Tonsillar hypertrophy linked to childhood wheeze and snoring

MedWire News: Children with a history of wheezing are more likely to have tonsillar hypertrophy than those without such a history, which may partly explain the association between asthma and obstructive sleep-disordered breathing (SDB) in childhood, say Greek researchers.

Athanasios Kaditis (University of Athens) and colleagues explain: “A number of reports in adults and children have correlated history of wheezing and/or a diagnosis of asthma with the presence of obstructive sleep apnea, and airway inflammation has been proposed as the pathogenetic link connecting these disease entities.”

However, in addition to airway inflammation, adenotonsillar hypertrophy is another factor that may increase upper airway resistance and predispose to SDB in childhood.

To investigate, the researchers studied 442 children, aged an average of 7.6 years, who presented to the emergency department for minor ailments or were referred to a pediatric pulmonology clinic for recurrent wheezing.

Parental questionnaires were used to gather information on symptoms of SDB (snoring), history of wheezing, use of inhaled bronchodilators or corticosteroids, history of tonsillectomy, and history of chronic disease in their children. The children also underwent clinical examinations and the size of their tonsils was measured by inspection of the oropharynx.

After accounting for factors such as age, gender, body mass index, and passive smoking, the researchers found that a history of wheezing was significantly associated with the presence of tonsillar hypertrophy and habitual snoring, at odds ratios (ORs) of 2.23 and 1.73, respectively.

A history of wheezing was significantly associated with the presence of snoring in children with tonsillar hypertrophy (OR=2.76), but not in those without.

Kaditis and team conclude in the journal Pediatric Pulmonology: “Children with history of wheezing have more frequently tonsillar hypertrophy than those without wheezing.

They add: “Tonsillar hypertrophy may mediate at least in part the reported association between asthma and obstructive sleep-disordered breathing in childhood.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010