Clin Exp Otorhinolaryngol.  2021 Aug;14(3):295-302. 10.21053/ceo.2020.01634.

Correlations Between the Adenotonsillar Microbiome and Clinical Characteristics of Pediatric Patients With Snoring

• Kim KS
• Min HJ

• KMID: 2519184
• DOI: http://doi.org/10.21053/ceo.2020.01634

Abstract

Objectives
. Few studies have reported combined analyses of the microbiome of the adenoids and tonsils in pediatric patients with snoring, and correlations of the adenotonsillar microbiome with clinical characteristics have not been evaluated to date. The aim of this study was to characterize the adenotonsillar microbiome and to determine its correlations with the subjective symptoms of pediatric patients with snoring and with levels of regional mucosal immune molecules.
Methods
. Twenty-four children who underwent tonsillectomy with adenoidectomy owing to snoring were enrolled in this cross-sectional study conducted between August 2017 and December 2018. The microbiome of the adenoids and tonsils was characterized, and its alpha- and beta-diversity was determined. Clinical characteristics, including subjective discomfort during sleep (assessed using the obstructive sleep apnea-18 questionnaire), the presence of allergic rhinitis, concentrations of heat shock protein (Hsp)27, Hsp70, and interleukin-8 (IL-8) in lavage fluids, and white blood cell (WBC) counts, were measured.
Results
. At the phylum level, the microbiome was not significantly different between the adenoids and tonsils; the alpha and beta indices were likewise not significantly different between these two regions. The alpha-diversity of the entire adenotonsillar microbiome was associated with sex, emotional stress, and IL-8 levels in the tonsil lavage fluids. Beta-diversity was associated with Hsp27 levels in the tonsil lavage fluids and WBC counts. Multiple allergen simultaneous test results were not significant, although total serum immunoglobulin E levels were significantly associated with the beta-diversity of the adenotonsillar microbiome.
Conclusion
. The data reported herein suggest, for the first time, that the adenotonsillar microbiome interacts with the regional mucosal immune system. The observed association of the microbiome with subjective discomfort is a novel finding that warrants further investigation.

Keyword

Adenoid; Snoring; Tonsil; Microbiome

Figure

• 

  Fig. 1. Bacterial community composition of the tonsils and adenoids of 24 patients at the phylum level (A) and genus level (B). The dominant phyla and genera within the samples are shown. (C) Linear discriminant analysis (LDA) score. Histogram of the LDA scores for genera that were differentially abundant between the tonsils and adenoids. Negative (blue bars) and positive (gray bars) LDA scores represent bacterial groups in the adenoids and tonsils, respectively.

• 

  Fig. 2. Alpha-diversity in the adenoid and tonsil samples. No significant difference was observed between the adenoid and tonsil samples based on the Chao 1 (A), observed operational taxonomic units (OTUs) (B), and Shannon diversity index (C) measures.

• 

  Fig. 3. Beta-diversity (dissimilarity of intra-individual adenotonsillar microbiomes) in the adenoid and tonsil samples. Principal component analysis of Bray-Curtis (A), unweighted UniFrac (B), and weighted UniFrac (C) distances. Each point represents an individual’s microbiota. ANOSIM, analysis of similarities.

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