Obstructive Tonsillar Hypertrophy Clinical Trial
Official title:
Development of an Assessment Method for Obstructive Tonsillar Hypertrophy in Children by Ultrasonography (Pamukkale Technique)
Chronic tonsillar hypertrophy is one of the most common causes of upper airway obstruction in children. Currently, several clinical staging systems are used to evaluate airway obstruction due to tonsillar hypertrophy. However, as these staging systems are based on a physical examination, it is not always possible to accurately evaluate the tonsil size, especially in children, and so objective and reliable methods are required in this field. In this study, the investigators aimed to develop a new method for the objective evaluation of airway obstruction due to tonsillar hypertrophy using submental ultrasonography (US) in children.
Tonsillectomy is one of the most frequently performed operations in childhood, and one of the
most important indications of this surgery is chronic tonsillar hypertrophy. Chronic
tonsillar hypertrophy accounts for 80% of cases with obstructive sleep apnea syndrome (OSAS)
in childhood, and growth and development delay, low academic performance, facial
developmental abnormalities, and cardiopulmonary diseases may emerge as a result. For this
reason, an accurate evaluation of tonsil size is crucial both during clinical follow-up and
in tonsillectomy decisions.
Currently, several clinical staging systems are used to evaluate tonsil size in children,
with the "Brodsky" and "Friedman" scales being the most commonly used systems. These staging
systems make use of a physical examination, with tonsil hypertrophies generally classified
into 4 stages based on the extension of the tonsil from the anterior plica to the midline.
Stages 3 and 4 tonsil hypertrophy are generally accepted as obstructive, and a tonsillectomy
decision is made when clinical complaints support this. For such an evaluation of tonsil
grade, the child should be cooperative, should easily open his/her mouth, and should not gag.
In the event of the patient's non-compliance, the size of the tongue and tongue base, the
hyperactive gag reflex, and trismus may challenge this evaluation. The gag reflex during the
examination causes the tonsils to move towards the midline, making the tonsils seem bigger
than the real size. An obstruction at the hypopharyngeal level due to hypertrophic tonsils
may be missed due to poor visualization of the inferior pole of the tonsil in patients with a
large tongue. For these reasons, a correct clinical evaluation of the tonsil size may not
always be possible through a physical examination. Thus objective and reliable methods are
required for the classification of tonsillar hypertrophy.
There have been no studies to date investigating the use of ultrasonography (US) in the
evaluation of airway obstruction due to tonsillar hypertrophy, despite the advantages of high
patient compliance, low cost, and no radiation exposure. The present study suggests a new
method for the evaluation of airway obstruction due to tonsillar hypertrophy using the
submental US in children.
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| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Not yet recruiting |
NCT00466544 -
Randomized Controlled Study of Plasmaknife Tonsillectomy Versus Monopolar Tonsillectomy
|
Phase 4 |