Abstract:
Background: Adenotonsillar hypertrophy is a leading cause of upper airway
obstruction in children and a common reason for paediatric referrals to Ear, Nose and
Throat (ENT) specialists. It can lead to complications such as pulmonary hypertension
and failure to thrive. Most of the children admitted to the paediatric wards in Moi
Teaching and Referral Hospital (MTRH) with adenotonsillar hypertrophy are
admitted when complications have already set in. There is paucity of local data on
children with this condition.
Objective: To determine the clinical profile of children presenting with adenotonsillar
hypertrophy at MTRH.
Study Methods: This was a cross-sectional descriptive study conducted in the ENT
Clinic and the Paediatric Ward at MTRH, from December 2014 to May 2016. The
study population included children aged between 2 months and 13 years clinically
diagnosed with adenotonsillar hypertrophy. Data was collected using a structured data
collection tool. Echocardiography was done on all patients to determine the
pulmonary pressures. Statistical analysis was performed using SAS version 9, and a pvalue
of less than 0.05 was used to define statistical significance. Demographic and
clinical characteristics were summarized using descriptive statistics. Categorical
variables were summarized as frequencies and percentages. Continuous variables
were summarized as mean and standard deviation. The test for association between
categorical variables was conducted using Pearson’s Chi Square. Data was presented
using table shells and graphs.
Results: A total of 105 participants were recruited into the study. There were 59
males (56.2%). The mean age was 3.5 years. The most common presenting symptoms
were nasal congestion and obstruction in 100 (95%) of the participants, mouth
breathing while asleep in 96 (91.4%), recurrent sore throat in 76 (72.4%) and snoring
in 64 (61.0%) participants. The most common physical examination findings were
mouth breathing, adenoid facies, tachycardia, tachypnea and tonsillar enlargement.
Pulmonary hypertension occurred in 24.8% of the patients, and was associated with
mouth breathing while asleep (OR 3.11, CI 95% 1.43-8.97; p=0.024), adenoid facies
(OR 2.45, CI 95% 0.57-10.12; p=0.029), hypoxia (OR 4.11, CI 95% 2.56-8.91;
p=0.037) and tonsils Grade 4 (OR 2.55, CI 95% 0.47-3.22; p=0.043).
Conclusion: The most common presenting complaints of adenotonsillar hypertrophy
are nasal blockage, mouth breathing while asleep, snoring and recurrent sore throat. A
quarter of the children with adenotonsillar hypertrophy had features of pulmonary
hypertension on echocardiography.
Recommendation: Early recognition and treatment of adenotonsillar hypertrophy is
recommended so as to avert the development of long-term complications.
Echocardiography should form part of the routine investigations for children with
adenotonsillar hypertrophy.