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.

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 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.

Caustic Agents Ingestion in Children: A 51-Year Retrospective Cohort Study.

OBJECTIVES: Children experience serious gastrointestinal tract injuries due to consumption of caustic agents more often than adults. The aim of the study was to analyze diagnostic methods and treatment of children with esophageal burns according to the degree of the injury. METHODS: Our one-center population-based retrospective cohort study included 150 children admitted between 1967 and 2018 to Clinic of Pediatric Otolaryngology, Phoniatrics and Audiology of University Children's Hospital in Lublin, Poland, due to the chemical burn of the mouth, throat, larynx, and esophagus. Each patient underwent a thorough laryngological examination and endoscopy to assess the place and degree of injury. RESULTS: Of 150 patients, 65.3% were male and 34.7% female. The median age was 4 years and 3 months. Salivation, dysphagia, burning sensation, edema, and whitish coating on the oral mucosa, palate, and throat were the most common clinical symptoms. In addition, dyspnea and chest pain were observed in 30% of patients. Esophagus endoscopy results were: Zargar grade I burn (84.7%), grade IIA (8%), grade IIB (2.6%), grade III (0%), and grade 0 (4.7%). Treatment included antibiotics, proton pump inhibitors, analgesics, and intravenous fluid therapy. Late sequelae (scarred esophageal strictures) developed in 20 (13.3%) patients. CONCLUSIONS: Accidental intake of caustic agents is observed in young children, especially younger than the age of 5. Early esophagus endoscopy should be performed in all patients to assess the grade of injury, plan initial treatment, and predict the risk of developing complications. Early diagnosis and immediate pharmacological treatment reduce the number of late sequelae.

[Maxillary sinus myxoma]. / Sluzak zatoki szczekowej.

Myxoma is a slow growing, benign neoplasm, which pathogenesis still remains disputed. The lesion has well-defined borders but a true capsule is absent. Because of that myxoma can be locally invasive causing bone destruction. A change is mainly observed among persons between 20-30 years of age and is very uncommon in the pediatric population. Most myxomas are observed in myocardium, but rarely may also manifest in the head and neck region. In the paper we describe an unusual case of myxoma of maxillary sinus in a female infant. Diagnostic challenges, treatment, outcome, post-operative follow-up are discussed as well as a review of the literature in order to present many features of this rare pathology.

Molecular Epidemiology of Streptococcus pneumoniae Isolates from Children with Recurrent Upper Respiratory Tract Infections.

A total of 125 isolates were recovered from adenoids and/or nasopharynx of 170 children aged 2 to 5 from south-east Poland; they had undergone adenoidectomy for recurrent and/or persistent symptoms of upper respiratory tract infections. Pneumococcal isolates were analyzed by phenotyping (serotyping and antimicrobial resistance tests) and genotyping together with the clonality of the pneumococcal isolates based on resistance determinants, transposon distribution and multilocus sequence typing (MLST). Serotypes 19F, 6B and 23F constituted 44.8% of the isolates. Among all of the strains, 44.8% showed decreased susceptibility to penicillin and resistance to co-trimoxazole (52.8%), tetracycline (38.4%), erythromycin (53.6%), clindamycin (52.8%) and chloramphenicol (27.2%) was observed. Tn6002 was found in 34.8% of erythromycin-resistant isolates while composite Tn2010-in 16.7% of erm(B)-carrying isolates that harboured also mef(E) gene. Tn3872-related elements were detected in 27.3% of erythromycin-resistant strains. In the majority of chloramphenicol-resistant catpC194-carrying isolates (79.4%), ICESp23FST81-family elements were detected. The genotyping showed that pneumococcal population was very heterogeneous; 82 sequence types (STs) were identified, and the most frequent contributed to not more than 8% of the isolates. Nearly 44% STs were novel, each of them was recovered only from one child. Four STs belonged to one of the 43 worldwide spread resistant pneumococcal clones currently accepted by Pneumococcal Molecular Epidemiology Network (PMEN), i.e. Spain 9V-3, Spain 23F-1, Norway NT-42 and Poland 6B-20, accounting for 12 (16.7%) of the 75 nonususceptible isolates, and five STs were single-locus variants of PMEN resistant clones (England 14-9, Spain 9V-3, Spain 23F-1, Greece 21-30, Denmark 14-32), accounting 9 (12%) of nonsusceptible isolates. A few MDR clones belonging to 6B and 19F serotypes found among preschool children emphasizes rather the role of clonal dissemination of local strains in the community than international clones spreading in the increase of resistance among pneumococcal strains.

Accumulation of CD5+CD19+ B lymphocytes expressing PD-1 and PD-1L in hypertrophied pharyngeal tonsils.

Programmed death-1 (PD-1) is one of the most important inhibitory co-receptors expressed predominantly on activated T and B lymphocytes whose expression could be sustained by permanent antigenic stimulation accompanying chronic or recurrent tonsillitis. The expression of PD-1 and PD-1L was analyzed using flow cytometry on hypertrophied tonsils collected from 57 children. We observed high expression of PD-1 and PD-1L on certain lymphocytes subpopulations of hypertrophied tonsils; among T cells, the expression of PD-1 on protein level was higher on CD4+ cells (70.3 %) than on CD8+ cells (35 %). Interestingly, a limited expression of PD-1 was observed on CD19+ B lymphocytes (6.5 %), while CD5+CD19+ B cells overexpressed PD-1 (52.5 %). Moreover, the expression of PD-1L was also higher on CD5+CD19+ B cells (16.5 %) than on CD19+ B cells (3.5 %) and on CD4+ T cells (20 %) than on CD8+ T cells (10 %). PD-1 and PD-1L expressions correlated only on CD5+CD19+ cells. In conclusion, high expression of PD-1 and PD-1L on T and B cells could represent hallmark of immune system adaptation to chronic antigenic exposition in patients with tonsillitis.

Nasopharyngeal and Adenoid Colonization by Haemophilus influenzae and Haemophilus parainfluenzae in Children Undergoing Adenoidectomy and the Ability of Bacterial Isolates to Biofilm Production.

Haemophili are pathogenic or opportunistic bacteria often colonizing the upper respiratory tract mucosa. The prevalence of Haemophilus influenzae (with serotypes distribution), and H. parainfluenzae in the nasopharynx and/or the adenoid core in children with recurrent pharyngotonsillitis undergoing adenoidectomy was assessed. Haemophili isolates were investigated for their ability to biofilm production.Nasopharyngeal swabs and the adenoid core were collected from 164 children who underwent adenoidectomy (2-5 years old). Bacteria were identified by the standard methods. Serotyping of H. influenzae was performed using polyclonal and monoclonal antisera. Biofilm formation was detected spectrophotometrically using 96-well microplates and 0.1% crystal violet.Ninety seven percent (159/164) children who underwent adenoidectomy were colonized by Haemophilus spp. The adenoid core was colonized in 99.4% (158/159) children, whereas the nasopharynx in 47.2% (75/159) children (P < 0.0001). In 32% (51/159) children only encapsulated (typeable) isolates of H. influenzae were identified, in 22.6% (36/159) children only (nonencapsulated) H. influenzae NTHi (nonencapsulated) isolates were present, whereas 7.5% (12/159) children were colonized by both types. 14.5% (23/159) children were colonized by untypeable (rough) H. influenzae. In 22% (35/159) children H. influenzae serotype d was isolated. Totally, 192 isolates of H. influenzae, 96 isolates of H. parainfluenzae and 14 isolates of other Haemophilus spp. were selected. In 20.1% (32/159) children 2 or 3 phenotypically different isolates of the same species (H. influenzae or H. parainfluenzae) or serotypes (H. influenzae) were identified in 1 child. 67.2% (129/192) isolates of H. influenzae, 56.3% (54/96) isolates of H. parainfluenzae and 85.7% (12/14) isolates of other Haemophilus spp. were positive for biofilm production. Statistically significant differences (P = 0.0029) among H. parainfluenzae biofilm producers and nonproducers in the adenoid core and the nasopharynx were detected.H. influenzae and H. parainfluenzae carriage rate was comparatively higher in the adenoid core than that in the nasopharynx in children undergoing adenoidectomy, suggesting that their involvement in chronic adenoiditis. The growth in the biofilm seems to be an important feature of haemophili colonizing the upper respiratory tract responsible for their persistence.

High prevalence of Streptococcus pneumoniae in adenoids and nasopharynx in preschool children with recurrent upper respiratory tract infections in Poland--distribution of serotypes and drug resistance patterns.

BACKGROUND: Streptococcus pneumoniae is one of the major bacterial pathogens colonizing nasopharynx, and often causes upper respiratory tract infections in children. We investigated the prevalence of S. pneumoniae in nasopharynx and adenoid core in 57 children aged 2-5 years who underwent adenoidectomy for recurrent pharyngotonsillitis, and we determined serotypes and antibiotic resistance patterns of the isolated pneumococci. MATERIAL/METHODS: The nasopharyngeal specimens obtained before adenoidectomy and the adenoids after the surgery were cultured for pneumococci. All isolates were serotyped by means of Quellung reaction. Susceptibility to antibiotics was determined according to EUCAST recommendations. RESULTS: S. pneumoniae colonization was observed in 40 (70.2%) children. From 29 (50.9%) children S. pneumoniae was isolated both from nasopharynx and adenoid core; 2 or 3 different isolates were identified in 8 (14.0%) children. In 8 (14.0%) children pneumococci were obtained from adenoid core only and in 3 (5.3%) children from nasopharynx only. Among the isolates, 35.3% were susceptible to all tested antimicrobials and 45.1% had decreased susceptibility to penicillin. Multidrug resistance was present in 52.9% of the isolates. The most frequent was serotype 19F (25.5%). The prevalence of serotypes included in pneumococcal conjugate vaccines PCV10 and PCV13 was 51.0% and 62.7%, respectively. CONCLUSIONS: The adenoids, like the nasopharynx, can be regarded as a reservoir of pneumococci, including multidrug resistant strains, especially in children with indication for adenoidectomy due to recurrent respiratory tract infections refractory to antibiotic therapy. Good vaccine coverage among the isolated pneumococci confirmed the validity of the routine immunization by PCVs in young children.

Serotypes and antibiotic resistance of Streptococcus pneumoniae from adenoids in preschool children with recurrent upper respiratory tract infections.

We investigated children aged 2-5, who had gone adenoidectomy for recurrent and/or persistent symptoms of upper respiratory tract infections for prevalence of pneumococci in adenoid tissue. Serotypes and antibiotic resistance patterns of the isolated pneumococci were determined and also risk factors of pneumococcal colonization were defined. S. pneumoniae colonization in adenoids was found in 62 (60.2%) children. Serotypes belonged to 10-valent and 13-valent pneumococcal conjugated vaccines (PCVs) constituted 56.1% and 68.2% of the isolates, respectively. Decreased susceptibility to penicillin was found in 45.5% of isolates; pneumococci were resistant to cotrimoxazole (62.1%), tetracycline (43.9%), erythromycin (54.5%), clindamycin (54.5%) and chloramphenicol (31.8%). Multidrug resistant S. pneumoniae comprised 57.6% of the isolates. Antibiotic resistant pneumococci were mostly distributed among serotypes belonged to 10-valent and 13-valent PCVs. Good vaccine coverage among the isolated pneumococci confirmed that the introduction of PCVs in the national immunization programme may reduce the pool of resistant and multidrug resistant pneumococci in a community.

Risk factors for otolaryngological foreign bodies in Eastern Poland.

OBJECTIVE: To identify the sociodemographic characteristics and risk factors associated with suspected foreign bodies in the ear, nose, throat, airway, and esophagus among Polish children. STUDY DESIGN: Case series with chart review. Setting Tertiary care medical center. SUBJECTS AND METHODS: A retrospective analysis of the medical records of patients hospitalized for a suspected foreign body (FB) between 1998 and 2008 was conducted. Data regarding place of residence, presence of siblings, parents' educational status, seasonality, psychomotor development, age, and sex were collected and statistically analyzed. RESULTS: Of the 1011 patients with suspected foreign body insertion, 849 (84%) had a positive diagnosis. Of the confirmed foreign bodies, 96 were found in the tracheobronchial tree, 142 were found in the esophagus, and 611 were located in the external auditory canals, nasopharyngeal passage, tonsils, auricles, or lips. Sociodemographically, 596 of the children came from urban areas, with a preponderance of males (55%). Objects were removed more frequently in summer and autumn (60%). Children with siblings (53%) predominated. The majority of patients (52%) had parents with an elementary education. Food was the most frequent foreign body in children under 3 years of age. Patients with delayed psychomotor development constituted 1.6% of the analyzed population. CONCLUSIONS: Being male, 1 to 3 years of age, belonging to an urban family with siblings, and having parents with an elementary education increased the risk of foreign body insertion. Training caregivers about proper nutrition and safety rules when playing with children can reduce the risk of accidents related to foreign body insertion.

Esophageal foreign bodies in pediatric patients: a thirteen-year retrospective study.

We discuss clinical symptoms and radiological findings of variable esophageal foreign bodies as well as therapeutic procedures in Caucasian pediatric patients. A retrospective study of 192 cases of suspected esophageal foreign bodies between 1998 and 2010 was conducted. Data were statistically analyzed by chi-square test. A foreign body was removed from a digestive tract of 163 children aged 6 months to 15 years (mean age 4.9). Most objects were located within cricopharyngeal sphincter. Dysphagia occurred in 43%, followed by vomiting (29%) and drooling (28%). The most common objects were coins. Plain chest X-rays demonstrated aberrations in 132 cases, and in doubtful situations an esophagram test was ordered. In the group of thirty-seven patients whose radiograms were normal, esophagoscopy revealed fifteen more objects, which were eventually successfully removed. No major complications occurred. Esophagram should be a second X-ray examination if an object is not detected in plain chest X-ray. We recommend a rigid esophagoscopy under general anesthesia in doubtful cases as a safe treatment for pediatric patients.

Upper respiratory colonization by Streptococcus pneumoniae in healthy pre-school children in south-east Poland.

OBJECTIVE: Carriage of Streptococcus pneumoniae in upper respiratory tract of healthy children is a major factor in the horizontal transmission of pneumococcal strains, especially between children attending day-care centers and may be also the source of infection in other individuals. During 8-month prospective study including 3 seasons (autumn, winter, spring), we determined risk factors for S. pneumoniae colonization in general and colonization at 2 or 3 time points in healthy pre-school children, including penicillin non-susceptible likewise multidrug resistant strains. METHODS: Pneumococcal cultures were obtained from 311 children aged 3-5. Finally, a total of 342 isolates were identified. Resistance of pneumococcal isolates was determined and information about potential risk factors were obtained from questionnaires. RESULTS: A total of 72.4% children were colonized by pneumococci at least once, including 8.4% children colonized at 3 time points, 25.4% children - twice and 38.6% children - only once. Penicillin non-susceptible pneumococcal colonization was found in 36.3% children at least once while multidrug-resistant pneumococcal colonization in 34.1% children. Of the 10.9% and 10.6% children were colonized at 2 or 3 time points by penicillin non-sussceptible and multidrug-resistant isolates, respectively. Pneumococcal colonization (in general or by non-susceptible to penicillin isolates) was independently associated with day care attendance, having no siblings, frequent respiratory tract infections and higher number of antibiotic courses. Children attending day care center, with frequent respiratory tract infections, exposed to tobacco smoke were prone to colonization by multidrug-resistant isolates. Risk of colonization at 2 or 3 time points by pneumococcal isolates, including penicillin-nonsusceptible isolates, was associated with age and day care attendance while multidrug-resistant pneumococcal colonization was found to be significantly higher in children aged 3, with frequent respiratory tract infections and higher number of antibiotic courses. CONCLUSION: These results indicate high rate of upper respiratory colonization by S. pneumoniae in healthy preschool children in Poland, including colonization by penicillin non-susceptible and multidrug-resistant pneumococci.

Dendritic cells and lymphocyte subpopulations of the adenoid in the pathogenesis of otitis media with effusion.

OBJECTIVE: To assess dendritic cells and lymphocyte subpopulations of adenoid and peripheral blood in patients with adenoid hypertrophy and otitis media with effusion (OME). To explain the influence of immunological status of adenoid on the development of OME. METHODS: The examined group covered 123 surgically treated patients due to adenoid hypertrophy (39 children with coexisting OME). Preoperative clinical examination included anamnesis and otorhinolaryngological examination with nasofiberoscopy, videootoscopy and assessment of the hearing organ. The material of the study were surgically removed adenoids and peripheral blood samples prepared and then analyzed by the means of tri-colour flow cytometry. The obtained results were statistically analyzed. RESULTS: Significant differences between patients with adenoid hypertrophy with coexisting OME and children without OME concerning CD19+CD69+, CD3+CD69+, CD4+CD69+CD8+CD69+ and CD19+CD25+ cells were observed. No statistical differences were revealed in the blood of patients with and without OME. Several statistical differences were noted between the adenoid and peripheral blood in patients with otitis media with effusion concerning BDCA-2+/CD123+ cells, CD3+ and CD19+ lymphocytes with the markers of their activation. CONCLUSIONS: The adenoid is involved in local immune response regardless of constitutional immunological mechanisms in patients with OME coexisting with adenoid hypertrophy. Significantly lower percentage of CD3+CD69+, CD4+CD69+, CD8+CD69+ and CD19+CD69+ cells of adenoid in patients with OME attests to reduced T-cells activation of the adenoid in relation to patients without OME.

Assessment of pulmonary function and nasal flow in children with adenoid hypertrophy.

OBJECTIVE: Adenotonsillar hypertrophy is the most common cause of upper airways obstruction in children. The consequences of this disorder were analyzed by many researchers. The aim of the study was the assessment of pulmonary function and nasal flow in children with adenoid hypertrophy. METHODS: The study group covered 30 children treated surgically due to adenoid hypertrophy. Nasometric and spirometric tests were performed before and after surgery. RESULTS: The results revealed statistically significant differences between pre- and post-operative values of nasometric flows and the following spirometric parameters: VC, FVC, PEF, FEV1/PEF and FEV1/FVC. CONCLUSION: The influence of adenoid hypertrophy on pulmonary function in children has been confirmed on the basis of the conducted research.

Nasal ganglioglioma--difficulties in radiological imaging.

Ganglioglioma is a tumour containing both astrocytic and neuronal components. Most gangliogliomas are observed in the brain, but may also manifest as a nasal glioma. Approximately 250 cases of nasal gliomas have been described in the literature. Gliomas are classified as heterotopias of glia tissue. In the paper we describe the case of nasal ganglioglioma and the diagnostic difficulties. The differences between ganglioglioma, nasal glioma and other congenital midline nasal masses are discussed.

Cervical lymphadenopathy in children--incidence and diagnostic management.

OBJECTIVE: Palpable lymph nodes are common due to the reactive hyperplasia of lymphatic tissue mainly connected with local inflammatory process. Differential diagnosis of persistent nodular change on the neck is different in children, due to higher incidence of congenital abnormalities and infectious diseases and relative rarity of malignancies in that age group. The aim of our study was to analyse the most common causes of childhood cervical lymphadenopathy and determine of management guidelines on the basis of clinical examination and ultrasonographic evaluation. MATERIAL AND METHODS: The research covered 87 children with cervical lymphadenopathy. Age, gender and accompanying diseases of the patients were assessed. All the patients were diagnosed radiologically on the basis of ultrasonographic evaluation. RESULTS: Reactive inflammatory changes of bacterial origin were observed in 50 children (57.5%). Fever was the most common general symptom accompanying lymphadenopathy and was observed in 21 cases (24.1%). The ultrasonographic evaluation revealed oval-shaped lymph nodes with the domination of long axis in 78 patients (89.66%). The proper width of hilus and their proper vascularization were observed in 75 children (86.2%). Some additional clinical and laboratory tests were needed in the patients with abnormal sonographic image. CONCLUSIONS: Ultrasonographic imaging is extremely helpful in diagnostics, differentiation and following the treatment of childhood lymphadenopathy. Failure of regression after 4-6 weeks might be an indication for a diagnostic biopsy.