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Child behavior and quality of life before and after tonsillectomy and adenoidectomy
Nira A Goldstein1, Mahnur Fatima, Thomas F Campbell
1Division of Pediatric Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, NY 11203-2098, USA. ngoldstein@netmail.hscbklyn.edu
Insights
Tonsillectomy and adenoidectomy improved child behavior and quality of life in children with sleep-disordered breathing. Standardized behavior assessments correlated with quality-of-life measures post-surgery.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Child Psychology
Background:
- Sleep-disordered breathing significantly impacts children's behavior and quality of life.
- Tonsillectomy and adenoidectomy are common interventions for pediatric sleep-disordered breathing.
Purpose of the Study:
- To assess the relationship between child behavior and quality of life before and after tonsillectomy and adenoidectomy.
- To evaluate the effectiveness of tonsillectomy and adenoidectomy in improving behavioral and emotional difficulties in children.
Main Methods:
- A before-after study design was employed.
- Sixty-four children undergoing tonsillectomy and adenoidectomy completed the Child Behavior Checklist (CBCL) and OSA-18 quality-of-life survey preoperatively and 3 months postoperatively.
Main Results:
- Post-surgery, children showed a significant decrease in total behavior problem scores (7.3 points, P<.001).
- The percentage of children with abnormal behavior scores decreased from 25% preoperatively to 8% postoperatively (P=.03).
- Preoperative OSA-18 scores and CBCL scores showed fair to good correlation (r=0.50), as did the change scores (r=0.54).
Conclusions:
- Behavioral and emotional difficulties in children with sleep-disordered breathing improve after tonsillectomy and adenoidectomy.
- Validated quality-of-life instruments correlate with standardized behavioral assessments in this pediatric population.
Objective:
To determine the relationship between child behavior and quality of life before and after tonsillectomy and adenoidectomy by means of a standardized assessment of child behavior, the Child Behavior Checklist (CBCL), and a validated quality-of-life survey of pediatric obstructive sleep apnea, the OSA-18.
Design:
Before-after study.
Setting:
Hospital-based pediatric otolaryngology practice in a metropolitan area.
Participants:
Sixty-four children (mean [SD] age, 5.8 [3.1] years; 36 boys, 28 girls) who underwent tonsillectomy and adenoidectomy for treatment of sleep-disordered breathing or recurrent tonsillitis.
Intervention:
Parents or caretakers completed the OSA-18 and the CBCL for ages 2 to 3 years or 4 to 18 years before surgery and 3 months postoperatively.
Main Outcome Measures:
The OSA-18 mean survey scores and change scores, and the CBCL total problem T scores and change in total problem T scores.
Results:
The mean (SD) preoperative OSA-18 score was 3.9 (1.5) and change score was 2.3 (95% confidence interval, 1.9-2.7). The mean total problem score was 7.3 points lower after surgery (95% confidence interval, 4.9-9.7), indicating a significant decrease (P<.001, matched t test). The preoperative CBCL total problem score was consistent with abnormal behavior for 16 children (25%), but only 5 children (8%) scored in the abnormal range postoperatively (P =.03, log-likelihood ratio test). The OSA-18 preoperative mean survey score had fair to good correlation with the preoperative CBCL total problem T score (r = 0.50, P<.001, Pearson correlation), and the OSA-18 change score had fair to good correlation with the change in CBCL total problem T score (r = 0.54, P<.001, Pearson correlation).
Conclusions:
Behavioral and emotional difficulties are found in children with sleep-disordered breathing before treatment and improve after intervention. Scores on a standardized measure of assessment of behavior demonstrate significant correlation with scores on a validated quality-of-life instrument.