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PubMed2005

Is Helicobacter pylori really present in the adenoids of children?

Adenoid hyperplasia is a common cause of nasal obstruction in the pediatric age group. Recently, the adenoids were shown to harbor Helicobacter pylori (HP) based only on the rapid urease test (RUT). We conducted this pilot study to identify the presence of HP in the adenoids histologically and assess the reliability of both the RUT and histology in detecting HP in an extragastric location, using nested (two-steps) polymerase chain reaction (nPCR). Consecutive patients undergoing adenoidectomy for obstructive adenoid hyperplasia were enrolled. Adenoid specimens were subjected to the RUT. Histological sections stained with hematoxylin and eosin, Giemsa and Warthin-Starry were examined. We then used nPCR to detect the presence of HP in the studied specimens. Twenty-five patients (3-10 years; mean of 5.5 years) were enrolled. Twenty-one (84%) adenoids were positive by the RUT. Seventeen (68%) had bacteria on histological sections; four (16%) contained HP-like organisms. However, all specimens were negative by nPCR. No patient had a history of symptoms suggestive of laryngopharyngeal reflux within 6 months of the study. In conclusion, the children enrolled in this study did not have HP in their adenoids. High false positive results can occur with the RUT when used on adenoid tissues. It is not possible to rely solely on morphology to detect HP in an extragastric location. The nPCR remains the best way to identify HP accurately, but does not imply its presence in an active role.

Adenoidectomy↗
PubMed2001

Lymphocyte subpopulations in hypertrophied adenoid in children.

Adenoid hypertophy is a common feature of childhood. It is currently accepted that it is caused by the antigen-stimulated increased activity of lymphocyte B (D. Bani, O. Gallo, O. Fini-Storchi, Intraepithelial lymphocyte subpopulations and dendritic accessory cells in normal and hypertrophic adenoids, Laryngoscope 10 (1994) 869-873). The adenoid decreases its size with age but the accompanying function alterations are not fully understood (L. Zawadzka-Glos, M. Chmielik, M. Wasik, Cell mediated response in hypertrophied tonsils in children, Nowa Pediatr. 4 (1997) 12-13). The understanding of the adenoid structure that undergoes some changes during the growth period is essential for evaluation of indications for adnoidectomy and assessment of its potential results. The aim of this study was to evaluate lymphocyte subpopulations in adenoid according to age. The analysed material was adenoids removed on the grounds of hypertrophy, which caused obstructive symptoms and/or otitis media with effusion onset. In the present study, we did not find any statistically significant differences among lymphocytes B, Th, and Ts subpopulations, respectively, in the adenoids of any of the age groups. We have found a statistically significant CD3(+) HLA-DR(+) cell percentage decrease in the group of children from 5 to 10 and above 10 years of age, respectively. We have also found a statistically significant increase in the percentage of NK (CD3(-) CD16(+) 56(+)) lymphocytes in relation to age. On the grounds of the current study, it may be stated that some changes in lymphocyte subpopulations in the adenoid take place with age.

Adenoids↗
PubMed1998

Laterally hypertrophic adenoids as a contributing factor in otitis media.

Adenoidectomy has been demonstrated in randomized controlled studies to be effective in the prevention of otitis media with effusion (OME). Despite an apparent lack of correlation between adenoid size and outcome, it has been suggested that the role of adenoid tissue in the pathophysiology of OME relates either to obstruction of the Eustachian tube (ET) with impairment of its function, or to adenoid tissue serving as a reservoir of infection. The aim of this study was to further delineate the relationship between adenoid hypertrophy and OME. This prospective survey was performed in an ambulatory care setting of a tertiary care pediatric hospital, where data was collected on 273 consecutive adenoidectomy patients. At the time of surgery, adenoid position in relation to the ET orifice was recorded as well as concurrent procedures performed (e.g. pressure equalization tubes; PET). Sixty percent of patients undergoing simultaneous PET insertion were found to have laterally hypertrophic adenoid tissue encroaching upon the ET orifice versus only 22% for those undergoing adenoidectomy alone. Thus, a strong correlation was found to exist between OME, requiring the placement of PET and lateral adenoids abutting the torus tubarius (chi2 = 39.12; P < 0.001). The clinical relevance of this finding is that it may allow the prediction of children with OME, who will benefit most from undergoing adenoidectomy. Patients with OME requiring PET insertion, who are found to have lateral adenoid hypertrophy encroaching upon the ET orifice, could be selected for adenoidectomy, thus allowing a more judicious application of this surgical procedure in the setting of OME.

Adenoidectomy↗
PubMed2006

Immunophenotypic overlap between adenoid cystic carcinoma and collagenous spherulosis of the breast: potential diagnostic pitfalls using myoepithelial markers.

Adenoid cystic carcinoma of the breast is a rare neoplasm whose cribriform architecture may mimic invasive cribriform carcinoma, cribriform ductal carcinoma in situ, and collagenous spherulosis. The diagnosis may be even more challenging in needle core biopsies. Immunohistochemical expression of p63 and c-kit distinguishes adenoid cystic carcinoma from invasive cribriform carcinoma and ductal carcinoma in situ. A formal comparison of the immunophenotype of adenoid cystic carcinoma to collagenous spherulosis has not been reported. Of concern is the overlap in myoepithelial markers between these two entities. Both may express S100, smooth muscle actin, and p63. This overlap may cause diagnostic confusion yet is under-emphasized in the literature. The expression profile of newer myoepithelial markers has not been studied in this setting. We evaluated smooth muscle actin, p63, calponin, smooth muscle myosin heavy chain, as well as c-kit, in nine cases of cribriform pattern adenoid cystic carcinoma of the breast in comparison to 12 cases of collagenous spherulosis. Both entities strongly expressed p63 and smooth muscle actin; in adenoid cystic carcinoma, the basaloid myoepithelial-like tumor cells expressed these markers, but the ductular epithelial cells did not. Neither calponin nor smooth muscle myosin heavy chain was expressed in adenoid cystic carcinoma but both were strongly expressed in collagenous spherulosis. Whereas the ductular epithelial cells of adenoid cystic carcinoma were positive for c-kit in all cases, collagenous spherulosis was negative for c-kit. Positive p63 expression by a cribriform breast lesion is not sufficiently specific to confirm a diagnosis of adenoid cystic carcinoma. A broader panel that includes calponin or smooth muscle myosin heavy chain and c-kit is required to exclude collagenous spherulosis in settings in which the distinctive morphologic features that separate these entities are not conspicuously present. Reliance on p63 or smooth muscle actin alone poses a potential diagnostic pitfall in evaluating cribriform breast lesions.

Actins↗
PubMed1999

Cellular immune response of adenoidal and tonsillar lymphocytes to the P6 outer membrane protein of non-typeable Haemophilus influenzae and its relation to otitis media.

Cellular immune responses to the P6 outer membrane protein of non-typeable Haemophilus influenzae (NTHi) were determined in vitro by measuring immunoglobulin (Ig) secreting cells and lymphocyte proliferation in adenoidal and tonsillar lymphocytes from 19 children. Preliminary tests showed that P6 did not stimulate naive cells such as cord blood lymphocytes, but did stimulate sensitized cells in adenoids and tonsils. Cellular proliferation was significantly higher in adenoidal lymphocytes than in tonsillar lymphocytes (median: quadratile of stimulation index = 3.7:2.3-5.5 vs. 1.2:1.0-2.1, p < 0.02). A comparison between children with or without otitis media revealed that proliferative responses to P6 of adenoidal lymphocytes from children with otitis media were significantly decreased (2.0:1.8-3.6 vs. 3.7:2.3-5.5, p < 0.04). P6-specific antibody secreting cells were identified in a total of 14 adenoids and the number of cells secreting IgA was decreased in the otitis media group compared to controls (median: quadratile/10(6) cells = 435:359-499 vs. 755:593-1870, p < 0.05). Cultivation with P6 stimulated IgA secretion in children without otitis media, while no response was seen in children with otitis media (median: quadratile/10(6) cells = 1323:915-2410 vs. 2240:1900-2830, p < 0.02). These preliminary data demonstrate that lymphocytes from adenoids and tonsils recognize P6 as a specific antigen and that the adenoid is the more reactive of the two organs. Impaired P6-specific cellular immune responses of adenoids in children with otitis media may explain the recurrent nature of otitis media due to NTHi in the otitis prone population.

Acute Disease↗
PubMed2001

Bacteriology of adenoids and tonsils in children with recurrent adenotonsillitis.

Adenoids and tonsils electively removed from 25 children with a history of recurrent group A beta-hemolytic streptococci (GABHS) adenotonsillitis were cultured for aerobic and anaerobic bacteria. Two hundred twenty-four organisms (112 aerobes and facultatives, 110 anaerobes, and 2 Candida albicans) were isolated from the tonsils, and 229 (111 aerobes and facultatives and 118 anaerobes) were isolated from the adenoids. Mixed infection was present in all instances, with an average of 9.1 isolates per specimen. The predominant aerobes were Streptococcus sp, Haemophilus influenzae, and GABHS, and the prevalent anaerobes were Peptostreptococcus, Prevotella, and Fusobacterium spp. Beta-lactamase-producing bacteria were detected in 72 isolates recovered from 22 tonsils (88%) and in 74 isolates recovered from 21 adenoids (84%). Discrepancies in the organisms recovered were found between the tonsils and adenoids. Of the aerobic isolates, 20% were isolated only in tonsils and 18% only in adenoids. Of the anaerobes, 20% were found only in tonsils and 26% only in adenoids. This study demonstrates a polymicrobial aerobic-anaerobic flora in both adenoids and tonsils, and discrepancies in recovery of pathogens such as GABHS. The adenoids may serve as a potential source of tonsillitis caused by GABHS.

Adenoids↗
PubMed2006

[Effect of volume reduction surgery by radiofrequency for enlarged adenoid causing recurrent otitis media with effusion].

PURPOSE: We studied the effect of volume reduction surgery by a radiofrequency (ENTec coblator) for enlarged adenoid causing recurrent otitis media with effusion. MATERIALS AND METHODS: The effect of volume reduction surgery by radiofrequency for enlarged adenoid was studied in 50 children with enlarged adenoid causing recurrent otitis media with effusion from June 2002 to September 2004, while a group of 50 children with tympanostomy-tube placement alone from April 2001 to September 2004, was used as the control group. Volume reduction surgery by radiofrequency system for enlarged adenoid was done with tympanostomy-tube placement under general anesthesia by laryngeal mask. We compared two groups in following 5 different aspects: (1) tympanostomy-tube replacement, (2) remyringotomy, (3) total visits to our clinic after surgery, (4) total days with antibiotics, (5) absence of effusion and normal middle ear function as seen on the tympanogram after tympanostomy-tubes loss. We evaluated the reduction of enlarged adenoid by using the pre-and postoperative obstructive rate of the choana through the nasopharyngoscope. RESULTS: The volume of enlarged adenoid was reduced an average of 52.2% by radiofrequency. The pharyngeal opening of the eustachian tube and the choana could be opened widely. No severe intra or postoperative complications occurred. Compared to the control group treated with tympanostomy tubes alone, postoperative tympanostomy-tube replacement, postoperative remyringotomy, total postoperative visits to our clinic, total postoperative days with antibiotics, and tympanogram types C2 and B after tympanostomy-tubes loss decreased notably in cases with volume reduction surgery by radiofrequency for enlarged adenoid and tympanostomy-tube placement. CONCLUSION: Volume reduction surgery by radiofrequency for enlarged adenoid is considered very safe, effective one-day surgery technique for recurrent otitis media with effusion.

Adenoidectomy↗
PubMed2001

[Lymphocyte subpopulations in the adenoids analyzed by flow cytometry].

Adenoid hypertrophy is a common problem of childhood. The peak occurrence of adenoid hypertrophy correlates with the onset of serous otitis media. The aim of the study was to evaluate the lymphocyte subpopulations in the adenoids of children with serous otitis media. The adenoids obtained from 65 children at the age of 1 to 17 years were examined. Two groups were studied: 1) children with persistent effusion in the middle ear, 2) children with adenoid hypertrophy without a history of otitis media. The percentage of the lymphocytes B in the adenoids was similar in both groups. However, the percentage of lymphocytes T (p < 0.04), and CD4+ (p < 0.005) was significantly lower in adenoids of children with serous otitis media. The percentage of lymphocytes T HLA-DR+ was slightly higher in this group, but the percentage of lymphocytes T CD25+ was the same in both groups. The quantitative differences in the lymphocyte subpopulations of adenoids may be the predisposing factor in serous otitis media.

Adenoids↗
PubMed1995

Pediatric adenoidal hypertrophy and nasal airway obstruction: reduction with aqueous nasal beclomethasone.

OBJECTIVE: Pediatric adenoidal obstruction of the nasal airway is associated with significant morbidity and is a frequent indication for surgery. Because efficacious medical alternatives to adenoidectomy are lacking, we assessed the potency of standard-dose topical nasal beclomethasone in reduction of adenoidal obstruction of the nasal airway. METHODS: Seventeen children, 5 to 11 years of age, exhibiting chronic obstructive nasal symptoms and a group mean (+/- SE) adenoid/choana ratio of 91 +/- 1% on rhinoscopic examination, completed an 8-week, double-blind, placebo-controlled crossover study of standard-dose aqueous nasal beclomethasone (total 336 micrograms/day) in the treatment of adenoidal hypertrophy. In a 16-week, open-label, follow-on study, subjects received beclomethasone 1 spray in each nostril twice daily (168 micrograms/day). RESULTS: Over the initial 4 weeks, improvements in the mean adenoidal obstruction of the choanae were significantly greater in the group receiving beclomethasone than in the group receiving placebo (right, -14.0% vs. +0.4%, P = .0002) (left, -15.0% vs. -2.0%, P = .0006). In the subsequent crossover 4 weeks, a significant beclomethasone carryover effect resulted in further adenoid size reduction in both treatment groups. All patients demonstrated a decrease in adenoid size with beclomethasone treatment, compared with a mixed response to placebo. Over the full 8-week crossover study, the mean (+/- SE) obstructive symptom score after beclomethasone treatment (20.5 +/- 3.0) was significantly improved compared to patients' initial (43.1 +/- 2.9) and placebo scores (31.1 +/- 4.2, P < or = .05), despite the active drug carryover effect into the placebo treatment period. Significant improvements in adenoidal obstruction and symptom scores over the 8-week crossover study were enhanced in the subsequent 16-week open-label period (P = .0001). By 24 weeks, an 82% reduction in group mean nasal obstruction symptom score accompanied a 29% mean reduction in adenoid/choana ratio. No clinical or demographic characteristic predicted a patient's degree of response to treatment. CONCLUSIONS: Properly administered aqueous nasal beclomethasone in standard doses can significantly reduce adenoidal hypertrophy and nasal airway obstructive symptoms in children.

Adenoids↗
PubMed1996

The role of adenoids in nasopharyngeal colonization with nontypeable Haemophilus influenzae.

Nasopharyngeal colonization with nontypeable Haemophilus influenzae (NTHi) and immune responses in the adenoid were studied in 18 patients with otitis media with effusion (OME) who underwent adenoidectomy. NTHi in excised adenoid tissue and in nasopharyngeal secretions was examined by quantitative culture assay. NTHi was detected in 13 adenoid samples and 12 nasopharyngeal secretions. In 11 cases, NTHi was cultured from both samples of nasopharyngeal secretion and adenoids, and the concentration of NTRi in nasopharyngeal secretions was significantly correlated with that in adenoids. A significant negative correlation was observed between anti-NTHi IgA antibody titers and the number of NTHi in nasopharyngeal secretions. The number of NTRi in nasopharyngeal secretions and adenoids was decreased in the cases having a large number of NTHi-specific IgA and IgG antibody-producing cells in their adenoids. The results suggest that mucosal immunity in the nasopharynx is responsible for reducing the colonization of NTHi, and that the adenoid plays an important role in regulating the immune responses.

Adenoids↗
PubMed2001

Validation of an outcomes instrument for tonsil and adenoid disease.

OBJECTIVE: To design and validate a disease-specific health status instrument-the Tonsil and Adenoid Health Status Instrument-for use in children with tonsil and adenoid disease. DESIGN: Prospective psychometric and clinimetric instrument validation in 3 stages. SETTINGS: A tertiary academic pediatric specialty hospital and a tertiary academic hospital, in 2 different cities. PATIENTS/OTHER PARTICIPANTS: Children with tonsil and adenoid disease presenting for evaluation and treatment (n = 224). INTERVENTION/METHOD: Prospective instrument validation. Stage 1 consisted of initial item testing, reduction, and subscale construction; stage 2, reliability and validity testing, factor analysis, and final item reduction; and stage 3, responsiveness analysis. MAIN OUTCOME MEASURES: Test-retest and internal consistency reliability; content, construct, and criterion validity; orthogonal principal components factor analysis; and response sensitivity analysis. RESULTS: Factor analysis and item analysis confirmed 6 distinct subscales measuring different constructs (aspects) of disease-specific health status that are affected by tonsil and adenoid disease: eating and swallowing, airway and breathing, infections, health care utilization, cost of care, and behavior. For each subscale, the Tonsil and Adenoid Health Status Instrument demonstrated excellent test-retest reliability (r = 0.72-0.88) and internal consistency reliability (Cronbach alpha = .73-.87). Content validity was ensured during the design process. Construct validity was demonstrated by means of convergent and divergent validity with a global quality-of-life instrument (the Child Health Questionnaire, version PF28). Criterion validity was also satisfactory. Finally, the instrument was appropriately sensitive, with high standardized response means and effect sizes. CONCLUSIONS: The Tonsil and Adenoid Health Status Instrument is a valid, reliable, and sensitive instrument with 6 distinct subscales. This instrument has significant utility for outcomes research in children with tonsil and adenoid disease.

Adenoids↗
PubMed1980

Subpopulation of adenoidal lymphocytes of recurrent infection in the upper respiratory tract.

A subpopulation of adenoidal lymphocytes was determined by the E- and EAC-rosetting techniques in order to study an immunological profile of adenoids in 61 children with recurrent otitis media, rhinosinusitis or recurrent tonsillitis. Though there was no significant difference in E- and EAC-rosette forming cells of adenoid tissues from children with recurrent infection in the upper respiratory tract, our results indicated the following. (1) A higher proportion of EAC-rosette forming cells (EAC-RFC) without a change of E-RFC was found in the adenoids of children with recurrent tonsillitis than those without it. (2) The percentage of EAC-RFC appears to increase proportionally to the size of adenoid viewed on the X-ray film. (3) The higher percentage was more remarkable in cases with rhinosinusitis and recurrent otitis media. From the data obtained it is concluded that adenoids may play some part in immunity responses against infection in the upper respiratory tract reflecting adenoidal hypertrophy.

Adenoids↗
PubMed1992

Distribution characteristics of immunoglobulin-secreting cells in adenoids. Relationship to age and disease.

Forty-four adenoids and 52 palatine tonsils from 71 children and adolescents (age 3-21 years) undergoing surgery because of adenoidal hypertrophy or recurrent tonsillitis were examined for the presence of immunoglobulin-secreting cells (ISC) employing an enzyme-linked immunospot assay (ELISPOT). ISC constituted less than 2% of the mononuclear cell population. Adenoids contained IgG, IgA, and IgM ISC in significantly lower numbers than palatine tonsils. The predominant isotype of the ISC was IgG, in adenoids accounting for 62% of the ISC and in palatine tonsils for 73%. The relative numbers for IgA and IgM ISC were similar. A significant correlation existed between autologous adenoids and palatine tonsils for the numbers of IgA and IgM ISC, but not for the numbers of IgG cells. These observations suggest that, adenoid and palatine tonsils display similar immunoglobulin distribution patterns within a single individual. However, individuals with hypertrophied adenoids exhibited a numeric decrease in IgG ISC with increasing age (P less than 0.01). Both lymphoid tissues may be involved in mucosal immune defense.

Adenoids↗
PubMedDate not supplied

Adenoids and otitis media with effusion: nasopharyngeal flora.

In order to clarify the role of the microflora of the nasopharynx and adenoids as causative factors of otitis media with effusion (OME), bacteriologic species in middle ear effusions (MEEs), nasopharyngeal smears, and adenoid tissues of children with OME were cultured. The change in the microflora of the nasopharynx after adenoidectomy, and the degree of bacterial agreement between the microflora of the nasopharynx and adenoid tissue were investigated. Nasopharyngeal bacterial flora were investigated in 259 children with OME from November 1984 to November 1987. The patients were divided into two groups: group A (43 patients) underwent adenoidectomy, and group B (216 patients) had no adenoidectomy. Hemophilus influenzae, Streptococcus pneumoniae, Branhamella catarrhalis, and Staphylococcus aureus were cultured in 66.7% of nasopharyngeal smears from group B, and in 46.5% from group A. Adenoid specimens for bacteriologic investigation were obtained from 38 adenoidectomy patients at surgery. Of these, H influenzae were cultured from adenoid specimens taken from 16 of the 26 patients with OME (group C), while only three of the 12 adenoidectomy patients without OME (group D) were found to have H influenzae in their adenoid specimens. The findings of this study suggest that adenoid vegetation plays an important role in the etiology of OME.

Adenoidectomy↗
PubMed2006

Assessment of lateral cephalometric diagnosis of adenoid hypertrophy and posterior upper airway obstruction: a systematic review.

INTRODUCTION: Our objective was to evaluate the capability of lateral cephalograms in diagnosing hypertrophied adenoids and obstructed posterior nasopharyngeal airways. METHODS: A systematic review of the literature by using several electronic databases (Cochrane Library, Medline, Medline in progress, PubMed, Web of Science, Embase, and Lilacs) was performed with the help of a senior health-sciences librarian. The electronic search was followed up with hand searches. After applying our inclusion-exclusion criteria, the search yielded 11 articles that were then scored based on their methodological validity. RESULTS: Lateral cephalograms performed reasonably well in evaluating adenoid size; both quantitative measures of adenoid area and subjective grading of adenoid size on lateral cephalograms had reasonable correlations to actual adenoid size (range of r, 0.60 to 0.88). However, evidence suggested that cephalograms were less ideal for evaluating the size of the posterior nasopharyngeal airway. The diagnostic difference is likely because the adenoid is a simpler 3-dimensional structure than the nasopharynx; therefore, it loses less information when compressed into 2 dimensions by the radiograph. CONCLUSIONS: Being used as a screening tool to determine the need for more rigorous ENT follow-up appears to be the greatest utility of lateral cephalograms. Because no consensus could be reached on what are the most useful landmarks, we recommend that clinicians look for multiple deviant measures of adenoid size rather than one definitive quantification.

Adenoids↗
PubMed2003

Adenoid tissue rhinopharyngeal obstruction grading based on fiberendoscopic findings: a novel approach to therapeutic management.

OBJECTIVE: A grading into four classes of hypertrophied adenoid rhinopharyngeal obstructions in children on the basis of fiberendoscopic findings to outline an effective therapeutic program according to this classification. METHODS: Ninety-eight children with chronic nasal obstruction and oral respiration were examined by anterior rhinoscopy, and fiberendoscopy. During the investigation, the fiberendoscopic images of the choanal openings were divided into four segments from the upper choanal border to the nasal floor. In view of clinical findings, 78 patients also underwent active anterior rhinomanometry. RESULTS: In eight patients (8.2%), the fiberendoscopic imaging revealed that the adenoid tissue occupied only the upper segment in the rhinopharyngeal cavity (< 25%). Therefore, choanal openings were free (first degree obstructions). In 20 patients (20.4%), the adenoid tissue was confined to the upper half (< 50%) of the rhinopharyngeal cavity (second degree obstructions) and in 63 patients (64.3%) the tissue extended over the rhinopharynx (< 75%) with obstruction of choanal openings and partial closure of tube ostium (third degree obstructions). Only in seven cases (7.14%), the obstruction was almost total. As a consequence, both the tube ostium and the lower choanal border could not be observed (fourth degree obstructions). CONCLUSIONS: In the first two classes of obstructions, characterized by moderate or discrete adenoid hypertrophy, adenoidectomy should not be performed. In these conditions, the causes of possible nasal obstructions are usually due to either dysmorphic, allergic or phlogistic pathologies. For the fourth degree adenoid obstructions, surgery is always recommended. The most important therapeutic problems occur in the third degree obstructions which include most patients who suffered from hypertrophied adenoids. Moreover, the therapeutic strategy can be conditioned not only by nasal respiratory difficulties but also by frequent concomitant complications such as otitis, sinusitis, sleep apnea, etc. These disorders may be caused by both nasal obstruction and/or phlogistic problems (adenoiditis).

Adenoidectomy↗
PubMed2004

Rhinovirus in adenoid tissue.

OBJECTIVE: Rhinovirus (RV) infection is the most common single cause of acute respiratory illness in children. The purpose of the study was to evaluate the prevalence of RV in adenoid tissue throughout the year. MATERIAL AND METHODS: Fifty-six samples of adenoid tissue removed either due to recurrent otitis media or adenoid hypertrophy were collected for in-situ hybridization (ISH) of RV. To confirm the specificity of the ISH probe, eight adenoid biopsies were investigated by reverse transcriptase-polymerase chain reaction (RT-PCR) as well. RESULTS: ISH was positive for RV RNA in 45% of the specimens. There was a statistically significant difference (P = 0.002) in the prevalence of RV positive adenoid biopsies from late fall to spring (65%) in comparison to late spring to early fall (20%). Children with middle ear effusion were more often ISH positive than those with dry ears, but the number of past ear infections, signs of chronic nasal obstruction or recent runny nose did not correlate to the finding in ISH. There was a good concordance between the results obtained by ISH and by RT-PCR. CONCLUSION: Both epithelial and/or germinal cells of adenoid tissue are frequently loaded with RV during the cold months of the year, also known to have a high incidence of RV infections among population. Children with otitis media with effusion are more likely to harbor RV in adenoid tissue than those with dry ears. Further studies are, however, needed to show whether the effusion is due to RV or whether this association exists by coincidence.

Adenoids↗
PubMed2005

The role of topical nasal steroids in the treatment of children with otitis media with effusion and/or adenoid hypertrophy.

OBJECTIVES: Topical steroid treatment can be a powerful alternative to surgery in controlling adenoid hypertrophy and otitis media with effusion (OME). METHODS: A prospective, controlled, randomized, clinical study in an academic tertiary care center. A total of 122 children (3-15-year-old) on the waiting list for an adenoidectomy and/or ventilation tube placement were enrolled into the study and control groups. The study group (67 patients with adenoid hypertrophy, 34 of them with otitis media with effusion) received intranasal mometasone furoate monohydrate 100 mcg/day, and the control group (55 patients with adenoid hypertrophy, 29 of them with otitis media with effusion) was followed up without any treatment. All patients were evaluated at 0 and 6 weeks. The assessment of each patient included history, a symptom questionnaire, a skin prick test, a tympanogram, if possible a pure tone audiogram, and otoscopic and endoscopic examinations. The size of adenoid tissue was graded as a percentage according to obliteration of the choanae. The adenoid/choana ratio (A/C) was recorded for each patient. Symptoms were scored as 0 (absent), 1 (intermittent/periodic), or 2 (continuous). The data were analyzed with the "Statistical Package for the Social Sciences" (SPSS 9.0) using the appropriate nonparametric tests for nominal and ordinal data. RESULTS: Resolution of otitis media with effusion in the study group (42.2%) was significantly higher than that in the control group (14.5%) (p<0.001). Forty-five patients (67.2%) with adenoid hypertrophy in the study group showed a significant decrease in adenoid size according to the endoscopic evaluation compared to the control group (p<0.001). A significant improvement in obstructive symptoms was seen in the study group (p<0.001). The endoscopically measured adenoid/choana ratio and degree of obstructive symptoms showed a significant correlation (r=0.838 p<0.001, r=0.879 p<0.001, r=0.838 p<0.001, r=0.879 p<0.001). The adenoid/choana ratio improved significantly in atopic patients in the study group (p<0.05), whereas in atopic patients in the control group there was no change (p=0.221). CONCLUSION: Nasal mometasone furoate monohydrate treatment can significantly reduce adenoid hypertrophy and eliminate obstructive symptoms. It is a useful alternative to surgery, at least in the short term, for otitis media with effusion.

Academic Medical Centers↗