Clinical profile of children with adenotonsillar hypertrophy at Moi Teaching and Referral Hospital, Eldoret, Kenya

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.