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Published on: December 6, 2016
Polysomnographic studies in children undergoing adenoidectomy and/or tonsillectomy
1Department of Otolaryngology, and Lady Hardinge Medical College and Associated Smt. Sucheta Kriplani and Kalawati Saran Children's Hospitals, New Delhi, India.
Insights
Adenoid size, not tonsil size, significantly correlates with obstructive sleep apnea (OSA) severity in children. Surgical removal of adenoids and tonsils led to significant improvements in sleep apnea symptoms.
Area of Science:
- Otolaryngology
- Pediatric Sleep Medicine
- Respiratory Medicine
Background:
- Obstructive sleep apnea (OSA) is a common condition in children, often associated with enlarged tonsils and adenoids.
- Accurate assessment of airway obstruction is crucial for effective treatment planning.
Purpose of the Study:
- To evaluate the correlation between tonsil and adenoid size and the severity of obstructive sleep apnea (OSA) in children.
- To assess the post-operative improvement in OSA after adenoidectomy and/or tonsillectomy.
Main Methods:
- Pre- and post-operative polysomnography was performed on 40 children (aged 4-12 years) undergoing adenoidectomy/tonsillectomy.
- Clinical tonsil grading (I-IV) and radiographic adenoid measurements were conducted.
- A specific adenoid size ratio was calculated and correlated with OSA severity (apnea index).
Main Results:
- 75% of children presented with obstructive symptoms, and 73.3% of these had OSA.
- A significant correlation was found between relative adenoid size (ratio > 0.64) and OSA.
- No correlation was observed between tonsil size and OSA severity.
- All patients showed significant improvement in polysomnography scores post-surgery.
Conclusions:
- Relative adenoid size is a significant predictor of OSA severity in children.
- Adenoidectomy and/or tonsillectomy effectively improve OSA symptoms and polysomnographic outcomes.
- Tonsil size does not appear to be a reliable indicator of OSA severity in this pediatric cohort.
Abstract:
Forty children (age group four to 12 years) undergoing adenoidectomy and/or tonsillectomy were subjected to pre- and post-operative polysomnography. Thorough clinical evaluation and X-ray soft tissue nasopharynx lateral view was carried out for all the patients. The tonsils were clinically graded from grade I to IV, whereas the adenoids were measured radiographically (using three different measurements) in all children. Thirty out of 40 (75 per cent) children presented with predominant obstructive symptoms, out of whom 22 (73.3 per cent) were found to have obstructive sleep apnoea (OSA), i.e. apnoea index > five per hour. The remaining 10 (25 per cent) had predominantly inflammatory symptoms on presentation and out of these two (20 per cent) were found to have OSA. Relative adenoid size expressed as a ratio between the distance from the point of maximum thickness of adenoids along a line drawn along a straight part of the basiocciput and distance from the posterior nasal spine to the antero-inferior edge of the sphenobasioccipital synchondrosis, was found to have a highly significant correlation with the grade of OSA. In our study, all patients with this ratio greater than 0.64 were found to have OSA. No correlation between tonsil size and grade of OSA was found. There was a highly significant improvement in polysomnographic scores following surgery in all patients.
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