title: The ubiquity of asymptomatic respiratory viral infections in the tonsils and adenoids of children and their impact on airway obstruction.
abstract: BACKGROUND
  Airway obstruction due to enlargement of tonsils and adenoids is a common pediatric problem resulting in sleep disordered breathing. The cause for the relatively abnormal growth of tonsils and adenoids is poorly understood.
  
  
  METHODS
  Non-acutely ill children undergoing tonsillectomy and adenoidectomy (T&A) for various reasons were enrolled prospectively in a study to determine the frequency of asymptomatic respiratory viral infections in each lymphoid tissue and to relate the number and types of virus to the degree of airway obstruction. Molecular techniques were used to detect 9 respiratory viruses while Brodsky scores and measurements of percentages airway obstruction were used to estimate the degree of airway compromise due to the tonsil and adenoid, respectively.
  
  
  RESULTS
  Viruses were detected in 70.9% of tonsils and 94.7% of adenoids, p < 0.001. Adenovirus was the most common virus detected at 71.1%. Adenoids had an average of 2.4 viruses compared to 0.92 for tonsils, p < 0.001. Higher Brodsky scores were only associated with EBV in tonsils, p = 0.03, while greater percentages of airway obstruction in the adenoids were associated with adenovirus, EBV, corona virus, parainfluenza virus and rhinovirus, p ≤ 0.005.
  
  
  CONCLUSIONS
  Asymptomatic viral infections are common and directly related to the degree of airway obstruction significantly more often in adenoids than tonsils.
authors.affiliation: State University of New York, School of Medicine, Buffalo, NY, USA; Women & Children's Hospital of Buffalo/Kaleida Health, 219 Bryant St., Buffalo, NY 14222, USA. Electronic address: hfaden@upa.chob.edu.
authors.forename: Howard
authors.initials: H
authors.lastname: Faden
authors.affiliation: Women & Children's Hospital of Buffalo/Kaleida Health, 219 Bryant St., Buffalo, NY 14222, USA. Electronic address: vcallanan@kaleidahealth.org.
authors.forename: Vincent
authors.initials: V
authors.lastname: Callanan
authors.affiliation: Women & Children's Hospital of Buffalo/Kaleida Health, 219 Bryant St., Buffalo, NY 14222, USA. Electronic address: mikepizzuto@roadrunner.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Pizzuto
authors.affiliation: Women & Children's Hospital of Buffalo/Kaleida Health, 219 Bryant St., Buffalo, NY 14222, USA. Electronic address: nagys6@verizon.net.
authors.forename: Mark
authors.initials: M
authors.lastname: Nagy
authors.affiliation: Women & Children's Hospital of Buffalo/Kaleida Health, 219 Bryant St., Buffalo, NY 14222, USA. Electronic address: mwilby@kaleidahealth.org.
authors.forename: Mark
authors.initials: M
authors.lastname: Wilby
authors.affiliation: Laboratory of Viral Diseases, Wadsworth Center, New York State Department of Health, 120 New Scotland Avenue, Albany, NY 12208, USA. Electronic address: daryl.lamson@health.ny.gov.
authors.forename: Daryl
authors.initials: D
authors.lastname: Lamson
authors.affiliation: Women & Children's Hospital of Buffalo/Kaleida Health, 219 Bryant St., Buffalo, NY 14222, USA; D'Youville College, 320 Porter Ave., Buffalo, NY 14201, USA. Electronic address: wrotniak@dyc.edu.
authors.forename: Brian
authors.initials: B
authors.lastname: Wrotniak
authors.affiliation: North Shore-LIJ Health Systems and Hofstra University School of Medicine, 500 Hofstra University, Hempstead, NY 11549, USA. Electronic address: sjuretschko@nshs.edu.
authors.forename: Stefan
authors.initials: S
authors.lastname: Juretschko
authors.affiliation: Laboratory of Viral Diseases, Wadsworth Center, New York State Department of Health, 120 New Scotland Avenue, Albany, NY 12208, USA. Electronic address: kirsten.st.george@health.ny.gov.
authors.forename: Kirsten
authors.initials: K
authors.lastname: St George
mesh_terms: D000233:Adenoidectomy; D000234:Adenoids / Q000473:pathology; D000258:Adenovirus Infections, Human / Q000453:epidemiology; D000293:Adolescent; D000402:Airway Obstruction / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D058345:Asymptomatic Infections / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D018352:Coronavirus Infections / Q000453:epidemiology; D004769:Enterovirus Infections / Q000453:epidemiology; D020031:Epstein-Barr Virus Infections / Q000453:epidemiology; D005260:Female; D006801:Humans; D006984:Hypertrophy; D007223:Infant; D007251:Influenza, Human / Q000453:epidemiology; D008199:Lymphadenitis / Q000453:epidemiology* / Q000821:virology; D008297:Male; D014066:Palatine Tonsil / Q000473:pathology; D018184:Paramyxoviridae Infections / Q000453:epidemiology; D010850:Picornaviridae Infections / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology; D012891:Sleep Apnea Syndromes / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D014068:Tonsillectomy; D014069:Tonsillitis / Q000453:epidemiology* / Q000821:virology; D014481:United States / Q000453:epidemiology; D014777:Virus Diseases / Q000453:epidemiology* / Q000821:virology
keywords: Adenoid; Airway obstruction; Obstructive sleep apnea; Recombinant adenovirus; Respiratory virus; Sleep-disordered breathing; Tonsil; Tonsil and adenoid hypertrophy