Patient evaluations
Besides polysomnography, those patients who were able to cooperate had flexible laryngobronchoscopy, otoscopy, tympanograms, and audiometry. The following evaluations were carried out: the annual number of upper respiratory tract infections (URTIs) and OME episodes; the degree of adenoid hypertrophy (Grade 1: none of the adjacent structures such as vomer, soft palate and torus tubaris contact with the adenoid tissue; Grade 2: the adenoid tissue contacts with the torus tubaris; Grade 3: the adenoid tissue contacts with torus tubaris and vomer; Grade 4: the adenoid tissue contacts with torus tubaris, vomer and soft palate in resting position) [14]; the degree of tonsillar hypertrophy (Grade 0: absence of tonsillar tissue; Grade 1: within the pillars; Grade 2: extended to the pillars; Grade 3: extended past the pillars; Grade 4: extended to the midline) [15]; the apnea-hypopnea index (AHI, number of obstructive apnea and hypopnea events per hour of sleep), and oxygen saturation (Sat % O2) to identify obstructive sleep apnea syndrome (OSAS).
We also used the infection score system [16] to evaluate the severity of respiratory tract and otological infections. This includes an evaluation of type of infection, systemic symptoms, daily activity, therapy, hospitalization, and resolution time (Table 1; Total score ≤ 5: mild respiratory tract and/or otological infection; Total score 6-11: moderate respiratory tract and/or otological infection; Total score = 12: severe respiratory tract and/or otological infection).