Vitamin D level in Egyptian children with otitis media with effusion

Background This prospective case-control study was conducted from June 2018 to October 2019 in a tertiary referral hospital to investigate the correlation between otitis media with effusion (OME) and serum vitamin D level in children. The study population included 50 children with adenotonsillar hypertrophy and OME (group A) who underwent adenotonsillectomy with tympanostomy tubes insertion compared to 50 children free from any medical or surgical disease (control group). Serum 25-hydroxy vitamin D was measured using electrochemiluminescence technique for both groups. Results The mean age in group A was 53.4 ± 9.2 months whereas in group B (control group) it was 65.0 ± 13.2 months (P <0.001). In group A, there were 29 (58 %) male children and 21 (42%) female children while in group B, there were 27 (54%) male children and 23 (46%) female children (P = 0.689). The mean vitamin D level in group A was 16.0 ± 6.1 ng/mL with a minimum of 7 ng/mL and a maximum of 32.10 ng/mL. In group B, the mean vitamin D level was 15.7 ± 5.3ng/mL with a minimum of 7.38 ng/mL and a maximum of 27.90 ng/mL. The statistical analysis showed that there was no significant difference in the level of vitamin D level between both groups (P = 0.770). Conclusion In this study, the mean level of serum vitamin D was low in children suffering from OME with adenotonsillar hypertrophy and in children without any medical or surgical disease; however, there was no statistically significant difference in the mean serum level of vitamin D between both groups. Therefore, a further study on a larger sample is needed.

P029 Home video sleep recording as a screening tool for paediatric obstructive sleep apnoea

Introduction Polysomnography (PSG) remains gold standard for assessment of paediatric OSA, despite limitations. Home-based video sleep recordings offer a promising screening tool that would be relatively simple and inexpensive but have been minimally investigated. This study aims to assess the ability of short home-based video sleep recordings to predict PSG-diagnosed OSA in a population of healthy children. Methods Healthy children aged 1–18 years undergoing PSG to assess for OSA were recruited. Those with comorbidities likely to cause/exacerbate OSA, aside from adenotonsillar hypertrophy and obesity, were excluded. Thirty-minute video recordings of sleep shortly after sleep onset capturing the face and exposed torso were obtained. A previously validated scoring system was modified to include six parameters: snore, inspiratory noise, respiratory events, respiratory effort, mouth breathing and neck extension. Results We report interim results of this ongoing study. Of the 51 children meeting inclusion criteria, videos for 44 (28M, mean (SD) age 8.58 (2.96) years) were deemed satisfactory and analysed. Four (9%) children had OAHI &gt;5 episodes/h on PSG and median Total Video Score (TVS) was 0 (IQR 0–1). TVS and OAHI &gt;5 episodes/h on PSG showed a statistically significant association (OR 2.782, p=0.006) with area under the curve of 0.847. TVS ≥4 showed sensitivity of 75% and specificity of 100% for OAHI &gt;5 episodes/h. Discussion This video scoring system, when applied to short home-based video sleep recordings, showed acceptable diagnostic accuracy for PSG-diagnosed OSA. Full data analysis will further clarify the role of this modality as a screening tool for paediatric OSA.

Management of obstructive sleep apnea in children: a Canada-wide survey

Background Obstructive sleep apnea frequently persists in children following adenotonsillectomy, which is the first-line treatment recommended for obstructive sleep apnea with adenotonsillar hypertrophy. Drug-induced sleep endoscopy (DISE) is a diagnostic tool increasingly used to assess pediatric obstructive sleep apnea, but its use has not been standardized. The overarching goal of this study was to document the current practice of Canadian otolaryngologists managing this population. Methods A nation-wide online cross-sectional survey of Canadian otolaryngologist members of the Canadian Society of Otolaryngology – Head and Neck Surgery and the Association d’otorhinolaryngologie et chirurgie cervico-faciale du Québec. The 58-question electronic survey was developed based on a validated survey redaction guide with the aim to assess management and treatment of pediatric obstructive sleep apnea, as well as indications and performance of DISE. Consensus on practice items was defined by a minimum of 75% similar answers. Results One hundred and nine Canadian otolaryngologists completed the survey on management of pediatric obstructive sleep apnea, among which 12 of them completed the questions on DISE. Overall, there was a poor rate of agreement of 55% among the respondents for the 58 questions altogether. There was a consensus to assess pediatric obstructive sleep apnea clinically ± with videos (82.6%), to assess adenotonsillar hypertrophy clinically (93.6%) and with flexible scope in the office (80.7%), as well as for the airway sites examined endoscopically during DISE. However, there was no consensus regarding anesthetic protocol and scoring system. DISE was mostly performed in cases of persistent obstructive sleep apnea after adenotonsillectomy rather than before performing any surgical procedure. There was no difference in the management of obstructive sleep apnea between otolaryngologists who perform DISE and those who do not. The only difference between otolaryngologists who practice in community centers versus in tertiary care centers was the more frequently use of the Brodsky tonsil scale by the latter ones. Conclusion This Canadian-wide survey highlighted a lack of consensus in the management of pediatric obstructive sleep apnea and DISE. Certain aspects regarding DISE remain unclear, including establishment of its ideal timing in order to eventually avoid unnecessary tonsillectomies.

Outcomes of flexible fiberoptic laryngoscopy in patients with stridor: a cross-sectional study in a tertiary care pediatric center in Saudi Arabia

BACKGROUND: Successful evaluation of a patient with stridor requires a thorough history and physical examination followed by a flexible fiberoptic laryngoscopy (FFL), which provides visualization of the upper airway. OBJECTIVES: Estimate the prevalence of causes of stridor in children who underwent FFL and compare different age groups. Find any significant associations between symptoms and laryngoscopic findings. Identify patients who needed further evaluation using direct laryngobronchoscopy (DLB). DESIGN: Retrospective, cross-sectional. SETTING: Tertiary care center in Riyadh. PATIENTS AND METHODS: We included all pediatric patients aged 1 month to 14 years who underwent fiberoptic laryngoscopy for stridor evaluation from January 2015 to January 2018 (37 months). Patients older than the age of 14 years, and patients with a workable diagnosis with adenotonsillar hypertrophy, choanal atresia, or laryngotracheo-bronchitis (croup) were excluded. MAIN OUTCOME MEASURES: Findings of FFL. SAMPLE SIZE: 217 pediatric patients. RESULTS: The median (interquartile range) age of the patients was 5 (8) months. Laryngomalacia was the most common diagnosis (n=149, 69%) followed by laryngopharyngeal reflux (n=42, 19%). Subglottic stenosis was the most common finding in patients who underwent DLB for further evaluation (n=19, 49%). Laryngomalacia was more frequent in children ≤12 months of age (83% vs 43% in children >12 months, P <.001). Vocal cord paralysis was more common in children >12 months of age (27% vs 9%, P <.001). FFL was effective in finding the diagnosis in 178 (82%) patients; only 39 (18%) patients needed further assessment using DLB. CONCLUSION: FFL is an effective and important tool for evaluating patients with stridor. LIMITATIONS: Retrospective design and single-centered. CONFLICTS OF INTEREST: None.

Prevalence of Allergic Rhinitis in Children with Adenotonsillar Hypertrophy Referred to Imam Khomeini Hospital of Ahvaz from 2019 to 2020

Background: Allergic diseases are among the most common chronic conditions in pediatrics. Objectives: This study aimed to evaluate the relative frequency of allergic rhinitis (AR) in children with adenotonsillar hypertrophy. Methods: In this descriptive study, 175 patients with adenotonsillar hypertrophy referred to the Imam Khomeini hospital of Ahvaz from March 2019 to March 2020 were enrolled. Allergic rhinitis was diagnosed based on the Score for AR (SFAR) questionnaire. The questionnaire, including the expert-designed SFAR, has eight main components that evaluate eight quantitative features of AR, and each was designated with a specific weighted score based on previous clinical studies. The total score could vary from 0 to 16. Frequency and percentage were used to describe the data. The chi-square test and Fisher's exact test were used to analyze the data. Results: One hundred seventy-five patients with adenotonsillar hypertrophy in the age range of 1 to 17 years were studied. Ninety-one patients (52%) were male, and 84 patients (48%) were female. Based on the score obtained from the questionnaire, 146 patients (83.4%) had a score of less than seven, indicating susceptibility to AR. Twenty-nine patients (16.6%) had a score equal to or higher than 7, confirming the diagnosis of AR. The Chi-square test showed that AR was significantly associated with all the components of the questionnaire, except for cigarette smoking (P-value < 0.001). Conclusions: This study showed the strong association of AR with some demographic factors. Allergic rhinitis could potentially increase the risk of adenotonsillar hypertrophy in children.

557 Nasal cavity narrowing in pediatric obstructive sleep apnea

Introduction The contribution of nasal cavity narrowing to obstructive sleep apnea (OSA) in children has not been well-defined. Acoustic rhinometry is a non-invasive technique that uses acoustic pulses to measure nasal cavity cross-sectional area (CSA) at defined distances from the tip of the naris. This study evaluated the relationship between nasal cavity CSA and OSA in children. We hypothesized that OSA severity would correlate with reduced nasal CSA. Methods Children 5–12 years of age with OSA underwent polysomnography and acoustic rhinometry at baseline and after 3 months and 12 months of growth as part of a randomized controlled trial. Statistical analysis of the nasal cavity CSA up to 6 cm from the tip of the naris was performed using mixed-effects linear regression model with visit month, age at visit, trial number, OSA severity, and side (left or right naris), and statistical interaction between OAHI category and distance from the tip of the nose as a fixed effect and the random effects set on the level of individual subject. Least significant differences were used to account for multiple comparisons. An unbiased approach using latent class analysis was used to determine OSA severity categories based on obstructive apnea hypopnea index (OAHI). Post-hoc analysis was used assess the model adjusted (marginal) means and pairwise effects. Results 112 participants completed testing (50% male, aged 7.9±2.1 years). Median (IQR) OAHI for subjects with mild OSA (n=69) was 4.4/hr (3.2), moderate OSA (n=35) was 9.7/hr (7.1), and severe OSA (n=8) was 21.3/hr (17.2). There was a significant difference in linear trend for nasal cavity narrowing of the CSA between patients with mild vs. moderate OSA, p=0.023. There was no difference in nasal cavity narrowing between the severe group and other groups, likely due to the small sample size of this group. Conclusion There is a difference in the anterior nasal cavity narrowing between children with mild OSA and moderate OSA. In addition to structural narrowing from adenotonsillar hypertrophy, this may be another contributor to pediatric OSA. Support (if any) R01 HL120909 K23 HL135346 K01 HL130719

Comparative Evaluation of the Effects of Adenotonsillar Hypertrophy on Oral Health in Children

We aimed to investigate the oral health of children in terms of the presence of dental caries, periodontal health, halitosis, and dentofacial changes in patients who had adenotonsillar hypertrophy related to mouth breathing and compared these findings with nasal breathing healthy and adenotonsillectomy-operated children. The patient group comprised 40 mouth-breathing children who were diagnosed with adenotonsillar hypertrophy, while the control group consisted of 40 nasal breathing children who had no adenotonsillar hypertrophy. Forty children who had undergone an adenotonsillectomy operation at least 1 year prior to the study were included in the treatment group. Oral examinations of all children were conducted, and the parents were asked about medical and dental anamnesis, demographic parameters, toothbrushing and nutrition habits, oral health-related quality of life (OHRQoL), and symptoms of their children. Demographic parameters, toothbrushing and nutrition habits, and the presence of bad oral habits did not differ between groups ( p > 0.05 ). Adenotonsillectomy is associated with a remarkable improvement in symptoms; however, some symptoms persist in a small number of children. The salivary flow rate, dmft/s, DMFT/S index, plaque, and gingival index scores did not differ between groups ( p > 0.05 ). The patient group showed higher rates of halitosis when compared with the treatment and control groups ( p < 0.001 ). Mouth breathing due to adenotonsillar hypertrophy caused various dentofacial changes and an increase in Class II division 1 malocclusion ( p < 0.001 ). It was shown that adenotonsillar hypertrophy does not negatively affect OHRQoL, it could be a risk factor for dental caries, periodontal diseases, and halitosis, but by ensuring adequate oral health care, it is possible to maintain oral health in children with adenotonsillar hypertrophy. Also, it is recommended that orthodontic treatment should start as soon as possible if it is required. In this context, otorhinolaryngologists, pedodontists, and orthodontists should work as a team in the treatment of children with adenotonsillar hypertrophy.