Pediatric airway study: Endoscopic grading system for quantifying tonsillar size in comparison to standard adenotonsillar grading systems

Patel, Neha A.; Carlin, Kristen; Bernstein, Joseph

doi:10.1016/j.amjoto.2017.10.013

Cited by 11 publications

(12 citation statements)

References 11 publications

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“…The method of aerosol delivery in post-TL subjects relative to HOA and HYA was necessarily different, as post-TL subjects have complete separation of the airway and alimentary tracts and airway access can only be achieved through a stomal aperture in the neck. Lip-to-carina distance is 216-243 ± 11 mm (Stoneham, 1993;Varshney et al, 2011) in men and women, respectively, whereas distance from stoma to carina, likely within 60-90 mm, is considerably shorter, depending on extent of resection. Thus, the distance traversed by aerosolized stimulant is much shorter in the laryngectomy population and with fewer opportunities for deposition of inhaled particulates along the way, likely resulting in greater delivery of larger droplets (and volume) to the lower airways/carina than in our healthy control groups.…”

Section: Discussionmentioning

confidence: 97%

Impact of Tussigenic Stimuli on Perceived Upper Airway Sensation and Motor Cough Response Following Total Laryngectomy

et al. 2020

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Background: Total laryngectomy (TL) is standard intervention for carcinoma of the head and neck or, in cases of non-functional larynx, as a result of disease or radiation exposure. Laryngeal extirpation serves as a unique human model of both recurrent and superior laryngeal nerve section and offers insight into motor and sensory aspects of cough: both volitional and in response to tussigenic stimuli. While motor changes in cough function are expected among those status post-TL due to postoperative reconstruction of the upper airway, motor cough parameters have not been well described and sensory aspects of cough are unknown in this population, which provides insight into a vagal denervation model in humans. Methods: Data were collected from three groups totaling 80 adults (39 male), including 25 healthy younger adults (HYA), 27 healthy older adults (HOA), and 28 adults post-TL. Cough was elicited both upon command and in response to nebulized capsaicin. Outcome measures included urge to cough and cough airflows. Results: Kruskal-Wallis test showed that two of the three groups differed significantly by urge to cough χ 2 (2, N = 244) = 8.974, p = 0.011. Post hoc analysis showed that post-TL subjects had reduced perceived urge to cough at all concentrations of capsaicin (p < 0.05). Cough airflows were significantly reduced for post-TL subjects compared to healthy controls in all metrics except post-peak phase integral (PPPI) for which HOA and TLs were comparable under both volitional and capsaicin-induced conditions. Conclusions: These findings support the hypothesis that both cough airflow and sensations are significantly reduced in post-TL subjects when compared with HOA. Interestingly, HOA and post-TL subjects have comparably reduced UTC and cough airflows when compared to HYA. The only metric of cough airflow for which these groups differ is the PPPI, which may be a compensatory adaptation for reduced cough airflows and/or sensation.

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Section: Discussionmentioning

confidence: 97%

Impact of Tussigenic Stimuli on Perceived Upper Airway Sensation and Motor Cough Response Following Total Laryngectomy

et al. 2020

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“…Adenoidectomy can be performed under a clear visual field by both microdebrider and coblation under nasal endoscopy. As a result, surgeon is able to accurately identify the relationship between the adenoid tissue and the surrounding adjacent structures such as the tubal torus, so as to determine the precise extent of the operation 9 . The problem with microdebrider is the high risk of bleeding, which hinders the operation.…”

Section: Discussionmentioning

confidence: 99%

Adverse events of coblation or microdebrider in pediatric adenoidectomy: A retrospective analysis in 468 patients

Liu

Sun

et al. 2022

Laryngoscope Investig Oto

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Objective: Childhood obstructive sleep apnea hypopnea syndrome (OSAHS) is a common clinical disease that can cause serious complications if not treated in time.Adenoidectomy with or without tonsillectomy is the most important first line surgical treatment of obstructive sleep apnea in children. The aim of this study was to compare the differences between these two surgical procedures for adenoidectomy in terms of operation time, intraoperative blood loss, proportion of patients experiencing postoperative delayed hemorrhage, and incidence of adverse events.Study Design: Retrospective analysis.Methods: We performed a retrospective systematic analysis of patient data using the in-house electronic patient records and considered a 2-year period from 2016 to 2017. In total, 468 patients who underwent adenoidectomy under nasal endoscopy with coblation or microdebrider were identified. Results:The coblation adenoidectomy technique was associated with significantly reduced blood loss and operation time. However, incidence of fever, neck pain, and halitosis were significantly lower in the microdebrider adenoidectomy group (p < .01).The difference in the postoperative primary and secondary hemorrhage between the two groups was not statistically significant (p > .05). Conclusion:Coblation adenoidectomy had a significantly higher incidence of adverse events such as halitosis, neck pain, and fever. Therefore, otorhinolaryngologists should consider the differences in adverse events when selecting use of coblation adenoidectomy for pediatric patients.

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“…We believe the authors meant a higher sensitivity is preferred not a low sensitivity, because it leads to a low rate of false-negative cases. After all, a link between AH and upper airway obstruction has been reported [18,19], such obstruction may lead to SBD, to a compromised quality of life and general physical conditions [9,20], and that a delay in treatment also increases the need for more complex medical interventions [21,22]. Therefore, the AD 3D depiction seems to have achieved the study goal for correctly identifying enlarged adenoids, and also beat a previously [17] set up cutoff values for specificity at 90%.…”

Section: Discussionmentioning

confidence: 99%

Development, validation and application of a 3D printed model depicting adenoid hypertrophy in comparison to a Nasoendoscopy

et al. 2020

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Background: The exploration of tridimensional (3D) technology of computational tomography and the development of valid 3D printed models may improve the assessment of adenoid obstruction. The identification of an enlarged adenoid in childhood would streamline the referral of appropriately selected cases to an otolaryngologist, leading to early treatment of affected children when indicated. The objective of this study is to validate the use of a 3D printed model depicting adenoid hypertrophy based on the pediatric otolaryngologist, head and neck surgeon (OHNS) participants assessment. Methods: A cross-sectional study was performed to develop and validate 3D depictions, including print-outs, of the nasopharynx including different degrees of Adenoidal Hypertrophy (AH). The print-outs were obtained from 14 Cone-beam computed tomography (CBCT) scans of 14 children (12 boys, 2 girls; mean age of 10.61 years) representing grades 1, 2, 3, and 4 nasopharyngeal adenoidal obstructions, according to a previously Nasoendoscopy-graded (NE) classification by a licensed OHNS. The prevalence of AH in this study was 36%. Two OHNS were recruited to assess the print-outs representing two different representations of the nasopharyngeal airway, the lumen (LU) and adenoid mass (AD). LU and AD were visualized in 2D -pictures-and in 3Dprinted prototypes. Intraclass correlation was used to assess intra-and inter-reliability. The validity of our depictions was analyzed through comparison (accuracy and correlation) to the reference standard (NE). The data were clustered to calculate the sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV). Cross-tab and Pearson's T-test were performed. Results: Overall, the 3D depiction tools showed different diagnostic capabilities. AD representations showed strong (AD 2D, 75%) to almost perfect (AD 3D, 88%) accuracy compared to NE. Excellent sensitivity and specificity were observed for the AD 3D (100, 70%), as well as adequate PPV and NPV (66 and 97% respectively), with only 5% of false-negative cases. Conclusion: The use of Dolphin software for the acquisition of a 3D printed prototype of the nasopharyngeal adenoidal region seems promising. These prototypes may be a practical and readily available alternative for the assessment of the nasopharyngeal obstructed area. CBCT in children must be taken under strong solid indications. Early referral to an OHNS for a full assessment remains the main objective in children with unclear symptoms.

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Pediatric airway study: Endoscopic grading system for quantifying tonsillar size in comparison to standard adenotonsillar grading systems

Cited by 11 publications

References 11 publications

Impact of Tussigenic Stimuli on Perceived Upper Airway Sensation and Motor Cough Response Following Total Laryngectomy

Impact of Tussigenic Stimuli on Perceived Upper Airway Sensation and Motor Cough Response Following Total Laryngectomy

Adverse events of coblation or microdebrider in pediatric adenoidectomy: A retrospective analysis in 468 patients

Development, validation and application of a 3D printed model depicting adenoid hypertrophy in comparison to a Nasoendoscopy

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