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The Cleft Palate-craniofacial Journal :... Aug 2023To determine the risk factors and their respective magnitudes for developing Obstructive Sleep Apnea (OSA) in Down syndrome (DS) patients.
OBJECTIVE
To determine the risk factors and their respective magnitudes for developing Obstructive Sleep Apnea (OSA) in Down syndrome (DS) patients.
DESIGN
Retrospective cohort study.
PATIENTS
The 2016 Kids' Inpatient Database (KID) was queried to identify all patients diagnosed with DS.
MAIN OUTCOME MEASURES
The primary predictor variables were tonsillar hypertrophy (TH), adenoidal hypertrophy (AH), Hypertrophy of Tonsils & Adenoids (HTA), Laryngeal Stenosis (LS), Hypotonia, Glossoptosis, Congenital Laryngomalacia (CL), and Overweight & Obesity (OO). The primary outcome variable was OSA.
RESULTS
The final sample consisted of 18,181 patients with a diagnosis of DS. Relative to patients aged 0-5, patients aged 6-10 (OR 3.5, P < 0.01), 11-5 (OR 3.4, P < 0.01), and 16 & above (OR 3.6, P < 0.01) were each independently associated with increased odds of OSA. Further, TH (OR 23.2, P < 0.01), AH (OR 20.3, P < 0.01), HTA (OR 64.2, P < 0.01), glossoptosis (OR 5.0, P < 0.01), CL (OR 4.3, P < 0.01), and OO (OR 3.7, P < 0.01) were all independent risk factors for OSA.
CONCLUSIONS
The presence of hypertrophied tonsils and adenoids together was the strongest risk factor for OSA. DS patients aged six and above were at risk for OSA development relative to younger patients. Patients with DS should be tested for OSA, which otherwise will deteriorate their existing comorbidities.
Topics: Humans; Down Syndrome; Retrospective Studies; Glossoptosis; Sleep Apnea, Obstructive; Risk Factors; Hypertrophy
PubMed: 35306875
DOI: 10.1177/10556656221088171 -
BMC Medicine May 2023Removal of tonsils and adenoids is among the most common surgical procedures worldwide. Evidence of increased risk of cancer following such surgery is, however,...
BACKGROUND
Removal of tonsils and adenoids is among the most common surgical procedures worldwide. Evidence of increased risk of cancer following such surgery is, however, inconclusive.
METHODS
We conducted a population-based, sibling-controlled cohort study of 4,953,583 individuals in Sweden with a follow-up during 1980-2016. History of tonsillectomy, adenotonsillectomy, and adenoidectomy was identified from the Swedish Patient Register whereas incident cases of cancer during follow-up were identified from the Swedish Cancer Register. We used Cox models to calculate hazard ratios (HR) with 95% confidence intervals (CI) of cancer in both a population and a sibling comparison. The sibling comparison was used to assess the potential impact of familial confounding, due to shared genetic or non-genetic factors within a family.
RESULTS
We found a modestly increased risk for any cancer following tonsillectomy, adenoidectomy, or adenotonsillectomy in both the population (HR 1.10; 95%CI 1.07-1.12) and sibling (HR 1.15; 95%CI 1.10-1.20) comparisons. The association did not differ greatly by type of surgery, age at surgery, or potential indication for surgery, and persisted more than two decades after surgery. An excess risk was consistently observed for cancer of the breast, prostate, thyroid, and for lymphoma in both population and sibling comparisons. A positive association was observed for pancreatic cancer, kidney cancer, and leukemia in the population comparison whereas a positive association was observed for esophageal cancer in the sibling comparison.
CONCLUSIONS
Surgical removal of tonsils and adenoids is associated with a modestly increased risk of cancer during the decades following the surgery. The association is unlikely attributed to confounding due to shared genetic or non-genetic factors with a family.
Topics: Male; Humans; Palatine Tonsil; Adenoids; Sweden; Cohort Studies; Siblings; Kidney Neoplasms
PubMed: 37226237
DOI: 10.1186/s12916-023-02902-x -
European Archives of... Mar 2022This study aimed to detect the epidemiological relevance between adenoid hypertrophy (AH) and rhinosinusitis, and AH and allergic rhinitis (AR) through an Internet...
PURPOSE
This study aimed to detect the epidemiological relevance between adenoid hypertrophy (AH) and rhinosinusitis, and AH and allergic rhinitis (AR) through an Internet search.
METHODS
Internet search query data from January 2011 to December 2019 in China were retrieved from the Baidu Index (BI). Spearman's correlation coefficients were used to detect the correlation among the search volumes of AH, rhinosinusitis, and AR. We also collected search data from the first 5 months of 2020, when quarantine was implemented in China due to the coronavirus disease 2019 epidemic. Then, we compared the search data to those obtained during the same period in 2019 to assess the effects of isolation on AH and AR.
RESULTS
Statistically significant relevance was found between the search variations of AH and rhinosinusitis during 2011-2019 (R = 0.643, P < 0.05). However, the relationship between AH and AR was weak (R = - 0.239, P < 0.05) and that between rhinosinusitis and AR (R = - 0.022, P > 0.05) was not relevant. The average monthly search volume of AH and rhinosinusitis had a strong correlation (R = 0.846, P < 0.01), but AH and AR and rhinosinusitis and AR were not correlated (R = - 0.350, P > 0.05; R = - 0.042, P > 0.05, respectively). AH and rhinosinusitis search volumes decreased consistently during the first 5 months of 2020 (isolation), whereas that for AR increased during January-February.
CONCLUSION
AH had an epidemiological relationship with rhinosinusitis, which was not consistent with AR. The decrease in public gathering effectively reduced the morbidities of AH and rhinosinusitis but not those of AR.
Topics: Adenoids; COVID-19; Humans; Hypertrophy; Internet; Rhinitis, Allergic; SARS-CoV-2
PubMed: 34104981
DOI: 10.1007/s00405-021-06885-4 -
European Archives of... Mar 2022Adenoid or adenotonsillar hypertrophy (AATH) causes upper airway obstruction, leading to cardiovascular complications. This meta-analysis was conducted to evaluate the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Adenoid or adenotonsillar hypertrophy (AATH) causes upper airway obstruction, leading to cardiovascular complications. This meta-analysis was conducted to evaluate the efficacy of adenoidectomy or adenotonsillectomy (AATE) on the cardiovascular system.
METHODS
Using the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases, we identified studies involving a comparison of preoperative and postoperative cardiovascular function in children with AATH. The Cochrane Collaboration's Review Manager 5.3 software was used for meta-analysis.
RESULTS
A total of 13 studies with 706 participants were included. The meta-analysis demonstrated a significant reduction in mean pulmonary artery pressure (mPAP) of patients after AATE compared with preoperative values. The left ventricular myocardial function index (LVMPI) and the right ventricular myocardial function index (RVMPI) showed a significant decrease after the operation. Moreover, AATE prominently increased left ventricular ejection time (LVET) and right ventricular ejection time (RVET) and reduced the left ventricular interventricular septum diameter (LVIVSD) and the right ventricular end-diastolic diameter (RVedD). There was no significant difference in mPAP, LVMPI, RVMPI, LVET, RVET, LVIVSD, and RVedD between postoperative patients and healthy children (P > 0.05).
CONCLUSION
AATE can improve cardiovascular function in pediatric patients with AATH. Specifically, it reduces mPAP and LVMPI/RVMPI in pediatric patients. Furthermore, AATE increases LVET and RVET and reduces LVIVSD and RVedD.
Topics: Adenoidectomy; Adenoids; Airway Obstruction; Child; Humans; Hypertrophy; Pulmonary Artery; Tonsillectomy
PubMed: 34269887
DOI: 10.1007/s00405-021-06986-0 -
Otolaryngologia Polska = the Polish... Sep 2023<br><b>Introduction:</b> Malignant minor salivary gland tumors are rare, accounting for fewer than 1% of all laryngeal cancers.</br>...
<br><b>Introduction:</b> Malignant minor salivary gland tumors are rare, accounting for fewer than 1% of all laryngeal cancers.</br> <br><b>Aim:</b> This study aims to share our experiences regarding clinical, radiological, pathological profiles and their management.</br> <br><b>Materials and methods:</b> The current study reviews 11 cases of malignant minor salivary gland tumors of the larynx treated surgically at our Institute between 2005 and 2019.</br> <br><b>Results:</b> The mean age of the patients was 54 years (range 38-75 years) with six females and five males in the series (1.2:1). Subglottis and trachea were the sites of origin in 54% of the cases, and hoarseness with dyspnea were the most common presenting symptoms. There were nine Adenoid cystic and two Mucoepidermoid carcinoma patients. Surgery was the primary mode of treatment.</br> <br><b>Conclusions:</b> Most of the larynx's malignant minor salivary gland tumors are submucosal in origin. The outcome and prognosis vary considerably based on the tumor's histology, grade, and stage.</br>.
Topics: Female; Male; Humans; Adult; Middle Aged; Aged; Adenoids; Hoarseness; Laryngeal Neoplasms; Larynx; Salivary Gland Neoplasms
PubMed: 38032326
DOI: 10.5604/01.3001.0053.4040 -
Pediatric Radiology Jun 2020Information about the normal [F-18]2-fluoro-2-deoxyglucose (FDG) uptake in the adenoids and palatine tonsils in children is not available.
BACKGROUND
Information about the normal [F-18]2-fluoro-2-deoxyglucose (FDG) uptake in the adenoids and palatine tonsils in children is not available.
OBJECTIVE
The purpose of this study was to report the range of standardized uptake values (SUVs) in the normal adenoids and palatine tonsils in children, assess for the degree of asymmetry between the right and left tonsils and evaluate for the correlation of SUVs between the adenoids and tonsils.
MATERIALS AND METHODS
Pediatric patients who had had an FDG positron emission tomography (PET)/magnetic resonance imaging (MRI) brain study in our institution from January 2018 to March 2019 were identified. Patients with a history of malignancy, adenoidectomy and/or tonsillectomy, incomplete imaging coverage of Waldeyer ring and the presence of artifact on PET/MRI were excluded. Two pediatric radiologists independently measured the mean and maximum SUVs of the right tonsil, left tonsil and the adenoids. Range, mean and standard deviation were calculated for all measurements. Ratios of SUV of the left to right tonsils and the adenoids to the tonsils were calculated. The paired t-test and Pearson's correlation test were used for statistical analysis with a P-value <0.05 considered to be significant.
RESULTS
Sixty-one PET/MRI brain scans were performed in our institution during the study period. After reviewing for exclusion criteria, 41 patients were included in the study (mean age: 10.1 years, range: 2-17 years; 19 boys and 22 girls). The mean SUV was 5.30±1.57 in the right tonsil, 5.25±1.53 in the left tonsil and 4.56±1.90 in the adenoids. The maximum SUV was 8.47±2.22 in the right tonsil, 8.45±2.18 in the left tonsil and 7.59±2.94 in the adenoids. The difference between the SUVs of the right and left tonsil was not statistically significant (P=0.69 for mean SUV and P=0.90 for maximum SUV). There was a statistically significant moderately positive correlation between the FDG uptake in the adenoids and the right and left tonsil for both mean and maximum SUV (r=0.36-0.41; P=0.008-0.022).
CONCLUSION
There is a wide variation of FDG uptake in the normal tonsils and adenoids in children. Uptake in the right and left tonsils is not significantly different. There is a moderately positive correlation between the FDG uptake in the adenoids and the tonsils.
Topics: Adenoids; Adolescent; Child; Child, Preschool; Female; Fluorodeoxyglucose F18; Humans; Infant; Magnetic Resonance Imaging; Male; Multimodal Imaging; Palatine Tonsil; Positron-Emission Tomography; Radiopharmaceuticals; Reference Values
PubMed: 32198664
DOI: 10.1007/s00247-020-04650-z -
Georgian Medical News Dec 2020Endoscopic adenoidectomy with shaver is a safe, precise and fast procedure with minimal blood loss. With the help of this method, adenoids are completely removed without...
Endoscopic adenoidectomy with shaver is a safe, precise and fast procedure with minimal blood loss. With the help of this method, adenoids are completely removed without damage to adjacent tissues. Use of endoscope provides the possibility to display the operation on the screen in enlarged format and if applicable, the operation may be recorded. Controlled resection of tissues with shaver minimizes complications to the extent possible. 50 patients have been participated in the prospective study, all these patients had adenoidectomy with shaver, within the period from January 2019 to June 2020 inclusive. Age range was 2-26 years old. In order to determine efficacy of the method during the operation course, attention is to be paid to the following criteria: duration of the operation, blood loss, complications, perfection, depth of wound, satisfaction of a surgeon and recovery period. Average duration of the operation accounted for 15 minutes (10-20 minutes) and average blood loss was 30ml (within the range of 24-42ml). Complete resection was made under visual control amid insignificant complications, adequate depth of wound and surgeons' high satisfaction was achieved. Adenoidectomy with shaver is a fast, precise and safe procedure. The operation is made through full visual control, accordingly, complete resection of adenoids is carried out without damage to adjacent tissues ensuring a minimum chance for postoperative complications.
Topics: Adenoidectomy; Adenoids; Adolescent; Adult; Child; Child, Preschool; Endoscopy; Humans; Otolaryngology; Prospective Studies; Young Adult
PubMed: 33526725
DOI: No ID Found -
Sleep Medicine Feb 2021The efficacy and safety of montelukast in children with obstructive sleep apnea (OSA) remain controversial. Therefore, the aims of this systemic review and meta-analysis... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The efficacy and safety of montelukast in children with obstructive sleep apnea (OSA) remain controversial. Therefore, the aims of this systemic review and meta-analysis are to verify this issue and further provide reference for clinical practice.
METHODS
Seven databases were searched for randomized controlled trials (RCTs) up to September 30, 2019. The literature screening and data extraction were performed by two independent researchers. Adverse reactions from trials were also recorded. Meta-analysis was performed and analyzed heterogeneity. Methodological and evidence quality were followed by to evaluate according to Cochrane handbook.
RESULTS
A total of 4 RCTs including 305 children with mild to moderate OSA were involved. Compared with placebo, we found that oral montelukast (OM) significantly improved polysomnography (PSG) monitoring parameters, typical and relevant symptoms including snoring and mouth breathing, and adenoid morphology in children with OSA. When compared with routine drugs, not only PSG monitoring parameters and adenoid morphology, but also sleep-disordered breathing (SDB)-related questionnaire scores were improved in patients with OSA treated by combination of OM and routine drugs. In addition, compared with single nasal spray of mometasone furoate, the present study also showed that OM combined with nasal spray of mometasone furoate significantly improved PSG monitoring parameters, symptoms of snoring and mouth breathing and reduced tonsil morphology in pediatric OSA. In terms of treatment safety, one study reported adverse reactions of OM such as headache, nausea and vomiting, while no adverse events were reported after OM treatment in another study.
CONCLUSION
As a classic leukotriene receptor antagonist, montelukast can be used to treat children with mild to moderate OSA in the short term and improve clinical characteristics. The promotion and application of OM in clinic is considered to be a noninvasive option to avoid surgical treatment.
Topics: Acetates; Adenoids; Child; Cyclopropanes; Humans; Quinolines; Sleep Apnea, Obstructive; Sulfides
PubMed: 33465554
DOI: 10.1016/j.sleep.2020.11.009 -
JAAPA : Official Journal of the... Oct 2020Sleep-disordered breathing (SDB) and attention deficit hyperactivity disorder (ADHD) are common disorders diagnosed in children. Although these diagnoses were previously... (Review)
Review
Sleep-disordered breathing (SDB) and attention deficit hyperactivity disorder (ADHD) are common disorders diagnosed in children. Although these diagnoses were previously considered unrelated, research now is showing that some symptoms of ADHD, specifically oppositional behavior, hyperactivity, and impulsivity, can be related to SDB in children and differs from bona fide ADHD. This article explores the connection between the two disorders and the importance of identifying and screening for SDB in children presenting with similar symptoms related to ADHD. The article also examines symptom improvement in patients with ADHD symptoms after an adenotonsillectomy, one of the first-line treatments for children diagnosed with SDB; this procedure may reduce the need for long-term stimulant use in some children with ADHD.
Topics: Adenoidectomy; Adenoids; Attention Deficit Disorder with Hyperactivity; Body Mass Index; Child; Chronic Disease; Female; Humans; Hypertrophy; Male; Palatine Tonsil; Sleep Apnea Syndromes; Tonsillectomy
PubMed: 32976233
DOI: 10.1097/01.JAA.0000697248.35685.c6 -
Medical Physics Jun 2020Adenoid hypertrophy is a pathological hyperplasia of adenoids and may cause snoring, apnea, and impede breathing during sleep. In clinical practice, radiologists...
PURPOSE
Adenoid hypertrophy is a pathological hyperplasia of adenoids and may cause snoring, apnea, and impede breathing during sleep. In clinical practice, radiologists diagnose the severity of adenoid hypertrophy by measuring the ratio of adenoid width (A) to nasopharyngeal width (N) according to the lateral cephalogram, which indicates the locations of four keypoints. The entire diagnostic process is tedious and time-consuming due to the acquisition of A and N. Thus, there is an urgent need to develop computer-aided diagnostic tools for adenoid hypertrophy.
METHODS
In this paper, we first propose the use of deep learning to solve the problem of adenoid hypertrophy classification. Deep learning driven by big data has developed greatly in the image processing field. However, obtaining a large amount of training data is hard, making the application of deep learning to medical images more difficult. This paper proposes a keypoint localization method to incorporate more prior information to improve the performance of the model under limited data. Furthermore, we design a novel regularized term called VerticalLoss to capture the vertical relationship between keypoints to provide prior information to strengthen the network performance.
RESULTS
To evaluate the performance of our proposed method, we conducted experiments with a clinical dataset from the First Affiliated Hospital of Anhui Medical University consisting of a total of 688 patients. As our results show, we obtained a classification accuracy of 95.6%, a macro F1-score of 0.957, and an average AN ratio error of 0.026. Furthermore, we obtained a macro F1-score of 0.89, a classification accuracy of 94%, and an average AN ratio error of 0.027 while using only half of the data for training.
CONCLUSIONS
The study shows that our proposed method can achieve satisfactory results in the task of adenoid hypertrophy classification. Our approach incorporates more prior information, which is especially important in the field of medical imaging, where it is difficult to obtain large amounts of training data.
Topics: Adenoids; Deep Learning; Hypertrophy; Image Processing, Computer-Assisted
PubMed: 32017124
DOI: 10.1002/mp.14063