Adenoidal hypertrophy as the presenting feature of HIV infection

A case of symptomatic recurrent adenoidal hypertrophy, as the presenting feature of HIV infection in a haemophiliac child, is reported. The incidence of non-malignant nasopharyngeal lymphoid hyperplasia in HIV infection is examined and the relevance of the histological appearance is discussed in relation to progression of disease.     

The adenoidal-nasopharyngeal ratio (AN ratio). Its validity in selecting children for adenoidectomy

The present study disclosed that the AN ratio measured on simple lateral skull radiographs reliably expressed the adenoidal size and patency of the nasopharyngeal airway, and correlated well with the clinical assessment score and the weight of adenoids removed at operation. The inter-observer agreement was satisfactory, and for practical purposes, a value of AN ratio greater than 0.73 may be considered indicative of pathological enlargement of the adenoids. Hopefully this study will facilitate more accurate detection of those children most likely to benefit for adenoidectomy.     

Measuring the correlation between adenoidal-nasopharyngeal ratio (AN ratio) and tympanogram in children

OBJECTIVE: To evaluate the correlation between adenoidal-nasopharyngeal ratio (AN ratio) and tympanogram in children. STUDY DESIGN: A prospective clinical study from June 2002 to May 2003. METHOD: A total of 64 children, aged 6-9 years who presented with nasal obstruction, snoring, mouth breathing, and hyponasal speech were examined and AN ratio was calculated by using the lateral neck radiograms and compared with the tympanometric values. The relationship between AN ratio and middle-ear pressure was evaluated, regarding the AN ratio of 0.71. The chi-square test was used to analyze the correlation between AN ratio and middle ear pressures and Wilcoxon test was used to compare the changes between the mean AN ratio values, and mean middle ear pressures (including A and C type tympanograms) before and after medical therapy. RESULTS: Middle-ear effusions and C type tympanograms in impedance audiometry were both related to eustachian tube dysfunction resulting from enlargement of the adenoids with AN ratios higher than 0.71. Middle ear pressures were found lower in children with AN ratio greater than 0.71 than in children AN ratio less than 0.71 and the difference was highly significant (p<0.001). Although medical treatment of large adenoids was rather effective to shrink the adenoid tissue (p<0.001), it did not cause a statistically significant change in tympanometric values (p>0.05). CONCLUSIONS: Antibiotherapy is effective in reducing adenoid size without signs and symptoms of infection. The reduction of the adenoids in size after 3 weeks of antibiotherapy has an positive effect on recovery of eustachian tube function but is not sufficient in patients with middle ear effusion. Early ventilation tube insertion may be an alternative therapy for the middle ear effusions not improving by 3 weeks medical therapy.     

A study on the relationship between adenoid vegetation and rhinosinusitis

The relationship between adenoidal-nasopharyngeal ratios (AN ratios) and sinusitis were evaluated in 404 children. The AN ratios of children with snoring, mouth breathing, or nasal obstruction (major symptoms of adenoidal enlargement) were significantly higher than those of children without these symptoms. However, the AN ratios of children with sinusitis were almost equal to those of normal children.     

The Bcl-2 protein expression in germinal centers of hypertrophied adenoids in children

The aim of this study was to evaluate Bcl-2 expression in the germinal centers of adenoid in children on the assumption that it can be treated as a marker of adenoidal tissue function. The study involved 95 children. The patients were divided into three age groups: aged up to 5, 5-10 and above 10 years. The analysed material were adenoids removed on the grounds of hypertrophy. Immunohistochemical analyses were carried out using monoclonal antibodies (DAKO/Bcl-2, No. M0887) directed against human Bcl-2 protein. The presence of Bcl-2 positive lymphocytes within the lymphoid follicles and Bcl-2 immunostaining were scored. The immunohistochemical staining showed Bcl-2 positive lymphocytes in the examined sections of adenoidal tissue and their characteristic location, mainly within the mantle zone. Bcl-2 reactivity was widespread in hyperplastic lymphoid tissue, including germinal centers surroundings, scattered cells within the germinal centers and the T-cell areas in general. We have not found statistically significant correlation between Bcl-2 expression and clinical status and change in Bcl-2 expression level according to age. The apoptosis presence within the germinal centers and its lack in mantle zone, the manifestation of which is Bcl-2 expression, is a sign of a proper lymphocytes maturation within lymphoid follicles. It seems that these processes are not influenced by age, so the adenoid involution is probably associated with the changes in the number of lymphoid follicles rather than change or inhibition of the processes that take place in them.     

EB病毒在儿童腺样体肥大和扁桃体炎组织内的定量研究及意义

目的:探讨EB病毒在儿童慢性扁桃体炎、腺样体肥大中的流行病学特点及其在儿童腺样体肥大、慢性扁桃体炎疾病发病机制中的作用.方法:采用实时荧光定量PCR技术对52例慢性扁桃体炎、腺样体肥大患儿手术摘除的腺样体、扁桃体组织及血浆标本进行EB病毒定量检测.结果:患有慢性扁桃体炎和(或)腺样体肥大的儿童扁桃体、腺样体组织中EB病毒感染率为51.9%;其中男性患儿EB病毒感染率为50.0%,女性患儿为55.6%,两者差异无统计学意义(P＞0.05).扁桃体组织EB病毒感染率为40.4%,腺样体组织为48.9%,差异无统计学意义(P＞0.05).学龄组(7～14岁)患儿扁桃体和腺样体组织EB病毒感染率为65.5%,明显高于学龄前组(2～6岁)患儿的感染率(34.8%).比较轻、中、重度肥大的腺样体组织中EB病毒-DNA拷贝数发现:重度肥大组EB病毒-DNA拷贝数明显高于其他两组(P＜0.05).52例患儿血浆标本检测发现:EB病毒-DNA拷贝数均在正常范围内(＜1×10~3 copies/ml).结论:腺样体肥大组织与慢性扁桃体炎组织对EB病毒有相同的易感性,男、女性患儿的扁桃体和腺样体组织对EB病毒易感性基本相同,且随着患儿年龄的增长、病程的延长,EB病毒的感染率也会相应增高.腺样体的增生、肥大与EB病毒的感染有一定相关性.     

Immunocytochemical identification of HIV (p24) antigen in parotid lymphoid lesions

Antibodies to specific human immunodeficiency virus (HIV) polypeptides are important laboratory markers of HIV infection. We have used an antibody to the major structural gag protein p24 of HIV-1 virus to immunochemically localize this capsid antigen in lymphoid cells from seven of eight patients at risk for HIV infection and who presented with parotid lymphadenopathy and lymphoepithelial cysts of the parotid gland. A clinicopathological assessment of these two manifestations as they relate to HIV infection is also presented.     

Prospective, randomized, single-blind, controlled study to compare two methods of performing adenoidectomy

OBJECTIVE: To compare adenoidectomy using suction-diathermy ablation to curettage adenoidectomy with respect to operative time and adenoid regrowth at 6 months after surgery. STUDY DESIGN: A prospective, randomized, single-blind, study to compare two methods of performing adenoidectomy. A group of 100 children, undergoing adenoidectomy alone or in combination with tonsillectomy, were randomized into two groups and underwent either suction diathermy or curettage adenoidectomy by a single surgeon. SETTING: A tertiary care Paediatric Hospital. METHOD: Indication for surgery, adenoidal size, duration of surgery and complications were recorded and compared. Six-month follow-up was conducted and adenoidal size and symptom status were recorded and compared. Statistical analysis was performed using Microsoft Excel. RESULTS: One hundred patients participated in this study and underwent adenoidectomy alone or adenotonsillectomy. Ninety-two patients returned for follow-up and 91 patients completed the study. The two treatment groups were well matched for age and gender. The main indications for both groups were snoring, nasal obstruction and obstructive sleep apnoea. For adenoidectomy alone there was no significant difference in duration of surgery between the curette and suction diathermy groups. When performing tonsillectomy and adenoidectomy together suction diathermy took significantly longer to complete than curettage (P<0.001). Overall 96% of patients' symptoms had either improved or resolved. The post-operative comparison at 6 months showed a significant difference in the residual adenoidal size between the two groups, the suction diathermy group being generally smaller than the curettage group. CONCLUSIONS: Suction diathermy was better at reducing the adenoidal size 6 months after surgery. Although the difference in size was statistically significant it did not seem to be of clinical significance.     

儿童腺样体肥大与中耳咽鼓管功能相关性分析

目的:探讨腺样体大小与中耳功能和咽鼓管功能的相关性。方法:回顾性分析2004年2月~2004年10月因腺样体肥大收入院手术患儿的中耳功能,并比较腺样体肥大患儿和正常同龄儿童的咽鼓管功能的差异。结果:①腺样体大小与中耳压力有明显的负相关性(r=-0.41,P<0.05);②腺样体肥大患儿咽鼓管功能(13.9±13.2)daPa,与正常儿童咽鼓管功能(22.5±10.4)daPa比较,差异有统计学意义(t=-3.1,P<0.01);③患儿腺样体的大小程度与咽鼓管功能无明显相关性(r=-0.19,P>0.05)。结论:腺样体病理性肥大可引起咽鼓管功能障碍,是分泌性中耳炎(SOM)的发病基础。     

Subpopulation of adenoidal lymphocytes of recurrent infection in the upper respiratory tract

A subpopulation of adenoidal lymphocytes was determined by the E-and EAC-rosetting techniques in order to study an immunological profile of adenoids in 61 children with recurrent otitis media, rhinosinusitis or recurrent tonsillitis.Though there was no significant difference in E- and EAC-rosette forming cells of adenoid tissues from children with recurrent infection in the upper respiratory tract, our results indicated the following. (1) A higher proportion of EAC-rosette forming cells (EAC-RFC) without a change of E-RFC was found in the adenoids of children with recurrent tonsillitis than those without it. (2) The percentage of EAC-RFC appears to increase proportionally to the size of adenoid viewed on the X-ray film. (3) The higher percentage was more remarkable in cases with rhinosinusitis and recurrent otitis media. From the data obtained it is concluded that adenoids may play some part in immunity responses against infection in the upper respiratory tract reflecting adenoidal hypertrophy.     

Medical treatment for rhinosinusitis associated with adenoidal hypertrophy in children: an evaluation of clinical response and changes on magnetic resonance imaging

OBJECTIVES: The association between adenoidal hypertrophy and rhinosinusitis with upper airway inflammation is increasingly recognized; however, no study has used magnetic resonance imaging (MRI) to assess the changes in adenoid size after medical treatment of rhinosinusitis. METHODS: Thirteen children referred to a tertiary allergy clinic with symptoms of rhinosinusitis received medical treatment over a 4-month period. All underwent MRI before and after treatment. The medical treatment regimen comprised a short course of oral antibiotics and oral steroids and a longer course of oral antihistamines and intranasal steroids. RESULTS: The pretreatment MRI demonstrated enlarged adenoids and rhinosinusitis in all 13 children, with evidence of extensive rhinosinusitis in 9 of the 13. The treatment resulted in an improvement in overall symptom score; the most significant improvement was seen in mouth breathing. The posttreatment MRI showed a statistically significant reduction in adenoid size and adenoid/nasopharynx ratio, which was associated with a significant decrease in sinus involvement on MRI. CONCLUSIONS: There is a high association between adenoidal hypertrophy and rhinosinusitis in the context of an allergy clinic. Magnetic resonance imaging can document the changes in adenoid size associated with resolution of rhinosinusitis. Further studies are necessary to validate these pilot data and further assess the effects of medical treatment and the role of MRI in adenoidal hypertrophy.     

睡眠呼吸紊乱儿童腺样体中糖皮质激素受体的表达

目的 了解阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)儿童腺样体组织中糖皮质激素受体(glucocorticoid receptor,GR)亚型mRNA表达.方法 34例儿童行腺样体切除,术前睡眠监测;应用荧光定量逆转录PCR法检测患者腺样体组织中GR-α和GR-β mRNA的表达.结果 腺样体组织中均存在GR-α和GR-β的mRNA表达,且GR-αmRNA呈高表达.OSAHS患儿(22例)腺样体组织中的GR-α和GR-β mRNA(-x±s,以下同)分别为(9.40±3.06)×105cDNA copies/μg和(1.57±0.35)×104 cDNA copies/μg;非OSAHS患儿(12例)腺样体组织中的GR-α和GR-β mRNA分别为(1.60±0.26)×106cDNA copies/μg和(1.52±0.18)×104cDNA copies/μg.非OSAHS患儿腺样体组织中的GR-α mRNA较OSAHS患儿腺样体组织中的GR-α mRNA增高(F=40.285,P＜0.001);OSAHS患儿腺样体组织中的GR-β mRNA较非OSAHS患儿腺样体组织中的GR-β mRNA稍高,但差异无统计学意义(F=0.145,P=0.706).OSAHS、非OSAHS腺样体组织中GR-α/GR-β比值分别为62.3±20.3和107.4±24.4,差异有统计学意义(F=33.059,P＜0.001).结论 OSAHS儿童腺样体组织中存在糖皮质激素受体亚型表达,非OSAHS儿童腺样体对糖皮质激素可能比OSAHS儿童更敏感.GR在儿童OSAHS中的作用有待进一步研究.     

手术治疗腺样体肥大对儿童睡眠结构的影响

目的 观察腺样体肥大儿童在行腺样体切除术后睡眠结构的改变。方法 对120例行腺样体肥大切除术的儿童,分别于术前及术后1个月行夜间睡眠多导监测,比较手术前后宏观、微观睡眠结构的变化。结果 腺样体肥大儿童术后S1期和S2期所占比例与术前比较无统计学意义(P>0.05);SWS期和REM期所占比例增加(P>0.05)。腺样体肥大儿童术后觉醒指数AI(2.8±0.3)较术前(6.3±0.4)明显减小(P<0.01);术后最低SaO2（93.4±1.4）较术前(70.3±1.3) 明显提高(P<0.01)。 结论 腺样体肥大儿童术后宏观睡眠结构无明显改善,微观睡眠结构的改善可能是腺样体肥大儿童术后症状改善的病理生理学基础。     

Characterization of Smoking-Induced Nasopharyngeal Lymphoid Hyperplasia

The frequency of smoking-induced nasopharyngeal lymphoid hyperplasia in heavy smokers and its potential clinical implications are still unknown. Precise criteria to differentiate this entity from other types of nasopharyngeal lymphoid hyperplasia are needed. A prospective clinicopathological study of smoking-induced nasopharyngeal lymphoid hyperplasia was conducted in 17 heavy smokers. Ten nonsmoking patients, five of them with chronic sinusitis, three with adult-onset adenoid hypertrophy, and two children with adenoidal hypertrophy served as a control group. Both in smokers and in nonsmokers, lymphocytic infiltration of the mucosa was characterized immunohisto-chemically as T cells. In smokers, semithin (1 micron) sections revealed deformed and migrating cytotoxic lymphocytes in the nasopharyngeal mucosa. The lymphocytes were attached to epithelial, ciliated, and goblet cells, resulting in cell damage. Transmission electron microscopy of biopsies from smokers revealed emperipolesis, characterized by mucosal invasion and epithelial cell damage by an unusual population of migrating T lymphocytes that penetrate them. These findings confirm a direct effect of smoking on the nasopharyngeal lymphoid tissue, which forms part of the immune system. It is concluded that the diagnostic evaluation and therapeutic approach of heavy smokers with otological and airway symptoms should be based on thorough endoscopic examination of the nasopharynx. When the diagnosis is not clear-cut, selective tele-endoscopic biopsy and electron microscopic examination are recommended. This entity should be added to the list of known clinical manifestations of the smoking habit.     

药物置换疗法在儿童腺样体肥大继发分泌性中耳炎治疗中的应用

目的：探讨药物置换疗法在腺样体肥大继发分泌性中耳炎治疗中的应用及疗效。方法观察316例（505耳）腺样体肥大继发分泌性中耳炎患者,在腺样体切除的同时施行鼓膜切开、强的松龙置换鼓室内分泌物达到治疗分泌性中耳炎的目的。分析其疗效并探讨其与性别、年龄、双耳是否同时发病、病程时长以及病情严重程度的相关性。结果术后随访12个月,疗效明显,治愈率98.2%（496耳）。治疗效果与性别、年龄、双耳是否同时发病无关（P〉0.05）,而与病程时长、病情严重程度相关（P〈0.05）。结论药物置换疗法在腺样体肥大继发分泌性中耳炎的治疗中效果明显,值得临床推广应用。     

A potential role for arginase in recurrent infections and hypertrophy of tonsillar and adenoidal tissue

Since arginase has been found to be an arginine-depleting and nitric oxide synthase-regulating enzyme, the present study was devised to examine hypertrophied and infected tonsil and adenoid arginase activity in relation to a metabolic arginase-nitric oxide pathway and its association with disease processes. Tissues were taken from 32 children undergoing adenotonsillectomy. There was a statistically significant difference between the two tissue enzyme activities, with tonsillar arginase activity being higher than the corresponding adenoidal tissue (P < 0.005). This suggests a potential role for tissue arginase activity as an outcome module and a contributing factor in chronic recurrent infection and hypertrophy of tonsillar and adenoidal tissues. Received: 8 October 1998 / Accepted: 22 April 1999     

Head and neck cancer in patients with human immunodeficiency virus-1 infection: incidence, outcome and association with Epstein-Barr virus

Head and neck cancers have been described in patients with human immunodeficiency virus-1 (HIV-1) infection. However the incidence, aetiology and clinical features of the disease remain unclear. Patients with head and neck cancer and HIV were identified from a large HIV centre. The incidence and clinical features were recorded, and the tumours were stained for Epstein-Barr virus (EBV). Head and neck cancer occurred more frequently than in an age-matched control group (1.66 vs 0.55/10,000 patient years respectively p < 0.05). Highly active anti-retroviral therapy has not significantly altered the incidence of the disease. All of the tumours tested were positive for EBV. Patients were moderately immunosuppressed at diagnosis and had aggressive tumours. All but one of the patients died of cancer with a median survival of 28 months. Head and neck cancer occurs more frequently in HIV. It is an aggressive disease and EBV may play a role in its pathogenesis.     

Audiologic and vestibular findings in a sample of human immunodeficiency virus type-1-infected Mexican children under highly active antiretroviral therapy

OBJECTIVE: There is little information about audiologic and vestibular disorders in pediatric patients infected with the Human Immunodeficiency Virus type-1 (HIV-1). The aim of this study was to evaluate audiologic and vestibular disorders in a sample of HIV-1-infected children receiving Highly Active Antiretroviral Therapy. METHODS: Patients underwent pure tone audiometry, speech discrimination testing, auditory brainstem responses, electronystagmography, and rotatory testing. HIV-1 viral load and absolute CD4+ cell counts were registered. RESULTS: Twenty-three patients were included, aged 4.5 years (median, range 5 months to 16 years). Pure tone audiometry was carried out in 12 children over 4 years of age: 4 (33%) showed hearing loss, 2 were conductive. Auditory brainstem responses were measured in all 23 patients, suggesting conductive hearing loss in 6 and sensorineural hearing loss in 2. Most patients with conductive hearing loss had the antecedent of acute or chronic suppurative otitis media but with dry ears at the time of evaluation (p=0.003). Abnormal prolongations of interwave intervals in auditory brainstem responses were observed in 3 children (13%, 4 ears), an abnormal morphology in different components of auditory brainstem responses in 4 (17.4%, 7 ears), and abnormal amplitude patterns in 11 patients (48%, 17 ears). Vestibular tests were abnormal in all six patients tested, with asymmetries in caloric and rotatory tests. Although differences were not significant, in general, audiologic abnormalities were more frequent in patients with more prolonged HIV-1 infections, higher viral loads, or lower absolute CD4+ cell counts. CONCLUSIONS: Conductive hearing loss associated with previous otitis media events, abnormalities in auditory brainstem responses suggesting disorders at different levels of the auditory pathways, and unilateral vestibular hyporeflexia were frequent findings in our sample of HIV-1-infected children under Highly Active Antiretroviral Therapy. These findings suggest that HIV-1-infected children should be submitted to audiologic and vestibular evaluation as early as possible in order to reduce their impact on the psychosocial development of these patients.     

儿童鼻-鼻咽疾病对中耳功能的影响

目的探讨儿童分泌性中耳炎的病因和治疗。方法对213例患有鼻-鼻窦炎和腺样体肥大的儿童分别按腺样体肥大程度分为轻度组和重度组，按病程长短分为3个月以下组和3个月以上组。所有患者均行电耳镜、声导抗等检查，并计分评价其中耳功能。结果轻度组的中耳功能明显好于重度组（P〈0．05）；3个月以下组的中耳功能明显好于3月以上组（P〈0．05）。结论鼻-鼻窦炎和腺样体肥大影响儿童中耳功能，且随着病情的加重和病程的延长对中耳功能的影响越明显；早期对患有鼻-鼻窦炎和腺样体肥大的儿童进行干预，有利于保护儿童的中耳功能和听力言语的正常发育。     

腺样体肥大儿童分泌性中耳炎发生率及其影响因素分析

目的探讨腺样体肥大儿童分泌性中耳炎(SOM)的发病情况及其影响因素。方法对6 256例住院手术治疗的腺样体肥大儿童进行纤维鼻咽镜或鼻内镜及声导抗检查,对声导抗结果异常的患儿行纯音测听或ABR检查,统计分析不同年龄、不同腺样体肥大程度及不同病程患儿SOM的发生率。结果 6 256例腺样体肥大患儿中合并SOM者2 702例(43.19%,2 702/6 256),而病史中有明确听力减退主诉者仅654例(10.45%,654/6 256);3～5岁年龄段SOM的发生率最高,为69.76%(1 119/1 604),随年龄增长,SOM发生率逐渐下降;Ⅲ°腺样体肥大患儿中SOM发生率为61.73%(1 639/2 655),显著高于Ⅰ度(21.11%,163/772)、Ⅱ度(31.81%,900/2 829)腺样体肥大患儿(P<0.05);不同病程腺样体肥大患儿中SOM发生率差异无统计学意义(P>0.05)。结论本组腺样体肥大患儿SOM发生率为43.19%,低龄和腺样体肥大程度是腺样体肥大患儿并发SOM的影响因素,而病程对其无明显影响。