Adenotonsiller hipertrofisi olan okul öncesi çocuklarda gelişimsel gecikmeler

Amaç: Bu çalışmada adenotonsiller hipertrofili çocuklarda Denver Gelişimsel Tarama Testi-2 uygulanarak adenotonsiller hipertrofinin genel gelişimin yanı sıra ince ve kaba motor yetenekler, sosyal iletişim ve dil gelişimi üzerindeki etkileri araştırıldı.Hastalar ve Yöntemler: Şubat 2013 - Temmuz 2013 tarihleri arasında adenotonsiller hipertrofi nedeniyle adenotonsillektomi endikasyonu konulan 30 hasta 12 erkek, 18 kız; ort. yaş 53.3±12.2 ay; dağılım 32-72 ay çalışmaya dahil edildi. Kontrol grubuna adenotonsillektomi endikasyonu olmayan 30 çocuk katılımcı 12 erkek, 18 kız; ort. yaş 53.1±12.8 ay; dağılım 32-72 ay dahil edildi. Çalışmaya alınan tüm katılımcılara rutin fizik muayene, fleksibl fiberoptik nazofarengoskopi ve timpanometri uygulandı. Tonsil ve adenoid boyutlarını sınıflandırmak için sırasıyla Brodsky skalası ve fiberendoskopik bulgular kullanıldı. Kulak, burun, boğaz değerlendirmesinin ardından tüm katılımcılara bir psikolog tarafından kör olarak Denver Gelişimsel Tarama Testi-2 uygulandı.Bulgular: Adenotonsiller hipertrofi hastalarının anormal genel gelişim seviyeleri daha yüksek idi c2=7.13, p=0.028 . Hastalar ve kontrollerin ince ve kaba motor ile kişisel-sosyal gelişim düzeyleri benzer olmasına karşın dil gelişimi açısından aralarında istatistiksel olarak sınır düzeyde farklılık vardı t=1.82, p=0.074 .Sonuç: Genel gelişim ve dil gelişimi geriliği olan çocuklarda adenotonsiller hipertrofi olasılığı mutlaka akla getirilmelidir

Developmental delays in preschool children with adenotonsillar hypertrophy

Objectives: This study aims to investigate the effects of adenotonsillar hypertrophy on general development, as well as fine and gross motor capabilities, social communication, and language development in children with adenotonsillar hypertrophy by applying the Denver Developmental Screening Test-II. Patients and Methods: The study included 30 patients 12 boys, 18 girls; mean age 53.3±12.2 months; range 32 to 72 months who were indicated for adenotonsillectomy due to adenotonsillar hypertrophy between February 2013 and July 2013. The control group comprised 30 children participants 12 boys, 18 girls; mean age 53.1±12.8 months; range 32 to 72 months with no adenotonsillectomy indication. All participants included in the study were performed routine physical examination, flexible fiberoptic nasopharyngoscopy, and tympanometry. Brodsky scale and fiberendoscopic findings were used to categorize tonsil and adenoid sizes, respectively. Following ear, nose, and throat evaluation, a psychologist conducted Denver Developmental Screening Test-II in all participants blindly. Results: Adenotonsillar hypertrophy patients had higher abnormal levels of general development c2 =7.13, p=0.028 . Although patients and controls had similar levels of fine motor, gross motor, and personal-social development levels, there was a statistically borderline difference between them in terms of language development t=1.82, p=0.074 . Conclusion: The possibility of adenotonsillar hypertrophy should definitely be considered in children with delayed general and language developments.

___

  • Paradise JL, Bernard BS, Colborn DK, Janosky JE. Assessment of adenoidal obstruction in children: clinical signs versus roentgenographic findings. Pediatrics 1998;101:979-86.
  • Mitchell RB, Kelly J. Behavior, neurocognition and quality-of-life in children with sleep-disordered breathing. Int J Pediatr Otorhinolaryngol 2006;70:395-406.
  • Guilleminault C, Pelayo R, Leger D, Clerk A, Bocian RC. Recognition of sleep-disordered breathing in children. Pediatrics 1996;98:871-82.
  • Marcus CL, Carroll JL, Koerner CB, Hamer A, Lutz J, Loughlin GM. Determinants of growth in children with the obstructive sleep apnea syndrome. J Pediatr 1994;125:556-62.
  • Stradling JR, Thomas G, Warley AR, Williams P, Freeland A. Effect of adenotonsillectomy on nocturnal hypoxaemia, sleep disturbance, and symptoms in snoring children. Lancet 1990;335:249-53.
  • Brouillette RT, Fernbach SK, Hunt CE. Obstructive sleep apnea in infants and children. J Pediatr 1982;100:31-40.
  • Williams EF, Woo P, Miller R, Kellman RM. The effects of adenotonsillectomy on growth in young children. Otolaryngol Head Neck Surg 1991;104:509-16.
  • Freezer NJ, Bucens IK, Robertson CF. Obstructive sleep apnoea presenting as failure to thrive in infancy. J Paediatr Child Health 1995;31:172-5.
  • Bar A, Tarasiuk A, Segev Y, Phillip M, Tal A. The effect of adenotonsillectomy on serum insulin-like growth factor-I and growth in children with obstructive sleep apnea syndrome. J Pediatr 1999;135:76-80.
  • Singer LP, Saenger P. Complications of pediatric obstructive sleep apnea. Otolaryngol Clin North Am 1990;23:665-76.
  • Goldstein SJ, Wu RH, Thorpy MJ, Shprintzen RJ, Marion RE, Saenger P. Reversibility of deficient sleep entrained growth hormone secretion in a boy with achondroplasia and obstructive sleep apnea. Acta Endocrinol (Copenh) 1987;116:95-101.
  • Richards W, Ferdman RM. Prolonged morbidity due to delays in the diagnosis and treatment of obstructive sleep apnea in children. Clin Pediatr (Phila) 2000;39:103-8.
  • Rosen CL, Storfer-Isser A, Taylor HG, Kirchner HL, Emancipator JL, Redline S. Increased behavioral morbidity in school-aged children with sleep- disordered breathing. Pediatrics 2004;114:1640-8.
  • Kurnatowski P, Putyński L, Lapienis M, Kowalska B. Int J Pediatr Otorhinolaryngol 2006;70:419-24.
  • Gozal D, Pope DW Jr. Snoring during early childhood and academic performance at ages thirteen to fourteen years. Pediatrics 2001;107:1394-9.
  • Kim JK, Lee JH, Lee SH, Hong SC, Cho JH. School performance and behavior of Korean elementary school students with sleep-disordered breathing. Ann Otol Rhinol Laryngol 2011;120:268-72.
  • Soylu E, Soylu N, Yıldırım YS, Polat C, Sakallıoğlu O. The prevelance of psichiatric symptoms in preschool children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2013;77:1094-8.
  • Soylu E, Soylu N, Yıldırım YS, Sakallıoğlu Ö, Polat C, Orhan I. Psychiatric disorders and symptoms severity in patients with adenotonsillar hypertrophy before and after adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2013;77:1775-81.
  • Brodsky L. Modern assessment of tonsils and adenoids. Pediatr Clin North Am 1989;36:1551-69.
  • 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 Pediatr Otorhinolaryngol 2003;67:1303-9.
  • Frankenburg WK, Dodds JB. The Denver developmental screening test. J Pediatr 1967;71:181-91.
  • Frankenburg WK, Camp BW, Van Natta PA, Demersseman JA. Reliability and stability of the Denver Developmental Screening Test. Child Dev 1971;42:1315-25.
  • Yalaz K, Epir S. Denver Developmental Screening Test Manuel. Adaptation to Turkish Children and Standardisation. Ankara: Meteksan Matbaası.; 1982.
  • Blunden S, Lushington K, Kennedy D, Martin J, Dawson D. Behavior and neurocognitive performance in children aged 5-10 years who snore compared to controls. J Clin Exp Neuropsychol 2000;22:554-68.
  • Kaemingk KL, Pasvogel AE, Goodwin JL, Mulvaney SA, Martinez F, Enright PL, et al. Learning in children and sleep disordered breathing: findings of the Tucson Children's Assessment of Sleep Apnea (tuCASA) prospective cohort study. J Int Neuropsychol Soc 2003;9:1016-26.
  • Franco RA Jr, Rosenfeld RM, Rao M. First place-- resident clinical science award 1999. Quality of life for children with obstructive sleep apnea. Otolaryngol Head Neck Surg 2000;123:9-16.
  • Ali NJ, Pitson D, Stradling JR. Sleep disordered breathing: effects of adenotonsillectomy on behaviour and psychological functioning. Eur J Pediatr 1996;155:56-62.
  • Ezzat WF, Fawaz S, Abdelrazek Y. To what degree does adenotonsillectomy affect neurocognitive performance in children with obstructive sleep apnea hypopnea syndrome due to adenotonsillar enlargement? ORL J Otorhinolaryngol Relat Spec 2010;72:215-9.
  • Löfstrand-Tideström B, Thilander B, Ahlqvist-Rastad J, Jakobsson O, Hultcrantz E. Breathing obstruction in relation to craniofacial and dental arch morphology in 4-year-old children. Eur J Orthod 1999;21:323-32.
  • Hultcrantz E, Larson M, Hellquist R, Ahlquist- Rastad J, Svanholm H, Jakobsson OP. The influence of tonsillar obstruction and tonsillectomy on facial growth and dental arch morphology. Int J Pediatr Otorhinolaryngol 1991;22:125-34.
  • Mora R, Crippa B, Dellepiane M, Jankowska B. Effects of adenotonsillectomy on speech spectrum in children. Int J Pediatr Otorhinolaryngol 2007;71:1299-304.
  • American Academy of Pediatrics. Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002;109:704-12.
  • Weatherly RA, Mai EF, Ruzicka DL, Chervin RD. Identification and evaluation of obstructive sleep apnea prior to adenotonsillectomy in children: a survey of practice patterns. Sleep Med 2003;4:297-307.
  • O'Brien LM, Mervis CB, Holbrook CR, Bruner JL, Klaus CJ, Rutherford J, et al. Neurobehavioral implications of habitual snoring in children. Pediatrics 2004;114:44-9.
  • Kennedy JD, Blunden S, Hirte C, Parsons DW, Martin AJ, Crowe E, et al. Reduced neurocognition in children who snore. Pediatr Pulmonol 2004;37:330-7.