Prevalence of tonsillar hypertrophy and associated oropharyngeal symptoms in primary school children in Denizli, Turkey

doi:10.1016/S0165-5876(02)00247-1

International Journal of Pediatric Otorhinolaryngology

Volume 66, Issue 2, 11 November 2002, Pages 175-179

https://doi.org/10.1016/S0165-5876(02)00247-1 Get rights and content

Abstract

Objective: The purpose of this study is to investigate the prevalence of tonsillar hypertrophy and associated oropharyngeal symptoms in primary school children. Methods: The study was performed in two primary schools which were chosen randomly in Denizli. Size of the tonsils was evaluated and scored on a five-point scale and weights of children were measured. The mothers or primary caregivers of children were asked to fill a questionnaire that included questions concerning the associated symptoms of tonsillar hypertrophy. The interrelations between tonsillar hypertrophy and other studied items were examined by χ² tests. Results: The study population consisted of 1211 (636 boys, 575 girls) primary school children between 6 and 13 years old (mean 9.3±2 years). Prevalence of tonsillar hypertrophy in school children was found as (133) 11% in the school children. There were a statistically significant association between tonsillar hypertrophy and history of frequently having tonsillitis, habitual snoring, observed apnea, oral breathing during sleep and difficulty eating. Conclusion: The prevalence of tonsillar hypertrophy was found to be 11% in school children in Denizli, Turkey. Primary school children with tonsillar hypertrophy have signs and symptoms of frequent upper airway infections and upper airway obstruction so they need further evaluation for associated oropharyngeal symptoms of tonsillar hypertrophy.

Introduction

Typically, the tonsils and adenoids are very small at birth and progressively enlarge over the 1st to 4th years of life and tend to regress in adolescence. In this course children with adenotonsillar hypertrophy may show some pathologic signs and symptoms [1]. While in some children recurrent acute or chronic infection of tonsils can be found as a frequently associated sign, the recurrent acute or chronic inflammation was also proposed as a cause of adenotonsillar hypertrophy [1], [2]. The children with obstruction usually have difficulty eating, reduced appetite and are usually small and in the lower percentile by weight. On the other hand, hypertrophy of the tonsils and adenoids is the most common cause of pharyngeal obstruction and sleep related breathing disorders that range in disease severity from habitual snoring to obstructive sleep apnea syndrome. Nighttime signs consist of snoring, snorting, mouth breathing, apnea, and enuresis nocturia. Since the developmental peak of these tissues appear between 2 and 5 years, studies of signs and symptoms of adenotonsillar hypertrophy mainly focused on pre-school children [3], [4], [5], [6], [7], [8]. This study set out to determine the prevalence of tonsillar hypertrophy and to find out whether there is any association between tonsillar hypertrophy and medical history of oropharyngeal symptoms and body weight percentile in primary school children.

Section snippets

Materials and method

The study was performed in two primary schools which were chosen randomly in Denizli. After a pilot study, a questionnaire about oropharyngeal symptoms was constructed. Informed consent was obtained from the parents of the children and mothers or primary caregivers of children who were asked to answer a questionnaire about children. The questionnaire included questions concerning frequency of having tonsillitis, upper respiratory system infections and fever, the regularity of snoring, observed

Results

Because of uncompleted or improperly completed questionnaires, 22 children were excluded from the study. Also, 69 children who had adenoidectomy with or without tonsillectomy or any chronic disease were excluded from the study. The study population consisted of 1211 (636 boys, 575 girls) primary school children between 6 and 13 years old (mean 9.3±2 years). Results were summarized in Table 1. Results of tonsil scoring: grade 0, 227 (18.7%); grade 1, 686 (56.6%); grade 2, 165 (13.6%); grade 3,

Discussion

Tonsillar hypertrophy begins in early childhood and continues until puberty, after which atrophic changes may occur [2]. Hypertrophic tonsils may cause obstruction or accompany chronic or recurrent tonsillitis in some children. Previous studies mainly focused on preschool children and sleep related disorders due to adenotonsillar obstruction [3], [4], [5], [6], [7]. In the literature there is a lack of knowledge about prevalence of tonsillar hypertrophy in school children. In this study

Conclusion

The prevalence of tonsillar hypertrophy was found to be 11% in school children in Denizli, Turkey. Primary school children with tonsillar hypertrophy still have signs and symptoms of often having upper airway infection and upper airway obstruction. They need further evaluation for associated oropharyngeal symptoms of tonsillar hypertrophy.

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To compare the dentofacial characteristics of children with and without adenoid and/or tonsillar hypertrophy.
A consecutive sample of orthodontic patients aged 6–12 that took pre-treatment lateral cephalograms were included in this study. Those with history of previous orthodontic treatment, adenoidectomy or tonsillectomy, or craniofacial anomalies were excluded. The diagnosis of adenoid and tonsillar hypertrophy was based on Fujioka's and Baroni's methods, according to which the subjects were divided into four groups: the adenoid hypertrophy only (AHO) group; tonsillar hypertrophy only (THO) group; combined adenoid and tonsillar hypertrophy (AH+TH) group; and no adenoid or tonsillar hypertrophy (NH) group. Cephalograms were used for skeletal and dental measurement. Data were analyzed using one-way ANOVA, LSD post-hoc tests and Chi-square test.
A total of 598 patients were included. Compared with the NH group, the THO group had significantly larger SNB angle (P < 0.001), as well as significantly smaller ANB angle (P<0.001) and Wits value (P = 0.001). The U1-L1 angle of AHO group was significantly smaller than that in the NH group (P = 0.035). The proportion of adenoid hypertrophy in Class II patients was significantly higher than that in Class III patients (P = 0.001). The proportion of tonsillar hypertrophy in Class III patients was significantly higher than that in Class I patients (P < 0.001) and Class II patients (P < 0.001).
Over 80 % of children seeking orthodontic treatment had either adenoid or tonsillar hypertrophy. Children with adenoid hypertrophy tend to have skeletal Class II malocclusion, while those with tonsillar hypertrophy tend to have skeletal Class III malocclusion.
Paired qualitative and quantitative analysis of bacterial microcolonies in the tonsils of patients with tonsillar hyperplasia
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The discovery of bacterial microcolonies in tonsillar tissue of patients with tonsillar hyperplasia has raised the question of their role in provoking the local immune response. Tonsils collected from patients undergoing tonsillectomy were stained for three clinically relevant bacterial taxa and lymphocytes. The bacterial composition and abundance of microcolonies was investigated using a combination of laser-microdissection, amplicon sequencing and Droplet Digital polymerase chain reaction. Microcolonies were detected in most samples (32/35) with a high prevalence of Haemophilus influenzae (78% of samples). B and T cell lymphocytes were significantly higher in the epithelium adjacent to microcolonies compared to epithelium distal to microcolonies. Furthermore, significant positive and negative correlations were identified between bacterial taxa and lymphocytes. Genus Streptococcus, which includes Group A Streptococcus (traditionally described as the main pathogen of tonsillar hyperplasia), was found in low abundance in this study. These results suggest other potential pathogens may be involved in stimulating the local immune response leading to tonsillar hyperplasia.
Impact of rapid palatal expansion on the size of adenoids and tonsils in children
2022, Sleep Medicine
Adenoid and tonsillar hypertrophy in children often leads to adverse respiratory symptoms and obstructive sleep apnea (OSA). Current clinical guidelines from the American Academy of Pediatrics and American Academy of Otolaryngology–Head and Neck Surgery recommend tonsillectomy as the first line of pediatric OSA treatment for children with tonsillar hypertrophy. Rapid palatal expansion (RPE) performed by orthodontists improves obstructive sleep apnea in children by reducing nasal airway resistance, increasing nasal volume, raising tongue posture, and enlarging pharyngeal airway. However, the role of RPE in alleviating adenoid and tonsillar hypertrophy remains elusive. In this study, we aim to evaluate the changes in adenoid and palatine tonsil sizes following RPE using 3D volumetric analysis of cone beam computational tomography (CBCT) imaging.
In this retrospective cohort study, a total of 60 pediatric patients (mean age: 8.00, range: 5–15, 32 females and 28 males) who had tonsillar hypertrophy (size 3 and 4) were included and divided into the control group (n = 20) and expansion group (n = 40). The control group did not undergo any treatment. The expansion group underwent RPE using a conventional Hyrax expander, activated 0.25 mm per day for 4–6 weeks. Final CBCT scans (T2) were performed 13.8 ± 6.5 months after the initial scan (T1). Pediatric sleep questionnaire (PSQ) and BMI were obtained at each timepoint. Volumetric analysis of adenoid and palatine tonsils was performed using a combination of bony and soft tissue landmarks in CBCT scans through Anatomage Invivo 6 imaging software. Paired t-tests were used to evaluate the difference between the initial and final adenoid and tonsil volumes. p values less than 0.05 were considered statistically significant.
Compared to the control group, the expansion group experienced a statistically significant decrease in both adenoid and tonsil volume. There was non-statistically significant increase in volume from T1 to T2 for the control group. For the expansion group, 90.0% and 97.5% of patients experienced significant reduction in adenoid and tonsil volume, respectively. The average volume decrease of adenoids was 16.8% while that of tonsils was 38.5%. The patients had up to 51.6% and 75.4% reduction in adenoid and tonsil size, respectively, following RPE orthodontic treatment. Pearson correlation ranged from 0.88 to 0.99 for each measurement, representing excellent internal consistency. There was a significant reduction in the PSQ scores from 5.81 ± 3.31 to 3.75 ± 2.38 in expansion group (p < 0.001).
Our results demonstrated that RPE significantly reduced the size of both adenoid and palatine tonsils and revealed another long-term benefit of RPE treatment. To our knowledge, this is the first study to quantify the changes of adenoids and tonsils following RPE. RPE treatment can be considered as a valid and effective treatment option for pediatric OSA population with narrow high arch palate and adenotonsillar hypertrophy.
A review of adenotonsillar hypertrophy and adenotonsillectomy in children after solid organ transplantation
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Paediatric solid organ transplantation is an increasingly successful treatment. Improved survival is paralleled by increased secondary complications of immunosuppression, including post-transplant lymphoproliferative disease (PTLD). PTLD frequently presents in Waldeyer's lymphatic ring. Adenotonsillar hypertrophy (ATH) is common in children, however in children after transplant, ATH may indicate PTLD. We review the literature on ATH and the role of adenotonsillectomy in children after transplantation.
A comprehensive literature search was performed on the 26 th September 2017 of Ovid Medline (1996–September 2017), Embase (1996–2017) and EBM reviews (Cochrane database of systematic reviews 2005–September 20 th 2017). Results were limited to English language publications within the last 20 years. Abstracts were screened for relevance to PTLD and ATH in the paediatric solid organ transplantation population. Screening of the bibliographies identified further articles.
85 unique articles were screened to yield 18 relevant publications. 10 were retrospective studies and 8 were prospective studies.
In children, we report a PTLD incidence of up to 15%, with up to 63% of cases presenting in the head and neck. Histological examination of adenotonsillectomy specimens found PTLD in a mean 5.7% (range 0–39%). We found a lack of prospective studies into this topic and further high quality research is needed. Clinical assessment of ATH in children after transplantation and when to perform a diagnostic adenotonsillectomy remains challenging. Children with ATH warrant prompt further investigation and support from colleagues in transplantation and oncology is required.
Oral health status of children with mouth breathing due to adenotonsillar hypertrophy
2018, International Journal of Pediatric Otorhinolaryngology
Citation Excerpt :
Generally, it has been observed the most frequent and serious between 4 and 8 ages [5]. According to the results of a study, the prevalence was 11% in Turkey [6]. In the pediatric population, the obstructive sleep apnea (OSA) prevalence is 3%, especially related to adenotonsillar hypertrophy [7,8].
Mouth breathing is an important health problem, commonly encountered in children. In children, adeno-tonsillar hypertrophy is the main reason causing partial or complete upper airway obstruction and reduction in airflow. This study aimed to determine the oral health status of children aged 3–15 years, with mouth breathing who were due to have surgery for adeno-tonsillar hypertrophy and referred to the Department of Otorhinolaryngology at Children's Hospital of a University in Ankara, Turkey between January–July 2015.
The approval of the Non-Interventional Clinical Researches Ethics Board of Hacettepe University and written informed consents from the parents were obtained. The parents completed a questionnaire before the surgery. The children were examined using dental mirror and explorer under dental unit lighting. Oral health status was evaluated with DMFT/S, dmft/s, ICDAS II, dental plaque and gingival indices. The chi-square test, Kruskal Wallis and Mann Whitney U tests were used to statistically analyse the results, with statistical significance p<0.05.
Of the 170 children who had adenotonsillar hypertrophy with mouth breathing, 150 the parents agreed to participate the study. 77 of the children (51.3%) were male; the mean age was 5.9 ± 2.6. Mean dmft was 3.8 ± 3.6, dmfs 9.7 ± 1.1, DMFT 0.4 ± 1.0 and DMFS 0.6 ± 1.5 respectively. Among the children, 101 (67.3%) had cavitated dental caries, and according to ICDAS II, none had healthy teeth, 15 (10.0%) had initial, 42 (28.0%) had moderate and 93 (62.0%) had advanced caries. Of the children, 89.3% had gingivitis and the proportion of gingivitis in posterior region was found to be significantly higher than anterior region (p < 0,001).
The oral health status of mouth breathing in children with adeno-tonsillar hypertrophy was poor. To reduce the risk of dental caries and periodontal disease among these children, regular dental follow-up and preventive programmes for oral health are needed.
Prevalence of upper respiratory tract infections in habitually snoring and mouth breathing children
2018, International Journal of Pediatric Otorhinolaryngology
The aim of the study was to investigate the prevalence of upper respiratory tract infections (URI) – as indicated by rhinosinusitis (RS), ear infections (EI), and antibiotic consumption – in a general pediatric population and evaluate the relationship between these conditions and habitual snoring and mouth breathing during sleep.
A population-based cross-sectional study was performed in three medium-sized Polish cities from 2011 to 2015.
4837/6963 questionnaires (69.5%) were completed, returned and analyzed. Mean age of studied group was 7.07 ± 0.72 and 7.14 ± 0.73 in girls and boys, respectively. Habitual mouth breathing during sleep (MB) was reported in 907 (18.7%) children and habitual snoring (HS) in 290 (6.0%). 230/290 (79.3%) of children with HS were also MB. Both HS and MB were more prevalent in boys than in girls (p = 0.027 and p < 0.0001, respectively) and neither was associated with BMI (p = 0.11 and p = 0.07, respectively).
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Higher rates of rhinosinusitis, ear infections, and antibiotic consumption were similarly associated with HS and MB. MB is over three times more prevalent in the pediatric population relative to HS, therefore it might be considered as a risk factor for URI and may be included in history of URI.

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Prevalence of tonsillar hypertrophy and associated oropharyngeal symptoms in primary school children in Denizli, Turkey

Abstract

Introduction

Section snippets

Materials and method

Results

Discussion

Conclusion

Am. J. Otolaryngol.

Int. J. Pediatr. Otorhinolaryngol.

Int. J. Pediatr. Otorhinolaryngol.

Int. J. Ped. Otorhinolaryngol.

Chest

Int. J. Pediatr. Otorhinolaryngol.

Auris Nasus Larynx

Non-neoplastic disease of the tonsils and adenoids

Snoring, apnea and ENT symptoms in the pediatric community

Clin. Otolaryngol.