Adenoidal tissue mass as a clinical guide of disease evolution in vertically HIV-1 infected children

Pelkonen

Eur Arch Otorhinolaryngol

et al. 2011

The otorhinolaryngological (ORL) manifestations of Human Immunodeficiency virus (HIV) are common, but remain poorly characterized among children of Sub-Saharan Africa, where 90% of new pediatric infections occur. Our objective was to compare ORL findings and hearing in HIV-positive and -negative children of Luanda, Angola, using a comparative study of 78 outpatients from the HIV polyclinic and of 78 age- and sex-matched controls in a pediatric hospital with interview, general and ORL examination, brainstem auditory evoked potentials, and at age >5 years pure tone open-air audiometry. ORL pathology emerged in 92% of HIV-positive and 78% (p = 0.02) of control children. HIV-associated ORL findings comprised dental caries (56 vs. 32%; p = 0.0009), cervical lymphadenopathy >1 cm (45 vs. 10%; p < 0.0001), facial skin lesions (32 vs. 5.1%; p < 0.0001), chronic suppurative otitis media (26 vs. 3.8%; p = 0.0002), dry tympanic membrane perforations (9 vs. 1%; p = 0.03), tonsils of Mallampati score 0-1 (87 vs. 64%; p = 0.0009), and bilateral hearing loss of >25 dB (13 vs. 1%; p = 0.009). Other HIV-associated characteristics included ear pain (44 vs. 27%; p = 0.006), earlier otorrhea episodes (34 vs. 17%; p = 0.004), tuberculosis (29 vs. 2.6%; p < 0.0001), and pneumonia (22 vs. 2.6%; p = 0.0003). ORL pathology appeared usual in both HIV-positive and -negative children. However, the overall high frequency and severity of the findings among the HIV-positive children require regular inclusion of the ORL area in these children's clinical evaluation.

Section: Discussioncontrasting

confidence: 78%

Otorhinolaryngological findings and hearing in HIV-positive and HIV-negative children in a developing country

Pelkonen

Eur Arch Otorhinolaryngol

et al. 2011

Rev. Bras. Otorrinolaringol.

“…This is one of the determining factors in order to guarantee a good response to HIV-infection treatment. 37 The methodology employed by the present investigation is based on the assessment of nasopharynx obstruction by calculating the area, which seems to be more accurate and encompassing than a linear evaluation as the AN measure, used in the study by Benito et al (1999). 18 Differences in these two methods of assessment may impact the final results of the studies, and it may show statistically significant differences between the studies.…”

Section: Discussionmentioning

confidence: 96%

“…37 The methodology employed by the present investigation is based on the assessment of nasopharynx obstruction by calculating the area, which seems to be more accurate and encompassing than a linear evaluation as the AN measure, used in the study by Benito et al (1999). 18 Differences in these two methods of assessment may impact the final results of the studies, and it may show statistically significant differences between the studies. By using a linear measure, many things may happen: we may be facing a large pharyngeal tonsil and the nasopharyngeal space be large enough to accommodate it and, therefore, it may not negatively impact the patient's breathing; as well as a small tonsil in a large space; or, one may have a small tonsil, in a small nasopharynx, causing obstruction, however a large enough tonsil may also cause obstruction.…”

Section: Discussionmentioning

confidence: 96%

“…These observations indicate that the disease is active and progressive in lymphoid organs, while the infection is clinically latent for prolonged periods. 18,19 HIV-1-infected cells are found in the lympho-epithelium of pharyngeal tonsil invaginations. The lymphoid tissue in the nasopharynx contributes to the chronic replication of HIV-119, and the ThCD4+ lymphocytes and monocytes/macrophages play an important role in the interaction and spread of such infection.…”

Section: Introductionmentioning

confidence: 99%

“…Statistically significant differences in the AN ratio were found among the groups, showing that the radiographic alterations in pharyngeal tonsil size in HIV-infected children are of great diagnostic value and is important in treatment planning. 18 The high incidence of upper airway infections seen in HIV-infected children, especially recurrent chronic otitis media and suppurative otitis media, are included in the AIDS diagnostic criteria, which leads almost always to the clinical suspicion of upper airway obstruction. 16 Taking these aspects into account, the present investigation aimed at studying the association between breathing pattern and nasopharynx obstruction by the pharyngeal tonsil in HIV-infected children, comparing the behavior of these two variables with those from a group of children without prior history of HIV infection.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Estudo comparativo do padrão de respiração e a porcentagem de ocupação da nasofaringe pela tonsila faríngea em crianças com ou sem história de infecção pelo HIV

Zastrow¹,

Grando

Carvalho

et al. 2007

OBJETIVO: o objetivo deste estudo foi estudar a associação entre o padrão de respiração e o tamanho da tonsila faríngea em 122 crianças (60 infectadas pelo HIV e 62 sem infecção). MATERIAL E MÉTODO: As crianças foram analisadas quanto ao padrão de respiração, fluxo nasal e ocupação da tonsila faríngea em radiografias cefalométricas de perfil, através de uma análise computadorizada. RESULTADOS: O padrão de respiração de maior ocorrência nos dois grupos foi o tipo misto. A maioria das crianças apresentou tipo de respiração bucal ou mista, não havendo associação entre o tipo de respiração e presença do HIV (p=0,091). O fluxo nasal mostrou predomínio do fluxo médio nos dois grupos. As crianças sem história de infecção pelo HIV apresentaram fluxo nasal de médio a grande e a maioria das crianças infectadas pelo HIV apresentou de pouco a médio fluxo nasal de ar, havendo uma associação positiva entre o fluxo nasal e a infecção pelo HIV (p<0,0001). A porcentagem média de ocupação da tonsila faríngea foi alta nos dois grupos, não havendo diferença estatisticamente significante entre eles. As crianças dos dois grupos apresentaram aumento moderado ou acentuado do tamanho da tonsila faríngea, não havendo associação entre o tamanho da tonsila faríngea e presença do HIV (p=0,201).

European Annals of Otorhinolaryngology, Head and Neck Diseases

International consensus (ICON) on management of otitis media with effusion in children

Simon

Haggard

Rosenfeld

et al. 2018

108

Otitis media with effusion (OME) is a common childhood disease defined as the presence of liquid in the middle ear without signs or symptoms of acute ear infection. Children can be impacted mainly with hearing impairment and/or co-occurring recurrent acute otitis media (AOM) thus requiring treatment. Although many meta-analyses and national guidelines have been issued, management remains difficult to standardize, and use of surgical and medical treatments continue to vary. We convened an international consensus conference as part of the 2017 International Federation of Oto-rhino-laryngological Societies Congress, to identify best practices in OME management. Overall, regional differences were minor and consensual management was obtained on several important issues. At initial assessment, although a thorough medical examination is necessary to seek reflux, allergy or nasal obstruction symptoms; an age-appropriate auditory test is the only assessment required in children without abnormal history. Non-surgical treatments poorly address the underlying problem of an age-dependent dysfunctional Eustachian tube; auto-inflation seems to be the only beneficial, low-risk and low-cost non-surgical therapy. There was a clear international recommendation against using steroids, antibiotics, decongestants or antihistamines to treat OME, because of side-effects, cost issues and no convincing evidence of long-term effectiveness. Decisions to insert tympanostomy ventilation tubes should be based on an auditory test but also take into account the child's context and overall hearing difficulties. Tubes significantly improve hearing and reduce the number of recurrent AOM with effusion while in place. Adjuvant adenoidectomy should be considered in children over four years of age, and in those with significant nasal obstruction or infection.