Nasal Mucociliary Clearance in Adenoid Hypertrophy and Otitis Media with Effusion

Adenoid facies: a long-term vicious cycle of mouth breathing, adenoid hypertrophy, and atypical craniofacial development

Adenoid hypertrophy (AH) is characterized by pathological hyperplasia of the nasopharyngeal tonsils, a component of Waldryer's ring, which represents the first immune defense of the upper respiratory tract. The pathogenic factors contributing to AH remain to be comprehensively investigated to date. Although some studies suggest that environmental exposure to smoke and allergens, respiratory tract infections, and hormonal influences likely contribute to the development of AH, further research is necessary for fully elucidating the effects of these factors on the onset and progression of AH. AH is the most common cause of airway obstruction in the pediatric population, with a prevalence rate of 49.7%, and is frequently accompanied by various comorbidities. These patients often present with distinctive dental characteristics, including increased overjet, posterior crossbite, a high palatal plane, narrow dental arches, and facial features characterized by disproportionate alterations in facial height, commonly referred to as "adenoid facies." Individuals with adenoid facies frequently display abnormal breathing patterns, especially mouth breathing. The present review summarizes the findings of research articles sourced from PubMed, IEEE, and Web of Science over the last 20 years up to September 2024. Several high-quality studies screened using the PICOPS framework reported that perioral muscle dysfunction, dental and skeletal malocclusions, and upper airway obstruction caused by AH are interdependent issues and mutually exacerbate one another. The review summarizes the potential associations and mechanisms linking AH, mouth breathing, and the subsequent development of adenoid facies in children.

The therapeutic use of exosomes in children with adenoid hypertrophy accompanied by otitis media with effusion (AHOME): a protocol study

BACKGROUND

The adenoids act as a reservoir of bacterial pathogens and immune molecules, and they are significantly involved in children with otitis media with effusion (OME). As an essential carrier of intercellular substance transfer and signal transduction, exosomes with different biological functions can be secreted by various types of cells. There remains significant uncertainty regarding the clinical relevance of exosomes to OME, especially in its pathophysiologic development. In this study, we will seek to determine the biological functions of exosomes in children with adenoid hypertrophy accompanied by OME (AHOME).

METHODS

The diagnostic criteria for OME in children aged 4-10 years include a disease duration of at least 3 months, type B or C acoustic immittance, and varying degrees of conductive hearing loss. Adenoidal hypertrophy is diagnosed when nasal endoscopy shows at least 60% adenoidal occlusion in the nostrils or when nasopharyngeal lateral X-ray shows A/N > 0.6. Children who meet the indications for adenoidectomy surgery undergo adenoidectomy. Peripheral blood, nasopharyngeal swab, and adenoid tissue will be collected from patients, and the exosomes will be isolated from the samples. Following the initial collection, patients will undergo adenoidectomy and peripheral blood and nasopharyngeal swabs will be collected again after 3 months.

EXPECTED RESULTS

This study aims to identify differences in exosomes from preoperative adenoid tissue and peripheral blood samples between children with AHOME and those with adenoid hypertrophy alone. Additionally, it seeks to determine changes in microbial diversity in adenoid tissue between these groups.

CONCLUSIONS

The findings are expected to provide new insights into the diagnosis and treatment of OME, to identify novel biomarkers, and to enhance our understanding of the pathophysiology of OME, potentially leading to the development of innovative diagnostic and therapeutic approaches.

Allergy in pathogenesis of Eustachian Tube Dysfunction

Eustachian tube dysfunction (ETD) is a condition where the Eustachian tube (ET) fails to function normally, resulting in symptoms such as aural fullness, tinnitus, autophony, and hearing loss. ETD can further lead to middle ear diseases such as otitis media effusion and adhesive otitis media, which is becoming more common in the field of otology. Although the pathogenesis of ETD remains unclear, recent animal studies and clinical experiments have found allergic reactions and allergic diseases are closely related to the occurrence of ETD. As the mucosa of the ET is continuous with that of the nasopharynx and tympanic cavity, it is reasonable to assume that the immunological basis of the ET itself is similar to that of respiratory allergic diseases. However, due to the special anatomical location and complex pathogenesis of the ET, there is still no unified diagnostic gold standard. Additionally, there is an ongoing debate regarding whether ETD can be classified as a distinct disease or even an allergic disease. Furthermore, the effectiveness of anti-allergic therapy in patients with ETD is yet to be fully understood. Therefore, this review elaborates on the possible mechanisms of allergic reactions in the occurrence and development of ETD, and explores the potential role of anti-allergic therapy in managing this condition, in order to provide new insights into the pathogenesis and prevention of ETD.

Proteomic Study of Middle Ear Effusion and Its Clinical Application for Otitis Media with Effusion

Background

Proteins found in middle ear effusion play crucial roles in the physiological and pathological processes of otitis media with effusion (OME), influencing the etiology and clinical characteristics of this disease. The qualitative and quantitative composition of these proteins depending on the underlying pathogenesis of middle ear effusion. Understanding their physiological and pathological functions is of great importance.

Methods

We collected samples from 19 volunteers diagnosed with OME. After offline separation using high-pH reversed-phase liquid chromatography (RPLC), the pooled sample was subjected to LC-MS/MS analysis to obtain a comprehensive profile of the OME proteome. Functional analysis was performed using Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Ingenuity Pathway Analysis (IPA) annotations. Data-independent acquisition (DIA) technology was utilized to analyze samples and fix whether the OME proteome could replicate the pathophysiological features associated with this disease. We conducted a differential proteomic analysis between patients with simple OME and patients who had received radiotherapy. The radiotherapy-reduced group was further divided into two subgroups: nasopharyngeal carcinoma (NPC) and other types of carcinoma. Parallel reaction monitoring (PRM) technology was used for validation of 36 differentially expressed proteins (DEPs).

Results

A number of 732 proteins were identified in the OME proteome database. Among them, 527 proteins were quantified using peak intensity-based semi-quantification (iBAQ), covering a wide dynamic range of approximately 8 orders of magnitude. Based on the functional analysis, we proposed a hypothetical mechanism of OME.

Conclusion

This study managed to put up an inclusive analysis of the OME proteome, establishing the first human OME proteome database. We focused on differential proteomic analysis among different groups to gain a more comprehensive concept of the OME proteome and search for meaningful biomarkers.

Risk factors for otitis media with effusion in children with adenoid hypertrophy

The aim of this study was to determine the most important risk factors in the development of otitis media with effusion (OME) in children with adenoid hypertrophy. A total of 539 patients undergoing surgery for adenoid hypertrophy (AH Group) (n = 429) or adenoid hypertrophy and otitis media with effusion (AH + OME Group) (n = 110) between February 2012 and February 2018 constituted the study group. Data were obtained on neonatal history (breastfeeding, bottle feeding), past health and medical history (presence of atopy or allergic rhinitis, snoring at night, cough, tonsillitis in the past 12 months), environmental factors (presence of pets, attending to daycare centers, district of school), family history (passive smoking at home, number of siblings, family size, parental education), and family income. The groups did not differ from each other for age (p = 0.684) and gender (p = 0.728). Our data support the presence of atopy or allergic rhinitis (p < 0.001), frequent (> 5) tonsillitis (p < 0.001), attending to daycare centers (p < 0.001), exposure to smoke (p < 0.001), having 3 or more siblings (p < 0.001), and 4 or more people in the household (p < 0.001) as the main risk factors for OME. Comprehensive knowledge of modifiable risk factors found in this study could help to minimise the complications of OME in children.

[Comparative cytological analysis of the middle ear exudate in different children's groups]

The purpose: to compare the types of cytograms of exudate from the middle ear between patients with exudative otitis media (EOM) with congenital clefts of the lip/palate (CCLP) and without CCLP, determining the stages of chronic disease and the significance of surgery on the middle ear.

PATIENTS AND METHODS

Two clinics was parallel conducted a cytological examination of exudate of the middle ear in children. The first group consisted of 30 patients aged 2 to 17 years with EOM without CCLP (n=54 ears). The 2nd group included 17 patients aged 1 year 4 months to 10 years with EOM with CCLP (n=34 ears).

RESULTS

In the 1st group, in 61% of cases (n=33), an inflammatory-regenerative type of cytogram was detected, in 39% (n=21) - a regenerative, inflammatory type of cytogram was not detected. In the 2nd group, in 82.4% of cases (n=28), an inflammatory type of cytogram was observed, in 14.7% (n=5) - an inflammatory-regenerative type, in 2.9% (n=1 ear) - a regenerative type.

CONCLUSION

With CCLP, the inflammatory nature of the cytogram of the resulting exudate from the middle ear is more common, which is characterized by signs of destruction of the mucous membrane, decay and degradation of the basal and cell membranes. Patients with CCLP often suffer from EOM. They are more likely to development of chronic purulent otitis media, including with cholesteatoma. Destructive changes in the mucous membrane of the middle ear are found in children of different ages. Taking into account the analysis of cytograms of the exudate of the middle ear with CCLP, the imposition of long-term ventilation tubes is justified.

Relationship between nasal mucociliary clearance and disease severity in children with allergic rhinitis: A comparative cross-sectional study

OBJECTIVES

Mucociliary clearance (MCC) is impaired due to chronic inflammation in allergic rhinitis. Our aim was to evaluate MCC in children with allergic rhinitis, to determine its relationship with disease severity and evaluate MCC change after nasal irrigation.

MATERIALS AND METHODS

Saccharin test was performed in 51 patients with allergic rhinitis and in 50 controls. Nasal irrigation was performed to the patients and saccharin test was repeated at the 10th minute. Total nasal symptom score (TNSS) and visual analogue scale (VAS) results were recorded. Patients were divided into mild/moderate-severe groups according to TNSS, VAS, and ARIA guidelines. Nasal MCC time (NMCCT) of the patients and the controls and NMCCT before and after nasal irrigation of the patients were compared. Correlations between NMCCT and TNSS/VAS were evaluated. NMCCTs of the mild and moderate-severe groups were compared. The cut-off values ​​were calculated to discriminate the patient group.

RESULTS

The mean NMCCT of the patient group was higher than the controls. Mean NMCCTs were different between before and after irrigation. NMCCT was higher in uncontrolled/moderate-severe groups than in controlled/mild groups. NMCCT correlated positively with VAS and TNSS. The sensitivity and specificity of NMCCT>535s were found to be 86.27% and 94%, respectively.

CONCLUSIONS

In children with allergic rhinitis, the prolongation of MCC may be identified with the easily applicable saccharin test, the deterioration in MCC increases as disease severity increases. Nasal irrigation is important in children with allergic rhinitis to improve MCC.

Comparison of desflurane and sevoflurane on postoperative recovery quality after tonsillectomy and adenoidectomy in children

Comparison of desflurane and sevoflurane on the postoperative recovery quality after tonsillectomy and adenoidectomy in children was carried out. A retrospective analysis was performed on the medical records of 165 children who underwent tonsil and adenoid radiofrequency ablation under low-temperature plasma and were admitted to the Xuzhou Children's Hospital, Xuzhou Medical University from February 2014 to May 2017. In total, 79 children with sevoflurane anesthesia were in the sevoflurane group, and 86 children with desflurane anesthesia in the desflurane group. The non-invasive blood pressure (NIBP), heart rate (HR) and oxygen saturation (SpO₂) level, the postoperative sedation (Ramsay) scores, the modified objective pain score (MOPS) of children were recorded. The pediatric anesthesia emergence delirium (PAED) scores of children were recorded. Children in the sevoflurane group had longer operation time, anesthesia time, extubation time and coincidence time than those in the desflurane group (P<0.05). At the beginning of operation (t1), 10 min after operation (t2), at the time of entering anesthesia recovery room (t3), at the time of tracheal catheter extubated (t4), 10 min after extubation (t5), and at the time of leaving the anesthesia recovery room (t6), children in the sevoflurane had higher NISBP and NIDBP, lower HR than those in the desflurane group (P<0.05). At the time of the tracheal catheter extubation (c2), 10 min after extubation (c3), 30 min after extubation (c4), children in the sevoflurane group had lower Ramsay scores and higher PAED scores than those in the desflurane group (P<0.05). More suitable as an anesthetic maintenance drug for tonsillectomy and adenoidectomy in children, desflurane has a better anesthetic effect and is safer. In addition, children with desflurane anesthesia have high postoperative recovery quality and quick recovery in the short term, with better sedative and analgesic effects. Therefore, it is worthy of promotion in clinic practice.

Evaluation of allergic rhinitis with nasal symptoms and nasal mucociliary clearance in patients with fibromyalgia syndrome

BACKROUND

The exact etiopathogenesis of fibromyalgia syndrome (FM) is still unclear but the pathogenesis of FM is associated with neurogenic inflammation. Allergic rhinitis (AR) is a common inflammatory and immunological disease of the nasal mucosa. As a result, it is known that neurogenic inflammation has a role in the pathophysiology of both FM and AR.

OBJECTIVE

The aim of this study was to evaluate AR and nasal allergic inflammation using nasal mucociliary clearance time (NMC) in FM patients.

METHODS

Forty-five FM patients and fifty healthy controls were included in the study. In both groups, AR was evaluated by total nasal symptom scoring (TNSS) and NMC was measured using saccharine transit time test (STT).

RESULTS

TNSS was positive in 9 patients (20%) in the FM group and no positivity in the control group. In FM group, the mean value of TNSS was higher than that of the control group (p= 0.0001). The average value of STT of FM patients was statistically significantly longer when compared to the control group (p= 0.0001).

CONCLUSION

The results we obtained suggest that there is a high possibility of coexistence of FM and AR. As a result, the coexistence of AR and FM cannot be denied but we believe that comprehensive clinical studies should be conducted on this subject.

Challenges in nasal drug absorption: how far have we come?

The nasal route is commonly used for local delivery of drugs to treat inflammatory conditions. It is also an attractive route for systemic delivery of some drugs. Irrespective of intended use, administered drugs must permeate the epithelial or olfactory membrane to be effective. The enthusiasm for potential use of the nasal route for systemic drug delivery has not been met by comparable success. In this paper, the anatomical and physiological attributes of the nasal cavity and paranasal sinuses important for drug delivery and challenges limiting drug absorption are discussed. Efforts made so far in improving nasal drug absorption such as overcoming restrictive nasal geometry and paranasal sinuses accessibility, mucociliary clearance, absorption barriers, metabolism and drug physicochemical challenges are discussed. Highlights on future prospects of nasal drug delivery/absorption were discussed.

Intranasal Steroid Use for Otitis Media with Effusion: Ongoing Opportunities for Quality Improvement

Objectives Our objectives were (1) to assess patterns of intranasal steroid administration when otitis media with effusion (OME) has been diagnosed in children, (2) to investigate whether usage varies according to visit setting, and (3) to determine if practice gaps are such that quality improvement could be tracked. Study Design Cross-sectional analysis of an administrative database. Subjects and Methods National Ambulatory and Hospital Ambulatory Medical Care Surveys, 2005 to 2012; univariate, multivariate, and stratified analyses of intranasal steroid usage were performed. The primary outcome was intranasal steroid administration, and the primary predictor was a diagnosis of OME. The impact of location of service was also analyzed. Results Data representing 1,943,177,903 visits demonstrated that intranasal steroids were administered in 10.0% of visits in which OME was diagnosed, in comparison to 3.5% of visits in which OME was not diagnosed (univariate odds ratio, 3.07; 95% confidence interval [CI], 1.85-5.08; P < .001). After adjusting for age, sex, race/ethnicity, and other confounding conditions, multivariate analysis demonstrated that OME remained associated with an increase in intranasal steroid usage (odds ratio, 3.58; 95% CI, 1.60-8.01; P = .002). This practice pattern was more prevalent in the ambulatory office setting (risk difference 6.6%, P < .001) and less seen in a hospital-based office or emergency department. Conclusion Despite randomized controlled trials showing a lack of efficacy for isolated OME, nasal steroids continue to be used in treating children with OME in the United States. Related quality improvement opportunities to prevent usage of an ineffective treatment exist.