Role of endoscopic nasal examination in reduction of nasopharyngeal adenoid recurrence rates

Objectives

To evaluate the benefit of endoscopic examination after adenoidectomy in detecting residual adenoid tissue that would need completion surgery, in ultimate aim to reduce rates of adenoid recurrence.

Methods

A total of 312 children were included in the study conducted at Ain-Shams University Hospital from January till December 2007, following routine adenoidectomy, 118 had a nasal and nasopharyngeal rigid fiberoptic examination and 194 did not, randomly according to the surgical subunit that performed the surgery. Patients were followed up for a minimum of 2 years for recurrence of symptoms of adenoid enlargement.

Results

Endoscopic examination revealed that 14.5% of patients undergoing adenoidectomy had residual adenoid tissue that needed further removal, of these the most common site was at the lateral walls of the nasopharynx (47%). The recurrence rate of adenoid hypertrophy needing re-surgery with endoscopic examination (0.85%) approaches that of the lowest recorded (0.5%) with more expensive and costly methods, and statistically significant lower than rates when endoscopy is not performed (5.6%). Additional time needed for such examination was negligible in terms of cost-benefit relationship.

Conclusion

Rigid fiberoptic endoscopy of the posterior choana and nasopharynx at the end of adenoidectomy provides the benefit of detecting unremoved adenoid tissue without significantly extra cost, time, nor expertise, and helps reduce significantly the rates of recurrence of adenoid enlargement, which might be attributed to residual “missed” adenoid tissue.     

Diagnostic efficacy of different methods in the assessment of adenoid hypertrophy

Objective

This study was designed for better understanding of the role of different methods of nasal endoscopy in the assessment of adenoid hypertrophy and comparing them with lateral neck radiography and patients' symptoms.

Subjects and method

From August 2007 until January 2009, in the otolaryngology ward of a tertiary referral center, 89 patients who had symptoms related to chronic mouth breathing participated in this study. History of the symptoms related to adenoid hypertrophy was obtained from them. In addition, all patients underwent nasal endoscopy and lateral nasopharynx x-ray. The clinician who did nasal endoscopy was blinded to information about clinical data and x-ray and vice versa. Afterward, the relationship between symptoms and each diagnostic procedure was evaluated.

Results

Patients had a mean age of 9.47 ± 4.68 years. In the evaluation of the relationship between symptoms grading and grading in lateral neck radiography, this relationship was significant about snoring. Furthermore, there was a significant relationship between the endoscopic size of adenoid and number of the episodes of acute otitis media. The sum of symptoms grading had a significant relationship with the size of adenoid in lateral neck x-ray, but not in nasal endoscopy.

Conclusion

The results of the present study indicated that both radiography and nasal endoscopy could define the relationship between adenoid hypertrophy and associated symptoms and therefore are complementary. Between them, despite the popularity of nasal endoscopy, radiography can serve as a better planning tool.     

Expression of aryl hydrocarbon receptor and aryl hydrocarbon receptor nuclear translocators in human adenoid tissue

Objective

The aim of this study was to determine whether aryl hydrocarbon receptor (AhR) and AhR nuclear translocators (ARNTs) are expressed in human adenoid tissue.

Methods

Paraffin-embedded human adenoid tissue specimens were obtained from eight children with adenoid hypertrophy. Sections were stained immunohistochemically with specific polyclonal antibodies to evaluate the expression pattern of AhR, ARNT1 and ARNT2 were evaluated.

Results

AhR-immunoreactivity was ubiquitously seen in human adenoid tissue such as the epithelium, subepithelial layer, germinal center, mantle zone and interfollicular area. ARNT1 was also widely expressed in the same regions as AhR. Although ARNT2 was expressed in the human adenoid, the expression level was significantly lower than that of ARNT1.

Conclusion

These data suggest that the relationship between AhR and ARNTs may play an important role in the local immune response in adenoid and that ARNT1 may be more important than ARNT2 especially in adenoid tissue.     

Comparison of adenoidectomy methods: Examining with digital palpation vs. visualizing the placement of the curette

Objective

To evaluate the effectiveness of adenoidectomy by defining the remnant volume and localization in nasopharynx, following being satisfied with completeness of removal of the adenoid tissue with digital palpation.

Methods

A prospective study conducted on 99 patients undergoing adenoidectomy ± tonsillectomy. The main mass of the patient's adenoid tissue was removed with a sharp adenoid curette without visualization and the surgeon was allowed to palpate the adenoid bed and repeat the curettage until satisfied with completeness of removal. Then nasopharynx was visualized with a laryngeal mirror for defining the anatomical localization of the residual adenoid tissue and curettage completed under indirect mirror visualization. The volumes of the adenoid tissue excised at both stages were measured.

Results

By blunt curettage and digital palpation, only 20.2% of the patients (20) had no residual adenoid tissue. In patients who had residual adenoid tissue, the proportion of the median percentage of residual adenoid tissue to total adenoid tissue was 19.98% (range 3.22-50%). The anatomical localization of the residual adenoid tissue were, along the torus tubarius on either side of the nasopharynx in 9 (11.4%), on the pharyngeal roof near choanal openings in 64 (81%), along the torus tubarius on either side of the nasopharynx + on the pharyngeal roof near choanal openings in 5 (6.3%), and on the pharyngeal roof near choanal openings + on the posterior wall of nasopharynx in 1 (1.3%) patients. There was no difference found among surgeons in the percentage and the location of the residue left (p > 0.05).

Conclusion

Digital palpation is not a dependable technique and visualization of the nasopharynx is crucial for a complete adenoidectomy.     

Gold laser adenoidectomy: Long-term safety and efficacy results

Objectives

To report the long-term results of Gold laser adenoidectomy with pressure equalization tube (PET) placement by measuring the incidence of otorrhea and middle ear effusion after tube extrusion.

Study design

A prospective study of 50 patients, ages 8-48 months, that underwent Gold laser adenoidectomy with PE tube placement in a pediatric outpatient setting.

Methods

We previously reported the initial results at 4 months post-op of 50 patients treated for adenoid hypertrophy and chronic otitis media with effusion (COME). All patients were then evaluated at 8, 12, and 16 months post-operatively. The incidence of otorrhea, extrusion of the PE tubes, and middle ear status was recorded.

Results

The incidence of otorrhea was 3/50 (6%) at 8 months, 0 (0%) at 12 months, and 2 (4%) at 16 months. At 16 months, the PE tubes had extruded in 29 (58%) and 28/29 (97%) of these had clear middle ears. Forty-nine patients (98%) overall had clear middle ears at the last exam. One patient required a second set of tubes.

Conclusion

The long-term results of Gold laser adenoidectomy with PE tube placement for adenoid hypertrophy and COME compare favorably with the initial report of the technique, as well as with other techniques as reported in other studies.     

Medical treatment of adenoid hypertrophy with “fluticasone propionate nasal drops”

Background

Adenoid hypertrophy treatment for children is generally planned in accordance with the degree of airway obstruction and related morbidity. If surgical treatment is indicated, the individual risk/benefit analysis of patients should be assessed in terms of anesthetic and postoperative complications. Although there are few alternative treatment options, these may be considered as a nonsurgical approach in less serious cases. Accordingly, studies about intranasal steroid applications under various protocols have been presented.

Study design

The prospective, randomized, placebo-controlled study.

Setting

Tertiary referral center.

Patients and methods

Patients indicated for surgery were randomly divided into two groups. The study group was treated by fluticasone propionate nasal drops (NSD-nasal steroid drops) of 400 μg/day for 8 weeks. The control group was treated by normal saline (NS) in the same way. All the patients were called for follow-up every 4 weeks.

Results

At the end of 8 weeks, statistically significant improvement (p < 0.05) was observed in the NSD treated group compared to the NS treated group in terms of nasal airway obstruction, mouth breathing, speech abnormalities, apnea and night cough. At the end of 8 weeks, the average total symptoms score of the NSD treated group dropped from 13.7 to 2.9 while the NS treated group's score changed from 14.8 to 14.6. After 8 weeks of NSD treatment the initial adenoid/choana (A/C) rate had dropped from 87 to 56% and a total decrease of 35.6% was observed. After 8 weeks of NS treatment the A/C rate dropped from 87 to 85% and a total decrease of 2.2% was observed.

Conclusions

In this study, the effect of fluticasone propionate nasal drops on adenoid hypertrophy is examined for the first time. This method provides an effective alternative to surgical treatment in children with adenoid hypertrophy. With the protocol applied in this study 76% of the patients were eliminated the surgery and removed from the surgical waiting list.     

Thin-plate spline analysis of craniofacial morphology in subjects with adenoid or tonsillar hypertrophy

Objective

To compare the skeletal features of subjects with adenoid hypertrophy with those of children with tonsillar hypertrophy using thin-plate spline (TPS) analysis.

Materials and methods

A group of 20 subjects (9 girls and 11 boys; mean age 8.4 ± 0.9 years) with adenoid hypertrophy (AG) was compared with a group of 20 subjects (10 girls and 10 boys; mean age 8.2 ± 1.1 years) with tonsillar hypertrophy (TG). Craniofacial morphology was analyzed on the lateral cephalograms of the subjects in both groups by means of TPS analysis. A cross-sectional comparison was performed on both size and shape differences between the two groups.

Results

AG exhibited statistically significant shape and size differences in craniofacial configuration with respect to TG. Subjects with adenoid hypertrophy showed an upward dislocation of the anterior region of the maxilla, a more downward/backward position of the anterior region of the mandibular body and an upward/backward displacement of the condylar region. Conversely, subjects with tonsillar hypertrophy showed a downward dislocation of the anterior region of the maxilla, a more upward/forward position of the anterior region of the mandibular body and a downward/forward displacement of the condylar region.

Conclusions

Subjects with adenoid hypertrophy exhibited features suggesting a more retrognathic mandible while subjects with tonsillar hypertrophy showed features suggesting a more prognathic mandible.     

Patency of nasopharynx and a cephalometric image in the children with orthodontic problems

Objectives

To study a possible impact of adenoidectomy on malocclusion on the base of cephalometry.

Methods

Retrospective analysis of 148 patients qualified into the orthodontic treatment (77 girls and 71 boys) at the age of 9-11 years (an average age: 10 years and 3 months). Material was divided into three groups, equalized regarding sex and age. The first one consisted of the patients after adenoidectomy, at the moment of orthodontic assessment without any organic pathology within a nasal cavity or nasopharynx. To the second group were included children who for different reasons were not a subject of adenoidectomy despite clinical diagnosis of adenoid hypertrophy. In the third group were patients whose only problem was malocclusion. X-ray pictures taken on a cephalostate were scanned and given to cephalometric assessment. In statistics Bartlett's test, Tukey's test and Pearson's correlation coefficients were used.

Results

The significant differences with respect to many skull parameters appeared among the groups. The inappropriate respiratory habits find their reflection mainly within anterior and lower anterior facial height, angle of mandibular plane, nasopharyngeal flow and dental parameters. An evident beneficial influence of adenoidectomy is observed within a period of 36-41 months after an operation. Nasopharyngeal flow is the most sensitive parameter indicating the respiratory conditions, and is strongly connected with the key cephalometric parameters.

Conclusions

In cases of malocclusion of skeletal character, coexisting with adenoid hypertrophy, adenoidectomy should be carried out as early as possible.     

Ghrelin levels in children with adenoid or chronic tonsil hypertrophies before and after surgery

Objective

We aimed to evaluate the ghrelin levels in the children with adenoid or tonsil hyperthrophies.

Methods

The study included 27 children (17 boys and 10 girls). Mean age was 6.9 ± 3.5 years, ranging from 3 to 16. Ghrelin levels in the patients and their weight and height measurements were evaluated before surgery and after 3 months later of the operation.

Results

While 18 (67%) children were operated for adenoid hypertrophy, 9 (33%) children were operated for adenoid and tonsil hypertrophy. It was found that postoperative ghrelin levels were significantly decreased whereas weight and BMI scores were significantly increased (p < 0.01). A weak correlation was observed between preoperative ghrelin and weight (r = −0.29). This negative correlation became more profound at the postoperative 3rd month examination (r = 0.85) (p < 0.01).

Conclusions

The present study showed that the surgical treatment provides positive contributions on the growing of children with adenoid and tonsil hypertrophies. The ghrelin levels were significantly decreased at the postoperative period in the children, and a negative relationship was observed between the ghrelin levels and the weight. These findings suggest that blood ghrelin levels may be useful as a parameter for following the development of the children.     

Does adenoid hypertrophy really have effect on tympanometry?

Objective

The goal of this study is to determine the correlation between the radiographic measurements of adenoid size and tympanometric findings.

Study design

Prospective study.

Setting

Haydarpasa Numune Research and Education Hospital, Istanbul, Turkey.

Subjects and methods

Nine five consecutive children complaining of one or more of the symptoms of upper airway obstruction (UAO) (presence of snoring, mouth breathing or difficulty in breathing during sleep, obstructive breathing or apnea during sleep) were included in the study. Symptom severity was assessed by a standardized questionnaire. All patients underwent digital lateral soft tissue radiographs. Assessment of nasopharyngeal obstruction in radiographs was done according to four different methods. Tympanometry was used to evaluate the middle ear.

Results

Of 190 ears, 79 were type A, 49 were type B and 62 were type C tympanograms. The symptom severity of 14 patients was graded as mild, 56 patients as moderate and 25 patients as severe. There was no statistically significant difference between UAO symptom severity groups and tympanogram types (p > 0,05). Each one of the four methods of radiologic measurements of the adenoid enlargement showed no statistically significant difference between the tympanogram types (p > 0,05).

Conclusion

The adenoid hypertrophy in both means of radiologic measurements and symptom severity does not correlate with the changes in tympanograms. These findings do not support the hypothesis that adenoidal size plays a major role in the etiopathogenesis of middle ear effusion (MEE).     

Correlation between adenoid–nasopharynx ratio and endoscopic examination of adenoid hypertrophy: A blind, prospective clinical study

Objective

To determine the reliability of adenoid-nasopharynx (A/N) ratio that is calculated on lateral cephalometric graphies for measuring the adenoid tissue size.

Methods

85 patients that had been examined in our clinic with a prediagnosis of adenoid hypertrophy between June 2007 and March 2008 were included in the study. Local ethics committee approved the study protocol. Patients who had a previous adenoidectomy history and anatomic anomaly or acute infection in nose, palate or nasopharynx were excluded. Endoscopic nasal examination was done in all patients in addition to the routine ear nose throat examination. Lateral cephalometric graphs were obtained from all patients. Digital images obtained during endoscopic examination were evaluated on computer and obstruction ratios of adenoid tissue to choanal opening were calculated. Each cephalometric graph was evaluated by a blinded author. A/N ratio was calculated by dividing the distance from the outermost point of convexity of adenoid shadow to basiocciput to the distance between sphenobasiocciput and posterior end of hard palate (Fujioka Method). A/N ratio of each patient was then compared with the obstruction ratio obtained in nasal endoscopy. Pearson correlation test was used for statistical analysis and a p-value of <0.05 was accepted as significant.

Results

There were 52 male and 33 female patients between the ages of 2 and 12 years (mean age, 5.0 ± 2.2; median, 4.5). In nasal endoscopy, adenoid tissue was determined to obstruct the choanal opening as 88.5 ± 12.0% (range, 51-99%) in an average. Mean adenoid nasopharynx ratio was found to be 0.87 ± 0.1. There was a statistical significant correlation between A/N ratio and nasal endoscopic examination findings (r = 0.511; p < 0.0001).

Conclusions

A/N ratio is an easily applicable, noninvasive method that can correctly measure the size of the adenoid tissue in patients who are suspected to have adenoid hypertrophy.     

Assessment of adenoid size: A comparison of lateral radiographic measurements, radiologist assessment, and nasal endoscopy

Objectives

Correlate adenoid size as determined by lateral neck radiographs and intra-operative mirror exam. Determine if a radiologist's assessment of the lateral neck X-ray correlates with adenoid size. Assess the correlation of endoscopic findings to the degree of adenoid hypertrophy seen on intra-operative mirror exam. To perform a cost analysis of radiographic and endoscopic evaluations of the adenoids.

Study design

Retrospective study.

Methods

Patients who underwent adenoidectomy were reviewed. The adenoid size as determined by the adenoid-to-nasopharyngeal (A/N) ratio, radiology report, and flexible nasal endoscopy were compared to the adenoid size as determined by intra-operative mirror nasopharyngeal exam. Compensation rates for each modality were compared.

Results

Sixty-one children had pre-operative airway radiography. Ninety-nine patients underwent flexible nasopharyngoscopy. When the A/N ratio was compared to the intra-operative mirror exam, the Pearson Correlation coefficient was 0.64 (p < 0.0001). The radiology reading was compared to intra-operative mirror exam and the Spearman Correlation coefficient was 0.29 (p = 0.0258). When endoscopic nasopharyngoscopy was compared to intra-operative mirror exam, the Pearson Correlation coefficient was 0.62 (p < 0.0001). The cost of nasal endoscopy was $654. Lateral airway radiography plus radiology interpretation cost $605.

Conclusion

Children who undergo lateral radiographs to assess adenoid size are younger than those who undergo awake flexible endoscopic nasopharyngoscopy. Both the A/N ratio and endoscopic nasopharyngoscopy correlate well with the findings of the intra-operative mirror exam. The radiologist interpretations that do not utilize the A/N ratio measurement do not correlate well with intra-operative mirror exam findings. Both modalities are comparable in cost.     

Identification of adenoid biofilms with middle ear pathogens in otitis-prone children utilizing SEM and FISH

Objectives

Biofilms have been implicated in the development of several chronic infections. We sought to demonstrate middle ear pathogens in adenoid biofilms using scanning electron microscopy (SEM) and fluorescent in situ hybridization (FISH) with confocal laser scanning microscopy (CLSM).

Methods

Comparative micro-anatomic investigation of adenoid mucosa using SEM and FISH with confocal scanning laser microscopic (CLSM) imaging from patients with recurrent acute otitis media (RAOM).

Results

All otitis-prone children demonstrated biofilm surface area presence greater than 85% by SEM. FISH accompanied by CLSM imaging also demonstrated patchy biofilms All biofilms contained middle ear pathogens and were frequent in polymicrobial distributions: 4 of 6, 4 of 6 and 3 of 6 samples contained Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis, respectively.

Conclusions

Dense adenoid biofilms may act as a reservoir for reinfection of the tubotympanum. Aspiration of planktonic middle ear pathogens existing in resistant adenoid biofilms during a viral upper respiratory tract infection may be an important event in the development of RAOM.     

Partial adenoidectomy by suction diathermy in children with cleft palate, to avoid velopharyngeal insufficiency

Objectives

Adenoidectomy is indicated for the relief of paediatric nasal obstruction, sleep-disordered breathing and otitis media with effusion (OME). Velopharyngeal insufficiency (VPI) is a rare complication. The main risk factor is the presence of pre-existing velopharyngeal closure-impaired mechanisms, including submucosal or overt cleft palate. Despite possible benefits, adenoidectomy is frequently withheld in such children to avoid VPI. This study aims to demonstrate the efficacy and safety of partial adenoidectomy using suction diathermy in children who previously underwent overt cleft palate repair during infancy, to allow selective resection of tissue and symptom resolution without producing VPI.

Methods

Since 1994, 18 patients with previously corrected overt cleft palate have undergone partial adenoidectomy at this centre, for the treatment of nasal obstruction or sleep-disordered breathing, with or without OME. Three had existing VPI following their cleft correction surgery. Selective resection of the adenoid was performed transorally under indirect vision, using a malleable suction coagulator. This allowed exposure of the posterior choanae, leaving the remaining adenoid bulk intact.

Results

Patients were followed up at 4 weeks, and subsequently at regular intervals (total follow up 30-180 months, median 92 months), including perceptual speech assessment in all cases. All demonstrated symptomatic improvement with respect to the original indications for surgery. None developed worsening hypernasal speech or other features of VPI, and there were no cases of symptomatic adenoidal re-growth.

Conclusions

Partial adenoidectomy, employing a variety of methods, has been used successfully in children with submucosal cleft palate. This study demonstrates the safe and effective use of suction diathermy to enable partial adenoidectomy in children who have previously undergone surgical correction of overt cleft palate, allowing symptom resolution without producing VPI.     

Relevance and characteristics of gastroesophageal reflux in adult patients with otitis media with effusion

Objective

To investigate relevance and characteristics of gastroesophageal reflux (GER) in adult patients with otitis media with effusion (OME) of unknown etiology who attended private clinics.

Materials and methods

A total of 186 adults with OME of unknown etiology (OME group) and 156 adults without OME (control group) were asked to answer a questionnaire specific for the diagnosis of GER disease. Pepsinogen (PG) levels in the middle-ear effusions (MEEs) of the OME group were measured using a chemiluminescence enzyme immunoassay kit. Distributions of PG concentrations by age or body mass index (BMI) in the OME group were analyzed. Patients with high PG levels received proton pump inhibitors (PPIs) and their responses were evaluated.

Results

Symptoms of GER were reported by significantly more patients in the OME group than in the control group (43.0% vs. 12.8%). Patients with GER symptoms tended to have higher MEE PG concentrations than those without symptoms. PG levels did not show a significant difference by age. However, high PG levels were less found in patients over 60 years old with high BMI >25. This tendency was not observed in patients under 60 years old. PG levels decreased in seven out of ten patients with high PG concentrations after PPI therapy, corresponding with palliation of GER-related symptoms. Two patients had high MEE bilirubin concentration, and OME resolved in these patients after instruction about lifestyle factors related to GER, including sleeping position.

Conclusions

GER symptoms were more prevalent than expected in patients with OME of unknown etiology. BMI might affect GER-related OME, especially in elderly patients. Instruction about lifestyle factors related to GER, especially in patients who do not respond to PPI therapy, may be effective for patients with intractable OME.     

How to improve the accuracy of diagnosing otitis media with effusion in a pediatric population

Objective

To determine the accuracy of pneumatic otoscopy, a tympanogram and otomicroscopy for diagnosing otitis media with effusion (OME) in a pediatric population.

Study design

Prospective blinded clinical and IRB-approved study at a secondary referral hospital.

Subjective and methods

Eighty-one children (155 ears) were recruited for this study, who were referred to my secondary referral hospital after OME was diagnosed at other primary clinics. The examiner was blinded for the findings of the diagnostic tools. Myringotomy under local anesthesia was used as the diagnostic reference standard. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the three diagnostic tools were calculated.

Results

Otomicroscopy was the most sensitive and specific tool among the three diagnostic tools. Otomicroscopy showed the best agreement with myringotomy (kappa = 0.784).

Conclusion

Otomicroscopy can make a more accurate diagnosis even for children who are seen at an outpatient clinic. The much higher specificity of otomicroscopy makes it the best confirmative test and its much higher positive predictive value can prevent a late diagnosis of OME, which can result in severe sequelae.     

Optimal utilization of histopathologic analysis of tonsil and adenoid specimens in the pediatric population

Objective

To evaluate the optimal utilization of histopathologic analysis of tonsil and adenoid specimens in the pediatric population.

Methods

A retrospective review was performed on 7837 tonsil and adenoid specimens submitted from January 2004 to April 2008. The records were reviewed for the patients’ age, sex, and pathologic analysis. The time and cost per analysis of each specimen were determined.

Results

Histopathology was performed on 347 specimens based on clinical suspicion by the surgeon, a difference of 0.5 cm or more among tonsils, gross abnormalities, and history of malignancy, transplant, or immunocompromise. Malignancy was diagnosed in 0.026% of patients. Post-transplant lymphoproliferative disease was diagnosed in 6 of 24 immunocompromised patients. The use of these criteria resulted in a savings of $518,088.47 and 461 h of dedicated technician time per year.

Conclusions

Histologic examinations in selected specimens should be based on specific criteria that should be determined by each hospital based on hospital size, finances and input from their pathologists and otolaryngogists. Storage of a representative specimen for possible retrospective review may be useful.     

A study of the role of different forms of chronic rhinitis in the development of otitis media with effusion in children affected by adenoid hypertrophy

Objective

The aim of the present study was to evaluate the role of the different forms of chronic rhinitis in the pathogenesis of otitis media with effusion in children affected by obstructive adenoid hypertrophy.

Methods

81 patients, aged between 4 and 15 years (mean age of 6.9 years), affected by obstructive adenoid hypertrophy were evaluated. All patients underwent accurate history taking, physical examination with endoscopy of the nasopharynx, skin prick test, nasal cytology and hearing evaluation.

Results

Nasal citology showed that 21% of patients had a non-allergic rhinitis (NAR) subtype, 17.4% NAR overlapping with infectious rhinitis (IR), 29.6% IR, 4.9% allergic rhinitis (AR), 2.5% AR overlapping with IR and the remaining 24.6% a negative cytology. The presence of OME was positively correlated with neutrophils (p = 0.01) and mast cells (p = 0.022), while it was negatively correlated with the presence of eosinophils (p = 0.02) and bacteria (p = 0.02).

Conclusions

A chronic rhinitis was present in more than 70% of children with AH and 60% of them showed OME. Nasal cytology together with SPT showed that AR was rarely present in this group of children, while the mast-cells and neutrophils positively correlated with OME.     

Molecular characterization of Staphylococcus aureus isolated from children with adenoid hypertrophy: emergence of new spa types t7685 and t7692

Objective

Adenoids have been associated with the pathogenesis of acute, recurrent and chronic infectious diseases of the upper respiratory system and their hypertrophy is one of the most common causes of upper airway obstruction affecting children. In this study, the characteristics of Staphylococcus aureus isolates from patients who had undergone adenoidectomy were investigated via spa typing method.

Methods

A total of 113 children with adenoid hypertrophy who underwent adenoidectomy during September 2009 to November 2010, were included in the study. The isolates were identified to the species level as S. aureus using standard biochemical methods, following which the amplification and sequencing of the spa gene X region were carried out.

Results

S. aureus was found in the adenoid tissue of 26 (23%) patients. Out of the 26 S. aureus isolates, 5 (19%), 3 (11.5%) and 3 (11.5%) were resistant to tetracycline, erythromycin and oxacillin respectively. All the isolates were susceptible to vancomycin, rifampin, ciprofloxacin, gentamicin, mupirocin and quinupristin-dalfopristin and were typed using spa typing method. All the isolates were found to include 21 spa types, including two previously unreported types (t7685 and t7692). The most prevalent spa types were t7685 (11.5%), t230 (8%), t325 (8%) and t1149 (8%).

Conclusion

This study demonstrates that the prevalence rate of S. aureus in the adenoid tissue of the children assessed was 23%. An interesting point to note was the dominance of the spa type t7685 that has not been previously reported by other studies.