Adenoid tissue rhinopharyngeal obstruction grading based on fiberendoscopic findings: a novel approach to therapeutic management

Cassano, Pasquale; Gelardi, Matteo; Cassano, Michele; Fiorella, Maria Luisa; Fiorella, R

doi:10.1016/j.ijporl.2003.07.018

Cited by 240 publications

(223 citation statements)

References 17 publications

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“…Grades of adenoid hypertrophy as described by Clemens and McMurray [6]. The above mentioned fact is well supported with a study of 98 patients by Cassano et al [17], which also shows similar findings.…”

Section: Discussionsupporting

confidence: 79%

Changing Trends in Adenoidectomy

Anand

Sarin

Singh

2013

Indian J Otolaryngol Head Neck Surg

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Adenoid hypertrophy treatment is must to alleviate chronic nasal obstruction, mouth breathing, rhinosinusitis and eustachian tube dysfunction. For proper management of this clinical entity a thorough clinical examination along with radiological and endoscopic evaluation is mandatory. Although, few children having adenoid hypertrophy respond to medical treatment, surgery remains the mainstay. An adenoidectomy can be performed by variety of techniques. Conventional adenoidectomy is by the curettage method, still practiced in many institutions, though, a recent technique of endoscopic assisted adenoidectomy by microdebrider is also getting popularized. Both the techniques have their own merits and demerits. However, which of the two surgical techniques is better, is still a matter of preference and experience of the surgeon with the technique. In the present study we will compare the conventional curettage adenoidectomy with endoscopically assisted adenoidectomy done with microdebrider in 40 pediatric patients of adenoid hypertrophy.

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Section: Discussionsupporting

confidence: 79%

Changing Trends in Adenoidectomy

Anand

Sarin

Singh

2013

Indian J Otolaryngol Head Neck Surg

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“…We excluded the <25% obstruction as grade 1 and 25%-50% as grade 2 (19). We excluded patients who had severe symptoms such as obstructive sleep apnea that required surgery.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of the effects of montelukast, mometasone furoate, and combined therapyon adenoid size: a randomized, prospective, clinical trial with objective data

Tuhanioğlu¹,

Erkan²

2017

Turk J Med Sci

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IntroductionAdenoids are pyramid-shaped enlarged masses of lymphoid tissue in the nasopharynx (1), and they form an important part of Waldeyer's tonsillar ring. Although the adenoids are very small at birth, they may exhibit growth in the first 4 years of life, depending on the development of the immune system (2).The incidence of adenoid hypertrophy is 2%-3% in children (2). Untreated adenoid hypertrophy may lead to difficulty in breathing through the nose, snoring, sleep apnea, nasal speech, ear problems, growth retardation, and craniofacial anomalies (1,2). Various methods are used for the diagnosis of adenoid hypertrophy including lateral head radiography, videofluoroscopy, palpation, and nasal endoscopy; the most recent methods are lateral radiographs and nasal endoscopy (3).Adenoidectomy is a commonly performed procedure in children that may cause complications such as early or late bleeding (4%-5%), adenoid tissue recurrence (10%-20%), and postoperative respiratory problems (27%) (2). In addition, anesthesia risks are also among the factors that should be taken into account (4). As such, medical therapy alternatives to adenoidectomy are important and must be tried before surgery.Leukotrienes are inflammatory mediators found in the respiratory system and these play a role in several allergic childhood diseases (5). Cysteinyl leukotriene receptor-1 mediates the inflammatory pathway and has been found in high rates in postoperative adenotonsillar tissues in pediatric patients with obstructive sleep apnea (6-8). Montelukast is an effective and reliable cysteinyl leukotriene receptor antagonist that can be used in oral form and has high bioavailability. It was approved by the United States Food and Drug Administration (FDA) for preventive therapy against the inflammatory component in asthma and allergic rhinitis in children aged over 1 year. Background/aim: The incidence of adenoid hypertrophy is 2%-3% in children. Adenoidectomy is a commonly performed procedure in children that may cause complications such as early or late bleeding (4%-5%), recurrence of adenoid tissue (10%-20%), and postoperative respiratory problems (27%). Therefore, medical therapy alternatives to adenoidectomy are important and must be tried before surgery. In this study, we investigated the efficacy of mometasone furoate, montelukast, and a combination of these drugs in pediatric patients with adenoid hypertrophy who were scheduled for reduction with medical therapy after not being recommended for surgery. Materials and methods:The study included 120 children with adenoid hypertrophy aged between 4 and 10 years. The patients were randomized into 4 separate groups, with 30 in each group. Group 1 received 100 µg of mometasone furoate per day, group 2 received 4/5 mg (for age) montelukast per day, and group 3 received mometasone furoate + montelukast. Medical therapy continued for 3 months in the treatment groups. Group 4, which comprised patients with mild symptoms, received no treatment and was the control group. The pre-and posttreatment ...

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“…After creating a good rapport with the child and administering adequate local anaesthesia and vasoconstriction with nasal sprays, rigid nasal endoscopy was performed using a 2.7 mm zero degree paediatric endoscope. The size of the adenoid mass was graded endoscopically as suggested by Cassano et al [7]. Grade 1 less than or equal to 25 % Grade 2 more than 25 % but less than or equal to 50 % Grade 3 more than 50 % but less than or equal to 75 % Grade 4 more than 75 % but less than or equal to 100 % Soon after, a pernasal nasopharyngeal swab was taken using a calcium alginate swab with a flexible aluminium shaft.…”

Section: Methodsmentioning

confidence: 99%

Relative Etiological Importance of Adenoid Hypertrophy Versus Sinusitis in Children with Persistent Rhinorrhoea

Maheswaran

Rupa

Ebenezer

et al. 2014

Indian J Otolaryngol Head Neck Surg

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Persistent rhinorrhoea is a common, yet often neglected, problem among Indian children. This study was designed to evaluate the relative etiological importance of adenoid hypertrophy versus sinusitis in children with persistent rhinorrhea. Additionally, the association between S. pneumoniae colonization and adenoid hypertrophy was studied. Children aged 1-14 years with persistent rhinorrhea underwent clinical evaluation, rigid nasal endoscopy and xrays of the nasopharynx and paranasal sinuses to ascertain the presence of adenoid hypertrophy and sinusitis using standard criteria. Nasopharyngeal swabbing to ascertain the presence of nasopharyngeal colonization with S. pneumoniae was also performed. Adenoid hypertrophy was more consistently associated with persistent rhinorrhea than sinusitis (p \ 0.0001). Coincident adenoid hypertrophy and sinusitis occurred in 57 %. S. pneumoniae was cultured in only 29 % of children. Up to 47 % of patients had features of nasal allergy. There was no association between S. pneumoniae colonization and adenoid hypertrophy (p = 0.1). Adenoid hypertrophy is an important cause of persistent rhinorrhea in children. Measures to evaluate for and treat adenoid hypertrophy should be instituted early to alleviate the problem of persistent rhinorrhoea in children. S. pneumoniae colonization of the nasopharynx is not a major etiological factor for persistent rhinorrhoea in these children. Nasal allergy may be a cause of adenoid hypertrophy in roughly half the children.

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Adenoid tissue rhinopharyngeal obstruction grading based on fiberendoscopic findings: a novel approach to therapeutic management

Cited by 240 publications

References 17 publications

Changing Trends in Adenoidectomy

Changing Trends in Adenoidectomy

Evaluation of the effects of montelukast, mometasone furoate, and combined therapyon adenoid size: a randomized, prospective, clinical trial with objective data

Relative Etiological Importance of Adenoid Hypertrophy Versus Sinusitis in Children with Persistent Rhinorrhoea

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