Audiological Profile in Adenoid Hypertrophy.

Aim: The study aims to investigate the correlation between grade of adenoid hypertrophy and severity of hearing loss and to profile tympanometric findings in children with Adenoid Hypertrophy. Materials and methods: A within group comparison study was carried out in Father Muller College, Department of Speech and Hearing, Mangalore where 123 patients diagnosed with Adenoid Hypertrophy (86 males and 37 females; mean age 7.146; range 2 to 12 years) were analyzed using detailed case history, Pure tone audiometry (PTA) and Tympanometry. Results: The most prevalent presenting problems with adenoid hypertrophy were snoring (68.29%), mouth breathing (57.72%) and reduced hearing (35.77%). PTA results showed majority had bilateral hearing loss (60.27%). In the 230 ears that were tested, 50.85% had hearing loss. Majority of these ears had a minimal loss (23.91%), followed by mild loss (18.69%), moderate loss (7.82%), and moderately severe loss (0.43%). No correlation was found between the grade of Adenoid hypertrophy and the severity of hearing loss noted (p > 0.05). According to tympanometric findings, the most common tympanogram pattern was 'B' type (39.15%), 'A' type (31.60%), and 'C' type (18.39%). A small proportion of the population had 'As' (4.71%), 'Cs' (5.66%), and 'Ad' (0.47%). No correlation was found between the grade of adenoid hypertrophy and the type of tympanogram obtained (p > 0.05). Conclusion: In a significant percentage of cases, Adenoid hypertrophy affects the middle ear leading to conductive hearing loss. If left untreated it can lead to delayed speech and language development, auditory processing disorders, mental retardation, and physical and social complications. These are avoidable through primary health care education, accurate diagnosis, and effective treatment. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04714-8.

The therapeutic use of exosomes in children with adenoid hypertrophy accompanied by otitis media with effusion (AHOME): a protocol study.

BACKGROUND: The adenoids act as a reservoir of bacterial pathogens and immune molecules, and they are significantly involved in children with otitis media with effusion (OME). As an essential carrier of intercellular substance transfer and signal transduction, exosomes with different biological functions can be secreted by various types of cells. There remains significant uncertainty regarding the clinical relevance of exosomes to OME, especially in its pathophysiologic development. In this study, we will seek to determine the biological functions of exosomes in children with adenoid hypertrophy accompanied by OME (AHOME). METHODS: The diagnostic criteria for OME in children aged 4-10 years include a disease duration of at least 3 months, type B or C acoustic immittance, and varying degrees of conductive hearing loss. Adenoidal hypertrophy is diagnosed when nasal endoscopy shows at least 60% adenoidal occlusion in the nostrils or when nasopharyngeal lateral X-ray shows A/N > 0.6. Children who meet the indications for adenoidectomy surgery undergo adenoidectomy. Peripheral blood, nasopharyngeal swab, and adenoid tissue will be collected from patients, and the exosomes will be isolated from the samples. Following the initial collection, patients will undergo adenoidectomy and peripheral blood and nasopharyngeal swabs will be collected again after 3 months. EXPECTED RESULTS: This study aims to identify differences in exosomes from preoperative adenoid tissue and peripheral blood samples between children with AHOME and those with adenoid hypertrophy alone. Additionally, it seeks to determine changes in microbial diversity in adenoid tissue between these groups. CONCLUSIONS: The findings are expected to provide new insights into the diagnosis and treatment of OME, to identify novel biomarkers, and to enhance our understanding of the pathophysiology of OME, potentially leading to the development of innovative diagnostic and therapeutic approaches.

The Diagnostic Value of CT Scan in Identifying Adenoid Hypertrophy in Adults: A Case Report.

The utility of computed tomography (CT) scan in diagnosing adenoid hyperplasia in adults. A 22-year-old woman presented with persistent bilateral nasal obstruction, anterior nasal discharge, mouth breathing, and snoring over the past three months. Despite attempts with both local and systemic decongestants, there was no improvement, and flexible nasopharyngoscopy could not be conducted. CT scans revealed a heterogeneously enhancing space-occupying mass in the nasopharynx, and a rare diagnosis of adult adenoid hypertrophy was reported. The patient responded to a combination of painkillers, antibiotics, and nasal decongestants. Adenoid hyperplasia in adults is quite rare and inadequate examination by indirect posterior rhinoscopy may lead to misdiagnosis and mismanagement. A CT scan not only provides a clearer view of the nasopharyngeal space and adenoids but also reveals details about the nature of lesions, including their extension and potential bone destruction, suggesting the presence of a malignant tumor. Additionally, a CT scan proves valuable in diagnosing chronic sinusitis.

Correlation of the Size of Adenoids With Impedance Audiometry Findings.

Introduction Adenoid tissue is part of the first line of immunity of the upper aero-digestive tract. It is located in the postero-superior wall of the nasopharynx behind the choana. Adenoid hypertrophy, a common childhood disorder, significantly contributes to the pathogenesis of otitis media with effusion (OME), which is the leading cause of hearing impairment in young children. This condition can result in delayed speech, poor academic performance, and language development issues. Assessing the size of the adenoids and their correlation with OME is crucial, as undiagnosed cases can lead to complications such as atelectasis of the tympanic membrane and cholesteatoma. Clinical examination of the nose alone is often insufficient, and children do not cooperate for nasal endoscopy. Therefore, a lateral radiograph of the skull is considered the most reliable method for assessing the adenoid size. The size of the adenoids can affect Eustachian tube patency, which is reflected in the results of impedance audiometry. This study aimed to correlate the size of adenoids with impedance audiometry findings. Methods This cross-sectional observational study was conducted in the Department of Otorhinolaryngology of a tertiary care hospital from October 1, 2022, to March 31, 2024. A sample size of 50 patients was taken for the study. The inclusion criterion of selection of the patients included patients aged 3 to 15 years, who suffered from recurrent attacks of upper respiratory tract infections, particularly those with adenoid facies confirmed by X-ray with a non-perforated tympanic membrane. Exclusion criteria encompassed patients below 3 or above 15 years, and those with acute or chronic suppurative otitis media, craniofacial anomalies, or nasal pathologies like polyps. Adenoids were graded using X-ray imaging of the nasopharynx, and correlations between the adenoid size and impedance audiometry findings, such as middle ear pressure and compliance, were analyzed.  Results The study assessed the relationship between the adenoid size and impedance audiometry findings, focusing on middle ear pressure and compliance, as well as the occurrence of OME. The results indicated a significant decline in middle ear pressure with increasing adenoid grades. Specifically, adenoid grade 1 had an average pressure of -3.50 daPa, while grade 4 had the lowest average pressure at -119.72 daPa. This trend was statistically significant with a p-value of 0.00042. Similarly, compliance values also decreased with higher adenoid grades. Grade 1 had an average compliance of 0.64 ml, whereas grade 4 had the lowest average compliance at 0.28 ml. This relationship was statistically significant, as indicated by a p-value of 0.0048. Additionally, the analysis showed that a significant majority of patients with enlarged adenoids also presented with OME, highlighting a strong association between adenoid hypertrophy and this condition. Conclusion The study concluded that larger adenoids were associated with lower middle ear pressure and reduced compliance. Additionally, a significant majority of patients with enlarged adenoids also had OME. This underscores the importance of evaluating adenoid hypertrophy in the context of OME due to its potential impact on childhood hearing and development.

Effectiveness of Adenoidectomy as a Standalone Procedure in Improving the Quality of Life of Children with Obstructive Sleep Apnea.

Adenoid hypertrophy (AH) and its sequel like nasal obstruction, obstructive sleep apnoea (OSA), recurrent rhinitis and middle ear disorders are common diseases of pediatric age group, forming the major bulk of pediatric outpatient visits. The recommended approach to treating OSA in children is through adenotonsillectomy. Adenoidectomy is the surgical procedure of removal of hypertrophied adenoid tissues, which is the most common surgery performed by Ear, Nose, and Throat (ENT) surgeons. Given that adenoidectomy alone might lead to reduced instances of adverse outcomes, decreased risk of complications, and lower expenses, our objective was to explore the viability and suitability of adenoidectomy as a standalone treatment for pediatric OSA and to learn the significant effect of adenoidectomy on the quality of life (QOL) of children. Multicentric prospective study conducted in Department of ENT, Head and Neck Oncosurgery, Smita Memorial Hospital, Thodupuzha & Department of ENT, Head and Neck surgery, MCS Hospital, Muvattupuzha, Kerala, India from June 2022 to June 2023. Children between the age group of 5-10 years, who underwent adenoidectomy during the study period, satisfying the inclusion criteria were subjected for the study. Adenoidectomy was done for them using endoscope assisted coblation technique. Postoperative improvement in symptoms and change in quality of life were analyzed using obstructive sleep disorders-6 (OSD-6) questionnaire at the end of 3 months follow up. The surgeon observed a statistically significant improvement in all domains of OSD-6; and there by improvement in QOL in all patients, who underwent adenoidectomy in a course of three months. Adenoid hypertrophy is the most common cause of nasal obstruction in pediatric population and is creating a significant negative impact on the quality of life of children. Adenoidectomy is a safe and simple procedure which can provide significant improvement in quality of life of kids. Adenoidectomy in isolation could be a valid and recommended surgical choice for selected population of children displaying symptoms of pediatric OSA.

The role of adenoid immune phenotype in polysensitized children with allergic rhinitis and adenoid hypertrophy.

BACKGROUND: There is increasing interest in elucidating the relationship between adenoid hypertrophy (AH) and allergic rhinitis (AR). However, the impact of aeroallergen sensitization patterns on children with AH and AR remains unclear. METHODS: Patients aged 2-8 years (recruited from January 2019 to December 2022) with nasal symptoms were assessed for allergies, adenoid size, and respiratory viral infection history. The serum total immunoglobulin E (IgE) and specific IgE levels were measured, and flexible nasal endoscopy was performed. The relationship between AH, aeroallergen sensitization patterns, and lymphocyte subpopulations in adenoid samples was analyzed using flow cytometry. RESULTS: In total, 5281 children were enrolled (56.5% with AR; and 48.6% with AH). AH was more prevalent in children with AR. Compared to nonsensitized individuals, those polysensitized to molds had a higher prevalence of AH (adjusted OR 1.61, 95% CI 1.32-1.96) and a greater occurrence of two or more respiratory viral infections, particularly in adenoidectomy patients. The percentages and corrected absolute counts of regulatory T (Treg) cells, activated Tregs, class-switched memory B cells (CSMBs), natural killer (NK) T cells, and NK cell subpopulations were reduced in the adenoid tissues of children with both AH and AR (AH-AR) compared to AH-nAR children. Polysensitization in AH-AR children correlated with lower CSMB percentages. CONCLUSION: Polysensitivity to molds is associated with an increased risk of AH in children with AR. Fewer B cells, NK cells, and Treg cells with an effector/memory phenotype were detected in the adenoids of AR children, and these lower percentages of immune cells, particularly CSMBs, were closely linked to aeroallergen sensitization models and respiratory viral infection.

Efficacy of montelukast for adenoid hypertrophy in paediatrics: A systematic review and meta-analysis.

INTRODUCTION: Leukotrienes play a significant role in the pathogenesis of adenoid hypertrophy (A.H.). Therefore, we aimed to analyse the role of montelukast, a leukotriene receptor antagonist, alone or in combination with mometasone, a potent local intranasal steroid, for the treatment of A.H. METHODS: Participants were children with A.H. were treated with montelukast alone or montelukast and mometasone furoate. The main outcome measures were effect of montelukast on clinical symptoms of A.H. A literature review was conducted using online search engines, Cochrane Library, PubMed, Web of Science and Scopus, for randomized clinical trials assessing children with A.H. treated with montelukast alone or montelukast and mometasone furoate. Seven randomized clinical trials (RCTs) were included with 742 children. RESULTS: Our study reveals that montelukast alone or in combination with intranasal mometasone furoate significantly improves clinical symptoms of adenoid hypertrophy such as snoring, sleeping disturbance, mouth breathing and A/N ratio. Montelukast was superior to placebo in decreasing snoring (SMD = -1.00, 95% CI [-1.52, -0.49]), sleep discomfort (SMD = -1.26, 95% CI [-1.60, -0.93]), A/N ratio (MD = -0.11, 95% CI [-0.14, -0.09]) and mouth breathing (SMD = -1.36, 95% CI [-1.70, -1.02]). No difference was detected between montelukast and mometasone versus mometasone alone in snoring (SMD = -0.21, 95%CI [-0.69, 0.27]); however, the combination group was superior to the mometasone alone in mouth breathing (SMD = -0.46, 95% CI [-0.73, -0.19]). CONCLUSIONS: The limitation of studies included a small sample size, with an overall low to medium quality. Thus, further larger, higher-quality RCTs are recommended to provide more substantial evidence.

Otitis media with effusion in preschool children with adenoid hypertrophy: Risk factors and nursing care.

AIM: To evaluate the influencing factors of otitis media with effusion (OME) in children with adenoid hypertrophy and to provide evidence for clinical treatment and care of children with adenoid hypertrophy. DESIGN: A retrospective study. METHODS: Preschool children with adenoid hypertrophy treated in our hospital from 1 January 2021 to 30 July 2022 were included. We analysed the characteristics of OME and non-OME children with adenoid hypertrophy. Pearson correlation analysis and logistic regression analysis were performed to evaluate the risk factors for OME in children with adenoid hypertrophy. CONCLUSION: A total of 166 children with adenoid hypertrophy were included; the incidence of OME in children with adenoid hypertrophy was 34.94%. The incidence of OME decreased significantly with the increase in age (p = 0.014). Logistic regression analysis showed that age < 3 years (OR = 3.149, 95%CI: 2.812-3.807) and duration of adenoid hypertrophy ≥12 months (OR = 2.326, 95%CI: 2.066-2.612) were the risk factors of OME in children with adenoid hypertrophy (all p < 0.05). PATIENT CONTRIBUTION: The incidence of adenoid hypertrophy with OME is high in preschool children, and it is related to the age and duration of adenoid hypertrophy.

Nasopharyngeal Chordoma: A Case Report.

Chordoma is a rare malignant neoplasm arising from remnants of primitive notochord. The most common location for chordoma is in the sacrum. This case presents a 10-year-old medically free male who came to the ENT clinic with the impression of adenoid hypertrophy. After further investigations, including imaging and biopsy, it was found to be a nasopharyngeal chordoma. Our aim, in this case, is to increase the suspension of differential diagnosis of nasopharyngeal masses other than adenoid hypertrophy. In addition, it highlights the importance of imaging in the evaluation of nasopharyngeal masses.

A rat model of adenoid hypertrophy constructed by using ovalbumin and lipopolysaccharides to induce allergy, chronic inflammation, and chronic intermittent hypoxia.

BACKGROUND: Adenoid hypertrophy (AH) is a common pediatric disease that significantly impacts the growth and quality of life of children. However, there is no replicable and valid model for AH. METHODS: An AH rat model was developed via comprehensive allergic sensitization, chronic inflammation induction, and chronic intermittent hypoxia (CIH). The modeling process involved three steps: female Sprague-Dawley rats (aged 4-5 weeks) were used for modeling. Allergen sensitization was induced via intraperitoneal administration and intranasal provocation using ovalbumin (OVA); chronic nasal inflammation was induced through intranasal lipopolysaccharide (LPS) administration for sustained nasal irritation; CIH akin to obstructive sleep apnea/hypopnea syndrome was induced using an animal hypoxia chamber. Postmodel establishment, behaviors, and histological changes in nasopharynx-associated lymphoid tissue (NALT) and nasal mucosa were assessed. Arterial blood gas analysis and quantification of serum and tissue levels of (interleukin) IL-4 and IL-13, OVA-specific immunoglobulin E (sIgE), eosinophil cationic protein (ECP), tumor necrosis factor (TNF-α), IL-17, and transforming growth factor (TGF)-ß were conducted for assessment. The treatment group received a combination of mometasone furoate and montelukast sodium for a week and then was evaluated. RESULTS: Rats exhibited notable nasal symptoms and hypoxia after modeling. Histopathological analysis revealed NALT follicle hypertrophy and nasal mucosa inflammatory cell infiltration. Elevated IL-4, IL-13, IL-17, OVA-sIgE, ECP, and TNF-α levels and reduced TGF-ß levels were observed in the serum and tissue of model-group rats. After a week of treatment, the treatment group exhibited symptom and inflammatory factor improvement. CONCLUSION: The model effectively simulates AH symptoms and pathological changes. But it should be further validated for genetic, immunological, and hormonal backgrounds in the currently used and other strains and species.

Numerical and experimental evaluation of nasopharyngeal aerosol administration methods in children with adenoid hypertrophy.

Administering aerosol drugs through the nasal pathway is a common early treatment for children with adenoid hypertrophy (AH). To enhance therapeutic efficacy, a deeper understanding of nasal drug delivery in the nasopharynx is essential. This study uses an integrated experimental, numerical modelling approach to investigate the delivery process of both the aerosol mask delivery system (MDS) and the bi-directional delivery system (BDS) in the pediatric nasal airway with AH. The combined effect of respiratory flow rates and particle size on delivery efficiency was systematically analyzed. The results showed that the nasopharyngeal peak deposition efficiency (DE) for BDS was approximately 2.25-3.73 times higher than that for MDS under low-flow, resting and high-flow respiratory conditions. Overall nasopharyngeal DEs for MDS were at a low level of below 16 %. For each respiratory flow rate, the BDS tended to achieve higher peak DEs (36.36 % vs 9.74 %, 37.80 % vs 14.01 %, 34.58 % vs 15.35 %) at smaller particle sizes (15 µm vs 17 µm, 10 µm vs 14 µm, 6 µm vs 9 µm). An optimal particle size exists for each respiratory flow rate, maximizing the drug delivery efficiency to the nasopharynx. The BDS is more effective in delivering drug aerosols to the nasal cavity and nasopharynx, which is crucial for early intervention in children with AH.

The effects of adenoid hypertrophy and oral breathing on maxillofacial development: a review of the literature.

According to modern epidemiological surveys, the prevalence of adenoid hypertrophy in children and adolescents ranges from 42% to 70%. Adenoid hypertrophy can lead to airway obstruction; thus forces a child to breathe through their mouth, thus affecting the normal development of the dental and maxillofacial area, and can lead to malocclusion. Long-term mouth breathing can cause sagittal, vertical and lateral changes in the maxillofacial area. In this article, we review the current research status relating to the association between adenoid hypertrophy, oral breathing and maxillofacial growth and development in children and adolescents. We also discuss the personalized formulation of treatment plans.

Maximal medical treatment of adenoid hypertrophy: a prospective study of preschool children.

PURPOSE: This study aimed to examine the effectiveness of the combined maximal medical treatment for adenoid hypertrophy in preschool children. METHODS: Sixty-four children underwent one-year combined therapy with intranasal mometasone furoate, oral desloratadine, nasal saline irrigation, and bacteriotherapy. Additionally, decongestion drops were applied during scheduled breaks. RESULTS: Of the 64 treated children, 72% showed clinical improvement in adenoid symptoms while 28% did not improve and underwent surgery. These groups differed significantly in terms of the overall reduction in ailments after treatment (p < 0.001), infection rate (p < 0.001), catarrh severity (p < 0.001) and nasal patency (p < 0.001). Endoscopic examination confirmed that responders experienced, on average, a decrease of 8.4% in the adenoid/choana ratio and an improvement in mucosal coverage of the adenoid. These effects were not observed in the group of children whose parents opted for surgery after nine months of conservative treatment. CONCLUSIONS: The proposed new schema of long-term maximal medical treatment with the use of combined intermittent treatment of intranasal mometasone furoate and decongestion drops, oral desloratadine, nasal saline irrigation, and bacteriotherapy can be attempted in patients with adenoid hypertrophy symptoms, and responders may avoid the need for surgery. The applied treatment breaks resulted in a low number of therapeutic side effects.

Inflammatory endotypes of adenoidal hypertrophy based on a cluster analysis of biomarkers.

OBJECTIVE: To identify adenoid inflammatory endotypes based on inflammatory markers, match endotypes to phenotypes, and predict endotypes. METHODS: This cross-sectional study included 72 children with adenoid hypertrophy. Thirteen inflammatory markers and total immunoglobulin E (TIgE) in adenoid tissue were analyzed using Luminex and enzyme-linked immunosorbent assay (ELISA) for performing cluster analysis. Correlation analysis was used to examine the characteristics of each cluster. Receiver operating characteristic (ROC) curve analysis was performed to screen for preoperative characteristic data with predictive value for adenoid inflammation endotype. RESULTS: The patients were divided into four clusters. Cluster 1 exhibited non-type 2 signatures with low inflammatory marker concentrations, except for the highest expression of Th1-related cytokines. Cluster 2 showed a non-type 2 endotype with the highest concentration of interleukin (IL)-17A and IL-22. Cluster 3 exhibited moderate type 2 inflammation, with the highest concentration of neutrophil factors. Cluster 4 demonstrated significant type 2 inflammation and moderate neutrophil levels. The proportions of AR and serum TIgE levels increased from clusters 1 to 4, and there was a gradual increase in the prevalence of chronic sinusitis from low to high neutrophilic inflammation. The area under the ROC curve for serum TIgE was higher than those for combined or other separate preoperative characteristics for predicting non-type 2 and type 2 inflammation in the adenoid tissue. CONCLUSIONS: The evaluation of cytokines in adenoid tissue revealed four endotypes. Serum TIgE level was an important indicator of the endotype of adenoid inflammation. Identification of adenoid inflammatory endotypes can facilitate targeted treatment decisions.

Association between adenotonsillar hypertrophy and dentofacial characteristics of children seeking for orthodontic treatment: A cross-sectional study.

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.

Medical treatment does not reduce surgery rates in children with adenoid hypertrophy.

OBJECTIVE: We sought to study adenoidectomy rates in children with adenoid hypertrophy (AH) who were either treated with medical therapy or not during a 2-year follow-up period in a longitudinal population-based study. METHODS: We retrospectively identified healthy children aged 1-18 years between 2014 and 2020 with AH diagnosis from the Clalit Health Services database, the largest healthcare maintenance organization in Israel. The main outcome was adenoidectomy alone or in combination with other procedures performed within 2 years after diagnosis. The treatment group consisted of children who received medical therapy, defined as a pharmacy purchase of montelukast, nasal steroid sprays and/or antihistamines (medical therapy aimed to reduce AH) for ≥2 consecutive months, while the control group consisted of untreated children. RESULTS: We identified 68,356 unique children with AH, of them 56 % were boys, with a mean age of 4.9 ± 3.3 years. Of them, 5310 (7.7 %) received medical therapy. Overall, 6633 (9.7 %) underwent adenoidectomy within 2 years following diagnosis. There was no significant difference in surgery referral rates between the treatment and the control groups, 10 % vs. 9.7 %, respectively (p = 0.3). When adjusted for age and sex, the likelihood of undergoing adenoidectomy was similar in both groups (HR = 0.98, 95 % CI = 0.90-1.07, p = 0.6). Among operated children, the average time from diagnosis to surgery was statistically significantly longer in the treatment group than in the control group, 346 ± 180 vs 311 ± 175 days (p < 0.001). CONCLUSION: Prescribing montelukast, nasal steroids and/or oral antihistamines was not associated with a reduction in adenoidectomy rates and was associated with an average surgery delay of 35 days.

Altered intestinal microbiota enhances adenoid hypertrophy by disrupting the immune balance.

Introduction: Adenoid hypertrophy (AH) is a common upper respiratory disorder in children. Disturbances of gut microbiota have been implicated in AH. However, the interplay of alteration of gut microbiome and enlarged adenoids remains elusive. Methods: 119 AH children and 100 healthy controls were recruited, and microbiome profiling of fecal samples in participants was performed using 16S rRNA gene sequencing. Fecal microbiome transplantation (FMT) was conducted to verify the effects of gut microbiota on immune response in mice. Results: In AH individuals, only a slight decrease of diversity in bacterial community was found, while significant changes of microbial composition were observed between these two groups. Compared with HCs, decreased abundances of Akkermansia, Oscillospiraceae and Eubacterium coprostanoligenes genera and increased abundances of Bacteroides, Faecalibacterium, Ruminococcus gnavus genera were revealed in AH patients. The abundance of Bacteroides remained stable with age in AH children. Notably, a microbial marker panel of 8 OTUs were identified, which discriminated AH from HC individuals with an area under the curve (AUC) of 0.9851 in the discovery set, and verified in the geographically different validation set, achieving an AUC of 0.9782. Furthermore, transfer of mice with fecal microbiota from AH patients dramatically reduced the proportion of Treg subsets within peripheral blood and nasal-associated lymphoid tissue (NALT) and promoted the expansion of Th2 cells in NALT. Conclusion: These findings highlight the effect of the altered gut microbiota in the AH pathogenesis.

Impact of Breastfeeding Duration on Adenoid Hypertrophy, Snoring and Acute Otitis Media: A Case-Control Study in Preschool Children.

BACKGROUND: The aim of this study was to analyze the relationship between breastfeeding duration and adenoid size, snoring and acute otitis media (AOM). METHODS: We analyzed the medical history of children admitted to the ENT outpatient clinic in 2022 and 2023, reported symptoms, ear, nose and throat (ENT) examination, and flexible nasopharyngoscopy examination of 145 children aged 3-5 years. RESULTS: Breastfeeding duration of 3 and 6 months or more had a significant effect on the reduction of snoring (p = 0.021; p = 0.039). However, it had no effect on the adenoid size, mucus coverage and sleeping with an open mouth. Snoring was correlated with open mouth sleeping (p < 0.001), adenoid size with a 75% A/C ratio or more (p < 0.001), and adenoid mucus coverage in the Mucus of Adenoid Scale by Nasopharyngoscopy Assessment-MASNA scale (p = 0.009). Children who were breastfed for less than 3 months had more than a four-fold greater risk of snoring. There was a statistically significant correlation between AOM and gender (p = 0.033), breastfeeding duration in groups fed 1, 3 or 6 months or more (p = 0.018; p = 0.004; p = 0.004) and those fed with mother's breast milk 3 or 6 months or more (p = 0.009; p = 0.010). Moreover, a correlation was found between adenoid size and mucus coverage, tympanogram, and open-mouth sleeping (p < 0.001). Independent factors of snoring in 3- to 5-year-old children were breastfeeding duration of less than 3 months (p = 0.032), adenoid size with an A/C ratio of 75% or more (p = 0.023) and open mouth sleeping (p = 0.001). CONCLUSIONS: Children breastfed for 3 and 6 months or more exhibited reduced rates of snoring. There was no effect of breastfeeding duration on adenoid size in children aged 3 to 5 years, suggesting that the link between breastfeeding duration and snoring is primarily associated with craniofacial development and muscle tone stimulation. A breastfeeding duration of 1 month or more plays a key role in reducing the rate of AOM. The mother's milk plays a protective role against AOM. The presence of mucus might be responsible for snoring in preschool children. A medical history of breastfeeding should be taken into consideration when snoring children are suspected of adenoid hypertrophy.

Severe Chronic Gingivitis in Association With Hypothyroidism and Grade 2 Adenoid Hypertrophy: A Case Report.

Hypothyroidism is the second-commonest endocrine disorder in the world. Similarly, gingivitis is also a highly prevalent oral condition in every population globally. Adenoid hypertrophy and associated mouth breathing may aggravate preexisting gingival inflammation. Here, we are presenting the case of a 22-year-old female gingivitis patient with bleeding from gums on the slightest provocation and with a two-year history of preexisting hypothyroidism. Thorough systemic examinations and investigations ruled out the presence of hematological and/or coagulation disorders. However, she was found to have grade 2 adenoid hypertrophy along with a habit of mouth breathing. Periodontal and systemic management of the patient has resolved her gingival bleeding to a greater extent. Still, there remain a lot of ambiguity and a lack of clarity about the exact etiology and mechanism of pathogenesis behind her oral and general health status. Cases like these pose a diagnostic challenge for the treating dentist or periodontist and thus require a coordinated and collaborative effort of multiple health specialties.

Influences of Adenoid Hypertrophy on Children's Maxillofacial Development.

This study aims to investigate the association between adenoid hypertrophy and facial development. A total of 388 children aged 1-13 years old who had undergone head MRI in Foshan Maternal and Child Health Hospital were collected, including 196 hypertrophic cases and 192 normal cases. The maxillofacial soft tissue indicators were measured and compared. The A/N ratio and adenoid thickness consistently increased with age in the hypertrophic group and the A/N ratio reached a maximum value three years earlier than the normal group. The pharyngeal airway space, vallecula of epiglottis to anterior plane distance of the third/fourth cervical vertebrae, angle of convexity, total angle of convexity, and the nasolabial angle in the hypertrophy group were smaller than those in the control group (p < 0.05). The thickness of adenoids, palate height, palate length, and tongue length in the hypertrophy group exceeded that of the control group (p < 0.05). To conclude, adenoid hypertrophy was associated with craniofacial features such as a convex facial profile, a narrowed nasopharyngeal airway, an elongated and heightened palate, a lengthened tongue or a lower tongue position. These findings emphasize the importance of early intervention for children with adenoid hypertrophy to mitigate potential adverse effects on maxillofacial development.