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Medical Principles and Practice :... 2007This study was undertaken to investigate the presence and nature of granulomatous changes in the adenotonsillar tissues and their relation to systemic disorders.
OBJECTIVES
This study was undertaken to investigate the presence and nature of granulomatous changes in the adenotonsillar tissues and their relation to systemic disorders.
MATERIALS AND METHODS
The study was a retrospective clinicopathological review; 21,410 specimens of tonsil and adenoid tissue were subjected to histological examination during the period from 1995 to 2003. Twenty-three cases of tonsillar and adenoid granuloma (12 males and 11 females) were identified. Haemotoxylin and eosin stains were reviewed and clinical features noted.
RESULTS
Of 23 cases, 11 were adenotonsillectomies, 10 tonsillectomies, 1 adenoidectomy and 1 excision biopsy of the right tonsil. Histologically, the slides reviewed showed 4 types of granulomatous inflammation that can affect the adenotonsillar tissues. The most common type was non-caseating epithelioid granulomas. Clinically, 22 cases presented with symptoms of chronic tonsillitis, nasal obstruction and obstructive sleep apnoea. None had any systemic granulomatous disorders. Only 1 case had tuberculosis.
CONCLUSION
In all the cases but one there was no obvious systemic aetiology for the granulomatous changes in the adenotonsillar tissues. Hence, the cost effectiveness of clinicopathological examination of the resected adenoid and tonsil is still questionable.
Topics: Adenoidectomy; Adenoids; Adolescent; Adult; Aged; Child; Child, Preschool; Female; Granuloma; Humans; Male; Middle Aged; Nasal Obstruction; Retrospective Studies; Sleep Apnea, Obstructive; Tonsillectomy; Tonsillitis
PubMed: 17917445
DOI: 10.1159/000107750 -
Journal of Otolaryngology - Head & Neck... Sep 2016Deformity in the dental arc and facial skeleton by adenoid hypertrophy due to chronic mouth breathing is a well-known process. Most of the related studies have been...
BACKGROUND
Deformity in the dental arc and facial skeleton by adenoid hypertrophy due to chronic mouth breathing is a well-known process. Most of the related studies have been based on cephalometric analyses. The aim of this study is to detect the presence of skeletal deformities on the soft tissue by analyzing distances and angles on photographs.
METHODS
Ninety-seven children having between 25 and 100 % of adenoids, ages 4-12 years (48 boys, 49 girls), and 90 cases having 0-25 % adenoid tissue, ages 4-12 years (54 boys, 36 girls), were studied by clinical history, physical examination (including endoscopy), and standardized clinical photographs. The children and parents were asked if any of the following were present in the children: snoring, sleep apnea, daytime sleepiness, poor school performance, mouth breathing during sleep, smoking parents, and restlessness during sleep.
RESULTS
The assessment of linear and angular measurements on the clinical photographs showed, in the group having thicker adenoids compared with controls, a statistically significant increase in the distance between nasion and tip and nasion and subnasale and in the angle between Frankfort horizontal plane-gnathion-angulus mandible; there was also a statistically significant decrease in the distance between endocanthion and exocanthion and the angles between tragion-angulus mandible and gnathion and between nasion-angulus mandible and gnathion.
CONCLUSIONS
The analyses showed a significant increase in the anterior face height and increase in the angle between Frankfort horizontal plane-gnathion-angulus mandible and a retropositioned and posterior-rotated mandible due to thicker adenoids.
TRIAL REGISTRATION
2010/140 Date: 04 January 2010.
Topics: Adenoids; Child; Child, Preschool; Face; Female; Humans; Hypertrophy; Male; Mandible; Maxillofacial Development; Photography
PubMed: 27647047
DOI: 10.1186/s40463-016-0161-3 -
Archivos Argentinos de Pediatria Jan 2015Adenotonsillectomy is the most common surgical procedure in otolaryngology.The main indication for this procedure is upper airway obstruction associated with... (Comparative Study)
Comparative Study
INTRODUCTION
Adenotonsillectomy is the most common surgical procedure in otolaryngology.The main indication for this procedure is upper airway obstruction associated with hypertrophic tonsils and/or adenoids.
OBJECTIVES
To describe the differences in quality of life before and after an adenoidectomy and/or tonsillectomy and compare it with that of healthy children.
POPULATION AND METHODS
All children aged 1 to 17 years old hospitalized for an elective surgery between July 2012 and April 2014 were enrolled.They were compared to a control group of children in the same age range. The survey used was validated in Spanish (OSA-18) and has been especially designed to establish a relationship between obstructive sleep apnea and quality of life in pediatrics.
RESULTS
Eighty-five surgery patients and 100 healthy control children were assessed. The impact on quality of life was mild in 37.6% of children, moderate in 32.9%, and severe in 29.4%,while it was mild for 96% of the control group.The average±SD of the total pre-surgery score was 67.5±20.3 (95% confidence interval [CI]:63.13-71.88). The average post-surgery scores were 37.9±21.4 (95% CI: 33.24-42.48) and 37.25±23.9 (95% CI: 32.19-42.33) at 3 and 6 months,respectively (p<0.001). The average score for the control group was 31.2±13.2 (95% CI: 28.6-33.8) and was significantly different from the post-surgery groups (p=0.03).
CONCLUSIONS
Quality of life was reduced in children with a surgical indication for symptomatic adenotonsillar hypertrophy, while it was significantly improved after the surgery.
Topics: Adenoidectomy; Adenoids; Adolescent; Child; Child, Preschool; Female; Humans; Hypertrophy; Infant; Male; Palatine Tonsil; Prospective Studies; Quality of Life; Sleep Apnea, Obstructive; Tonsillectomy
PubMed: 25622157
DOI: 10.5546/aap.2015.eng.21 -
Head and Neck Pathology Jun 2022Adenoid ameloblastoma is a hybrid odontogenic tumour showing histopathological features of both ameloblastoma and adenomatoid odontogenic tumour (AOT), with... (Review)
Review
Adenoid ameloblastoma is a hybrid odontogenic tumour showing histopathological features of both ameloblastoma and adenomatoid odontogenic tumour (AOT), with approximately 40 cases reported in the literature. The aims of the report are to illustrate the diagnostic challenges of adenoid ameloblastoma using three new cases and to analyze evidence in literature to consider adenoid ameloblastoma as a new sub type of ameloblastoma. A literature review was performed with the key words-adenoid ameloblastoma, hybrid/composite odontogenic tumours, hybrid ameloblastoma and adenomatoid odontogenic tumour, ameloblastoma with inductive changes, dentinoid and dentinoma to select the cases compatible with the diagnosis of adenoid ameloblastoma. Out of the 40 cases reported in literature, 31 cases with sufficient information and 3 new cases were analyzed. Out of the 34 adenoid ameloblastomas majority of tumours (76.5%) occurred in adults with age ranging from 25 to 55 years. Slight female predilection with a male:female ratio of 0.9:1 was observed. Approximately, 64.7% occurred in the mandible. Radiologically, 82.4% of adenoid ameloblastomas presented as radiolucent lesions while 47.1% occurred with ill-defined margins and cortical perforation at diagnosis. Histopathologically, 70.8% of tumours presented as plexiform ameloblastomas, while duct like structures/glandular structures were the commonest feature supportive of adenomatoid odontogenic tumour observed in overwhelming majority of 95.9% of adenoid ameloblastomas. 91.6% of tumours showed inductive change in the form of dentinoid. Further, 45.4% of the tumours developed at least one recurrence following surgical excision. The report presents literature review based evidence to show the existence of adenoid ameloblastoma, which is demographically similar to conventional ameloblastoma but with histopathological differences and presenting with higher rate/multiple recurrences, indicating its biological aggressiveness. Thus, we would like to propose the inclusion of adenoid ameloblastoma as a sub type of ameloblastoma in the next revision of the WHO odontogenic tumour classification.
Topics: Adenoids; Adult; Ameloblastoma; Female; Humans; Male; Mandible; Middle Aged; Odontogenic Tumors
PubMed: 34282559
DOI: 10.1007/s12105-021-01358-w -
The Israel Medical Association Journal... Jun 2019Hypertrophy of the adenoids is common in children. However, the anatomical site makes the adenoids difficult to assess, and studies evaluating the subject are ambiguous,... (Comparative Study)
Comparative Study
BACKGROUND
Hypertrophy of the adenoids is common in children. However, the anatomical site makes the adenoids difficult to assess, and studies evaluating the subject are ambiguous, especially with regard to the use of X-ray as an evaluation tool.
OBJECTIVES
To compare medical history with clinical, radiological, and endoscopic evaluations of the adenoids and compare obstructed and non-obstructed children relative to the assessment methods.
METHODS
A prospective comparative study was conducted with children who were suspected of having enlarged adenoids. All parents completed a medical history questionnaire and patients underwent clinical evaluation based on Nasal Obstruction Index (NOI) scores, radiological assessment based on the lateral neck X-ray adenoid-nasopharynx (A/N( ratio, and endoscopic evaluation based on anatomical relations. Spearman correlations were used for comparison between methods.
RESULTS
We evaluated 36 patients, median age 5.33 years. Correlation measurements for clinical assessment and questionnaire (r = 0.582, P < 0.0001), questionnaire and endoscopy (r = 0.462, P = 0.005), and clinical assessment and nasal endoscopy (r = 0.621, P < 0.0001) were statistically significant. None of the parameters correlated with the radiological findings. A statistically significant difference was found between the obstructed and non-obstructed groups in both questionnaire (P = 0.004) and clinical assessment (P < 0.0001). However, no difference was found in X-ray measurements.
CONCLUSIONS
Lateral neck X-ray measurements were not correlated to symptoms, signs, or endoscopic findings. Therefore, medical professionals should use lateral neck radiography when considering adenoidectomy only on a highly selective basis.
Topics: Adenoids; Child; Child, Preschool; Cross-Sectional Studies; Endoscopy; Female; Humans; Hypertrophy; Male; Medical History Taking; Nasal Obstruction; Prospective Studies; Radiography
PubMed: 31280504
DOI: No ID Found -
The Journal of International Medical... Dec 2020We explored the relationship between enuresis and obstructive sleep apnea-hypopnea syndrome (OSAHS) in children and influencing factors of enuresis with OSAHS.
OBJECTIVE
We explored the relationship between enuresis and obstructive sleep apnea-hypopnea syndrome (OSAHS) in children and influencing factors of enuresis with OSAHS.
METHODS
We recruited 196 children ≥5 years old from the otolaryngology outpatient department, who experienced snoring and underwent nasopharynx lateral radiography and in-laboratory polysomnography. We analyzed correlations between the apnea-hypopnea index (AHI) and lowest oxygen saturation (L-SaO2) with age, body mass index (BMI), tonsil size, and adenoidal-nasopharyngeal (A/N) ratio using the Pearson correlation test. Differences in severe OSAHS prevalence, age, AHI, L-SaO2, tonsil size, and A/N ratio between children with and without enuresis were assessed using the chi-square test and t-test. Risk factors of enuresis were analyzed using logistic regression. Follow-up was conducted to assess remission in children with enuresis after adenotonsillectomy.
RESULTS
BMI, tonsil size, and A/N ratio were correlated with AHI and L-SaO2. Severe OSAHS prevalence, AHI, tonsil size, and A/N ratio were higher and L-SaO2 were lower in children with enuresis. Logistic regression showed that BMI, AHI, tonsil size, and sleep apnea were risk factors for enuresis.
CONCLUSIONS
Our study findings showed that enuresis was associated with OSAHS in children. Adenotonsillectomy may improve the symptoms of enuresis.
Topics: Adenoids; Child; Child, Preschool; Enuresis; Humans; Polysomnography; Sleep Apnea, Obstructive; Snoring
PubMed: 33290113
DOI: 10.1177/0300060520977407 -
California Medicine Nov 1949Edema is the chief factor in enlargement of tonsils of children with allergic disease. In the absence of infection tonsillectomy and adenoidectomy are contraindicated in...
Edema is the chief factor in enlargement of tonsils of children with allergic disease. In the absence of infection tonsillectomy and adenoidectomy are contraindicated in the allergic child except when obstruction is present. Infection produces one of two distinct patterns when it influences allergic states, the pattern depending upon the nature of the infectious disease. Chronic infection of the upper respiratory tract in the allergic child produces a pattern simulating that of acute respiratory infection.If, in the presence of infected tonsils and adenoids, management of the allergic state does not produce results, tonsillectomy and adenoidectomy are indicated. Management of the allergic disease must be continued postoperatively. Whether infection is present or absent, allergic disease can be controlled only through competent management of it.
Topics: Acute Disease; Adenoidectomy; Adenoids; Anaphylaxis; Child; Child, Preschool; Chronic Disease; Humans; Hypersensitivity; Hypertrophy; Palatine Tonsil; Postoperative Period; Respiratory Tract Infections; Tonsillectomy
PubMed: 15392819
DOI: No ID Found -
California Medicine May 1953It is doubtful that the tonsils or adenoids contribute sufficiently to immunity or to hematopoiesis to warrant withholding adenotonsillectomy when there is need for the...
It is doubtful that the tonsils or adenoids contribute sufficiently to immunity or to hematopoiesis to warrant withholding adenotonsillectomy when there is need for the operation. Focal infection, rheumatic fever and allergic disease must be evaluated in the individual case. A seldom discussed reason for operation is the prophylaxis or treatment of malformation of the nose, sinuses, mouth and jaw. Well defined indications for adenotonsillectomy include frequent occurrence of infection, peritonsillar abscess, cervical lymph node disease believed caused by tonsillar infection, otitis media, and hypertrophy sufficient to embarrass swallowing or breathing. The operation may also be indicated in certain cases of impaired hearing, halitosis, or anorexia, and sometimes for carriers of diphtheria. Psychic trauma can be obviated by proper preparation of a child for the operation he is to undergo. There is a good evidence of evidence of relationship between recent adenotonsillectomy and infection with poliomyelitis-and a good deal of evidence to the contrary. Nationwide rules cannot be established on the basis of the evidence presented thus far. Since in many cases it is unwise to put off adenotonsillectomy, each case in each community in each season must be evaluated separately.
Topics: Adenoidectomy; Adenoids; Child; Diphtheria; Focal Infection; Halitosis; Humans; Hypersensitivity; Hypertrophy; Lymph Nodes; Male; Mouth; Nasal Surgical Procedures; Nose; Palatine Tonsil; Peritonsillar Abscess; Poliomyelitis; Rheumatic Fever; Tonsillectomy
PubMed: 13042678
DOI: No ID Found -
Scientific Reports May 2022Revealing the structural morphology and inner flow field of the upper airway is important for understanding obstructive sleep apnea-hypopnea syndrome (OSAHS) incidence...
Revealing the structural morphology and inner flow field of the upper airway is important for understanding obstructive sleep apnea-hypopnea syndrome (OSAHS) incidence phenomena and pathological diagnosis in children. However, prior work on this topic has been focused on adults and the findings cannot be directly extrapolated to children because of different inducing factors. Therefore, this paper employs a simulation method to investigate upper airway flow characteristics of childhood OSAHS. It is found that the Reynold number changes highly throughout the whole upper airway, and the laminar assumption is no longer suitable for low Reynold number flow, which is much unlike classic fluid mechanics. Turbulent models of Standard k-ω and Spalart-Allmaras were developed prior to suggestion. The simulation is validated by experiments with an error of approximately 20%. Additionally, carried out in this analysis is the influence of adenoidal hypertrophy with different narrow levels. The cross-sectional area, flow velocity, pressure drop and volume rate will change greatly when the narrow level is above 64% of the upper airway, which can be a quantitative explanation for medical intervention if adenoid hypertrophy blocks 2/3 of the upper airway in the common clinical judgment of otorhinolaryngology. It is expected that this paper can be a meaningful instruction on OSAHS surgery plan making as well as recovery evaluation postoperatively.
Topics: Adenoids; Adult; Child; Computer Simulation; Humans; Hypertrophy; Nose; Sleep Apnea, Obstructive; Syndrome
PubMed: 35513462
DOI: 10.1038/s41598-022-10367-w -
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