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PubMed2005

[The relationship between adenoids hypertrophy and secretory otitis media].

OBJECTIVE: To investigate the relationship between immune status of adenoids and secretory otitis media (SOM). METHOD: All the 76 cases of SOM were divided into 2 groups: recurrent group (46 cases) and control group (30 cases whose occurrence was less than 3 times). The manifestation of CD45RO, CD20, PCNA and BCL-2 in adenoids was detected with ultrasensitive (TM)S-P immunohistology. RESULT: The expression of CD44Ro, CD20, PCNA and BCL-2 in recurrent group was significantly higher than that in control group (P < 0.05 or P < 0.01). CONCLUSION: In adenoid tissues of recurrent SOM patients, the activities of lymphocytes and cells in hypertrophic status increase, the adenoids enlarge and local immunity enhances. Therefore, adenoidectomy for SOM patients should be carried out as early as possible.

Adenoids↗
PubMed2005

[Influence of obstructive sleep apnea-hypopnea syndrome in children on hearing problem].

OBJECTIVE: To analyze the effects of obstructive sleep apnea hypopnea syndrome on hearing among children. METHODS: One hundred and forty three apnea children proved with overnight polysomnography received pure tone audiometry, acoustic impedance test, and lateral nasopharyngeal airway X-ray. Hearing threshold level and blood oxygen's saturation, apnea hypopnea index were analyzed. RESULTS: Among the 127 cases,63 cases had type C or B tympanograms, and 33 of them had lifted hearing threshold level. The remaining 64 cases had normal hearing and tympanograms. It was found correlation between the A/N ratio and blood oxygen's saturation, and no correlation between the A/N ratio and average of hearing threshold level. There was no correlation between AHI and average of hearing threshold level of each group. Hearing level can be improved after adenoidectomy or adenotonsillectomy. CONCLUSIONS: The upper airway obstruction due to adenotonsillar enlargement is common in children. It also affects the middle-ear impedance. Although short -term and mild degree of hypoxemia has few influence on hearing threshold level, it may affect cochlear function.

Acoustic Impedance Tests↗
PubMed2005

The effectiveness of unilateral tonsillectomy in chronic adenotonsillar hypertrophy.

OBJECTIVES: This study sought to determine whether unilateral tonsillectomy was effective in the treatment of chronic adenotonsillar hypertrophy. PATIENTS AND METHODS: A total of 197 patients (96 girls, 101 boys) with chronic adenotonsillar hypertrophy were prospectively included. The patients were randomly assigned to either bilateral tonsillectomy (n=113; mean age 10.1 years; range 4 to 18 years) or unilateral tonsillectomy (n=84; mean age 4.5 years; range 3 to 8 years) performed with or without adenoidectomy. All the patients were followed-up for at least a year. RESULTS: The two groups did not differ significantly with respect to preoperative symptoms, the size of tonsils, and the presence of adenoid hypertrophy. At the end of the follow-up, no significant differences were found with respect to relief of snoring, mouth breathing, and upper airways obstruction between the two groups. A greater number of patients achieved complete improvement in snoring in the bilateral tonsillectomy group (p<0.05). With unilateral tonsillectomies, three patients required tonsillectomy to the other side, two had recurrent tonsillitis, and one had severe compensatory hypertrophy with persistent difficulty in inspiration and mouth breathing. CONCLUSION: Unilateral tonsillectomy seems to be as effective as bilateral tonsillectomy in the treatment of chronic adenotonsillar hypertrophy.

Adolescent↗
PubMed2005

[Aspects of biological activity of T and NK lymphocytes in children with adenoid hypertrophy and concomitant otitis media with effusion].

UNLABELLED: The aim of this study was to inquire whether it has got an influence on the number and activity of peripheral blood T and NK cells. MATERIAL AND METHODS: The examined group consisted of 51 children with adenoid hypertrophy. The first group consisted of 17 children with only one episode of otitis media with effusion (ome). The second group consisted of 14 children with more than 4 episodes of ome and the third group consisted of 20 children with adenoid hypertrophy without ome. Evaluation of percentage of CD4+, CD8+ and NK subsets with co-expression of CD69, HLA-DR molecules in peripheral blood was performed by flow cytometry method. In examined groups with ome the decrease of CD4 number was compensated by increase of the number of NK and CD19 cells. In these groups the increase of CD69 and HLA-DR expression on the examined subsets was observed. The results suggest that in recurrent otitis media with effusion may be one of the factors causing T lymphocytes deficiency. Obtained results might be one of the criteria of using adenoidectomy.

Adenoids↗
PubMed2005

[Laser Nd-Yag assisted myringotomy for secretory otitis media in children].

The aim of the study was assessment of the qualities of ND-YAG laser assisted myringotomy as a treatment for secretory otitis media. Nd-Yag laser myringotomy was performed on 52 children (104 ears) mean age 6.8 years diagnosed with secretory otitis media and recurrent secretory otitis media (14.4%). Myringotomy was performed under general anesthesia using the laser (CWNd-YAG laser 3100 Sharplan). Adenoidectomy alone or with tonsillotomy was performed at the same time. Laser tympanostomies remained patent for 6-35 days. All tympanostomies healed with no noticeable scarring. In 15 ears pressure equalization tubes were inserted after myringotomy with laser. Septoplasty performed in 5 children. Laser myringotomy appears to be a safe, and easy to performed, alternative technique in the treatment of secretory otitis media.

Child↗
PubMed2005

[Clinical analysis of 68 patients with obstructive sleep-disordered breathing in children].

OBJECTIVE: To explore the clinical features and the diagnosis and the treatment of pediatric obstructive sleep-disordered breathing. METHOD: Sixty- disordered breathing. METHOD: Sixty eight cases with obstructive sleep-disordered breathing were reviewed including clinical features and cephalometric analysis and endoscopic examination, 46 of all them were study of polysomnography. RESULT: Forty-six cases were examined with polysomnography in preoperative. AHI 0.1 approximately 24.0 times/hour. Follow-up 3 months to 1.5 year, 68 patients were performed with adenotonsillectomy, upper airway obstruction caused by adenotonsillar hypertrophy were enlarged remarkably. Fifty-six cases main symptoms (snoring, mouth breathing and apnea) disappeared completely, nine cases were relief, 3 cases were reappear. Eleven cases (16 ears) of secretory otitis media after insert plastic tube into tympanum and 9 cases chronic sinusitis were relief. CONCLUSION: Upper airway obstruction caused by adenotonsillar hypertrophy were major reasons to lead to pediatric obstructive sleep-disordered breathing. The diagnosis and treatment must be combined clinical features with all kinds of examinations (cephalometric, endoscopic, polysomnography). Tonsillectomy and/or adenoidectomy with soft-tissue shavers were safe and effective in treatment of OSAHS children.

Child↗
PubMed2006

[Chronic otitis media in children].

Otitis media with effusion is the main chronic otitis in children. It is very common under 5 years of age. It is often asymptomatic or is revealed by a hearing loss, delaying language development or causing behaviour troubles or balance troubles. Repeated acute otitis media may also occur. Tympanic membrane aspect is variable: pneumotoscopy and tympanometry are valuable diagnostic tools. Long term consequences on child development and possible scarring of the eardrum and the ossicles must be kept in mind. Treatment consists in watchful waiting during 3 months, then adenoidectomy and middle ear drainage. There is no efficient drug. Other chronic middle ear infections may cause serious hearing and infectious complications and require surgical treatment.

Child↗
PubMed2006

[Assessment of adenoid size in children by flexible fibrescope examination].

OBJECTIVE: To assess the adenoid size in children by flexible fibrescope examination and outline an effective therapeutic program according to the examination. METHOD: In this study, the flexible fibrescope examination of the nasal cavity and nasopharynx and a lateral skull radiograph examination were performed in 130 children with snoring and the same examinations were performed in another 30 children without snoring. RESULT: The size of adenoid was negatively associated with the degree of snoring. (P < 0.01). There is a high correlation between the flexible fibrescope examination and the lateral skull radiograph examination (r = 0.435, P < 0.01). CONCLUSION: The application of the flexible fibrescope examination of the nasal cavity and nasopharynx has proved to be of great clinical value, especially in the selection of children for adenoidectomy. It is an examination with minor invasion which can be well tolerated by most children, giving more information than a lateral skull radiograph and avoiding unnecessary radiation.

Adenoids↗
PubMed2006

Operative workload of a paediatric otolaryngology department over a five-year period.

INTRODUCTION: The KK Women's and Children's Hospital (KKWCH) is Singapore's only tertiary institution dedicated wholly to the provision of healthcare for women and children. Since its opening in 1997, the clinical caseloads and the complexity of medical conditions managed by the various departments has increased considerably. This review aims to analyse the operative caseloads in the Department of Otolaryngology over five years from 2000 to 2004. METHODS: This is a retrospective review of the KKWCH Department of Otolaryngology operative records from year 2000 to 2004. The data on the type of operation and their frequency were collated, and the data are presented in a descriptive format. RESULTS: There was an increase in the number of operations performed from 656 in year 2000 to 1,148 in 2004, an increase of 75 percent. The increase in the staffing and operating clinical hours (in 2003 and 2004) plus the significant demand for paediatric otolaryngology service probably contributed to this increase. Tonsillectomy, with or without adenoidectomy, continues to be the most common procedure being performed in children, with myringotomy and tympanostomy tube insertion being the second commonest. Together, the ten most common operative procedures constitute 78.2 percent of all paediatric otolaryngological operative workload in the department over a five-year period. CONCLUSION: The data provided a review of the current pattern of otolaryngological surgical disease in the Singapore paediatric population, which may require operative intervention. Understanding and monitoring of this trend is important, as it allows the proper allocation of appropriate resources for the prevention and treatment of common paediatric surgical otolaryngological conditions.

Humans↗
PubMed2006

[Multiple plane operations in treating severe obstructive sleep apnea-hypopnea syndrome].

OBJECTIVE: To investigate the effect and clinical value of multiple plane operations in treating severe OSAHS. METHOD: The clinical data of 28 patients with severe OSAHS were retrospectively analyzed. All the patients were performed two planes of operations or more as below: submucous nasal septum resection, nasal sinus endoscopy, adenoidectomy, uvulopalatopharyngoplasty (UPPP), tongue base incision, hyoid suspension, tongue base Coblation etc. Operations were finished in the same term or by stages. All patients underwent polysomnography(PSG) examination before operation, and 6-month and 1-year after surgical treatment separately. RESULT: No severe complication occurred, the 6-month, 1-year responders are 100% and 89.29% respectively. Both AHI and LSaO2 changed obviously (P < 0.01). CONCLUSION: Most OSAHS have multi-level obstructions in upper airway caliber, such as nasal, nasopharyngeal, velo-pharyngeal and tongue-pharyngeal obstruction. Multiple plane operations which based on idiographic obstruction sites can improve curative effect. Operation project should be established according to the conditions of upper airway and patients' intention.

Adult↗
PubMed1991

Otolaryngologic approach to the diagnosis and management of otitis media.

Otitis media is a common childhood disease caused by multiple factors. Understanding the pathogenesis of otitis media is important in the diagnosis and management of it. The mode of therapy should be chosen depending on the type and stage of the disease. Treatment options available to an otolaryngologist include antibiotics, tympanocentesis, myringotomy and tympanostomy tube insertions, adenoidectomy with or without tonsillectomy, exploratory tympanotomy, atympanoplasty, and mastoidectomy.

Anti-Bacterial Agents↗
PubMed1991

Otitis media in day-care children. A report from the International Primary Care Network.

The relationship between day care and acute otitis media and its adverse consequences was analyzed as part of a collaborative multinational study. Data from primary care research networks in eight countries were collected on 1335 children, aged 0 to 60 months, at the time of initial visits to their primary care physicians for acute otitis media. A history of recurrent acute otitis media, poor hearing, and tonsillectomy or adenoidectomy were all more frequent in day-care children aged 25 to 60 months, compared with those cared for at home. Day-care children were brought to their physicians more promptly after the onset of symptoms and received more referrals to otolaryngologists at the time of the index visit for acute otitis media. Day care may pose a significant risk for otitis media and its adverse consequences.

Acute Disease↗
PubMed1991

[Adenoid hypertrophy as initial symptom of an infection with the human immunodeficiency virus].

A woman aged 25 yr consulted the Department of Otorhinolaryngology with complaints of persistent nasal obstruction caused by adenoid hypertrophy recurring shortly after recent adenoidectomy. Previous elaborate investigations did not reveal the cause of this unexplained phenomenon. Testing for human immunodeficiency virus (HIV) was positive. In case of an unexplained recurrent adenoid hypertrophy, an infection with the human immunodeficiency virus should be considered in the differential diagnosis.

Adenoids↗
PubMed1991

Hemostasis in Glanzmann's thrombasthenia (GT): GT platelets interfere with the aggregation of normal platelets.

The transfusion requirements for a 6-year-old Glanzmann's thrombasthenia (GT) patient undergoing tonsillectomy and adenoidectomy were studied. Transfusion of pheresed platelets from a single normal donor increased the platelet count by 63 x 10(9)/L but did not correct the bleeding time. Since the ratio of normal:GT platelets in vivo was approximately 1:5, it was possible that GT platelets interfered with the function of normal platelets. To test this hypothesis, mixtures of platelet-rich plasma (PRP) from a normal donor and the patient were studied to determine a ratio of normal:GT platelets that would yield acceptable in vitro aggregation. Normal:GT ratios of 1:4 and 3:2 resulted in 25% and 59% aggregation, respectively. Mixtures of normal and nonfunctional ethylene glycol tetra-acetic acid-treated platelets gave similar results. Aggregates from mixtures of normal and patient platelets were also examined morphologically by light microscopy and were proportional in size to the normal:GT platelet ratio. Transfusion of platelets from the pheresis of four donors increased the patient's platelet count by greater than 300 x 10(9)/L (normal:GT ratio 1:1), produced 53% aggregation, and resulted in satisfactory postoperative hemostasis. The platelet transfusion requirement for this GT patient was much greater than would have been expected in the absence of aggregation-defective platelets.

Antibodies, Monoclonal↗
PubMed1990

[Classification of secretory otitis based on cytological analysis of middle ear transudate].

On the basis of the number of cell elements in the cytologic smear of the transudate from the middle ear, secretory otitis media was divided into four groups providing indication for therapeutic procedures. The first group is characterized by a mass of mucus and very scarce cell elements, suggesting a relatively short duration of illness and the healing by conservative therapy and adenoidectomy. The second group contained somewhat more cell elements in the cytologic smear, suggesting a longer duration of illness and requiring the use of a ventilation tubule in the therapeutic procedure. The third group showed a considerable cell infiltration and the appearance of individual collagenic fibres scattered in disorder in the smear. The transudate is dense, sticky, and dark. Its aspiration from the cavum is not easy. The finding suggests a long duration of illness, requiring a more active approach of the otosurgeon. The fourth group is characterized by a very scarce but dense aspirate from the middle ear. The cytologic smear shows an intense cell infiltration and a mass of collagenic fibres, which speaks for a very long duration of illness and for the necessity, in view of the formation of connective tissue in the middle ear, of an explorative tympanotomy coupled with adhesiolysis and the use of the ventilatory tubule.

Child↗
PubMed1990

Abnormal maxillary sinus radiographs in children: do they represent bacterial infection?

Thirty-three children with chronic tonsillitis and/or adenoid enlargement and without previous diagnosis of sinusitis were studied regarding the bacterial flora of their maxillary sinuses. Puncture of maxillary sinus was performed at surgery (adenoidectomy and/or tonsillectomy) and aspirates were cultured. Streptococcus pneumoniae was isolated from 8 of 12 (66.7%) patients whose x-rays showed completely opacified maxillary sinus. Streptococcus viridans, Streptococcus faecalis, and Staphylococcus epidermidis were recovered from 6 (28.6%) of the 21 patients with normal maxillary sinus radiographs. Bacterial titers were greater than 10(4) colonies/mL in all but one of the positive cultures. No anaerobic bacteria were isolated. History of bronchial asthma, presence of nasal purulent secretion, elevated blood eosinophils, and elevated serum IgE were found more frequently in children with complete opacification of maxillary sinus. Serum levels of IgG2 were low in 29% of the children, but no correlation was found between low IgG2 levels and positive cultures from maxillary sinus aspirates. We concluded that children with complete radiologic opacification of maxillary sinus had bacterial infection in almost 70% of the cases with symptoms that did not prompt their physicians to consider the diagnosis of sinusitis.

Child↗
PubMed1990

Obstructive sleep apnea syndrome in children.

Partial or complete repetitive obstructions of the upper airway during sleep give rise to clinical symptoms associated with heavy, chronic snoring. The number of obstructive sleep apneas during the night may be less important than the repetitive inspiratory increases in upper airway resistance, even if these are associated only with a partial airway collapse. Oxygen saturation may not be severely affected by partial occlusion during nocturnal recording, although clinical symptoms may occur. Esophageal pressure measurements and breathing frequency during sleep are key features in the polygraphic evaluation of prepubertal children. Tonsillectomy and adenoidectomy may be helpful in treating children with small upper airway during sleep. The marked interaction between upper airway adequacy and craniofacial morphology make it critical to evaluate the impact of partial or complete airway occlusion during sleep on facial prognathism. Nasal continuous positive airway pressure is a safe treatment for persistent, partial or complete upper airway occlusion during sleep, but it does not address the mandibular deficiency often seen in symptomatic children. Orthodontic evaluation and treatment may make maxillomandibular surgery unnecessary during the pubertal years.

Child↗
PubMed1979

Endoscopic findings in sleep apnea syndrome.

Sleep apnea syndrome is a constellation of symptoms resulting from recurrent episodes of apnea during sleep. Often the upper airway becomes obstructed during slumber in this disorder. Symptoms relate to sleep deprivation and include morning headaches, daytime somnolence, personality changes with deteriorating intellectual capacity, nocturnal enuresis, and sexual dysfunction. Diagnosis is assisted by polysomnographic recordings. Therapy is directed at the cause of obstruction when one can be found, weight loss in massively obese patients, tracheostomy in the symptomatic patient. Four patients with documented sleep apnea syndrome are discussed. One patient, a thin adolescent female underwent adenoidectomy without improvement. Two massively obese adult males required tracheostomy with marked amelioration of symptoms. One additional adult male was found to have sleep apnea due to severe, acquired micrognathia; he was significantly improved by tracheostomy. All three adult patients were found by endoscopic visualization to have marked pharyngeal soft tissue collapse with inspiration during apneic episodes. Possible causes of pharyngeal collapse are discussed.

Adolescent↗