Development of an Assessment Method for Obstructive Tonsillar Hypertrophy in Children by Ultrasonography
Condition: Obstructive Tonsillar Hypertrophy
MeSH terms: Hypertrophy
Study type: Observational

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): The ROC analysis
Intervention type(s): Diagnostic Test
Intervention description(s): The Brodsky clinical stage and ultrasonographic data of the participants will be matched, and the diagnostic value of the submental US in the classification of tonsil hypertrophy as non-obstructive and obstructive will be evaluated. A ROC analysis will be used to determine the optimal cut-off value.
Observational model: Case-Crossover
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The pediatric patients who presented to the otorhinolaryngology outpatient clinic with
        complaints of recurrent tonsillitis, snoring, and/or witnessed apnea between January 2019
        and December 2019.
      
Keywords: tonsil; tonsillar hypertrophy; ultrasonography; children