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Deniz I, Eyigor H, Yalcin M, Ozturk Yilmaz G, Yilmaz MD, Osma U, Selcuk OT, Renda L. The usefulness of transcervıcal ultrasonography for the predıctıon of obstructıve sleep apnea ın chıldren. Cranio 2024:1-8. [PMID: 38863170 DOI: 10.1080/08869634.2024.2358740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
OBJECTIVE It was aimed to investigate the role of tonsil ultrasonography(USG) in the diagnosis of pediatric OSAS. METHODS Before tonsillectomy (±adenoidectomy) for OSAS, all patients tonsil USG and polysomnography (PSG) tests were performed. Tonsil volume was measured preoperatively with the Brodsky tonsil grading scale and by postoperative water displacement test. RESULTS In total, 47 patients were included in the study. We observed a positive correlation between tonsil volumes measured by preoperative USG and water displacement test postoperatively. There was a statistically significant correlation between tonsil sizes measured by tonsil USG, PSG AHI and questionnaire scores(p < .05). CONCLUSION Preoperative tonsil USG may be helpful test in children with suspected OSAS.
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Affiliation(s)
- Ismail Deniz
- Department of Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Hulya Eyigor
- Department of Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mustafa Yalcin
- Department of Radiology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Gamze Ozturk Yilmaz
- Department of Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mustafa Deniz Yilmaz
- Department of Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ustun Osma
- Department of Otorhinolaryngology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Omer Tarik Selcuk
- Department of Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Levent Renda
- Department of Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey
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Kalkanis A, Testelmans D, Papadopoulos D, Van den Driessche A, Buyse B. Insights into the Use of Point-of-Care Ultrasound for Diagnosing Obstructive Sleep Apnea. Diagnostics (Basel) 2023; 13:2262. [PMID: 37443656 DOI: 10.3390/diagnostics13132262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/06/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a sleeping disorder caused by complete or partial disturbance of breathing during the night. Existing screening methods include questionnaire-based evaluations which are time-consuming, vary in specificity, and are not globally adopted. Point-of-care ultrasound (PoCUS), on the other hand, is a painless, inexpensive, portable, and useful tool that has already been introduced for the evaluation of upper airways by anesthetists. PoCUS could also serve as a potential screening tool for the diagnosis of OSA by measuring different airway parameters, including retropalatal pharynx transverse diameter, tongue base thickness, distance between lingual arteries, lateral parapharyngeal wall thickness, palatine tonsil volume, and some non-airway parameters like carotid intima-media thickness, mesenteric fat thickness, and diaphragm characteristics. This study reviewed previously reported studies to highlight the importance of PoCUS as a potential screening tool for OSA.
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Affiliation(s)
- Alexandros Kalkanis
- Department of Respiratory Diseases, University Hospitals Leuven, KU Leuven, Campus Gasthuisberg, 3000 Leuven, Belgium
| | - Dries Testelmans
- Department of Respiratory Diseases, University Hospitals Leuven, KU Leuven, Campus Gasthuisberg, 3000 Leuven, Belgium
| | - Dimitrios Papadopoulos
- Department of Respiratory Diseases, University Hospitals Leuven, KU Leuven, Campus Gasthuisberg, 3000 Leuven, Belgium
| | | | - Bertien Buyse
- Department of Respiratory Diseases, University Hospitals Leuven, KU Leuven, Campus Gasthuisberg, 3000 Leuven, Belgium
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Ece B, Aydin S. Can Shear Wave Elastography Help Differentiate Acute Tonsillitis from Normal Tonsils in Pediatric Patients: A Prospective Preliminary Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040704. [PMID: 37189953 DOI: 10.3390/children10040704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023]
Abstract
Shear wave elastography (SWE) is a non-invasive imaging technique used to quantify the elasticity/stiffness of any tissue. There are normative SWE studies on tonsils in healthy children in the literature. The purpose of this study is to analyze the palatine tonsils in children with acute tonsillitis using ultrasound and SWE. In this prospective study, pediatric patients aged 4-18 years diagnosed with acute tonsillitis and healthy children were included. Those with antibiotic use, chronic tonsillitis, adenoid hypertrophy, and having chronic disease, immunodeficiency, and autoimmune disease, or any rheumatological disease were excluded. The volume and elasticity of palatine tonsil were measured via ultrasound and SWE. The study included 81 (46 female, 35 male) acute tonsillitis patients, and 63 (38 female, 25 male) healthy children between the ages of 4 and 18. Elasticity (kPa) values of tonsils were found significantly higher in the tonsillitis group (SWE-R: 25.39 ± 4.64, SWE-L: 25.01 ± 4.17) compared to the normal group (SWE-R: 9.71 ± 2.37, SWE-L: 9.39 ± 2.19) (p < 0.001). In the tonsillitis group, a significant positive correlation was found between tonsil volume and elasticity (r: 0.774, p: 0.002). In conclusion, in pediatric patients with acute tonsillitis, higher kPa values were obtained with SWE in the palatine tonsils.
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Affiliation(s)
- Bunyamin Ece
- Department of Radiology, Kastamonu University, Kastamonu 37150, Turkey
| | - Sonay Aydin
- Department of Radiology, Erzincan University, Erzincan 24100, Turkey
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Tschopp S, Azalmad K, Tschopp K. Tonsil volume and outcome of radiofrequency uvulopalatoplasty with or without tonsillectomy in adults with sleep-disordered breathing. Eur Arch Otorhinolaryngol 2023; 280:3005-3013. [PMID: 36906856 PMCID: PMC10175372 DOI: 10.1007/s00405-023-07914-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/04/2023] [Indexed: 03/13/2023]
Abstract
PURPOSE Predictors for the outcome of uvulopalatopharyngoplasty with and without tonsillectomy (UPPP ± TE) in sleep-disordered breathing have not been fully established. This study investigates tonsil grade, volume, and preoperative examination in predicting radiofrequency UPP ± TE outcomes. METHODS All patients undergoing radiofrequency UPP with tonsillectomy if tonsils were present between 2015 and 2021 were retrospectively analyzed. Patients underwent a standardized clinical examination, including Brodsky palatine tonsil grade from 0 to 4. Preoperatively and 3 months after surgery, sleep apnea testing was performed using respiratory polygraphy. Questionnaires were administered assessing daytime sleepiness using the Epworth Sleepiness Scale (ESS) and snoring intensity on a visual analog scale. Tonsil volume was measured intraoperatively using water displacement. RESULTS The baseline characteristics of 307 patients and the follow-up data of 228 patients were analyzed. Tonsil volume increased by 2.5 ml (95% CI 2.1-2.9 ml; P < 0.001) per tonsil grade. Higher tonsil volumes were measured in men, younger patients, and patients with higher body mass indices. The preoperative apnea-hypopnea index (AHI) and AHI reduction strongly correlated with tonsil volume and grade, whereas postoperative AHI did not. The responder rate increased from 14% to 83% from tonsil grade 0 to 4 (P < 0.01). ESS and snoring were significantly reduced after surgery (P < 0.01), but the reduction was not influenced by tonsil grade or volume. No other preoperative factor other than tonsil size could predict surgical outcomes. CONCLUSIONS Tonsil grade and intraoperatively measured volume correlate well and predict the reduction of AHI, while they are not predictive of ESS and snoring response after radiofrequency UPP ± TE.
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Affiliation(s)
- Samuel Tschopp
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Baselland, Mühlemattstrasse 13, 4410, Liestal, Switzerland. .,Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
| | - Khalid Azalmad
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Baselland, Mühlemattstrasse 13, 4410, Liestal, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Kurt Tschopp
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Baselland, Mühlemattstrasse 13, 4410, Liestal, Switzerland
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Palatine Tonsil Measurements and Echogenicity during Tonsillitis Using Ultrasonography: A Case-Control Study. Diagnostics (Basel) 2023; 13:diagnostics13040742. [PMID: 36832230 PMCID: PMC9955242 DOI: 10.3390/diagnostics13040742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/18/2023] Open
Abstract
This case-control study aimed to assess the size and echogenicity of inflamed tonsils using ultrasonography. It was carried out at different hospitals, nurseries, and primary schools in Khartoum state. About 131 Sudanese volunteers between 1 and 24 years old were recruited. The sample included 79 volunteers with normal tonsils and 52 with tonsillitis according to hematological investigations. The sample was divided into groups according to age-1-5 years old, 6-10 years old, and more than ten years. Measurements in centimeters of height (AP) and width (transverse) of both tonsils (right and left) were taken. Echogenicity was assessed according to normal and abnormal appearances. A data collection sheet containing all the study variables was used. The independent samples test (t-test) showed an insignificant height difference between normal controls and cases with tonsillitis. The transverse diameter increased significantly with inflammation (p-value < 0.05) for both tonsils in all groups. Echogenicity can differentiate between normal and abnormal tonsils (p-value < 0.05 using the chi-square test) for samples from 1-5 years and 6-10 years. The study concluded that measurements and appearance are reliable indicators of tonsillitis, which can be confirmed with the use of ultrasonography, helping physicians to make the correct diagnosis and decisions.
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Burns DW, Chan VWS, Trivedi A, Englesakis M, Munshey F, Singh M. Ready to scan? A systematic review of point of care ultrasound (PoCUS) for screening of obstructive sleep apnea (OSA) in the pediatric population. J Clin Anesth 2022; 83:110973. [PMID: 36152603 DOI: 10.1016/j.jclinane.2022.110973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/30/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
STUDY OBJECTIVE Diagnosis of obstructive sleep apnea (OSA) in pediatric practice is challenging, as screening questionnaires are inadequate and sleep studies are resource limited and time-consuming. A recent systematic review and meta-analysis of perioperative point-of-care ultrasound (PoCUS) in adults identified several parameters which correlate with OSA diagnosis and are the subject of an ongoing prospective study. The objective of this systematic review was to evaluate the usefulness of surface airway ultrasound as a PoCUS tool for OSA screening in the pediatric population. DESIGN Databases were searched for observational cohort studies and randomized controlled trials of patients under 18 years of age undergoing quantitative surface US measurement of extra-thoracic airway structures where correlation or association was examined either directly to OSA diagnosis or indirectly to an alternative reference measure. Diagnostic properties and correlation between US parameters (index test) and reference measures were evaluated where possible. MAIN RESULTS Of the initial 8499 screened articles, 12 articles (8 airway, 4 non-airway) evaluating 1237 patients were included. Six of these studies were conducted in the sleep/obesity clinic and six in in the perioperative population. Ten studies were prospective and two were cross sectional studies. Airway parameters which correlated with moderate-severe OSA were lateral pharyngeal wall thickness and total neck thickness at the retropharyngeal level. Tonsil volume was not correlated with OSA diagnosis or severity. In tonsillectomy patients, tonsil volume on preoperative ultrasound correlated well with volume of surgical specimens. Adenoid thickness correlated strongly with radiological and endoscopic measures of size and occlusion. CONCLUSION Ultrasound measurement in children indicates several parameters which correlate with OSA diagnosis or with other reference measurements. This has not yet been validated as a diagnostic tool, however the recent emergence of research in this area is encouraging and the findings from this review will inform future studies.
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Affiliation(s)
- Donogh W Burns
- Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Vincent W S Chan
- Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Aditya Trivedi
- Department of eHealth, McMaster University, Hamilton, Ontario, Canada
| | - Marina Englesakis
- Library & Information Services, University Health Network, Toronto, Canada
| | - Farrukh Munshey
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mandeep Singh
- Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Toronto Sleep and Pulmonary Centre, Toronto, Canada; Department of Anesthesiology and Pain Management, Women's College Hospital, Toronto, Ontario, Canada.
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Sağtaş E, Mengi E, Kara CO, Şenol H. A Novel Assessment Method With Ultrasound for Obstructive Tonsillar Hypertrophy in Children. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1795-1801. [PMID: 33200837 DOI: 10.1002/jum.15559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/23/2020] [Accepted: 10/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To develop a new method for the objective evaluation of airway obstruction due to tonsillar hypertrophy using ultrasound (US) in children. METHODS The oropharynx was examined in patients, and tonsil grades were evaluated according to the staging system of Brodsky et al (Int J Pediatr Otorhinolaryngol 1987; 13:149-156). The narrowest intertonsillar distance (ITD) and widest transverse length of the tongue base (TLTB) were then measured by US, and their ratio was calculated. The clinical value of US was investigated for the classification of tonsillar hypertrophies as nonobstructive or obstructive by matching the patients' clinical grades with the US data. RESULTS A total of 102 patients (age range, 2-12 years) were included in the study. According to the Brodsky staging system, 44.1% and 55.9% of the patients were in nonobstructive (stages I and II) and obstructive (stages III and IV) tonsillar hypertrophy groups, respectively. The area under the curve was 0.991 (95% confidence interval, 0.977-0.999) according to a receiver operating characteristic curve analysis between the Brodsky staging and the ITD/TLTB ratio. The optimal cutoff value for the ITD/TLTB ratio for the diagnosis of obstructive tonsillar hypertrophy was found to be 0.3 or less, which had 96.5% sensitivity and 95.6% specificity. CONCLUSIONS The degree of airway obstruction due to tonsillar hypertrophy can be objectively determined by US in children. An ITD/TLTB ratio of 0.3 or less was found to be compatible with obstructive tonsillar hypertrophy. This new and easily applicable evaluation method may provide considerable value and guidance for tonsillectomy decisions.
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Affiliation(s)
- Ergin Sağtaş
- Department of Radiology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Erdem Mengi
- Department of Otolaryngology-Head and Neck Surgery, Pamukkale University School of Medicine, Denizli, Turkey
| | - Cüneyt Orhan Kara
- Department of Otolaryngology-Head and Neck Surgery, Pamukkale University School of Medicine, Denizli, Turkey
| | - Hande Şenol
- Department of Biostatistics, Pamukkale University School of Medicine, Denizli, Turkey
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