Pulmonary arterial hypertension in children with adenoid and or tonsillar hypertrophy attending ear, nose and throat clinic at Mulago hospital.
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Background to the study Adenotonsillar hypertrophy, a common child hood condition, is the leading cause of upper airway obstruction in children. This may results into a devastating and fatal complication of pulmonary arterial hypertension (PAH) and eventually cor pulmonale. In Uganda, there was no published study regarding the prevalence of pulmonary arterial hypertension and its associated clinical radiological features in children with adenoid and or tonsillar hypertrophy, hence there was a need to carry out this study. Objective To determine the prevalence of pulmonary arterial hypertension and associated clinicalradiological features of adenoid and or tonsillar hypertrophy in children attending Ear, Nose and Throat (ENT) clinic at MulagoNational Referral Hospital (MNRH). Methods This was a cross sectional study conducted among children aged 1 to 14 years with clinicalradiological diagnosis of adenoid and or tonsillar hypertrophy attending the Ear, Nose and Throat outpatient clinic at Mulago National Referral Hospital. Doppler echocardiography was used to determine pulmonary arterial hypertension defined as Pulmonary artery acceleration time (PAAT) to Right ventricular ejection time (RVET)-index below 0.29 .Children with PAAT/RVET-index below 0.29 were compared to those with PAAT/RVET-index above 0.29 then clinical and radiological features of adenoid and or tonsillar associated with pulmonary arterial hypertension was determined using multivariable logistic regression analysis. Results: The prevalence of PAH among the 140 children with adenoid and or tonsillar hypertrophy attending ENT clinic at MNRH was 11.4% (95% Cl 7.8-17.9). Children with presence of mouth breathing on physical examination, were six times more likely to have PAH (OR=6.36 CI 95% =1.52-26.45 P-value =0.0I1). The degree of adenoid hypertrophy is not directly proportional to presence of PAH. Conclusion: The prevalence of PAH among children with adenoid and or tonsillar hypertrophy attending ENT clinic at Mulago National referral Hospital is 11.4% and is associated with presence of mouth breathing on physical examination.