleeding points, which aids in the provision of optimal care and in the achievement of a better outcome. [ABSTRACT FROM AUTHOR]

Background: For a long time, the hypertrophied tonsils impact on velopharyngeal closure has been a point of concern. Objectives: To identify the alterations in the velopharyngeal valve (VPV) closure patterns following adenotonsillectomy in Arabic-speaking children, to predict the incidence of complications as nasal regurgitation or open nasality. Patients and methods: This observational prospective research was performed on 100 patients, with hypertrophied adenoid and tonsils, who were collected from outpatient clinic of Benha University Hospitals. All cases underwent preoperative laboratory investigations, otorhinolaryngology examination and video-nasoendoscopy and speech assessment before and after adenotonsillectomy. Results: The VP closure pattern was insignificantly different between both groups. However, the Nasality was significantly different among the 3 studied periods (P<0.001). There was no relation between gender and VP closure pattern preoperatively and 1 month after surgery. Regarding the postoperative nasality (hypernasality), the most prevalent observed VP closure patterns were both coronal and circular ones. Conclusions: The coronal pattern of closure of the VPV is the most prevalent type, which remains even postoperatively, also the type of closure has no significant value in predicting outcoming hypernasality. [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: A paramount adenoidectomy procedure should enhance visualization of the adenoid pad for the surgeon and promote efficient tissue excision with limited blood loss. The study thought to compare the outcomes of endoscopic-assisted adenoidectomy performed using either a microdebrider or coblation. Parameters of interest included blood loss, pain, surgical duration, and immediate postoperative complications. Methods: In this randomized, prospective clinical trial, 54 patients diagnosed with hypertrophied adenoiditis were enrolled. They were equally distributed into two cohorts: Group I (endoscopic-assisted adenoidectomy using a microdebrider) and Group II (endoscopicassisted adenoidectomy using coblation). Metrics assessed encompassed operative duration, blood loss, pain intensity, related trauma, adequacy of adenoid removal, and instances of nasal/oral hemorrhage. Results: The mean operation time for Group I (microdebrider) was 20.19 minutes, significantly shorter than the 34.26 minutes in Group II (coblation) (p <0.0001). Postoperative pain, gauged using the VAS score, was notably elevated at 1 hour (p=0.001) and 1 day post-operation (p <0.0001) in Group I (microdebrider) relative to Group II (coblation). The two groups exhibited no statistically discernible differences in terms of postoperative complications. Conclusion: Endoscopic-assisted adenoidectomy via coblation is both safe and efficacious. This method facilitates comprehensive adenoid removal with decreased blood loss. Although the procedure's duration may extend longer than the microdebrider method, coblation offers fewer postoperative complications and reduced postoperative pain duration. [ABSTRACT FROM AUTHOR]

Background: Exploring bidirectional causal associations between gastroesophageal reflux disease (GERD) and chronic disease of the tonsils and adenoids and chronic sinusitis, respectively. Methods: We first conducted a TSMR (two-sample mendelian randomization) study using the results of the inverse variance weighting method as the primary basis and bidirectional MR to rule out reverse causation. Subsequently, MVMR (multivariate MR) analysis was performed to identify phenotypes associated with SNPs and to explore the independent effect of GERD on two outcomes. Finally, we calculated MR-Egger intercepts to assess horizontal polytropy and Cochran's Q statistic to assess heterogeneity and ensure the robustness of the study. Results: For each standard deviation increase in genetically predicted GERD rate, there was an increased risk of chronic disease of the tonsils and adenoids (OR 1.162, 95% CI 1.036–1.304, P: 1.06E−02) and of developing chronic sinusitis (OR 1.365, 95% CI 1.185–1.572, P: 1.52E−05), and there was no reverse causality. Causality for TSMR was obtained on the basis of IVW (inverse variance weighting) and appeared to be reliable in almost all sensitivity analyses, whereas body mass index may be a potential mediator of causality between GERD and chronic sinusitis. Conclusion: There is a causal association between GERD and chronic disease of the tonsils and adenoids and chronic sinusitis, respectively, and the occurrence of GERD increases the risk of developing chronic disease of the tonsils and adenoids and chronic sinusitis. [ABSTRACT FROM AUTHOR]

Nasal obstruction is one of the main symptoms of different nasal pathologies. Many physiological and pathological conditions can produce nasal airflow impairment causing nasal obstruction and affecting patients' quality of life. There are different methods for the measurement of nasal obstruction, but in clinical practice the most common used are acoustic rhinometry, rhinomanometry, and peak nasal inspiratory flow. This review describes the fundamentals of acoustic rhinometry, its normal values, the different physiological and pathological conditions that can modify nasal patency, and the utility of this instrument for the measurement of nasal obstruction in clinical practice. Acoustic rhinometry is a simple test, so it is suitable for measurements in the pediatric population, i.e., for evaluating adenoid hypertrophy. Acoustic rhinometry normal values are available, unilaterally and bilaterally for pediatric and adult populations. Acoustic rhinometry has been demonstrated to be reproducible and even superior to rhinomanometry when measuring nasal modifications during challenges. It is possible to use acoustic rhinometry before and after nasal surgery. Measuring nasal cavities volume and cross-sectional area, acoustic rhinometry is particularly indicated in rhinosurgery, especially for the evaluation of spreader grafts. Brief considerations about the correlation between nasal symptoms, in particular the subjective sensation of nasal obstruction, and the acoustic rhinometry results as well as the correlation of acoustic rhinometry with other methods for the measurement of nasal obstruction are also reported. Objective and subjective evaluation of nasal obstruction gives different information that together optimizes the diagnosis and the treatment of rhinologic patients. Acoustic rhinometry alone or in combination of other instruments for the measurement of nasal obstruction or patency should be used regularly in every outpatient clinic that treats patients with nasal obstruction as there is an increasing need of evidence-based therapies. [ABSTRACT FROM AUTHOR]

Adenoid hypertrophy (AH) and its sequel like nasal obstruction, obstructive sleep apnoea (OSA), recurrent rhinitis and middle ear disorders are common diseases of pediatric age group, forming the major bulk of pediatric outpatient visits. The recommended approach to treating OSA in children is through adenotonsillectomy. Adenoidectomy is the surgical procedure of removal of hypertrophied adenoid tissues, which is the most common surgery performed by Ear, Nose, and Throat (ENT) surgeons. Given that adenoidectomy alone might lead to reduced instances of adverse outcomes, decreased risk of complications, and lower expenses, our objective was to explore the viability and suitability of adenoidectomy as a standalone treatment for pediatric OSA and to learn the significant effect of adenoidectomy on the quality of life (QOL) of children. Multicentric prospective study conducted in Department of ENT, Head and Neck Oncosurgery, Smita Memorial Hospital, Thodupuzha & Department of ENT, Head and Neck surgery, MCS Hospital, Muvattupuzha, Kerala, India from June 2022 to June 2023. Children between the age group of 5–10 years, who underwent adenoidectomy during the study period, satisfying the inclusion criteria were subjected for the study. Adenoidectomy was done for them using endoscope assisted coblation technique. Postoperative improvement in symptoms and change in quality of life were analyzed using obstructive sleep disorders-6 (OSD-6) questionnaire at the end of 3 months follow up. The surgeon observed a statistically significant improvement in all domains of OSD-6; and there by improvement in QOL in all patients, who underwent adenoidectomy in a course of three months. Adenoid hypertrophy is the most common cause of nasal obstruction in pediatric population and is creating a significant negative impact on the quality of life of children. Adenoidectomy is a safe and simple procedure which can provide significant improvement in quality of life of kids. Adenoidectomy in isolation could be a valid and recommended surgical choice for selected population of children displaying symptoms of pediatric OSA. [ABSTRACT FROM AUTHOR]

Objective: To assess the role of laryngo-tracheo-bronchoscopy in children with obstructive sleep apnoea by identifying airway abnormalities at surgery, that occur separately or in addition to adenotonsillar hypertrophy, and examining the correlation with respiratory parameters. Methods: A retrospective study was conducted of children with obstructive sleep apnoea who underwent laryngo-tracheo-bronchoscopy intra-operatively, performed by a single ENT surgeon from February 2016 to July 2019. Pre- and post-operative minimum oxygen saturation, apnoea-hypopnoea index, and oxygen desaturation index were recorded. Results: Sixty-five children were identified; 34 were aged less than three years and 31 were aged three years or more. 77 per cent and 13 per cent respectively had an airway abnormality; the t -test showed a significantly higher mean oxygen desaturation index and lower mean minimum oxygen saturation pre-operatively compared to children without an airway abnormality. Conclusion: An update of the surgical pathway for children aged less than three years with obstructive sleep apnoea is required to include laryngo-tracheo-bronchoscopy intra-operatively. A t -test analysis of the pre-operative respiratory parameters suggests that airway abnormalities contribute to obstructive sleep apnoea severity. [ABSTRACT FROM AUTHOR]

Background: Obstructive adenoid enlargement is common in our environmentit, it manifests with nasal obstruction, persistent mouth breathing, snoring, sleep apnea, and daytime somnolence, which results in poor school performance. Fibreoptic nasopharyngoscopy has recently been recommended for the diagnosis of adenoid enlargement. It is, however, expensive and not readily available in a resource-constrained setting. Clinical symptomatology is invaluable to the physician, as it may be the only assessment tool available to a healthcare provider in a rural setting. However, some workers considered it unreliable and insufficient for the diagnosis of adenoid enlargement. Objectives: The research’s aim was to find out how reliable clinical symptoms are for diagnosing obstructive adenoid enlargement compared to fiberoptic nasopharyngoscopy. Materials and methods: This was a cross-sectional study among children with obstructive adenoid enlargement. Ethical approval and informed consent were given. A structured questionnaire was utelized to assess clinical symptomatology. A fiberoptic nasopharyngoscopic examination was carried out, and the data were analyzed. Results: This study recruited 79 (56.4%) men and 61 (43.6%) women within the age range of 2–10 years with a mean of 4.5 ± 2.5 years. The clinical symptomatology score correctly predicted 60% of endoscopic grade 1, 67.5% of endoscopic grade 2, and 78.9% of endoscopic grade 3 adenoid enlargement. There was a statistically significant association between clinical symptomatology score and fiberoptic endoscopic findings (χ² = 96.9, P-value = 0.000). Conclusion: This study found that the clinical symptomatology score is reliable in diagnosing obstructive adenoid enlargement. [ABSTRACT FROM AUTHOR]

Background: There is increasing interest in elucidating the relationship between adenoid hypertrophy (AH) and allergic rhinitis (AR). However, the impact of aeroallergen sensitization patterns on children with AH and AR remains unclear. Methods: Patients aged 2–8 years (recruited from January 2019 to December 2022) with nasal symptoms were assessed for allergies, adenoid size, and respiratory viral infection history. The serum total immunoglobulin E (IgE) and specific IgE levels were measured, and flexible nasal endoscopy was performed. The relationship between AH, aeroallergen sensitization patterns, and lymphocyte subpopulations in adenoid samples was analyzed using flow cytometry. Results: In total, 5281 children were enrolled (56.5% with AR; and 48.6% with AH). AH was more prevalent in children with AR. Compared to nonsensitized individuals, those polysensitized to molds had a higher prevalence of AH (adjusted OR 1.61, 95% CI 1.32–1.96) and a greater occurrence of two or more respiratory viral infections, particularly in adenoidectomy patients. The percentages and corrected absolute counts of regulatory T (Treg) cells, activated Tregs, class‐switched memory B cells (CSMBs), natural killer (NK) T cells, and NK cell subpopulations were reduced in the adenoid tissues of children with both AH and AR (AH‐AR) compared to AH‐nAR children. Polysensitization in AH‐AR children correlated with lower CSMB percentages. Conclusion: Polysensitivity to molds is associated with an increased risk of AH in children with AR. Fewer B cells, NK cells, and Treg cells with an effector/memory phenotype were detected in the adenoids of AR children, and these lower percentages of immune cells, particularly CSMBs, were closely linked to aeroallergen sensitization models and respiratory viral infection. [ABSTRACT FROM AUTHOR]

Objective • This study compares the efficacy of low-temperature plasma excision and adenoidectomy performed under a nasal endoscope (NE) to treat adenoid hypertrophy (AH). The goal is to offer valuable insights and guidance for future treatments. Methods • We selected a cohort of 83 children diagnosed with AH admitted to our hospital between August 2019 and August 2022. The observation group included 45 children treated with low-temperature plasma excision under NE, while the control group consisted of 38 children treated with adenoidectomy under NE. We compared various parameters, including operative time, intraoperative bleeding, the time for white film disappearance, and the duration of hospitalization between the two groups. Additionally, we assessed levels of superoxide dismutase (SOD), malondialdehyde (MDA), glutathione peroxidase (GSH-Px), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), nasal pharyngeal volume (NPV), total inspiratory resistance (TIR), and total expiratory resistance (TER). Pain and sleep were evaluated using the Visual Analogue Scale (VAS) and the Pittsburgh Sleep Quality Index (PSQI). Finally, we recorded perioperative complications in both groups. Results • No significant difference was observed in the time of albuginea regression between the two groups (P > .05). However, the observation group demonstrated shorter operative time, quicker dietary recovery, and reduced hospital stay compared to the control group (P < .05). After treatment, the two groups had no significant differences in NPV, TIR, and TER (P > .05). Nevertheless, the observation group exhibited higher levels of SOD and GSH-Px, while MDA, CRP, TNF-α, IL-6, VAS, and PSQI scores were lower (P < .05). Furthermore, the incidence of complications in the observation group was significantly lower than in the control group (P < .05). Conclusions • Low-temperature plasma excision performed under NE for AH demonstrates superior outcomes and improved surgical safety and is strongly recommended for the treatment of adenoid hypertrophy. [ABSTRACT FROM AUTHOR]

We present a case of a 12-year-old male who presented with complaints of nasal congestion, intermittent throat pain, and odynophagia. He was taken to the operating room for inferior turbinate reduction and adenoidectomy and found to have stones within adenoid crypts. Adenoidectomy resulted in resolution of the patient's throat pain and pain with swallowing. Not previously described in the literature, adenoid stones may represent an unrecognized etiology of odynophagia and throat pain in the pediatric population. Adenoidectomy should be considered for patients symptomatic from adenoid stones. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to examine the effectiveness of the combined maximal medical treatment for adenoid hypertrophy in preschool children. Methods: Sixty-four children underwent one-year combined therapy with intranasal mometasone furoate, oral desloratadine, nasal saline irrigation, and bacteriotherapy. Additionally, decongestion drops were applied during scheduled breaks. Results: Of the 64 treated children, 72% showed clinical improvement in adenoid symptoms while 28% did not improve and underwent surgery. These groups differed significantly in terms of the overall reduction in ailments after treatment (p < 0.001), infection rate (p < 0.001), catarrh severity (p < 0.001) and nasal patency (p < 0.001). Endoscopic examination confirmed that responders experienced, on average, a decrease of 8.4% in the adenoid/choana ratio and an improvement in mucosal coverage of the adenoid. These effects were not observed in the group of children whose parents opted for surgery after nine months of conservative treatment. Conclusions: The proposed new schema of long-term maximal medical treatment with the use of combined intermittent treatment of intranasal mometasone furoate and decongestion drops, oral desloratadine, nasal saline irrigation, and bacteriotherapy can be attempted in patients with adenoid hypertrophy symptoms, and responders may avoid the need for surgery. The applied treatment breaks resulted in a low number of therapeutic side effects. [ABSTRACT FROM AUTHOR]

Objective: Craniofacial anomalies are widely discussed as predisposing factors of breathing disorders. Since many more cofactors exist, this study investigated the association between maxillary micrognathia and morphological changes of posterior airway space and adenoids in these patients. Material and methods: Cephalometric radiographs of n = 73 patients were used for data acquisition. The patients were divided into two groups according to certain skeletal characteristics: maxillary micrognathia (n = 34, 16 female, 18 male; mean age 10.55 ± 3.03 years; defined by a SNA angle < 79°) and maxillary eugnathia (n = 39, 19 female, 20 male; mean age 10.93 ± 3.26 years; defined by a SNA angle > 79°). The evaluation included established procedures for measurements of the maxilla, posterior airway space and adenoids. Statistics included Kolmogorov–Smirnov-, T- and Mann–Whitney-U-Tests for the radiographs. The level of significance was set at p < 0.05. Results: The cephalometric analysis showed differences in the superior posterior face height and the depth of the posterior airway space at palatal level among the two groups. The depth of the posterior airway space at mandibular level was the same for both groups, just as the size of the area taken by adenoids in the nasopharynx. Conclusions: Skeletal anomalies affect the dimension of the posterior airway space. There were differences among the subjects with maxillary micrognathia and these with a normal maxilla. However, the maxilla was only assessed in the sagittal direction, not in the transverse. This study showed that the morphology of the maxilla relates to the posterior airway space whereas the adenoids seem not to be affected. Clinical relevance: Maxillary micrognathia is significantly associated with a smaller depth of the posterior airway space at the palatal level compared to patients with maxillary eugnathia. [ABSTRACT FROM AUTHOR]

Background • Adenoid is a mass of lymphoid tissue seen in the posterior nasopharyngeal wall, generally seen in the pediatric age group, and it disappears as age advances till puberty. Patients with recurrent allergic rhinitis, otitis media, or persistent nasopharyngeal obstruction is associated with adenoid hypertrophy can be considered for adenoidectomy. Objective • To evaluate the potential role of Individualised Homeopathic medicine in managing allergic rhinitis and troublesome symptoms of upper respiratory tract in case of Enlarged adenoid. Method • An 8-year-old boy came with complaints of Allergic rhinitis, snoring, and recurrent upper respiratory tract infection. He had taken treatment for the same from modern medicine, but still, a recurrence of symptoms occurred. His radiological investigations showed grade II Adenoid Hypertrophy. The patient was advised surgical intervention, but their parents were unwilling to the same so the patient came for Homoeopathic Management. Individualized Homeopathic Medicine Calcarea carbonicum 200 C was prescribed to the patient. The patient’s condition significantly improved during the course of his five years of treatment; his snoring has decreased, his allergic manifestations have diminished, and monthly check-ups have revealed that the patient’s general and particular condition are improving. indicating the positive result of homeopathic medicine in the treatment of enlarged adenoid. Assessment of outcome is based on Radiological reports and modified Naranjo criteria. Result • Homoeopathic medicine Calcarea Carb 200 C is given to the patient based on the totality of symptoms. The incidence of allergic rhinitis has also declined following treatment. Furthermore, there has been a decrease in the grade of adenoid hypertrophy and a noticeable improvement in symptoms. Conclusion • This is a single case where evidence shows that complete patient recovery occurs with individualized Homoeopathic Medicine. this is single case study and more researches, observational studies and randomized control trials are required to ascertain homeopathy’s efficacy in managing enlarged Adenoids. [ABSTRACT FROM AUTHOR]