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Abstract Background and Objectives Epstein‐Barr virus (EBV) infection is ubiquitous all around the world. Tonsils seem to be candidate replication sites for EBV, and these tissues can be infected acutely or chronically. Some studies reported an association between EBV infection and tonsillar hypertrophy. In this study, we aimed to evaluate the presence and copy number of the EBV genome in tonsil tissue specimens of patients with tonsillar hypertrophy. Methods A cross‐sectional study was performed on 50 fresh tonsil tissue samples from children, who underwent tonsillectomy because of tonsillar hypertrophy. Patients' tonsil tissues were evaluated using real‐time polymerase chain reaction for EBV genome and viral load. Finally, the results were analyzed using SPSS software. Results EBV genome was detected in 58% (29/50) of tonsillar tissues. The relationship between EBV genome detection rate and age groups was in the statistical significance range (P = 0.051). Among 29 positive cases, the average EBV viral load was (3.1 × 105) copy/g ± (0.5 × 105) copy/g. No significant difference was observed among different sex and age groups for EBV viral load. Conclusion Herein, EBV genome detection could support the colonization of EBV in the tonsils, which may have a direct or indirect association with the pathogenesis of tonsillar hypertrophy.

To evaluate Tonsitin (10% DL -lactic acid) safety, tolerability, and efficacy, as a treatment for recurrent tonsillitis (RT) in children. This is a clinical prospective, randomized, double blind pilot study, to evaluate the safety, tolerability and efficacy of Tonsitin in healthy children with RT. Safety evaluated in terms of adverse events (AEs), tolerability in terms of compliance, and efficacy in terms of tonsils' size and frequency of tonsillitis, and quality of life. The study included 51 children. The treatment regimen was tolerable among the participants. Six children experienced AEs, but mostly mild. Tonsil size declined in both groups, but these results did not reach statistical significance. Tonsillitis episodes' frequencies were random and not significant. Tonsitin treatment was found to be feasible in the clinical setup and was well tolerated, and appears to be safe. Study efficacy results did not reach statistical significance. [ABSTRACT FROM AUTHOR]

Background: For a long time, the hypertrophied tonsils impact on velopharyngeal closure has been a point of concern. Objectives: To identify the alterations in the velopharyngeal valve (VPV) closure patterns following adenotonsillectomy in Arabic-speaking children, to predict the incidence of complications as nasal regurgitation or open nasality. Patients and methods: This observational prospective research was performed on 100 patients, with hypertrophied adenoid and tonsils, who were collected from outpatient clinic of Benha University Hospitals. All cases underwent preoperative laboratory investigations, otorhinolaryngology examination and video-nasoendoscopy and speech assessment before and after adenotonsillectomy. Results: The VP closure pattern was insignificantly different between both groups. However, the Nasality was significantly different among the 3 studied periods (P<0.001). There was no relation between gender and VP closure pattern preoperatively and 1 month after surgery. Regarding the postoperative nasality (hypernasality), the most prevalent observed VP closure patterns were both coronal and circular ones. Conclusions: The coronal pattern of closure of the VPV is the most prevalent type, which remains even postoperatively, also the type of closure has no significant value in predicting outcoming hypernasality. [ABSTRACT FROM AUTHOR]

ABSTRACT Children diagnosed with severe tonsillar hypertrophy display discernible craniofacial features distinct from those with adenoid hypertrophy, prompting illuminating considerations regarding microbiota regulation in this non-inflammatory condition. The present study aimed to characterize the salivary microbial profile in children with tonsillar hypertrophy and explore the potential functionality therein. A total of 112 children, with a mean age of 7.79 ± 2.41 years, were enrolled and divided into the tonsillar hypertrophy (TH) group (n = 46, 8.4 ± 2.5 years old), adenoid hypertrophy (AH) group (n = 21, 7.6 ± 2.8 years old), adenotonsillar hypertrophy (ATH) group (n = 23, 7.2 ± 2.1 years old), and control group (n = 22, 8.6 ± 2.1 years old). Unstimulated saliva samples were collected, and microbial profiles were analyzed by 16S rRNA sequencing of V3–V4 regions. Diversity and composition of salivary microbiome and the correlation with parameters of overnight polysomnography and complete blood count were investigated. As a result, children with tonsillar hypertrophy had significantly higher α-diversity indices (P＜0.05). β-diversity based on Bray–Curtis distance revealed that the salivary microbiome of the tonsillar hypertrophy group had a slight separation from the other three groups (P＜0.05). The linear discriminant analysis effect size (LEfSe) analysis indicated that Gemella was most closely related to tonsillar hypertrophy, and higher abundance of Gemella, Parvimonas, Dialister, and Lactobacillus may reflect an active state of immune regulation. Meanwhile, children with different degrees of tonsillar hypertrophy shared similar salivary microbiome diversity. This study demonstrated that the salivary microbiome in pediatric tonsillar hypertrophy patients had different signatures, highlighting that the site of upper airway obstruction primarily influences the salivary microbiome rather than hypertrophy severity.IMPORTANCETonsillar hypertrophy is the most frequent cause of upper airway obstruction and one of the primary risk factors for pediatric obstructive sleep apnea (OSA). Studies have discovered that children with isolated tonsillar hypertrophy exhibit different craniofacial morphology features compared with those with isolated adenoid hypertrophy or adenotonsillar hypertrophy. Furthermore, characteristic salivary microbiota from children with OSA compared with healthy children has been identified in our previous research. However, few studies provided insight into the relationship between the different sites of upper airway obstruction resulting from the enlargement of pharyngeal lymphoid tissue at different sites and the alterations in the microbiome. Here, to investigate the differences in the salivary microbiome of children with tonsillar hypertrophy and/or adenoid hypertrophy, we conducted a cross-sectional study and depicted the unique microbiome profile of pediatric tonsillar hypertrophy, which was mainly characterized by a significantly higher abundance of genera belonging to phyla Firmicutes and certain bacteria involving in the immune response in tonsillar hypertrophy, offering novel perspectives for future related research.

Available information on clinical characteristics and post-operative outcomes in children with very severe obstructive sleep apnea (OSA) is limited. Our study evaluates the clinical features and polysomnographic (PSG) variables that predict post-operative outcomes in children with an obstructive apneal hypopnea index (AHI) of more than 25 events/hr. In this study from a single tertiary care center, we performed a retrospective chart review of patients with an AHI > 25/hr, who underwent tonsillectomy and adenoidectomy (T&A) between January 2016 and September 2021. In total, 50 children were included in the study: 26.0% (13/50) of children experienced post-operative respiratory events and four children needed intubation and ventilator support. Compared with children without respiratory events, children requiring post-operative respiratory interventions were younger (4.4 ± 5.2 vs. 8.0 ± 5.2 years; p = 0.04), had higher pre-operative AHI (73.6 ± 27.4 vs. 44.8 ± 24.9; p < 0.01), lower oxygen nadirs (70.0 ± 13.0% vs. 83.0 ± 7.0%; p < 0.01), and had lower body metabolic index Z-scores (−0.51 ± 2.1 vs. 0.66 ± 1.5; p < 0.04). Moderate to severe residual OSA was identified in 70% (24/34) of children with available post-operative PSG; younger children had better PSG outcomes. Our study shows that post-operative respiratory events are frequent in children with very severe OSA, particularly with an AHI > 40/h, younger children (

IntroductionAdenoid and tonsillar hypertrophy in children often leads to adverse respiratory symptoms and obstructive sleep apnea (OSA). Current clinical guidelines from the American Academy of Pediatrics and American Academy of Otolaryngology-Head and Neck Surgery recommend tonsillectomy as the first line of pediatric OSA treatment for children with tonsillar hypertrophy. Rapid palatal expansion (RPE) performed by orthodontists improves obstructive sleep apnea in children by reducing nasal airway resistance, increasing nasal volume, raising tongue posture, and enlarging pharyngeal airway. However, the role of RPE in alleviating adenoid and tonsillar hypertrophy remains elusive. In this study, we aim to evaluate the changes in adenoid and palatine tonsil sizes following RPE using 3D volumetric analysis of cone beam computational tomography (CBCT) imaging.Materials and methodsIn this retrospective cohort study, a total of 60 pediatric patients (mean age: 8.00, range: 5-15, 32 females and 28 males) who had tonsillar hypertrophy (size 3 and 4) were included and divided into the control group (n = 20) and expansion group (n = 40). The control group did not undergo any treatment. The expansion group underwent RPE using a conventional Hyrax expander, activated 0.25 mm per day for 4-6 weeks. Final CBCT scans (T2) were performed 13.8 ± 6.5 months after the initial scan (T1). Pediatric sleep questionnaire (PSQ) and BMI were obtained at each timepoint. Volumetric analysis of adenoid and palatine tonsils was performed using a combination of bony and soft tissue landmarks in CBCT scans through Anatomage Invivo 6 imaging software. Paired t-tests were used to evaluate the difference between the initial and final adenoid and tonsil volumes. p values less than 0.05 were considered statistically significant.ResultsCompared to the control group, the expansion group experienced a statistically significant decrease in both adenoid and tonsil volume. There was non-statistically significant increase in volume from T1 to T2 for the control group. For the expansion group, 90.0% and 97.5% of patients experienced significant reduction in adenoid and tonsil volume, respectively. The average volume decrease of adenoids was 16.8% while that of tonsils was 38.5%. The patients had up to 51.6% and 75.4% reduction in adenoid and tonsil size, respectively, following RPE orthodontic treatment. Pearson correlation ranged from 0.88 to 0.99 for each measurement, representing excellent internal consistency. There was a significant reduction in the PSQ scores from 5.81 ± 3.31 to 3.75 ± 2.38 in expansion group (p

Abstract Objectives To analyze the diagnostic value of the tonsil–oropharynx (T/O) ratio on lateral cephalograms for evaluating tonsillar hypertrophy (TH). Methods A cross-sectional study was performed on 185 consecutive children (101 males, 84 females; mean age 7.3 ± 1.4 years) seeking orthodontic treatment. The T/O ratios on lateral cephalograms were calculated following Baroni et al.’s method. Tonsil sizes were clinically determined according to the Brodsky grading scale. Spearman correlation coefficients between the T/O ratio and clinical tonsil size were calculated with the total sample and subgroups and then compared between subgroups. Diagnostic value was analyzed using the receiver operating characteristic (ROC) curve, sensitivity, specificity, positive and negative predictive values, and accuracy. Results There was a strong correlation between the T/O ratio and clinical tonsil size in children (ρ = 0.73; P

Objectives: Nocturnal enuresis (NE) is a common urological complaint among children. The most common cause of obstructive airway disease in children is enlarged tonsils and adenoids. Although the relationship between the presence of NE and sleep disorders is unclear, some studies show that enuresis improves after airway obstruction is resolved. We aimed to investigate the relationship between upper airway obstruction and NE in children. Methods: Between September 2020 and June 2021, 66 pediatric patients diagnosed with persistent NE were included in the study. A total of 57 healthy patients were included in the control group. The presence of snoring and apnea, the presence of Attention-Deficit/Hyperactivity Disorder (ADHD)/social adjustment disorder, academic achievement, and family members’ history of NE were asked through questionnaires filled out by the families. An upper airway examination was done with a flexible nasopharyngoscope. Results: The mean ages of the study patients and healthy controls were 8.32±2.1 and 8.18±2.3 years. The female/male ratio was (25/41) and (33/24), respectively. Of the case group, 62.1% were male, and 78.8% were under nine years old. The frequency of snoring/apnea in children with enuresis was 27.3%, while it was 19.3% in the control group (p=0.299). It was found that more enuresis developed in children with high BMI (p=0.044). Family history was higher in the NE group than in the control group, but it was not statistically significant (p=0.173). Conclusion: Nocturnal enuresis is commonly associated with obstructive sleep apnea. Upper airway obstruction, obesity, and male gender are important risk factors for NE.

Copyright of Medical Journal of Babylon is the property of Wolters Kluwer India Pvt Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: To analyze the diagnostic value of the tonsil–oropharynx (T/O) ratio on lateral cephalograms for evaluating tonsillar hypertrophy (TH). Methods: A cross-sectional study was performed on 185 consecutive children (101 males, 84 females; mean age 7.3 ± 1.4 years) seeking orthodontic treatment. The T/O ratios on lateral cephalograms were calculated following Baroni et al.'s method. Tonsil sizes were clinically determined according to the Brodsky grading scale. Spearman correlation coefficients between the T/O ratio and clinical tonsil size were calculated with the total sample and subgroups and then compared between subgroups. Diagnostic value was analyzed using the receiver operating characteristic (ROC) curve, sensitivity, specificity, positive and negative predictive values, and accuracy. Results: There was a strong correlation between the T/O ratio and clinical tonsil size in children (ρ = 0.73; P < 0.001). A significantly higher correlation coefficient was found in the Class III children. The ROC curve revealed an area under the curve of 0.90 (95% CI, 0.86–0.94; P < 0.001). The optimal cutoff value of the T/O ratio for predicting TH was 0.58, with a sensitivity of 98.7% and specificity of 64.2%. Employing the cutoff value of 0.5, the sensitivity was 100% and the specificity was 45.9%. Conclusions: Measurement of the T/O ratio on lateral cephalograms may be helpful to initial screening in children for TH. Practitioners may combine the clinical examination of tonsil size with the cephalometric findings for a more comprehensive evaluation. [ABSTRACT FROM AUTHOR]

Introduction: The palatine tonsils are secondary lymphoid organs where immune processes occur, influencing the development of a targeted cellular and humoral response. The diseased tonsils are subject to immunological imbalances, including the activity of pro-inflammatory and anti-inflammatory factors. This leads to the development of palatine tonsil diseases, such as palatine tonsillitis and palatine tonsillar hypertrophy. Aim: The main aim of the study was to evaluate the similarities and differences in the clinical and pathomorphological pictures of patients qualified for surgical treatment due to hypertrophy or inflammation of the palatine tonsils. The aim was achieved by demonstrating the relationship between the patient's medical history and physical examination and histopathological diagnosis of a given tonsillar disease, evaluating the usefulness of basic blood tests (leukocytosis, ASO, ESR, and CRP) in differential diagnosis, and assessing the immunohistochemical assessment of palatine tonsil tissue. Material and Methods: The tonsils were stained with the following antibodies: IL-1, IL-2, IL-6, IL-8 IL-10, and IL-37 and CD25, CD40, and CD69, taking into account the histological division of the studied lymphatic tissue (epithelial, subepithelial, follicular, follicular center, and interfollicular). Patients aged between 19 and 70 years with tonsillitis or clinical signs of tonsillar hypertrophy were qualified for tonsillectomy/UPPP. Seventy-two males (68.6%) and thirty-three females (31.4%) were enrolled in the study. Histopathological and immunohistochemical assessment was performed on 105 palatine tonsils. Results: The diagnostic value of blood tests, including determination of ASO, ESR, CRP, and leukocyte level, proved to be a significant predictor of tonsil disease. In the pathomorphological assessment, 75% of the subjects who had simultaneously elevated ESR (>4.73) and leukocytosis (>6.96) and reduced ASO (<161.03) and CRP (<0.31) belonged to the tonsillitis group. The immunohistochemical assessment revealed a diverse profile of the markers tested depending on the diagnosed disease of the tonsils. The follicular center proved to be the region of palatine tonsil tissue for which the most statistically significant differences between the markers were found. Responses to CD-40 and IL-1 were observed in this region. The tissue of epithelial, follicular, and interfollicular regions each showed one statistically significant value for the studied chemokines and lymphokines. However, the lack of significant statistical differences for p < 0.05 between the study groups was only noted in the subepithelial region. It should be emphasized that for the data as a whole (calculated on the basis of the data for all regions together), no statistically significant differences were observed. Conclusion: In conclusion, the results obtained are indicative of the presence of a specific immunohistochemical profile for palatine tonsil diseases. Significant discrepancies have been found in the clinical and pathomorphological assessment of tonsils qualified for tonsillectomy. Therefore, these methods should be considered complementary. The patient's medical history and physical examination, depending on the adopted clinical or histopathological classification, show a variation in the distribution of features that are the basis for allocation to a particular group. [ABSTRACT FROM AUTHOR]

ObjectiveTo explore the effect of esketamine nasal drops on pain in children after tonsillectomy using low-temperature plasma ablation.Methods76 children who underwent tonsillectomy between May 2020 and July 2021, were randomly divided into two groups of 38 cases each. Patients in the control group were treated with conventional medication, while those in the study group were treated with esketamine nasal drops, along with the routine drug treatment. Pain levels of children in the two groups were compared within 1–3 days post-surgery, and the pseudomembrane formation and shedding-off time and recovery time were statistically analyzed.ResultsThe pain level of children in the study group was lower than that of the control group 1–3 days post-surgery. The pseudomembrane formation and shedding-off time and recovery time in the study group were shorter than in the control group (P 0.05).ConclusionIt is safe to use esketamine nasal drops in children after tonsillectomy using low temperature plasma ablation, and this is found to reduce pain and shorten the recovery time.

Tularemia is a potentially fatal, multisystemic infectious disease of humans and some animals caused by Fran- cisella Tularensis bacteria. Up to six forms of clinical manifestations of tularemia have been identified, ulcer- oglandular tularemia being the most common form. Up- per airway manifestations of tularemia include tonsillar hypertrophy and pharyngitis, accompanied by cervical lymphadenopathies. Anatomical alterations of the cervi- cal district represent an additional risk in airways man- agement. Between 2016 and 2019, only three cases of tu- laremia have been described in Italy, but some authors consider Tularemia underreported, especially in Europe. We describe a case of a 17-year-old boy who presented to our clinic with massive cervical left lymphadenopathy and enlargement of the ipsilateral palatine tonsil associ- ated with fever. The symptoms persisted after antibiotic and corticosteroid treatment. To exclude a lymphoprolif- erative disease, a full body CT scan with contrast was performed, showing multiple cervical bilateral lymphadenopathies, especially on the left side and hyper- trophy of the left palatine tonsil and splenomegaly. The biopsy of the left tonsil, performed under general anes- thesia, demonstrated a granulomatous inflammation. A more accurate reconstruction of the patient history re- vealed domestic presence of rabbits. Therefore, serologic and molecular tests for F. Tularensis were performed, with positive results. Proper antibiotic treatment was ad- ministered with gradual and complete symptoms regres- sion.

Objectives: To develop a novel ultrasound (US) plane to diagnose palatine tonsillar hypertrophy objectively in children. Methods: Tonsillar ultrasonography of children (age 2–14 years) who had a clinical diagnosis of tonsillar hypertrophy or not were analyzed retrospectively. Clinical data (including gender, age, body mass index (BMI)), and volume (V) of tonsils measured by the US, were recorded. Furthermore, we found a new US plane to diagnose tonsillar hypertrophy and named it the submental oblique cross‐section. In this plane, diameters of the left tonsil, right tonsil, and central oropharynx were designated as T1, T2, and O. Then, we calculated the ratio by the formula (T1 + T2)/O. Results: A total of 172 cases (85 hypertrophy and 87 non‐hypertrophy) were included in this study. There were no significant differences in gender (P =.844), age (P =.666), and BMI (P =.089) between the groups. In the non‐hypertrophy group, the V of both sides had a positive linear correlation with age or BMI. In contrast, there was no linear correlation between ratio and age or BMI. The area under the curve (AUC) of ratio and V was 0.970 (95%CI: 0.947–0.993) and 0.835 (95%CI: 0.778–0.893) by receiver operating characteristic (ROC) analysis, respectively. The optimal cutoff value of ratio for diagnosis of tonsillar hypertrophy was 2.293 (sensitivity = 88.2%, specificity = 95.4%). Conclusions: We established a new US section to evaluate tonsillar hypertrophy. This approach could be easily acquired and provide a reference value to guide clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Tonsils are the first line defense agonist the microbe that enters the body through the respiratory tract. Tonsillectomy is most commonly used to treat tonsillitis and tonsillar hypertrophy. Methods: The current study investigates the relationship between the Brodsky grading scale of palatine tonsils and Vitamin D of recurrent tonsillitis patients(T patients)and tonsillar hypertrophy patients(H patients)in addition to some serological test.The samples were taken from 20 children with tonsillitis and 20 children with tonsillar hypertrophy and 20 as a control group.The physical examination of tonsil grading was done during the operation of tonsillectomy the period from November 2019 to January 2020 in the Central Pediatrics Teaching hospital. Results: The most dominant grade in the T patient group was +1 and in the H group was +3 and +2 respectively.The result showed significant differences in the Anti-streptomycin O test(ASOT)between patients and the control group,as well as there was a significant elevation in ASOT in T group as compared to H group.The concentration of vitamin D was decreased in T group(17.5±5.3ng/ ml)and H group(18.4±7.2ng/ml)than in control group(28.9±6.1ng/ml)which showed a statistically significant difference.Also,Vitamin D levels in the T and H groups did not significantly differ.The IgE level was higher in the T group(191.3±56IU/ml)and H group(215.2±61IU/ml)when compared with the control group(25.4±11.7 IU/ml)which reported a highly significant difference.Also,the IgE level showed a significant difference between the T group and H group. Conclusion: From the present study can conclude the relationship between deficiency of vitamin D, and elevation of IgE with a grade of tonsils in T and H groups. [ABSTRACT FROM AUTHOR]

Copyright of China Journal of Oral & Maxillofacial Surgery is the property of Shanghai Jiao Tong University, College of Stomatology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: To determine predictors of obstructive sleep apnea (OSA) in underweight children and to describe the demographic, clinical, and polysomnographic characteristics of an ethnically diverse population of underweight children with OSA. Study Design: Case-control study. Setting: University of Texas Southwestern Medical Center and Children's Medical Center of Dallas Methods: Underweight children aged 2 to 18 years who underwent a polysomnogram for suspected OSA between January 2014 and December 2020 were included. Underweight was defined as body mass index <5th percentile per Centers for Disease Control and Prevention guidelines. Children with apnea-hypopnea index <1.0 served as a control group. Univariate and multiple logistic regression analysis was used to determine the predictors of OSA. Significance was set at P <.05. Results: An overall 124 children met inclusion criteria: mean age, 6.4 years; 50% female; 44% Hispanic, 31% African American, and 18% Caucasian. A total of 83 children had OSA (apnea-hypopnea index ≥1.0). Height was negatively correlated with OSA (odds ratio, 0.94; 95% CI, 0.88-0.99; P =.02) while allergic rhinitis (odds ratio, 2.97; 95% CI, 1.24-7.08; P =.01) and tonsillar hypertrophy (odds ratio, 3.38; 95% CI, 1.42-8.02; P =.01) were predictors for the presence of OSA. No demographic or clinical characteristics were predictors for severe OSA. Conclusion: Underweight children with OSA, as compared with those without OSA, are more likely to have decreased height, tonsillar hypertrophy, and allergic rhinitis. There are no predictors of severe OSA in underweight children. We recommend polysomnography for the diagnosis of OSA in symptomatic underweight children with large tonsils, especially when they have a history of allergies. [ABSTRACT FROM AUTHOR]

Introduction: Small cell neuroendocrine carcinoma (NEC) that arises from the tonsil is a particularly rare head and neck carcinoma. This kind of neoplasm mainly originated from the bronchopulmonary area; however, there were reported cases of extrapulmonary areas. The prognosis is poor as the tumour is an aggressive tumour and have a high risk of metastasis. Case Report: We experienced a patient presented with painless right neck swelling and hard tonsillar hypertrophy for past six month. Computer tomography showed the tumour extended to the parapharyngeal space and metastasized to the thoracolumbar vertebras. The intraoral biopsy of the tonsil confirmed primary small cell neuroendocrine carcinoma of the tonsil. The clinical presentation, radiological imaging, histopathological investigations, and methods of treatment are discussed. Conclusions: Due to the rarity of this disease, there is no definitive treatment yet for this disease. The physicians must thoroughly understand the nature and characteristic of the disease to find the best treatment. The latest discoveries in chemotherapy drugs and radiotherapy may improve the treatment modalities in the future. [ABSTRACT FROM AUTHOR]

Introduction: During the first years of life, the oro-pharyngeal lymphoid tissue gradually increases in size, causing in some children difficulty breathing and often leading to surgical removal of the tonsils and adenoids. The objective of the study is to assess the effects of the Mediterranean diet in children who had chronic upper airway obstruction. Material and methods: This was a prospective study pre-test/post-test comparison. Eighty-seven patients from two to eight years old were recruited. A food reeducation program based on the Mediterranean diet was applied for one year. Clinical, therapeutic, and anthropometric variables were studied. Results: The degree of nasal obstruction decreased in 95.1% of the patients. After the nutritional intervention, the number of colds with bacterial complications decreased by 80.26%; 60.9% had no bacterial complications during the year of the study. The use of antibiotics decreased by 81.94%. Symptomatic treatment decreased by 61.2%. Most patients did not require surgical intervention, and clinical evolution suggested that it would no longer be necessary. Conclusions: We can conclude by saying that the application of the traditional Mediterranean diet could be effective in the prevention and treatment of persistent nasal obstruction, limiting pharmacological and surgical intervention in many of these patients.

Introduction Palatine and pharyngeal tonsils are the first line of defense against pathogens. Clinically, two alterations may require surgical removal of the tonsils: hypertrophy and recurrent tonsillitis. The two conditions probably result from a dysfunction of the immune system. Objective To evaluate possible differences in the plasma levels of tumor necrosis factor-a (TNF-a), interleukin-6 (IL-6), and interleukin-10 (IL-10) in patients submitted to adenotonsillectomy. Methods Prospective, longitudinal study with 25 children undergoing adenotonsillectomy separated into 3 different groups: recurrent tonsillitis (RT), composed of 7 patients; recurrent hypertrophy tonsillitis (RTTH), with 8 patients; and the tonsillar hypertrophy (TH) group, with 10 patients. Ten healthy control children (SD) were also included in the study. Peripheral blood was collected, and plasma was separated to measure the levels of TNF-a, IL-6, and IL-10. The Mann-Whitney test was used for statistical analysis. Results The plasma level of IL-6 was higher in the RT (p=0.0394) and TH (p=0.0009) groups, compared with the control group. The TH group also had higher levels of IL-6 than the RT group (p=0.039). The IL-6/IL-10 ratio was higher in the RT (p=0.029) and TH (p=0.0005) groups compared with the control group. Between the RT and RTTH groups, the IL-6/IL-10 ratio was higher in the RT group, with a statistically significant difference (p=0.0091). Conclusion Patients with a history of chronic tonsillitis had higher levels of IL-6, compared with the control group. [ABSTRACT FROM AUTHOR]

Goltz-Gorlin syndrome, also known as focal dermal hypoplasia or nevoid basal cell carcinoma syndrome, is a rare multisystemic disease caused by autosomal dominant mutations in the PORCN gene. The characterizing features are keratocystic odontogenic tumors in the jaw, multiple basal cell carcinomas, calcification of the falx cerebri, palmar or plantar pits, and skeletal abnormalities. This paper reports the case of a 3-yearold girl with Goltz-Gorlin syndrome, showing progressively increasing tonsillar hypertrophy with obstructive effect on the oropharynx. The lymphatic tissue was remarkably papillomatous in aspect. Pathologic examination after tonsillectomy showed hyperplastic, morphologically normal tonsillar tissue, without arguments for papilloma, active inflammation, or malignancy. This paper highlights the rare manifestations of ENT pathologies in GGS which demand attention early on and long-term follow-up. [ABSTRACT FROM AUTHOR]

Tonsillar hypertrophy is a common disease in 3-to-6-year-old children, which may cause serve symptoms like airway obstruction. Microbiological factors play an important role in the etiology of tonsillar hypertrophy. As the starting point of digestive and respiratory tracts, the microbial composition of the oral cavity is not only unique but also closely related to the resident microbiota in other body sites. Here we reported a correlation study of the microbiota between oral cavity and tonsils in children with tonsillar hypertrophy. Saliva, supragingival plaque, and wiped samples from the tonsil surface were collected from both tonsillar hypertrophy patients and participants with healthy tonsils and were then analyzed using Illumina Miseq Sequencing of the 16S rRNA gene. In the tonsillar hypertrophic state, more genera were detected on the tonsil surface than in the tonsil parenchyma, with more intra-microbiota correlations. When tonsillar hypertrophy occurred, both the oral cavity and tonsil surface endured microbiome shift with increased genera category and more active bacterial interactions. Over half of the newly detected genera from the tonsillar hypertrophic state were associated with infection and inflammation process or exhibited antibiotic-resistant characters. Of each individual, the microbial composition and structure of saliva seemed more similar to that of the tonsil surface, compared with the supragingival plaque. In salivary microbiota, genus Johnsonella might be relative with the healthy state of tonsils, while Pseudoxanthomonas might be relative with tonsillar hypertrophy. Our study supported the link between oral microbiota with the healthy and hypertrophic states of tonsils and may provide new directions for future researches in the specific role of oral microbiota in the etiology of tonsil diseases.

Tonsillar hypertrophy is a common disease in 3-to-6-year-old children, which may cause serve symptoms like airway obstruction. Microbiological factors play an important role in the etiology of tonsillar hypertrophy. As the starting point of digestive and respiratory tracts, the microbial composition of the oral cavity is not only unique but also closely related to the resident microbiota in other body sites. Here we reported a correlation study of the microbiota between oral cavity and tonsils in children with tonsillar hypertrophy. Saliva, supragingival plaque, and wiped samples from the tonsil surface were collected from both tonsillar hypertrophy patients and participants with healthy tonsils and were then analyzed using Illumina Miseq Sequencing of the 16S rRNA gene. In the tonsillar hypertrophic state, more genera were detected on the tonsil surface than in the tonsil parenchyma, with more intra-microbiota correlations. When tonsillar hypertrophy occurred, both the oral cavity and tonsil surface endured microbiome shift with increased genera category and more active bacterial interactions. Over half of the newly detected genera from the tonsillar hypertrophic state were associated with infection and inflammation process or exhibited antibiotic-resistant characters. Of each individual, the microbial composition and structure of saliva seemed more similar to that of the tonsil surface, compared with the supragingival plaque. In salivary microbiota, genus Johnsonella might be relative with the healthy state of tonsils, while Pseudoxanthomonas might be relative with tonsillar hypertrophy. Our study supported the link between oral microbiota with the healthy and hypertrophic states of tonsils and may provide new directions for future researches in the specific role of oral microbiota in the etiology of tonsil diseases. [ABSTRACT FROM AUTHOR]

Abstract Background Tonsillitis, with associated tonsillar hypertrophy, is a common disease of childhood, yet it is rarely associated with sudden death due to airway obstruction. Lethal complications involving the inflamed tonsils include haemorrhage, retropharyngeal abscess and disseminated sepsis. Case presentation We report on a case of sudden and unexpected death in an 8-year-old female who was diagnosed with and treated for tonsillitis. The child was diagnosed with acute tonsillitis 2 days prior to her collapse and was placed on a course of oral antibiotics. There were no signs of upper or lower airway obstruction. She was found to be unresponsive by her caregiver and gasping for air in her bed in the early hours of the second morning after the start of treatment. Autopsy showed massive and symmetrically enlarged palatine tonsils. The tonsils filled the pharynx almost completely. The epiglottis and laryngeal mucosa at the base of the epiglottis in the vicinity of the aryepiglottic membrane and the superior aspect of the larynx displayed red-purple discoloration, with mucosal swelling and edema. Histological examination of the palatine tonsils revealed prominent lymphoid hyperplasia, but no evidence of acute inflammation. Conclusion Palatine tonsillar hypertrophy in infants is a common feature of both viral and bacterial tonsillitis and has been postulated as a possible risk factor for Sudden and Unexplained Death in Infancy (SUDI), based on the theory of mechanical impediment of breathing by narrowing of the upper airway. The rounded shape of the tonsils may facilitate some airflow past the enlarged structures and hence protect against asphyxial death when the enlarged tonsils fill the laryngo-pharynx. Epiglottal and proximal laryngeal edema may play a more significant role in asphyxial unexpected deaths in cases of tonsillitis with tonsillar hypertrophy than previously suspected. This focusses the importance of careful examination of the epiglottis and proximal laryngeal mucosa, as part of a thorough examination of the laryngo-pharynx in cases of sudden death associated with tonsillar hypertrophy.

Background and Objective To begin with, an adenotonsillectomy is one of the most common operations in children who have been diagnosed with a condition of sleep-disordered breathing. Upon the preoperative evaluation of tonsil and adenoid size, it is important to predict the probable postoperative outcome. In this study, we investigated the correlation between the subjective tonsil grade, tonsil shadow area on skull lateral view radiographs, and tonsil volume after tonsillectomy. Methods We retrospectively reviewed the medical records of 234 patients who underwent an adenotonsillectomy in the tertiary referral hospital from January to June 2014. We demarcated the tonsil shadow area on the skull lateral view. When visible, the tonsil shadow area was considered as ellipse. The tonsil area was calculated by measuring the major (2a) and minor (2b) axes of shadow (S=πab). The tonsil volume was measured at the time of surgery. Results The tonsil shadow was visible in 180 cases and invisible in 54 cases. The tonsil volume varied from 1.0 cm3 to 9.5 cm3. It is noted that the tonsil volume was significantly greater in the visible group than in the invisible group, based on the lateral radiograph (3.81 ± 1.21 cm3, 3.24 ± 1.03 cm3, respectively; p = 0.002). In a review of the visible tonsil group (n = 180), there was a positive correlation between the tonsil shadow area and tonsil volume (r = 0.489, p < 0.001) and between tonsil grade and tonsil volume (r = 0.239, p < 0.001). Conclusion s Tonsillar hypertrophy can be evaluated more accurately when using skull lateral view radiographs as compared with the use of a clinical examination. A tonsil shadow on skull lateral view can be a helpful, non-invasive, and relatively easy tool to predict tonsil volume in many cases.

Aim:We aimed to assess the prevalence of actinomycosis in tonsillectomy specimens and its clinical importance and management in our center.Materials and Methods:In this retrospective matched case-control study, patients who underwent tonsillectomy during 2010-2015 in Shahid Mostafa Khomeini Hospital, Tehran, were studied. Data regarding age, sex, indication for surgery (such as recurrent tonsillitis or sleep-disordered breathing), tonsil size, and length of disease before surgery were collected in both histopathologically positive (case) and negative (control) patients for actinomycosis.Results:From the 260 studied tonsillectomy specimens, actinomycosis was found in 20 (8.75%) and 60 Actinomycosis negative cases were chosen randomly for the control group. There was no statistically significant difference between the groups with respect to age, sex, length of disease before surgery, and incidence of actinomycosis in tonsillectomy due to recurrent tonsillitis or sleep-disordered breathing. However, the tonsil size was significantly greater in specimens positive for actinomycosis (8.65±1.5 mL versus 4.38±0.22 mL, p

Objectives: To develop a new method for the objective evaluation of airway obstruction due to tonsillar hypertrophy using ultrasound (US) in children. Methods: The oropharynx was examined in patients, and tonsil grades were evaluated according to the staging system of Brodsky et al (Int J Pediatr Otorhinolaryngol 1987; 13:149–156). The narrowest intertonsillar distance (ITD) and widest transverse length of the tongue base (TLTB) were then measured by US, and their ratio was calculated. The clinical value of US was investigated for the classification of tonsillar hypertrophies as nonobstructive or obstructive by matching the patients' clinical grades with the US data. Results: A total of 102 patients (age range, 2–12 years) were included in the study. According to the Brodsky staging system, 44.1% and 55.9% of the patients were in nonobstructive (stages I and II) and obstructive (stages III and IV) tonsillar hypertrophy groups, respectively. The area under the curve was 0.991 (95% confidence interval, 0.977–0.999) according to a receiver operating characteristic curve analysis between the Brodsky staging and the ITD/TLTB ratio. The optimal cutoff value for the ITD/TLTB ratio for the diagnosis of obstructive tonsillar hypertrophy was found to be 0.3 or less, which had 96.5% sensitivity and 95.6% specificity. Conclusions: The degree of airway obstruction due to tonsillar hypertrophy can be objectively determined by US in children. An ITD/TLTB ratio of 0.3 or less was found to be compatible with obstructive tonsillar hypertrophy. This new and easily applicable evaluation method may provide considerable value and guidance for tonsillectomy decisions. [ABSTRACT FROM AUTHOR]

ABSTRACT Chronic tonsillitis (CT) and tonsillar hypertrophy (TH) are common tonsillar diseases that are related to infection and inflammation. Little is known about tonsillar microbiota and its role in CT and TH. This study aims to identify palatine tonsillar microbiota both on the surface and in the core tissues of CT and TH patients. In total, 22 palatine tonsils were removed and collected from CT and TH patients who underwent surgery. The surface and core microbiota in the tonsils of CT and TH patients were compared using 16S rRNA gene sequencing of V3-V4 regions. Differential tonsillar microbiotas were found in the CT versus TH patients and surface versus core tissues. Further, a higher relative abundance of bacterial genera, including Haemophilus, Streptococcus, Neisseria, Capnocytophaga, Kingella, Moraxella, and Lachnospiraceae [G-2] in patients with TH and Dialister, Parvimonas, Bacteroidales [G-2], Aggregatibacter, and Atopobium in patients with CT, was observed. Of these, the differential genera of Dialister, Parvimonas, and Neisseria served as key factors in the tonsillar microbiota network. Notably, four representable tonsillar microbial types were identified, with one, consisting of a higher abundance of Haemophilus and Neisseria, exclusively detected in the TH patients. This study analyzed the different tonsillar microbiota from the surface and core tissues of CT and TH patients. Several bacteria and various microbial types related to CT and TH were identified, along with potential bacterial networks and related immune pathways. IMPORTANCE The human microbiota has been shown to be functionally connected to infectious and inflammation-related diseases. So far, only limited studies had been performed on tonsillar microbiota, although tonsils play an essential role in the human immune defense system and encountered numerous microorganisms. Our work presented different tonsillar microbiota from surface and core tissues of chronic tonsillitis (CT) and tonsillar hypertrophy (TH) patients. Notably, one tonsillar microbiota type, which contains a higher abundance of Haemophilus and Neisseria, was only detected in the TH patients. Furthermore, certain bacteria, such as Haemophilus, Neisseria, Dialister, and Parvimonas, may serve as microbial biomarkers to discriminate CT patients from TH patients. These data provide important microbiota data in the tonsillar research area and are highly useful for researchers both in the oral microbiome field and clinical field.

Available information on clinical characteristics and post-operative outcomes in children with very severe obstructive sleep apnea (OSA) is limited. Our study evaluates the clinical features and polysomnographic (PSG) variables that predict post-operative outcomes in children with an obstructive apneal hypopnea index (AHI) of more than 25 events/hr. In this study from a single tertiary care center, we performed a retrospective chart review of patients with an AHI > 25/hr, who underwent tonsillectomy and adenoidectomy (T&A) between January 2016 and September 2021. In total, 50 children were included in the study: 26.0% (13/50) of children experienced post-operative respiratory events and four children needed intubation and ventilator support. Compared with children without respiratory events, children requiring post-operative respiratory interventions were younger (4.4 ± 5.2 vs. 8.0 ± 5.2 years; p = 0.04), had higher pre-operative AHI (73.6 ± 27.4 vs. 44.8 ± 24.9; p < 0.01), lower oxygen nadirs (70.0 ± 13.0% vs. 83.0 ± 7.0%; p < 0.01), and had lower body metabolic index Z-scores (−0.51 ± 2.1 vs. 0.66 ± 1.5; p < 0.04). Moderate to severe residual OSA was identified in 70% (24/34) of children with available post-operative PSG; younger children had better PSG outcomes. Our study shows that post-operative respiratory events are frequent in children with very severe OSA, particularly with an AHI > 40/h, younger children (2), and poor nutritional status, necessitating close monitoring.

Objectives/Hypothesis: To evaluate the application and advantages of coblation tonsillectomy with inferior pole capsule preservation in pediatric patients with tonsillar hypertrophy and recurrent tonsillitis. Study Design: Retrospective chart review. Methods: A total of 726 children who were diagnosed with either tonsillar hypertrophy or recurrent tonsillitis were included. Children were divided into two groups according to the surgical technique: conventional coblation tonsillectomy and coblation tonsillectomy with inferior pole capsule preservation. The duration of surgery, intraoperative hemorrhage volume, and postoperative pain, as well as postoperative hemorrhage data in the format of time, location, and degree were compared between the two groups. Results: Of the 726 children included, conventional coblation tonsillectomy was performed in 320 children, coblation tonsillectomy with inferior pole capsule preservation was performed in 406 children. There were no significant differences in duration of surgery or intraoperative hemorrhage volume between the two groups. Children who underwent coblation tonsillectomy with inferior pole capsule preservation showed a remarkable improvement in postoperative pain on days 3 and 5 postoperatively. Additionally, the coblation tonsillectomy with inferior pole capsule preservation group exhibited a significantly lower total postoperative hemorrhage rate, secondary hemorrhage rate, and hemorrhage rate in the inferior pole compared with that in the conventional coblation tonsillectomy group. During the 1‐year follow‐up period, no cases of tonsillar re‐hypertrophy or recurrent tonsillitis were observed in either group. Conclusion: For pediatric tonsillar hypertrophy and recurrent tonsillitis, coblation tonsillectomy with inferior pole capsule preservation is a safe and effective technique, capable of reducing postoperative pain and hemorrhage, especially secondary hemorrhage at the inferior pole. Level of Evidence: 3b Laryngoscope, 131:1157–1162, 2021 [ABSTRACT FROM AUTHOR]

The laryngeal mask airway (LMA) has become an important choice in both routine and difficult airway management. We aimed to evaluate the safety and effectiveness of LMA use in pediatric patients with tonsillar hypertrophy. This study was a randomized controlled trial. The study included 100 pediatric patients who had first or second degree tonsillar hypertrophy. Pediatric patients undergoing elective laparoscopic inguinal hernia repair were randomly divided into two groups (n = 50): LMA group and the endotracheal tube (ETT) group. The primary outcomes were ventilation leak volume, peak airway pressure, and partial pressure of end-tidal carbon dioxide (P ET co 2). Data for primary outcomes were collected before and 5-, 15-, and 25-minute after opening pneumoperitoneum, and on closing the pneumoperitoneum. Complications such as laryngospasm, bronchospasm, desaturation, severe coughing, blood on the device after removal, and sore throat were recorded. A total of 100 pediatric patients were assessed and 97 eligible patients were randomly assigned to receive an LMA (n = 49) or an ETT (n = 48). There was no statistically significant difference in ventilation leak volume and P ET co 2 between the LMA and ETT groups (P >.05). Compared with T 1-4 , peak airway pressure was significantly lower in T 0 (LMA group 12.6 ± 0.9, 95% confidence interval 12.2 to 13.0; ETT group 12.8 ± 1.2, 95% confidence interval 12.2 to 13.3; P <.05). The incidences of laryngospasm 11 (22.9%), desaturation 18 (37.5%), and severe coughing 13 (27%) were higher in the ETT group (11 [22.9%] vs 3 [6.1%], 18 [37.5%] vs 6 [12.2%], 13 [27%] vs 3 [6.1%]; P <.05). The application of LMA has a lower incidence of complications. LMA as an airway device is effective and perhaps superior in appropriate patients. [ABSTRACT FROM AUTHOR]

Objective: To compare the dentofacial characteristics of children with and without adenoid and/or tonsillar hypertrophy., Methods: A consecutive sample of orthodontic patients aged 6-12 that took pre-treatment lateral cephalograms were included in this study. Those with history of previous orthodontic treatment, adenoidectomy or tonsillectomy, or craniofacial anomalies were excluded. The diagnosis of adenoid and tonsillar hypertrophy was based on Fujioka's and Baroni's methods, according to which the subjects were divided into four groups: the adenoid hypertrophy only (AHO) group; tonsillar hypertrophy only (THO) group; combined adenoid and tonsillar hypertrophy (AH+TH) group; and no adenoid or tonsillar hypertrophy (NH) group. Cephalograms were used for skeletal and dental measurement. Data were analyzed using one-way ANOVA, LSD post-hoc tests and Chi-square test., Results: A total of 598 patients were included. Compared with the NH group, the THO group had significantly larger SNB angle (P < 0.001), as well as significantly smaller ANB angle (P<0.001) and Wits value (P = 0.001). The U1-L1 angle of AHO group was significantly smaller than that in the NH group (P = 0.035). The proportion of adenoid hypertrophy in Class II patients was significantly higher than that in Class III patients (P = 0.001). The proportion of tonsillar hypertrophy in Class III patients was significantly higher than that in Class I patients (P < 0.001) and Class II patients (P < 0.001)., Conclusion: Over 80 % of children seeking orthodontic treatment had either adenoid or tonsillar hypertrophy. Children with adenoid hypertrophy tend to have skeletal Class II malocclusion, while those with tonsillar hypertrophy tend to have skeletal Class III malocclusion., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Objectives: This study aims to identify structural and functional craniofacial characteristics that correlate with higher incidence of 'probable' sleep bruxism in children.Methods: From March 2018 until March 2019, a cross-sectional clinical study was performed with ninety-six healthy children ages 6-12 years who presented for routine dental examination at the UCLA pediatric dental clinic. Variables of interest included: (1) assessment of probable bruxism based on parental awareness on the frequency of tooth grinding during sleep and clinical signs of bruxism based on tooth wear; (2) parental reports of mouth breathing while awake and asleep, snoring during sleep, difficulty breathing and/or gasping for air during sleep; (3) parental reports of psychosocial distress; (4) assessment of tonsil hypertrophy, tongue mobility, and nasal obstruction. Three pediatric dental residents were calibrated to perform the clinical data collection. All dental residents were graduated dentists with licensure and at least one year of experience examining children. The methodology to take the specific measurements administered in the manuscript were calibrated between the data-collectors under the supervision of a board-certified pediatric dentist and orthodontist (AY).Results: The mean age of individuals was 8.9 (SD = 1.9) years with a gender distribution of 46 males and 50 females. There were 23 out of the 96 (24%) individuals who met the diagnostic criteria for probable sleep bruxism (PSB). Sleep Disturbance Scale for Children (SDSC) scores were significantly elevated among children positive for PSB, indicating that they are at higher risk for sleep disturbances (PSB-positive: 45.1 ± 13.0, PSB-negative: 34.8 ± 5.5; p < 0.0001). Impaired nasal breathing, parental reports of mouth breathing when awake or asleep, restricted tongue mobility, and tonsillar hypertrophy were found to be significant risk factors for PSB. Exploratory analysis further suggests a synergistic effect between tonsil hypertrophy, restricted tongue mobility, and nasal obstruction. The incidence of probable sleep bruxism among individuals without any of the exam findings of tonsillar hypertrophy, restricted tongue mobility, and nasal obstruction was 5/58 (8.6%), whereas the incidence of PSB among individuals with all three exam findings was 10/11 (90.9%), p < 0.0001. Among the 23 individuals with PSB, however, there were n = 5 (21.7%) who did not have any of the three exam findings, suggesting an additional role of psychosocial distress, postural maladaptation, malocclusion, or other factors in the etiology of sleep bruxism.Conclusion: This study shows that tonsil hypertrophy, restricted tongue mobility, and nasal obstruction may have a synergistic association on the presentation of PSB. Dentists should evaluate for tonsillar hypertrophy, restricted tongue mobility, and nasal obstruction in the evaluation of PSB, as these exam findings are highly prevalent in the majority of cases. [ABSTRACT FROM AUTHOR]

Background Hypertrophy of tonsils is common in the pediatric population, primarily affecting younger children, aged 3-6 years. Tonsillar hypertrophy symptoms are among the most common causes for pediatric or ENT visits in children. Hence, doctors also need to be informed of the potential complications of tonsillar hypertrophy and the surgical indications. Therefore, the physiology of tonsils, their function for the immune system, and the early and late effects of tonsillar hypertrophy also need to be understood. Objective The aim was to measure the total serum and tonsillar tissue immunoglobulin E (IgE) level in children with chronic hypertrophied tonsils who will undergo for tonsillectomy (symptomatized children) and serum IgE level in nonsymptomatized children. Patients and methods This is a prospective comparative study that was carried out at the Otorhinolaryngology Department at Al-Zahraa University hospital and Al Mataria General Hospital. The study included 40 children, and their ages ranged from 5 to 15 years. Overall, 19 were males and 21 were females diagnosed with chronic hypertrophied tonsils. Half of them were symptomatized and underwent tonsillectomy, and the rest were not symptomatized. Results There was no significant difference in the serum IgE level in symptomatized and nonsymptomatized children. A statistically significant difference was found between the serum IgE level and the grades of tonsillar hypertrophy in both symptomatized and nonsymptomatized children. Tonsillar IgE level was also increased with increase in the grade of tonsillar hypertrophy. The relation between the serum and the tonsillar IgE levels in symptomatized children was found to be significant. Conclusion The authors observed a strong relationship between the serum IgE level and the grade of tonsillar hypertrophy in the two groups. Regarding the tonsillar IgE level in symptomatized children, there was an increase with increase in the grade of tonsillar hypertrophy, and there was also a positive correlation between serum and tonsillar IgE levels. [ABSTRACT FROM AUTHOR]

Background: Tonsillar hypertrophy, which is an indicator of tonsillectomy, is less accurate in making indications, so more specific indicators are needed. In chronic tonsillitis, biofilm bacteria are found which can cause antibiotic resistance. The presence of biofilm bacteria in chronic tonsillitis causes antibiotic drugs to not work properly, which is indicated to be the cause of delayed recovery in chronic tonsillitis. Purpose: Knowing the relationship between the gradation of biofilm bacterial density and tonsillar hypertrophy in patients with chronic tonsillitis. Method: This study was an observational analytic study with a cross-sectional study design. All patients with chronic tonsillitis who undergo tonsillectomy were selected by consecutive sampling. Gradations of tonsillar hypertrophy and bacterial biofilm were examined by scanning electron microscopy (SEM). Result: The results of biofilm density gradation from 26 samples obtained grade 0 results of 1 (3.85%) patient with T2 tonsils, class 1 as many as 1 (3.85%) patient with T2 tonsils. Class 2 were 2 (7.69%) patients with T2 tonsils and 3 (11.54%) patients with T3 tonsils. Class 3 were 1 (3.85%) patient with T2 tonsils, 7 (26.92%) patients with T3 tonsils and 1 (3.85%) patient with T4 tonsils. Class 4 (biofilms> 76%) as many as 2 (7.69%) patients with T3 tonsils and 8 (30.76%) patients with T4 tonsils. Conclusion: There is a relationship between the gradation of biofilm bacterial density and tonsillar hypertrophy in patients with chronic tonsillitis. The higher the gradation density of biofilm bacteria, the higher the gradation of tonsillar hypertrophy. [ABSTRACT FROM AUTHOR]

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Background: Tonsillitis, with associated tonsillar hypertrophy, is a common disease of childhood, yet it is rarely associated with sudden death due to airway obstruction. Lethal complications involving the inflamed tonsils include haemorrhage, retropharyngeal abscess and disseminated sepsis.Case Presentation: We report on a case of sudden and unexpected death in an 8-year-old female who was diagnosed with and treated for tonsillitis. The child was diagnosed with acute tonsillitis 2 days prior to her collapse and was placed on a course of oral antibiotics. There were no signs of upper or lower airway obstruction. She was found to be unresponsive by her caregiver and gasping for air in her bed in the early hours of the second morning after the start of treatment. Autopsy showed massive and symmetrically enlarged palatine tonsils. The tonsils filled the pharynx almost completely. The epiglottis and laryngeal mucosa at the base of the epiglottis in the vicinity of the aryepiglottic membrane and the superior aspect of the larynx displayed red-purple discoloration, with mucosal swelling and edema. Histological examination of the palatine tonsils revealed prominent lymphoid hyperplasia, but no evidence of acute inflammation.Conclusion: Palatine tonsillar hypertrophy in infants is a common feature of both viral and bacterial tonsillitis and has been postulated as a possible risk factor for Sudden and Unexplained Death in Infancy (SUDI), based on the theory of mechanical impediment of breathing by narrowing of the upper airway. The rounded shape of the tonsils may facilitate some airflow past the enlarged structures and hence protect against asphyxial death when the enlarged tonsils fill the laryngo-pharynx. Epiglottal and proximal laryngeal edema may play a more significant role in asphyxial unexpected deaths in cases of tonsillitis with tonsillar hypertrophy than previously suspected. This focusses the importance of careful examination of the epiglottis and proximal laryngeal mucosa, as part of a thorough examination of the laryngo-pharynx in cases of sudden death associated with tonsillar hypertrophy. [ABSTRACT FROM AUTHOR]

Aim: We aimed to assess the prevalence of actinomycosis in tonsillectomy specimens and its clinical importance and management in our center. Materials and Methods: In this retrospective matched case-control study, patients who underwent tonsillectomy during 2010-2015 in Shahid Mostafa Khomeini Hospital, Tehran, were studied. Data regarding age, sex, indication for surgery (such as recurrent tonsillitis or sleepdisordered breathing), tonsil size, and length of disease before surgery were collected in both histopathologically positive (case) and negative (control) patients for actinomycosis. Results: From the 260 studied tonsillectomy specimens, actinomycosis was found in 20 (8.75%) and 60 Actinomycosis negative cases were chosen randomly for the control group. There was no statistically significant difference between the groups with respect to age, sex, length of disease before surgery, and incidence of actinomycosis in tonsillectomy due to recurrent tonsillitis or sleep-disordered breathing. However, the tonsil size was significantly greater in specimens positive for actinomycosis (8.65±1.5 mL versus 4.38±0.22 mL, p<0.001). Conclusion: Actinomycosis in tonsillectomy specimens is an incidental histopathological finding and does not necessarily correlate with active disease; while it is associated with tonsillar hypertrophy and increased tonsil size. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to determine the relationship between primary nocturnal enuresis (PNE) and upper airway obstructive pathologies such as allergic rhinitis (AR), nasal septum deviation (NSD), adenoid hypertrophy (AD) and tonsillar hypertrophy (TH). Methods: The study included 78 volunteer PNE patients (42 males, 36 females; mean age: 7.2 ± 1.6 years, range: 5.4 to 11.6 years) who applied to Pediatrics and Urology outpatient clinics of a second-stage hospital between June 1, 2018 and September 1, 2018. The control group included 72 volunteer children (34 males, 38 females; mean age: 7.6 ± 1.4 years, range: 5.1 to 12.7 years) who were admitted to the inpatient outpatient clinics of the same hospital and had no PNE complaint. All participants included in the study were applied routine physical examination, flexible fiberoptic nasopharyngoscopy and score for allergic rhinitis (SFAR) questionnaire. Brodsky scale and fiberendoscopic findings were used to classify tonsil and adenoid dimensions respectively. Results: There was no significant difference between PNE (+) and PNE (-) groups in terms of age and gender (respectively p = 0.203 and p = 0.819). Although AR and NSD were similar in both groups, the ratio of AH and TH was statistically significantly higher in the PNE (+) group (p = 0.016 and p = 0.05, respectively). Conclusion: Adenotonsillar hypertrophy must be considered in children with primary nocturnal enuresis. [ABSTRACT FROM AUTHOR]

Abstract Objective Tonsillar hypertrophy may affect velopharyngeal closure and speech resonance. The aim of this study was to assess the impact of hypertrophied tonsils on velopharyngeal function in children with normal palate and to measure the effect of tonsillectomy on velopharyngeal closure and speech resonance. Methods Eighty seven children with hypertrophied tonsils and normal palate were subjected to tonsillectomy for indications other than speech problems. Preoperative and postoperative evaluation of velopharyngeal function was performed. Auditory perceptual assessment of speech (APA) and nasometric assessment of nasalance was measured, and velopharyngeal closure was evaluated by flexible nasopharyngoscopy. Results Thirteen patients were excluded from the study because of associated adenoid hypertrophy. The mean baseline of APA scores showed insignificant changes postoperatively. However, significant postoperative changes of nasometric parameters were detected, and the overall postoperative nasalance score was improved for nasal and oral sentences. Also, improvement of velopharyngeal closure was observed postoperatively with accession of palatal mobility and significant increase in coronal closure pattern. Conclusion hypertrophied tonsils may impair velopharyngeal function in children with normal palate by hindering palatal elevation. Tonsillectomy is a beneficial procedure for such patients as it can improve the velopharyngeal closure and speech resonance. [ABSTRACT FROM AUTHOR]

Myringotomy with tympanostomy tube placement and tonsillectomy (with or without adenoidectomy) are two of the most common procedures performed in the pediatric population. Indications for these surgical treatments are for correspondingly prevalent conditions affecting children, including middle ear and adenotonsillar disease, which are treated by many specialty groups spanning family physicians, pediatricians, emergency care physicians, and otolaryngologists. Despite the common nature of these diseases and respective indicated surgeries, their management has in the past had limited evidence-based guidelines. This article consolidates the most up-to-date evidence from the otolaryngology, pediatric, and infectious disease literature to guide the management with tympanostomy tube insertion and adenotonsillectomy in the pediatric population. [ABSTRACT FROM AUTHOR]

This study aimed to compare the tonsillar microbiota between post tonsillectomy patients with bleeding and without bleeding, and to investigate the potential role of tonsillar microbiota in the development of post-tonsillectomy hemorrhage (PTH). Nineteen tonsillar tissues from PTH patients and 21 tissues from control patients were collected. Metagenomic sequencing was used to compare the microbiota in PTH and control groups. Alpha diversity indices were used to compare the richness and evenness of the microbiota between the two groups. PCoA and NMDS analyses were used to evaluate beta diversity. LDA analysis was conducted to identify significantly abundant genera. No significant difference in alpha diversity indices was found between PTH and control patients. The dominant bacteria in the tonsillar microbiota were Haemophilus, Streptococcus, and Fusobacterium. PCoA and NMDS analyses showed significant differences in beta diversity between PTH and control patients. PTH patients had a significantly higher relative abundance of Neisseria, Capnocytophaga, and Veillonella. Capnocytophaga was also identified as a significantly abundant genus by LDA analysis. This study demonstrates that there is a difference in the tonsillar microbiota between PTH and control patients. The results suggest that Neisseria, Capnocytophaga, and Veillonella may be associated with the development of PTH. These findings provide new insights into the potential role of the tonsillar microbiota in the development of PTH, and may help to develop new strategies for preventing and treating this potentially life-threatening complication. [ABSTRACT FROM AUTHOR]

Objectives: This study was organized to assess the relationship of enuresis nocturna (EN) and upper airway obstruction (UAO) in children. Material and Methods: This study was multi-centrically and prospectively designed including 79 children who presented to a urology clinic with symptoms of EN between January 2013 and February 2014. Sixty-four age-matched children with no history of urological complaints were randomly recruited from children admitted to a pediatric clinic as a control group. All children and parents were asked to fill out a dysfunctional elimination syndrome (DES) questionnaire and children were examined by an ear, nose and throat (ENT) specialist to evaluate the UAO. Descriptive statistics, chisquare and Mann-Whitney-U tests were used to compare variables. Results: The mean ages of the 79 children (48 male, 31 female) in the study group and the 64 children (41 male, 23 female) in the control group were 10.14+/-3.38 and 9.17+/- 2.85, respectively. Family history of the study showed that 19% of the children’s mothers, 10% of the children’s fathers and 37% of the children’s siblings had experienced EN. There was a significant difference between the study and the control groups in terms of urge to urinate, bladder emptying, bowel symptoms and psychological stress. There was also a significant difference between rates of tonsillar hypertrophy and nasopharynx obstruction in the EN group (p = 0.009). Conclusion: In this study we found that half of the children with EN had tonsillar hypertrophy, which was significantly higher than in the control group. Further studies are needed to clarify the exact relationship between UAO and EN.

Actinomycosis is an infrequent bacterial infection encountered nowadays, caused by anaerobic Gram-negative bacterium of Actinomyces species. We report an unusual case of a unilateral tonsillar hypertrophy in a 40-year-old male, caused by actinomycosis masquerading as malignant tumor. To the best of our knowledge, only seven cases of actinomycosis causing unilateral tonsillar hypertrophy have previously been published. Since this anaerobic organism is difficult to culture, the diagnosis is made by observing its associated sulfur granules in the biopsy specimens. Still, actinomycosis represents an important entity in today's context as it is the great masquerader of the head-and-neck lesions because of its myriad presentation that may mimic other common diseases, the difficulties involved in its diagnosis, and the long course of treatment mandatory to eradicate the disease.

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