Influence of nasal septum deformity on nasal obstruction, disease severity, and medical treatment response among children and adolescents with persistent allergic rhinitis

Screening for Obstructive Sleep Apnea and Associated Risk Factors in Adolescents and Adults With Isolated Robin Sequence

OBJECTIVE

To investigate the subjective risk for obstructive sleep apnea (OSA) in adolescents and young adults with isolated Robin sequence (IRS). Additionally, to investigate the association of OSA risk with respiratory signs/symptoms, and retrognathia.

DESIGN

Prospective, observational, and cross-sectional study.

SETTING

Tertiary reference hospital for the rehabilitation of craniofacial anomalies.

PARTICIPANTS

Adolescents and adults (n = 30) with IRS were clinically evaluated and screened through the Berlin Questionnaire (BQ) and Respiratory Symptoms Questionnaire. The maxillomandibular relationship was assessed on lateral cephalograms of those that reached skeletal maturity (n = 13). Polysomnography (PSG) was performed in a subgroup of 4 individuals.

RESULTS

The mean age of the sample was 18.2 (±3.4) years, 17 (56.7%) were adolescents (14-19 years), and 16 were (53.3%) female, all presented a repaired cleft palate.

CLINICAL PARAMETERS

Systemic arterial pressure (118.0 ± 4.1/76.3 ± 4.9 mmHg), body mass index (BMI) (20.9 ± 2.8 kg/m2), neck (33.2 ± 2.3 cm), and waist circumferences (72.0 ± 5.8 cm) were within normal ranges. A skeletal class I pattern was observed in 61.5% of the participants while a class II was seen in 15.4% of them. A high risk for OSA was detected in 16.7%, and it was associated with nasal obstruction, snoring and drowsiness, and a skeletal class II pattern (P ≤ .05). One patient presented with mild OSA (apnea-hypopnea index [AHI] = 10.1 events/hour) at the PSG exam.

CONCLUSIONS

A high risk for OSA can be observed with a moderate frequency among adolescents and young adults with IRS, especially among those who are concurrently suffering from nasal obstruction, snoring and retrognathia.

Visual analysis of allergic rhinitis in children based on web of science and CiteSpace software

BACKGROUND

In recent years, Allergic Rhinitis (AR) in children has caused widespread public concern. However, there are few studies concerning the overall trends in AR research in children based on bibliometric analysis.

OBJECTIVE

This study aims to explore hotspots and emerging trends in AR in children.

METHODS

The relevant publications were searched for in the Web of Science (WOS) Core Collection on December 31, 2021. The searched studies were exported to CiteSpace and Microsoft Excel for further visualized analysis.

RESULTS

In total, 649 articles were included. The number of publications related to AR in children has increased steadily in the last 20 years. Giorgio Ciprandi from Italy has the most articles and the leading countries were China and the USA. Guangzhou Medical University in China and Hallym University in Korea were the institutions with the most articles. The high-frequency keywords included AR, asthma, children, prevalence, and symptoms. Pathogenesis, comorbidity, epidemiology, symptoms, and therapy of AR in children are research hotspots.

CONCLUSION

Over the past 20 years, research on AR in children has gradually improved. Visualization analysis indicates that pathogenesis, comorbidity, epidemiology, symptoms, and therapy are research hotspots, and immunotherapy and severity are probably the main research directions.

Rhinitis Phenotypes

Rhinitis is an umbrella term of a group of upper airway diseases with nasal symptoms and signs with different etiologies and various clinical features or traits. It can be classified into different "phenotypes," based on these observable traits. A proper differential diagnosis is necessary to adequately manage the disease. The objective of this review is to clarify the concept of rhinitis phenotypes while analyzing the clinical features and/or traits of each in order to determine a proper differential diagnosis and appropriate treatment.

Risk of dental malocclusion in children with upper respiratory tract disorders: A case-control study of a nationwide, population-based health claim database

OBJECTIVES

The aim of this study was to evaluate the association between different upper respiratory tract disorders and severe dental malocclusion in pediatric patients.

METHODS

Newly diagnosed patients (N = 773) with dental malocclusion aged 8-18 years and controls (N = 3865) were identified from the health claim records of the Longitudinal Health Insurance Database 2000 of Taiwan's National Health Insurance Research Database. Controls were frequency matched to the cases by sex, age group, and index year. Univariate and multiple logistic regression analyses were used to evaluate the association between severe dental malocclusion and six common upper respiratory tract disorders, including acute sinusitis, allergic rhinitis, chronic sinusitis, nasal septum deviation, nasal polyps, and hypertrophy of tonsil and adenoids.

RESULTS

The risk of severe dental malocclusion was significantly elevated in pediatric patients with three upper respiratory tract disorders, including acute sinusitis (adjusted odds ratio [aOR] = 1.66, 95% confidence interval [95% CI] 1.39-1.99), allergic rhinitis (aOR = 1.64, 95% CI 1.34-2.02), and chronic sinusitis (aOR = 2.01, 95% CI 1.27-3.19). When all the six upper respiratory tract disorders were simultaneously included in the multiple logistic regression analysis, acute sinusitis (aOR = 1.48, p < 0.001) and allergic rhinitis (aOR = 1.34, p < 0.010) were significantly and independently associated with an increased risk of severe dental malocclusion.

CONCLUSIONS

Findings from this nationwide, population-based case-control study indicated that acute sinusitis and allergic rhinitis were independently and significantly associated with an increased risk of severe dental malocclusion in pediatric patients. Pediatricians should remain vigilant for the risk of dental malocclusion in their patients with these disorders.

Multimorbidities of Pediatric Allergic Rhinitis

PURPOSE OF REVIEW

Most children and adolescents with allergic rhinitis (AR) present extra-nasal multimorbid conditions, including conjunctivitis, asthma, atopic dermatitis, rhinosinusitis, or seromucous otitis. Additionally, they may present nasal obstructive disorders, such as septal deformity, turbinate enlargement, and adenoidal hyperplasia, which worsen nasal symptoms, especially nasal obstruction. This is a narrative review on the current state of the concomitant presence of AR and one or more multimorbidities.

RECENT FINDINGS

The presence of AR and one or more accompanying multimorbidities is associated to a higher severity and duration of the disease, a negative impact on quality of life, with worse control and lack of improvement with medical treatment. Therefore, AR needs to be managed with a multidisciplinary collaborative approach. Pediatric AR needs to be considered in the context of a systemic disease, which requires a coordinated therapeutic strategy.

Dependence of Anterior Active Rhinomanometry Indices on Nasal Obstructive Disorders in Children with Atopic Bronchial Asthma Complicated by Nasal Symptoms

BACKGROUND

Atopic bronchial asthma (BA) in children is associated with upper airways pathology (UAP). Among them, a combination of allergic rhinitis (AR) and nasal obstructive disorders (NOD), including hypertrophy of the pharyngeal tonsil (HPT) and anomalies of the intranasal structures (AINS), is abundant. In such patients, anterior active rhinomanometry (AARM) is an important method of examining nasal patency. However, NOD can influence the AARM parameters in children with BA and nasal symptoms, and this effect must be taken into account in clinical practice. Study goal was to elucidate the effect of NOD on rhinomanometric parameters in this group of patients.

METHODS

Total of 66 children with BA and AR were examined with AARM, rhinovideoendoscopy, spirometry, and standard clinical tests allowing revealing the structure of comorbid pathologies. In order to avoid the influence of anthropometric parameters of children and their age on AARM parameters, a special index of reduced total nasal airflow was used.

RESULTS

It has been established that NOD, especially HPT, have a significant negative impact on the indices of anterior active rhinomanometry during the periods of both AR remission and AR exacerbation. The effect of AINS is much weaker and was remarkable only in combination with HPT.

Diagnostic Algorithm for Evaluating Nasal Airway Obstruction

Nasal obstruction is a common symptom and can have a large impact on patient quality of life. There are numerous causes, including anatomic, congenital, inflammatory, infectious, neoplastic, toxic, and systemic. An algorithmic approach can aid in ensuring all pertinent patient information is incorporated into the final diagnosis and treatment plan. Key components include a thorough history, physical examination including modified Cottle and Cottle maneuver, patient-reported outcome measures and/or quality of life questionnaires, examination with and without decongestion, and nasal endoscopy. The resultant information can then be effectively used to narrow the differential and guide the next steps in management.

Effect of Nasal Obstructive Disorders on Sinonasal Symptoms in Children with Different Levels of Bronchial Asthma Control

Allergic rhinitis (AR) and allergic rhinosinusitis (ARS) are typical upper airway pathologies (UAP) in children with bronchial asthma (BA) frequently accompanied with nasal obstructive diseases (NOD). In order to establish the effect of NOD on correlations between nasal and synonasal symptoms with clinical assessments of asthma control, 82 children, 9.8 [8.9; 10.7] years old, with atopic BA were assessed using ACQ-5 for the BA control level, TNSS for nasal symptoms, and SNOT-20 for synonasal quality of life in combination with rhinovideoendoscopy for NOD. All patients had AR/ARS; in 76.3% (63/82) of children, UAP had a multimorbid character with the presence of NOD. Significant correlations were found between ACQ-5 and TNSS (R=0.40, p < 0.0001) and ACQ-5 and SNOT-20 (R=0.42, p < 0.0001). Correlations between TNSS/ACQ-5 and SNOT-20/ACQ-5 were higher in patients who do not have a combination of AR/ARS with NOD (R=0.67, p=0.0012; R=0.50, p=0.022, resp.) than in patients who have AR/ARS combined with NOD (R=0.30, p=0.015; R=0.26, p=0.04, resp.). Thus, the association of BA control level with the expression of nasal and synonasal symptoms is higher in children who do not have multimorbid UAP.