The use of topical nasal steroids to improve continuous positive airway pressure compliance in patients with obstructive sleep apnea: An updated systematic review and meta-analysis of randomized control trials.

BACKGROUND: Nasal steroids are commonly prescribed to reduce nasal side effects, which are the primary cause of continuous positive airway pressure (CPAP) intolerance in obstructive sleep apnea (OSA) patients. OBJECTIVE: We conducted a systematic review and meta-analysis of OSA patients to assess the effect of nasal steroids on CPAP compliance and nasal symptoms. METHODS: PubMed, Scopus, Ovid, and Cochrane Library were searched through March 2022. Randomized controlled trials (RCTs) evaluating the effects of nasal steroids on CPAP compliance in adult patients, which reported quantitative data on CPAP use and nasal symptoms, were included. RESULTS: Three RCTs (224 patients) were eligible for the meta-analysis. At the 4-week follow-up, the study did not demonstrate a statistically significant difference in CPAP compliance (average hours of CPAP use per night: mean difference 0.45; 95% confident interval (CI) (-0.01, 0.90); P = 0.06, percentage of nights device used: mean difference 1.79; 95%CI (-2.59, 6.17); P = 0.42). There was also no difference in overall nasal symptoms (mean difference 0.47, 95%CI (-0.00, 0.94); P = 0.05), with significantly more sneezing and rhinorrhea among patients with nasal steroids (sneezing: mean difference 0.64, 95%CI (0.23, 1.05); P = 0.002, rhinorrhea: mean difference 0.78, 95%CI (0.24, 1.31); P = 0.005). CONCLUSIONS: At the 4-week follow-up, the pooled results did not demonstrate significant benefits of nasal steroids on CPAP compliance. There was also no significant benefit for relieving nasal symptoms. To further explore the benefit of nasal steroids on CPAP use, additional, longer-term studies are required.

A comparison of artificial intelligence versus radiologists in the diagnosis of thyroid nodules using ultrasonography: a systematic review and meta-analysis.

BACKGROUND: Thyroid nodules are common. Ultrasonography (US) is the first investigation for thyroid nodules. Artificial Intelligence (AI) is widely integrated into medical diagnosis to provide additional information. The primary objective of this study was to accumulate the pooled sensitivity and specificity between all available AI and radiologists using thyroid US imaging. The secondary objective was to compare AI's diagnostic performance to that of radiologists. MATERIALS AND METHODS: A systematic review meta-analysis. PubMed, Scopus, Web of Science, and Cochrane Library data were searched for studies from inception until June 11, 2020. RESULTS: Twenty five studies were included in this meta-analysis. The pooled sensitivity and specificity of AI were 0.86 (95% CI 0.81-0.91) and 0.78 (95% CI 0.73-0.83), respectively. The pooled sensitivity and specificity of radiologists were 0.85 (95% CI 0.80-0.89) and 0.82 (95% CI 0.77-0.86), respectively. The accuracy of AI and radiologists is equivalent in terms of AUC [AI 0.89 (95% CI 0.86-0.92), radiologist 0.91 (95% CI 0.88-0.93)]. The diagnostic odd ratio (DOR) between AI 23.10 (95% CI 14.20-37.58) and radiologists 27.12 (95% CI 17.45-42.16) had no statistically significant difference (P = 0.56). Meta-regression analysis revealed that Deep Learning AI had significantly greater sensitivity and specificity than classic machine learning AI (P < 0.001). CONCLUSION: AI demonstrated comparable performance to radiologists in diagnosing benign and malignant thyroid nodules using ultrasonography. Additional research to establish its equivalency should be conducted.

Adenotonsillectomy in children with syndromic craniosynostosis: a systematic review and meta-analysis.

OBJECTIVE: To conduct a systematic review and meta-analysis in children with syndromic craniosynostosis, to evaluate the effect of adenotonsillectomy for the treatment of obstructive sleep apnea (OSA). STUDY DESIGN: A systematic review and meta-analysis. SEARCH METHODS: Data sources: a comprehensive search of PubMed, SCOPUS, Ovid Medline, and Web of science databases was performed through June 22nd, 2018. Manual searches and subject matter expert input were also obtained. This article includes studies assessing the effectiveness of adenotonsillectomy in syndromic craniosynostosis children, in which apnea-hypopnea index (AHI) or oxygen desaturation index (ODI) was reported. RESULTS: A total of 3 retrospective studies (24 patients) met the inclusion criteria. Pooled random effect analysis did not identify a statistically significant difference between preoperative and postoperative AHI. But there was an overall reduction of AHI of 5.00 events per hour [95% confidence interval (CI) (- 17.79, 7.79); P = 0.44]. However, the fixed effect model demonstrated a statistically significant difference between preoperative and postoperative ODI with an overall reduction of 8.5 per hour [95% CI (- 15.01, - 1.99); P = 0.01]. CONCLUSION: Adenotonsillectomy showed benefits for the treatment of OSA in syndromic craniosynostosis children, in terms of AHI and ODI. However, only ODI, but not AHI, reached statistical significance. Data were based on meta-analysis of retrospective reviews. Further studies that are conducted at multiple centers are needed to confirm the benefits of adenotonsillectomy for the treatment of OSA in syndromic craniosynostosis children.

Lingual tonsillectomy with palatal surgery for the treatment of obstructive sleep apnea in adults: a systematic review and meta-analysis.

OBJECTIVE: To conduct a systematic review and meta-analysis to evaluate effects of lingual tonsillectomy with palatal surgery as a combined procedure for the treatment of obstructive sleep apnea (OSA) in adults. SEARCH METHODS: Data source: a comprehensive search of MEDLINE, Scopus, Ovid, Web of Science, and the Cochrane Library was performed through November 2017. Manual searches and subject matter expert input were also obtained. This review includes studies assessing efficacy of lingual tonsillectomy with palatal surgery as a combined procedure for the treatment of OSA in adults, who had multilevel obstruction including lingual tonsil hypertrophy, in which apnea/hypopnea index (AHI) or respiratory disturbance index (RDI) were reported. RESULTS: A total of four studies (107 patients) met our inclusion criteria. Pooled random effects analysis demonstrated a statistically significant improvement of polysomnographic respiratory events postoperatively, with average AHI reduction of 18.51 events per hour, [95% confidence interval (CI) (- 31.72, - 5.31); P = 0.006] and increase in minimal arterial oxygen saturation of 5.26 [95% CI (0.10, 10.42); P = 0.05]. The result also showed that the procedures significantly improved sleepiness resulting in an average Epworth Sleepiness Scale (ESS) reduction of 5.44 [95% CI (- 8.69, - 2.18); P = 0.001]. CONCLUSION: A combination of lingual tonsillectomy with palatal surgery may offer benefits in a selected group of OSA adults, in terms of apnea/hypopnea index, minimal arterial oxygen saturation and Epworth Sleepiness Scale. Data were based on meta-analysis of all case series with 2-6 months' follow-up.

The effects of topical nasal steroids on continuous positive airway pressure compliance in patients with obstructive sleep apnea: a systematic review and meta-analysis.

OBJECTIVES: The purpose of the study was to conduct a systematic review and meta-analysis in patients with obstructive sleep apnea (OSA), evaluating effects of topical nasal steroids on continuous positive airway pressure (CPAP) machine use and nasal symptoms. SEARCH METHODS: Data source: A comprehensive search of Pubmed, Scopus, Web of Science, and the Cochrane Library was performed through April 2016. Manual searches and subject matter expert input were also obtained. Studies assessing effects of nasal steroids on CPAP machine use in adults, which reported quantitative outcome data of CPAP compliance, were included. RESULTS: Two studies (144 patients) met inclusion criteria. Both were randomized, placebo-controlled clinical trials (RCT). Pooled fixed effects analysis did not identify a statistically significant difference between both the groups for average duration of CPAP machine use per night. But there was an overall increase in the usage of 0.4 h (95 % confidence interval (CI) (-0.20, 1.00); P = 0.19) in favor of nasal steroids. Difference of percentage of nights with CPAP use was not demonstrated (mean difference 0.06, 95 % CI (-0.27, 0.39); P = 0.71). There was also no significant difference in nasal symptoms (mean difference 0.63, 95 % CI (-0.11, 1.36), P = 0.1). CONCLUSION: Nasal steroids showed benefits on CPAP use, but did not reach statistical significance. Data was based on meta-analysis of RCTs of 4-week follow-up in unselected OSA patients. Future controlled studies with selected group and longer follow-up duration are needed to confirm the benefits of nasal steroid on CPAP compliance in OSA patients.

The effects of a cold pack on postoperative turbinate and/or septal bleeding and pain.

BACKGROUND: The objective of this study is to evaluate the effects of a cold pack in postoperative turbinate and/or septal surgery in terms of postoperative bleeding control, pain management, and patient preference for or against application of a cold pack. METHODS: A randomized controlled trial was done at the Department of Otolaryngology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Ninety-nine adult subjects intending to have turbinate and/or septal surgery were consecutively enrolled in this study. Intervention was randomized into two groups. Postoperative bleeding was collected by paper tissue and weighed to determine amount and/or volume of blood loss. Postoperative pain was measured by using the visual analog scale. Patient preference for or against the use of a cold pack was also assessed. RESULTS: The mean (standard deviation) postoperative bleeding in the cold pack group was 1.31 ± 1.50 g compared with 1.81 ± 1.89 g in the control group. The mean difference was 0.50 g (95% confidence interval, -0.19 to 1.19 g; p = 0.15). The mean (standard deviation) postoperative visual analog scale pain score in the cold pack group was 2.40 ± 2.32 compared with 3.33 ± 2.83 in the control group. The mean difference was 0.94 (95% confidence interval, -0.11 to 1.99; p = 0.79). Most of the subjects preferred using a cold pack (78.7%) to not using a cold pack (21.3%) (p < 0.001). CONCLUSION: A cold pack after turbinate and/or septal surgery had no benefit in terms of postoperative bleeding or postoperative pain.

Comparison of polysomnographic and clinical presentations and predictors for cardiovascular-related diseases between non-obese and obese obstructive sleep apnea among Asians.

INTRODUCTION: Unlike Caucasians, many Asians with obstructive sleep apnea (OSA) are non-obese but are affected by the disease due to predisposing craniofacial structure. Therefore, non-obese and obese OSA may represent different disease entities. The associated risk factors for developing cardiovascular-related diseases, consequently, may be considered separately for the two types of OSA. METHOD: We reviewed polysomnographic studies performed in adults (aged ≥ 18 years) diagnosed with OSA (respiratory disturbance index [RDI] ≥ 5). We divided the patients into obese (body mass index [BMI] ≥ 25) and non-obese (BMI < 25) groups. We aimed to determine the differences between these two groups in terms of clinical presentations, polysomno-graphic findings, and association with cardiovascular-related diseases including hypertension, diabetes mellitus, coronary artery disease, and/or cerebrovascular disease. RESULTS: Among 194 patients with OSA (RDI ≥ 5), 63.4% were non-obese and 36.6% were obese. Compared with obese OSA patients, non-obese OSA patients were noted to have smaller neck size, less prevalence of hypertension, and less history of frequent nocturia (> 3-4/week), with equal prevalence of excessive daytime sleepiness. Overall, non-obese OSA patients were noted to have milder disease indicated by lower total, supine, and non-supine, NREM RDI and higher mean and nadir oxygen saturations. In the non-obese group, only total obstructive apnea index (OAI) was noted to be a predictor for developing any of the cardiovascular-related diseases after controlling for age, sex, and RDI (odds ratio = 9.7). However, in the obese OSA group, frequent snoring (> 50% of total sleep time), low sleep efficiency (≤ 90%), and low mean oxygen saturation (< 95%) were noted to be significant predictors of cardiovascular-related diseases (odds ratios = 12.3, 4.2, and 5.2, respectively). CONCLUSION: Among Asians, most OSA patients were not obese. Compared to obese OSA patients, non-obese OSA patients were noted to have less prevalence of hypertension and less history of nocturia. They were also noted to have overall milder OSA. Only OAI was noted to be a significant predictor for cardiovascular-related disease in the non-obese OSA group.

Development and validation of the body image scale among Thai breast cancer patients.

OBJECTIVE: To examine the psychometric property of the Thai version of the Body Image Scale (BIS) in breast cancer patients in Thailand. MATERIAL AND METHOD: The authors conducted a cross-culture translation of the BIS into the Thai language and administered it to 242 breast cancer patients who had surgery and had completed chemo-radiation for more than one year. RESULTS: The present study confirmed a good reliability and validity of Thai version of BIS. The questionnaire has high internal and external consistency; Cronbach's alpha was above 0.8 and test-retest reliability was more than 0.7. Content validity was confirmed by expert opinion and cognitive interview with breast cancer patients. Construct validity was examined though factor analysis showed a single-factor solution which excludes one item from the original 10-item scale. Discriminant validity which confirmed by different score between mastectomy and breast conserving surgery group and good response prevalence also supported the clinical validity of the test. CONCLUSION: Thai version of the BIS showed a good psychometric property and can be used as a patient-physician communication and quality of life evaluation tool after breast cancer treatment in Thai women.

A multicenter, randomized, controlled clinical trial of LigaSure small jaw vessel sealing system versus conventional technique in thyroidectomy.

The objective of this work was to compare efficacy and adverse effects between vessel sealing system thyroid lobectomy (VSSL) with the new LigaSure™ Small Jaw Instrument and conventional thyroid lobectomy (CTL). This is a multicenter, randomized and controlled study, conducted in the Department of Otolaryngology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University, Bangkok and Division of Otolaryngology, Sukhothai General Hospital, Sukhothai, Thailand. Forty subjects with solitary thyroid nodule planned for thyroid lobectomy were enrolled consecutively in both centers. Intervention was randomized by block randomization into two groups (VSSL, CTL). Primary outcomes were operative time and intraoperative blood loss. Secondary outcomes were postoperative blood loss and recurrent laryngeal nerve paralysis. There was clinically significant less operative time (VSSL/CTL = 62.4 ± 15.9/83.3 ± 16.1 min, p < 0.001) and less intraoperative blood loss (VSSL/CTL = 40.5 ± 19.1/63.3 ± 22.4 mL, p = 0.001) in VSSL group compared with CTL group. There was no significant difference of postoperative blood loss (VSSL/CTL = 58.8 ± 30.6/76.0 ± 36.9 mL, p = 0.116) between both the groups. There was one case of permanent recurrent laryngeal nerve injury found in both groups. VSSL with the new LigaSure™ Small Jaw Instrument was better than conventional technique in terms of shortening operative time. It was also better in reducing intraoperative hemorrhage, but this effect did not exceed clinically significant levels. Postoperative blood loss and recurrent laryngeal nerve injury were not significantly different between both the groups.

Efficacy study of nasal irrigation after radiofrequency tissue volume reduction for inferior turbinate hypertrophy: An equivalence randomized controlled trial.

BACKGROUND: To determine the benefits of nasal irrigation after radiofrequency tissue volume reduction (RFTVR) for inferior turbinate hypertrophy (ITH) in terms of nasal obstructive symptoms, endoscopic nasal findings, and acoustic rhinometry. An equivalence randomized controlled trial was performed at the Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand. METHODS: Seventy-nine subjects with ITH planned for RFTVR were enrolled consecutively. The intervention was randomized into two groups: with and without nasal saline irrigation. Primary outcome was visual analog scale (VAS; 0-10) of postoperative nasal obstructive symptoms. Rhinorrhea, pain, nasal itching and sneezing, foul odor, bleeding, crusting and discharge, and patient satisfaction were self-assessed by the patients. Findings from endoscopic nasal examination and acoustic rhinometry (total nasal volume and cross-sectional area 2 [CSA2]) were performed before and after the intervention by blinded assessors. RESULTS: The study revealed no difference of nasal obstruction and other symptoms between the saline group and the control group on the 1st postoperative week, except nasal itching and sneezing. The saline group had itching and sneezing symptoms lower than the control group on the 5th-7th postoperative day. All patients had minimal or no postoperative nasal bleeding. There were also no differences of satisfaction and acoustic rhinometry findings between both groups. CONCLUSION: The nasal irrigation with normal saline had no additional benefits after RFTVR for ITH in terms of nasal obstructive symptoms, endoscopic nasal findings, and acoustic rhinometry except nasal itching and sneezing symptoms.

Severity of obstructive sleep apnea in patients with and without cardiovascular-related diseases.

BACKGROUND: Previous studies have often investigated the association of obstructive sleep apnea (OSA) with cardiovascular morbidity and mortality, but the possibility of reverse causation has not been clearly defined. OBJECTIVE: To examine if the presence of any of the cardiovascular-related diseases, including hypertension, diabetes mellitus, coronary artery disease, and/or cerebrovascular disease, correlates with more severe OSA. METHODS: This was a retrospective study where all patients age ≥ 18 years referred to our sleep laboratory for suspected OSA were included. The data from the full-night baseline and split-night polysomnographic reports were reviewed. Data were then evaluated by logistic regression analysis to compare between 2 groups, the severity of OSA (respiratory disturbance index [RDI] < 15 vs RDI ≥ 15, and RDI < 5 vs RDI ≥ 5), other polysomnographic variables and daytime sleepiness score (Epworth Sleepiness Scale [ESS] score < 10 and ≥ 10). RESULTS: 190 patients were analyzed. The patients with any of the cardiovascular-related diseases were noted to have more severe sleep apnea (RDI ≥ 15), with an adjusted odds ratio of 3.24. Sleep efficiency ≥ 90% and mean oxygen saturation ≥ 95% were observed less commonly in the patients with any of the cardiovascular-related diseases (adjusted odds ratios of 0.45 and 0.36, respectively). There was no statistically significant difference in ESS score. CONCLUSIONS: Patients with any of the cardiovascular-related diseases are at a higher risk of having moderate to severe OSA without significant increase in daytime sleepiness. Therefore, we suggest that patients with any of the cardiovascular-related diseases should be screened for OSA, even if they are asymptomatic.

Clinical and polysomnographic data of positional sleep apnea and its predictors.

INTRODUCTION: In Asian population, facial structure may contribute to the primary pathophysiology of obstructive sleep apnea (OSA). We hypothesized that sleep position may have more effect on OSA in Asians compared to the Western population. If this hypothesis is accurate, positional therapy will have a major impact on treatment of OSA among Asians. PATIENTS/METHODS: We reviewed 263 polysomnographic studies from our laboratory from January 1, 2010 to June 30, 2010. Criteria for positional and non-positional OSA were (1) supine respiratory disturbance index (RDI)/non-supine RDI ≥2 and total RDI ≥5 and (2) supine RDI/non-supine RDI <2 and total RDI ≥5, respectively. We aimed to determine the difference in baseline characteristics, polysomnographic findings, and predictors for positional OSA. RESULTS: We found 144 patients diagnosed with OSA (RDI ≥5), and 96 patients met the criteria for positional OSA (67%), in which in almost half of these patients (47%), RDI was normalized (RDI < 5) in non-supine position. Snoring frequency were significantly lower among positional OSA and OSA was less severe indicated by lower RDI and arousal index, higher mean and nadir oxygen saturation, and higher %NREM3. We also found that low snoring frequency (less than 20% of total sleep time) was a significant predictor for positional OSA (odd ratio of 3.27; p = 0.011), contrarily to low mean oxygen saturation (<95%) which was found to be a negative predictor (odd ratio of 0.31; p = 0.009). Among OSA patients, low RDI (<15) was a significant predictor for normalization of RDI in non-supine position (odd ratio of 8.77; p = < 0.001), contrarily to low mean oxygen saturation (<95%) which was also found to be a negative predictor (odd ratio of 0.13; p = 0.001). CONCLUSION: Positional OSA is very prevalent and noted in almost 70% of our patients. Low snoring frequency was noted to be a positive predictor for positional OSA, contrarily to low mean oxygen saturation which was found to be a negative predictor. These findings are encouraging that positional therapy can be very beneficial as the treatment modality for OSA among Asians.

Vessel sealing system uvulopalatoplasty versus uvulopalatal flap: a randomized, controlled study of efficacy and adverse effects.

The objective of this randomized, controlled study is to compare intraoperative blood loss, operative time, postoperative pain and postoperative adverse effects (bleeding, velopharyngeal insufficiency and others) between vessel sealing system uvulopalatoplasty (VSSU) and uvulopalatal flap (UPF). The study was conducted at the Department of Otolaryngology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. 31 subjects with sleep-disordered breathing and obstruction at the retropalatal level were enrolled consecutively. Intervention was randomized by mixed block randomization into 2 groups (UPF, VSSU). Stratification was also done by the presence or absence of concomitant tonsillectomy. Measured outcomes, which were blinded to patients and outcome assessor, were intraoperative blood loss, operative time, postoperative pain, postoperative bleeding, postoperative velopharyngeal insufficiency and other adverse effects. Median (IQR) of intraoperative blood loss from VSSU and UPF was 0.00 (0.00-1.00) and 6.00 (1.25-12.75) ml (p < 0.001). Median (IQR) of operative time from VSSU and UPF was 3.50 (3.00-5.00) and 15.00 (12.25-18.00) min (p < 0.001). There was significantly less pain in VSSU group on operative day (p = 0.001) and postoperative day 1 (p = 0.009). However, no significant difference of pain on postoperative day 2 to day 14 (p = 0.055-0.983) between both groups. Regarding postoperative bleeding, 1 case of immediate bleeding in UPF group and 1 case of delayed bleeding in VSSU group were found in this study. Postoperative velopharyngeal insufficiency and other adverse effects were not found in both groups. In conclusion, VSSU was better than UPF in terms of less intraoperative blood loss, less operative time and less pain in early postoperative period. Postoperative velopharyngeal insufficiency and other adverse effects were not found in both groups.

Radiofrequency tissue volume reduction: suggested treatment for lymphatic malformation.

Lymphatic malformation is a benign congenital lesion but is often challenging to deal with. Complete excision is its treatment of choice. It has a high rate of recurrence, since a complete excision is difficult, and it may cause cosmetic or functional defect. Radiofrequency tissue volume reduction (RTVR) is used for the treatment of sleep-disordered breathing and other areas of surgery. A case of cervical lymphatic malformation reported here is effectively treated by radiofrequency without scar or any complication.

Recurrent epistaxis from an intranasal glomus tumor: the 22nd case report.

The case of a 66-year-old Thai woman who was treated at King Chulalongkorn Memorial Hospital due to recurrent epistaxis for two years is presented. Her physical examination revealed a 0.7-cm tumor mass on the right nasal septum. A biopsy was subsequently done and the tissue was sent for pathological examination. The lesion was then diagnosed as "glomus tumor of the nasal septum". Histologically, the tumor was rather well-circumscribed and located in the submucosal region. The neoplastic cells were uniform, round to ovoid in shape and contained bland-looking, finely chromatic nuclei and moderate amount of cytoplasm with ill-defined cell borders. These cells were intervened by tortuous vascular structures. Immunohistochemically, the tumor cells were strongly reactive to smooth muscle actin and negative to cytokeratin and S-100 protein. A glomus tumor is rare in the sinonasal region. So far, there have been only 21 reported cases in the literature. Almost all cases of sinonasal glomus tumor are benign and are usually cured by complete excision.

Results of temperature-controlled radiofrequency tissue volume reduction for the turbinate hypertrophy.

OBJECTIVES: To assess the efficacy of temperature-controlled radiofrequency tissue volume reduction (RFTVR) for the inferior turbinate. RESEARCH DESIGNS: Prospective, single-blinded, experimental clinical trial. METHOD: Twenty patients with nasal obstruction secondary to inferior turbinate hypertrophy were enrolled. Nasal obstruction was compared between before and after the treatment (at 1-3 days, 1 week and 6-8 weeks) of RFTVR using subjective symptom scores, physical findings and videotape images. RESULTS: Improvement of nasal symptoms was observed as early as 1 week after the operation. However, significant improvement was obtained at 6-8 weeks. CONCLUSION: RFTVR for the turbinate may be useful as an alternative approach for the treatment of chronic turbinate hypertrophy.

A comparative study of diagnostic tests for tuberculous lymphadenitis: polymerase chain reaction vs histopathology and clinical diagnosis.

UNLABELLED: To compare diagnostic tests for tuberculous lymphadenitis by polymerase chain reaction (PCR) with histopathology and clinical diagnosis in sensitivity, specificity and predictive value. This retrospective analytic, single blind study was done at King Chulalongkorn Memorial Hospital. Paraffin-embedded specimens were classified into 2 groups. The study group contained 30 proved AFB positive paraffin-embedded specimens from patients who also had clinical diagnosis of tuberculosis and improved by antituberculous treatment. The control group contained 30 formalin-fixed, paraffin-embedded specimens of lymph node hyperplasia proved by histopathological and clinical review. All 60 specimens were slided, and systematically labeled and sent to PCR lab. Polymerase Chain Reaction method had sensitivity = 43.33 per cent, specificity = 100 per cent, positive predictive value = 100 per cent and negative predictive value = 63.83 per cent. The present findings revealed that the PCR results were related to the age of the paraffin-embedded tissues. No positive results were obtained from tissues kept since 1996. Positive results were obtained in 3/7 cases (42.86%), 2/3 (66.67%) and 8/10 cases (80%) from tissue of 1997, 1998 and 1999 respectively. CONCLUSION: Polymerase chain reaction has sufficient reliability best as a confirmatory diagnostic test for tuberculous lymphadenitis; however, it is not appropriate as a screening test.