DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20201274

Correlation between clinical grading of adenoid or tonsil hypertrophy and adenoid or tonsil volume post adenotonsillectomy: a prospective cohort study

Daniel D. Kokong, Adeyi A. Adoga, Ishaku Turaki, Nuhu D. Maan, John P. Yaro, Emmanuel Innocent

Abstract


Background: Measuring adenoid or tonsil volume in surgically removed specimens is likely the most accurate method for quantifying adenotonsillar hypertrophy severity which may predict the extent of surgery to curtail post tonsillectomy haemorrhage a potential lethal complication.

Methods: All patients with adenoid or tonsil hypertrophy were graded clinically while the objective grading by volumetric saline displacement in accordance with Archimedes’ principle; between August 1, 2017 to July 31, 2019 at the Jos University Teaching Hospital, Plateau State, Nigeria. Data analysis was by the SPSS version 21.0 Chicago IL, USA.  

Results: The study had 96 participants with a M:F=1.7:1. Age range was 9 months to 51 years, median was 3 yrs, mean was 9.5 yrs±15.5 yrs with 83 (86.5%) who were ≤18 yrs. Main features of this study, no. of patients in snoring was 83 (86.5%), nasal obstruction 71 (74.0%), rhinorrhoea 32 (33.3%), noisy breathing 23 (24.0%), dysphagia- 18 (18.8%), mouth breathing 18 (18.8%). Grading of this study was 78 (81.2%) were Brodsky grade III & IV while 72 (75.0%) had ANR of ≥0.5. Blood loss was range 10 ml to 250 ml, median 35 ml, mean 52.7±46.9 ml while 51 (63.0%) had blood loss of ≤50 ml. Volume of surgical specimen of adenoid; range 0.20-4.50 ml, mean 1.56±0.83 ml while tonsil; (Rt)-range 1.00-12.50 ml, mean 3.18±1.97 ml. There was a positive correlation between adenoid or tonsil grade and volume at 99% CI; (r)=0.409, (p=0.000) and grade (mean) 3.11±0.78, volume (mean) 3.18±1.96.

Conclusions: This study establishes a positive correlation between clinical grading of adenoid or tonsil and volume with a certain level of accuracy which may predict extent of surgery to avoid post tonsillectomy hemorrhage, a life-threatening/lethal complication from excessive, partial or suboptimal surgery commonly.


Keywords


Adenoid or tonsil, Grading or volume, Correlation, Surgical, Accuracy

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References


Ackay A, Kara CO, Dagdeviren E, Zencir M. Variation of tonsil size in 4- to 17-year-old schoolchildren. J Oto Laryngol. 2006;35:270-4.

Barr GS, Crombie IK. Comparison of size of tonsils in children with recurrent tonsillitis and in controls. Br Med J. 1989;298:804.

Li AM, Au CT, Sung RY, Ho C, Ng PC, Fok TF, et al. Ambulatory blood pressure in children with obstructive sleep apnoea: a Community based study. Thorax. 2008;63:803-9.

Gozal D, Kheirandish-Gozal L. Neurocognitive and behavioral morbidity in children with sleep disorders. Curr Opin Pulm Med. 2007;13:505-9.

Kang KT, Lee PL, Weng WC, Hsu WC. Body weight status and obstructive sleep apnea in children.Int J Obes (Lond). 2012;36:920-4.

Shine NP, Coates HL, Lannigan FJ. Obstructive sleep apnea, morbid obesity, and adenotonsillar surgery: a review of the literature. Int J Pediatr Otorhinolaryngol. 2005;69:1475-82.

Friedman M, Wilson M, Lin HC, Chang HW. Updated systematic review of tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg. 2009;140:800-8.

Brietzke SE and Gallagher D. The Effectiveness of tonsillectomy and adenoidectomy in the treatment of Paediatric obstructive sleep apnoea/hypopnea syndrome: A Meta-Analysis. Otolaryngol Head Neck Surg. 2006;134:979-84.

Patel NA, Carlin K, Bernstein JM. Paediatric Airway study: Endoscopic grading system for quantifying tonsillar size in comparison to standard Adenotonsillar grading systems. Am J Otolaryngol Head Neck Med Surg. 2018;39(1):56-64

Brodsky L. Modern assessment of tonsils and adenoids. Pediatr Clin North Am. 1989;36(6):1551-69.

Fujioka M, Young L, Gridang B. Radiographic evaluation of Adenoid size in children:Adenoidal-Nasopharyngeal ratio. Am J Radiol. 1979;133:401-4.

Warwick R, Williams PL. Gray’s anatomy. Philadelphia: W. B. Saunders, Company; 1973: 1471.

Yasan H, Aynali G, Erdogan O, Yariktas M. Does subjective tonsillar grading reflect the real volume of palatine tonsils? Int J Pediatr Otorhinolaryngol. 2011;75(5):618-9.

Sahin M, Bilgen C, Tasbakan MS, Midilli R, and Basoglu OK. A Clinical Prediction Formula for Apnea-Hypopnea Index. Int J Otolaryngol. 2014;438376:5.

Tang A, Benke JR, Cohen AP, Ishman SL, Influence of Tonsillar Size on OSA Improvement in Children Undergoing Adenotonsillectomy. Otolaryngol Head Neck Surg (United States). 2015;153(2):281-5.

Jara SM, Weaver EM. Association of palatine tonsil size and obstructive sleep apnea in adults. The Laryngoscope. 2018;128(4):1002-6.

Cahali BM, de Paula Soares CF, da Silva Dantas DA, Formigoni GGS. Tonsil Volume, Tonsil grade and Obstructive Sleep apnoea:Is there any meaningful correlation?. Clinics. 2011;66(8):1347-51.

Windfuhr JP, Schloendorff G, Sesterhenn AM, Prescher A, Kremer B. A devastating outcome after adenoidectomy and tonsillectomy:Ideas for improved prevention and Management. Otolaryngol Head Neck Surg. 2009;140(2):191-6.

American Academy of Otolaryngology-Head and Neck Surgery: Clinical indicators compendium, Alexandria, Virginia, American Academy of Otolaryngol Head Neck Surg; 1995.

Cassano P, Gelardi M, Cassano M, Fiorella ML, Fiorella R. Adenoid tissue Rhinopharyngeal obstruction grading based on Fiberendoscopic findings:A Novel approach to therapeutic Management. Int J Ped Otorhinolaryngol 2003;67(12):1303-9.

Anan V, Sarin V and Singh B. Changing Trends in Adenoidectomy. Indian J Otolaryngol Head Neck Surg. 2014;66(4):375-80.

Lu X, Zhang J and Xiao S. Correlation between Brodsky Tonsil grade and Tonsil volume in Adult Patients. Biomed Res Int. 2018;2018:6434872.

Wong HT, Hui TS, and Chong AW. Is Day Care Tonsillectomy safe? Iran J Otorhinolaryngol 2016;28(86):183-8.

Bluestone CD. Status of Tonsillectomy and Adenoidectomy. Laryngoscope. 1977;87(8):1233-43.

Ranjit S, Brett RH, Lu PK, Aw CY. The Incidence and Management of PTH:A Singaporean Experience. Singapore Med J. 1999;40(10):622-6.

Ozturk M, Kilinc T. Ultrasonographic measurement of palatine tonsil volume in children and comparison with actual volume. Med Sci. 2017;6(4):685-8.

Francis DO, Fonnesbeck C, Sathe L, McPheeters M, Krishnaswami S, Chinnandurai S. Post-operative bleeding and Associated Utilization following Tonsillectomy in children: A Systemic Review and Meta-Analysis. Otolaryngol Head Neck Surg. 2017;156(3):442-55.

De Luca Canto G, Pacheco Pareira C, Aydinaz S. Adenotonsillectomy complications:A Meta-Analysis. Paediatrics. 2015;136(4):702-18.

Kaditis AG, Lianou L, Hatzinikolaou S, Kalampouka E, Gartagani-Panayiotopoulou P. Tonsillar size in 2- to 14-year-old children with and without snoring. Pediatr Pulmonol. 2009;44:1216-22.

Kang KT, Chou CH, Weng WC, Lee PL, Hsu WC. Association between Adenotonsillar hypertrophy, Age and Obesity in Children with Obstructive Sleep Apnoea. PloS One. 2013;8(10):e78666.

Venkatesha BK, Yogeesha BS, Asha M. Clinical grading of tonsils:does it truly represent total tonsil volume in patients with Recurrent Tonsillitis. Int J Otorhinolaryngol Head Neck Surg. 2017;3(2):354-8.

Prim MP, De Diego JI, Garcia-Bermudez C, Perez-Fernandez E, Hardisson D. A Method to calculate the volume of palatine tonsils. The Anatomical Record. 2010;293:2144-6.

Sagiroglu A, Acer N, Okuducu H et al. Palatine tonsil estimation using different methods after tonsillectomy. Anatomical Sci Int. 2017;92(4):500-8.

Mazlumoglu MR. Hemorrhage after Tonsillectomy in Paediatric patients Living in Rural regions. J Otolaryngol ENT Res. 2017;9(3):00288.

Milosevic DN. Intensity of hemorrhage post tonsillectomy. Vojnosanit Pregl. 2012;69(6)500-3.

Senska G, Schroder H, Putter C and Dost P. Significantly reducing post tonsillectomy haemorrhage requiring suturing the faucial pillars: A Retrospective Analysis. PLoS One. 2012;7(10):e47874.

Ribeiro da Silva BS, Garcia LB, dos Reis Ortiz L, Monteiro LCS, Maeda NA. Hemorrhage in Adenoidectomy and/or Tonsillectomy Immediate postoperative. Intl Arch Otorhinolaryngol Sao Paulo. 2009;13(2):155-160

Sharma K and Kumar D. Ligation Vs Bipolar Diathermy for hemostasis in Tonsillectomy: A Comparative Study. Indian J Otolaryngol Head Neck Surg. 2011;63(1):15-9.

Windfuhr JP. Malpractice claims and unintentional outcome of tonsil surgery and other standard procedures in Oto-laryngology. GMS Current Topics Otorhinolaryngol-Head Neck Surg. 2013;12:DOC08.

Datta Lt Col R, Singh Col VP. Deshpal Col. Conventional versus Endoscopic powered adenoidectomy: a Comparative Study. MJAFI. 2009;65:308-12.

Bitar M, Dunya G, Khalifee E, Muwakkif S, Barazi R. Risk of post-operative hemorrhage after adenoidectomy and Tonsillectomy:value of the pre-operative determination of Partial Thromboplastin Time and Prothrombin Time. Int J Paediatr Otolaryngol. 2019;116(2019):62-4.

Onakoya PA, Nwaorgu OGB, Abja UM and Kokong DD. Adenoidectomy and Tonsillectomy; Is Clotting profile Relevant. Nig. J Surg Res. 2004;6(1-2):34-6.

Bangera A. Anaesthesia for adenotonsillectomy: An update. Indian J Anaesth. 2017;61(2):103-9.

Gavel G, Walker RWM. Laryngospasm in Anaesthesia. Continuing Education Anaesthesia Critical Care Pain Management. 2014;14(2):46-51.