Clinical characteristics of obstructive sleep apnea versus infectious adenotonsillar hyperplasia in children

Johnston, James; McLaren, Holly; Mahadevan, Murali; Douglas, Richard

doi:10.1016/j.ijporl.2018.11.004

Cited by 16 publications

(23 citation statements)

References 33 publications

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“…Some studies have reported higher weights and higher BMI's in patients with OSA, which might indicate that the reason for OSA in these children was more related to obesity than to adenotonsillar hypertrophy . Others have reported lower age, weight and BMI at the time of surgery in children with OSA, possibly because the children were failing to thrive or the symptoms and signs were being noticed earlier due to their severity .…”

Section: Discussionmentioning

confidence: 99%

Risk factors for children requiring adenotonsillectomy and their impact on postoperative complications: a retrospective analysis of 2000 patients

et al. 2019

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Summary Adenotonsillectomies are commonly performed procedures and sleep‐disordered breathing is becoming increasingly important as an indication for surgery. Because of the higher risks in patients with obstructive sleep apnoea, the required level of postoperative care for these patients is currently under discussion, and better identification of patients at risk may reduce unnecessary postoperative monitoring. To evaluate the influence of obstructive sleep apnoea, and other risk factors, on peri‐operative complications in children requiring adenotonsillectomy, we performed a retrospective case‐control study that included 1995 patients treated between January 2009 and June 2017. In our analysis, young age (OR 3.8, 95%CI 2.1–7.1), low body weight (OR 2.6, 95%CI 1.5–4.4), obstructive sleep apnoea (OR 2.4, 95%CI 1.5–3.8), pre‐existing craniofacial or syndromal disorders (OR 2.3, 95%CI 1.4–3.8) and adenotonsillectomy, compared with adenoidectomy alone, (OR 7.9, 95%CI 4.7–13.1) were identified as risk factors for complications during or after surgery, p < 0.001. All 13 patients suffering from complications more than 3 h postoperatively had obstructive sleep apnoea plus at least one more of these risk factors. Patients at risk of postoperative complications can therefore be identified by several criteria pre‐operatively, and should be monitored postoperatively using pulse oximetry overnight. For all other patients, postoperative observation on a surgical ward without extra monitoring is sufficient. Admission to paediatric intensive care should be reserved for patients suffering serious intra‐operative complications.

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Section: Discussionmentioning

confidence: 99%

Risk factors for children requiring adenotonsillectomy and their impact on postoperative complications: a retrospective analysis of 2000 patients

et al. 2019

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“…AR has clinical relevance as is frequently associated with comorbidities, including other allergies, asthma, rhinosinusitis, recurrent respiratory infections, otitis, adenoid hypertrophy (AH) and tonsillar hypertrophy (TH), as recently reported by several recent studies [72][73][74][75]. Moreover, the possible correlation between AR and AH-TH has been investigated by some studies which reported a positive association between the two disorders [76][77][78][79][80]. Atopy, such as the genetic predisposition to allergic diseases, is also common in AR children.…”

Section: Allergic Rhinitismentioning

confidence: 98%

Inflammation, infection, and allergy of upper airways: new insights from national and real-world studies

Varricchio¹,

Mantia

Brunese³

et al. 2020

Ital J Pediatr

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The upper airways (UA) should be considered as a functional unit. Current functional anatomy divides URT in three, mutually dependent, "junction boxes": i) the ostio-meatal complex (OMC), ii) the spheno-ethmoidal recess (SER), and iii) the rhinopharynx (RP). Correct ventilation and effective mucociliary clearance of these sites significantly affect the healthy physiology of the entire respiratory system. The OMC, SER, and RP obstruction is the first pathogenic step in the inflammatory/infectious cascade of UA disorders. The inflammation of the respiratory mucosa is the main pathogenic factor for airway obstruction. Moreover, bacterial biofilm (a strategy modality of bacterial survival) is an important local cause of systemic antibiotic ineffectiveness, recurrent infections, and antibiotic resistance. Health microbiota guarantees UA wellness; on the contrary, dysbiosis promotes and worsens UA infections. Allergy, namely type 2 inflammation, is a common cause of UA obstruction such as promoting in turn infections. Fiberoptic endoscopy is a mandatory diagnostic tool in clinical practice. Nasal cytology, mainly concerning flow cytometry, allows defining rhinitis phenotypes so allowing a precision medicine approach. Several conventional therapeutic approaches are available, but efficacy and safety should be ever properly considered before the prescription. Also, complementary medicine plays a fruitful role in the management of UA diseases. National and real-world studies are reported and discussed as they may be useful in daily clinical practice.

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“…AR is frequently associated with relevant comorbidities, including other allergies, rhinosinusitis, recurrent respiratory infections, otitis, adenoid hypertrophy (AH) and tonsillar hypertrophy (TH), as recently reported by several recent studies (2)(3)(4)(5)(6). Moreover, the possible correlation between AR and AH-TH has been investigated by some studies which reported a positive association between the two disorders (7)(8)(9)(10)(11). Familiar atopy is also common in AR children.…”

Section: Introductionmentioning

confidence: 90%

Can an otorhinolaryngological visit induce the suspect of allergic rhinitis in children?

Ameli

Tosca

Licari

et al. 2019

Eur Ann Allergy Clin Immunol

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Allergic rhinitis (AR) is very frequent in childhood. AR is commonly associated with some co-morbidities and typical clinical features. This study aimed to test the hypothesis whether an otorhinolaryngological (ORL) visit could induce the suspect of AR. Globally, 1,002 children (550 males, mean age 5.77 years) were consecutively visited at an ORL clinic. Clinical visit, nasal endoscopy, and skin prick test were performed in all patients. In particular, history investigated atopic familiarity, birth, feeding type, passive smoking, comorbidities, including asthma, respiratory infections, otitis media, respiratory sleep disorder. Endoscopy assessed the tonsil and adenoid volume, turbinate contacts, mucosal color, and nasal discharge. Univariate and multivariate analysis were performed. The study showed that 547 (54.6%) children had AR. Some parameters were predicting factor for suspecting AR: middle turbinate contact (OR=9.27), familial atopy (OR=6.24), pale nasal mucosa (OR=4.95), large adenoid volume (OR=3.02 for score 4), and asthma co-morbidity (OR=2.95). In conclusion this real-life study showed that during an ORL visit it is possible to suspect AR in children with turbinate hypertrophy, familial atopy, nasal pale mucosa, adenoid enlargement, and asthma comorbidity.

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Clinical characteristics of obstructive sleep apnea versus infectious adenotonsillar hyperplasia in children

Cited by 16 publications

References 33 publications

Risk factors for children requiring adenotonsillectomy and their impact on postoperative complications: a retrospective analysis of 2000 patients

Risk factors for children requiring adenotonsillectomy and their impact on postoperative complications: a retrospective analysis of 2000 patients

Inflammation, infection, and allergy of upper airways: new insights from national and real-world studies

Can an otorhinolaryngological visit induce the suspect of allergic rhinitis in children?

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