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Standardized tonsillar hypertrophy grading scale. (0) Tonsils are entirely within the tonsillar fossa. (1+) Tonsils occupy less than 25 percent of the lateral dimension of the oropharynx as measured between the anterior tonsillar pillars. (2+) Tonsils occupy less than 50 percent of the lateral dimension of the oropharynx. (3+) Tonsils occupy less than 75 percent of the lateral dimension of the oropharynx. (4+) Tonsils occupy 75 percent or more of the lateral dimension of the oropharynx.  

Standardized tonsillar hypertrophy grading scale. (0) Tonsils are entirely within the tonsillar fossa. (1+) Tonsils occupy less than 25 percent of the lateral dimension of the oropharynx as measured between the anterior tonsillar pillars. (2+) Tonsils occupy less than 50 percent of the lateral dimension of the oropharynx. (3+) Tonsils occupy less than 75 percent of the lateral dimension of the oropharynx. (4+) Tonsils occupy 75 percent or more of the lateral dimension of the oropharynx.  

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Childhood obstructive sleep apnea syndrome (OSAS) is characterized by recurrent episodes of partial or complete upper airway obstruction during sleep. The disease encompasses a continuum from primary snoring (a benign condition without physiological alterations or associated complications) to increased upper airway resistance, obstructive hypoventi...

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... Therefore, recurrent infections of these tissues may act as chronic foci that activate secondary inflammatory mediators, resulting in endothelial damage, which enhances the sickling of RBCs [12]. In addition, adenotonsillar hypertrophy is one of the main causes of obstructive sleep apnea syndrome in children [13]. Notably, this syndrome can lead to ischemic stroke and transient ischemic attacks through hypoxemia [14]. ...
Article
Sickle cell disease (SCD) typically manifests in early childhood as attacks of pain known as vaso-occlusive crises. Infection and hypoxemia have been linked with these recurrent episodes and with prolonged hospitalization in SCD patients. However, adenoids and tonsils as sources of infection and causes of hypoxemia have not been adequately investigated in association with vaso-occlusive crises in SCD. To assess the association between adenotonsillectomy and frequency of vaso-occlusive crisis in SCD patients who underwent this procedure at our Hospital, and between adenotonsillectomy and frequency of blood transfusions and emergency department and intensive care unit admissions. We used medical record data to conduct a retrospective review of SCD patients who underwent adenoidectomy and/or tonsillectomy between 2005 and 2017. Eligible subjects were assessed for frequency of vaso-occlusive crises, blood transfusions, and emergency department and intensive care unit admissions. Using the Wilcoxon signed rank test, we compared the frequencies of each outcome preoperatively and 1, 3, 5, and 10 years postoperatively. Of 524 records reviewed, 40 eligible patients were included in the study. Minimal reduction was observed in the frequency of vaso-occlusive crisis episodes within 1 and 3 years after adenotonsillectomy (p = 0.337 and p = 0.549, respectively). Although the 5- and 10-year postoperative vaso-occlusive crisis frequency tended to be higher than that in the preoperative period, none of the results reached statistical significance. The number of emergency department admissions showed a statistically significant increase 3 years postoperatively compared with that in the preoperative period (P = 0.043). There were no statistically significant differences in perioperative blood transfusion frequency or number of intensive care unit admissions in any period. Adenotonsillectomy in SCD patients does not seem to be related to the frequency of vaso-occlusive crises, blood transfusions, or emergency department or intensive care unit admissions. Prospective studies with larger sample sizes are recommended to further evaluate these findings.
... Our findings suggest that the PSQ, despite its limitations, has utility as a screening tool for OSA in children and adolescents [19][20][21][22]. Our proposed algorithm for the diagnosis of OSA is illustrated in Figure 1. ...
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... The major risk factors for OSAS are: obesity, craniofacial malformations, and neuromuscular diseases. The prevalence of childhood snoring, based on clinical history/ examination and structured questionnaires, varies from 1.5 to 15% (2). The OSAS pathophysiology is multifactorial, with many anatomical/functional/neuromuscular factors involved. ...
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Background To evaluate the treatment efficacy of a mandibular advancement intraoral appliance (MOA) for treatment of obstructive sleep apnea syndrome (OSAS) in pediatric patients. Material and Methods Eighteen patients (mean=8.39 years old, women=44.4%) were selected. Sleep disorders, sleep bruxism, and temporomandibular disorders were assessed by the Sleep Disturbance Scale for Children (SDSC), the BiteStrip® (portable SB device), and the Research Diagnostic Criteria for Temporomandibular Disorders, respectively. The clinical diagnosis of OSAS was confirmed with a type 3 portable monitor device (ApneaLinkTM Plus). A silicon-based material MOA was used by patients for 60 days, and the results were compared to baseline. Results The median RDI was significantly reduced from 10 to 4.5 events/hour. Nadir SpO2 significantly increased from 82.6% to 88.9%. Total snoring events/hour have also significantly decreased from 205.5 to 91.5. Signs and symptoms of TMD remained unaltered. There was also a reduction from moderate to absence of SB in 12 patients. Similarly, all variables measured by the SDSC have had very significant reductions: disorders of initiating and maintaining sleep, sleep disordered breathing, disorders of arousal, nightmares, sleep wake transition disorders, disorders of excessive somnolence, and sleep hyperhidrosis. Conclusions In selected cases, OA maybe considered as an alternative for the OSAS treatment. Key words:Snoring appliances, sleep apnea, bruxism, sleep disorders, children
... The diagnosis of OSAS is less reliable when it is based on clinical findings alone; polysomnography is required to confirm it ( Brietzke et al., 2004). In children and adolescents, the epidemiologic profile, clinical characteristics, and treatment of OSAS are distinct from those in adults with the disorder ( Accardo et al., 2010;Anders and Guilleminault, 1976;Fagondes and Moreira, 2010;GriggDamberger et al., 2007;Guilleminault and Anders, 1976). Within this context, the present study sought to elucidate the respiratory profile during sleep of a group of children who had undergone primary surgical repair of unilateral cleft lip and palate. ...
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... 37 As shown in this series, overweight children and adolescents are a relevant group, including simple and secondary obesity, and in both situations a dietary plan should be part of the therapeutic approach. 38 GER or rhinitis must be actively sought and should be medically controlled. Specifically the treatment of allergic rhinitis is an adjuvant measure in controlling AOS, 38 and rhinitis can also interfere with NIV compliance, worsening nasal obstruction and mucosal dryness, frequent side effects associated to NIV. ...
... 38 GER or rhinitis must be actively sought and should be medically controlled. Specifically the treatment of allergic rhinitis is an adjuvant measure in controlling AOS, 38 and rhinitis can also interfere with NIV compliance, worsening nasal obstruction and mucosal dryness, frequent side effects associated to NIV. ...
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... Apesar de autores afirmarem que as alterações de pO 2 e pCO 2 existam, sabe-se que o ph pouco altera-se em crianças, pois elas possuem boa capacidade de compensação central de seu equilíbrio ácidobase 5 . Entretanto, outros estudos mostram que alterações graves de pH, as quais provavelmente ocorreram pelo avançado tempo e/ou intensidade do mecanismo que tenha levado à obstrução da via aérea, podem ter sido a causa de envolvimento do sistema cardiopulmonar, e o motivo desse envolvimento foi porque seus sistemas compensatórios foram exauridos 16,17 . ...
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