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PubMed1998

Adenoidal and tonsillar lymphocyte subsets in AIDS children.

Tonsils and adenoids are secondary lymphoid organs exposed to the environment. The most important classifications of AIDS include the lymphocyte subsets of peripheral blood. We have studied the lymphocyte subsets in peripheral blood and secondary lymphoid organs in a control group of children suffering adenotonsillar pathology and in five children with AIDS and the same adenotonsillar pathology. The antigen surface markers were determined by flow cytometry in lymphocytes isolated from peripheral blood, and from tonsils and adenoids after tonsillectomy and adenoidectomy, in the control group and in children diagnosed with AIDS. The most important findings in tonsils and adenoids were a decrease of the total T lymphocytes, helper T lymphocytes and CD4/CD8 ratio; an increase of cytotoxic T lymphocytes and B lymphocytes, as well as a 200% increase in monocytes of AIDS-affected children. These observations show the value of analyzing the lymphocyte subsets of the tonsils and adenoids of AIDS-affected children, and establishing an earlier relation to clinical symptoms.

Acquired Immunodeficiency Syndrome↗
PubMed1999

In vitro inhibition of S. pneumoniae, nontypable H. influenzae and M. catharralis by alpha-hemolytic streptococci from healthy children.

The present study aimed to investigate the inhibitory activity of the normal epipharyngeal flora against the three most common acute otitis media (AOM) pathogens in healthy children, and to study if the inhibitory activity differs between alpha-hemolytic streptococci (AHS) sampled from the tubal orifice and from those sampled from the adenoid. A total number of ten isolates of AHS were collected from the tubal orifice and the adenoid, respectively, in ten children undergoing adenoidectomy or tonsillectomy. None of the children had a history of otitis media, neither secretory otitis media (SOM) nor AOM. The method used to test the bacterial interference in vitro was a modified agar overlay method. The results showed that the AHS from nasopharynx were able to inhibit the majority of the S. pneumoniae, nontypable Haemophilus influenzae and Moraxella catharralis isolates tested. The AHS isolates from the tubal orifice inhibited growth of 93% of S. pneumoniae, 79% of H. influenzae and 84% of M. catharralis isolates. The corresponding figures among isolates from the adenoid were 76, 48 and 62%. This difference in the inhibitory capacity between the AHS isolates collected from the adenoid, compared with the AHS collected from the tubal orifice, is statistically significant (P<0.01) and implies that it is important to know the exact sampling locality before conclusions are made concerning the significance of bacterial interference in the upper airways.

Adenoids↗
PubMed1999

Bacteriology of the middle meatus in children.

Little is known about the bacteriology of the middle meatus in children. Therefore, middle meatal samples were obtained from 50 children who underwent adenoidectomy or adenotonsillectomy, while a group of 50 children submitted to minor non-ENT surgical procedures, were used as a control group. Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae were the most frequent cultured organisms, not only in the ENT group (in 68, 50 and 60% of the children respectively) but also in the control group (40, 34 and 50%). These three potential pathogens were more frequently seen among the children of the ENT group but only for H. influenzae was the observed difference statistically significant (P = 0.009). On semiquantitative analysis, there seemed to be more negative cultures or cultures with only a few colonies in the control group, while the richer cultures were obtained from the ENT group. Again, only for H. influenzae, these differences reached a statistical significance (P = 0.003). Streptococcus viridans and Neisseria species, both organisms that might be able to inhibit colonisation by some of the pathogens, were more frequently cultured in the control than in the ENT group: Strep. viridans 30 vs. 10% (P = 0.025) and Neisseria species 14 vs. 2% (P = 0.069).

Child, Preschool↗
PubMed1999

Increased adenoid mast cells in patients with otitis media with effusion.

OBJECTIVE: Previous studies have been suggested the possible role of adenoid mast cells in the pathogenesis of otitis media with effusion (OME). The aim of the present study was to evaluate the possible relationship of adenoid mast cells and hearing loss in patients with chronic OME. METHODS: Twenty patients with combined chronic OME and chronic adenoiditis (OME-A) and 20 patients with isolated chronic adenoiditis were studied. Hearing thresholds were determined by pure tone audiometry in both groups. All subjects underwent adenoidectomy and adenoid mast cells were counted in each specimen. Number of adenoid mast cells were determined in both groups. Possible relationship of adenoid mast cells and hearing thresholds in OME-A patients was evaluated by comparing the hearing thresholds of OME-A patients with mast cell count above the mean of OME-A group and hearing thresholds of OME-A patients with mast cell count below the mean of OME-A group. RESULTS: All isolated chronic adenoiditis patients had normal hearing thresholds. OME-A patients had hearing thresholds ranging from 12-52 dB. The number of adenoid mast cells in OME-A group (median: 80) was significantly greater than isolated chronic adenoiditis group (median: 38) (P < 0.05). OME-A patients with adenoid mast cell count above the mean of OME-A group had significantly higher hearing thresholds compared to OME-A patients with mast cell count below the mean of OME-A group (P < 0.05). CONCLUSIONS: Patients with OME-A have greater number of adenoid mast cells than patients with isolated chronic adenoiditis. OME-A patients with adenoid mast cell count above the mean of the OME-A group had higher hearing thresholds than OME-A patients with adenoid mast cell count below the mean of the OME-A group. Increased number of adenoid mast cells may contribute to the pathogenesis of higher hearing thresholds in some OME-A patients.

Adenoids↗
PubMed1999

What is wrong in chronic adenoiditis/tonsillitis anatomical considerations.

Waldeyer's ring is most prominent during childhood, when the size of the oro-nasopharyngeal space is not yet fully developed, but decreases spontaneously with age. In the child, enlarged tonsils and/or adenoids may cause Eustachian tube dysfunction/otitis media, rhinosinusitis, obstructive sleep apnea, voice changes, change in facial growth, swallowing problems and can affect overall quality of life. Consequently, tonsillectomy and/or adenoidectomy are among the most common surgical procedures in children. The size of the oro- and nasopharynx has been investigated in normal children with and without tonsil/adenoid hyperplasia, to assess whether or not it is the adenoid and tonsillar tissue that are enlarged and not the dimensions of the anatomic space that are reduced. Studies have supported that the nasopharyngeal space is not smaller in children with hyperplastic adenoids when compared to normal children. However, children with large obstructing tonsils have a smaller oropharyngeal diameter compared to children with small tonsils. Tonsil/adenoid hyperplasia appears to be due to an increase in the lymphoid elements. The size of the tonsil has been shown to be directly proportional to aerobic bacterial load and absolute number of B and T cells. Bacteria have been suggested in the etiology of the development of hyperplasia. Of interest is that of the different pathogens, Haemophilus influenzae in particular, has been associated with tonsil/adenoid hyperplasia. The distribution of dendritic cells, antigen presenting cells, is altered during disease, with fewer dendritic cells in the surface epithelium and more in the crypts and extrafollicular areas.

Adenoids↗
PubMed2000

Nasalance scores in snoring children with obstructive symptoms.

OBJECTIVE: Snoring and the sleep apnea syndrome (OSAS) in children are usually caused by adenotonsillar hypertrophy, which may affect air escape into the nose and nasal resonance. A microcomputer-based system makes it possible to objectively determine whether the oral passage is adequately separated from the nasal passage during phonation. The score thus obtained is called nasalance. This study was conducted to verify whether there exists differences in nasalance between primary snorers and OSAS-children. DESIGN: Fifty-three habitually snoring children (31 boys), mean age 6.1 years (range 3.2-10.5 years), were subjected to overnight sleep polygraphy (PG) and nasalance measurements with the Nasometer 6200. The study was successfully repeated 6 months later on 36 children. RESULTS: Nineteen children had obstructive apnea-h ypopneaindex (OAHI)> 1 on overnight polygraphy (OSAS-children), while 32 were considered primary snorers (PS), (OAHI<1). No statistically significant difference in nasalance scores was found between the OSAS- and PS children. Both groups of children had somewhat higher mean nasalance values both for oral and nasal passage sentences than the normative values for Finnish speech. In general, the most habitual snorers had lower nasalance scores than the less frequently snoring children (P=0.05). Earlier adenoidectomy or palatine tonsillar size did not have a significant influence on the nasalance. Adenotonsillectomy did not affect the nasalance scores of the nine children operated on during the follow-up period. CONCLUSIONS: According to the present study, nasalance measurements cannot be used to predict the incidence of OSAS among snoring children.

Child↗
PubMed1996

Tonsillectomy in children with or at risk for velopharyngeal insufficiency: effects on speech.

Recent case reports have challenged the notion that tonsillectomy is contraindicated in patients with or at risk for velopharyngeal insufficiency. The purpose of this study was to quantify the effects of tonsillectomy (with or without adenoidectomy) on perceptual speech characteristics, aerodynamic measures, and endoscopic descriptions of velopharyngeal function in a clinical population. Fifteen children 4 to 10 years of age received preoperative and postoperative evaluations. Perceptual speech characteristics improved or remained the same for most variables. There was no statistically significant difference between preoperative and postoperative ratings of hypernasality or frequency and severity of nasal emission. However, ratings of voice quality (pitch and breathiness) were significantly improved after surgery. Aerodynamic measures showed improvement or no change in velopharyngeal function for 12 of 15 children. Endoscopic assessment showed improvement or no change in velopharyngeal closure for 7 of 11 children tested. Cross-method analysis indicated that no single subject showed deterioration in velopharyngeal function in all three measures. The data from this investigation do not support the assumption that tonsillectomy is contraindicated for all children with or at risk for velopharyngeal insufficiency.

Child↗
PubMed1999

Posterior wall augmentation for treatment of velopharyngeal insufficiency.

Velopharyngeal insufficiency (VPI) can be treated surgically with various operations. This article describes the use of a superiorly based folded pharyngeal flap for posterior wall augmentation to treat VPI. This is a retrospective study indicating that a folded flap to augment the posterior wall is likely to be as effective as other surgical techniques to treat small velopharyngeal gaps. Patients selected for this procedure had very good velar motion. Postoperative nasometric zoo passage scores improved by an average of 18 over preoperative scores. Additionally, a correlation was found between age and nasometry improvement after surgery. Younger patients did better. Patients in whom VPI was caused by adenoidectomy did well. The 2 syndromic patients did not do as well when treated with this type of operation.

Adolescent↗
PubMed1999

Alternative to endoscopic sinus surgery in the management of pediatric chronic rhinosinusitis refractory to oral antimicrobial therapy.

We determined the safety, feasibility, and efficacy of a treatment regimen consisting of maxillary sinus aspiration and irrigation with or without adenoidectomy, followed by culture-directed intravenous antibiotics and oral prophylaxis, for children with chronic rhinosinusitis refractory to oral antimicrobial therapy. Twenty-seven children (age 1-12 years, mean 6.7 years) with symptomatic (mean duration 16 months) and computed tomography-proven sinus disease, which persisted despite at least 1 month of oral antibiotics, were treated. Twenty-four patients (89%) had complete resolution of their presenting symptoms after intravenous therapy; in 3 (11%), intravenous therapy failed and endoscopic sinus surgery was required. Follow-up data were available for 26 of the children (96%); 23 of them had initial complete resolution. At last follow-up (mean 282 days, range 26-1095 days), 10 of these 23 patients (44%) remained asymptomatic, and 13 (57%) had had at least one other episode of sinusitis (mean 1.0, range 1-3) treated with oral antibiotics, with resolution. Treatment-related complications included superficial thrombophlebitis (7%), diarrhea (7%), intravenous catheter guide-wire kink requiring venotomy (4%), and serum sickness-like syndrome (4%). These preliminary results suggest that this treatment plan is relatively safe and feasible and that it may be a reasonable alternative to endoscopic sinus surgery in children with chronic rhinosinusitis unresponsive to orally administered antimicrobial therapy.

Anti-Bacterial Agents↗
PubMed1997

Value of preoperative prothrombin time/partial thromboplastin time as a predictor of postoperative hemorrhage in pediatric patients undergoing tonsillectomy.

OBJECTIVE: Hemorrhage after tonsillectomy is a potentially lethal complication. Preoperative assessment consisting of prothrombin time (PT) and activated partial thromboplastin time (PTT) has been used to identify patients at risk for hemorrhage after tonsillectomy and adenoidectomy. We sought to assess the value of PT/PTT screening as a predictor of posttonsillectomy hemorrhage. DESIGN: A retrospective chart review was carried out with a minimum of 1 month follow-up. SETTING: Tertiary academic referral center. PATIENTS: Between January 1992 and June 1995, 382 patients undergoing tonsillectomy were examined; 339 patients with a minimum of 1 month follow-up were reviewed for this study. MAIN OUTCOME MEASURE: Normal and prolonged PT/PTT values were examined. Bleeding in the intraoperative, immediate postoperative, and delayed phases of healing was examined. RESULTS: Two-hundred and twenty-two patients had normal PT/PTT, 39 had prolonged PT/PTT, and 78 had no preoperative studies performed. Bleeding occurred in 2.7%, 2.6%, and 3.3%, respectively, of patients. Eight patients had positive family histories of bleeding tendencies. One patient (12.5%) with a normal PT/PTT experienced a delayed posttonsillectomy bleed. Of 39 patients with abnormal coagulation studies, 30 were borderline elevations with no repeat studies done; one patient experienced postoperative hemorrhage. Nine abnormal results were repeated; three returned to normal, three remained prolonged but underwent tonsillectomy with no intervention, and three received hematology consultations. One patient had lupus anticoagulant, one had Hageman Factor deficiency, and one was cleared for surgery with no diagnosis. All patients underwent tonsillectomy with no episodes of postoperative bleeding. CONCLUSIONS: Preoperative PT/PTT provides no additional information than does a bleeding history for the general pediatric population undergoing tonsillectomy. This should only be done in selective cases where warranted by history.

Child↗
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↗
PubMed2001

Immediate abscess tonsillectomy--a safe procedure?

OBJECTIVE: Peritonsillar abscess is the most common infection involving deep neck planes to be treated by otolaryngologists with varying management strategies. In some countries, like Japan, immediate tonsillectomy is considered only for selected cases due to the risk of post-operative complications. Post-tonsillectomy bleeding is considered as the major complication following surgery and serves as a landmark for the safety of the operation. The purpose of this study was to evaluate if there is an increased risk of post-tonsillectomy haemorrhage following immediate tonsillectomy in non-selected patients. METHODS: A retrospective study was performed on 6329 patients who underwent tonsillectomy, with or without adenoidectomy, in St. Anna Hospital, Duisburg, between January 1988 and August 2000 to evaluate the complication rate following 1481 immediate tonsillectomies (group A) compared to 4848 patients who underwent elective tonsillectomy (group B). 56.9% (group A) were male, the youngest patient was 18 months, the oldest 87 years old. Patients of group B were younger in general (mean age: 18.7 vs. 32.9 years), 49.9% were male, between 5 months and 93 years of age. Patients of both groups underwent surgery under general anaesthesia and were observed for 6 days. The incidence of post-tonsillectomy haemorrhage in both groups was compared using chi(2)-test, the age distribution was compared by Mann-Whitney U-test. RESULTS: Bleeding occurred in 43 patients of group A (2.9%) and 138 patients (2.8%) of group B. Excessive bleeding requiring ligature of the external carotid artery became necessary in one patient of group A (0.13%) and four patients of group B (0.08%). A 42-month-old patient (group B) died due massive haemorrhage at home 6 days after surgery. The latest bleeding occurred 12 (group B) and 13 days (group A) after surgery. Statistical evaluation (Pearson chi(2)-test P=0.908) shows no significant difference of post-operative bleeding between the compared groups. Post-tonsillectomy haemorrhage occurred with statistical significance (P<0.001) in elder patients after immediate tonsillectomy. CONCLUSIONS: We conclude, that immediate tonsillectomy can be recommended as a safe surgical procedure in non-selected patients to evacuate quinsy without an additional risk of bleeding thus making a second hospital stay unnecessary.

Adolescent↗
PubMed1985

Treatment of otitis media with effusion.

It seems probable that otitis media with effusion (OME) arises from acute OM and cannot be mistaken for suppurative OM since its inflammation recedes to a lesser degree. Accordingly, my concept for treatment of patients with OME focuses on the inflammation. The purpose of this paper is to describe treatment on the basis of this concept. 1) Frequent lavages are extremely helpful in the amelioration of sinusitis in children. 2) Adenoidectomy should be performed after the condition of sinusitis has improved. 3) Salpingitis should be treated by Eustachian catheterization in combination with antral lavage. 4) Patients should be classified as one of two groups for treatment of the middle ear and mastoid: mild cases and severe cases. In mild cases, the lesions in the middle ear and mastoid are considered to be reversible; the lesions are treated by paracentesis and aspiration of effusion. In severe cases, with cholesterol crystal deposits and/or resistance to conservative therapy, and in any case in which lesions are considered to be irreversible, conservative treatment following total mastoidectomy is recommended. 5) In young children with OME, observation is required until about 8 years of age, since proper treatment of relapses or exacerbation should be carried out as early as possible.

Adenoids↗
PubMed2000

[Study of passive smoking measured by urinary cotinine in maternal and child protective health centers in North-Pas-de-Calais].

BACKGROUND: The aim of the study was to determine the circumstances of exposure to environmental tobacco smoke, to evaluate its importance by measurement of urinary cotinine, and to study the relationship with the children's medical history. POPULATION AND METHODS: It was a prospective investigation realized in 20 outpatient pediatric clinics. The parents answered a questionnaire to assess the child's exposure as well as the child's medical and surgical history. Cotinine was measured in urine samples collected during the visit. Concentrations > 6 ng/mL were considered to be positive. RESULTS: Two hundred and one children were included in the study (mean age 17 months, extremes: 1-72 months), 107 of whom were exposed to environmental tobacco smoke. Urinary cotinine was found to be positive in 27 cases (13%). There was a positive relation between passive tobacco exposure and positive urinary cotinine (P < 0.001). Eighty of 201 mothers and 135 of 185 fathers smoked. There was a relation between positive urinary cotinine and the mother's smoking, as well as with a history of upper respiratory tract infection (rhinitis, otitis media) or adenoidectomy. No relation was found between a history of bronchiolitis and passive smoking. CONCLUSIONS: Passive tobacco exposure is very frequently encountered in our region. Urinary cotinine, which can be easily measured, might constitute an efficient tool in order to convince the parents of the reality of passive smoking.

Child↗
PubMed1996

Obstructive sleep apnea in children.

The obstructive sleep apnea syndrome is a common cause of morbidity during childhood. Childhood obstructive sleep apnea syndrome is usually secondary to adenotonsillar hypertrophy. Other risk factors include craniofacial anomalies, obesity, and neuromuscular disease. Symptoms include snoring and difficulty breathing during sleep. Definitive diagnosis is made by polysomnography. Normative polysomnographic parameters vary with age; thus age-appropriate norms must be used. In contrast to adults, children often manifest a pattern of persistent partial airway obstruction during sleep, rather than cyclical, discrete obstructive apneas. Most children are cured by tonsillectomy and adenoidectomy. However, some children require further therapy, such as continuous positive airway pressure.

Adolescent↗
PubMed2006

Huge Thornwaldt's cyst: a case report.

Thornwaldt's bursa, also known as nasopharyngeal bursa, is a recess in the midline of the nasopharynx that is produced by persistent notochord remnants. If its opening becomes obstructed, possibly due to infection or a complication from adenoidectomy, a Thornwaldt's cyst might develop. Here, we present a 53-year-old man who complained of nasal obstruction that had progressed for 1 year. Nasopharyngoscopy showed a huge nasopharyngeal mass. Thornwaldt's cyst was suspected. Magnetic resonance imaging showed a lesion measuring 3.6 x 3.4 cm, intermediate on T1-weighted and high signal intensity on T2-weighted imaging, neither bony destruction nor connection to the brain. The patient underwent endoscopic surgery for this huge mass. Afterwards, his symptoms improved significantly. We present the treatment and differential diagnosis of a nasopharyngeal cyst.

Cysts↗
PubMed1976

Mycotic flora in tonsils and adenoids. A microbiological and histological evaluation.

The tonsils of 147 patients with chronic tonsillitis and the adenoids of 134 children with recurrent respiratory infections were cultured for fungal organisms and studied microscopically. A control group consisted of 68 healthy persons. Positive cultures were obtained in 64% of patients with chronic tonsillitis, in 21% of children treated with adenoidectomy, and in 69% of the control group. Candida albicans, Saccharomyces sp. and Aspergillus were the most common organisms. The histological investigations revealed no evidence of pathogenecity in these organisms. They were found in the tonsillar crypts, and no granulomatous inflammation was seen surrounding them.

Adenoids↗
PubMed1978

Guillotine tonsillectomy: anachronism or pragmatism.

The results of a retrospective survey comparing the complications of guillotine tonsillectomy with those of dissection tonsillectomy are given. The problem of tonsil tags and adenoidectomy are discussed and a reappraisal of the indications for guillotine tonsillectomy are considered. We feel that guillotine tonsillectomy should only be carried out in very special circumstances.

Child↗