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Background and Objectives: Adenotonsillar enlargement is a common cause of pediatric illnesses, including obstructive respiratory disease and recurrent airway infection. The current tonsil grading systems evaluate tonsil size, but the correlation with actual tonsillar size in a clinical setting has not been established.Materials and Method: Between May and July of 2018, we recruited 31 children who underwent adenotonsillectomy with no major craniofacial abnormalities. The actual size of the palatine tonsils, the long (L1) and short (S1) axes of the tonsil beyond the anterior pillar, and the real axes (L2 and S2) after tonsil extraction from the fossa were measured during surgery. Adenoid size was determined by measuring the adenoid-nasopharynx (AN) ratio through lateral view x-ray of the neck.Results: Though S1 was related to the Friedman scale (p

Tonsillitis is an inflammation of the palatine tonsils originating from the Waldeyer ring. Eustachian tubal tonsils, lingual tonsils, palatine tonsils, and pharyngeal tonsils are the composition of the lymph glands in the oral cavity and are the waldayer ring's composition. Tonsillectomy is one type of ENT (Ear Nose and Throat) surgery most often performed on children, adolescents, and adults. Tonsillectomy is also a procedure that can be done if there is a chronic infection or a recurring infection. This study aims to determine the characteristics of age, sex, tonsillar size of Tonsillitis patients in Tonsillectomy at Pertamina Bintang Amin Hospital in Bandar Lampung. Method: The research method used is a quantitative descriptive analysis method with data taken retrospectively. The source of the research data is secondary data obtained from medical records of patients diagnosed with Tonsilitis in Tonsillectomy at Pertamina Bintang Amin Hospital in Bandar Lampung. A total of 92 patients. Data collection in November 2019 - finished. Analysis through univariate analysis. The results show the characteristics of Tonsillitis Patients in Tonsillectomy in Pertamina Bintang Amin Hospital are 12-25 years of age (52.5%) and 6-11 years of age 30 (3 2.6%) and ages 26-45 5 years (5.4%) and ages 46 - 65 years 3 (3.3%), with 50 (54.3%) female and 42 (45.3%) men, with T3 tonsil size was 47 (51.1%), and T2 size was 27 (29.3%), and T4 was 18 (19.6), and T1 was 0 (0%). Characteristics of Tonsillitis Patients in Tonsillectomy at Pertamina Bintang Amin Hospital in Bandar Lampung, the most age was 12-25 years old, and the most sex is in women, the most tonsil size in T3 size was 47 people.

Chronic tonsillitis is a recurring infection that most often occurs in the throat, especially in children and adolescents. Tonsillectomy is one type of Ear Nose Throat (ENT) surgery that is most often performed on children, adolescents and adults. Tonsillectomy is also a procedure that can be done if there is a chronic infection or a recurring infection. Factors that can affect tonsillectomy are age, major complaints and size of the tonsils. This study was conducted to determine the relationship of tonsillectomy with age, major complaints and the size of tonsils in chronic tonsillitis patients in RSPBA of Lampung city in 2018-2019. This study uses cross-sectional, quantitative, analytic methods with secondary tonsillitis data collection. Sampling uses a total sampling technique. Data collection was done by recording data in the form of major complaints, age and size of the tonsils and analyzed using the chi-square test. The results showed that 109 tonsillitis patients showed that the majority of tonsillitis patients were group: age ≤ 18 years as many as 73 people, tonsillectomy was 66 people (90.4%), main complaints >1 were 90 people, tonsillectomy was 83 people (83 people) 92.2%) and T3-T4 tonsil size of 70 people, with tonsillectomy of 65 people (92.2%). The results also showed that there was a relationship between tonsillectomy between age (p = 0.01, OR = 3.626), main complaints (p = 0.00, OR = 13.175), tonsil size (p = 0.00, OR = 5.778) in chronic tonsilits patients at RSPBA Bandar Lampung in 2018-2019. This study concluded that there was a significant relationship between tonsillectomy with age, major complaints and the size of tonsils in chronic tonsillitis patients in Bandar Lampung RSPBA 2018-2019 with a p-value

OBJECTIVE: 1) Determine the correlation of awake tonsil scores and pre-adenotonsillectomy sleep endoscopy findings and 2) Assess the relationship between polysomnographic adenotonsillectomy outcomes with awake tonsil scores and sleep endoscopy ratings of tonsil and adenoid obstruction. STUDY DESIGN: Retrospective case series with chart review SETTING: Tertiary care children’s hospital SUBJECTS AND METHODS: Children ages 1–18 years who underwent sleep endoscopy and adenotonsillectomy from 1/1/2013 to 8/30/2016 were included. Pre-adenotonsillectomy sleep endoscopy findings were scored with the Sleep Endoscopy Rating Scale. Awake tonsil scores and sleep endoscopy ratings were compared using Spearman correlation. Associations between changes in pre- and post-adenotonsillectomy polysomnography parameters and a) awake tonsil scoring and b) sleep endoscopy scoring were assessed using one-way analysis-of-variance and linear regression. RESULTS: N = 36, mean age 6.8 ± 4.3 years, 68% male, 44% obese. Awake tonsil scores and sleep endoscopy ratings were strongly correlated (R = 0.58, P=0.003). Awake tonsil scores were not associated with changes in any polysomnography parameters after adenotonsillectomy (all p > 0.05) while sleep endoscopy ratings of adenotonsillar obstruction were significantly associated (all p < 0.05, R-squared 0.16–0.35). Patients with minimal adenotonsillar obstruction during sleep endoscopy had less improvement than those with partial or complete obstruction (mean obstructive apnea-hypopnea index change −8.2 ± 11.5 vs. −15.9 ± 14.3 and −46.8 ± 31.3, respectively, p

This study was performed to establish the reference for tonsil size in children, including neonates, without tonsil-associated symptoms, in relation to anthropometric indices (sex/age/height/weight/body mass index).We evaluated the size of both tonsils in 362 children by ultrasonography. Tonsil size was calculated as 0.523abc (a, transverse diameter on the transverse image; b, longitudinal diameter on the transverse image; c, longitudinal diameter on the longitudinal image) and compared between each age year using the Wilcoxon signed rank sum test with Bonferroni correction. We evaluated the relationships between tonsil size and anthropometric indices.Among these children, tonsil size was significantly increased by the age of 3 years (0-1 vs 1-2 [volume (right) = 210.15 ± 205.27 vs 737.83 ± 335.72 mm, P (right) < 0.0001 and volume (left) = 218.26 ± 207.23 vs 645.33 ± 240.31 mm, P (left) < 0.0001]; 1-2 vs 2-3 [volume (right) = 737.83 ± 335.72 vs 1073.86 ± 468.21 mm, P (right) = 0.004 and volume (left) = 645.33 ± 240.31 vs 1109.73 ± 563.20 mm, P (left) < 0.0001]). Although there was a tendency for the tonsil size to increase in years 3-12, there was no significant difference. Using single linear regression analysis, we found a correlation between tonsil size and age (r right/left = 0.67/0.65), height (r right/left = 0.72/0.70), and weight (r right/left = 0.66/0.64), with height having the strongest correlation.In conclusion, tonsil size significantly increased by 3 years of age. Tonsil size was correlated with anthropometric indices, with height showing the strongest correlation.

The aim of this study was to evaluate the association between genioglossus activity during sleep onset and the outcome of uvulopalatopharyngoplasty (UPPP) in patients with obstructive sleep apnea.Case series with planned data collection.Sleep medical center.Forty-four patients with obstructive sleep apnea underwent overnight polysomnography with synchronous genioglossus electromyography (GGEMG) with intraoral electrodes. In addition, all patients underwent revised UPPP with uvula preservation and were followed up with polysomnography at least 3 months after surgery.Twenty-five patients (56.8%) were responders. Multiple regression analysis revealed that increasing tonsil size (odds ratio [OR], 0.086;Sleep-onset GGEMG and tonsil size are both important in deciding outcomes of UPPP. Patients with tonsil size III or IV and higher sleep onset may be more suitable candidates for UPPP because of the higher probability of surgical success.

Purpose To evaluate the effects of short-term postoperative continuous positive airway pressure (CPAP) on the outcomes of velopharyngeal surgery for obstructive sleep apnea (OSA). Materials and methods This study included 119 OSA patients who underwent velopharyngeal surgery. Based on the results of postoperative pulse oximetry, the patients were divided into 3 groups: intervention, control, and observation. Patients with oxygen desaturation index (ODI) > 10 and lowest SpO2 Results Baseline data showed no significant differences between the three groups except the observational group showed a significantly larger tonsil size relative to the intervention and control groups. However, there was no significant difference in terms of tonsil size between the control and intervention groups. The surgical success rate of the intervention group was 80.65%, whereas it was 55.17% in the control group, with significant difference. The success rate of the observation group was 85.71% which was significantly different from that of the control group, but not the intervention group. Conclusion Short-term postoperative CPAP treatment may improve the outcomes of velopharyngeal surgery for OSA in patients who have respiratory events related hypoxia after surgery. Further studies are necessary for the underlying mechanisms.

Efficient screening for severe obstructive sleep apnea (OSA) is important for children with snoring before time-consuming standard polysomnography. This retrospective cross-sectional study aimed to compare clinical variables, home snoring sound analysis, and home sleep pulse oximetry on their predictive performance in screening severe OSA among children who habitually snored. Study 1 included 9 (23%) girls and 30 (77%) boys (median age of 9 years). Using univariate logistic regression models, 3% oxygen desaturation index (ODI3) ≥ 6.0 events/h, adenoidal-nasopharyngeal ratio (ANR) ≥ 0.78, tonsil size = 4, and snoring sound energy of 801–1000 Hz ≥ 22.0 dB significantly predicted severe OSA in descending order of odds ratio. Multivariate analysis showed that ODI3 ≥ 6.0 events/h independently predicted severe pediatric OSA. Among several predictive models, the combination of ODI3, tonsil size, and ANR more optimally screened for severe OSA with a sensitivity of 91% and a specificity of 94%. In Study 2 (27 (27%) girls and 73 (73%) boys, median age, 7 years), this model was externally validated to predict severe OSA with an accuracy of 76%. Our results suggested that home sleep pulse oximetry, combined with ANR, can screen for severe OSA more optimally than ANR and tonsil size among children with snoring.

This study was carried out to measure the volume of the palatine tonsil in otorhinolaryngology outpatients with complaints of adenotonsillar hypertrophy and chronic tonsillitis who had undergone tonsillectomy. To date, no study has investigated palatine tonsil volume using different methods and compared with subjective tonsil size in the literature. For this purpose, we used three different methods to measure palatine tonsil volume. The correlation of each parameter with tonsil size was assessed. After tonsillectomy, palatine tonsil volume was measured by Archimedes, Cavalieri and Ellipsoid methods. Mean right-left palatine tonsil volumes were calculated as 2.63 +/- 1.34 cm(3) and 2.72 +/- 1.51 cm(3) by the Archimedes method, 3.51 +/- 1.48 cm(3) and 3.37 +/- 1.36 cm(3) by the Cavalieri method, and 2.22 +/- 1.22 cm(3) and 2.29 +/- 1.42 cm(3) by the Ellipsoid method, respectively. Excellent agreement was found among the three methods of measuring volumetric techniques according to Bland-Altman plots. In addition, tonsil grade was correlated significantly with tonsil volume.

Objective The goal of this study is to determine the correlation of clinical symptoms of UAO (upper airway obstruction) with radiographic evaluation of adenoidal obstruction and tonsil size in children with adenotonsillar hypertrophy and to evaluate the usefullness of lateral neck radiography. Study design Prospective study. Setting Haydarpasa Numune Research and Education Hospital, Istanbul, Turkey. Subjects and methods This study analyses 95 children with one or more of the symptoms of UAO. Clinical symptoms were assessed by a standardized questionnaire evaluating the severity of symptoms. All patients underwent otolaryngologic examination and their tonsil sizes were graded. 74 of 95 patients underwent digital lateral soft tissue radiographs. Assessment of nasopharyngeal obstruction in radiographs was done according to four different methods. Results We did not find statistically siginificant correlation between symptom scores and radiologic measurements according to Johanneson (r = 0.072, p = 0.544, p > 0.05) and Crepeau (r = 0.034, p = 0.773, p > 0.05). The correlations between OSA score and Cohen and Konak's method and AN ratio were weak and not statistically siginificant (p = 0.133, r = 0.176; p = 0.290, r = 0.125 respectively; p > 0.05). But, we found a statistically siginificant correlation between the tonsil grade and symptom scores (r = 0.216, p = 0.036, p Conclusion Our results have demonstrated that radiologic measurements of the nasopharyngeal obstruction do not correlate with clinical symptoms of UAO, but clinical assessment of tonsil size does.

Objective To investigate the correlation of subjective tonsil size with real palatine tonsil size and to compare the differences of each parameter according to subjective tonsil size and between children and adults. Study Design Prospective evaluation of subjective tonsil size (0-4+) and real palatine tonsil size, including tonsil height (TH), tonsil width (TW), tonsil thickness (TT), total tonsil volume (TTV), and embedded tonsil volume (ETV) within the tonsillar fossa. Setting Tertiary-care rhinologic clinic. Subjects and Methods We measured TH, TW, TT, TTV, and ETV in 277 children and 63 adults with sleep-disordered breathing (SDB). Results In both children and adults, subjective tonsil size was significantly correlated with TTV, TH, TW, and TT (correlation coefficients 0.199-0.427 for children and 0.462-0.551 for adults). In children, TTV increased in proportion to subjective tonsil size, but about 45 percent and 34 percent of tonsils markedly deviated from the mean value of their TTV in size 2 and 3 groups, respectively. In adults, TTV of subjective tonsil size 3 and 4 groups was significantly larger than that of size 1 and 2 groups. Conclusions Real palatine tonsil size correlated with subjective tonsil size in both children and adults with SDB. Although there is a statistical correlation in children between TTV and subjective tonsil size, there is significant discordance in size 2 and 3 groups, thus greatly limiting the value of subjective tonsil size assessment in the majority of children. However, adult subjective tonsil size may reflect real palatine tonsil size and may help predict it preoperatively.

To compare the surgical results of uvulopalatopharyngoplasty (UPPP) and uvulopalatal flap (UPF) procedures in the treatment of primary snoring.Two study groups were formed and UPPP and UPF procedures were performed. All patients were stratified according to the modified Friedman staging system. Patients with tonsil size 2-4, palatal position scale grade 2, and body mass index lower than 30 were enrolled in the study. The success of surgical procedures was evaluated by applying a snoring questionnaire and Epworth sleepiness scale preoperatively and 90 days after the operation. Patients were followed for postoperative pain and other complications.Snoring was relieved in 85% of UPPP and in 83.3% of UPF patients 90 days after the operation. Postoperative pain complaint was more prominent in the UPPP group and mean duration of pain was significantly longer compared with the UPF group.Despite similar success rates in the short-term, we can say that the UPF procedure is more practical and comfortable when compared to the UPPP in the military setting.

Summary Introduction The role of tonsils in the origin of sagittal skeletodental abnormalities has been widely discussed in the literature but remains controversial. Data on the probable relationship between enlarged tonsils and the presence of these abnormalities were subjective. The aim of this study was to quantify the relationship between the space occupied by the palatine tonsils and sagittal cephalometric measurements. Materials and methods A cross-sectional study was performed on a group of children divided into 5 subgroups according to the standardized tonsillar hypertrophy grading scale. Cephalometric measurements were recorded for each child. Data were analyzed using SPSS 20.0 for Windows. The strength of the association between tonsil grades and quantitative variables was assessed using Spearman's rank correlation coefficient (Rho). The level of significance was fixed at P = 0.05. Results Lengths SN, t2-p3, h-Gn and Xi-pm, and angles I/F, I/SN, i/M, SNB, SNPog and SNGn were significantly and negatively correlated with grades. The ANB angle, the sagittal position of the pogonion and the angle of facial convexity were significantly and positively correlated with grades. Conclusion Early evaluation of tonsil size can prevent certain skeletodental abnormalities in the sagittal plane caused by upper airway obstruction. Thus, more aggressive late treatments, which are not always as effective as when they are performed during childhood, can be avoided.

Objective: The purpose of this study was to investigate the relationship between tonsillar hypertrophy and body mass index (BMI). Material and Methods: This is a cross-sectional study which was conducted in three primary schools located in Duzce. A total of 1,282 children between 7 and 12 years of age were evaluated and the size of their tonsils was investigated with regard to height and weight. This study was performed in the course of school screening, and the correlation between estimated tonsil size and BMIs of the children was investigated. Results: Sixteen of 1,282 students were excluded from the study, leaving 1,266 children in the study. The mean (±SD) age of the children was 9.13 ± 1.45 (range 7–12) years. The mean height of the 1,266 children was 129.07 ± 9.95 (range 105–163) cm, the mean weight was 28.81 ± 6.96 (range 15–68) kg, and the mean BMI was 17.09 ± 2.33 (range 12.07–30.0) kg/m2. There was no statistically significant effect of tonsil size on BMI. We could not find a significant relation of isolated tonsillar hypertrophy with BMI. Conclusions: No relation could be found between tonsillar hypertrophy and BMI.

Objectives:There is conflicting opinion regarding the clinical utility of removing small tonsils in children with obstructive sleep apnea (OSA). We sought to (1) determine if OSA improves after adenotonsillectomy (AT) in children with small tonsils; and (2) investigate the relationship between OSA resolution and tonsil size after AT.Methods:Retrospective study of 1- to 18-year-old consecutive nonsyndromic children with OSA who underwent polysomnography before and after AT. Complete response was defined as obstructive respiratory disturbance index (RDI) .05). Overall RDI improved from 18.6 ± 8.6 to 4.0 ± 6.0 with 44% (31/70) complete responders. In the 2+ group, AI and saturation nadir significantly improved (P = .004-.033) ...

Dear Editor:Over the years, various scales have been proposed for grading tonsils. A recent article by Kumar et al. titled ‘The Reliability of Clinical Tonsil Size Grading in Children’1 and the rec...

Objective: To evaluate the effect of the recently published pediatric tonsillectomy and polysomnography clinical guidelines on current practice patterns.Method: An anonymous 15-question survey was sent to members of the American Academy of Otolaryngology–Head and Neck Surgery regarding their awareness of the Clinical Practice Guideline: Tonsillectomy in Children and Clinical Practice Guideline: Polysomnography for Sleep-Disordered Breathing Prior to Tonsillectomy in Children and whether or not they have changed their practice as a result.Results: A total of 93% of respondents read the guidelines. Most respondents had completed a pediatric otolaryngology fellowship (84%). A small majority of physicians (54%) continue to prescribe antibiotics within 24 hours after surgery. One-third of respondents stopped prescribing antibiotics because of the new guidelines. Discord between severity of symptoms and tonsil size was the most common reason cited for ordering a polysomnogram prior to tonsillectomy (76%) in con...

We hypothesized, allergic reactions of the tonsillar mucosa may cause secondary lymphoid hypertrophy in children. To evaluate this, we compared tonsil sizes and skin prick test results. Children of ages 6–12 years were divided into two groups according to the results of the skin prick tests (SPT), as atopic and non-atopic groups. All tonsil sizes were evaluated by the same observer using the Brodsky L. Scala. No statistically meaningful difference was found between the tonsil sizes of the atopic and the non-atopic groups of children. No statistically meaningful correlation was found between tonsil sizes and allergen sensitivity degrees. Even though some highly allergic children were observed to have large tonsils, it was not statistically meaningful. Since no correlation is found between SPT and tonsil sizes, allergy may not be an etiologic factor of tonsillar hypertrophy in children.

Objective: Determine whether the acoustic characteristics of snoring sounds differed between 30 simple male adult snorers (group A) and 30 healthy adult male subject (group B) by using a multidimensional voice program (MDVP), which is a commonly used computer program that analyzes various aspects of voice.Method: Group A patients presented a Friedman tongue position grade I, tonsil size 2 to 3, a body mass index of 15. Phonetically balanced sentences and sustained vowels a, e, and i were digitally recorded with the MDVP; evaluation of voice handicap index (VHI) was done too.Results: Compared with control group, in group A: the acoustic parameters presented a statistically significantly higher value (P < .05) of fundamental frequency (158.2 Hz vs 120.2 Hz), jitter (2.03 % vs 0.66 %), shimmer (6.54 % vs 3.77 %), NHR (0.24 vs 0.11), SPI (13.7 vs 8.71), DVB (2.23 % vs 0.12 %), DUV (9.31 % vs 0.54 %) and vAm (22.09 % vs 11.13 %), according to the degree of hearing loss; VHI had a mean value of 66 (vs 37 of gro...

OBJETIVO: o objetivo deste estudo foi estudar a associação entre o padrão de respiração e o tamanho da tonsila faríngea em 122 crianças (60 infectadas pelo HIV e 62 sem infecção). MATERIAL E MÉTODO: As crianças foram analisadas quanto ao padrão de respiração, fluxo nasal e ocupação da tonsila faríngea em radiografias cefalométricas de perfil, através de uma análise computadorizada. RESULTADOS: O padrão de respiração de maior ocorrência nos dois grupos foi o tipo misto. A maioria das crianças apresentou tipo de respiração bucal ou mista, não havendo associação entre o tipo de respiração e presença do HIV (p=0,091). O fluxo nasal mostrou predomínio do fluxo médio nos dois grupos. As crianças sem história de infecção pelo HIV apresentaram fluxo nasal de médio a grande e a maioria das crianças infectadas pelo HIV apresentou de pouco a médio fluxo nasal de ar, havendo uma associação positiva entre o fluxo nasal e a infecção pelo HIV (p

수면무호흡증 환자의 진료에서 적절한 치료법의 선택은 가 장 중요하고 어려운 과정이다. 가장 확실한 치료법으로 인정 받고 있는 지속적 양압기의 순응도는 매우 낮고, 특히 우리나 라의 경우 수술비가 저렴하기 때문에 많은 수면무호흡증 환자 들이 수술적 치료를 선호한다. 수술은 과거에 치료 성공률 이 매우 낮은 것으로 간주되었으나, 최근의 보고에 의하면 적절히 환자를 선택할 경우 성공률을 상당히 높일 수 있으 며, 이를 위한 다양한 수술법이 소개되고 있다. 이비인후과 의사의 입장에서는 수술적 치료의 성공률이 높다고 판단되 면 수술을 하고, 그렇지 못할 것 같으면 지속적 양압기나 구 강내 장치를 권유하는 것이 이상적인 수순일 것이다. 수면무호흡증의 수술적 결과를 예측하기 위한 연구들이 꾸준히 이어졌는데, 대부분은 구개수구개인두성형술에 관한 것이다. 상하악전진술은 매우 성공률이 높지만, 이환율이 높 고 수술비가 비싸 국내에서 수면무호흡증의 치료목적으로 사 용하기에는 상당한 한계가 있다. 또한, 설근부나 하인두 수술 은 아직 널리 보급되지 않았으며, 이들 수술에 대한 대부분의 연구가 구개수구개인두성형술과 함께 시행한 결과만을 제시 하고 있어, 설근부 혹은 하인두 수술만의 효과를 분석하기가 어렵다. 더욱이 대부분의 이비인후과 의사들은 구개수구개 인두성형술을 수면무호흡증의 주수술로 사용하고 있다. 따라 서 본 종설에서는 구개수구개인두성형술의 결과 예측인자들 에 대해서 정리해 보았다.

Tonsillitis disease is a major cause of serious diseases such as heart attack and pneumonia. This paper proposes a computer-aided-diagnosis of tonsillitis using tonsil size and color. In this method, we employ red color and tonsil size as features. In order to detect the abnormal features, the proposed idea considers a trend of changing the features in each day. The change of tonsillitis features in each day would be computed in order to input into a decision model. As the features (color and size) are so difficult to exactly divide into each range, this paper applies a fuzzy logic as a decision unit. To evaluate the performance of the proposed method, the experiments with tonsillitis images are performed. The results reveal about 84 % accuracy for tonsillitis detection.

OBJECTIVE: To assess a new method (modified cautery-assisted palatal stiffening operation [CAPSO]) to treat snoring and mild obstructive sleep apnea (OSA).DESIGN: A prospective, nonrandomized trial.METHODS: Thirteen patients with simple snoring and mild OSA underwent the modified CAPSO under local anaesthesia. All patients had preoperative polysomnography and at 3 months postoperatively.RESULTS: All patients were Friedman stage II and III, with tonsil size 0, 1, or 2. All patients had improvement in their snoring. Eighty-four percent of the patients had improvement in the Epworth Sleepiness Scale, from 12.2 to 8.9. Objective success on the polysomnogram was noted in six out of the eight patients (75%) with mild OSA. The AHI improved from 12.3% to 5.2% (P < 0.05), and the LSAT improved from 88.3% to 92.5% (P < 0.05).CONCLUSION: The modified CAPSO is a simple, low-cost, and effective office-based method to treat snoring and mild obstructive sleep apnea.

Objective: The purpose of this study was to evaluate the variation in tonsil size and prevalence of asymmetric tonsils in 4- to 17-year-old schoolchildren and the relationships between tonsillar hypertrophy and frequent tonsillitis, frequent fever, and sleep-related symptoms observed by parents. Design: Cross-sectional study. Setting: Six daycare centres, four primary schools, and four high schools. Methods: Questionnaire and physical examination. Main Outcome Measures: The size of the tonsils was evaluated and scored on a 4-point scale. The interrelationships between tonsillar hypertrophy and other studied symptoms were examined. Results: In the study, the parents of 1784 children, consisting of 803 (45%) boys and 981 (55%) girls, completed the questionnaires. The prevalence rates of snoring, habitual snoring, observed apnea, and habitual observed apnea were 24.6%, 4.1%, 3.8%, and 0.9%, respectively. The results of tonsil scoring were grade 1, 62.7%; grade 2, 28.4%; grade 3, 3.3%; and grade 4, 0.1%. The prevalence rate of grade 1 tonsils was increasing, whereas the prevalence rates of grade 2 and 3 tonsils were decreasing with increasing age. Tonsil size peaked in 4- to 8-year-old children. The prevalence rates of tonsillar hypertrophy and asymmetric tonsils were 3.4% and 1.7%, respectively. Tonsillar hypertrophy was found to be significantly associated with male gender, a history of frequent tonsillitis, a history of frequent fever, often or always snoring, and often or always observed apnea. Conclusions: A tonsil size curve was developed in 4- to 17-year-old schoolchildren. Children aged 4- to 8 years with oropharyngeal symptoms and particularly male gender should undergo consultation with otorhinolaryngology and pediatric pulmonology physicians for the evaluation of adenotonsillar tissue. C1 Pamukkale Univ, Fac Med, Dept Pediat, TR-20100 Denizli, Turkey. Pamukkale Univ, Fac Med, Dept Otorhinolaryngol, TR-20100 Denizli, Turkey. Pamukkale Univ, Fac Med, Dept Publ Hlth, TR-20100 Denizli, Turkey.

Severe airway obstruction caused by tonsillar enlargement can result in disturbances in body growth. In this study, 1136 children between 7 and 12 years of age, were evaluated and the size of their tonsils was investigated with regard to height and weight. This study was performed in the course of school screening, and correlation between estimated tonsil size and height and weight of the children was sought. Statistically, no such correlation was found (P>0.05).

Severe airway obstruction caused by tonsillar enlargement can result in disturbances in body growth. The effect of this interference and of tonsillectomy in the child with only moderate symptoms have been less satisfactoril evaluated. In this study, 122 children with symptoms and signs of tonsillar obstruction were investigated concerning the height and weight before and after tonsillectomy. None of the individuals demonstrated cardiopulmonary complications of tonsillar obstruction. Altogether 10% of the children exhibited abnormalities in body weight and/or length prior to surgery. Especially during the first postoperative year, the weight and height gain exceeded the expected in 75% of the patients. The accelerated weight gain increased with tonsil size, but there was no relation to the extent of difficulties in swallowing or sleeping disruptions. The results support the hypothesis that tonsillar hypertrophy frequently is associated with disturbances in body growth and that this is seldom demonstrable prior to tonsillectomy.

To investigate whether tonsillar size was related to human morphology, age or duration of disease, 100 consecutive patients undergoing tonsillectomy for recurrent tonsillitis were investigated. The lengths, widths and volumes of each resected tonsil were measured and compared with patient characteristics ascertained on the day before surgery. The volume of tonsillar tissue was directly related to height (ρ=0.46, P

Nearly 70 percent of contemporary ENT consultants perform adenoidectomy as a routine when removing the tonsils. It has been stated in the literature that adenoid and tonsillar hypertrophy tend to co-exist and so a study was set up to investigate this hypothesis, with the possible that it may be of diagnostic importance. A series of 45 children admitted for the operations of tonsillectomy and adenoidectomy was investigated. No correlation was found between adenoid weight and tonsil weight. In view of this, it was concluded that tonsil and adenoid hypertrophy do not necessarily co-exist and that tonsil size cannot be used to predict adenoid size.