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PubMed2004

Electrosurgical adenoid ablation.

OBJECTIVE: The technique of adenoidectomy has undergone many refinements over the years with, most recently, the addition of electrosurgery alone as a viable method for removal of adenoid tissue. Several studies have suggested good efficacy with this method. The objective of this study is to examine the effectiveness of adenoidectomy by electrosurgical ablation by the following measures: reduction of the adenoid size, blood loss, and postoperative complications. DESIGN AND METHODS: In this prospective study, we reviewed patients who underwent electrosurgical adenoid ablation for either nasal obstructive symptoms or chronic otitis media with effusion requiring a second or greater set of pressure equalization tubes and adenoidectomy. Preoperative and postoperative videonasopharyngoscopy were performed and evaluated. A grading system for adenoid size for the endoscopic parameters was used. The amount of blood loss and postoperative complications were recorded. RESULTS: On preoperative nasopharyngoscopy, 7 of 23 children had a grade II adenoid size, 15 of 23 had grade III adenoid pads, and 1 of 23 had grade IV adenoid size. Postoperative follow-up at 6 to 8 weeks revealed that 19 of 23 children showed no evidence of adenoid tissue. Three of 23 children had only tiny residual tissue that fell into grade I and one had regrowth of tissue to fit into grade III. Eight patients were seen at 6 months postoperatively, four of whom were followed up to 12 months postoperatively; all showed no evidence of regrowth of adenoid tissue. Average blood loss for the procedure was 2.6 cc. No postoperative complications (postoperative bleed, dehydration requiring hospitalization, infection, velopharyngeal insufficiency) were encountered. CONCLUSIONS: Electrosurgical adenoid ablation is a safe method with minimal intraoperative blood loss and postoperative complications. Follow-up at 6 to 8 weeks and up to 1 year postoperatively suggests that it is an effective method in removing adenoid tissue and alleviating nasal obstruction.

Adenoidectomy↗

PubMed2006

Adenoid basal carcinoma of the cervix in a 20-year-old female: a case report.

BACKGROUND: Adenoid basal carcinoma of the cervix is a rare condition mostly occurring among postmenopausal women. Although it can be confused with adenoid cystic carcinoma of the cervix, adenoid basal carcinoma has several clinicopathologic features that will allow distinction from adenoid cystic carcinoma. CASE PRESENTATION: This is the case of a twenty-year old African-American female who initially presented with a high-grade squamous intraepithelial lesion on Pap smear, with a subsequent cervical LEEP specimen revealing adenoid basal carcinoma. The lesion showed the characteristic histologic features of adenoid basal carcinoma and was positive for the immunohistochemical marker EMA and negative for collagen IV, further defining the tumor while helping to rule out the possibility of adenoid cystic carcinoma. As far as the authors are aware, this is the youngest reported case of adenoid basal carcinoma to date. CONCLUSION: This case shows that adenoid basal carcinoma can deviate markedly from its typical postmenopausal demographics to affect women as young as 20 years of age. In addition, adenoid basal carcinoma has several identifiable features that will differentiate it from adenoid cystic carcinoma including histologic and cellular morphologies, as well as immunohistochemistry. Treatment for most patients involves hysterectomy, LEEP, or a conization procedure which provides a favorable prognosis because of this lesion's low potential for recurrence and metastasis.

Journal Article↗

PubMed1984

Adenoid hypertrophy and nasal mucociliary clearance in children. A morphological and functional study.

The authors have studied nasal mucociliary function and adenoid surface characteristics in a group of 86 children, aged between 4 and 10 years, divided in two groups according to the presence or absence of clinical, instrumental and röntgenographic signs of nasal obstruction due to hypertrophied adenoids. Each group was divided into 3 age-related subgroups (group I: 4-5 years; group II: 6-7 years; group III: 8-10 years). A population of normal adults was chosen both for functional and ultrastructural characteristics. Nasal mucociliary clearance velocity values were evaluated by means of the saccharine method and the surface characteristics of the adenoid tissue by means of scanning electron microscopy. The data obtained show that the nasal mucociliary function is generally reduced in children but, while in the group with poorly developed adenoids an early and progressive improvement can be observed, the children with severely hypertrophied adenoids show an impaired function up to 10 years, without age-related improvements. At almost 10 years, children with poorly developed adenoids reach normal adult clearance values. These functional data can be related to the surface characteristics of adenoid tissue. In fact, while poorly developed adenoids are characterized by a compact layer of ciliated cells, severely hypertrophied adenoids are characterized by a metaplasic epithelium, with almost complete loss of cilia. Such findings, which are probably due to the inflammatory events frequently complicating adenoid hypertrophy, could explain, together with the obstructive effects, the impairment of the nasal mucociliary clearance in childhood.

Adenoids↗

PubMedDate not supplied

Clinical, bacteriological, and histological study of adenoids in children.

PURPOSE: The adenoid has long been recognized as an important factor in the pathogenesis of otitis media with effusion (OME). However, there is still considerable debate concerning how the condition of the adenoid tissue is involved in the cause of OME. The purpose of this study is to investigate whether the adenoid is an active agent of OME. PATIENTS AND METHODS: One hundred forty-six patients aged from 3 to 6 years who underwent adenoidectomy at Oita Medical University (Japan) were retrospectively compared with patients with and without OME regarding macroscopic size of the adenoid, adenoidal-nasopharyngeal ratio (AN ratio), incidence of sinusitis and nasal allergy, bacteriological examination of adenoid tissues, reticular formation of the epithelium, and the percent of ciliated epithelium. RESULTS: There was no significant difference in the size of adenoids. Haemophilus influenzae (HI) was cultured more frequently in adenoid specimens from patients with OME. A tendency toward increased stratified squamous epithelium and decreased ciliated epithelium was apparent in patients with OME. Reticular epithelium extension was greater in patients with than without OME. CONCLUSION: Adenoid inflammation is implicated in the pathogenesis of OME and the adenoids have an important role in the cause of OME by being a reservoir for HI.

Adenoids↗

PubMed2005

Immunoreactivity for c-kit and p63 as an adjunct in the diagnosis of adenoid cystic carcinoma of the breast.

Adenoid cystic carcinoma of the breast represents a unique clinicopathologic entity with a variable histological appearance and a relatively indolent clinical course in most of the cases. Adenoid cystic carcinoma may be difficult to differentiate from infiltrating duct carcinomas, and in particular from tubular and cribriform carcinomas, especially in core or vacuum-assisted biopsies. We evaluated the prevalence of c-kit, p63, and e-cadherin immunoreactivity in a series of 20 adenoid cystic carcinomas, comparing the results with those obtained in a series of infiltrating tubular carcinomas and infiltrating cribriform carcinomas. The hormone receptor status, proliferation labeling index, and HER/2 immunoreactivity had been previously investigated in all the cases. Three (15%) adenoid cystic carcinomas and all infiltrating tubular and cribriform carcinomas showed estrogen receptor and/or progesterone receptor immunoreactivity (P < 0.00001 for estrogen and P = 0.00002 for progesterone receptors). Adenoid cystic carcinomas consistently lacked any immunoreactivity for HER/2, whereas three (15%) infiltrating and cribriform carcinomas showed weak and incomplete membrane staining (P = 0.23077). Membranous immunoreactivity for c-kit was found in all except one (predominantly basaloid) adenoid cystic carcinomas (95%), and in none of the infiltrating tubular and cribriform carcinomas (P < 0.00001). Nuclear immunoreactivity for p63 was found in all except three (predominantly basaloid) adenoid cystic carcinomas (85%) and in none of the infiltrating tubular and cribriform carcinomas (P < 0.00001). All infiltrating tubular and cribriform carcinomas and 18/20 (90%) adenoid cystic carcinomas showed immunoreactivity for e-cadherin (P = 0.48718). In summary, adenoid cystic carcinomas showed the following phenotype: estrogen receptor-/progesterone receptor-/c-kit+/p63+ (13 cases, 65%), estrogen receptor-/progesterone receptor/c-kit+/p63- (three cases, 15%), estrogen receptor-/progesterone receptor-/c-kit-/p63+ (one case, 5%), estrogen receptor+/progesterone receptor+/c-kit+/p63+ (two cases, 10%), and estrogen receptor+/progesterone receptor-/c-kit+/p63+ (one case). By contrast, all the infiltrating tubular and cribriform carcinomas showed the estrogen receptor+/progesterone receptor+/c-kit-/p63- phenotype. Our data provide evidence that immunoreactivity for c-kit and/or p63 may be useful in differentiating adenoid cystic carcinomas from other types of breast cancer.

Adult↗

PubMed1998

Immune responses of adenoidal lymphocytes specific to Haemophilus influenzae in the nasopharynx.

OBJECTIVES: Investigate immune responses of adenoidal lymphocytes against outer-membrane protein P6 purified from nontypeable Haemophilus influenzae (HI). Clarify the role of adenoids in regulating the colonization of HI in the nasopharynx. STUDY DESIGN: Microbiological and immunological examinations of adenoids obtained from 21 children, 15 boys and five girls, from 1 to 13 years of age (median, 5 y), suffering from adenoidal hypertrophy complicated by otitis media with effusion (OME). METHODS: The incidence of HI in adenoids was compared with the number of P6-specific immunoglobulin (Ig) A-secreting cells in adenoids, determined by enzyme-linked immunoassay. RESULTS: Quantitative culture assay showed significant correlation between the numbers of HI in adenoids and those in nasopharyngeal secretions (NS). In children aged 5 years and younger, the numbers of P6-specific IgA-secreting cells in adenoids were significantly correlated with IgA antibody titers in NS (r = 0.68, P < .05). The numbers of P6-specific IgG- and IgA-secreting cells were lower in children aged 6 years and older than in children aged 5 years and younger. Furthermore, the number of P6-specific IgA-secreting cells was significantly increased in HI-negative subjects when compared with HI-positive subjects (P < .05). CONCLUSIONS: Adenoids play an important role as an effector site of the mucosal immune system in the upper respiratory tract. IgA immune responses in adenoids are responsible for the clearance of HI from the nasopharynx.

Adenoids↗

PubMedDate not supplied

Differential diagnosis of adenoid cystic carcinoma from pleomorphic adenoma of the salivary gland on fine needle aspiration cytology.

OBJECTIVE: To evaluate the distinguishing morphologic features of pleomorphic adenoma and adenoid cystic carcinoma on fine needle aspiration cytology. STUDY DESIGN: A retrospective study was undertaken to compare the cytomorphology of 9 adenoid cystic carcinomas with that of 12 pleomorphic adenomas of the salivary gland among histologically proven cases. RESULTS: The most consistent finding for differentiating adenoid cystic carcinoma from pleomorphic adenoma in our study was the amount of cytoplasm of individual tumor cells. Plasmacytoid appearance is a reliable finding for pleomorphic adenoma, and it enables us to rule out adenoid cystic carcinoma. All 12 cases of pleomorphic adenoma showed tumor cells containing abundant cytoplasm in clusters and isolated cells, with plasma cell-like appearance in 9 cases, especially in isolated cells. In contrast with pleomorphic adenoma, most adenoid cystic carcinomas showed little cytoplasm. Hyaline spherical globules were found in four of nine adenoid cystic carcinomas but were not found in any case of pleomorphic adenoma. It was specific but not sensitive to adenoid cystic carcinoma. Fibrillary chondromyxoid ground substance and a mixture of epithelial cells with stroma were found in two-thirds of the pleomorphic adenomas in our cases. The pattern of cell clusters was helpful to differentiate pleomorphic adenoma from adenoid cystic carcinoma. Large, loose clusters with a spindle cell core suggested pleomorphic adenoma. Small, dense trabeculae with a smooth margin and dense clusters containing clear, round spaces were more suggestive of adenoid cystic carcinoma. Overall cellularity, proportion of isolated cells, orientation of cellular clusters and degree of cellular overlapping gave almost no help in making the distinction between the lesions. CONCLUSION: A plasmacytoid appearance of individual tumor cells with abundant cytoplasm was a reliable finding in pleomorphic adenoma for differentiating it from adenoid cystic carcinoma. Practically, nuclear features were not enough to distinguish the two lesions in isolated cases.

Adenoma, Pleomorphic↗

PubMed2000

Resistant bacteria in the adenoids: a preliminary report.

OBJECTIVE: To determine the incidence of resistant bacteria in adenoid cultures from children with and without middle ear disease and rhinosinusitis symptoms. DESIGN: Children meeting the requirement for tympanostomy tube placement underwent an adjuvant adenoidectomy for symptoms of adenoid hypertrophy or recurrent rhinosinusitis. Adenoid tissue and coexisting middle ear fluid, if present, were cultured. SETTING: Tertiary referral children's hospital with community-based satellite clinics. PATIENTS: Forty-six patients ranging in age from 1 to 11 years (68% <3 years) with recurrent or persistent otitis media and symptoms of adenoid hypertrophy or rhinosinusitis (study patients) underwent tympanostomy tube placement and adenoidectomy with culture of the adenoids and middle ear effusions. Eighteen patients with adenoid hypertrophy without ear disease or rhinosinusitis were used as controls. INTERVENTIONS: Tympanostomy tube placement and adenoidectomy. MAIN OUTCOME MEASURES: Presence or absence of resistant bacteria. RESULTS: Resistant bacteria were found in cultures of the adenoids in 56% (26/46) of the study group compared with 22% (4/18) of the control patients (P<.02). Also, strains of Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis were found in cultures from 78% (36/ 46) of the study group, compared with 44% (8/18) of those from the control group (P<.01). Resistant isolates were found in 65% (23/35) of the S. pneumoniae, 37% (18/49) of the H. influenzae, and 100% (19/19) of the M. catarrhalis cultures from the adenoids or middle ear spaces. CONCLUSION: Resistant bacteria are present in significant amounts in the adenoids of children with middle ear disease and rhinosinusitis symptoms compared with patients without those diseases or symptoms.

Adenoids↗

PubMed2003

Otitis media with effusion and histopathologic properties of adenoid tissue.

OBJECTIVE: Adenoidectomy is being generally used for the treatment of otitis media with effusion (OME). The purpose of current study was to determine objectively the significance of the histopathology of adenoid tissue on the development of otitis media with effusion. METHODS: The records of all the patients operated on with the diagnosis of adenoid enlargement with or without OME were reviewed and pathologic specimen were re-evaluated regarding histopathological properties by one pathologist unfamiliar with the diagnosis. Sixty-one patients with adenoid hyperplasia were enrolled in the study group, 38 males and 23 females. Age ranged between 3 and 13 years (mean age was 7.03+/-3.26 years). All the patients of study group were those operated on due to the adenoid hyperplasia and uni- or bilateral OME. Control group was composed of 39 male and 26 female patients (age range was between 3 and 13 years, and mean age was 7.06+/-3.04 years) with solely adenoid hyperplasia. RESULTS: The squamous metaplasia was present in 47 (77%) and 14 (22%) patients of study and control groups, respectively. The fibrosis of connective tissue interspersed follicles of adenoid was present in 29 (48%) and 6 (9%) patients of study and control groups, respectively. The statistical analysis revealed a significant prevalence of squamous metaplasia (P<0.001) and fibrosis of connective tissue interspersed follicles of adenoid (P<0.001) for a surgical indication of adenoid hyperplasia with OME than for without OME. The prevalence of other parameters was not significantly different between two groups. CONCLUSIONS: Adenoid tissue not only exerts an obstructive influence on the eustachian tube lumen when enlarged, but also impedes (hinders) mucociliary drainage of the middle ear by the way of non-ciliated metaplastic epithelium and fibrosis of connective tissue.

Adenoidectomy↗

PubMed1997

Adenoid bacteriology and sinonasal symptoms in children.

OBJECTIVE: To study the correlation between sinonasal symptoms in children and the prevalence of bacterial pathogens in the adenoid core. DESIGN: Prospective cross-sectional survey. SETTING: Tertiary referral center. PATIENTS: Consecutive sample of 84 children, aged 2 to 12 years, scheduled for adenoidectomy between July 1995 and November 1995. A blocked recruitment scheme was used to ensure a balanced distribution of sinonasal symptoms in the study sample. METHODS: A caregiver-completed quality-of-life survey was used to measure the frequency and severity of baseline sinonasal, ear, obstructive, and behavioral symptoms. Standard microbiologic techniques were used for qualitative and quantitative adenoid bacteriology. OUTCOME MEASURES: Pathogenic and nonpathogenic bacteria isolated, percentage of specimens with no growth, colony-forming units of pathogens per gram of adenoid tissue, dominant bacterial organism, and number of pathogenic species per adenoid with concentration greater than 10(5) colony-forming units. RESULTS: One or more bacterial pathogens were recovered from core samples of all adenoids, with a concentration greater than 10(5) colony-forming units in 31 specimens (26%). Haemophilus influenzae, group A beta-hemolytic streptococcus, and Staphylococcus aureus were encountered most often. Multivariate analysis revealed a significant correlation of sinonasal infection symptom scores with colony-forming units of adenoid core pathogens (R2 = 0.48, p < 0.0001), adjusted for the confounding effects of nasal obstructive symptoms and adenoid size (specimen weight). CONCLUSIONS: Sinonasal infectious symptoms explain 48% of the variability in quantitative bacteriology of the adenoid core, independent of adenoid size. Although longitudinal studies are required, our results support a potential role for adenoidectomy in the management of refractory pediatric sinusitis.

Adenoidectomy↗

PubMed1995

Adenoids in school-aged children.

A total of 687 school children, aged six to 15 years, were examined clinically, radiologically and audiometrically. Lateral radiological examination of paranasal sinuses was carried out in 663 (96.5 per cent) children for evaluation of the size of adenoids. The size of the soft tissue shadow (adenoids) was assessed as normal or large. It was large in 133 (25 per cent) children, three times more frequently in seven-year-old than in 14-year-old children. The occurrence of adenoidal symptoms (blocked nose, mouth breathing, snoring, snuffling or rhinitis) varied from 14.3 to 30.1 per cent in children with large adenoids compared to 7 to 9.8 per cent in children with normal adenoids. Logistic regression analysis revealed that only recurrent snoring and the child's age were significantly associated with radiologically large adenoids. The hearing thresholds were 1.1 to 4.2 dB poorer and mean middle ear pressure values were 60 to 70 mmH2O lower in children with large adenoids compared to those with normal size adenoids. Large adenoids have an influence on the hearing level of a child, but probably via the negative middle ear pressure.

Acoustic Impedance Tests↗

PubMed2003

The role of nuclear factor-kappa B in interleukin-8 expression by human adenoidal fibroblasts.

OBJECTIVES/HYPOTHESIS: The production of cytokines by adenoids is known to be associated with inflammation of nasopharynx and the pathogenesis of otitis media with effusion. However, the role of adenoids in producing inflammatory cytokines such as interleukin-8 (IL-8) is not yet clear. In the present study, expression of IL-8 in adenoidal fibroblasts was investigated at the level of transcription factors. Further, the effects of clarithromycin, a 14-member ring macrolide, on IL-8 gene expression and nuclear factor-kappa B (NF-kappa B) activation in adenoidal fibroblasts were evaluated. STUDY DESIGN: In vitro study for the production of inflammatory cytokine from human adenoidal fibroblasts. METHODS: Adenoidal fibroblasts were incubated with nontypeable Haemophilus influenzae endotoxin or interleukin-1 beta. Then the expression of IL-8 and the influence of NF-kappa B inhibitor and clarithromycin were evaluated. Interleukin-8 protein production was assessed by ELISA, and IL-8 messenger RNA production was measured by Northern blot analysis and reverse transcriptase-polymerase chain reaction. Activation of NF-kappa B and inhibition of its activation were determined by electrophoretic mobility shift assay. RESULTS: The expression of both IL-8 protein and messenger RNA in adenoidal fibroblasts was enhanced by Haemophilus influenzae endotoxin and interleukin-1 beta and was positively correlated with increases in NF-kappa B activity. Treatment of cells with the NF-kappa B inhibitor N-tosyl-(L)-phenylalanine chloromethyl ketone, as well as with clarithromycin, reduced expression of IL-8 and NF-kappa B activity in a dose-dependent manner. CONCLUSIONS: Results suggest that adenoidal fibroblasts produce IL-8 in response to endotoxin through NF-kappa B activation. The inhibitory effects of clarithromycin on NF-kappa B activation and IL-8 production in adenoidal fibroblasts might explain, in part, the mechanism of this drug in improving otitis media with effusion.

Adenoids↗

PubMed2003

Dedifferentiated adenoid cystic carcinoma: a clinicopathologic study of 6 cases.

Dedifferentiated adenoid cystic carcinomas are a recently defined, rare variant of adenoid cystic carcinomas characterized histologically by two components: conventional low-grade adenoid cystic carcinoma and high-grade "dedifferentiated" carcinoma. We examined six cases and analyzed their clinicopathologic profiles, including immunohistochemical features and p53 gene alterations. The 6 patients (3 men and 3 women) had a mean age of 46.8 years (range, 34-70 y). The mean size of the tumors was 3.5 cm (range, 1.7-6 cm). The submandibular gland, maxillary sinus, and nasal cavity were involved in 2 cases each. Postoperatively, 5 patients had local recurrence and 5 developed metastatic disease. Five patients died of disease at a mean of 33.7 months after diagnosis (range, 6-69 mo), and one other was alive with disease at 60 months. Histologically, the conventional low-grade adenoid cystic carcinoma component of the tumors consisted of a mixture of cribriform and tubular patterns with scant solid areas. The high-grade dedifferentiated carcinoma component was either a poorly differentiated adenocarcinoma (4 cases) or undifferentiated carcinoma (2 cases). Three tumors were studied immunohistochemically. Myoepithelial markers were expressed in low-grade adenoid cystic carcinoma but not in the dedifferentiated component. In 2 cases, diffusely positive p53 immunoreactivity together with HER-2/neu overexpression was restricted to the dedifferentiated component. Loss of pRb expression was demonstrated only in the dedifferentiated component of the 1 other case. The Ki-67-labeling index was higher in the dedifferentiated component than in the low-grade adenoid cystic carcinoma component. Furthermore, molecular analysis of 2 cases demonstrated the loss of heterozygosity at p53 microsatellite loci, accompanied by p53 gene point mutation, only in the dedifferentiated carcinoma component of 1 case, which was positive for p53 immunostaining. These results indicate that dedifferentiated adenoid cystic carcinoma is a highly aggressive tumor. Because of frequent recurrence and metastasis, the clinical course is short, similar to that of adenoid cystic carcinomas with a predominant solid growth pattern. Limited evidence suggests that p53 abnormalities in combination with HER-2/neu overexpression or loss of pRb expression may have a role in dedifferentiation of adenoid cystic carcinoma.

Adult↗

PubMed1992

Anatomic correlates of normal and diseased adenoids in children.

In order to better understand the pathogenesis and sequelae of obstructive adenoid hyperplasia in children, the anatomic relationships of the adenoids to the hard and soft palates, oropharynx, and nasopharynx were studied in vivo in 94 children. Direct, intraoperative palatal, nasopharyngeal, and oropharyngeal measurements were performed in 19 children with normal, nondiseased adenoids (controls [C]) and compared to 75 children undergoing adenoidectomy for obstructive adenoid hyperplasia (OAH) (n = 44) or chronic adenoid infection (CAI) (n = 31). As expected, the weight and volume of the adenoids removed were significantly greater in the OAH vs. CAI group (P < .001). Before adenoidectomy, the volume of the nasopharynx was significantly smaller in the OAH group; however, nasopharyngeal volumes after adenoidectomy were quite similar in all three groups and ranged from 5.4 to 6.2 cc. Only the change in the volume of the nasopharynx after adenoidectomy for obstruction was significant (2.5 +/- 1.2 cc, P < .01). Differences in oropharyngeal and palatal dimensions were not associated with longstanding obstruction from adenoid hyperplasia. These data indicate that the nasal obstruction from adenoid hyperplasia is due to an absolute increase in adenoid size rather than a relatively smaller nasopharynx. Differences in palatal and oropharyngeal dimensions usually described and attributed to longstanding nasal obstruction could not be demonstrated in this study.

Adenoidectomy↗

PubMed2002

Correlation on cine MR imaging of size of adenoid and palatine tonsils with degree of upper airway motion in asymptomatic sedated children.

OBJECTIVE: The objective of this study was to use MR fluoroscopy to evaluate variations in size of the adenoid and palatine tonsils and the relationship between tonsil enlargement and airway motion dynamics in asymptomatic children during sleep. SUBJECTS AND METHODS: We performed sagittal midline cine MR imaging (fast gradient-echo series: TR/TE, 8.2/3.6 sec; flip angle, 80 degrees; slice thickness, 8 mm; 128 consecutive images; imaging time, 2 min; displayed in cine mode) in children referred for MR imaging of the brain who required sedation. The largest transverse diameter of the adenoids was recorded. A subjective impression was made as to whether the adenoids were enlarged or normal in size. Palatine tonsils were considered enlarged when a soft-tissue mass was identified on the midline cine images, and maximum diameter was recorded. Enlarged and nonenlarged adenoid and palatine tonsil groups were compared using motion parameters (chi-square or Fisher's exact test): mouth position (opened or closed); vertical motion (present, absent); nasopharyngeal, oropharyngeal, and hypopharyngeal motion (static patent, dynamic patent, intermittent collapsed, or static collapsed, and greatest change in size). RESULTS: We studied 148 subjects who had a mean age of 3.4 years. The adenoid tonsils were considered enlarged in 64 patients (43%), and the palatine tonsils were considered enlarged in 29 patients (20%). The mean size of the enlarged adenoid tonsils was 11.6 mm and of the nonenlarged adenoid tonsils was 6.2 mm. Enlarged adenoids correlated with the open mouth position (p = 0.0242) and increased dynamic motion of the oropharynx (p = 0.0413). A trend was also seen for increased dynamic motion of the nasopharynx (p = 0.0723). Enlarged palatine tonsils correlated with an increased frequency of dynamic motion of the oropharynx (p = 0.0006) and the nasopharynx (p = 0.0033) and a trend for increased frequency of the open mouth position (p = 0.0692). CONCLUSION: Large adenoid and palatine tonsil size affects breathing dynamics of the upper airway even in asymptomatic children.

Adenoids↗

PubMed2004

Acoustic rhinometry in the assessment of adenoid hypertrophy in allergic children.

BACKGROUND: Due to the difficulties involved in assessing adenoidal tissue and the nasopharyngeal airway in children, it is necessary to find an accurate pre-operative method of measuring these structures. MATERIAL/METHODS: We used acoustic rhinometry and endoscopy both to the evaluate results of surgical and medical treatment in allergic children with adenoid hypertrophy and to evaluate the influence of pollination on adenoid size in children with seasonal allergic rhinitis. Three separate groups of children were examined. The first group consisted of nine children with adenoid hypertrophy and positive skin-prick test results of year-round allergens. In this group we examined the influence of adenoidectomy on the rhinometric curve. The second group consisted of sixteen children with adenoid hypertrophy and perennial allergic rhinitis. In this group we examined the influence of medical treatment (topical nasal steroid and antihistaminic) on the adenoid size and rhinometric curve. The third group consisted of twelve birch pollen-sensitive children who had symptoms of seasonal allergic rhinitis. In this group we examined the influence of pollination on the nasopharyngeal period of rhinometric curve. RESULTS: In the two first groups we observed a significant increase of the nasopharyngeal cavity after surgical removal of the adenoids and medical treatment of the allergy. In the third group most of the children experienced a significant decrease in nasopharyngeal cavity volume during pollination. CONCLUSIONS: Acoustic rhinometry seems to be a very promising method of assessment of the amount of adenoid, and allergy can play an important role in adenoid hypertrophy in hypersensitive children.

Adenoidectomy↗

PubMed2006

[The influence of medical treatment of the perennial allergic rhinitis on the adenoid size in children].

BACKGROUND: Allergic sensitization of the airways occurs not only in the mucosa of the shock organ, but also in the lymphatic stations draining these structures. The lymphatic structure closest to the nasal mucosa in humans is the adenoid. Many researches show that in part of children allergic rhinitis can be a risk factor for adenoid hypertrophy. MATERIAL AND METHODS: We examined changes in clinical symptoms score, and used acoustic rhinometry and endoscopy to evaluate the influence of three months anti-allergic treatment (topical nasal steroid and antihistaminic) on the adenoid size in children with adenoid hypertrophy. Three separate groups of children were examined. The study group consisted of 31 children with adenoid hypertrophy and perennial allergic rhinitis (interview, positive skin-prick test results, presence of sIgE in the serum and positive nasal provocation test with dust allergens). The first control group consisted of 23 atopic children hypersensitive to dust allergens (positive skin-prick test results, presence of sIgE in the serum) with adenoid hypertrophy but without signs of perennial allergic rhinitis and with negative nasal provocation test. This group was not treated. The second control group consisted of 20 non-allergic children with adenoid hypertrophy. The children were treated similar to the children from the study group. RESULTS: In children from the study group we observed the most significant decrease of clinical symptoms and endoscopic adenoid size and increase of nasopharyngeal cavity in acoustics rhinometry after the treatment. In the first control group there were almost no changes and in the second control group, the improvement concern only 25% of children. The medical treatment had however no statistical important influence on the tympanometry results in all the examined groups. CONCLUSION: Properly administered nasal glucocorticoid spray together with antihistaminic in standard doses can significantly reduce adenoidal hypertrophy and considerably eliminate airway obstructive symptoms in children with allergic rhinitis. Likely only in this children the antiallergic treatment can be a useful alternative to surgery.

Adenoids↗

PubMed1996

Secretory IgA and squamous epithelization in adenoids of children with otitis media with effusion.

Infection of adenoids has been considered a causative factor of otitis media with effusion (OME). We believe that the deterioration in the mucosal barrier of adenoids makes the adenoids vulnerable to bacterial infections, resulting OME. In this study, we evaluated secretory IgA, secretory component (SC) and reticular and squamous changes of ciliated epithelium in adenoids. Fourteen children with OME (OME(+)) and 6 children without any history of OME (OME(+)) were enrolled in the study. Immunohistological study on the adenoids using anti-IgA and anti-SC revealed no significant difference between two groups in the number of IgA positive cells in the subepithelial layer. However, the proportion of the secretory component-positive area in the epithelium was significantly lower in the OME(+) group (11.4 +/- 13.0%) than in the OME(+) group (20.7 +/- 9.6%) (Mann Whitney U test, p <0.05). Histological study using hematoxylin and eosin staining revealed that the area of squamous epithelization was bigger in the OME(+) group (32%) than in the OME(+) group (16%) (p <0.05). The number of ciliated cells was decreased in the OME(+) group (13%) compared with the OME(+) group (31%). The epithelium was thicker in the OME(+) group (101 mu m) than in the OME(+) than in the OME(+) group (79 mu mm) (p <0.05). These results suggest that the production of the secretory component is lower in the epithelium of adenoids in children with OME. Hyperplasia, squamous epithelization and decreased number of ciliated cells may also hamper mucosal clearance of the adenoids of children with OME. These findings suggest that the adenoids of children with OME are more susceptible to infections than adenoids of children without OME.

Adenoids↗