Jeyasakthy Saniasiaya , Ed Toll , Craig McCaffer , Michel Neeff , Graeme van der Meer , Colin Barber , Hannah Burns
{"title":"Management of persistent tracheocutaneous fistula in children: Survey among paediatric otorhinolaryngologists","authors":"Jeyasakthy Saniasiaya , Ed Toll , Craig McCaffer , Michel Neeff , Graeme van der Meer , Colin Barber , Hannah Burns","doi":"10.1016/j.ijporl.2025.112583","DOIUrl":"10.1016/j.ijporl.2025.112583","url":null,"abstract":"<div><h3>Introduction</h3><div>Persistent tracheocutaneous fistula (TCF) is a common sequelae following paediatric tracheostomy, often leading to significant morbidity for both the child and their caregivers. Its presence can result in chronic airway issues, increased risk of infection, impaired phonation, cosmetic concerns, and a substantial psychosocial burden for families. We aim to evaluate the current practices, preferences, and variations among paediatric otorhinolaryngologists worldwide in the management of persistent (TCF) in children to identify areas of consensus and gaps that may guide future standardisation of care.</div></div><div><h3>Methods</h3><div>A 24-item cross-sectional survey was developed and distributed via a global WhatsApp™ group of paediatric otorhinolaryngologists between July and August 2024. The survey assessed surgical preferences, timing of intervention, preoperative investigations, and postoperative care. Descriptive statistics and chi-square tests were used to analyse practice variations based on years of experience and surgical preferences.</div></div><div><h3>Results</h3><div>Out of 319 members invited to participate, 121 paediatric otorhinolaryngologists completed the survey, yielding a response rate of 37.9 %. 121 Paediatric Otorhinolaryngologists answered the survey. Respondents were from six different continents, with the majority from Europe, 43 %. 68.6 % of the respondents have been practising for more than 10 years. The mean of tracheostomies performed in a year among the respondents was 10.6 per year. 46.5 % of respondents preferred primary closure and healing by secondary intention by 46.5 %, while 7 % preferred both surgical techniques. Airway assessment will be performed by 87 % of the respondents before the closure of TCF. The surgeons who performed more tracheostomies were found to prefer primary closure (p = 0.034). Choice of closure was not associated with years of experience, place of practice, underlying comorbidities, and investigations performed (p > 0.05).</div></div><div><h3>Conclusion</h3><div>There is significant variation in the management of persistent TCF among paediatric otorhinolaryngologists. Primary closure and healing by secondary intention were equally favoured, with surgical choice influenced by patient-specific factors, institutional resources, and regional practices, although surgeons who perform more tracheostomies prefer primary closure of TCF. Preoperative airway assessment was widely adopted, but postoperative follow-up protocols varied. Given the lack of standardised guidelines, a multicentre prospective study is warranted to establish evidence-based recommendations for optimal TCF management.Level of Evidence: V.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"198 ","pages":"Article 112583"},"PeriodicalIF":1.3,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Predicting surgical intervention in infants with laryngomalacia","authors":"Robert Brinton Fujiki , Michael D. Puricelli","doi":"10.1016/j.ijporl.2025.112582","DOIUrl":"10.1016/j.ijporl.2025.112582","url":null,"abstract":"<div><h3>Purpose</h3><div>Laryngomalacia management involves determining when symptoms can be conservatively monitored and when surgical intervention is necessary to promote weight gain, respiratory function, and overall health. This study examined factors predicting the need for surgical intervention in infants with laryngomalacia.</div></div><div><h3>Methods</h3><div>A retrospective cohort design was employed. Infants diagnosed with laryngomalacia were identified from the electronic medical record (EMR) of a tertiary children's hospital. Two groups of infants were identified; those without any history of surgical intervention (non-surgery group = 82) and those who had undergone supraglottoplasty (surgery group = 62). Laryngomalacia diagnosis was determined by pediatric otolaryngologists using distal chip fiberoptic laryngoscopy. Data extracted from the EMR included patient demographics, medical history, laryngomalacia symptoms, comorbidities, swallow assessments, and laryngomalacia-related care information.</div></div><div><h3>Results</h3><div>Initial presentation of laryngomalacia symptom severity (<em>p</em> < .001), history of respiratory illness (e.g., pneumonia or respiratory syncytial virus; <em>p</em> < .001), sleep-disordered breathing (<em>p</em> < .001), and an uncoordinated suck-swallow-breathe pattern during feeding (<em>p</em> = .009) significantly predicted likelihood of supraglottoplasty. Likelihood of supraglottoplasty increased 2.8 times in infants with severe laryngomalacia symptoms (<em>p</em> < .001), 5.6 times in patients with sleep-disordered breathing (<em>p</em> < .001), and 2.5 times in those with an uncoordinated suck-swallow-breathe patterns (<em>p</em> < .001) when compared to patients without these conditions. On average, infants requiring supraglottoplasty reported earlier symptom onset than those not requiring surgical intervention (<em>p</em> = .006).</div></div><div><h3>Conclusions</h3><div>Surgical intervention in infants with laryngomalacia was predicted by symptom severity, history of respiratory illness, sleep breathing, and suck-swallow-breathe coordination. These data may aid clinicians in determining course of treatment for patients with mild to moderate laryngomalacia.</div></div><div><h3>Level of evidence</h3><div>4.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"198 ","pages":"Article 112582"},"PeriodicalIF":1.3,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Oliver Greenwood , Bebek Bhattarai , Kerrie McAllister
{"title":"Using melatonin to induce sleep as an alternative to general anaesthesia in auditory brainstem response testing","authors":"Oliver Greenwood , Bebek Bhattarai , Kerrie McAllister","doi":"10.1016/j.ijporl.2025.112587","DOIUrl":"10.1016/j.ijporl.2025.112587","url":null,"abstract":"<div><h3>Objectives</h3><div>Auditory Brainstem Response (ABR) is an objective, non-invasive hearing test requiring the subject to remain still for accurate results. This poses challenges in children with neurodevelopmental disabilities. Traditionally, general anaesthesia (GA) was employed, but it carries risks, high costs, and long waiting times. Melatonin, with minimal side effects and no need for monitoring, offers a potential alternative. This study evaluates the feasibility and efficacy of melatonin-induced sleep as an alternative for GA in ABR testing.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted on 52 children with neurodevelopmental disabilities referred for ABR under melatonin-induced sleep at the Royal Hospital for Children, Glasgow, from July 2023 to November 2024. Pre-test sleep deprivation and a 9 mg dose of melatonin were used. Children with unsuccessful first tests were invited for a second attempt. If both attempts failed, GA was required.</div></div><div><h3>Results</h3><div>Of 47 attendees, 53 % achieved successful ABR testing on the first attempt, and 26.7 % at the second attempt. Cumulatively, 61.7 % did not require GA. No significant correlation was found between age, sex, or co-morbidities and success rates. Median GA ABR waiting times decreased by 25.8 %, and 26 children were removed from the GA waiting list. Cost analysis showed a 43.32 % saving per patient using melatonin-induced sleep compared to GA. Parent acceptability was high, irrespective of testing outcomes.</div></div><div><h3>Conclusions</h3><div>Melatonin-induced sleep is a feasible, cost-effective alternative to GA for ABR testing. Despite the relatively low success rates, it reduces waiting times, lowers costs, and minimises the need for GA.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"198 ","pages":"Article 112587"},"PeriodicalIF":1.3,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145217340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Asher T. Ripp , Ethan M. Kallenberger , Shaun A. Nguyen , Isabella V. Schafer , Clarice S. Clemmens , David R. White
{"title":"Topical nasal steroids for adenoid hypertrophy in children: A systematic review and meta-analysis","authors":"Asher T. Ripp , Ethan M. Kallenberger , Shaun A. Nguyen , Isabella V. Schafer , Clarice S. Clemmens , David R. White","doi":"10.1016/j.ijporl.2025.112580","DOIUrl":"10.1016/j.ijporl.2025.112580","url":null,"abstract":"<div><h3>Objective</h3><div>Adenoid hypertrophy (AH) is a common pathology in children leading to nasal obstruction, sleep disordered breathing, and obstructive sleep apnea. Symptomatic AH is often treated surgically, and several medical interventions have been investigated with varying results. The objective of this study is to provide a comprehensive meta-analysis of the use of intranasal corticosteroids (INCS) for AH.</div></div><div><h3>Data sources</h3><div>Cochrane, SCOPUS, PubMed, CINAHL.</div></div><div><h3>Review methods</h3><div>This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies of interest included those evaluating INCS for adenoid hypertrophy in children with the presence of a control group.</div></div><div><h3>Results</h3><div>A total of 16 studies comprising 1156 patients were included. INCS were evaluated in 636 patients, and 520 patients served as controls. The percentage of patients with severe AH in the INCS group saw a significantly greater decrease after treatment compared to the control group (−43.5 vs −13.3, [95 % CI: 19.8–39.7 %], p < 0.0001). The INCS group also experienced greater decreases in nasal obstruction (−1.6 vs −0.6) and nasal itching (−0.7 vs −0.2) compared to the control group (both p < 0.05). The rate of adenoidectomy following medical treatment was 22.3 % in the treatment group, compared to 98.6 % in the control group (76.2 % [95 % CI: 57.0–86.6 %] p < 0.0001).</div></div><div><h3>Conclusion</h3><div>INCS demonstrate efficacy in treating adenoid hypertrophy and its related sequelae in children. Improvements were noted in both subjective symptom severity and physiologic measurements of AH, indicating that INCS may reduce the need for surgery in selected patients.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"198 ","pages":"Article 112580"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christopher Ndoleriire , Peter Böttcher , Michaela Hinterholzer , Sophie Anyait , Simon Peter Namingira , Joel Musinzi
{"title":"Quality controlled neonatal hearing screening in children 0–3 months at post natal wards in Uganda: A multi-center study","authors":"Christopher Ndoleriire , Peter Böttcher , Michaela Hinterholzer , Sophie Anyait , Simon Peter Namingira , Joel Musinzi","doi":"10.1016/j.ijporl.2025.112579","DOIUrl":"10.1016/j.ijporl.2025.112579","url":null,"abstract":"<div><h3>Introduction</h3><div>Congenital and early-onset hearing loss in low- and middle-income countries constitutes the majority of global cases of permanent childhood hearing loss. Early detection through neonatal hearing screening programs is pivotal for timely intervention. However, such programs are infrequently implemented in low- and middle-income countries due to systemic challenges.</div></div><div><h3>Objective</h3><div>The primary goal was to evaluate the feasibility of establishing a comprehensive, quality-controlled newborn hearing screening (NHS) program in Uganda, following standards comparable to those in countries with well-established NHS systems.</div></div><div><h3>Methods</h3><div>This cross-sectional, multi-center study evaluated the performance of a quality-controlled neonatal hearing screening program in five public hospitals in Uganda. The study used a combined screening approach of Transient Evoked Otoacoustic Emissions and Automated Auditory Brainstem Responses. Data analyses were made by Microsoft Excel.</div></div><div><h3>Results</h3><div>This study analyzed data from 12,996 newborns. The findings revealed that newborn hearing screening coverage rates and referral rates across the five participating hospitals varied from 4.9 % to 23.2 % and 1.2 %–42.6 %, respectively. Notably, the loss to follow-up rates exhibited significant variation, spanning from 12.5 % to 90.7 % among the hospitals. Three children (0.23 per thousand) were identified with congenital hearing loss.</div></div><div><h3>Conclusion</h3><div>This study demonstrated both the feasibility and the necessity of implementing a quality controlled newborn hearing screening program in Uganda. Addressing challenges related to coverage rates, referral rates, and loss to follow-up rates is important in early detection and effective management of congenital hearing loss.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"198 ","pages":"Article 112579"},"PeriodicalIF":1.3,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pooja D. Reddy , Sarah Ung , Jiage Qian , Brian Ocasio-Nieves , Amber D. Shaffer , Marina V. Rushchak , Amanda L. Stapleton
{"title":"Does inferior turbinate reduction improve outcomes following adenotonsillectomy in pediatric OSA and allergic rhinitis patients?","authors":"Pooja D. Reddy , Sarah Ung , Jiage Qian , Brian Ocasio-Nieves , Amber D. Shaffer , Marina V. Rushchak , Amanda L. Stapleton","doi":"10.1016/j.ijporl.2025.112578","DOIUrl":"10.1016/j.ijporl.2025.112578","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate persistent obstructive and allergic rhinitis (AR) symptoms in pediatric patients with concurrent sleep disordered breathing (SDB) and AR, comparing adenotonsillectomy (T&A) alone to T&A and inferior turbinate reduction (ITR).</div></div><div><h3>Study design</h3><div>This retrospective cohort study examined patients ages 5–18 years who underwent T&A±ITR from 2007 to 2017. Exclusions were no AR (n = 1771), no SDB (n = 170), no otolaryngology clinic note (n = 60), tonsillectomy or adenoidectomy only (n = 53), no follow-up (n = 142), age <5 years (n = 5), syndrome (n = 9), concomitant airway surgery (n = 3), and ITR before T&A (n = 1).</div></div><div><h3>Setting</h3><div>UPMC Children's Hospital of Pittsburgh.</div></div><div><h3>Methods</h3><div>Chi-squared, Fisher's exact, Wilcoxon rank-sum, Wilcoxon signed-rank, McNemar's, and Spearman correlation tests were used (α = 0.05).</div></div><div><h3>Results</h3><div>Of the 269 patients, 42 had T&A with ITR, and 227 had T&A only (median age: 12 years, range 5–18 years). Pre-T&A±ITR, common medications were oral antihistamines (112/269, 41.6 %) and nasal corticosteroids (104/269, 38.7 %). In the T&A only group, fewer patients used oral antihistamines post-operatively compared with pre-operatively (χ<sup>2</sup> (1) = 30.6, p < 0.001). In both the T&A only (χ<sup>2</sup> (1) = 9.28, p = 0.002) and T&A with ITR (χ<sup>2</sup> (1) = 14.2, p < 0.001) groups, fewer patients used nasal corticosteroids post-operatively. No significant differences in complications or post-op AR symptoms or sleep abnormalities were observed between groups. Seven T&A-only patients underwent ITR in the following 5 years.</div></div><div><h3>Conclusions</h3><div>Both T&A with ITR and T&A alone resulted in reduced AR symptoms and improved AHI post-operatively. While no significant differences were observed in complications, post-op AR symptoms, or AHI between the groups, T&A with ITR significantly reduced post-operative nasal corticosteroid use. This study highlights the benefits of appropriate patient selection for T&A vs T&A with ITR in managing patients with SDB and AR.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"198 ","pages":"Article 112578"},"PeriodicalIF":1.3,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Evaluation of the relationship between otitis media with effusion and the need for cochleostomy in pediatric cochlear implant patients","authors":"Enver Can Öncül, Yüksel Olgun, Beyazıt Buğra Akbay, Enes Bilgin Türkmenoğlu, Özden Savaş, Erdoğan Özgür, Aslı Çakır Çeti̇n, Enis Alpin Güneri̇","doi":"10.1016/j.ijporl.2025.112575","DOIUrl":"10.1016/j.ijporl.2025.112575","url":null,"abstract":"","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"198 ","pages":"Article 112575"},"PeriodicalIF":1.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lindsey Herberger , Sydney Gilliam , Mehrdad Hosseini , Patrick Bishara , Soroush Farsi , Peter Eckard , Courtney Hunter , Gresham T. Richter
{"title":"Assessing the effectiveness of propranolol in treating pediatric airway hemangiomas: A systematic review and meta-analysis","authors":"Lindsey Herberger , Sydney Gilliam , Mehrdad Hosseini , Patrick Bishara , Soroush Farsi , Peter Eckard , Courtney Hunter , Gresham T. Richter","doi":"10.1016/j.ijporl.2025.112576","DOIUrl":"10.1016/j.ijporl.2025.112576","url":null,"abstract":"<div><h3>Objective</h3><div>Infantile hemangiomas are vascular tumors that present substantial challenges when they involve the airway. This systematic review and meta-analysis aims to explore the safety, efficacy, dosing protocols, and potential adverse effects of propranolol for management of pediatric airway hemangiomas.</div></div><div><h3>Methods</h3><div>Embase, PubMed, Cochrane, and Web of Science were thoroughly searched for articles from their inception up to March 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The quality of the included studies was evaluated using the Newcastle-Ottawa scale (NOS) criteria. In this review paper, successful treatment was defined as achieving full airway clearance to the extent that it no longer posed a threat to the patient's airway as assessed clinically by the treating physician.</div></div><div><h3>Results</h3><div>Of the 835 abstracts screened, 12 articles met inclusion criteria and encompassed 124 patients. The patients’ ages ranged from 2 months to 2.7 years (mean = 1 year). Most patients were female (n = 72, 58 %), and the mean treatment duration was 9.3 months. The pooled data indicated an overall airway clearance rate of 96.3 % (95 %CI 0.908–0.989, I2 = 0 %). Notably, the most reported method of medication delivery was 2 mg/kg/body weight/day divided into 3 oral doses. Furthermore, the pooled complication rate of 3.7 % (95 %CI: 0.010–0.092, I2 = 0 %, n = 4).</div></div><div><h3>Conclusion</h3><div>This meta-analysis strongly supports that propranolol provides a safe and effective approach to managing infantile hemangiomas of the airway. Propranolol can be given at 2 mg/kg/day divided in 3 doses for 6–12 months for 96 % complete clearance rate and limited rebounds after treatment cessation.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"198 ","pages":"Article 112576"},"PeriodicalIF":1.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145217341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Expression levels of MMP-1, MMP-3, and TIMP-1 in pediatric tonsillar tissue: A comparative study of tonsillar hypertrophy and chronic tonsillitis","authors":"Seren Karabiber Cicek , Gul Acar , Ilknur Bingul , Serdal Celik","doi":"10.1016/j.ijporl.2025.112573","DOIUrl":"10.1016/j.ijporl.2025.112573","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study is to investigate the tissue levels of Matrix Metalloproteinase-1 (MMP-1), Matrix Metalloproteinase-3 (MMP-3), and Tissue Inhibitor of Matrix Metalloproteinase-1 (TIMP-1) in cases of chronic tonsillitis and tonsillar hypertrophy, in order to elucidate their mechanisms of action in inflammatory processes.</div></div><div><h3>Materials and methods</h3><div>A total of 72 pediatric patients with an indication for tonsillectomy were included in the study. Of these, 36 patients diagnosed with chronic tonsillitis comprised the chronic tonsillitis (CT)group, while 36 patients diagnosed with tonsillar hypertrophy formed the tonsillar hypertrophy (TH) group. Punch biopsies were obtained from the tonsillar tissue following tonsillectomy in all patients. The samples were homogenized, sonicated, and centrifuged, and the supernatant fluid was analyzed for MMP-1, MMP-3, and TIMP-1 tissue levels using ELISA protocols.</div></div><div><h3>Results</h3><div>In this study, MMP-1, MMP-3 and TIMP-1 levels and the rates of these biomarkers were examined in the chronic tonsillitis and hypertrophic tonsil groups, and no statistically significant difference was found between this two groups. Although a weak positive correlation was noted between age and MMP/TIMP values in both clinical groups, this was not statistically significant. Median values of MMP-1, MMP-3, and TIMP-1 appeared higher in females, but this difference was not statistically significant when compared to males.</div></div><div><h3>Conclusion</h3><div>In this study, tissue levels of MMP-1, MMP-3, and TIMP-1 and their ratios were evaluated in children diagnosed with chronic tonsillitis and tonsillar hypertrophy, with no significant differences detected between the groups. The findings suggest that the MMP/TIMP system maintains a stable balance in tonsillar tissue during childhood and does not appear to distinguish between chronic tonsillitis and tonsillar hypertrophy in clinical practice.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"198 ","pages":"Article 112573"},"PeriodicalIF":1.3,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145155834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}