Reduced E-cadherin expression is associated with lymph node metastases in laryngeal squamous cell carcinoma

Objective

To investigate the expression of E-cadherin and its relationship with clinicopathological parameters in laryngeal squamous cell carcinoma (LSCC).

Methods

Sixty-four patients who had previously undergone complete resection of tumor for LSCC were studied retrospectively. The level of E-cadherin expression in tumor tissues and paired nontumor tissues were determined by immunohistochemistry.

Results

The expression of E-cadherin in tumor tissues was significantly lower than nontumor tissues (P < 0.001). Reduced E-cadherin expression was significantly correlated with lymph node metastases (P < 0.001). Kaplan–Meier survival estimates showed a significant correlation between E-cadherin expression and patient survival rate (log-rank P < 0.05). Multivariate Cox proportional hazards model analysis confirmed that lymph node metastases (P = 0.001) and tumor stage (P = 0.013) were statistically significant, independent predictor of prognosis.

Conclusion

Expression of E-cadherin is an independent predictor of lymph node metastases in LSCC. However, it does not appear to be a better prognostic predictor than other established markers in LSCC.     

Prognostic value of matrix metalloproteinase 9 expression in patients with juvenile nasopharyngeal angiofibroma: Tissue microarray analysis

Objective

Although JNA is a benign neoplasm histopathologically, it has a propensity for locally destructive growth and remains a higher postoperative recurrence rate. The aim of this study was to analyze the expression and localization of MMP-9 in JNA using tissue microarray to elucidate its correlation with clinicopathological features and recurrence.

Materials and methods

The expression of MMP-9 was assessed by immunohistochemistry in a tissue microarray from 70 patients with JNA and 10 control subjects. Correlation between the levels of MMP-9 expression and clinicopathologic variables, as well as tumor recurrence, were analyzed.

Results

MMP-9 was detected in perivascular and extravascular less differentiated cells and stromal cells of patients with JNA but not in the matured vascular endothelial cells of these patients. The presence of MMP-9 expression in JNA was correlated with patient's age (p = 0.001). Spearman correlation analysis suggested that high expression of MMP-9 in JNA had negative correlation with patient's age (r = −0.412, p < 0.001). The recurrence rate in JNA patients with high MMP-9 expression was significantly higher than those with low MMP-9 expression (p = 0.002). In multivariate and ROC curve analysis, MMP-9 was a good prognostic factor for tumor recurrence of JNA.

Conclusion

Higher MMP-9 expression is a poor prognostic factor for patients with JNA who have been surgically treated.     

Expression of interleukin-33 is correlated with poor prognosis of patients with squamous cell carcinoma of the tongue

Objective

The aim of this study was to clarify the role of IL-33 in tumor progression.

Methods

Surgical specimens from 81 patients with squamous cell carcinoma of the tongue were studied using immunohistochemistry. Primary tumor sections were analyzed for IL-33 and ST2 expression. To examine the influence of IL-33 on the microenvironment of the tumor, we determined the mast cell density (MCD) and microvessel density of the stroma.

Results

Patients with high IL-33 expression had a significantly worse prognosis (p = 0.004). IL-33 expression was significantly elevated in patients with local and nodal recurrence (p = 0.014 and p = 0.019). ST2 expression was also associated with a worse prognosis (p = 0.024) and was significantly elevated in patients with nodal recurrence (p = 0.004). MCD was associated with worse prognosis (p = 0.038) and correlated significantly with IL-33 expression (r = 0.626, p < 0.001). Micovessels in the stroma were significantly increased in the high IL-33 group (p < 0.001).

Conclusion

These data suggest that the IL-33/ST2 axis contributes to tumor aggressiveness and affects the tumor microenvironment. Immunohistochemical evaluation of IL-33 and ST2 is useful for identifying patients at a high risk for poor prognosis.     

Expression of CC-chemokine receptor 7 (CCR7) and CXC-chemokine receptor 4 (CXCR4) in head and neck squamous cell carcinoma

Objectives

We tried to clarify the correlation of the expression of CCR7 and CXCR4 with lymph node and distant metastasis.

Materials and methods

We examined expression of CCR7 and CXCR4 in 9 HNSCC cell lines and 25 HNSCC tissues by semi-quantitative RT-PCR and immunohistochemistry study. We examined the expression levels of CCR7 and CXCR4 in undifferentiated and differentiated human normal keratinocyte.

Results

All cell lines expressed CCR7 mRNA, and three expressed CXCR4 mRNA. CCR7 and CXCR4 mRNAs were significantly higher in HNSCC tissues than in non-neoplastic tissues (p < 0.05, respectively) and correlated with lymph node metastasis (p < 0.05, respectively). The level of CXCR4 mRNA also correlated with distant metastasis (p < 0.05). Immunohistochemistry demonstrated localization of CCR7 and CXCR4 to carcinoma cells and lymphocytes and immunohistochemical staining scores of CCR7 and CXCR4 also showed similar correlation to lymph node and distant metastasis with CCR7 and CXCR4 mRNA levels. The level of CCR7 mRNA was significantly higher in poorly and moderately differentiated than in well-differentiated HNSCC (p < 0.05). The level of CCR7 mRNA in undifferentiated keratinocyte was significantly higher than that in differentiated keratinocyte.

Conclusion

The expression of CCR7 in HNSCC increases by dedifferentiation and plays an important role in lymph node metastasis of HNSCC and CXCR4 plays an important role in lymph node metastasis as well as distant metastasis.     

Adenoid cystic carcinomas of minor salivary glands

Objectives

Adenoid cystic carcinoma (ACC) is a very rare epithelioid tumor with different prognostic factors relating to overall survival. This study aims to analyze the prognostic factors, outcome and the value of surgical therapy on recurrent disease.

Materials and methods

From 1992 to 2006, a total of 33 patients with ACC originating in minor salivary glands of the oral cavity were clinicopathologically reviewed. Clinical and histological data was analyzed by univariate analysis using the log-rank test.

Results

64% of patients had a low-grade and 36% had a high grade disease. The 2-, 5- and 10-year survivals were 89.7%, 62.1% and 54.2%. The T category (p = 0.001), N category (p = 0.027), UICC stage (p < 0.0001), and resection margins (p = 0.024) influenced survival. Salvage treatment influenced patient's overall survival (p = 0.002).

Conclusion

This study confirms that in ACC T category, N category, UICC stage, and resection margin status correlates well with prognosis. Salvage surgery of patients with recurrent ACC should be performed if possible as the survival is significantly increased.     

Clinicians and laypeople assessment of facial attractiveness in patients with cleft lip and palate treated with LeFort I surgery or late maxillary protraction

Objective

To assess the changes in the facial attractiveness (FA) in two groups of cleft lip and palate patients with Class III malocclusions treated using LeFort I surgery or late maxillary protraction.

Materials and methods

Standardized pre- and post-treatment photographs were taken of 32 patients (17 corrected by orthognathic surgery and 17 by late maxillary protraction). The photographs were randomized and 42 clinicians and 121 laypeople rated them on a 10-point FA scale via a web-based survey.

Results

Clinicians’ mean FA values increased from 4.45 to 5.16 [95% CI of mean difference (MD), 0.59–0.82, p < 0.001] in surgical cases and 4.84 to 5.30 (95% CI of MD, 0.35–0.56, p < 0.001) in protraction cases. The laypeople mean FA values increased from 5.07 to 5.54 (95% CI of MD, 0.40–0.53, p < 0.001) in surgical cases and 5.51 to 5.68 (95% CI of MD, 0.11–0.23, p < 0.001) in protraction cases. When patients combined, laypeople rated FA 0.64 points higher (95% CI, 0.54–0.74, p < 0.001) in pre-treatment and 0.38 points higher (95% CI, 0.27–0.48, p < 0.05) in post-treatment relative to clinicians.

Conclusion

Both clinicians and laypeople perceived an improvement of FA after both treatments. Laypeople rated FA higher compared to clinicians.     

Expression of KITENIN and its association with tumor progression in oral squamous cell carcinoma

Objective

KAI1 COOH-terminal interacting tetraspanin (KITENIN) contributes to tumor invasion and metastasis in various cancers. The aim of this study was to investigate expression of KITENIN in patients with oral cavity squamous cell carcinoma (SCC) and to determine whether KITENIN affects tumor cell behavior in oral cavity SCC cell line.

Methods

Western blotting and immunohistochemistry was used to assess alteration of KITENIN expression in human oral cavity SCC and normal oral cavity mucosa. To evaluate the impact of KITENIN knockdown, the cell invasion assay and cell migration assay using small-interfering RNA were performed.

Results

KITENIN protein expression was significantly increased in human oral cavity SCC tissues than in normal oral cavity mucosa by Western blotting. KITENIN immunoreactivity was strongly identified in human oral cavity SCC relative to adjacent normal tissue. Knockdown of KITENIN resulted in significantly reduced cell invasion in human oral cavity SCC cells (p = 0.001). Cell migration showed a marked decrease in KITENIN knockdown oral cavity SCC cells compared to the negative control oral cavity SCC cells (p = 0.01).

Conclusion

KITENIN is associated with tumor invasiveness and metastasis in human oral cavity SCC.     

Nasal cavity dimensions in congenital pyriform aperture stenosis

Objective

To determine the dimensions of the nasal cavity in infants with congenital pyriform aperture stenosis (CPAS).

Study design

The nasal cavities of seven children with CPAS were identified and were compared to the nasal cavities of 13 neonates (<30 days old) who had received CT scans for other indications.

Methods

The width of the nasal cavities was measured at the pyriform aperture, choana, and at two standardized points along the lateral nasal wall (LW-1 and LW-2) between the pyriform aperture and choana.

Results

Comparison between neonates with and without CPAS demonstrates significant narrowing of the nasal cavity (not just the pyriform aperture) in infants with CPAS. Significantly smaller nasal width was noted at pyriform aperture, LW-1, and LW-2 (p < 0.01, p < 0.01, p = 0.02). No significant narrowing was seen at the choana.

Conclusion

These findings suggest that CPAS is associated with narrowing of the anterior 75% of the nasal cavity. This has implications for surgical management because simple pyriform aperture ostectomy may not be sufficient to relieve symptoms of obstruction.     

Validation of the Greek OSD-6 quality of life questionnaire in children undergoing polysomnography

Objective

OSD-6 is a disease specific questionnaire for pediatric obstructive sleep apnea (OSA). The aims of this study were to validate OSD-6 in Greek language and correlate OSD-6 with polysomnography results.

Study design

Prospective study.

Setting

Tertiary referral center.

Subjects and methods

OSD-6 questionnaire was translated to Greek and back to English. A prospective study was conducted on children undergoing overnight polysomnography due to snoring and disrupted sleep. Test–retest evaluation was carried out. Internal consistency and test–retest reliability were evaluated. Validity was assessed by exploring correlations between OSD-6 scores and apnea–hypopnea index (AHI), and by comparing total scores of OSA and non-OSA groups. Responsiveness was assessed by comparing preoperative to postoperative total scores in OSA children who underwent adenotonsillectomy.

Results

Test–retest evaluation of 91 subjects showed good internal consistency (Cronbach’s alpha 0.860 for test and 0.873 for retest) and reliability (Pearson’s correlation coefficients between test and retest scores: 0.751–0.546; p < 0.01). Total and domains’ OSD-6 scores and AHI were significantly correlated (Spearman’s correlation coefficients: 0.277–0.630; p < 0.01), while children with OSA had higher total OSD-6 score than those without OSA (median (interquartile range): 16 (11) vs. 10 (7), respectively; p < 0.01), indicating good validity. Postoperative OSD-6 scores were significantly lower than preoperative (2.84 ± 3.21 vs. 15.42 ± 6.48, respectively; p < 0.001), suggesting good responsiveness.

Conclusion

The Greek version of the OSD-6 questionnaire proved to be a valid instrument with satisfactory internal consistency, reliability, validity and responsiveness. Furthermore, in our study OSD-6 was significantly correlated to polysomnography results.     

Impact of tonsillectomy on health-related quality of life and healthcare costs in children and adolescents

Background

Tonsillectomy is a common surgical intervention in children, but its efficacy is under debate. We studied whether tonsillectomy is a cost-effective intervention with a positive impact on health-related quality of life (HRQoL).

Methods

Children (aged 7–11 years) and adolescents (aged 12–15 years) undergoing tonsillectomy answered the 17D or 16D HRQoL questionnaires before tonsillectomy and at 6 and 12 months postoperatively. At the same time-points, data on the use of healthcare services and school absenteeism were collected by questionnaire.

Results

Altogether 49 children and 42 adolescents returned all HRQoL questionnaires. Tonsillectomy improved the mean total HRQoL score clinically and statistically significantly in both children (from 0.935 at baseline to 0.958 at 12 months, p = 0.002) and adolescents (from 0.930 to 0.957, p = 0.004). The mean direct self-reported healthcare service costs diminished after tonsillectomy in both groups. The mean number of days on sick leave due to oropharyngeal problems during the preceding 3 months decreased from the preoperative 4.6 days to postoperative 0.5 days (p < 0.001) in children, and from 4.9 days to 0.8 days (p < 0.001) in adolescents at 12 months.

Conclusions

Tonsillectomy improves HRQoL in both school-aged children and adolescents and reduces healthcare service needs and school absenteeism due to oropharyngeal symptoms.     

Clinical utility of PPPM and FPS-R to quantify post-tonsillectomy pain in children

Objectives

As pain is a subjective and difficult parameter to assess in children, we aimed to evaluate the correspondence of two pain scales – parents’ post-operative pain measure (PPPM) and faces pain scale-revised (FPS-R) with analgesic intake in the assessment of post-tonsillectomy pain in a pediatric population.

Methods

Children aged 4–10 years (n = 174) undergoing tonsillectomy with or without adenoidectomy had their pain monitored by PPPM and FPS-R over 7 days following surgery. The amount of analgesic (acetaminophen or dipyrone) intake was also recorded each day. Linear regression and correlation analysis were performed for pain scales and Poisson regression model for analgesic administration. To evaluate influence of gender linear regression and logistic regression with random effects were performed.

Results

PPPM and FPS-R presented a significant positive correlation (τ = 0.5; R² = 0.36; p < 0.001). PPPM and FPS-R also showed a significant correlation with analgesic use over the 7 post-operative days (p < 0.0001). No influence of gender was observed in pain levels by both scales.

Conclusions

Our data demonstrate that PPPM and FPS-R are equivalent pain scales to quantify post-tonsillectomy pain in children and are useful tools in post-tonsillectomy clinical research.     

Children with cochlear implants: Cognitive skills,adaptive behaviors,social and emotional skills

Objective

The aim of this study is to examine cognitive skills, adaptive behavior, social and emotional skills in deaf children with cochlear implant (CI) compared to normal hearing children.

Methods

The study included twenty children affected by profound hearing loss implanted with a CI compared to 20 healthy children matched to chronological age and gender.

Results

Results of this study indicated that 55% of children with CI showed a score in the normal range of nonverbal intelligence (IQ > 84), 40% in the borderline range (71 < IQ < 84) and 5% were in mild range (50 < IQ < 70). No significant differences were found after comparison with normal hearing children. Children with CI reported more abnormalities in emotional symptoms (p = .018) and peer problems (p = .037) than children with normal hearing. Age of CI was negatively correlated with IQ (p = .002), positively correlated with emotional symptoms (p = .04) and with peer problems (p = .02).

Conclusions

CI has a positive effect on the lives of deaf children, especially if it is implanted in much earlier ages.     

Parental perception of speech and tongue mobility in three-year olds after neonatal frenotomy

Objectives

The goal of this study was to evaluate parental speech outcomes and tongue mobility in children with ankyloglossia who underwent frenotomy by an otolaryngologist during the neonatal period.

Study design

Cohort study and retrospective telephone survey.

Study setting

University Hospital.

Subjects and methods

Neonates previously diagnosed with congenital ankyloglossia were separated into Surgical Intervention (N = 71) and No Surgical Intervention (N = 15) Groups. A Control Group (N = 18) of patients was identified from the hospital medical record database, which were not diagnosed with congenital ankyloglossia. A survey provided by a certified speech pathologist utilized a Likert scale to assess speech perception and tongue mobility by parental listeners. The questionnaire also analyzed oral motor activities and the medical professionals that identified the ankyloglossia shortly after birth. Statistical analyses were performed with the Wilcoxon Rank Sum Test and Fischer's Exact Test in order to determine an effect size = 1.

Results

There was significantly improved speech outcomes designated by parents in the Surgical Intervention Group when compared to the No Surgical Intervention Group [p < 0.0001, p < 0.0001], respectively. Furthermore, parents designated no difference in speech outcomes between the Surgical Intervention Group when analyzed against the Control Group [p = 0.3781, p < 0.2499], respectively.

Conclusions

There was a statistically significant improvement in speech outcomes and tongue mobility in children who underwent frenotomy compared to individuals who declined the operation. As a result of the data presented within this study, there appears to be a long-term benefit beyond feeding when frenotomy is performed in newborns with ankyloglossia.     

Surgical complications and recurrence after central neck dissection in cN0 papillary thyroid carcinoma

Objectives

To evaluate surgical complications and recurrence patterns after central neck dissection (CND) in papillary thyroid carcinoma (PTC).

Methods

A retrospective analysis was performed on 361 patients who underwent total thyroidectomy with or without CND for PTC from 2000 to 2007. Clinicopathological results and recurrence were stratified according to treatment modality.

Results

Incidence of occult central metastasis of PTC was 64.3%. With respect to surgical morbidities, the total thyroidectomy (TT) with CND group exhibited a significantly higher incidence of transient vocal fold paralysis (10.0% vs 3.4%, p = 0.029) and permanent hypocalcaemia (11.4% vs 4.5%, p = 0.041), and significantly prolonged mean operating time (195.8 min vs 153.0 min, p < 0.001) than the TT alone group. Analysis of the recurrence patterns revealed that level IV was most commonly involved in both groups. When the location of recurrence was categorised into central and lateral neck, the recurrence rate in the lateral neck was significantly higher than that in the central neck, regardless of initial CND.

Conclusions

CND was associated with permanent hypocalcaemia and transient vocal fold paralysis. The lateral neck was mainly involved in recurrence regardless of initial CND, suggesting the clinical benefit of CND may be small.     

Comparing auditory brainstem responses (ABRs) to toneburst and narrow band CE-chirp in young infants

Objective

The difference of characteristics (latency and amplitude) between toneburst and narrow CE-chirp^® stimuli on ABR recording was analyzed in normal hearing infants.

Methods

500, 1000, 2000 and 4000 Hz toneburst and narrow band CE-chirp^® auditory brainstem responses (ABRs) were recorded in 40 normal-hearing infants. The amplitude and latency parameters of the ABR were collected for each of the four stimulus levels: 80, 60, 40, and 20 dB nHL. Both stimuli started from 80 dB nHL using alternating polarity and the rates were both 27.1/s.

Results

The toneburst latencies are greater than narrow band CE-chirp latencies for all intensities at 500, 1000 and 2000 Hz (p < 0.001). However, at 4000 Hz this difference was not significant. At 500 Hz, wave V amplitude is larger for toneburst than narrow CE-chirp^® (p < 0.001) in 80 dB nHL. The difference between the two stimuli in 60 dB nHL was not significant (p = 0.495) and at 40 and 20 dB nHL the wave V narrow band CE-chirp^® amplitude is greater than toneburst amplitude (p < 0.001). At 1000, 2000 and 4000 Hz there is no difference between the wave V toneburst and narrow band CE-chirp^® amplitudes at 80 dB nHL (p = 0.940; p = 0.776 and p = 0.217 respectively). On the other hand, in the levels to 60, 40 and 20 dB nHL, narrow band CE-chirp^® amplitudes are larger than toneburst amplitude (p < 0.001).

Conclusion

Narrow band CE-chirp^® ABRs generates shorter latencies than the toneburst ABRs, especially to low frequencies. Higher amplitudes were found with narrow band CE-chirp^® stimuli for all frequencies tested, except to high levels.     

Evaluation of ceruloplasmin levels in patients undergoing surgical interventions with nasal polyps

Objective

Oxidative stress is believed to have a role in the development of nasal polyps (NPs). It is also known that ceruloplasmin (CP), an acute phase protein, limits oxidative stress. The purpose of this study was to evaluate the ceruloplasmin levels in patients with NPs.

Methods

One hundred and twenty patients with NPs, septal deviations and concha hypertrophies were recruited to the study. Patients were divided in two groups; group 1 (n = 60) consisted of patients with NPs, and group 2 (n = 60) consisted of septal deviations and concha hypertrophies. Polyp specimens were taken from all patients who underwent endoscopic surgery due to NPs, as well as control specimens were acquired who underwent an operation due to septoplasty or concha hypertrophy. Blood and tissue samples were obtained to assess CP levels.

Results

There were no statistical differences in gender, age and biochemical values between two groups (p > 0.05 for all). Compared to group 2, group 1 had significantly higher CP levels both in serum and the tissue samples (both p < 0.001).

Conclusion

As a result of our study; CP levels both in serum and the tissue in patients with NPs were higher, may be consequence of the inflammation, than in patients without NPs.     

Vitamin D levels and effects of vitamin D replacement in children with periodic fever,aphthous stomatitis,pharyngitis, and cervical adenitis (PFAPA) syndrome

Background

The periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome is an autoinflammatory disease characterized by regularly recurrent fever episodes due to seemingly unprovoked inflammation.

Objective

To assess serum 25-hydroxyvitamin D [25(OH)D] concentrations in children with PFAPA syndrome and evaluate longitudinally the effect of wintertime vitamin D supplementation on the disease course.

Study design

We have evaluated 25 Italian patients (19 males, 6 females, aged 2.4–5.3 years), fulfilling the Euro-Fever PFAPA criteria. For each patient, we recorded demographic and anthropometric data, clinical manifestations, serum calcium, phosphate, and 25(OH)D. After 400 IU vitamin D supplementation during wintertime, clinical and auxological characteristics, calcium, phosphate, and 25(OH)D levels were re-evaluated. Data were compared with a sex- and age-matched control group.

Results

PFAPA patients showed reduced 25(OH)D levels than controls (p < 0.0001). Regarding the effect of seasons on vitamin D, winter 25(OH)D levels were significantly reduced than summer ones (p < 0.005). Moreover, these levels were significantly lower than in healthy controls (p < 0.005), and correlated with both fever episodes (p < 0.005) and C-reactive protein values (p < 0.005).After vitamin D supplementation, PFAPA patients showed a significantly decreased number of febrile episodes and modification of their characteristics (mean duration of fever episodes, p < 0.05; number of febrile episodes per year p < 0.005).

Conclusions

Deficient and insufficient vitamin D serum levels were found in most children with PFAPA syndrome, and hypovitaminosis D might be a significant risk factor for PFAPA flares. However, vitamin D supplementation seems to significantly reduce the typical PFAPA episodes and their duration, supporting the role of vitamin D as an immune-regulatory factor in this syndrome.     

Subjective cold hyper-responsiveness grade reflects age- and duration-related increase of nonspecific nasal hyperreactivity

Objective

We evaluated the effect of patients’ age and duration of allergic rhinitis on nonspecific nasal hyper-reactivity (NHR) using cold dry air (CDA) provocation.

Methods

In 156 patients of various ages with allergic rhinitis and different symptom duration, we evaluated the change of symptoms, the subjective cold hyper-responsiveness (SCH) grade, the change of acoustic parameters such as total nasal volume (TNV) and minimal cross-sectional area (MCA), and the amount of rhinorrhea before and after CDA provocation.

Results

Patients in different age or duration groups did not show significant differences in the change of each nasal symptom. SCH grade 2 or 3 was more frequently observed in patients older than 30 years (p = 0.018). There was a significant correlation between the age of the patients and the SCH grade (R = 0.184, p = 0.022). Patients with >10 years of duration reported higher SCH grade (p = 0.022). There was a significant correlation between the duration of disease and SCH grade (R = 0.284, p < 0.001). However, there were no significant differences in the change of TNV and MCA, and the amount of rhinorrhea after CDA provocation between different age and duration groups.

Conclusion

SCH grade reflects the age- and duration-related increase of NHR. Further studies to elucidate the pathophysiologic mechanisms are needed in the future.     

Cochlear implantation outcomes in advanced otosclerosis

Introduction

Several studies support the use of cochlear implants (CI) in far-advanced otosclerosis (FAO).

Material and methods

We compared our results of CI in patients with FAO and unknown origin hearing loss (UOHL) and our incidence of facial electrical stimulation and difficult insertion of the electrode bundle up to 3 to 5 years from surgery.

Results

We found 17 patients with CI in FAO and UOHL. FAO patients achieved better results on the pure tone average (PTA) and recognition of monosyllables by GEE test (p = 0.022; p = 0.006), and particularly at 1 year on the PTA (p = 0.002), at 6 months and a year in monosyllables (p = 0.002; p = 0.001), and at 6 months in disyllables (p = 0.004). There were no differences toward complications.

Conclusion

In our experience, placement of CI in FAO has proven successful, with results comparable to other similar cohorts, and with low complications.     

Do synchronous airway lesions predict treatment failure after adenotonsillectomy in children less than 3 years of age with obstructive sleep apnea?

Objectives

Determine the efficacy of adenotonsillectomy and the role of synchronous airway lesions in treatment failure in children younger than 3 years of age with obstructive sleep apnea.

Methods

A retrospective chart review was conducted for children younger than 3 years of age with obstructive sleep apnea who were evaluated and treated at a tertiary care hospital between 2005 and 2011. All participants underwent adenotonsillectomy or powered-intracapsular tonsillectomy with adenoidectomy and had both pre- and post-operative polysomnograms. Children eligible for airway evaluation underwent flexible laryngoscopy, direct laryngoscopy or bronchoscopy. For analysis, participants were categorized as cured or not-cured with an obstructive apnea–hypopnea index (OAHI) threshold of ≥1.4 indicating residual obstructive sleep apnea.

Results

Thirty-nine children met inclusion criteria and 41% had a post-operative OAHI ≤ 1.4 by polysomnogram. Children failing adenotonsillectomy, (OAHI ≥ 1.4) had a significantly higher pre-operative OAHI (p < 0.001) and lower nadir SpO₂ (p < 0.03) than those considered cured. Thirty-eight percent of the total population underwent airway evaluation, and synchronous airway lesions were identified in 60% of that cohort. None of the children required surgery for their synchronous airway lesions and there was no significant difference between outcome groups in number of patients who underwent airway evaluation or had synchronous airway lesions (p = 1 and p = 0.14, respectively).

Conclusions

Adenotonsillectomy is effective for obstructive sleep apnea in children younger than 3 years of age and the presence of a synchronous airway lesion does not necessarily predict treatment failure.