Papillary Hypertrophy of the Palatine Tonsil Associated with Upper Airway Obstruction.

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A 2-year-old female with chief complaints of sneezing and mouth breathing was the 55th case of papillary hypertrophy of the palatine tonsil (PHPT) to be reported in Japan. She had no past history of frequent tonsillitis and no family history of PHPT. Polysomnographic examination showed that the maximum amplitude of mesopharyngeal pressure was 127 cmH2O and the minimum level of oxygen saturation was 52%. The diagnosis was severe upper airway obstruction (UAO), so adenotonsillectomy was performed. Postoperative improvement was definitive. Histological examination revealed chronic proliferative tonsillitis plus papillary structures and slight thickness of the surface epithelium.The reports of 55 patients with PHPT published in Japan are reviewed. Clinical symptoms are described in 50 cases. Of the 26 children (under 13 years of age) 10 had a positive family history of recurrent tonsillitis, while the family history was negative in 22 of the 24 older patients. UAO was described in 10 (63%) of the 16 children without a family history. There was no past history of recurrent tonsillitis in 5 patients (56% of the children with UAO with no family history). The results of our investigation suggest that PHPT can also be caused by the mechanical stimulation due to the negative pressure induced by UAO, although the etiology of PHPT has been thought to be mainly inflammatory stimulus or congenital anomaly.UAO in PHPT patients was relieved by tonsillectomy, although the adult type of UAO is usually not improved by tonsillectomoy alone. Thus, the etiology may be different between UAO in patients with PHPT and in those with the so-called adult type of UAO.
耳鼻咽喉科臨床学会の論文

Papillary Hypertrophy of the Palatine Tonsil Associated with Upper Airway Obstruction.

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