International Journal of Pediatric Otorhinolaryngology
Doppler echocardiography in adenotonsillar hypertrophy
Introduction
Adenotonsillar hypertrophy and upper airway obstruction takes the first order among the adenotonsillectomy indications [1]. Complications are, cardiovasculary system deterioration, sleep apnea syndrome and growth retardation [2].
Obstructive adenotonsillar hypertrophy is most easily diagnosed by the history and physical examination. Otolaryngologists and pediatricians must know that obvious anamnesis of upper airway obstruction is sufficient to indicate surgical intervention [3]. The relief of upper airway obstruction before causing any complication is important. When the clinical picture remains unclear, patients should be further evaluated by other laboratory methods to clarify surgical indication and to establish possible risk factors prior to surgery. Complications of adenotonsillar hypertrophy, especially cardiovasculary ones, can be easily recognized using supplemental diagnostic modalities [4].
In this study, the children who were affected by upper respiratory obstruction symptoms due to adenotonsillar hypertrophy were evaluated by clinical and laboratory investigations. The standard objective criterion for surgical intervention in children with hypertrophied adenoid and tonsils is polysomnography. This study aimed to clarify the diagnostic methods of this complication, to find another objective criterion for the surgical intervention and to demonstrate the curative effect of adenotonsillectomy on this complication using this objective criterion.
Section snippets
Materials and methods
This study has been performed on 17 children (11 male and 6 female). Children with the complaints of upper airway obstruction and diagnosed as having adenotonsillar hypertrophy by routine ENT examination were enrolled as candidates for this study. They were investigated for any cardiovasculary changes. Following routine cardiovasculary examination, they were also examined using 2-D Coloured Doppler Echocardiography, ‘Vingmed CFM 700’ which is able to produce both pulsed and continuous waves.
Results
The mean age of the children was 41 months (20–96 months). Six of them were females (35%) whereas 11 of them were males (65%). All of them had increased pulmonary arterial hypertension diagnosed by Doppler echocardiography preoperatively. Some of them also had additional echocardiographic pathologies, such as, first degree tricuspid valve insufficiency, moderate enlargement of right ventricle, pulmonary valve insufficiency, decreased ejection fraction of right ventricle and dilatation of
Discussion
Upper airway obstruction due to adenotonsillar hypertrophy is a common disorder during childhood. The recurrent infection is a major indication of adenotonsillectomy, but currently obstruction takes the first order among adenotonsillectomy indications. In a retrospective research of Rosenfeld [1], adenotonsillectomy due to adenotonsillar hypertrophy was 0% in 1978 and 19% in 1986. Achena [5] in 1991 reported this proportion as 35.9%. This author explained that this ratio increased by the
Conclusion
Cardiovasculary disturbances due to adenotonsillar hypertrophy may be reversible by adenotonsillectomy. Doppler echocardiography seems useful and practical for detecting the early signs of cardiovascular complications.
References (18)
- et al.
Cor pulmonale secondary to tonsillar and adenoidal hypertrophy: management considerations
Int. J. Pediatr. Otorhinolaryngol.
(1988) - et al.
Habitual snoring and obstructive sleep apnea syndrome in children: effects of early tonsil surgery
Int. J. Pediatr. Otorhinolaryngol.
(1993) - et al.
Cor pulmonale due to adenoidal or tonsillar hypertrophy in children. Noninvasive diagnosis and follow-up
Chest
(1988) - et al.
Hypoxic pulmonary vasoconstriction
Gen. Pharmacol.
(1999) - et al.
Noninvasive estimation of systolic pulmonary artery pressure using Doppler echocardiography in patients with chronic obstructive pulmonary disease
Chest
(1989) - et al.
Tonsillectomy and adenoidectomy: changing trends
Ann. Otol. Rhinol. Laryngol.
(1990) - et al.
Tonsillar hyperplasia in children. A cause of obstructive sleep apneas, CO2 retention and retarded growth
Arch. Otolaryngol.
(1982) - et al.
Evaluation of tonsils and adenoids in sleep apnea syndrome
Laryngoscope
(1980) - et al.
Tonsillectomy in childhood: personal considerations
Acta Otorhinolaryngol. Ital.
(1991)
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