Assessing the need for adenotonsillectomy for sleep-disordered breathing in a community setting: A secondary outcome measures analysis of a randomized controlled study.

OBJECTIVE: To assess whether children with sleep-disordered breathing (SDB) symptom severity above a certain level, measured by a validated questionnaire, improve after adenotonsillectomy (AT) compared to no intervention. METHODS: Children with snoring and tonsillar hypertrophy (4 to 10-years old), who were candidates for AT, were randomly assigned to two evaluation sequences (baseline and 3-month follow-up): (a) evaluation immediately before AT and at 3 months postoperatively (AT group); or (b) evaluation at the initial visit and at the end of the usual 3-month waiting period for surgery (control group). Outcomes were (a) Pediatric Sleep Questionnaire sleep-related breathing disorder scale (PSQ-SRBD); (b) modified Epworth Sleepiness Scale (mESS); and (c) proportion of subjects achieving PSQ-SRBD <0.33 (low-risk for apnea-hypopnea index ≥5/h) if they had score ≥0.33 at baseline. RESULTS: Sixty-eight children were assigned to the AT and 72 to the control group and two-thirds of them had PSQ-SRBD ≥0.33. The AT group experienced significantly larger improvement between follow-up and baseline than controls (between-group difference [95% CI] for PSQ-SRBD: -0.31 [-0.35 to -0.27]; and mESS: -2.76 [-3.63 to -1.90]; P < .001 for both). Children with baseline PSQ-SRBD ≥0.33 in the AT group had an eight-times higher probability of achieving PSQ-SRBD <0.33 at follow-up than controls with similar baseline score (risk ratio [95% CI]: 8.33 [3.92-17.54]; P < .001). CONCLUSION: Among children with snoring, tonsillar hypertrophy, and clinical indications for AT, those with preoperative PSQ-SRBD score ≥0.33 show measurable clinical benefit postoperatively.

Use of Oximetry to Determine Need for Adenotonsillectomy for Sleep-Disordered Breathing.

: media-1vid110.1542/5802711151001PEDS-VA_2017-3382Video Abstract OBJECTIVES: We evaluated the efficacy of adenotonsillectomy (T/A) in children with sleep-disordered breathing (SDB) in a controlled study using oximetry. We hypothesized that children with SDB and abnormal nocturnal oximetry in a community setting will have improved hypoxemia indices after T/A. METHODS: Children with snoring and tonsillar hypertrophy (4-10 years old) who were candidates for T/A were randomly assigned to 2 oximetry sequences (baseline and 3-month follow-up): (1) oximetry immediately before T/A and at the 3-month follow-up, which occurred postoperatively (T/A group); or (2) oximetry at the initial visit and at the end of the usual 3-month waiting period for surgery (control group). Outcomes were (1) proportion of subjects with McGill oximetry score (MOS) >1 at baseline acquiring MOS of 1 at follow-up and (2) proportion of subjects achieving oxygen desaturation (≥3%) of hemoglobin index (ODI3) <2 episodes per hour at follow-up if they had ODI3 ≥3.5 episodes per hour at baseline. RESULTS: One hundred and forty children had quality oximetry tracings. Twelve of 17 (70.6%) children with MOS >1 in the T/A group and 10 of 21 (47.6%) children with MOS >1 in the control group had MOS of 1 at follow-up (P = .14). More subjects in the T/A than in the control group achieved ODI3 <2 episodes per hour at follow-up (14 of 32 [43.8%] vs 2 of 38 [5.3%]; P < .001). Three children with elevated ODI3 were treated to prevent persistently abnormal ODI3 in 1 child at follow-up. CONCLUSIONS: An ODI3 ≥3.5 episodes per hour in nocturnal oximetry is related to increased resolution rate of nocturnal hypoxemia after T/A for SDB compared with no intervention.

Aeroallergens in West Crete, Greece: A five year (2010-2014) aerobiological study.

The objective of the analytic observational study was to present air-pollen counting program results for a 5-year period. Airborne pollens and fungi collection, from both urban and sub-urban areas, were obtained using a special Burkard pollen trap installed on the roof of Chania General Hospital. Aeroallergen concentration measurement was made in a standardized way with fixation of the material collected and then counting using an optical microscope. Annual and total circulating pollen and fungi counts for the study period are presented. In the year 2014, the highest total annual count was recorded, while 2013 was the year with the lowest one. Months with the highest average concentrations were June for the years 2010 and 2011 (1291 and 1114.6 grains/m(3), respectively) and May for the consecutive 3 years 2012-2014 (1120, 890 and 1353.1 g/m(3), respectively). Peak periods for circulating aeroallergens were April-June. Trees pollen accounted for the majority of circulating aeroallergens (615.9 and 677.1 g/m(3) during peak periods in the years 2012 and 2014), while fungi accounted for the majority of circulating aeroallergens (818.5, 729.4, 890.7 spores/m(3)), during the peak periods in the years 2010, 2011 and 2013. Variability in peak airborne allergen periods could be partly explained by the differences in climatic conditions during the study period.

Comparison of acoustic rhinometry and nasal inspiratory peak flow as objective tools for nasal obstruction assessment in patients with chronic rhinosinusitis.

BACKGROUND: Chronic rhinosinusitis (CRS) is a disease with increasing incidence, characterized by persistent symptoms and negative impact on patient`s quality of life. Nasal inspiratory peak flow (NIPF) and acoustic rhinometry (AR) were studied and compared as assessment tools for CRS with or without nasal polyps (NP), as well as, in follow up monitoring of conservative medical treatment. OBJECTIVES: Seventy-eight patients were prospectively studied. Objective assessment included NIPF and AR at baseline and at 4 and 8 weeks after onset medical treatment. Measurements were studied in correlation with Sinonasal Outcome Test-22 (SNOT-22) questionnaire, Visual Analogue Scale (VAS) and endoscopic appearance score (EAS). RESULTS: Both NIPF and AR improved significantly, after medical treatment. NIPF score reflected CRS symptoms` improvement according to SNOT-22 total score at the end of treatment protocol, showing moderate to strong correlation with nasal obstruction VAS grading during the treatment period. AR measures were associated with EAS in all sets of examinations and correlated moderately with VAS scoring at 8 weeks. CONCLUSION: NIPF and AR were proven to be promising methods for objective evaluation and monitoring of nasal obstruction based on different aspects of nasal physiology in patients with CRS.

Evaluating the outcome of phonosurgery: comparing the role of VHI and VoiSS questionnaires in the Greek language.

OBJECTIVES/HYPOTHESIS: The objective was to study the role of the Greek version of Voice Handicap Index (VHI) in comparison with Voice Symptom Scale (VoiSS) in terms of measuring voice surgery outcome in patients with benign laryngeal lesions. STUDY DESIGN: Nonrandomized prospective. METHODS: Forty-six patients operated for benign laryngeal lesions were enrolled in the present study. All patients were assessed according to the European Laryngological Society guidelines. In terms of self-evaluation, patients answered the Greek versions of both VHI and VoiSS, preoperatively and 6 weeks postoperatively, and the results were statistically analyzed. RESULTS: The strongest correlation was observed between the functional subscale of VHI and the impairment subscale of VoiSS, as well as, between the emotional subscales of both VHI and VoiSS, pre- and postoperatively. A statistically significant change in subscale and total scores was found. VHI and VoiSS subscales and total scores correlated with the stroboscopic and aerodynamic measurements in a variable manner. Perceptual measurements, as well as shimmer and harmonic-to-noise ratio showed significant correlation with both VHI and VoiSS subscale and total scores postoperatively. CONCLUSION: VHI and VoiSS are considered useful tools in evaluating voice surgery outcome, in the Greek language.