Luiza Hayashi Endo

Detection of Epstein-Barr virus in tonsillar tissue of children and the relationship with recurrent tonsillitis.

Recurrent tonsillitis has been the subject of much investigation. Events considered to predispose to or cause recurrent tonsillitis (RT) include the misuse of antibiotic therapy in acute bouts, alterations in the microflora, structural changes in crypt epithelium and certain viral infections. Epstein-Barr Virus (EBV) infection usually occurs in early childhood and can persist in palatine tonsil lymphocytes to induce tonsillitis at a later date. We have examined the presence of EBV in palatine tonsils in order to assess the relationship between this virus and recurrent acute tonsillitis. Tonsils were obtained from 85 patients, 2--14 years old (mean 5.6 years old) who underwent tonsils and adenoid (T&A) removal because of recurrent tonsillitis (RT) or T&A hypertrophy (TH). Tissues specimens were processed for non-isotopic in situ hybridization (ISH) using EBER 1/2 oligonucleotides (EBER RNA). The indications for surgery were RT in 42 patients and TH in 43 patients. In 25 out of 85 cases (29.4%) a positive EBER RNA reaction (15 RT and 33 TH) was found. The chi(2)-test showed no statistically significant difference in frequency of positive results between RT and TH group. We conclude that tonsils of children can be colonized by EBV and that the virus may be implicated in RT and TH.

Detection of Epstein–Barr virus and subsets of lymphoid cells in adenoid tissue of children under 2 years of age

Epstein-Barr virus (EBV) has been closely associated with undifferentiated nasopharyngeal carcinoma (NPC) and T/NK nasal non Hodgkin lymphoma. Nevertheless, the presence of EBV in non neoplastic lymphoid tissue of the nasopharynx has been rarely investigated. In a previous study by our group, using in situ hybridization to detect EBV in adenoids of children (2-13 years old) resected because of nasal obstruction due to hypertrophy, we found EBV genome in 72% of the cases. It was now intended to study the frequency of EBV expression in adenoids from children that underwent surgical removal, belonging to a lower age group (1-2 years old). It was also intended to establish which lymphoid subsets are involved in this infection. Adenoidal paraffin sections from 21 patients aged 1-2 years old (mean 1.6 years), 15 males and six females were submitted to double labeling: in situ hybridization with EBER 1/2 probes to detect EBV and immunohistochemistry to determine the lymphocyte typing of EBV-positive cells (CD20 for B-lymphocytes, CD3 for T-lymphocytes and CD56 and CD57 for NK-cells). Among 21 patients, seven showed positive lymphoid cells for EBV (33%). In almost all cases, EBV-positive cells were also CD20-positive. Some EBV-positive cells showed no labeling with any of the lymphoid markers, but in no instance they were positive for CD3, CD56 or CD57. This study confirms the preferential infection of B-lymphocytes by EBV, which in some instances can down regulate the expression of CD20.

The EBV action in tonsils and adenoids

Abstract The bacteria involved in tonsil disease have been well studied, but we cannot say the same for the viruses. The method to detect virus make this approach difficult to study. Epstein–Barr Virus (EBV) infection usually occurs in early childhood and can persist in palatine and pharyngeal tonsil lymphocytes. EBV has been closely associated with the undifferentiated form of nasopharyngeal carcinoma (NPC) in its effect. Nevertheless, the presence of EBV in non-neoplastic lymphoid tissue of the nasopharynx and tonsil has rarely been investigated. Our objective was to study the frequency of EBV in tonsils and adenoids and to define the correlation between EBV and adenoid hyperplasia. In this study, we looked for EBV in adenoid and tonsil tissue of 165 patients (2 and 15 years old ) by in situ hybridization (ISH) for EBER 1/2 RNA. Resection of the adenoids was done for relief of upper respiratory tract obstruction, and the tonsils were resected because of recurrent tonsillitis and/or hyperplasia with upper airway obstruction. We divided the adenoid samples in two groups: one group 12–24 months old (average 18 months old) and the second group, 25 months to 15 years old. Tonsils were obtained from 85 patients, 3–13 years old (mean age 5.6 years) who underwent surgery due to recurrent tonsillitis or hyperplasia. EBV was demonstrated in lymphoid cells of 11 (34.3%) out of 32 adenoids for the first group and 36 (72%) out of 48 children of the second group. EBV was found in the respiratory epithelial cells of adenoid in one case. Children under 24 months of age can be infected by EBV, and this virus might be responsible for obstructive hyperplasia. Tonsils are less affected by EBV than the adenoids, suggesting that the EBV is more attracted to the adenoid tissue than the tonsillar tissue.

[Antral choanal polyp--cause of nasal obstruction in children: report of 12 cases].

Nasal obstruction is a common pediatric clinical complaint that involves a great number of pathologies (allergic rhinopathy,adenoid hypertrophy, septal deformities, infectious sinusitis, tumours, choanal atresia, nasal foreign bodies, etc.). Not only the history, and a through physical examination but also, the subsidiary exams are of great value in the etiologic diagnostic. Antro-choanal polyp (Killians polyp) must be remembered in the differential diagnosis of nasal obstruction, when a sinus roentgenogram with unilateral maxillary opacification is seen. Clinically, the lesion often protrudes into the nasopharynx and in some cases it may even be seen extending into the oropharynx. The surgical procedure usually employed is a unilateral Caldwell-Luc antrostomy, with oropharyngeal remotion. We present 12 pediatric patients with antral-choanal polyps,and discuss history, radiology, nasal/nasopharyngeal endoscopic evaluation, considerations about the origin and surgical treatment of choice.

Detection of Epstein–Barr virus in children's adenoids by in situ hybridization

Abstract Adenoidal hypertrophy is the most frequent cause of superior airway obstruction in children. As a part of Waldeyers ring, adenoids play an important immunological role during childhood. Although this tissue serves as a defense against bacteria, viruses, and foreign bodies, it may present infections (adenoiditis). Sometimes adenoid increases in size due to immune response, allergic reaction, or an unknown mechanism. When the reason of increase is unknown, the term hypertrophy or idiopathic benign hyperplasia (IBH) is used. Among viral infections, Epstein–Barr virus (EBV) infection stands out. It is much more frequent in children than expected and can also be responsible for adenoidal hypertrophy. Primary infection by EBV occurs in early childhood, and is characterized by symptoms of the common cold and may be clinically silent. EBV infection has as a characteristic period of latency, and involves lymphoproliferation in the tissues. Frequently, an IBH can actually be caused by EBV. The purpose of this study was to detect the presence of EBV in adenoids of young and older children using in situ hybridization (ISH) to assess the possible influence of EBV in adenoidal hypertrophy. We selected children from 1 to 13 years old in two otorhinolaryngology services (private and public) who underwent adenoidectomy due to adenoidal hypertrophy (AH). We divided them into two age groups: 21 children aged between 12 and 24 months old (mean: 18 months), and 50 children aged between 25 months and 13 years old (mean: 6.6 years). After surgery, adenoids were fixed in formalin at 10% and processed for ISH techniques. We used Novocastra probes EBER. Rhinopharynx carcinoma was used as positivity control. In the first group of younger children, there were seven positive cases for EBV (33%), and in the second group, there were 36 positive cases for EBV (72%). In all cases, 61% was positive for EBV: 83% mildly positive, 8.5% moderately positive, and 8.5% strongly positive for EBV (number of infected lymphocytes). EBV has a tropism through the rhinopharynx and oral cavity, and our study enabled us to assess EBV frequency in the adenoids, and also to infer that children over 25 months old present a greater chance of being infected by EBV.

Otoscopy and tympanometry in the diagnosis of secretory otitis media

353 1. Profa Livre-docente de Otorrinolaringologia Pediátrica da UNICAMP. 2. Mestre em Fonoaudiologia pela Neurociência UNICAMP. A otoscopia é um recurso semiológico importante para a avaliação da membrana timpânica (MT). Através dela descrevemos a MT como uma membrana em forma de disco, semitransparente, branco acinzentado, que separa a orelha externa da orelha média. A MT apresenta uma depressão central (umbigo), que corresponde ao cabo do martelo, com a presença do triângulo luminoso, e é composta de duas porções: uma maior e inferior chamada parte tensa e outra menor e superior chamada parte flácida, que é separada pelos ligamentos tímpano-maleolares. No entanto, os detalhes com relação à inclinação (retração), perda de transparência por espessamentos da MT, alterações de coloração ou sinais indicativos de presença de líquido na caixa timpânica não são incisivamente abordados até pela exiguidade do tempo disponível para este tipo de ensino. No currículo das escolas médicas, geralmente, é enfatizado que quando a MT se apresenta hiperemiada e abaulada, isso indica infecção aguda (otite média aguda). Há quase três décadas a otite média secretora (otite com efusão no ouvido médio) tem sido muito citada na literatura e diagnosticada com maior freqüência. É claro que, paralelamente ao aparecimento dessa entidade, exames subsidiários foram desenvolvidos com o intuito de confirmar o diagnóstico, uma vez que a aparência da MT nesta patologia pode se apresentar com variabilidade muito grande e com detalhes sutis que acabam não sendo percebidos, a não ser por profissional da área, bem treinado. Assim a MT pode se apresentar retraída em vários graus, com retração total ou parcial num dos quadrantes; a MT pode estar espessada, de coloração rósea clara e até acinzentada; com vasos em disposição radiada, o que nos permite presumir a presença de líquido na caixa timpânica. Se há obstrução tubária sem a presença de líquido, a MT fica retraída, mas mantém, em geral, a transparência, indicando a ausência de efusão no ouvido médio. Um recurso semiológico prático, barato, é a pneumo-otoscopia. Através de uma pequena pera de borracha acoplada ao otoscópio, bem adaptado ao conduto auditivo externo (para impedir o escape de ar), podemos, pressionando o ar sobre a MT, verificar a mobilidade desta. É necessário que o examinador adquira experiência realizando estes exames em crianças com MT normal para obter parâmetros de mobilidade normal. O líquido dentro da caixa média traz diminuição da mobilidade e, também, a diminuição de audição em graus variados. A audiometria apresenta os inconvenientes de ser viável apenas a partir dos 3 a 4 anos de idade e de seus dados serem subjetivos. Segundo Bluestone 1(1973), a audiometria identifica apenas metade das crianças com efusão na orelha média. A timpanometria é uma medida objetiva, dinâmica, que avalia a mobilidade do conjunto tímpano-ossicular em resposta a graduais variações de pressão no meato acústico externo. O timpanograma é o gráfico que revela o grau de mobilidade ou a complacência (admitância) da orelha média. O timpanograma pode ser interpretado com base na altura do pico e sua relação com a linha horizontal. O princípio de interpretação do timpanograma está baseado na mobilidade da MT à pressão e no gradiente do pico 2. As primeiras classificações das diferentes curvas obtidas neste exame foram feitas por Lidén e cols. 3 e Jerger 4, separadamente, em 1970. Cada forma de curva estaria associada às diferentes condições do ouvido médio. A classificação de Jerger, em A,B e C, amplamente empregada, está baseada em dois pontos: altura do pico e a linha horizontal. A curva B seria uma curva que não tem pico (achatada) e está associada à presença de efusão no ouvido médio. Os Veja artigo relacionado na página 365 Otoscopia e timpanometria no diagnóstico de otite média secretora