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The Cochrane Database of Systematic... Jul 2008Adenoidal hypertrophy is generally considered a common condition of childhood. When obstructive sleep apnoea or cardio-respiratory syndrome occurs, adenoidectomy is... (Review)
Review
BACKGROUND
Adenoidal hypertrophy is generally considered a common condition of childhood. When obstructive sleep apnoea or cardio-respiratory syndrome occurs, adenoidectomy is generally indicated. In less severe cases, non-surgical interventions may be considered, however few medical alternatives are currently available. Intranasal steroids may be used to reduce nasal airway obstruction.
OBJECTIVES
To assess the effectiveness of intranasal corticosteroids for improving nasal airway obstruction in children with moderate to severe adenoidal hypertrophy.
SEARCH STRATEGY
Our search included the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2007), MEDLINE (1951 to 2007) and EMBASE (1974 to 2007). All searches were initially performed in May 2007 and updated in April 2008.
SELECTION CRITERIA
Randomised controlled trials comparing intranasal corticosteroids with placebo or no intervention or other treatment in children aged 0-12 years with moderate to severe adenoidal hypertrophy.
DATA COLLECTION AND ANALYSIS
Data from the included trials were extracted and trial quality was assessed by two authors independently. Meta-analysis was not applicable and data were summarised in a narrative format.
MAIN RESULTS
Five randomised trials, including a total of 349 patients, met the inclusion criteria of the review. All trials except one showed significant efficacy of intranasal corticosteroids in improving nasal obstruction symptoms and in reducing adenoid size. The first eight-week cross-over study showed that treatment with beclomethasone (336 micrograms/day) yielded a greater improvement in mean symptom scores than placebo (-18.5 vs. -8.5, P < 0.05) and a larger reduction in mean adenoid/choana ratio than placebo (right, -14% vs. +0.4%, p=0.002; left, -15% vs. -2.0%, p=0.0006) between week 0 and week 4. The second four-week cross-over study demonstrated that the nasal obstruction index decreased by at least 50% from baseline in 38% of patients treated with beclomethasone (400 micrograms/day) between week 0 and week 2, whereas none of the patients treated with placebo had such improvement (p<0.01). The third randomized, parallel-group trial showed that 77.7% of patients treated with mometasone (100 micrograms/day) for 40 days demonstrated an improvement in nasal obstruction symptoms and a decrease in adenoid size, such that adenoidectomy could be avoided, whereas no significant improvement was observed in the placebo group. The fourth randomized, parallel-group trial showed that eight-weeks of treatment with flunisolide (500 micrograms/day) was associated with a lager reduction in adenoid size than isotonic saline solution (p<0.05). In contrast, one randomised, parallel-group trial did not find significant improvement in nasal obstruction symptoms and adenoid size after eight weeks of treatment with beclomethasone (200 micrograms/day).
AUTHORS' CONCLUSIONS
Limited evidence suggests that intranasal corticosteroids may significantly improve nasal obstruction symptoms in children with moderate to severe adenoidal hypertrophy, and this improvement may be associated with a reduction of adenoid size. The long-term effect of intranasal corticosteroids in these patients remains to be defined.
Topics: Adenoids; Administration, Intranasal; Adrenal Cortex Hormones; Child; Humans; Hypertrophy; Nasal Obstruction; Randomized Controlled Trials as Topic
PubMed: 18646145
DOI: 10.1002/14651858.CD006286.pub2 -
The Laryngoscope Mar 1988The controversy surrounding the various approaches to palate repair continues unabated. Issues which have been studied relative to the development of normal speech...
The controversy surrounding the various approaches to palate repair continues unabated. Issues which have been studied relative to the development of normal speech following palate repair have included surgical technique and the timing of surgery. However, regardless of the various refinements in surgery, a percentage of children require secondary surgery to resolve velopharyngeal insufficiency. To date, other factors which might be responsible for the development of normal speech have been ignored. The purpose of this report is to discuss the importance of the relative size of the adenoids in relation to the success or failure of primary palatoplasty. Velopharyngeal valving in noncleft (normal) children was also observed. Eight hundred fifty children with nonsyndromic clefts and 138 children with syndromic clefts were analyzed for speech results postpalatoplasty relative to adenoid size. One hundred normal children were also studied. The data suggest a strongly positive correlation between the incidence of hypernasal resonance postpalatoplasty and relative adenoid size in the cleft children. Velar-adenoidal closure was consistently observed in both the cleft and normal children.
Topics: Adenoids; Child; Cleft Palate; Humans; Speech; Time Factors
PubMed: 3343880
DOI: 10.1288/00005537-198803000-00012 -
Journal of Dental Research Nov 2021Adenoid hypertrophy is a pathological hyperplasia of the adenoids, which may cause snoring and apnea, as well as impede breathing during sleep. The lateral cephalogram...
Adenoid hypertrophy is a pathological hyperplasia of the adenoids, which may cause snoring and apnea, as well as impede breathing during sleep. The lateral cephalogram is commonly used by dentists to screen for adenoid hypertrophy, but it is tedious and time-consuming to measure the ratio of adenoid width to nasopharyngeal width for adenoid assessment. The purpose of this study was to develop a screening tool to automatically evaluate adenoid hypertrophy from lateral cephalograms using deep learning. We proposed the deep learning model VGG-Lite, using the largest data set (1,023 X-ray images) yet described to support the automatic detection of adenoid hypertrophy. We demonstrated that our model was able to automatically evaluate adenoid hypertrophy with a sensitivity of 0.898, a specificity of 0.882, positive predictive value of 0.880, negative predictive value of 0.900, and F1 score of 0.889. The comparison of model-only and expert-only detection performance showed that the fully automatic method (0.07 min) was about 522 times faster than the human expert (36.6 min). Comparison of human experts with or without deep learning assistance showed that model-assisted human experts spent an average of 23.3 min to evaluate adenoid hypertrophy using 100 radiographs, compared to an average of 36.6 min using an entirely manual procedure. We therefore concluded that deep learning could improve the accuracy, speed, and efficiency of evaluating adenoid hypertrophy from lateral cephalograms.
Topics: Adenoids; Humans; Hypertrophy; Nasopharynx; Radiography
PubMed: 33913367
DOI: 10.1177/00220345211009474 -
Scandinavian Journal of Clinical and... Feb 2021Among the most common causes of nasal congestion in childhood is adenoid hypertrophy (AH) which leads to hypoxia. In this study, we studied plasma concentrations of...
Among the most common causes of nasal congestion in childhood is adenoid hypertrophy (AH) which leads to hypoxia. In this study, we studied plasma concentrations of hypoxia induced factor-1α (HIF-1α) in children undergoing adenoidectomy. The study included a total of 86 participants: 39 patients with AH and 47 healthy individuals. Serum HIF-1α levels (ng/mL) were measured by ELISA. HIF-1α concentrations were compared to the adenoid-nasopharyngeal ratio (ANR) of patients with AH, as recorded in the medical records. We found significantly higher concentrations of HIF-1α (0.30 ± 0.47 ng/mL) in patients with AH as compared to healthy controls (0.24 ± 0.07 ng/mL, = .011). HIF-1α levels were not significantly different regarding gender between patients with AH ( = .77) and in the control group ( = .97). In patients with AH, there was a moderately significant positive correlation between HIF-1α levels and Hb ( = .000), (correlation coefficient = 0.542). There was a positive correlation between HIF-1α and ANR in patients with AH ( = .005, = 0.439). This study indicates that AH increases HIF-1α levels. We also observed a moderately significant positive correlation between HIF-1α and ANR in patients with AH. HIF-1α levels are a potential biomarker for hypoxia in patients with AH.
Topics: Adenoidectomy; Adenoids; Child; Female; Hemoglobins; Humans; Hypoxia-Inducible Factor 1, alpha Subunit; Male; Nasopharynx; ROC Curve
PubMed: 33226863
DOI: 10.1080/00365513.2020.1849786 -
Journal of Molecular Histology Jun 2008The human adenoid epithelium forms a continuous barrier against a wide variety of exogenous antigens. In this study, to elucidate the structures of the epithelial...
The human adenoid epithelium forms a continuous barrier against a wide variety of exogenous antigens. In this study, to elucidate the structures of the epithelial barrier in the human adenoid, including M-cells, we identified M-cells using an anti-cytokeratin 20 (Ck20) antibody and investigated expression of tight junction proteins in human adenoid epithelium in vivo and in vitro. In human adenoid epithelium and primary cultures, mRNAs of occludin, junctional adhesion molecule-A, ZO-1, and claudin-1, -4, -7, and -8 were detected by reverse transcription-polymerase chain reaction, whereas claudin-2 and -9 were expressed in vitro. In the epithelium in vivo, some Ck20-positive cells were randomly observed and indicated pocket-like structures, whereas Ck7 was positive in almost cells. Transmission electron microscopy revealed that Ck20-associated gold particles could be identified in M-like cells which had short microvilli and harboured the lymphocyte in the pocket-like structure. In primary cultures in vitro, Ck20-positive cells were also detected and had a function to take up fluorescent microparticles. In Ck20-positive cells in vivo and in vitro, expression of occludin, ZO-1, claudin-1 and -7 were observed at cell borders. These results indicate that the epithelial barrier of the human adenoid is stably maintained by expression of tight junction proteins in the epithelium including Ck20-positive M-like cells.
Topics: Adenoids; Cells, Cultured; Child; Child, Preschool; Epithelial Cells; Epithelium; Gene Expression Regulation; Humans; Keratin-20; Membrane Proteins; RNA, Messenger; Reverse Transcriptase Polymerase Chain Reaction; Tight Junctions
PubMed: 18246436
DOI: 10.1007/s10735-008-9162-5 -
Archives of Disease in Childhood Nov 1978A group of 76 children who had been listed for adenoidectomy was investigated by scoring the symptoms and signs usually attributed to adenoidal hypertrophy, and removing...
A group of 76 children who had been listed for adenoidectomy was investigated by scoring the symptoms and signs usually attributed to adenoidal hypertrophy, and removing the adenoids and weighing them. With the possible exception of snoring there was no correlation between the size of the adenoids and the symptoms usually attributed to hypertrophy of this organ. We wish to acknowledge our gratitude to those consultants who allowed us access to their patients, to Dr Ian McDicken, Department of Pathology, University of Liverpool who did the histological examination, and to Mrs P. O'Brien who did the typing.
Topics: Adenoidectomy; Adenoids; Child; Child, Preschool; Female; Humans; Hypertrophy; Male; Organ Size
PubMed: 727816
DOI: 10.1136/adc.53.11.910 -
Comprehensive Therapy Dec 1983Tonsillectomy and adenoidectomy, though less frequently performed now than in the 1930s, remain among the most common surgical procedures in the United States. The need... (Review)
Review
Tonsillectomy and adenoidectomy, though less frequently performed now than in the 1930s, remain among the most common surgical procedures in the United States. The need for and benefits of tonsillectomy and adenoidectomy have been a source of controversy for several decades. Nonetheless, there are situations in which these procedures definitely are beneficial. Tonsillectomy and adenoidectomy are two distinct procedures with separate indications, and they are performed concurrently only when the specific indications for each coexist. Tonsillectomy is indicated by recurrent tonsillitis, peritonsillar abscess, chronic tonsillitis, tonsillar neoplasm, or tonsillar hypertrophy that is obstructive to the upper aerodigestive tract (respiratory distress, dysphagia, or interference with performance of an adenoidectomy). Adenoidectomy is indicated for nasal airway obstruction due to adenoidal enlargement from hypertrophic or inflammatory processes. Although correlation exists among obstructive adenoids, mouth breathing, and dentofacial anomalies, present evidence is not sufficient to justify adenoidectomy solely on the basis of craniofacial or dentofacial abnormalities. Today, elimination of an occult source of infection (once called focal infection) in patients with disorders such as rheumatic fever or serous otitis media is not a valid indication for either operation. Contraindications to tonsillectomy and adenoidectomy include bleeding disorders, familial anesthetic intolerance, velopharyngeal insufficiency, and concurrent disease that may enhance operative risks. Like all surgical procedures, tonsillectomy and adenoidectomy entail morbidity and risk of mortality. The most frequent complication of these operations is hemorrhage. Risk of mortality is approximately 0.006%. Mortality and morbidity can be minimized by appropriate preoperative evaluation, complete control of the airway with endotracheal anesthesia, and meticulous surgical technique.
Topics: Adenoidectomy; Adenoids; Humans; Hypertrophy; Palatine Tonsil; Peritonsillar Abscess; Postoperative Complications; Tonsillar Neoplasms; Tonsillectomy; Tonsillitis
PubMed: 6368111
DOI: No ID Found -
Arkhiv Patologii 2007Histological and immunohistochemical studies of surgically removed adenoid vegetations (a group included 100 children aged 2 to 14 years) have established that adenoids...
Histological and immunohistochemical studies of surgically removed adenoid vegetations (a group included 100 children aged 2 to 14 years) have established that adenoids represent pharyngeal tonsils with lymphoid tissue hyperplasia that reflects a cooperative immune response with the participation of various cell populations and subpopulations of cellular and humoral immunities. An immune response is induced outside through the specialized structures of the reticular epithelium that expresses HLA-DR molecules. The pharyngeal tonsil is shown to be not only an inductive organ of mucosal immunity, but also an organ that realizes an effector response of the immune system in complex with the mechanisms of nonspecific defense. Age-related morphologic changes reflect the preponderance of cellular immunological responses in young children and the higher humoral immunological responses as the child becomes adult. Whether there is a need for organ-preserving treatment of chronic adenoiditis is discussed.
Topics: Adenoids; Adolescent; Child; Child, Preschool; Female; Humans; Immunity; Male; Tonsillitis
PubMed: 17926580
DOI: No ID Found -
American Journal of Otolaryngology 1999The adenoid has long been recognized as an important factor in the pathogenesis of otitis media with effusion (OME). However, there is still considerable debate...
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.
Topics: Adenoids; Child; Child, Preschool; Epithelium; Female; Haemophilus influenzae; Humans; Male; Otitis Media with Effusion; Retrospective Studies
PubMed: 10203157
DOI: 10.1016/s0196-0709(99)90016-9 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Jun 2013To explore the relationship between food intolerance and adenoidal hypertrophy and accordingly to provide evidence for intolerance and adenoidal hypertrophy.
OBJECTIVE
To explore the relationship between food intolerance and adenoidal hypertrophy and accordingly to provide evidence for intolerance and adenoidal hypertrophy.
METHOD
Adenoidal hypertrophy in patients with a total of 111 cases as the experiment group, 30 cases of children with no history of allergies and allergy-related diseases and adenoidal hypertrophy symptoms as the control group, and compared the result of food intolerance between two groups.
RESULT
1) Food intolerance detected positive rate of adenoidal hypertrophy group was higher than the control group. 2) The distribution of the two groups of children in the extent of food intolerance is different. 3) Adenoid hypertrophy and how many types of the food, which is high, moderate intolerance, are unrelated. 4) The daily consumption of 14 kinds of food, the top three foods of adenoidal hypertrophy group and control group are eggs, milk, cod.
CONCLUSION
Food intolerance is the possible cause of adenoidal hypertrophy. The detection of specific IgG antibodies of food have positive significance in the prevention of adenoidal hypertrophy.
Topics: Adenoids; Adolescent; Case-Control Studies; Child; Child, Preschool; Female; Food Hypersensitivity; Humans; Hypertrophy; Immunoglobulin G; Infant; Male
PubMed: 24015630
DOI: No ID Found