AIMS: This study compares the efficacy of adenoidectomy on otitis media with effusion (OME) in patients with different size of adenoids and the connection between differently sized adenoids and middle ear effusion. MATERIAL AND METHODS: Children with a history of at least 3 months' OME underwent adenoidectomy and myringotomy without the insertion of a tympanostomy tube. Treatment assignment was stratified by adenoids' size causing choanal obstruction (grade I-III) and according to Eustachian tube ostium obstruction (grade A-C). The subjects were followed for 12 months. RESULTS: Adenoidectomy was significantly more effective in children with adenoids in contact with torus tubarius (grade B, C) compared to those with small adenoids without contact (P<0.001). The volume of the adenoids was irrelevant (P=0.146). The size of adenoids did not affect the viscosity of the middle ear secretion. The distribution of mucous and serous secretion was not dependent on the size of adenoids; the efficacy of adenoidectomy was 82% in mucous as well as serous secretion. CONCLUSION: The relation between adenoids and torus tubarius is more important than the volume of the adenoids. The viscosity of middle ear fluids (serous or mucous) did not influence the rate of treatment efficacy.
- MeSH
- Adenoidectomy * MeSH
- Adenoids pathology MeSH
- Child MeSH
- Hypertrophy classification MeSH
- Humans MeSH
- Adolescent MeSH
- Follow-Up Studies MeSH
- Otitis Media with Effusion surgery MeSH
- Child, Preschool MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Child, Preschool MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Cieľ štúdie: Objasniť vplyv adenoidných vegetácií na nosovú obštrukciu, parametre nosovej priechodnosti a posúdiť vplyv endoskopickej adenoidektómie. Metódy: U 156 detí priemerného veku 6,7 rokov a výšky 123 cm bolo vykonané nazofibroendoskopické vyšetrenie, ktorým bol objektivizovaný stav nosohltana a určený stupeň prípadnej hypertrofie adenoidných vegetácií, na základe čoho boli deti rozdelené do skupín. U detí bolo zároveň realizované rinomanometrické meranie metódou prednej aktívnej rinomanometrie a namerané hodnoty celkového prietoku vzduchu nosovou dutinou (Fl.L+R) a celkovej nosovej rezistencie (ResL+R) pri tlakovej diferencii 150 Pa. Získané hodnoty boli porovnávané s referenčnými parametrami, na základe čoho bol pre jednotlivé skupiny určený stupeň nosovej obštrukcie. U 50 detí boli vyšetrenia realizované aj po adenoidektómii. Následne bol štatisticky vyhodnotený vplyv adenoidných vegetácií a adenoidektómie na priechodnosť nosovej dutiny. Výsledky: V súbore 151 detí s verifikovanou hypertrofiou adenoidných vegetácií bola nameraná hodnota Fl.L+R zodpovedajúca 60 % a hodnota ResL+R zodpovedajúca 233 % referenčnej hodnoty pre danú výšku, čo zodpovedá stredne závažnej nosovej obštrukcii – 2. stupeň. V dôsledku prítomnosti adenoidov došlo v porovnaní zo skupinou bez adenoidov k signifikantnému zníženiu Fl.L+R (p = 0,01) a zvýšeniu ResL+R (p = 0,012). Bol zaznamenaný súvis medzi nárastom stupňa hypertrofie adenoidov a stupňa nosovej obštrukcie. Stupeň obštrukcie pred a po adenoidektómii bol štatisticky významne odlišný (p = 0,028), prínos adenoidektómie bez ohľadu na stupeň hypertrofie adenoidov predstavoval 0,58 stupňa. Hodnota Fl.L+R nameraná po adenoidektómii zodpovedala stredne závažnej nosovej obštrukcii – 2. stupeň. U pacientov s 2. stupňom hypertrofie adenoidov nedošlo po adenoidektómii k výrazným zmenám nosovej obštrukcie, u pacientov s 3. stupňom bolo zaznamenané zlepšenie o 1,11 stupňa. Závery: Štúdia potvrdila, že prítomnosť adenoidných vegetácií spôsobuje nosovú obštrukciu a zhoršuje parametre priechodnosti nosovej dutiny. Vyšší stupeň hypertrofie adenoidných vegetácií súvisí s vyšším stupňom nosovej obštrukcie. Prínos endoskopickej adenoidektómie na zmiernenie nosovej obštrukcie možno predpokladať len u detí s 3. a 4. stupňom hypertrofie adenoidných vegetácií, respektíve 3. a 4. stupňom nosovej obštrukcie.
Background: The aim of this study was to clarify changes of nasal obstruction, transnasal airflow and resistance resulting from adenoid hypertrophy and to assess the effect of endoscopic adenoidectomy. Methods: Altogether 156 children (average age of 6.7 years, with average high of 123 cm) were submitted to a nasal fiberoptic endoscopy, condition of nasopharynx and the grade of eventual adenoid hypertrophy was determined, according to which the children were divided into groups. We also conducted active anterior rhinomanometry (transnasal pressure 150 Pa) and assessed values of total transnasal inspiratory airflow (Fl.L+R) and total nasal resistance (ResL+R). We compared this values with reference parameters and assessed grade of nasal obstruction for all groups. In group of 50 children we conducted these measurements also after adenoidectomy and assessed the change of nasal patency due to adenoidectomy. Results: In a group of 151 children with verified adenoid hypertrophy we measured value of Fl.L+R corresponding to 60% and value of ResL+R corresponding to 233% of reference parameters what correlate with 2nd grade of nasal obstruction. We have noticed statistically significant decrease of Fl.L+R (p=0.01) and increase of ResL+R (p=0.012) due to adenoid hypertrophy. Also we have noticed relationship between increase of adenoid hypertrophy grade and grade of nasal obstruction. The grade of nasal obstruction due to AT statistically changed (p=0.028) and we recorded improvement of 0.58 grade. Value of Fl.L+R after adenoidectomy correlated with 2nd grade of nasal obstruction. We have not observed relevant changes in nasal obstruction after adenoidectomy in children with 2nd grade of adenoid hypertrophy; in children with 3rd grade of adenoid hypertrophy we have observed improvement of 1.11 nasal obstruction grade. Conclusions: In our study we have confirmed negative influence of adenoid hypertrophy on nasal obstruction and patency. Higher grade of adenoid hypertrophy relate with higher grade of nasal obstruction. The significant reduction of nasal obstruction symptoms after adenoidectomy might be expected only in group of patients with the 3rd and 4th grade of adenoid hypertrophy respectively 3rd and 4th grade of nasal obstruction.
