Algorithm of adenoiditis treatment in adults, depending on the pharyngeal tonsil hypertrophy stage

OBJECTIVE

Introduction: Implementation of the endoscopic technologies while the upper airways diseases gave opportunity to diagnose the adenoid vegetation in adults. The aim: Тo offer effective algorithm of curing adults for adenoiditis, depending on the degree of pharyngeal tonsil hypertrophy.

PATIENTS AND METHODS

Materials and methods: 43 patients aged 18 - 55 with hypertrophy of pharyngeal tonsil were examined. Depending on the degree of hypertrophy three clinical groups of patients was created: the first one receiving only conservative treatment, the second one receiving conservative therapy and radiowaveradiation coagulation with the apparatus "SURGITRON" and the third one receiving the endoscopic shave adenotomy. Statistical processing of the received data was made in the programs «Exсel» and «STATISTICA 6.0». Data rows were checked for the normality with the help of Shapiro-Wilk statistical criteria (small sample) and Kolmohorov-Smirnov (large sample). Checking of the dispersion uniformity was done by Leneva criteria. During the comparison of the rows criteria of Student and Wilkokson for the non-paired, Kolmogorov-Smirnov were used.

RESULTS

Results: During the re-examination of patients who received only conservative therapy treatment in a month endoscopic signs adenoiditis were distinguished and a year later percentage of relapse was higher than in patients with complex treatment. After shave adenotomy adenoiditis recurrence was not observed.

CONCLUSION

Conclusions: While treatment of the patients with the pharyngeal tonsil hypertrophy of the 1 and 2 degree conservative therapy is possible. Addition into the scheme of conservative treatment RWCAV actually reduces quantity of adenoiditis recurrence and allows fast recovery. Treatment of patients with the pharyngeal tonsil hypertrophy of 3 degree, in context of contraindication absence requires surgical treatment (adenotomy) in 100% of cases.

[Late effects of long-term exposure to low-dose ionizing radiation on lymphoid pharyngeal system in children]

The examination of 468 children and adolescents estimated frequency and structure of chronic pathology of the pharyngeal ring in long-term exposure to low-dose radiation. Chronic disease of the tonsils and adenoids was detected in 194 children (45.4%). Chronic tonsillitis was diagnosed in 142 (33.3%) examinees. 31.7 and 59.9% cases had compensated and subcompensated disease. Decompensated process took place in 8.5% cases of chronic tonsillitis. Hypertrophy of the palatine tonsils and adenoids was detected in 96 (22.5%) children. High incidence of lymphadenopathy of the neck in combination with chronic tonsillitis and tonsil and adenoid hypertrophy was found. Structure of chronic pathology of the lymphoid pharyngeal ring correlated with internal radiation dose. Comparison of postnatally and antenatally radiated children demonstrated less frequent incidence of affected lymphoid pharyngeal ring in children born before the Chernobyl accident.

Salivary gland tumors after childhood radiation treatment for benign conditions of the head and neck: dose-response relationships

We have investigated the dose-response relationships for the incidence of salivary gland tumors in a cohort of 2945 individuals who were irradiated as children between 1939-1962. Most of the patients were treated to reduce the size of their tonsils and adenoids. The mean dose to the salivary glands (+/-SD) was 4.2 +/- 1.7 Gy. Eighty-nine patients developed 91 salivary gland neoplasms; 22 had single malignancies, 64 had single benign neoplasms, 2 developed two separate benign neoplasms, and 1 developed a single neoplasm but did not have surgery. The majority (81 of 89) of the patients developed neoplasms in the parotid glands. Mucoepidermoid carcinomas were the most common malignancy and mixed (pleomorphic) adenomas were the most common benign neoplasm. For all salivary gland tumors, the excess relative risk per gray (ERR/Gy) was 0.82; however, the 95% confidence interval was wide (0.04, upper bound indeterminate). The trend was determined principally by benign tumors, as there was no dose-response relationship for salivary gland cancer, although there were too few cases to draw definitive conclusions. Overall, our study provides support for an association between salivary gland tumors and radiation exposure. Although most salivary gland tumors are benign and are usually readily detected, they may cause morbidity, and people who have been irradiated in the area should be monitored for their occurrence.

Change induced by radiation therapy in FDG uptake in normal and malignant structures of the head and neck: quantitation with PET

PURPOSE

To quantitate the changes induced in uptake of the glucose analog 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) in normal structures in the head and neck and compare these to the change in uptake in malignant structures in patients with head and neck tumors undergoing radiation therapy.

MATERIALS AND METHODS

Eleven patients with biopsy-confirmed squamous cell carcinoma of the head and neck were studied before, during, and after a 6-week course of radiation therapy with positron emission tomography (PET)-FDG imaging. A ratio of FDG uptake in the structure compared with that in the cerebellum (termed metabolic ratio) within and outside of the field of radiation was determined in the adenoids; lingual and palatine tonsils; parotid, submandibular, and sublingual glands; and nasal turbinates, soft palate, and gingiva.

RESULTS

The average metabolic ratio in the tonsils, nasal turbinates, soft palate, and gingiva did not change significantly with treatment.

CONCLUSION

FDG uptake in normal structures does not change with radiation therapy. This fact is in marked contrast to the FDG uptake in squamous cell carcinomas in the head and neck, which decrease dramatically with treatment (P < .005).

Multiple head and neck neoplasia following radiation for benign disease during childhood

A woman received radiation therapy to the adenoids for benign disease at the age of 10 years and subsequently developed an adenocarcinoma of the middle ear, a parathyroid adenoma, and a papillary carcinoma of the thyroid gland in adulthood. This appears to be the first such case on record. The literature of neoplasia after head and neck irradiation is briefly reviewed.

Childhood irradiation of pharyngeal lymphoid tissue: management considerations

Childhood irradiation to the head and neck increases the probability of developing regional glandular neoplasia. Life-long follow-up of these patients is warranted.

Neurilemomas and salivary gland tumors of the head and neck following childhood irradiation

In a program to contact and examine 4180 individuals with a history of childhood irradiation treatment for enlarged tonsils and adenoids, the authors have discovered 29 neurilemomas, two neurofibromas, and one ganglioneuroma in the 2311 subjects who have been found. Ten of these presented as acoustic neuromas, 21 presented as cervical mass lesions, and one was found in the superior posterior mediastinum. Because of their numbers and their strict localization to the area of treatment, it was concluded that they were radiation-induced. Analysis of the latency of these tumors indicates that they continue to occur for at least 30 years after the radiation exposure. In the same group of individuals, there have been 54 confirmed salivary gland tumors, 40 benign and 14 malignant. These tumors are also continuing to occur many years after the radiation exposure.