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Objective: Pediatric sleep disordered breathing (SDB) is a common childhood disease with a potential risk of several comorbidities. The most common cause of SDB in childhood is upper airway obstruction due to adenotonsillar hypertrophy and the classical treatment is adenotonsillectomy. However, it carries a risk of many complications and persistent apnea. Topical nasal steroid treatment may be an alternative to surgery in the treatment of pediatric SDB. However, histopathological effects of topical nasal steroids are mostly understudied. Methods: A retrospective controlled clinical study in an academic tertiary referral center. A total of 110 children were involved in the study who underwent adenoidectomy for the treatment of SDB. The study group (51-children) was treated with topical nasal mometasone furoate monohydrate 100 mcg/day. The control group (59-children) was selected randomly and all had no history of topical nasal steroid pre-operatively. Post-operative adenoidectomy specimens were reviewed according to acute/chronic inflammation findings, follicular hyperplasia, goblet cell hyperplasia, squamous metaplasia, fibrosis, atrophy, ulcer and hemorrhage. The findings were scored semiquantitatively for statistical analysis. Results: Chronic inflammation findings, follicular hyperplasia and goblet cell hyperplasia were significantly decreased in the study group in addition fibrosis, atrophy and ulcer findings were significantly increased in the study group. However, there was no statistical difference between the groups according to acute inflammation and hemorrhage. Conclusions: Topical nasal corticosteroids significantly suppress the nasopharyngeal inflammatory process in SDB. This treatment may be an alternative to surgery at least in patients with mild and moderate disease.

Objectives. We aimed to investigate iron metabolism and laboratory findings of anemia in children undergoing adenotonsillectomy for sleep disordered breathing. Methods. Consecutive children undergoing adenoidectomy/adenotonsillectomy for sleep disordered breathing between January 2013 and January 2015 were investigated. Routine preoperative blood tests including blood count and iron studies were analyzed. Subgroup analyses were performed addressing to the severity of sleep disordered breathing, age and duration of symptoms. Results were compared between subgroups and normal values. Results. The study included 171 children. The mean age was 5.44 ± 2.62 years. The mean hemoglobin level was 11.87 ± 1.125 gr/dL and 24 (14%) out of 171 patients had anemia (< 11 gr/dL). The mean ferritin levels were 23.23 ± 17.27 µg/L and 21.27 ± 15.44 µg/L in patients with anemia and non-anemic patients, respectively (p = 0.572). Ferritin levels decreased in only 8 (33%) out of 24 patients with anemia. The mean age, body mass index, hematocrit, mean corpuscular volume, unsaturated iron binding capacity and serum iron levels decreased in patients with anemia. The rate of anemia significantly increased in children less than or equal to 3 years of age (p = 0.020). There was no significant association between hemoglobin levels and sleep disordered breathing clinical score or duration of symptoms. Conclusion. The association between low iron status and sleep disordered breathing has previously published. Unfortunately, the type of anemia is still unclear. Our results supposed that the anemia of chronic disease secondary to chronic inflammatory process might play a role in pathogenesis of anemia in patients with sleep disordered breathing.

Aim: Tonsillectomy is one of the most common surgical procedures in the pediatric population, as well as one of the first operations learned during otolaryngology residency. This study aims to evaluate the effect of surgical technique on the occurrence of posttonsillectomy hemorrhage. Material and Methods: This prospectively-designed clinical trial was conducted in a tertiary referral center between May 2012 and April 2015. A total of 608 patients had tonsillectomies performed by a single surgeon with three different surgical techniques used during the study period. Patients in group one were operated on using cold dissection; group two comprised patients who underwent bipolar cautery; group three had the posterior pillar mucosal suturing technique performed. Results: 608 patients met inclusion criteria; 165 of them in group one, 274 in group two, and 169 in group three. The median age was 5 (2-14) years old. A total of five patients (0.82%) experienced post-operative bleeding. One of these patients (from group one) experienced primary hemorrhage. The four others were considered secondary hemorrhage; two from each the bipolar cautery and posterior pillar mucosal suturing groups. The rates of post-operative hemorrhage in each group were 0.61%, 0.73% and 1.18%, respectively (p=0.861). Only one of the five patients necessitated a return to the operating room to control the bleeding. Conclusion: Our study findings suggest that the choice of surgical technique does not affect the post-tonsillectomy bleeding rate. There were no significant differences in bleeding rates between subgroups.