Adenoid Hypertrophy And Behavioral Problems In Children

Research backgroundAdenoid is a mass of lymphoid tissue located at the junction of the top and the posterior wall of the nasopharynx.It is a part of the internal loop of the pharyngeal lymphoid ring.It is also called the paraphyte and the pharyngeal tonsil.It has both humoral and cellular immunity.Adenoidal hypertrophy(AH)is a common disease in pediatrics and otolaryngology.The incidence of adenoid hypertrophy was high in children aged 3-6 years,atrophic adenoids aged 6-12 years[1].The incidence of adenoid hypertrophy in children is about 9-30%[2].There are many reasons for adenoid hypertrophy,which are mainly related to children's immune factors,infection,allergic constitution [3-4] and environmental factors.In recent years,due to air pollution and excessive decoration,the incidence of AH in children has an obvious upward trend.The common complications of adenoid hypertrophy include chronic rhinosinusitis,secretory otitis media,chronic pharyngitis and sleep apnea[5].Recent studies have shown that sleep apnea can harm the central nervous system of children with AH and lead to a series of behavioral abnormalities.At present,there are more studies on adenoid hypertrophy and its common complications,but less on adenoid hypertrophy and behavioral problems in children.In the present study,the sleep disordered breathing caused by AH may lead to abnormal body behavior through the following mechanisms:(1)Intermittent hypoxia:can affect the energy metabolism of the brain tissue,cause hippocampal neuronal injury,which can cause the disorder of the advanced nerve function such asmemory,learning,attention,thought,etc.Which leads to the reduction of memory,learning difficulties,and attention loss of concentration and the like.At the same time,hypoxia can destroy brain microenvironment,lead to synaptic plasticity change.(2)Sleep disorder:sleep is very important to children's central nervous system development,children with sleep apnea caused by AH were mostly light sleep at night,and the arousal and arousal increased,while deep sleep and rapid eye movement sleep time decreased,the decrease of rapid eye movement sleep can damage the cerebral cortex and destroy the integrity of axons,thus affecting the development of nerve and inducing abnormal cognitive behavior;and reduced sleep at night can lead to daytime lethargy,affecting the body's memory,learning,attention and mood.(3)Metabolic imbalance:brain-derived neurotrophic factor has protective effect on neurons.Hypoxia caused by blocking of upper airway can lead to disorder of brain metabolism and decrease of the secretion of this substance in brain tissue,which will not alleviate the injury of neurons caused by hypoxia.Brain-derived neurotrophic factor can promote the growth of hippocampal neurons and promote the development of learning and memory function.The decrease of its secretion will lead to the decline of memory and learning ability.We found in our clinical work that children with adenoid hypertrophy were found to be hyperactive,impulsive,and painstakingly learning in children who had come to visit because of sleep snoring.There are relatively few studies on the correlation between adenoid hypertrophy and behavioral problems in children.In view of the occurrence of abnormal behavior will cause great harm to children themselves,familyes and society,early identification and effective intervention are beneficial to children's physical and mental health.We investigated the behavioral problems of children with adenoid hypertrophy by Conners parents questionnaire to explore the correlation between adenoid hypertrophy and behavioral problems.Research purposeBy comparing the index score relation between children with different degree of adenoid hypertrophy and normal children in the Conners parental questionnaire,toinvestigated:(1)Whether AH is related to children's behavioural problems and what are the aspects of behavioural abnormalities;(2)Correlation between the degree of adenoid hypertrophy and children's behavioral abnormality;(3)The influence of age on AH children's behavioral abnormality and its correlation,in order to provide clinical basis for the relationship between adenoid hypertrophy and children's behavioral problems.Research objectFrom January 2017 to December 2017,50 children with adenoid hypertrophy in pediatrics and otolaryngology of the second affiliated Hospital of Guangzhou Medical University were selected as AH group.A total of 25 normal children in the second affiliated Hospital of Guangzhou Medical University were selected as control group.1.AH group(1)Inclusion criteria:(1)general data:from Guangzhou city,aged 3 to 9 years;(2)with no abnormal birth history;(3)education is equivalent to that of children of the same age;(4)had typical clinical symptoms of AH,such as snoring,nasal obstruction,open mouth breathing and so on;(5)nasopharyngeal lateral radiography(using the grading method reported by the Qiang Jun in China,taking A as the thickness of the adenoid,N as the width of the nasopharynx,the ratio of airway thickness between adenoids and nasopharyngeal cavity was A/N),of those the A/N value was more than 0.6 was included in AH group.The patients were divided into mild AH group(0.60 <A/N?0.66),moderate AH group(0.66<A/N?0.70)and severe AH group(P<0.70).All the children were divided into 3-5 and 6-9 age groups according to their age.(2)Exclusion criteria:(1)congenital dysplasia of the nasopharynx;(2)nasal space occupying lesions;(3)has undergone adenoidectomy;(4)patients with asthma and congenital heart disease;(5)there are behavioral disorders in the family;(6)obesity.2.Normal control group(1)Inclusion criteria:(1)general data:from Guangzhou city,aged 3 to 9 years;(2)with no abnormal birth history;(3)education is equivalent to that of children of the same age;(4)physical examination results(including weight,height,blood routine,liver and kidneyfunction);(5)had no clinical symptoms such as snoring,nasal obstruction,open mouth breathing and so on.(2)Exclusion criteria:(1)there are behavioral disorders in the family;(2)obesity.Research methodAccording to the above criteria,50 children in AH group and 25 children in normal control group were selected.The names,sex and age of children in the two groups were recorded,and the course of AH symptoms and the value of A/N in AH group were also recorded.The parents and guardians of the children of the two groups were investigated with Conners' s parents questionnaire on the spot or on the network.The score data of 6 factors of each child's behavior problems,learning problems,psychosomatic problems,impulsive hyperactivity,anxiety and hyperactivity index were calculated and recorded.By comparing the scores of the above six factors between the AH group and the normal control group,to determine whether AH is related to behavioral problems and which behavioral anomalies.To explore the correlation between adenoid hypertrophy and behavioral abnormality by comparing the factor scores of children with different degrees(mild,moderate and severe AH).The factor scores of AH children aged 3-5 and 6-9 were compared,to investigate the influence of age on behavioral abnormality in children.The data were analyzed by SPSS 20.0 software,including:sex comparison between AH group and normal control group,chi-square test was used;age comparison between AH group and normal control group,comparison of each factor's score in AH group and normal control group,comparison of each factor's score in AH children aged 3-5 and 6-9,use two independent sample T test;comparison of factors in different AH groups,use single factor analysis of variance.Seem P<0.05 as the difference and P<0.01 as the significant difference.The correlation between the degree of adenoid hypertrophy and the scores of each factor,use linear regression analysis.Seem 0<R<1 and P<0.05 as positive correlation,P<0.01 as significant positive correlation,whereas-1<R<0 and P< 0.05 as negative correlation,and P<0.01 as significant negative correlation.Research results1.Relationship between age and sex in AH group and normal control group(1)(1)There were 50 children in AH group,27 males and 23 females.Normal control group of 25 children,13 males,12 females.Gender comparison between the two groups of children,P>0.05,there was no significant difference in sex between AH group and normal control group(P=0.871).(2)Age comparison between AH group and normal control group,P>0.05,the difference is not statistically significant(P=0.343).(2)The scores of behavior problems,learning problems,psychosomatic problems,impulse-hyperactivity,anxiety and hyperactivity index were compared between male and female children in AH group,P>0.05,there was no significant difference in scores of all factors between AH male children and AH female children(respectively:P=0.348,P =0.115,P=0.817,P=0.060,P=0.137,P=0.332).It can be concluded that there is no significant relationship between the scores of each factor and gender in AH group.2.Comparison of scores between AH group and normal control groupThe factor scores of AH group and normal control group were compared,the results are as follows:(1)The scores of behavior problems,impulsive hyperactivity and hyperactivity index in AH group were significantly different from those in normal control group,P<0.01,and the AH group had higher scores(respectively:T=2.713,P=0.008;T=3.974,P<0.001;T=3.334,P=0.001).(2)The scores of learning problems in the AH group were different from those in thenormal control group,P<0.05,and the scores of AH group were higher(T=2.071,P= 0.042).(3)There was no difference in the scores of psychosomatic problems and anxiety between the AH group and the normal control group,P>0.05(respectively:P=0.961;P=0.193).It can be concluded that the behavior problems,learning problems,impulsive hyperactivity and hyperactivity of children with adenoid hypertrophy are more seriousthan those of normal children.The degree of psychosomatic problems and anxiety was the same as that of normal children.3.The relationship between the degree of adenoid hypertrophy and the score(1)The scores of behavior problems,learning problems,impulsive hyperactivity and hyperactivity index of 25 children in AH group and normal control group were compared,the results were as follows:(1)There was no significant difference in the scores of behavior problems,learning problems,impulsive hyperactivity index and hyperactivity index between the mild AH group and the normal control group(P>0.05).It can be concluded that the children with mild adenoid hypertrophy have the same degree of behavioral problems as the normal children(respectively:P=0.997,P=0.704,P=0.860,P=0.962).(2)The scores of behavior problems and learning problems in the moderate AH group were significantly different from those in the normal control group,P<0.05,and the scores of impulse-hyperactivity index and hyperactivity index were significantly different,P<0.01.It can be concluded that the degree of behavior problems,learning problems,impulsive hyperactivity and hyperactivity of children with moderate adenoid hypertrophy is different from that of normal children,and that the children with moderate adenoid hypertrophy are more serious than normal children(respectively:T=2.109,P=0.042;T=2.056,P=0.046;T=2.896,P=0.007;T=3.152,P=0.003).(3)There were significant differences in the scores of behavior problems,learning problems,impulsive hyperactivity and hyperactivity index between the severe AH group and the normal control group,P<0.01.It can be concluded that behavioral behavior problems,learning problems,impulsive hyperactivity and hyperactivity in children with severe adenoid hypertrophy are significantly different from those in normal children,and that children with severe adenoid hypertrophy are more serious than normal children(respectively:T=4.870,P<0.001;T=3.361,P=0.002;T=5.648,P<0.001;T=5.117,P<0.001).(4)There was no difference in the scores of psychosomatic problems and anxiety between the mild AH group,moderate AH group,severe AH group and the normalcontrol group,P>0.05(respectively: p=0.060,p=0.572,p=0.522;p=0.951,p=0.075,p=0.218).(2)The scores of the above four factors in mild,moderate and severe AH groups were compared:(1)There were significant differences in the scores of behavior problems,impulsive hyperactivity and hyperactivity index among the three groups,all P<0.01(respectively: P=0.001,P<0.001,P<0.001).(2)Comparison of learning problem scores among three groups,P<0.05,there are differences in scores(P=0.027).(3)There was no difference in the scores of psychosomatic problems and anxiety among the three groups,all P>0.05(respectively: p=0.208,p=0.267).It can be concluded that the behavior problems,learning problems,impulsive hyperactivity and hyperactivity severity of children with adenoid hypertrophy are related to the degree of adenoid hypertrophy.(3)Correlation between adenoid A/N value and each factor score Further analysis of the correlation between the above four factor scores and the A/N value,showed that:the scores of behavioral problems,learning problems,impulsive hyperactivity and hyperactivity index were positively correlated with the A/N value of adenoids,all 0<R<1,and P<0.01(respectively:R=0.572,P<0.001;R=0.435 P=0.002;R=0.627,P<0.001;R=0.639,P<0.001).It can be concluded that with the increase of adenoid hypertrophy,children's behavior problems,learning problems,impulsive hyperactivity and hyperactivity are more serious.4.Comparison of scores of children of different ages50 children in AH group were divided into 3-5 years old group and 6-9 years old group,which were 28 cases and 22 cases respectively.The scores of behavior problems,learning problems,psychosomatic problems,impulsive hyperactivity,anxiety and hyperactivity index of children aged 3-5 years old AH group and 6-9 years old AH group were compared,results:there was no significant difference in the scores of all factors all P>0.05(respectively:P=0.890,P=0.471,P=0.149,P=0.165,P=0.235,P=0.430).It can be concluded that the degree of behavioral problems in children with adenoid hypertrophy is not related to age.Research conclusion1.Adenoid hypertrophy is associated with behavior problems,learning problems,impulsive hyperactivity and hyperactivity;but there was no linear correlation with psychosomatic problems and anxiety.2.In terms of behavior problems,learning problems,impulsive-hyperactivit and hyperactivity,the children with mild adenoid hypertrophy were the same as those with normal children,the children with moderate adenoid hypertrophy were more serious than those with normal children,and the children with severe adenoid hypertrophy were significantly more serious than those with normal children.Early intervention should be carried out in children with moderate and severe adenoid hypertrophy.3.The behavior problems,learning problems,impulse-hyperactivity and hyperactivity severity of children with adenoid hypertrophy were all related to the degree of adenoid hypertrophy.With the increase of adenoid hypertrophy,children's behavior problems,learning problems,impulsive hyperactivity and hyperactivity are more serious.4.The results showed that the severity of behavioral problems in children with adenoid hypertrophy was not related to age and sex.