Association between adenotonsillar hypertrophy, tonsillitis and painful crises in sickle cell disease

Abstract

Objectives: To determine the prevalence of obstructive adenotonsillar hypertrophy in children and adolescents with sickle cell anemia; to investigate possible associations between the presence of more than five episodes of tonsillitis in the last 12 months and episodes of painful crises in the same period; and to compare the mean annual hemoglobin level in children and adolescents with and without obstructive adenotonsillar hypertrophy. Methods:Prospective, observational, cross-sectional study involving 85 children and adolescents with sickle cell anemia. All patients answered a questionnaire and underwent a standard otolaryngology examination, including endoscopic endonasal approach. The diagnosis of obstructive adenotonsillar hypertrophy was made according to the Brodsky scale. Results:The prevalence of obstructive adenotonsillar hypertrophy was 55.3%. Obstructive adenotonsillar hypertrophy was associated with history of difficulty in eating (76.7 vs. 23.5%, p = 0.003), presence of more than five episodes of tonsillitis in the last 12 months (70.6 vs. 29.4%, p = 0.021), loud snoring (73.0 vs. 27.0%, p = 0.004), and sleep apnea (71.8 vs. 28.2%, p = 0.005). Patients with obstructive adenotonsillar hypertrophy had more episodes of recurrent upper airway tract infection (62.5 vs. 37.5; p = 0.010). The presence of more than five episodes of tonsillitis in the last 12 months was associated with episodes of painful crises (median = 12 vs. 2, p = 0.017). There was no significant difference between mean annual hemoglobin levels of patients with obstructive adenotonsilar hypertrophy vs. nonobstructive adenotonsillar hypertrophy: 7.6 vs. 8.2 g/dL, p = 0.199. Conclusion:The prevalence of obstructive adenotonsillar hypertrophy was 55.3% in children and adolescents with sickle cell anemia; the presence of more than five episodes of tonsillitis in the last 12 months was associated with episodes of painful crises in the same period; there was no difference in the mean annual hemoglobin value among those with or without obstructive adenotonsillar hypertrophy. J Pediatr (Rio J). 2009;85(3):249-253:Tonsil, tonsillitis, hemoglobin, children, adolescents, sickle cell disease. ResumoObjetivos: Determinar a prevalência da hipertrofia adenotonsilar obstrutiva em crianças e adolescentes portadores de anemia falciforme; investigar possível associação entre presença de mais de cinco episódios de tonsilite nos últimos 12 meses e episódios de crise álgica no mesmo período; e comparar a hemoglobina anual média entre os que apresentam e os que não apresentam hipertrofia adenotonsilar obstrutiva.Métodos: Trata-se de estudo prospectivo, observacional do tipo corte transversal, com 85 crianças e adolescentes com anemia falciforme. Todos responderam questionário e avaliação otorrinolaringológica, incluindo endoscopia nasossinusal. Para o diagnóstico da hipertrofia adenotonsilar obstrutiva foram adotados os critérios de Brodsky.Resultados: A prevalência da hipertrofia adenotonsilar obstrutiva foi de 55,3%. A hipertrofia adenotonsilar obs...

Prevalência da apneia obstrutiva do sono em crianças e adolescentes portadores da anemia falciforme

“…(14) The obstruction of the upper airways by ATH is one of the principal causes of OSAS in children, (15) as shown in the present study-patients with ATH presented more episodes of obstructive events (p = 0.010), as well as obstructive events that lasted longer (p = 0.015); in addition, we found a positive correlation between the size of the pharyngeal tonsils in these patients and the AHI (p = 0.018). One group of authors (7) observed a high prevalence of obstructive ATH in children and adolescents with SCA, reporting a prevalence of obstructive palatine tonsil hypertrophy of 18.8% and a prevalence of obstructive pharyngeal tonsil hypertrophy of 53.3%. The authors attributed this elevated prevalence to the fact that individuals with SCA present a greater susceptibility to severe infections due to asplenia, to the reduced capacity for opsonization and to alterations in the reticuloendothelial system and phagocytic function.…”

Otorhinolaryngological manifestations of sickle cell disease

“…They believe that oxygen desaturation during periods of apnoea was the cause of the frequent vaso-occlusive crisis. Physicians should be aware of possible exacerbation of SCD by sleep apnoea syndrome there is high prevalence (55%) of obstructive ATH in children and adolescents with sickle cell disease, while the prevalence of obstructive palatine tonsil hypertrophy is 19%, and prevalence of adenoid hypertrophy is 55% [10].…”

Preoperative transfusion versus no transfusion policy in sickle cell disease patients: a randomized trial

“…1 Patients with SCD commonly have adenotonsillar hypertrophy and chronic tonsillitis, with a prevalence ranging from 25 to 55%. 2,3 Though the causes of adenotonsillar hypertrophy are still unclear, numerous mechanisms are proposed such as compensatory hypertrophy of the lymphoid tissue for functional asplenia, reactive enlargement due to repeated infections and increased hematopoietic needs because of chronic hemolytic anemia. 4,5 Adenotonsillar hypertrophy can increase the risk of obstructive sleep apnea, hypoxemia, dehydration, and predisposes to several complications in patients with SCD including vaso-occlusive crisis (VOC), pulmonary hypertension, acute chest syndrome (ACS), priapism or even stroke.…”