Allergy is not a risk factor for recurrent acute otitis media: a real-life clinical experience.

BACKGROUND: Acute otitis media (AOM) is the most common bacterial infection in children. Some children with AOM tend to be otitis-prone, such as to have frequent recurrence of AOM (RAOM). The possible RAOM risk factors are widely debated. OBJECTIVE: The aim was to identify predictive factors, including clinical data and endoscopic findings, for RAOM in children. METHODS: The current study was performed in a real-life setting, such as an otorhinolaryngologic (ORL) clinic. In this study, 1,002 children (550 males, 452 females; mean age, 5.77 ± 1.84 years), complaining upper airway symptoms, were consecutively visited. Detailed clinical history and nasal endoscopy were performed. RESULTS: Throughout the ORL visit, it was possible to define some factors involved in the recurrence of AOM, including female sex, artificial feeding, tonsillar and adenoid hypertrophy, whereas male sex and recurrent respiratory infections could protect from RAOM. CONCLUSION: Allergy was not associated with RAOM. In addition, this real-life study identified some predictive factors of RAOM, thus also in a primary care setting it is possible to achieve important information that is relevant in clinical practice.

Turbinate hypertrophy in children with allergic rhinitis: clinical relevance.

Allergic rhinitis (AR) is the most common immune-mediated disorder in childhood as it may affect up to 40% of children. Turbinate hypertrophy (TH) is an important sign as reliably predicts AR both in children and adults. Consistently, nasal obstruction is a very common symptom in AR patients and is closely linked with turbinate hypertrophy. This study investigated 544 (304 males) children with AR to define factors associated with TH. TH was diagnosed in 438 (80.81%) AR children. The multivariate analysis demonstrated a significant association between age, male gender, and recurrent acute otitis media (RAOM), and TH (p-values: 0.0219, <0.0001, and 0.0003, respectively; OR 0.87, 3.97, and 0.22 respectively). In conclusion, this real-life study showed that TH was very frequent in children with AR and age, male gender, and RAOM were significantly associated with TH.

Tonsil volume may predict adenoid size: a real-life study.

Tonsil hypertrophy (TH) and adenoid hypertrophy (AH) are very common in children. Adenoid is visible only by endoscopy. This study investigated the possible relationship between the tonsil and adenoid volume and the possible prediction of adenoid size. Globally, 991 children (461 females, 530 males, mean age 6.2 ± 2.3 years), complaining persistent upper airway obstruction, were consecutively visited at an otorhinolaryngological unit. TH was significantly (p<0.0001) associated with AH and tonsil volume predicted adenoid size. This outcome could have relevance in clinical practice as adenoid are evaluable only by endoscopy, so tonsil assessment could mirror adenoid volume.

Recurrent respiratory infections in children: a study in clinical practice.

Recurrent respiratory infections (RRI) are very frequent in childhood. RRI are commonly associated with some co-morbidities and typical clinical features. This study aimed to test the hypothesis whether an ENT visit could identify predicting factors for IRR.Globally, 1,002 children (550 males, mean age 5.77 years) were consecutively visited at an ENT clinic. Clinical visit, nasal endoscopy, and skin prick test were performed in all patients. RRI were present in 633 (63.5%) children. Some parameters were predicting factor for RRI: male gender (OR=1.68), tonsil and adenoid volume, even if partially for some volume grading. On the other hand, familiar atopy (OR=0.68), acute otitis media (OR=0.29), and certain tonsil and adenoid size (OR range 0.61-0-47) seemed to be protecting factor for RRI. This real-life study showed that during an ENT visit it is possible to identify some predictive factors involved in RRI: some seem to be protective, whereas other seem to be predisposing.

Tonsil volume and allergic rhinitis in children.

Tonsil hypertrophy (TH) is very common in children. Previously, it has been reported that an inverse relationship exists between adenoid hypertrophy (AH) and allergic rhinitis (AR). This study aimed to investigate the possible relationship between tonsil volume and AR diagnosis in a group of children complaining of upper airways obstruction. Globally, 171 children (91 boys; mean age, 6.6 years) were studied. Clinical visit, nasal endoscopy, and skin-prick test were performed in all patients. TH and anterior nasal obstruction were graded using the Friedman's classifications. Adenoid volume was graded using the Parikh's classification. Fifty-eight children (33.9%) had relevant TH (grades 3-4); 77 children (44.94%) had AR. There was a strong correlation (gamma = 0.564; p < 0.001) between TH and AH. Tonsil volume was inversely associated with AR diagnosis (odds ratio [OR], 0.314). Risk factors for TH were intense mucosal inflammation (pale mucous membranes) and AH (OR, 3.54 and 2.856, respectively). This study shows that large tonsils are negatively associated with allergy, whereas intense inflammation is a risk factor for TH; AH may be frequently associated with TH.

Adenoidal hypertrophy and allergic rhinitis: is there an inverse relationship?

BACKGROUND: Nasal obstruction is a very common symptom in children. The main causes are allergic rhinitis (AR) and adenoidal hypertrophy (AH); the possible correlation between AR and AH has been investigated by few studies, mainly conducted using radiographic craniometry. This study aimed at investigating this topic by nasal endoscopy. METHODS: There were 205 children (134 boys; mean age, 6.7 years age range, 4-12 years) studied. Clinical visit, nasal endoscopy, and skin-prick test were performed in all patients. Anterior nasal obstruction was graded using the Friedmann's classification. Adenoid size was graded using the Parikh's classification. Perception of symptoms by children was also assessed using the visual analog scale. RESULTS: Ninety-two children (44.9%) had complete nasal obstruction and 28 children (13.7%) had choanae invasion. There was a negative significant correlation (r = -0.41; p < 0.001) between nose obstruction severity and volume of adenoids. Decreased probability of greater adenoid volume was associated with increased severity of nose obstruction (odds ratio [OR] = 0.13) and in patients with allergy compared with nonallergic patients (OR = 0.31). CONCLUSION: This real-life study shows that large adenoids may be associated with absence of allergy, whereas large turbinates may be associated with small adenoids.

Nasal endoscopy in children with suspected allergic rhinitis.

OBJECTIVES/HYPOTHESIS: Ear, nose, and throat assessment may be frequently requested for children with allergic rhinitis (AR). Nasal endoscopy allows a thorough evaluation of the nose. The aim of the study was to investigate whether there are endoscopic signs predictive for AR diagnosis in a cohort of children with suspected AR. STUDY DESIGN: Cohort of observational study. METHODS: There were 176 children (99 males; mean age, 7.5 years) studied. Clinical visit, nasal endoscopy, and skin prick test were performed in all patients. Nasal endoscopic signs were pale turbinates, middle turbinate contact, and inferior turbinate contact. The AR diagnosis was made when nasal symptom history was concordant with sensitization. RESULTS: AR was diagnosed in 141 children. Inferior and middle turbinate contact were reliable predictive factors for AR (odds ratio 5.38 and 3.42, respectively), whereas pale turbinates did not predict it. CONCLUSIONS: This study suggests that nasal endoscopy may reveal signs predictive for AR diagnosis in children.

Comparison between symptoms and endoscopy in children with nasal obstruction.

OBJECTIVE: Nasal obstruction is a common symptom in childhood. It may be frequently observed in children with allergic rhinitis and/or adenoidal hypertrophy. However, its assessment is very difficult. The aim of the study was to compare the use of both a Face Related Scale (FRS), recorded by children and their parents, and a simplified Visual Analogue Scales (sVAS) with nasal endoscopy in children complaining nasal obstruction. METHODS: 121 children (75 males, mean age 7.5 years) were studied. FRS and sVAS for nasal obstruction and endoscopy were performed in all patients. RESULTS: A moderate correlation has been observed between FRS and sVAS and obstruction of nasal anterior segment (r=0.51 for FRS; r=0.52 for sVAS), a strong correlation was observed with nasal posterior segment (r=0.60 for FRS; r=0.61 for sVAS) assessed by endoscopy. However, parents' perception did not relate with objective parameters. CONCLUSIONS: This study suggests that assessment of FRS and sVAS for nasal obstruction may be used in clinical practice to approximately quantify this symptom in children.

Tongue base suspension and radiofrequency volume reduction: a comparison between 2 techniques for the treatment of sleep-disordered breathing.

PURPOSE: Lingual suspension (LS) and tongue base radio frequency volume reduction (RFVR) have been proposed as means of correcting the obstruction caused by the collapse or hypertrophy of the tongue base in patients having sleep-disordered breathing (SDB). The aim of this study was to evaluate and compare long-term results (6 months and 2 years) in a population of 24 patients having mild obstructive sleep apnea syndrome (OSAS), of whom 12 were treated with LS and 12 with RFVR. MATERIALS AND METHODS: The study included 24 patients having mild OSAS (apnea-hypopnea index between 10 and 20). All patients were assessed by means of the Epworth Sleepiness Scale, collection of anthropomorphic data, fiber-optic evaluation with Muller's maneuver, cephalometric assessment, and polysomnography. Lingual suspension was performed under general anesthesia with cervical cutaneous access. Radio frequency volume reduction was performed under local anesthesia with an Ellman Surgitron Dual RF unit (Ellman International, Inc., New York, NY), using a resterilizable bipolar terminal prototype. The same ear, nose, and throat examinations and polysomnography were carried out 6 months and 2 years after the surgical procedure. RESULTS: The results were evaluated according to the criteria by Sher (Sleep. 1996,19:156-177); after 6 months, the success percentage was 67% in patients treated with LS and 75% in those with RFVR. These percentages dropped to 42% in the first group and 33% in the second group after 24 months. CONCLUSIONS: Lingual suspension and RFVR are simple procedures that can be quickly performed and are well tolerated by patients. However, their effectiveness drops after 2 years. Our experience has therefore led us to conclude that the minimally invasive treatment for tongue base surgery can guarantee long-term results only in 42% and 33% of patients, respectively. Moreover, RFVR is preferable because it is simpler to perform and less invasive than LS, and it can be repeated over time.

Clinical assessment of a nasal decongestion test by visual analog scale in allergic rhinitis.

BACKGROUND: Nasal airflow, as measured by rhinomanometry, is frequently impaired in allergic rhinitis (AR). The decongestion test evaluates whether the application of an intranasal vasoconstrictor drug increases nasal airflow. That allergy is characterized by inflammation and that the response to the decongestion test correlates with the grade of inflammatory reaction has previously been shown. The aim of this study was to verify the suitability of the use of the visual analog scales (VASs) as a surrogate for rhinomanometry in the decongestion test assessment in patients with persistent allergic rhinitis. METHODS: One hundred three patients (mean age, 23 years [2.24 SD]) were studied. Nasal symptoms, VAS, rhinomanometry, and nasal decongestion test were assessed in all patients. RESULTS: A significant association was observed between VAS and nasal airflow after the decongestion test (Spearman R = -33.3%; p < 0.001). Moreover, a significant inverse association between changes in decongestion measures was detected, with a Spearman R = -64.7% (p < 0.001). The associated sensitivity was of 92.5%, and the specificity for this test was 60.0%. The corresponding area under the receiver operating characteristic curve was 0.81. CONCLUSION: The use of VAS for assessing the decongestion test appears clinically relevant in that it allows, with a fair degree of reliability, such a test to be performed in the absence of rhinomanometry.

Adenotonsillectomy in obstructive sleep apnea syndrome. Proposal of a surgical decision-taking algorithm.

OBJECTIVE: The incidence of snoring in the pediatric population is 10% and the incidence of OSAS is equal to 2-3%. Sometimes, primary snoring and OSAS overlap and only polysomnography can differentiate the two disorders but its use is complex, expensive and highly controversial. The purpose of this paper is to demonstrate the value of the clinical assessment associated with the patient's history in selecting children with OSAS and to validate the therapeutic algorithm, thereby employing polysomnography only for selected cases. METHODS: A population of 118 patients was considered, selected by means of a questionnaire that indicated OSAS and a clinical evaluation that confirmed the diagnosis. The studied group underwent clinical assessment complete with fibreoptic survey as well as nocturnal pulse oxymetry, orthodontic and phoniatric evaluation. Regardless of the adenotonsillar size, all the selected children underwent adenotonsillectomy and were evaluated after 3 months with the help of a questionnaire, ORL examination and nocturnal pulse oxymetry. RESULTS: In all the patients we witnessed the disappearance of apnea. A 80.5% of children benefited from the surgical procedure. A 12.7% continued to present minor symptoms. A 6.8% continued to snore in a discontinuous manner, but without apnea: these children were re-assessed after a further 6 months with nocturnal pulse oxymetry and no oxymetric alteration was demonstrated. There were no significant differences between the degree of upper airway obstruction and the surgical outcome. CONCLUSION: The history and clinical exam are sensitive tools, even though relatively aspecific. Our results confirm the validity of the history and clinical exam as a screening method as well as the role of the surgical procedure that can re-establish the patency of the upper airways and to contrast the neuromuscular hypotonia as a result of the effect of the surgical scar. If it is true that primary snoring and OSAS are a continuum, our approach regarding surgery may be defined as a form of prevention regarding a pathology with potential complications. Polysomnography cannot be carried out routinely due to the lack of specialised centres and because of its excessive cost. It is an option to be used only in unsuccessful adenotonsillectomies and for those children who have complicated presentations from the outset.