Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0037315 (sleep apnea)
 8,000 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

61 snoring children selected for adenotonsillectomy, mainly for recurrent tonsillitis, were compared with a matched group of 31 healthy children for symptoms of sleep apnoea, extent of sleep hypoxaemia, and amount of sleep disturbance. The studies were repeated six months postoperatively, and after six months in the healthy children. Preoperatively, 61% of the children had degrees of sleep hypoxaemia above normal and 65% had abnormally disturbed sleep. A questionnaire administered to the parents about their children showed abnormal patterns of answers about sleep problems daytime sleepiness, hyperactivity, aggression, learning difficulties, restless sleep, and odd sleeping positions. After adenotonsillectomy, the abnormal hypoxaemia, excessive sleep disturbance, and multiple symptoms almost resolved; a growth spurt also occurred.
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PMID:Effect of adenotonsillectomy on nocturnal hypoxaemia, sleep disturbance, and symptoms in snoring children. 196 19

Forty-five patients with homozygous sickle cell disease who had tonsillectomy for recurrent tonsillitis, when compared with 45 matched controls with haemoglobin genotype AA, showed significant differences in the clinical manifestations and complications of recurrent tonsillitis between the two groups. Although throat swabs in the sickle cell group were mostly negative because they were on prophylactic penicillin, all tonsils harboured Streptococcus pneumoniae when cultured. This study suggests the tonsils to be the more specific source of pneumococcal infection that causes systemic complications which increase morbidity and mortality in sickle cell disease. Although the sickle cell patients may be less clinically symptomatic with tonsillitis, the incidence of serious complications caused by pneumococcal infections, now shown to arise from the tonsils, is significant. Adenotonsillar hypertrophy is linked with an increased risk of a sleep apnoea which causes serious neurological complications such as cerebral infarction and stroke. Tonsillectomy has greatly reduced the incidence of complications from pneumococcal infections in the sickle cell group and should therefore be recommended for sickle cell patients taking prophylactic penicillin and still developing pneumococcal infections.
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PMID:The significance of recurrent tonsillitis in sickle cell disease. 792 45

In children with recurrent tonsillitis there may be persistent antigen deposition in tonsil tissue. even between exacerbations. If so, upregulation of immunocompetent cells should occur continuously, in contrast to tonsil tissue from children with tonsillar hypertrophy. The cytokine pattern was studied in cell suspensions prepared from tonsils obtained from 12 children undergoing tonsillectomy. The study group comprised 6 children with recurrent tonsillitis and 6 who had a history of tonsillar hypertrophy causing sleep apnea. Cytokine-producing cells (IL-1alpha, IL-1beta, TNFalpha, IL-6, IL-8, IL-2, IFNgamma, TNFbeta, IL-10 and IL-4) were characterized at the single-cell level by use of cytokine-specific monoclonal antibodies and indirect immunofluorescence technique. A constitutive production of IL-1alpha, IL-1beta, TNFalpha, and IL-8 was found in both groups (10-300/10(5) cells). However, the frequency of spontaneous IL-2, IFNgamma, TNFalpha, IL-6 and IL-10 was consistently low (10 +/- 10 cells) in both groups. Following restimulation by T-cell receptor ligation, using immobilized anti-CD3 mAb, with concentrations chosen so that it did not activate resting cells, increased frequencies of TNFalpha, IL-6, IL-8, IL-2, IFNgamma, IL-4 and 1L-10 synthesizing cells were induced in the recurrent tonsillitis group. Significantly higher incidences of IL-1beta, IL-6 and IL-2 producing cells were found in the recurrent tonsillitis group (60-200/10(5) cells, p <0.05). Microbiological evaluation in the tonsil tissue could not reveal tiny differences between the studied groups regarding bacterial or viral pathogens. However, this does not exclude persistent increased intracellular deposition of microbial antigens as a possible explanation for the elevated incidence of IL-1beta, TNF-alpha, IL-6, IL-8, IL-2, IFNgamma, IL-10 and IL-4 expressing cells noticed in patients with recurrent tonsillitis.
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PMID:Upregulated local cytokine production in recurrent tonsillitis compared with tonsillar hypertrophy. 892 44

The failure to eradicate group A beta-hemolytic streptococci from the pharynx is partly due to a low compliance, but above all, an alteration of the oropharyngeal microbiological flora: reduction of alpha-haemolytic streptococci which inhibit group A beta-hemolytic streptococci and increase of microorganisms such as Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis. These latter act indirectly destroying the beta-lactamic ring of penicillins. However, this obstacle is overcome by the use of antibiotics which do not contain beta-lactamic rings such as macrolides or associating amoxicillin with clavulanic acid or with new cephalosporins which are more resistant to beta lactamases. To restrict the diffusion of resistance to antibiotics, it is essential to limit their use diagnosing streptococcal tonsillopharyngitis more precisely, thanks to an improved use of micro-biological diagnostic tests and by a more extended use of tonsillectomy in recurrent tonsillitis (more than 6-7 in 1-2 years). Adenoiditis is closely related to the post nasal drip syndrome, to recurrent otitis media and to otitis media with effusion. All these situations could, therefore, represent an indication, although not well defined, for adenoidectomy. Nasopharyngeal obstruction due to adeno-tonsillar hypertrophy becomes critical during sleep when the hypotony of the upper airway muscles becomes additional to the anatomical obstruction. At this point the inspiratory effort required and the consequent decrease of intra airway pressure increase the pharyngeal obstruction suctioning the pharyngeal walls toward the median line. The resulting clinical picture is defined as sleep-disordered breathing (SDB) due to adenotonsillar hypertrophy (idiopathic), to be distinguished from SDB due to cranio-facial abnormalities or neuromuscular diseases. SDB includes both the more serious sleep apnea syndrome and the less severe upper airway respiratory resistance syndrome. A combination of symptoms and clinical data detectable both while awake or asleep, make the diagnosis simple. During sleep, both apnea and paradoxical inspiratory movements are highly specific while snoring is highly sensitive. To evaluate nasopharyngeal obstruction radiography and optic fibre endoscopy are both equally reliable. The gold standard test for non idiopathic SDB is the polysomnography, whereas for SDB, due to adenotonsillar hypertrophy, one is limited today to the recording during sleep of O2 saturation or of end tidal CO2. These investigations are, however, generally used up to 2 years of age, when the decision to carry out an adenoidectomy and especially a tonsillectomy is more difficult because of the greater risks which surgery involves at this age. The pharmacological therapy has a purely palliative function and is based on antibiotics, local vasoconstrictors, steroids and theophylline which acts more as an antiflogistic than as a breath stimulant. O2 therapy and nasal continuous positive airway pressure (CPAP) give better results, but are more difficult to carry out, in particular on a long term basis. Adenoidectomy especially if associated with tonsillectomy, leads to the resolution of the symptoms, but not always to a normalization of functional alterations (hypoxia and hypercapnia). For this reason, it is necessary to act on other factors which cause oedema of the nasopharyngeal mucosa contributing to the obstruction. In this area, the prevention of viral infections can be achieved by vaccination against influenza and by preventing the child from attending crowded day care centers. With regard to allergic inflammation, skin prick tests could be a first step in view of allergens avoidance measures. With regard to indoor air pollution, passive smoke must be stopped and the child kept out of the kitchen.
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PMID:[The tonsils and adenoids as a site of infection and the cause of obstruction]. 986 45

Tonsillar microbial flora was studied in cultures of tonsillar core specimens from 34 patients tonsillectomized due to recurrent group A streptococcal pharyngotonsillitis (n = 17) or sleep apnoea (n = 17). Patients in the sleep apnoea subgroup, who had no history of recurrent tonsillitis and manifested no tonsillar hypertrophy at ENT examination, served as controls. Tonsillar core specimens were cultured for semi-quantitative estimation of growth of aerobic, anaerobic and facultative organisms. The recurrent tonsillitis and apnoea subgroups did not differ significantly in the mean number of isolates per patient, either of aerobic spp. (3.8 vs. 4.3) or anaerobic spp. (5.2 vs. 4.7). Nor did the two subgroups differ significantly in the proportion of patients whose specimens manifested beta-lactamase producers (71% vs. 59%), in the isolation frequency of viridans (alpha) streptococci, or in the occurrence of semi-quantitative growth estimates of 3-4+ for aerobic, anaerobic or beta-lactamase-producing spp. Thus, the study provided no support for the hypothesis that inactivation of penicillin V by beta-lactamase-producing bacteria in oral or throat flora, or the eradication of viridans streptococci with their GAS-inhibitory capacity, is an important factor with regard to recurrent group A streptococcal tonsillitis. Other possible explanations, such as poor antibiotic penetration at the site of infection, are discussed.
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PMID:Tonsillar microbial flora: comparison of recurrent tonsillitis and normal tonsils. 1021 95

Tonsillectomy, in 90% of cases combined with adenoidectomy, is one of the most frequently carried out operations on children in the Netherlands: in 1998 there were 33,471 operations in children aged 0-14 years. This high frequency is in stark contrast to the scientific basis for the efficacy of this intervention. A meta-analysis carried out recently revealed just one good study. The lack of scientifically based clinical guidelines, partly explains the large international and regional differences in the number of operations carried out. In the Netherlands only 35% of the children operated on satisfy one of the criteria for which the effectiveness of (adeno)tonsillectomy has been established: frequent recurrent tonsillitis or obstructive sleep apnoea. A project has been started in the Netherlands to further study the effectiveness of this intervention, the results of which must contribute to a more thoroughly substantiated indication.
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PMID:[Adenotonsillectomy in children: not yet scientifically validated]. 1180 40

Tonsillectomy (TE) is one of the most frequent as well as one of the most controversial surgical interventions. The objective of this paper was to assess the evidence of the most common indications for TE. For this purpose the literature of the past 25 years was analysed using the criteria of evidence based medicine. In children seventy-five percent of TEs are performed because of recurrent tonsillitis. Several randomised clinical trials (RCTs) have demonstrated the efficacy of TE in this disease. This indication is based on evidence grade I-II. No consensus has yet been reached, however, about the number of annual episodes that justify TE. The remaining paediatric TEs are performed to relieve symptoms of airway obstruction. TE has been shown to improve obstructive symptoms in up to 100% of patients. It is the accepted treatment of paediatric obstructive sleep apnoea, although the evidence is not based on major RCTs. In adults, too, the majority of TEs are performed for recurrent or chronic tonsillitis. There are no good RCTs, but the indication can be based on a series of well controlled studies (evidence grade III). Obviously, TE is indicated if there is suspicion of neoplasm. Peritonsillar abscess per se is no indication for TE, unless the abscess cannot be drained otherwise. TE plays no role in the standard management of OSAS and mononucleosis.
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PMID:[Evidence based indications for tonsillectomy]. 1519 18

This prospective study was designed to identify important clinical features in patients with recurrent acute tonsillitis. A total of 195 consecutive children aged from 1 to 16 years were examined and a history of recurrent acute tonsillitis recorded. Patients with obstructive sleep apnoea or recent acute tonsillitis were excluded. Tonsil size was measured on the Brodsky scale [Brodsky L. (1989) Paediatr Clin N Am 36, 1551], tonsil symmetry, cervical lymphadenopathy, and hyperaemia of the anterior pillars was recorded. Patients with a history of recurrent tonsillitis had larger tonsils than those without tonsillitis (P < 0.001). Tonsil asymmetry and cervical lymphadenopathy were more common in patients with recurrent tonsillitis (P < 0.001). Anterior pillar hyperaemia was also more frequent in recurrent tonsillitis (P < 0.01). In addition to the frequency and severity of tonsillitis it is suggested that the size and symmetry of the tonsils, plus cervical lymphadenopathy and anterior pillar hyperaemia should be taken into account when deciding which patients would benefit from tonsillectomy.
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PMID:Tonsillar size is an important indicator of recurrent acute tonsillitis. 1583 86

We conducted a feasibility study to examine whether a paediatric patient at a regional hospital could be assessed by an ear, nose and throat (ENT) specialist via videoconference, therefore saving at least one journey to the tertiary hospital for a pre-admission appointment. A video-otoscope was used with standard videoconference equipment, and realtime images were transmitted at a bandwidth of 384 kbit/s. In all, 13 telepaediatric ENT clinics were conducted between November 2003 and April 2005, and 98 consultations were facilitated for 64 patients. The main reasons for referral were recurrent tonsillitis (25%) and obstructive sleep apnoea (23%). Of the 64 patients examined by telemedicine, 42 (66%) were recommended for surgery and placed on the surgical waiting list. About 12 patients (19%) required travel to the tertiary centre for further investigations and tests not available locally, while four patients (6%) were reviewed via videoconference during a scheduled clinic. Six patients (9%) required no further follow-up after their initial telepaediatric consultation. Videoconferencing is an effective method of assessing ENT conditions of paediatric patients and for pre-screening potential surgical admissions to a tertiary hospital. Careful consideration of a number of economic and logistical factors needs to be made before large investments are made to expand the service.
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PMID:Realtime telemedicine for paediatric otolaryngology pre-admission screening. 1637 9

The study was carried out in the Department of Otorhinolaryngology NMCTH (n = 20, age 3-54yrs) who presented tonsil problems and underwent tonsillectomy over period of 1 year (2006-2007). Patients who underwent tonsillectomy were selected for study throughout preoperative and two months of postoperative period. Out of 20 patients (8 male andl2 female) 3 patients presented with sleep apnoea syndrome, 8 patients required hospitalization due to odynophagia and high fever and 9 of them suffered from recurrent tonsillitis. Post operative period was uneventful. The commonest presentation was recurrent sore throat and commonest organism isolated on throat swab culture (superficial) was S. aureus (26.0%). Sixty-nine percentage of culture was sterile, most probably because of prior antibiotics use. Only one out of twenty cultures showed a haemolytic streptococcus. According to previous studies carried out, organism obtained from superficial swab may be different from that of from core and there were some differences between children and adults. a haemolytic streptococci was the commonest organism (38.0%) isolated from surface.
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PMID:Patients with tonsil problems at NMCTH--a report. 1955 66


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