The Impact of the Thermal Seasons on Adenoid Size, Its Mucus Coverage and Otitis Media with Effusion: A Cohort Study

Background: The purpose of this study is to analyze seasonal differences in adenoid size and related mucus levels via endoscopy, as well as to estimate changes in middle ear effusion via tympanometry. Methods: In 205 children with adenoid hypertrophy, endoscopic choanal assessment, adenoid hypertrophy assessment using the Bolesławska scale, and mucus coverage assessment using the MASNA scale were performed in two different thermal seasons, summer and winter. The study was conducted in two sequences of examination, summer to winter and winter to summer, constituting two separate groups. Additionally, in order to measure changes in middle ear effusion, tympanometry was performed. Results: Overall, 99 (48.29%) girls and 106 (51.71%) boys, age 2–12 (4.46 ± 1.56) were included in the study. The first group, examined in summer (S/W group), included 100 (48.78%) children, while the group first examined in winter (W/S group) contained 105 (51.22%) children. No significant relationship was observed between the respective degrees of adenoid hypertrophy as measures by the Bolesławska scale between the S/W and W/S groups in winter (p = 0.817) and in summer (p = 0.432). The degrees of mucus coverage of the adenoids using the MASNA scale and tympanograms were also comparable in summer (p = 0.382 and p = 0.757, respectively) and in winter (p = 0.315 and p = 0.252, respectively) between the S/W and W/S groups. In the total sample, analyses of the degrees of adenoid hypertrophy using the Bolesławska three-step scale for seasonality showed that patients analysed in the summer do not differ significantly when compared to patients analysed in the winter (4.39%/57.56%/38.05% vs. 4.88%/54.63%/40.49%, respectively; p = 0.565). In contrast, the amount of mucus on the adenoids increased in winter on the MASNA scale (p = 0.000759). In addition, the results of tympanometry showed deterioration of middle ear function in the winter (p = 0.0000149). Conclusions: The obtained results indicate that the thermal seasons did not influence the size of the pharyngeal tonsils. The increase and change in mucus coverage of the adenoids and deterioration of middle ear tympanometry in winter may be the cause of seasonal clinical deterioration in children, rather than tonsillar hypertrophy. The MASNA scale was found to be useful for comparing endoscopy results.

Obstructive Sleep Apnea in Underweight Children

Objectives To determine predictors of obstructive sleep apnea (OSA) in underweight children and to describe the demographic, clinical, and polysomnographic characteristics of an ethnically diverse population of underweight children with OSA. Study Design Case-control study. Setting University of Texas Southwestern Medical Center and Children’s Medical Center of Dallas Methods Underweight children aged 2 to 18 years who underwent a polysomnogram for suspected OSA between January 2014 and December 2020 were included. Underweight was defined as body mass index <5th percentile per Centers for Disease Control and Prevention guidelines. Children with apnea-hypopnea index <1.0 served as a control group. Univariate and multiple logistic regression analysis was used to determine the predictors of OSA. Significance was set at P < .05. Results An overall 124 children met inclusion criteria: mean age, 6.4 years; 50% female; 44% Hispanic, 31% African American, and 18% Caucasian. A total of 83 children had OSA (apnea-hypopnea index ≥1.0). Height was negatively correlated with OSA (odds ratio, 0.94; 95% CI, 0.88-0.99; P = .02) while allergic rhinitis (odds ratio, 2.97; 95% CI, 1.24-7.08; P = .01) and tonsillar hypertrophy (odds ratio, 3.38; 95% CI, 1.42-8.02; P = .01) were predictors for the presence of OSA. No demographic or clinical characteristics were predictors for severe OSA. Conclusion Underweight children with OSA, as compared with those without OSA, are more likely to have decreased height, tonsillar hypertrophy, and allergic rhinitis. There are no predictors of severe OSA in underweight children. We recommend polysomnography for the diagnosis of OSA in symptomatic underweight children with large tonsils, especially when they have a history of allergies.

Predictive Risk Factors for Post Tonsillectomy Hemorrhage in Children

Objective: To assess the risk factors which determine the magnitude of post-tonsillectomy hemorrhage. Study Design: Prospective cross sectional study. Setting: A study carried out at otolyrangical unit at a tertiary care Isra University hospital Hyderabad, from June 2018 to April 2019. Materials and Methods: 110 pediatric patients age 5-17 years were included in this study. We administrated a structured questionnaire to parents of the patients. We selected cases for tonsillectomy as per criteria of the American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS). Those patients with a history of recurrent tonsillitis presented at the otolaryngology department were included. Patients with a history of use of anticoagulant therapy, obstructive sleep apnea, patients with a history of a bleeding disorder, and patients not giving consent were excluded. We diagnosed patients selected for tonsillectomy included with recurrent tonsillitis, peri-tonsillar hypertrophy, and tonsillar hypertrophy. Patients were observed and followed for postoperative hemorrhage. Data were analyzed by using Statistical Package for Social Sciences version 21 (SPSS 21). Results: Among 110 children included in the study, 41.8% patients were in the age group of 5-10 years, 30% were in the age group of 11-15 years and 28.2% were over 15 years. Among 110 patients 21.8% underwent tonsillectomy were diagnosed as recurrent tonsillitis, 19% were diagnosed as having tonsillar hypertrophy, 40.0% were suffering from both recurrent tonsillitis and tonsillar hypertrophy and 19.2% had peritonsillar hypertrophy. This shows that 14.5% were admitted to the hospital after 1-5 days, 58.1% developed post-tonsillectomy hemorrhage after 6-10 days and 27.2% developed post-tonsillectomy hemorrhage after 10 days. Conclusion: We conclude that age >10 years was significant predictive risk factors for post-tonsillectomy hemorrhage among children who undergo tonsillectomy.

Subtotal intracapsular tonsillectomy may be the first choice for tonsillectomy in children

Objective To investigate the effect and prognosis of subtotal intracapsular tonsillectomy. Methods All children (n=162) with tonsillar hypertrophy and chronic tonsillitis were randomly divided into two groups: tonsillectomy (n=75) and subtotal intracapsular tonsillectomy (n=87). Tonsillectomy: the tonsillar tissue was completely removed along with the tonsillar capsule. Subtotal intracapsular tonsillectomy: 80% to 90% of the tonsils and the complete epithelium of the tonsillar crypts were removed without damaging the tonsillar capsule. The Face, Legs, Activity, Cry, and Consolability (FLACC) and parents’ postoperative pain measure (PPPM) scales were used to evaluate postoperative pain, and the obstructive sleep apnea (OSA)-18 questionnaire was used to assess the children’s postoperative quality of life. The patients were followed-up for 2 years. Results 1. The FLACC and PPPM scales indicated that the children’s postoperative pain after subtotal intracapsular tonsillectomy was significantly less than that of children undergoing tonsillectomy. 2. The OSA-18 scale scores indicated that subtotal intracapsular tonsillectomy significantly improved the children’s quality of life. 3. Two years after subtotal intracapsular tonsillectomy, no patients required reoperation. Conclusion Subtotal intracapsular tonsillectomy may be the first choice for tonsillar hypertrophy and chronic tonsillitis patients.

Age-related hypertrophy of adenoid and tonsil with its effects on craniofacial morphology

The present retrospective cross-sectional study was to compare craniofacial patterns resulted from different locations of upper airway obstruction. The study was conducted among 466 consecutive orthodontic patients who were divided into four groups: adenoid hypertrophy group (AG: 70 girls and 56 boys, 11.73±2.51 years), tonsillar hypertrophy group (TG: 38 girls and 21 boys, 12.47±2.72 years), adenotonsillar hypertrophy group (ATG: 36 girls and 33 boys, 11.07±3.35 years) and control group (CG: 151 girls and 61 boys, 12.92±2.34 years). Standard cephalometric examinations were used to compare the craniofacial differences between groups. The result indicated that adenoids and tonsils reached peak at around 6 years of age, after which the tonsils decreased more remarkably than the adenoids. Compared with CG, the proportions of skeletal class II in AG (43.7%) and ATG (44.9%) were significantly increased and the proportion of skeletal class III in TG (32.2%) was significantly increased. In age- and sex-adjusted linear regression models regarding CG as a benchmark, AG and ATG were positively correlated with ANB, MP/SN and FH/SGn but negatively correlated with SNB. In contrast, TG was positively correlated with SNA and SNB. Conclusion: Adenoid hypertrophy tended to lead to mandibular retrusion and high mandibular plane angle. In contrast, tonsillar hypertrophy showed a trend in mandibular protrusion. However, children with adenotonsillar hypertrophy did not show a mean facial pattern of the above two but were rather similar to those with isolated adenoid hypertrophy. It seemed that adenoid hypertrophy lasted longer and played a greater role.

Tonsillar Microbiota: a Cross-Sectional Study of Patients with Chronic Tonsillitis or Tonsillar Hypertrophy

ABSTRACT Chronic tonsillitis (CT) and tonsillar hypertrophy (TH) are common tonsillar diseases that are related to infection and inflammation. Little is known about tonsillar microbiota and its role in CT and TH. This study aims to identify palatine tonsillar microbiota both on the surface and in the core tissues of CT and TH patients. In total, 22 palatine tonsils were removed and collected from CT and TH patients who underwent surgery. The surface and core microbiota in the tonsils of CT and TH patients were compared using 16S rRNA gene sequencing of V3-V4 regions. Differential tonsillar microbiotas were found in the CT versus TH patients and surface versus core tissues. Further, a higher relative abundance of bacterial genera, including Haemophilus, Streptococcus, Neisseria, Capnocytophaga, Kingella, Moraxella, and Lachnospiraceae [G-2] in patients with TH and Dialister, Parvimonas, Bacteroidales [G-2], Aggregatibacter, and Atopobium in patients with CT, was observed. Of these, the differential genera of Dialister, Parvimonas, and Neisseria served as key factors in the tonsillar microbiota network. Notably, four representable tonsillar microbial types were identified, with one, consisting of a higher abundance of Haemophilus and Neisseria, exclusively detected in the TH patients. This study analyzed the different tonsillar microbiota from the surface and core tissues of CT and TH patients. Several bacteria and various microbial types related to CT and TH were identified, along with potential bacterial networks and related immune pathways. IMPORTANCE The human microbiota has been shown to be functionally connected to infectious and inflammation-related diseases. So far, only limited studies had been performed on tonsillar microbiota, although tonsils play an essential role in the human immune defense system and encountered numerous microorganisms. Our work presented different tonsillar microbiota from surface and core tissues of chronic tonsillitis (CT) and tonsillar hypertrophy (TH) patients. Notably, one tonsillar microbiota type, which contains a higher abundance of Haemophilus and Neisseria, was only detected in the TH patients. Furthermore, certain bacteria, such as Haemophilus, Neisseria, Dialister, and Parvimonas, may serve as microbial biomarkers to discriminate CT patients from TH patients. These data provide important microbiota data in the tonsillar research area and are highly useful for researchers both in the oral microbiome field and clinical field.