Katılma Nöbetlerinin Etiyolojisinde Yumuşak Damak Evrelemesinin ve Palatonsiller Hipertrofinin Önemi

Year 2021, Volume: 15 Issue: 4, 306 - 311, 16.07.2021

Beril Dilber , Ahmet Ural , Tulay Kamasak , Ali Cansu

https://doi.org/10.12956/tchd.874440

Abstract

Amaç: Katılma nöbeti çocukluk yaş grubunda görülen epileptik olmayan paroksismal bir olaydır. Patofizyolojisi tam olarak aydınlatılamamıştır. Hipoksi neden ya da sonuç olsa da hipoksinin çocukta yaptığı hasar önemlidir ve maruziyeti azaltılmalıdır. Bizim çalışmamız katılma nöbeti olan çocuklarda palatintonsil hipertrofisinin ve yumuşak doku evrelemesinin katılma nöbeti üzerine etkisini ve ilişkisini göstermeyi amaçlayan ilk çalışmadır.

Gereç ve Yöntemler: 2012-2016 yılları arasında en az bir senedir takipli demir eksikliği anemisi olmayan ve sık enfeksiyon geçirmeyen 8-56 ay arasında toplam 90 çocuk (katılma nöbeti olan/kontrol: 45/45) retrospektif olarak tarandı ve çalışmaya dahil edildi. Katılma nöbeti tanısı hikaye ve klinik gözlemlerinden ve videolardan konuldu. Katılma nöbeti olan hastaların yaşa ve cinsiyete göre atak süreleri, atak tipleri palatotonsil ve yumuşak damak evreleri kendi arasında ve kontrol grubu ile karşılaştırıldı.

Bulgular: Hastaların ortalama yaşları 28.9±12.9 (8-56) aydı. Katılma nöbeti olan çocukların palatotonsil evre 1-2 (toplam %81.8) iken yumuşak damak evrelemeleri evre 2-3 (%78.9)’di ve kontrol grubu ile anlamlı farklılık vardı (p: 0.000). Siyanotik tipte katılma nöbeti olan çocuklarda tonsil büyüklüğü evre 2-3’di ve tonsil büyüklüğü ile katılma nöbeti sıklığı arasında pozitif korelasyon vardı (r: 0.315, p: 0.032). Katılma nöbeti süresi ortalama 3.5±1.3 dakikaydı. Palatotonsil büyüklüğü ve yumuşak damak evrelemesi ile atak süresi arasında da sırasıyla pozitif korelasyon mevcuttu (r: 0.459, p: 0.000; r: 0.734, p: 0,000).

Sonuç: Biz bu çalışmada; demir eksikliği anemisi olmayan ve sık enfeksiyon geçirmeyen katılma nöbeti olan çocuklarda kontrol grubuna oranla palatotonsil hipertrofinin belirgin olduğunu, ancak yumuşak damağın daha ileri evrelerde olduğunu gösterdik. Sonuç olarak katılma nöbeti etyolojisinde ve nöbet süresinin uzamasında bu hastalarda ileri evre yumuşak damak hipertrofisi olması riski 1.5 kat artırır ve erken müdahele ile akip gerektirir.

Keywords

katılma nöbeti süresi, palatotonsil hipertrofisi evrelemesi, yumuşak damak evrelemesi

The Importance of Palatitonsillar Hypertrophy and Soft Palate Staging in Etiology of Breathe Holding Spells

Abstract

Objective: Breath-holding spells (BHS) are common paroxysmal events in earlychildhood with unknown pathophysiology. Hypoxia can be the cause or result of BHS and the damage caused by hypoxia is of paramount importance. Therefore, exposure to hypoxia should be minimized in children with BHS. The present study, for the first time in the literature, investigated the staging of palatinetonsil and soft palate hypertrophy in children with BHS and their relationship with BHS.

Material and Methods: The retrospective study included 45 children with BHS with no iron deficiency and no complaints of frequent infections and had been followed up for a minimum of one year over between 2012 and 2016. A control group of 45 age-matched subjects. BHS was diagnosed based on patient history, clinical observations, and video records. Duration of spell, spell type, and the staging of palatinetonsil and soft palate hypertrophy were compared among the patients and with the control subjects in terms of age groups and genders.

Results: Mean age was 28.9±12.9 (range, 8-56) months in the BHS group. In the same group, the patients had stage 1-2 palatinetonsil hypertrophy (total 81.8%) and stage 2-3 soft palate hypertrophy (78.9%) and a significant difference was found between the BHS and control groups (p=0.000). In patients with cyanotic BHS, tonsillar hypertrophy was grade 2-3 and a positive correlation was found between cyanotic BHS and tonsillar hypertrophy (r: 0.315, p=0.032). Mean duration of spell was 3.5±1.3 minand tonsillar hypertrophy established a stronger correlation with spell duration and soft palatinetonsil hypertrophy (r: 0.459, p=0.000;r: 0.734, p=0.000, respectively).

Conclusion: The results indicated that the BHS patients with no iron deficiency and no complaints of frequent infections had greater palatinetonsil hypertrophy and a higher stage of soft palate hypertrophy compared to control subjects. We suggest that the presence of a high-stage soft palate hypertrophy increases the risk of developing BHS and the duration of spell by 1.5 times and thus requires early intervention and clinical follow-up.

Keywords

Breath-holding spell duration, Palatinetonsil hypertrophy, Soft-palate stage

References

• Referans1 DiMario FJ. Breath-holding spells in childhood. CurrProbl Pediatr. 1999;29:281-300.
• Referans2.) Carman KB, Ekici A, Yimenicioglu S, Arslantas D, Yakut A. Breath holding spells: point prevalence and associated factors among Turkish children. Pediatr Int. 2013;55:328-31
• Referans3.) Colina KF, Abelson HT. Resolution of breath-holding spells with treatment of concomitantan aemia. J Pediatr. 1995;126:395-97.
• Referans4.) Daoud AS, Batieha A, al-Sheyyab M, Abuekteish F, Hijazi S. Effectiveness of iron therapy on breath-holding spells. J Pediatr. 1997;130:547-50.
• Referans5.) Mattie-Luksic M, Javornisky G, DiMario FJ. Assessment of stress in mothers of childrenwith severe breath-holding spells. Pediatrics. 2000;106:1-5.
• 6.) Saad K, Farghaly Hikma S, Badry R. Othman Hisham A.K, Selenium andantioxidant levels decreased in blood of children with breathe holding spells. Journal of Child Neurology. 2014;29:1339-44
• Referans7.) Friedman M, Tanyeri H. Clinical Predictors of Obstructive Sleep Apnea. Laryngoscope 2009;109:1901-7
• Referans8.) Friedman M, IbrahimH, Bass L. Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg, 2020;127:12-13
• Referans9.) Mallampati S.R, Gatt S.P, Gugino L.D. A clinical sign to predict difficult intubation: a prospective study. Can Anaesth Soc J. 1985;32:429-34
• Referans10.) Paparella M, Shumrick DA, Gluckman JL, MeyerhofWL, Alan D, Kornblut A. Nonneoplastic diseases of the tonsils and adenoids. Otorhinolaryngology. 1991;3:2129-47.
• Referans11.) Isler, M, Delibas, N, Guclu, M, Gultekin, F, Sutcu, R, Bahceci, M, Kosar, A. Superoxide dismutase and glutathione peroxidase in erythrocytes of patients with iron deficiency anemia: effects of different treatment modalities. Croat Med J. 2002;43:16–19.
• Referans12.) Calik, M, Abuhandan, M, Aycicek, A, Taskin, A, Selek, S, Iscan, A. Increased oxidant status in children with breath-holding spells. Childs Nerv Syst. 2013;29:1015–1019.
• Referans13.) KhaledSaad, MD, Hikma S. Farghaly, MD, RedaBadry, MD, Hisham A.K Othman, MD. Selenium and antioxidant levels decreased in blood of children with breathe holding spells. Journal of Child Neurology. 2014;29:1339-1343
• Referans14.) Daoud AS, Batieha A, al-Sheyyab M, Abuekteish F, Hijazi S. Effectiveness of iron therapy on breath-holding spells. J Pediatr. 1997;130:547-550
• Referans15.) DingXiao-Xu, ZhaoLan-Qing, CuiXiang-Guo, YinYang, YangHuai-An. Clinicalobservation of softpalate-pharyngoplasty in thetreatment of obstructivesleepapneahypopneasyndrome in children. World J ClinCases. 2020;26:679-88
• Referans16.) DeeptiSinha D, Guilleminault C. Sleepdisorderedbreathing in childrenIndian J MedRes. 2010;131:311-20
• Referans17.) Kurnatowski P, Putynski L, Łapienis M, Kowalska B. Physical and emotional disturbances in children with adenotonsillar hypertrophy. J. Laryngol. Otol. 2008;122:931–35
• Referans18.) Kapur V.K, AuckleyD.H, Chowdhuri S, Kuhlmann D.C, Mehra R,.Ramar KHarrod C.G. Clinical Practice Guideline for DiagnosticTesting for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017;13:479-504