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Better behavior after tonsil and adenoid surgery for kids with sleep breathing trouble? Adapted from a Children’s Hospital of Philadelphia press release.
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ANN ARBOR, Mich. – Children with obstructive sleep apnea who had a common surgery to remove their tonsils and adenoids showed notable improvements in behavior, quality of life and other symptoms compared to those treated with “watchful waiting” and supportive care, according to a new study. However, surprisingly, there was no difference between both groups in the primary study outcome, attention and executive functioning, as measured by formal neuropsychological tests. The research was published online today in the New England Journal of Medicine, in conjunction with a presentation at the American Thoracic Society annual meeting. The study was conducted at seven hospitals outside Michigan, but University of Michigan Health System researchers helped design and lead it and are among the authors.
Members of the U- M Sleep Disorders Center, they have studied linkages between sleep apnea and behavior, cognition, and mental health for nearly two decades. The Childhood Adenotonsillectomy Trial (CHAT) studied 4. It was the first randomized clinical trial of surgery for obstructive sleep apnea in children. Ronald Chervin, M. D., M. S., a member of the Steering Committee for CHAT and a co- author on the new paper, notes that it was important to carry out a randomized, controlled trial to evaluate the impact of surgery. He notes that many studies have yielded promising evidence of associations, but not necessarily cause- and- effect, between childhood sleep apnea and suspected effects on the brain.“A number of researchers have shown that in children, disruptive daytime behavior is linked to abnormal breathing during sleep, or the overall quality and quantity of sleep,” he notes. The role of the tonsils and adenoids in interfering with breathing during a child’s sleep, and the impact of removing them, becomes much clearer with these results.”Obstructive sleep apnea, or OSA, is a condition of interrupted sleep and breathing caused by a narrowing in the throat or upper airway that worsens during sleep.
The narrowing can result from enlarged tonsils and adenoids, obesity or other medical problems. Occurring in both adults and children, it has a higher prevalence in African- American and obese patients. Independent Adults School San Jose there. Adenotonsillectomy, the surgical removal of tonsils and adenoids, is the primary treatment for OSA in children. Over half a million U.
S. children undergo the procedure annually. The study randomized 4. Nearly half the children were overweight or obese.
All underwent a sleep study at an outpatient sleep center at baseline and after seven months of treatment. The study did not include patients with the most severe sleep apnea. The primary outcome of the CHAT trial was the Attention/Executive Function Domain score in a formal test, the Developmental Neuropsychological Assessment, administered by licensed psychometricians. The study found no significant difference between the treatment groups in these test results. The secondary outcomes included ratings from parents and teachers who completed questionnaires rating a child’s behavior, sleepiness, quality of life, and executive functioning, including details about activities of daily living. For instance, adults rated the degree to which a child kept up with tasks, seemed to have hyperactive behavior, had angry outbursts or mood changes, got along with other children, planned ahead, worried frequently, or had trouble sleeping. The children who had surgery had significantly greater improvements, compared to children in the watchful waiting group, in the secondary outcomes listed above.
U- M’s Bruno Giordani, Ph. D, who led a Neuropsychology Core for CHAT, noted that these benefits from surgery are not likely to have emerged solely due to parental expectations, as parents’ ratings were consistent with those from the teachers. Overall, both surgery and watchful waiting were safe in this clinical trial, according to U- M’s Susan Garetz, M. D., who led a group of ear, nose, and throat surgeons who assisted with CHAT. Garetz interprets these results to mean that watchful waiting is a reasonable option for parents of some children with less severe OSAS who opt not to have surgery. However, clinicians should carefully monitor these children to ensure their condition does not worsen. The CHAT trial, says Chervin, left many questions for further research.
One in particular, he says, is whether OSA is definitely the cause for behavioral problems that children with OSA often experience. This is because the CHAT study only included children who had OSA. Rash Cream For Adults India. Furthermore, the severity of OSA did not predict the behavioral outcomes.“Sleep medicine is a very new field, with many unanswered questions,” concludes the study’s first author, Carole L. Marcus, M. D., a sleep specialist and director of the Sleep Center at The Children’s Hospital of Philadelphia.
Acoustic neuromas are benign tumors that arise from the cochleovestibular (hearing and balance) nerve. Three to four thousand of these tumors are diagnosed in the United States per year.
These tumors are slow growing and begin within the temporal bone which contains the inner ear. As these tumors expand, they grow into the intracranial cavity and lead to compression of cranial nerves that regulate facial movement, facial sensation, hearing, balance, and speech and swallowing. In addition, the portion of the brain that regulates coordination and motion (the cerebellum) and the brainstem itself may be severely compressed by these tumors.
Early in tumor growth the acoustic neuroma is limited to the internal auditory canal. Patients with a stage one or intracanalicular stage acoustic neuroma (confined entirely inside the internal auditory canal) often complain of difficulty with hearing in one ear, which may begin suddenly or insidiously. European Women Dating Sites. Hearing loss may be accompanied by noise inside the ear (tinnitus), dizziness and vertigo. Figure 1 is a view of the head from above. The posterior fossa with the intracranial contents of the cerebellum, brain stem and cranial nerves, as well as the temporal bone can be seen. The temporal bone is a part of the skull base. In the temporal bone is the internal auditory canal that allows the cochleovestibular (hearing and balance) nerve and the facial nerve to pass from their intracranial site of origin to either the cochlea (snail like hearing organ), vestibular apparatus (balance organ with the 3 semicircular canals), or the muscles that move the face.
Acoustic neuromas most commonly arise in this canal. In Figure 1, a small intracanlicular tumor (colored brown in this illustration) can be seen. In Figure 2, a larger acoustic neuroma is present. This tumor has grown out of the internal auditory canal into the region known as the cerebellopontine angle, or CPA.
The tumor has a characteristic shape, with a root- like extension in the internal auditory canal and a globular portion in the intracranial cavity, just touching the brainstem, cerebellum and some of the cranial nerves. Patients may have the same symptoms as when the tumor is in the internal auditory canal or patients may have additional symptoms such as headache. The brainstem compressive stage can be seen in Figure 3.
In this figure the brainstem, cerebellum and cranial nerves are being compressed by the tumor. Acoustic neuromas are almost universally benign (not cancer), so they do not erode into, or replace brain tissue. Rather acoustic neuromas cause damage by taking up space in the intracranial cavity where no extra space exists. Compression and attentuation of vital structures in this stage can lead to increased headaches and numbness of the face. The final stage of acoustic neuroma growth, seen in Figure 4, causes hydrocephalus or a blockage of drainage of the cerebrospinal fluid in the head that bathes the brain. This increased pressure and further compression of the brainstem, cerebellum and cranial nerves results in severe symptoms such as double vision, difficulty with speech and swallowing, and even difficulty with breathing, and eventually death. It is very unusual for patients to have tumors this large without seeking medical help when the tumors are in a smaller stage.
Also acoustic neuromas characteristically grow slowly, usually over years, so that patients with smaller size tumors very rarely grow to the point seen in the figure above. The treatment of acoustic neuromas is complex and requires a sophisticated and well coordinated team. Our Consortium on Cranial Base Surgery cares for patients with these and other complicated tumors in this region.
The cranial base surgery team is composed of a neurotologist- skull base surgeon and neurosurgeons who perform microsurgical resections of these lesions. During the microsurgery a third physician, a neurophysiologist, performs electrophysiologic monitoring of many of the nerves compressed by the tumor, so that these nerves can be both electrically and visually identified, and to help preserve them. Acne. What is acne? Acne is a disorder of the hair follicles and sebaceous glands.
With acne, the sebaceous glands are clogged, which leads to pimples and cysts. Acne is very common - nearly 1. US are affected by this condition. Acne most often begins in puberty. During puberty, the male sex hormones (androgens) increase in both boys and girls, causing the sebaceous glands to become more active - resulting in increased production of sebum.
Sebaceous glands are located in the dermis (the middle layer of skin) and secrete oil onto the skin. How does acne develop? The sebaceous glands produce oil (sebum) which normally travels via hair follicles to the skin surface. However, skin cells can plug the follicles, blocking the oil coming from the sebaceous glands.
When follicles become plugged, skin bacteria (called Propionibacterium acnes, or P. Acne progresses in the following manner.