Adenoid hypertrophy in children: a narrative review of pathogenesis and clinical relevance.

Adenoids (nasopharyngeal tonsils), being part of Waldeyer's ring, are masses of lymphoid tissues located at the junction of the roof and the posterior wall of the nasopharynx. Adenoids play an important role in the development of the immune system and serve as a defence against infections, being the first organs that come into contact with respiratory and digestive antigens. The causes of adenoid hypertrophy are not fully known. They are most likely associated with aberrant immune reactions, infections, environmental exposures and hormonal or genetic factors. The aim of this review is to summarise the current knowledge of adenoid hypertrophy in children and associated diseases. Adenoid hypertrophy has many clinical manifestations that are frequent in the paediatric population and is accompanied by various comorbidities.

An Evaluation of Health-Related Quality of Life in Children with Nasal Septum Deviation.

BACKGROUND: From the 1950s, the quality of life criterion came to be studied in earnest, originally forming a part of measurement of human development in Western Europe and the USA. The present study aims to compare the health-related quality of life (HRQL) between children with nasal septum deviation and healthy children controls. MATERIALS AND METHODS: Subjects were children suffering from nasal septum deviation, one of the commonest chronic diseases of the upper respiratory tract. Controls were randomly recruited from kindergarten, primary and secondary schools (junior high school & high school). All schools and subjects were randomly selected. The CHQ-PF50 questionnaire was used and outcome scores were calculated by an algorithm for the 13 tested HRQL variables. RESULTS: Means for all outcome scores in the test subjects (i.e., children with deviated nasal septums) varied between 3.65-89.27 with a standard deviation between 0.83-25.66 and a median between 3.4-100 (n = 101). Those for the controls (n = 102) were 3.78-97.11, 0.86-14.21 and 4.40-100, respectively. Test subjects showed significant scoring declines in Physical Fitness, Role/Social-Emotional/Behavioral, Role/Social-Physical, Mental Health, Self-esteem, General Health Perceptions, Parental Impact Emotional and Time and Family Limitations in Activities. CONCLUSIONS: 1. The well-being of children with nasal septum deviation was found to be chiefly limited by their physical fitness, effects of physical condition on social behavior/interaction and how health is perceived. 2. Parents considered their children's health to be paramount, as demonstrated by assessing the HRQL.

Physical and Psychosocial Concept Domains Related to Health-Related Quality of Life (HRQL) in 50 Girls and 52 Boys Between 5 and 18 Years Old in Poland Using the Parent-Reported 50-Item Child Health Questionnaire (CHQ-PF50).

BACKGROUND We used the parent-reported 50-item Child Health Questionnaire (CHQ-PF50) to evaluate parental by-proxy responses regarding 102 healthy Polish children and adolescents, aged 5 to 18 years, in 13 physical and psychosocial concept domains linked to health-related quality of life (HRQL) to determine which domains pose the greatest limitations to health. MATERIAL AND METHODS Participants were 50 healthy female and 52 healthy male school children (nursery, primary, junior-high, and high), selected randomly and found eligible from 585 participants originally recruited; participants with diseases/ailments and incomplete questionnaires were excluded. The CHQ-PF50 has 50 questions divided into 13 domains that represent physical and mental well-being; parents gave their retrospective responses from memory. Scores were expressed numerically using a standard algorithm and ranged from 0 to 100; higher scores represented more favorable HRQL outcomes. Summary statistics were performed, and age and sex effects were assessed. RESULTS Mean HRQL domain scores never attained 100 (maximum value). They were lowest (P<0.004) for domains of Family Cohesion (66.57), Parental Emotional (77.21), and General Health Perceptions (75.41), while highest (but still significantly <100, P<0.047) in Physical Functioning (97.11), Role/Social Emotional-Behavioral (96.51), and Role/Social-Physical (96.24). Neither age nor sex significantly affected domain scores. Outcomes were comparable to European and US studies but differed from a previous small-scale Polish study. CONCLUSIONS None of the CHQ-PF50 domain mean values reached the maximum in apparently healthy Polish children. HRQL was lowest in Family Cohesion, Parental Emotional, and General Health Perceptions. Outcomes are considered a useful control baseline in Polish studies on disease.

A review of health-related quality of life issues in children suffering from certain key otolaryngological illnesses.

Background: The health-related quality of life (HRQoL) concept is nowadays increasingly and more broadly used for helping evaluate the effectiveness of medical treatment, superseding the earlier "quality of life" approach. The HRQoL concept likewise applies to otolaryngology and this narrative review study is focused on HRQoL outcomes in four key childhood otolaryngological diseases as reported in the literature. Study aim: To retrospectively evaluate the literature on measuring HRQoL in children suffering from selected otolaryngological illnesses, during treatment. Materials and Methods: Published studies/case reports were searched for in Medline, PubMed, Web of Science, Scopus and ORCID on the quality of life based on paediatric patient questionnaires, whether completed by subjects themselves or by their parents (by proxy). The following key words were used: health quality of life, otolaryngology/ENT, pediatrics/paediatrics. Studies before 1999 were omitted because hitherto, the "quality of life" had been imprecisely defined thus rendering any subsequent comparisions problematic. Results: HRQoL scores and well-being were found to significantly deteriorate in child patients suffering from four important otolaryngological disorders: chronic sinusitis, nasal septum deviation, adenoid hypertrophy and hearing disease. The main problems found were infection, inflammation, disruption to family life and child-parental interaction, fitness-related issues, reduced ENT patencies and apnea. Conclusions: The HRQoL appears to significantly deteriorate in children suffering from otolaryngological diseases. Further such studies are needed for other ENT diseases.

Health-Related Quality of Life Assessed in Children with Chronic Rhinitis and Sinusitis.

INTRODUCTION: Quality of life (QoL) can be simply defined as an area of human life that directly affects people which they consider to be important. This can be defined in greater detail as 'an individual perception of an individual's life position within a cultural context, value system and in relation to their tasks, expectations and standards determined by environmental conditions'. The health-related quality of life (HRQoL) more specifically focuses on how the QoL affects health (including both medical and non-medical issues). Limitations in well-being will, by association, also occur in those children suffering with sinus diseases. STUDY AIM: To compare the quality of life in children-adolescents suffering from some of the most commonly occurring childhood diseases of chronic rhinitis and sinusitis on a group of healthy children-adolescents. Test materials and methods: Subjects were children-adolescents with at least one of the aforementioned conditions afflicting the upper respiratory tract. Admission criteria were: ages 5 to 18 years in the presence of a chronic disease such as chronic rhinitis and paranasal sinusitis. The Child Health Questionnaire-Parent Form 50 CHQ-PF-50 (CHQ-PF50) was used, which is a general-purpose research instrument based on psychometric testing designed for assessing physical and mental well-being in children-adolescents aged 5 to 18 years. RESULTS: Wellbeing significantly deteriorated in sick children within the following areas: current health status of the child (STAND), physical fitness (PF), social functioning resulting from behaviour or emotional state (REB), the impact of physical health on limitations in social functioning (RP), pain and discomfort (BP), behaviour (BE), mental health (MH), self-esteem (SE), general health perception (GH), influence of the child's health condition on parental emotions (PE), limitations on parental leisure time due to the child's health (PT) and restrictions on joint family activities (FA). CONCLUSIONS: The greatest impairment to well-being in children with chronic rhinitis and paranasal sinusitis was on the impact of the child's health status on parents' emotions, pain and discomfort and general perception of health. This study confirms that parents of healthy children attach great importance to their health and health-related quality of life.

Health-Related Quality of Life Assessed in Children with Adenoid Hypertrophy.

INTRODUCTION: The quality of life issue began to be earnestly studied in the second half of the 20th century. It had originally been used as a criterion for measuring levels of human development in the USA and Western Europe. At first, only objective parameters were assessed, such as material goods; however, later, subjective and non-material parameters were added, such as health, freedom, and happiness. Over time, more and more attention has been paid to the subjective parameters regarding any quality of life assessment. Adenoids are physiological clusters of lymphoid tissue included in Waldeyer's ring, which play an important role in shaping and directing the child's local and systemic lines of defence. Adenoid hypertrophy occurs due to a variety of factors, such as recurring or chronic infections of the upper respiratory tract. STUDY AIM: To assess health status in children with adenoid system hypertrophy compared with a group of healthy children. MATERIALS AND METHODS: The study group consisted of children suffering from adenoid hypertrophy, this being the most common chronic disease of the upper respiratory tract. The control group was composed of children attending nursery school (kindergarten), primary school, middle school, and high school. The study was performed by using the Child Health Questionnaire-Parent Form 50 CHQ-PF-50 (CHQ-PF50), which is a general purpose research tool based on psychometric testing when assessing physical and mental well-being in children aged 5 to 18 years. RESULTS: There were 101 filled out questionnaires for the test group (54 girls and 47 boys), mean age 8.62 years (ranging 5-17), whilst 102 questionnaires for the controls (50 girls and 52 boys), mean age 10.58 years (ranging 5-18). Insignificant differences were found between social functioning resulting from behaviour or emotional state (REB), pain and discomfort (BP), and family cohesion (FC). CONCLUSIONS: Children suffering from adenoid hypertrophy demonstrate the largest decreases in wellbeing in the following areas: behaviour, general perception of health, and mental health.

The Formation of Biofilm and Bacteriology in Otitis Media with Effusion in Children: A Prospective Cross-Sectional Study.

BACKGROUND: Otitis media with effusion (OME) can cause serious complications such as hearing impairment or development delays. The aim of the study was to assess the microbiological profile of organisms responsible for OME and to determine if a biofilm formation can be observed. METHODS: Ninety-nine samples from 76 patients aged from 6 months to 12 years were collected for microbiological and molecular studies. RESULTS: In microbiological studies, pathogenic bacteria Haemophilus influenzae (38.89%), Streptococcus pneumoniae (33.33%), and Staphylococcus aureus MSSA (27.78%), as well as opportunistic bacteria Staphylococcus spp. (74.14%), Diphtheroids (20.69%), Streptococcus viridans (3.45%), and Neisseria spp. (1.72%) were found. The average degree of hearing loss in the group of children with positive bacterial culture was 35.9 dB, while in the group with negative bacterial culture it was 25.9 dB (p = 0.0008). The type of cultured bacteria had a significant impact on the degree of hearing impairment in children (p = 0.0192). In total, 37.5% of Staphylococcus spp. strains were able to form biofilm. CONCLUSIONS: Staphylococcus spp. in OME may form biofilms, which can explain the chronic character of the disease. Pathogenic and opportunistic bacteria may be involved in the etiopathogenesis of OME. The degree of hearing loss was significantly higher in patients from which the positive bacterial cultures were obtained.

Macroscopic findings during endoscopic sinus surgery for chronic rhinosinusitis in children.

AIM: Endeavor to intraoperative macroscopic evaluation of changes in children with CRSs. Analysis of the type and incidence of pathological changes observed macroscopically during FESS was undertaken as well as an parallel attempt to correlate the level of inflammation markers with severity of disease. MATERIALS AND METHODS: Retrospective analysis of case records of 153 patients of the Department of Pediatric Otolaryngology, Medical University of Warsaw, hospitalized between 2010 and 2013. During that time 106 patients with a diagnosis of chronic maxillary sinusitis required surgical intervention. 102 children (avg-aged 11.5 years) were qualified to functional endoscopic surgery. The youngest patient was 3 years old and the oldest 18. 26 patients presented the polypoid lesions of sinuses or nasals. At 19 confirmed the coexistence of sinus polyps with nasal polyps. RESULTS: 76 patients had oedematous-inflammatory lesions and 26 polypoid. Among the group of listed above 26 children, 19 had either sinuses or nasal polyps. 15% children with polyps were diagnosed with cystic fibrosis and 8.0% with asthma. A common deviation in the results of morphology in children with CRSs is higher level of monocytes. Inflammation markers within the population of FESS qualified children were low. CONCLUSIONS: (1) Oedematous-inflammatory lesions are frequently intraoperatively identified. (2) The CRSs without polyps is the common type of chronic sinusitis in children. (3) Nasal polyps often coexist with sinus polyps. (4) If nasal polyps are found in pediatric population then diagnosis of CF, allergy and GERD should be considered. (5) Markers of inflammation in CRSs are low.

Perioperative problems and treatment of a teenager with a juvenile angiofibroma refusing blood transfusion.

OBJECTIVES: Juvenile angiofibroma is a benign, non-encapsulated neoplasm, consisting of vascular and connective tissue. Its main feature is a local malignancy. In its clinical course it destroys adjoining structures, without metastasizing. It appears rarely, and is mainly found in boys at puberty. Among theories about the aetiology of juvenile angiofibroma, we must consider a haematoma-like lesion, an angioma with an extended fibrous component, or type of inflammatory allergic polyp. In the development of the lesion the participation of hormonal disorders on the pituitary gland-gonad axis is also suggested. According to the latest research, juvenile angiofibroma is regarded as a developmental defect, affecting the embryonic vascular network surrounding the sphenoid bone. METHODS: If the patient or his/her parents refuse blood transfusion and use of blood products, it is necessary to apply modifications in the routine perioperative treatment. In the case of the patient refusing blood and blood products transfusion because of their beliefs, it is possible to get consent to use different, highly processed products like albumins or a cryoprecipitate, as well as applying some blood-saving techniques. CONCLUSIONS: 1. Removal of juvenile angiofibroma with minimal bleeding is possible. 2. Applying erythropoietin and iron preparations prior to surgery increases erythropoiesis and reduces the risks in transfusion. 3. Applying intraoperative normovolaemic haemodilution is a safe method and allows avoidance of transfusion of blood-derived products.

Ear tuberculosis: clinical and surgical treatment.

Two main points are discussed in this paper: First, the changing picture of the clinical process of tuberculosis, and second, various diagnostic problems caused by extra-pulmonary forms. We have analysed a case of ear tuberculosis in a child, and drawn the following conclusions: Directed chemotherapy is the primary method of treatment, and surgical methods should be used to provide tissue for bacteriological and histopathological analysis, to enable an early diagnosis during the first stage of the disease, and in other atypical cases.