| Purpose and significanceAdenoid hypertrophy(AH)is a common disease in children.It often causes children with poor breathing,nocturnal snoring,hearing loss and other symptoms.The causes include repeated microbial infections and allergic factors.In recent years,more and more studies have suggested that laryngopharyngeal reflux(LPR)is one of the important factors that cause AH in children.For detecting LPR in children with AH,mainly depends on the 24-hour dual-probe esophageal pH monitoring and multi-channel intraluminal impedance PH monitoring results.However,as its an invasive examination,children are often difficult to cooperate with.the inspection,meanwhile the above checking for the accuracy of the diagnosis of LPR is still controversial.Therefore,in clinical work,there is a lack of evaluation of LPR in children with AH,if neglecting the treatment of LPR,It may eventually lead to an increased risk of recurrence and complications after adenoidectomy.In recent years,pepsin has been recognized as a reliable marker for diagnosing LPR,and it has been fully recognized in vocal cord polyps,laryngeal cancer and in children with laryngomalacia.The aim of this study was to evaluate the relationship between AH and LPR by immunohistochemical staining to detect the expression of pepsin in adenoids.To assess the possibility and accuracy of Reflux symptom index(RSI)and Reflux Finding Score(RFS)in predicting the correlaition between AH and LPR.To explore the correlation between Obstructive sleep apnea-hypopnea syndrome(OSAHS)and LPR in children.Materials and methods1.Research objects1.1 A total of 71 children with adenoid hypertrophy(with or without tonsil hypertrophy)who were hospitalized in the Department of Otolaryngology and head and neck surgery of Nanfang Hospital of Southern Medical University from February 2017 to September 2017 to surgery were collected.Exclude diseases acute infection,coagulation dysfunction and cardiac dysfunction and other diseases.The above 71 children were the first and second research subjects.1.2 Among the above-mentioned children,56 patients underwent primary monitoring of sleep breathing,of which 28 were met with diagnostic criteria for OSAHS and 28 were children with pure snoring.The above 56 children were the third research subjects.2.Research methods2.1 Record the information of the selected children in detail and complete the RSI with the help of the parents;Observation of the size of bilateral tonsils in oropharynx and devided tonsils into 3 levels.To observe the degree of choana narium of adenoid obstruction by nasopharyngeal laryngoscopy before operation,the sized of adenoid was divided into 4 levels according to the classification method prosposed by Cassano.After that,we went on to observe the performance of the throat at the base of the tongue.At the same time,complete RFS assessment.After adenoidectomy,some tissues were taken and the expression of pepsin in adenoid tissues was detected by immunohistochemistry.2.2 Using pepsin-positive as the gold standard for the diagnosis of LPR,and to determine the possibility and accuracy of RSI and RFS in predicting the correlation between adenoid hypertrophy and laryngopharyngeal reflux(LPR).At the same time,the correlation between the performance of the scales and LPR was observed.To explore the causal relationship between Obstructive sleep apnea-hypopnea syndrome(OSAHS)and LPR in children.2.3 Using SPSS 21.0 for data processing,bivariate correlation analysis,the non-bivariate normal distribution data selection Spearman correlation analysis.Test level P<0.05 was considerd statistically significant.Results1.Pepsin expression in adenoid tissueThe expression of pepsin in adenoid tissue was localized on the ciliated columnar epithelium and squamous epithelium cells,with the cytoplasm as the main expression and rare nucleus staining.Pepsin can be detected in samples with strong pepsin stanining and in interstitial connective tissue.The total positive rate was 73.24%(52/71)by pepsin immunohistochemical staining,of which 15(21.13%)were strongly positive,23(32.39%)were moderately positive,14(19.72%)were weakly positive,19(26.76%)were negative,Spearman rank correlation results suggested that the higher the size of adenoid hypertrophy,the higher the expression intensity of Pepsin(r=0.476,P<0.001).2.Adenoid hypertrophy in children with RSI,RFSIn 71 patients with adenoid hypertrophy,RSI was greater than 13 points in 4 cases(5.63%),RPS was greater than 7 points in 26 cases(36.62%),and 1(1.41%)was positive in both scores.Compared with 9 signs of RSI,the Symptoms of 71 adenoid hypertrophy children included:Hoarseness or a problem with voice in 29 cases(40.85%),continuous clearing throat in 40 cases(56.34%),excess throat mucus or postnasal drip in 45 cases(63.38%),difficulty swallowing food,liquids,or pills in 10 cases(14.08%),coughing after ate or after lying down in 20 cases(28.17%),Breathing difficulties or choking episodes in 20 cases(28.17%),troublesome or annoying cough in 45 cases(63.38%),sensations of something sticking in throat or a lump in throat in 7 cases(9.86%),Heartburn,chest pain,indigestion,or stomach acid coming up in 2 cases 2.82%).Compared with 8 signs of RFS,the performance of 71 adenoid hypertrophy children under laryngoscopy included:subglottic edema in 1 cases(1.41%),ventricular patial or complete obliteration in 55 cases(77.46%),Erythema/hyperemia in 40 cases(56.34%),vocal fold edema in 32 cases(45.07%),diffuse laryngeal edema in 35 cases(49.30%),posterior commissure hypertrophy in 42 cases(59.15%),Granuloma/granulation tissue in 0 cases,thick endolaryngeal mucus in 7 cases(9.86%).Define the positive rate of pepsin as the gold standard for the diagnosis of LPR,the sensitivity and specificity of RSI and RFS were 5.77%、34.62%and 94.74%、57.89%respectively.Pepsin staining intensity was positively correlated with troublesome or annoying cough(r=0.356,P=0.002)and was negatively correlated with ventricular obliteration(r=-0.212,P=0.038).3.The causal relationship between OSAHS and LPR in children with adenoid h ypertrophyIn 28 cases of snoring group,the positive rate of pepsin expression in adenoid was 75.76%(21/28),of which 4 cases were strongly positive(14.29%),12 cases(42.86%)were moderately positive and 5 cases(17.86%)were weakly positive,7 cases(25.00%)were negative.The positive rate of pepsin expression in the OSAHS group was 78.57(22/28),of which 8 cases(28.57%)were strongly positive,8 cases(28.57%)were moderately positive,6 cases(21.43%)were weakly positive and 6 cases(21.43%)were negative.The nonparametric test indicated that there was no statistical difference in the expression of pepsin in adenoid between snoring group and OSAHS(P>0.05).There was no statistical difference in the expression level of pepsin between light,medium and severe patients in OSAHS group(P>0.05).ConclusionThere is a correlation between adenoid hypertrophy and LPR in children,as the low sensitivity of RSI and RFS,it is not suitable for the screening of adenoid hypertrophy in children with LPR.Children with adenoid hypertrophy cough for a long time and the laryngoscopy shows the ventricular obliteration,the presence of LPR should be warned.Children’s OSAHS is not the cause of LPR,the occurrence of LPR causes adenoid hypertrophy,which in turn causes OSAHS in children. |
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