Obstructive sleep apnea syndrome in the pediatric age: the role of the otorhinolaryngologist.

OBJECTIVE: Obstructive sleep apnea (OSA) is the primary indication for tonsillectomy, one of the most common pediatric surgical procedures, commonly performed in association with adenoidectomy. The objective of this review article is to evaluate the role of the otorhinolaryngologist in pediatric OSA. MATERIALS AND METHODS: A literature review has been performed on the following topics: peculiarities of sleep-disordered breathing in pediatric age; discrimination of sleep disorders; adenotonsillar hypertrophy; surgical techniques; adjuvant surgical procedures. RESULTS: The role of the otorhinolaryngologist in pediatric OSA is important for the evaluation of the upper airways and of essential biometric and polysomnographic data and for indication and execution of appropriate surgical treatment. In the majority of healthy children, adenotonsillectomy for OSA results in a dramatic improvement in respiratory parameters as measured by polysomnography. When post-surgical residual OSA occurs, it is essential to monitor patients by means of drug-induced sleep endoscopy (DISE). CONCLUSIONS: Otolaryngologic assessment is of paramount importance to correctly classify a child with OSA. Correct inspection of the upper airway and quantification of the quality of sleep through polysomnography lead to the right therapeutic choice. Knowledge of different surgical techniques helps to deal with residual OSA after studying the obstruction sites by drug-induced sedation endoscopy.

Increased expression of IL-19 in the epithelium of patients with chronic rhinosinusitis and nasal polyps.

BACKGROUND: Chronic rhinosinusitis (CRS) is an inflammation of the nose and of the paranasal sinuses. The involvement of the respiratory epithelium in the mechanisms of CRS is poorly understood. AIMS: Among proteins expressed by nasal epithelial cells in CRS, IL-19 may have key functions. We here aimed to determine the expression and regulation of IL-19. METHODS: Nasal biopsies from normal subjects (n = 12), subjects with CRS but without nasal polyps (NP) (CRSsNP, n = 12) and with CRS with NP (CRSwNP, n = 15) were collected. Human Asthma Gene Array and real-time PCR were used to evaluate gene expression, western blot analysis and immunohistochemistry for protein expression. Results for IL-19 were confirmed by real-time PCR. The constitutive and stimulated (LPS, TGF ß) expression of IL-19 and cell proliferation were evaluated in a nasal epithelial cell line (RPMI 2650). RESULTS: Human Asthma Gene Array showed an increased IL-19 gene expression in NP from patients with CRS in comparison with normal subjects. Real-time PCR confirmed the IL-19 mRNA up-regulation in patients with CRSwNP and showed an up-regulation of IL-19, at lower extent, in patients with chronic rhinosinusitis without nasal polyps (CRSsNP) in comparison with normal subjects. Western blot analysis confirmed that IL-19 is increased also at protein level in patients with CRSwNP in comparison with normal subjects. In NP, IL-19 is highly expressed in the metaplastic nasal epithelium when compared to normal or hyperplastic epithelium. LPS stimulation increased IL-19 expression, and recombinant IL-19 increased cell proliferation in nasal epithelial cells. CONCLUSIONS: IL-19 is overexpressed in the epithelium in CRSwNP and increases epithelial cell proliferation.

Localisation of Mediterranean Kaposi's sarcoma in Morgagni's ventricle.

OBJECTIVE: Head and neck involvement in Kaposi's Sarcoma (KS) is not unusual. However, laryngeal involvement is a relatively infrequent manifestation and ENT specialists should consider it in differential diagnosis in laryngeal lesions of AIDS patients and/or subjects from the Mediterranean area. METHODS: Case report and review of the literature in English. CLINICAL CASE: Male patient presenting with a three-month history of cough and acute dyspnoea. Laryngoscopy identified a laryngeal mass occluding the glottic plane. Tracheotomy was then performed and the laryngeal lesion was removed. Histopathology showed neoplastic spindle cells that were positive to immunostain with CD-31 and CD-34, and immunoreactivity for HHV-8 was present. A diagnosis of KS was then suspected and confirmed after dermatological inspection. CONCLUSION: Purple vascular mass lesions should lead in ENT to a high index of suspicion to exclude systemic diseases. Laryngeal KS must be included in the differential diagnosis of pigmented laryngeal lesions to plan correct management.

Uvulopalatopharyngoplasty with tonsillectomy in the treatment of severe OSAS.

OBJECTIVE: To establish the efficacy of uvulopalatopharyngoplasty with tonsillectomy for treating selected patients with severe obstructive sleep apnea syndrome. METHODOLOGY: Retrospective study of patients who underwent clinical/instrumental evaluation and surgical treatment. SETTING: University ENT division with a tertiary snoring referral center. PARTICIPANTS: Twenty-two patients with normal body mass index affected by severe obstructive sleep apnea syndrome. MAIN OUTCOME MEASURES: Pre- and post-operative cardiopulmonary monitoring during sleep, daytime sleepiness evaluation, post-treatment complication recording. RESULTS: Complete response to therapy was obtained in 78% of patients. Four patients had relief of symptoms but retained apnea/hypopnea index scores greater than 5. CONCLUSIONS: Uvulopalatopharyngoplasty associated with tonsillectomy can beemployed safely to treat patients with normal body mass index who suffer from severe obstructive sleep apnea.