Clinical symptoms that predict the presence of Obstructive Sleep Apnea

Publication date: April 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 95
Author(s): Kevin C. Lewis, James W. Schroeder, Bushra Ayub, Bharat Bhushan
ObjectiveTo determine if a set of clinical symptoms can help in determining the presence and severity of OSA.SettingTertiary urban pediatric hospital.MethodsParents of children undergoing an overnight PSG answered a 56 item questionnaire based on their child's symptoms. The responses to the questionnaire were compared between patients with different severities of OSA (s determined by PSG) and those without OSA. Responses to questionnaire were also analyzed between obese and non-obese patients.Results235 children were included (140 male and 95 female) with a mean age of 5.76 ± 2.78 years. The mean Apnea Hypopnea Index (AHI) was 7.78 ± 14.50 events/hour (range 0–110 events/h). 74 (31.5%) children had mild-OSA (AHI between 1 and 4.99 events/h), 31 (13.19%) had moderate-OSA (AHI between 5 and 9.99 events/h), 58 (24.7%) had severe-OSA (AHI≥10events/h) and the remaining 72 (30.64%) had No-OSA (AHI≤1event/h). 87 (37%) patients were obese. Eight clinical symptoms in non-obese and six clinical symptoms in obese patients predicted the mild to severe OSA. Sixteen symptoms in non-obese patients and nine symptoms in obese patients predicted the presence of severe OSA in these patients.ConclusionClinical symptoms reported in this study are useful to predict the presence of and the severity of OSA in children. Clinical symptoms can also predict the presence and severity of OSA in children who are obese, however, the symptoms required to make the prediction are different in obese children.



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The effect of caffeic acid phenethyl ester (CAPE) on tympanosclerosis

Publication date: April 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 95
Author(s): İbrahim Ağrı, Arzu Erdal Ağrı, Mehmet Eser Sancaktar, Asude Ünal, Erkan Can, Mustafa Bakırtaş, Fatih Yılmaz, Mehmet Derya Demirağ, Recep Ünal
ObjectiveTo investigate the effects of caffeic acid phenethyl ester (CAPE) on tympanosclerosis.Materials and methodsThirty-two male Sprague Dawley rats were separated into 4 groups as CAPE (n = 10), alcohol (n = 10), control (n = 8) and normal (n = 4) groups. All tympanic membranes except normal group were myringotomised and type 3 Streptococcus pneumoniae strains was injected into their middle ears. Myringotomies were repeated for 5 weeks. Intraperitoneal (i.p) CAPE were administrated to the CAPE group at 10 μmol/kg/day and 10% ethyl alcohol administrated to the alcohol group for 5 weeks. The control group were left untreated. Findings of myringosclerosis were recorded by otomicroscope at sixth week. Then, all rats were sacrificed and tympanic membrane thickness and severity of middle ear mucosal inflammation evaluated histopathalogically.ResultsSeverity of myringosclerosis was significantly higher in the alcohol and control groups compared to the CAPE group (p < 0.001), but was not significant when alcohol and control groups were compared (p = 0.17). The tympanic membrane thickness measured in the alcohol and control groups were significantly higher compared to the CAPE group (p < 0.001), but was not significant when alcohol and control groups were compared (p = 0.17). The severity of inflammation in the middle ear mucosa was significantly higher in the alcohol and control groups compared to the CAPE group (respectively, p < 0.001, p = 0.03). The severity of inflammation in the middle ear mucosa was not significant between alcohol and control groups (p = 0.30).ConclusionCAPE has anti-inflammatory and antioxidant effects on the development of MS in myringotomized rats, so reduces the severity of tympanosclerosis.



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PD-L1 expression and CD8+ infiltration shows heterogeneity in juvenile recurrent respiratory papillomatosis

Publication date: April 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 95
Author(s): Tingyu Liu, Max Greenberg, Carissa Wentland, Brandon Sepe, Sarah Bowe, Gillian Diercks, Tiffany Huynh, Mari Mino-Kenudson, Richard Schlegel, David Kodack, Cyril Benes, Jeffrey Engelman, Christopher Hartnick
IntroductionTumor immunotherapy have broadened therapeutic options for tumor treatment. The role of immune function in juvenile recurrent respiratory papillomatosis (JRRP) has not been investigated. Applying immunoblockade inhibitors as a novel disease treatment is unclear. Our study, for the first time, evaluates immune infiltration and immuno-suppressive molecule expression in JRRP. Our study provides insights in possibly treating this disease with tumor immunotherapies. We aimed to determine expression of programmed death-ligand 1 (PD-L1), a cancer escape protein, and presence of CD8+ T cell infiltration in tumor microenvironment.Material and methodsSeven patients with JRRP (mean age: 7.43; age range 3–17) in this study routinely have their tumors surgical debulked at Massachusetts Eye and Ear Infirmary. Following surgery, samples were de-identified and sent to pathology where they were stained and analyzed.ResultsSix out of seven patients expressed PD-L1 on tumor cells to various extents. Three patients showed concurrent PD-L1 expression on tumor cells and abundant CD8+ tumor infiltrating lymphocytes as well as PD-L1+ stromal lymphocytes, while PD-L1 expression on tumor cells were not associated with CD8+ tumor infiltrating T cells nor PD-L1+ stromal lymphocytes in the other three patients. HPV 6/11 and p16 was detected in all the patients. There appeared to be no correlation between either PD-L1 expression and CD8+ infiltration and clinical severity as measured by both the number of surgeries per year or Derkay score.ConclusionsDespite a small cohort, the expression of p16 and HPV 6/11 in all of the patients confirms the tissues were HPV tumor cells. PD-L1 expression was detected in the vast majority of tumor samples, while inflammatory cell compartments showed a higher degree of variation. Expression of PD-L1 on tumor cells but not inflammatory cells raises the possibility of a tumor cell intrinsic manner of PD-L1 expression. In contrast, a group of patients showed PD-L1 positivity in both tumor and inflammatory cells along with abundant CD8+ tumor infiltrating lymphocytes, suggesting adoptive immune resistance in these tumors and potential benefits from tumor immunotherapy.



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The relationship of serum vitamins A, D, E and LL-37 levels with allergic status, tonsillar virus detection and immune response

by Varpu Elenius, Oscar Palomares, Matti Waris, Riitta Turunen, Tuomo Puhakka, Beate Rückert, Tytti Vuorinen, Tobias Allander, Tero Vahlberg, Mübeccel Akdis, Carlos A. Camargo Jr, Cezmi A. Akdis, Tuomas Jartti

Background

Tonsils have an active role in immune defence and inducing and maintaining tolerance to allergens. Vitamins A, D, and E, and antimicrobial peptide LL-37 may have immunomodulatory effects. We studied how their serum levels were associated with allergy status, intratonsillar/nasopharyngeal virus detection and intratonsillar expression of T cell- and innate immune response-specific cytokines, transcription factors and type I/II/III interferons in patients undergoing tonsillectomy.

Methods

110 elective tonsillectomy patients participated. Serum levels of vitamins A, 25(OH)D, and E, LL-37 and allergen-specific IgE as well as nasopharyngeal/intratonsillar respiratory viruses were analyzed. The mRNA expression of IFN-α, IFN-β, IFN-γ, IL-10, IL-13, IL-17, IL-28, IL-29, IL-37, TGF-β, FOXP3, GATA3, RORC2 and Tbet in tonsils were analyzed by quantitative RT-PCR.

Results

The median age of the patients was 16 years (range 3–60), 28% of subjects had atopy, and 57% carried ≥1 respiratory virus in nasopharynx. Detection of viruses decreased by age. Higher vitamin A levels showed borderline significance with less viral detection (P = 0.056). Higher 25(OH)D was associated with less allergic rhinitis and atopy (P P P P Conclusions

Vitamin D and E levels were associated with less allergic disorders. Vitamin A was linked to antiviral and vitamin D with anti-inflammatory activity. LL-37 and was linked to T regulatory cell effects.

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The relationship of serum vitamins A, D, E and LL-37 levels with allergic status, tonsillar virus detection and immune response

by Varpu Elenius, Oscar Palomares, Matti Waris, Riitta Turunen, Tuomo Puhakka, Beate Rückert, Tytti Vuorinen, Tobias Allander, Tero Vahlberg, Mübeccel Akdis, Carlos A. Camargo Jr, Cezmi A. Akdis, Tuomas Jartti

Background

Tonsils have an active role in immune defence and inducing and maintaining tolerance to allergens. Vitamins A, D, and E, and antimicrobial peptide LL-37 may have immunomodulatory effects. We studied how their serum levels were associated with allergy status, intratonsillar/nasopharyngeal virus detection and intratonsillar expression of T cell- and innate immune response-specific cytokines, transcription factors and type I/II/III interferons in patients undergoing tonsillectomy.

Methods

110 elective tonsillectomy patients participated. Serum levels of vitamins A, 25(OH)D, and E, LL-37 and allergen-specific IgE as well as nasopharyngeal/intratonsillar respiratory viruses were analyzed. The mRNA expression of IFN-α, IFN-β, IFN-γ, IL-10, IL-13, IL-17, IL-28, IL-29, IL-37, TGF-β, FOXP3, GATA3, RORC2 and Tbet in tonsils were analyzed by quantitative RT-PCR.

Results

The median age of the patients was 16 years (range 3–60), 28% of subjects had atopy, and 57% carried ≥1 respiratory virus in nasopharynx. Detection of viruses decreased by age. Higher vitamin A levels showed borderline significance with less viral detection (P = 0.056). Higher 25(OH)D was associated with less allergic rhinitis and atopy (P P P P Conclusions

Vitamin D and E levels were associated with less allergic disorders. Vitamin A was linked to antiviral and vitamin D with anti-inflammatory activity. LL-37 and was linked to T regulatory cell effects.

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Pregabalin treatment in a pregnant woman with glossopharyngeal neuralgia

Publication date: Available online 24 February 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Azis Arruda Chagury, Karina Ribeiro Cavalcante Tavares, Raquel Marcon Camargo, Daniela Vieira Martins, Letícia Helena de Sousa Marques, Ali Mahmoud




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Rapid maxillary expansion in mouth breathers: a short-term skeletal and soft-tissue effect on the nose

Publication date: Available online 24 February 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Fauze Ramez Badreddine, Reginaldo R. Fujita, Fabio Eduardo Maiello Monteiro Alves, Mario Cappellette
IntroductionRapid maxillary expansion (RME) can change the form and function of the nose. The skeletal and soft tissue changes can influence the esthetics and the stability of the results obtained by the RME.ObjectiveThe aim of this retrospective study was to evaluate the short-term effects of RME on the skeletal and soft tissue structures of the nose, in mouth-breathing patients, using a reliable and reproducible, but simple methodology, with the aid of computed tomography.MethodsA total of 55 mouth-breathing patients with maxillary hypoplasia were assessed and were divided into an Experimental Group (EG) treated with RME (39 patients, 23 of which were male and 16 female, with an average age of 9.7 years and a standard deviation of 2.28, ranging from 6.5 to 14.7 years) and a Control Group (CG) (16 patients, 9 of which were male and 7 female, with an average age of 8.8 years, standard deviation of 2.17, ranging from 5.11 to 13.7 years). The patients of the EG were submitted to multislice computed tomography examinations (CT) at two different points in time: (T1) pre-RME and (T2) three months after the RME. The CG underwent to the same exams at the same intervals of time. Four skeletal and soft tissue variables were assessed, comparing the results of T1 and T2.ResultsThere was in the EG a significant increases in all the skeletal and soft tissue variables (p<0.05) but no significant alteration was found in the CG. When comparing the EG and the CG, the most important change occurred in the width of the pyriform aperture (p<0.001).ConclusionRME is capable of altering the shape and function of the nose, promoting alterations in skeletal and soft tissue structures. This kind of study may, in the future, permit the proper planning of esthetic procedures at the tip and base of the nose and also the performance of objective measurements in early or late surgical outcomes.



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