Predictors of a Normal Sleep Study in Healthy Children with Sleep Disordered Breathing Symptoms.

OBJECTIVE: To determine the prevalence and characteristics of children with normal elective polysomnography for obstructive sleep disordered breathing (oSDB) based on the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines. STUDY DESIGN: In this retrospective cohort study, we identified patients ages 2 to 18 who underwent diagnostic polysomnography (PSG) ordered by our otolaryngology department for SDB between 2012 and 2018. SETTING: All patients were seen by otolaryngologists at an urban tertiary safety net hospital. SUBJECTS AND METHODS: There were a total of 456 patients studied (average age 5.66 ± 3.19; 263 (57.7%) males, 193 (42.3%) females. Demographic factors (age, gender, race, ethnicity, language, insurance status) and clinical findings (symptom severity, tonsil size) were recorded. The data were analyzed by univariate and multivariate analysis. RESULTS: Two hundred four patients (44.7%) had no obstructive sleep apnea (OSA) based on AHI<2 on PSG. Children with a larger tonsil size had 3.18 times the odds of OSA compared to those with a medium tonsil size (95% CI 1.64, 6.19) when adjusting for symptoms, age category, and race (P = .0007). Children ages 4 to 6 years had 0.25 times the odds of OSA compared to those ages 2-3 years (95% CI 0.12, 1.54) when adjusting for symptoms, tonsil size, and race (P = .0011). White children had 0.28 times the odds of OSA compared to Black children (95% CI 0.14, 0.57) when adjusting for symptoms, tonsil size, and age category (P = .0004). CONCLUSION: Among our patient population, 44.7% had normal sleep studies. Younger children (ages 2-3) were less likely to have normal polysomnography. This research demonstrates that obtaining sleep studies in otherwise healthy children with SDB can affect management decisions, and they should be discussed with families with a focus on patient centered decision making.

Current Status and Future Trends: Pediatric Intracapsular Tonsillectomy in the United States.

OBJECTIVES: 1) To assess the current status of pediatric intracapsular tonsillectomy in the United States, and 2) To apply lessons from the scientific literature and adoption of surgical innovation to predict future trends in pediatric intracapsular tonsillectomy. METHODS: This was a cross-sectional survey study and literature review. An anonymous survey was sent to all members of the American Society of Pediatric Otolaryngology (ASPO) to determine current practices in pediatric tonsillectomy. Statistical analysis was performed to compare differences in individuals who perform intracapsular tonsillectomy as opposed to extracapsular tonsillectomy. A literature analysis of the adoption of new technological advancements and innovative surgical techniques was then performed. RESULTS: The survey was sent to 540 pediatric otolaryngologists with a response rate of 42%. Of all respondents, 20% currently perform intracapsular tonsillectomy. The primary reason cited for not performing the procedure was concern for tonsillar regrowth. Time in practice, practice setting, and fellowship status was not associated with an increased incidence of intracapsular tonsillectomy. CONCLUSIONS: Only 20% of pediatric otolaryngologist respondents in the United States perform intracapsular tonsillectomy. Based on the documented advantages of intracapsular tonsillectomy over extracapsular tonsillectomy and an analysis of adoption of novel surgical techniques, we predict a paradigm shift in the specialty toward intracapsular tonsillectomy. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:S1-S9, 2021.

Influence of the palatine tonsil grade on the morphology of the maxillary and mandibular dental arches / Influencia del grado de las tonsilas palatinas en la morfología de los arcos dentales maxilar y mandibular

SUMMARY: Enlarged palatine tonsils and adenoids are thought to cause obstruction of the upper airway, triggering changes in breathing patterns, which in turn lead to dentofacial alterations, including malocclusions. The object of the present study was to correlate the size (grade) of the palatine tonsil with measurements of the maxillary and mandibular dental arches in children. This was an observational cross-sectional study carried out in 35 children aged between 6 and 11 years. The inter- and intra-arch parameters were measured (horizontal, vertical and sagittal analyses) by making plastercasts and then taking measurements with callipers. The tonsil size was classified in 5 grades from 0-4, using the Brodsky tonsil grading scale. The researcher was calibrated prior to carrying out the measurements. Pearson's chi-squared test was used and Pearson's correlation coefficient was calculated. The SPSS v.22.0 software was used, with a significance threshold of 5 %. Six patients were classified as grade 1, sixteen grade 2, eleven grade 3, two grade 4 and none of the patients presented grade 0.A low positive association was found between tonsil grade and the total length of the mandibular arch, a very low positive association between tonsil grade and maxillary inter-first premolar distance, total length of the maxillary arch and depth of the palatine recess.A very low negative association was found for tonsil grade and overjet, overbite, mandibular inter-permanent first molar distance, mandibular inter-first premolar distance, and mandibular and maxillary intercanine widths. No statistically significant correlation was observed for any of the measurements. No association was found between the tonsil grade and Angle's Classification, canine relationship, overjet and overbite. According to the results of this study there is no significant correlation between the dental arches and the tonsil grade.

RESUMEN: Se ha considerado que el grado del tamaño de las tonsilas palatinas y los adenoides pueden ser factores que generan obstrucción de la vía aérea superior, desencadenando cambios en el patrón de respiración, lo que provoca alteraciones dentofaciales, entre ellas, maloclusiones. El objetivo del presente estudio fue correlacionar el grado tonsilar palatino con medidas de los arcos dentales maxilar y mandibular en niños. Se realizó un estudio observacional de corte transversal. Fueron incluidos 35 niños entre 6 y 11 años de edad. Fueron medidos parámetros interarco e intra-arco (análisis transversal, vertical, sagital). Para eso fueron tomados modelos de yeso y luego las medidas fueron realizadas con un caliper. El grado tonsilar fue clasificado en 5 grados (0-5), de acuerdo a la escala de graduación de Brodsky. Para la realización de las mediciones el evaluador fue previamente calibrado. Se realizó la prueba Chi-cuadrado de Pearson, y coefi- ciente de correlación de Pearson. Se utilizó el software SPSS 22.0, considerándose umbral de significación de 5 %. Seis pacientes fueron clasificados en grado 1, dieciséis grado 2, once grado 3, dos grado 4 y ningún paciente presentó grado 0. Se encontró una asociación positiva baja entre grado tonsilar y la longitud total del arco mandibular, positiva muy baja entre grado tonsilar y distancia inter-primer premolar maxilar, longitud total del arco maxilar y profundidad de la bóveda palatina. Una asociación negativa muy baja fue encontrada para el grado tonsilar y overjet, overbite, distancia inter-primer molar permanente mandibular, distancia inter- primer premolar mandibular, ancho intercanino mandibular y maxilar. Se observó ausencia de correlación estadísticamente significativa para todas las medidas. No se encontró asociación entre el grado tonsilar y clase molar de Angle, relación canina, overjet y overbite. Según los resultados de este estudio no se aprecia una correlación significativa entre los arcos dentales y el grado tonsilar.

MRI evaluation of distance between tonsillary fossa and internal carotid artery in children.

OBJECTIVES: The presence of the internal carotid artery (ICA) near tonsils can also cause severe bleeding during a tonsillectomy. We investigated the relationship between tonsil width and volume; and superior, middle and inferior tonsil-ICA distances in 5-9 and 10-15 years of age children. METHODS: Cranial MRI images of 200 children between 5 and 15 years of age were evaluated retrospectively. There were 100 children in group 1 (5-9 years of age) and 100 children in group 2 (10-15 years of age). Palatine tonsil width and volume; and superior, middle and inferior tonsil-internal carotid artery (ICA) measurements were performed bilaterally. RESULTS: Our results showed that bilateral tonsil width and volume; and left superior, middle and inferior tonsil-ICA distance of 5-9 years of age group were lower than those of the 10-15 year-of age group (p < 0.05). The nearest distance between ICA and palatine tonsil is at the inferior tonsil-ICA distance side in both age groups. Especially mean inferior and middle tonsil-ICA distances were lower than 8 mm in 5-9 years of age group and lower than 9 mm in 10-15 years of age group. Minimum middle tonsil-ICA distances were 2.0-2.50 mm in smaller children and 2.0-3.50 mm in older children. Similarly, the minimum inferior tonsil-ICA distances were 2.00 mm in smaller children and 2.20-3.00 mm in older children. There were positive correlations between tonsil width, volume, and superior tonsil-ICA distance; and middle and inferior tonsil-ICA distances (p < 0.05). CONCLUSION: In younger children, lower tonsil width; and in all children, lower tonsil volume can be a warning sign in terms of lower tonsil superior-ICA distance. During tonsillectomies, working at the middle and inferior tonsillary fossa, maximum attention must be performed for the possibility of the ICA being very closer to the tonsil to avoid unwanted bleedings.

Risk of internal carotid injury due to peritonsillar abscess drainage.

OBJECTIVE: Peritonsillar abscess (PTA) is one of the most commonly seen ear nose and throat (ENT) emergencies. The most catastrophic complication that may occur due to surgical treatment of PTA is injury of internal carotid artery. The aim of this study is to determine distance and angle between PTA with ICA; and to prevent possible complications. METHODS: A total of 34 adult patients with PTA were enrolled in this study. Neck computed tomographies of the patients with PTA were evaluated by a radiologist. The distance between PTA and ICA (DIP), and contralateral tonsil side and ICA (DIT) were measured and compared with each other. Also angle between PTA and ICA (AIP) was examined. RESULTS: This study contained 20 (58.8%) males and 14 (41.2%) females with a mean age of 32.20 ± 12.75 years (range 18-60 years). Mean DIP and DIT scores were 13.39 ± 3.7 mm (min: 5.32, max: 19.07) and 9.61 ± 3.17 mm (min: 4.95, max: 16.35) respectively, and the difference was statistically significant (p<0.05). Mean distance between anterior border of PTA and ICA was 36.18 ± 6.42 mm (min: 17.12 max: 47.43). The AIP was 33.40 ± 2.29° (min: 30.10° and max: 40.71°). According to risk classification system, the 28 (82.4%) patients constituted low risk, and 6 (%17.6) patients constituted moderate risk. CONCLUSION: According to the distance between the PTA and ICA, the risk of ICA injury was found to be mild and moderate in PTA patients. It is crucial for the surgeon to pay attention to the depth and angle of the incision during drainage of the abscess.

Normal palatine tonsil size in healthy children: a sonographic study.

OBJECTIVES: Magnetic resonance imaging (MRI) and computerized tomography (CT) have been widely used to assess palatine tonsils. However, these imaging modalities have some limitations, such as high costs, need for sedation, and exposure to ionizing radiation. Ultrasound has been increasingly used to diagnose tonsillar pathologies. We aim to define normal tonsil size and volume of healthy children according to age. METHODS: A total of 274 healthy children were included. Both right and left tonsil sizes were measured in anteroposterior (AP), transverse (Tr.), and longitudinal (Long.) planes. Patients were divided into six subgroups according to their age, and analysis was performed for these subgroups. Age, sex, height, weight, and body mass index were recorded to find possible correlations. RESULTS: Median age of the whole population was 7 years (0-16 years). Mean tonsil volume is 1.5 ± 0.9 cm3 for right and left sides. We cannot detect any significant correlation between PT values and sex. We detected a significant positive correlation between PT values and height, weight and BMI. CONCLUSION: US can be used as a diagnostic tool for PT pathologies. PT size correlates with age, height, weight, and BMI; however, no correlation is present for sex and side.

Pathogenic role of palatine tonsils in palmoplantar pustulosis: A review.

Palmoplantar pustulosis (PPP) is characterized by symmetrical, erythematous, scaly plaques, with numerous, sterile, non-bacterial, pinpoint pustules, which are restricted to the palms and soles. Because several reports have described the efficacy of tonsillectomy for improvement in PPP skin lesions, we consider that PPP is tonsil-induced autoimmune/inflammatory syndrome (TIAS) while other factors are also involved in the pathogenesis of PPP. Here, the association between PPP pathogenesis and TIAS was examined, with a focus on results of previous studies. PPP patients show a hyperimmune response to indigenous bacteria such as α-streptococci, due to impaired immunological tolerance towards such organisms. Such a novel immune response leads to T-cell activation through the abnormal expression of secondary stimulation molecules, including cytotoxic T-lymphocyte-associated antigen 4, inducible T-cell co-stimulator and Smad7, in the tonsils of PPP patients. Activated tonsillar T cells express cutaneous lymphocyte antigen (CLA), CCR6 and ß1-integrin, enter the blood circulation and are recruited to PPP skin lesions. Within lesions, T cells roll onto endothelial cells through the interaction between CLA and E-selectin, migrate into the extravascular area through ß1-integrin-vascular cell adhesion molecule 1 binding, and assemble in the skin through CCL20-CCR6 binding. Hyperimmune responses to autoantigens such as keratin and heat shock proteins could also be involved in PPP pathogenesis, through the stimulation of the T-helper 17 reaction.

Relationship between Drug-Induced Sleep Endoscopy Findings, Tonsil Size, and Polysomnographic Outcomes of Adenotonsillectomy in Children.

OBJECTIVE: (1) Determine the correlation of awake tonsil scores and preadenotonsillectomy (pre-AT) sleep endoscopy findings. (2) Assess the relationship between polysomnographic AT outcomes with awake tonsil scores and sleep endoscopy ratings of tonsil and adenoid obstruction. STUDY DESIGN: Retrospective case series with chart review. SETTING: Tertiary care children's hospital. SUBJECTS AND METHODS: Children aged 1 to 18 years who underwent sleep endoscopy and AT from January 1, 2013, to August 30, 2016, were included. Pre-AT sleep endoscopy findings were scored with the Sleep Endoscopy Rating Scale. Awake tonsil scores and sleep endoscopy ratings were compared with Spearman correlation. Associations between changes in pre- and post-AT polysomnography parameters and (1) awake tonsil scoring and (2) sleep endoscopy scoring were assessed with 1-way analysis of variance and linear regression. RESULTS: Participants included 36 children (mean ± SD age, 6.8 ± 4.3 years; 68% male, 44% obese). Awake tonsil scores and sleep endoscopy ratings were strongly correlated (R = 0.58, P = .003). Awake tonsil scores were not associated with changes in any polysomnography parameters after AT (all P > .05), while sleep endoscopy ratings of adenotonsillar obstruction were significantly associated (all P < .05, R2 = 0.16-0.35). Patients with minimal adenotonsillar obstruction during sleep endoscopy had less improvement than those with partial or complete obstruction (mean obstructive apnea-hypopnea index change: -8.2 ± 11.5 vs -15.9 ± 14.3, and -46.8 ± 31.3, respectively; P < .001). CONCLUSIONS: In children at risk for AT failure, assessment of dynamic collapse with sleep endoscopy may better predict the outcome of AT than awake tonsil size assessment, thus helping to inform surgical expectations.

Histological and immunohistochemical studies of the proximal caecum and caecal tonsils of quail (Coturnix coturnix japonica).

The proximal caecum in quails consists of lymphoid and non-lymphoid structures. The caecal tonsils in the proximal part of the caecum are units of gut-associated lymphoid tissue in poultry. This study aimed to examine the histological characteristics of the proximal caecum, as well as compositions of dendritic cells (DCs) and antigen-presenting cells (APCs) in the caecal tonsil of quails. Tissue sections were stained with Crossman's triple, periodic acid-Schiff, Gordon and Sweet's silver, Congo red and methyl green-pyronin dyes, as well as immunohistochemically by the streptavidin-biotin-peroxidase complex method. Caecal lymphoid tissue was located in the lamina propria and submucosa. Germinative centres were observed within the lymphoid tissue. Reticular fibres were mainly distributed in the border area of the germinal centre with only a few fibres scattered in the centre. Plasma cells were observed in the subepithelial region and germinal centres. Eosinophil granulocytes were prevalent in the lymphoid tissue. Additionally, CD83-immunoreactive DCs and MHC class II immunoreactive APCs were present in the subepithelial area and diffuse lymphoid tissue. While DCs were seen in the germinal centres of tonsillar units, APCs were rarely present in the germinal centres, but they were noticed around the germinal centres. In conclusion, the histological structure of the proximal caecum in quails and the distributions of some immunological cells in the caecal tonsils were revealed. Therefore, the defensive role of the caecal tonsils in the digestive system may be better understood, and comparative studies may be carried out.

Is Adenotonsillar Size a Significant Factor on Voice in Children Undergoing Adenotonsillectomy?

OBJECTIVE: To determine whether adenotonsillar size is a significant determinant of voice in children who have undergone adenotonsillectomy. STUDY DESIGN: Prospective cohort study. PLACE AND DURATION OF STUDY: Ear Nose Throat Clinic, Ankara Numune Training and Research Hospital, Ankara, Turkey, from July 2017 to June 2018. METHODOLOGY: A total of 57 patients, who have been diagnosed with chronic adenotonsillitis and operated for obstruction or infection, were included in the study. Patients were divided into two groups according to their palatine tonsil sizes. Each patient performed voice analysis preoperatively and one month postoperatively, recruiting both objective and subjective methods. F0, jitter % and shimmer % values were assessed with objective methods; while subjective methods evaluated pediatric voice handicap index (pVHI) scores. Pre- and post-operative F0, jitter % and shimmer % values and pVHI scores from each study group were compared. RESULTS: In each study group, pre- and post-operative F0, jitter % and shimmer % values were found to be similar. In Group A, postoperative pVHI scores were found to be significantly reduced (p<0.001). In Group B, however, pre- and postoperatively assessed pVHI scores were similar. CONCLUSION: Adenotonsillar hypertrophy in children, who underwent adenotonsillectomy, seems to be an important and positively effecting factor on the subjective, but not the objective, parameters of voice.

Craniofacial and occlusal development in 2.5-year-old children with obstructive sleep apnoea syndrome.

OBJECTIVES: Paediatric obstructive sleep apnoea syndrome (OSAS) is associated with a range of changes in craniofacial and occlusal development. There is, however, little knowledge of how early in life these changes can be found. The aim of the present study was to determine whether changes in dental arch morphology, occlusion, facial profile, tonsil size, breathing habit or body mass index (BMI) can already be found among 2.5-year-old children with OSAS. MATERIALS AND METHODS: Fifty-two children were recruited to the study. Of these, OSAS was diagnosed in 9 children and 18 children did not snore in polysomnography. These two groups were subsequently compared when evaluating polysomnographic, otorhinolaryngological and dental variables. RESULTS: Children with OSAS had narrower inter canine width than non-snoring children (P = 0.032). Furthermore, children with OSAS had larger adenoid size with respect to the nasopharyngeal volume (P = 0.020) and more tendency to mouth breathing (P = 0.002). No statistically significant differences were found when comparing palatine tonsil size, occlusal characteristics, soft tissue profile measurements or BMI. LIMITATIONS: The limitation of the study is the small sample size. CONCLUSION: Children with OSAS had narrower upper inter canine width than non-snoring children at the age of 2.5 years. Larger adenoid size and mouth breathing tendency were also more common among children with OSAS. Further studies with larger sample sizes are needed to determine if other changes in craniofacial and occlusal development can be found in this age group.

The porcine tonsils and Peyer's patches: A stereological morphometric analysis in conventionally and artificially reared piglets.

Selection for prolificacy in modern pig farming has resulted in increasing litter sizes. Since rearing large litters is challenging, artificial rearing of piglets with a milk replacer is an alternative strategy. It is hypothesized that the development of the piglets' mucosa-associated lymphoid tissues (MALT) is affected by these artificial conditions. Therefore, the stereologically estimated volumes of the tonsil of the soft palate, and the lingual, nasopharyngeal and paraepiglottic tonsils, as well as the jejunal and ileal Peyer's patches were statistically compared at day 21 postpartum between six conventionally reared piglets and six piglets that were artificially reared from day 7 onwards. In addition, six 7-day-old sow-fed piglets were examined to evaluate the effect of age. All tonsils and Peyer's patches significantly increased in volume with age. The rearing strategy had no significant effect on the volumes of the tonsil of the soft palate and the lingual tonsil. The former tonsil was by far the largest with a mean volume of 967.2 ± 122.4 mm3 and 822.3 ± 125.4 mm3 in the conventionally and artificially reared piglets, respectively. The lingual tonsil only measured 9.4 ± 6.4 mm3 and 6.3 ± 2.6 mm3 in conventionally and artificially reared groups, respectively. In contrast, the rearing strategy did affect the volumes of the nasopharyngeal and paraepiglottic tonsils, which had a mean volume of 137.1 ± 32.4 mm3 and 84.4 ± 26.9 mm3, and 30.7 ± 7.8 mm3 and 20.0 ± 3.9 mm3 in conventionally and artificially reared piglets, respectively. The rearing strategy did not affect the development of the Peyer's patches. At day 21, the jejunal Peyer's patches of the conventionally and artificially reared piglets presented a volume of 1.6 ± 0.4 cm3 and 1.3 ± 0.2 cm3, respectively. The volumes of the ileal Peyer's patch amounted to 15.1 ± 3.0 cm³ in conventionally reared piglets and 12.0 ± 2.6 cm³ in artificially reared piglets at day 21. The results showed that artificial rearing hampers the morphological development of the tonsils that are exposed to inhaled antigens, but the voluminous lymphoid tissues that sample oral antigens are not influenced. Since it is unlikely that the observed differences in both tonsils are due to the milk replacer, artificial rearing could be a valuable alternative for raising large litters. In addition, the presence of developing MALT in piglets allows for investigating the value of nasal and oral vaccination in this species for human or veterinary purposes.

Patterns of adenoid and tonsil growth in Japanese children and adolescents: A longitudinal study.

Lymphoid tissues, such as adenoids (Ad) and tonsils (Tn), are suggested to undergo hypertrophy during childhood and involution in adulthood. Enlargement of Ad and Tn can cause transient obstruction of the respiratory airways, thus inducing obstructive sleep apnoea. To date, the standard Ad and Tn sizes have not been reported, and there are no explicit objective criteria for evaluating their sizes or deducing whether they have enlarged, reduced, or remained constant over time. Our previous cross-sectional study revealed the age-dependent airway occupation ratio of Ad and Tn in Japanese individuals. We conducted a longitudinal observational study of the Ad and Tn sizes in Japanese individuals aged 6-20 years. Ninety individuals were retrospectively enrolled. The average and standard deviation of the sizes was calculated in 5 age-based groups.

Quantitative Assessment of Palatine Tonsils in Healthy Children and Adolescents With Shear-Wave Elastography.

The normal elasticity and velocity values for palatine tonsils (PTs) in healthy children and adolescents were defined using shear wave elastography, and the relationship with potential factors affecting these values was assessed. This prospective study included a total of 80 cases with ages ranging from 3 to 17 years. Sex, age, and body mass index (BMI) were recorded. Elasticity and velocity measurements of both PTs and the relationship with basic descriptive data were investigated. For statistical analyses, independent-samples t tests and Spearman ρ (r) correlation coefficient were used. Quantitative variables are shown as the mean ± SD, and categorical variables are shown as n (%). The mean age was 10.6 ± 6.4 years, and the mean BMI was 17.40 ± 4 kg/m. The mean elasticity and velocity values were 9.38 ± 1.27 kPa and 1.76 ± 0.11 m/s for the right PT and 9.57 ± 1.43 kPa and 1.79 ± 1.04 m/s for the left PT, respectively. The mean tonsil volume was 2.44 mL for the right PT and 2.36 mL for the left PT. There were no significant differences in elasticity, velocity, and volumes when comparing location, age, or sex groups. No significant correlations were observed between the elasticity and velocity values and BMI. In conclusion, this preliminary work can be used as a reference for the diagnosis of PT diseases. Future comprehensive studies are necessary to establish the role of elastography in the diagnosis of pathologic tissue differentiation confirmed by clinical, laboratory, or pathology analyses.

Relationships between the obstructive character of the tonsils and the type of ventilation and lip posture.

INTRODUCTION: The role of obstructive tonsils in ventilatory disorders and abnormal lip posture is widely discussed in the literature but remains controversial. The data reported on the probable relationship between obstructive tonsils and an existing breathing disorder or lip incompetence were subjective. The purpose of this study was to evaluate the relationship between the obstructive character of the tonsils and the type of ventilation and lip posture. MATERIALS AND METHODS: This is a cross-sectional study performed in children aged from 6 to 12 years old. The subjects were divided into two groups (A and B) according to the obstructive or non-obstructive character of the palatal tonsils. Type of ventilation and lip posture at rest were recorded for each child. The collected data were analysed using the SPSS 20.0 software (for Windows). A Student's t-test and a Chi2 test were respectively used to compare quantitative and qualitative variables according to the obstructive character of the tonsils for each group. The level of significance is fixed at P=0.05. RESULTS: The subjects in group B with obstructive palatal tonsils were significantly more likely to oral breathing and lip incompetence than the subjects with non-obstructive tonsils (group A). CONCLUSION: The clinical examination of children with ventilatory and postural disorders with lip incompetence must be directed towards the search for associated obstructive palatal tonsils in order to plan an early etiological treatment. This would allow to avoid subsequent problems in the dentofacial structures.

Superb Microvascular Imaging of Palatine Tonsils in Healthy Children: A Preliminary Study.

In healthy children, the normal vascularity index (VI) values were defined for palatine tonsils using the superb microvascular imaging (SMI), and the relationship with potential factors affecting these values was assessed. This prospective study evaluated 74 children (age range = 3-17 years, median = 13 years, SD = 6.4 years). The cases were divided into 3 subgroups based on age as 3 to 6 years (preschool), 7 to 12 years (school age), and 13 to 17 years (adolescent). Demographic data such as sex, age, and body mass index (BMI) were recorded. The VI values of tonsils were measured with SMI and power Doppler (PD), and the correlation with descriptive data was researched. The Student t test, Mann-Whitney U test, and Spearman ρ correlation coefficient were used. The mean VI values on the right tonsil were calculated as 7.5% and 2.6% and on the left tonsil were 6.5% and 2.3% according to SMI and PD, respectively. On SMI, the vascularity was similar in the preschool and school-age groups, with a significant reduction between the school-age and adolescent groups. As BMI increased, tonsil vascularity reduced on SMI and PD. There was no significant difference in tonsil vascularity between the sexes. The VI values were identified to be higher on SMI compared with PD (P = 0.001). In healthy children, the normal VI values for both tonsils were determined with SMI and PD. On SMI, tonsil vascularity reduced significantly in the transition from school age to adolescence. Tonsil vascularity was affected by variations in BMI.

Non-invasive evaluation of human mucosal structures by multiphoton laser scanning tomography in vitro.

BACKGROUND: Mucous membranes may be affected by various diseases and the diagnostic accessibility is limited. Multiphoton laser tomography (MPT) is a useful tool for in vivo evaluation of superficial skin structures and might also be useful for the imaging of mucosa. OBJECTIVES: In order to investigate the suitability of MPT for the evaluation of mucous membranes, tissue samples of different donors and anatomical localizations have been imaged. METHODS: Human mucosa samples from the urinary bladder, palatine tonsil and ocular conjunctiva were investigated by MPT and subsequently compared with conventional histology. RESULTS: Horizontal images of the epithelium and the underlying connective tissue were obtained using the autofluorescence and second harmonics generation signals by MPT. The stratification of multilayered epithelium was consistently reproduced. Also inflammatory changes like lymphocytic infiltrates and widened intercellular spaces were imaged in some cases. CONCLUSION: Mucous tissue samples were obtained and MPT imaging was successfully performed. In the direct comparison with histology of the same tissue samples, the characteristic morphology of the epithelia was found. Further studies are necessary in order to compare images of healthy and diseased mucosal epithelium and the use of MPT for its evaluation in vivo.

Normative Values for Tonsils in Pediatric Populations Based on Ultrasonography.

OBJECTIVES: Pediatric tonsillar infections are common, particularly in adolescents. Ultrasonography (US) has high sensitivity and specificity for diagnosing peritonsillar abscesses and can diagnose tonsillitis by enlargement of the gland. In this study, we established normal tonsillar measurements and volumes according to age in pediatric populations. METHODS: Transcervical US of the peritonsillar region to measure tonsillar size and volume was performed in patients who had undergone neck US without throat symptoms from October 2016 to May 2017. Transverse and anteroposterior diameters, length, and volume were measured. RESULTS: In total, 161 patients (age range, 1 month-18 years) were enrolled in the study. The mean tonsillar volumes ± SD were 1.58 ± 1.26 (total), 0.30 ± 0.14 (<1 year), 1.27 ± 0.57 (1-<5 years), 2.06 ± 1.09 (5-<10 years), and 2.19 ± 1.48 (>10 years) cm3 . Mean measurements for the sums of both tonsils for the transverse diameter, anteroposterior diameter, and length were 1.98 ± 0.61, 2.17 ± 0.66, and 2.28 ± 0.69 cm, respectively. Tonsillar size and volume increased according to age. Simplified models for volume estimation showed that anteroposterior diameters had the highest coefficients of determination (R2 = 0.71 and 0.74). Regression models for the tonsillar volume of 6 measurements in the multiple linear regression models showed an R2 of 0.89. Regression models for log(volume) showed an improved coefficient of determination (R2 = 0.96). CONCLUSIONS: These normal tonsillar sizes on transcervical ultrasound in pediatric patients can be used to diagnose tonsillar lesions.