Lee Dong-Jun, Chung Young-Jun, Yang Yeon-Jun, Mo Ji-Hun
Department of Otorhinolaryngology, Dankook University College of Medicine, Cheonan, Korea.
Clin Exp Otorhinolaryngol. 2018 Mar;11(1):52-57. doi: 10.21053/ceo.2017.00500. Epub 2017 Aug 1.
It is well known that allergic rhinitis (AR) has positive association with adenotonsillectomy. However, the impact of AR on symptom improvement after adenotonsillectomy is not well documented. Hence, we aimed to evaluate the effect of AR on the symptom improvement after adenotonsillectomy between AR and nonallergic patients.
A retrospective analysis was performed on 250 pediatric patients younger than 10 years old who received adenotonsillectomy from June 2009 to June 2014 in a tertiary referral hospital. All patients underwent skin prick test or multiple allergen simultaneous test (MAST) before surgery and classified into AR group and control group. Obstructive and rhinitis symptoms including snoring, mouth breathing, nasal obstruction, rhinorrhea, itching, and sneezing were evaluated before and 1 year after surgery using questionnaire and telephone survey.
AR group was 131 and control group was 119, showing higher prevalence (52.4%) of AR among adenotonsillectomized patients. Both groups showed dramatic improvement of symptoms such as snoring and mouth breathing after surgery (all <0.05). However, AR group showed significantly less improvement than control group in snoring, mouth breathing, nasal obstruction, and rhinorrhea (all <0.05). Multivariate analysis showed that preoperative mouth breathing and snoring were dependent on tonsil grade and postoperative symptoms were mainly dependent on presence of AR. Nasal obstruction was dependent on tonsil grade and presence of AR preoperatively and presence of AR postoperatively. These suggest the importance of AR as a risk factor for mouth breathing, snoring, and nasal obstruction.
AR has positive association with adenotonsillectomy and not only allergic symptoms but also obstructive symptoms such as snoring and mouth breathing improved less in AR group than control group. Hence, patients with AR should be monitored for long-term basis and more carefully after adenotonsillectomy.
众所周知，变应性鼻炎（AR）与腺样体扁桃体切除术呈正相关。然而，AR对腺样体扁桃体切除术后症状改善的影响尚无充分记录。因此，我们旨在评估AR对AR患者和非变应性患者腺样体扁桃体切除术后症状改善的影响。
对2009年6月至2014年6月在一家三级转诊医院接受腺样体扁桃体切除术的250例10岁以下儿科患者进行回顾性分析。所有患者在手术前均接受皮肤点刺试验或多种变应原同步试验（MAST），并分为AR组和对照组。术前和术后1年使用问卷和电话调查评估阻塞性和鼻炎症状，包括打鼾、口呼吸、鼻塞、流涕、瘙痒和打喷嚏。
AR组131例，对照组119例，显示腺样体扁桃体切除患者中AR的患病率较高（52.4%）。两组术后打鼾和口呼吸等症状均有显著改善（均P<0.05）。然而，AR组在打鼾、口呼吸、鼻塞和流涕方面的改善明显低于对照组（均P<0.05）。多因素分析显示，术前口呼吸和打鼾取决于扁桃体分级，并术后症状主要取决于AR的存在。鼻塞术前取决于扁桃体分级和AR的存在，术后取决于AR的存在。这些提示AR作为口呼吸、打鼾和鼻塞危险因素的重要性。
AR与腺样体扁桃体切除术呈正相关，AR组不仅变应性症状而且打鼾和口呼吸等阻塞性症状的改善均低于对照组。因此，腺样体扁桃体切除术后应对AR患者进行长期且更仔细的监测。
