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The effects of adenotonsillectomy on growth in young children
E F Williams1, P Woo, R Miller
1Department of Otolaryngology, State University of New York, Syracuse 13210.
Insights
Adenotonsillar hypertrophy often causes poor weight gain in children. Adenotonsillectomy significantly improved growth rates in young children with upper airway obstruction, suggesting a link between surgery and better weight gain.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Pulmonology
- Pediatric Endocrinology
Background:
- Chronic upper airway obstruction due to adenotonsillar hypertrophy is linked to poor weight gain in young children.
- Identifying underlying causes of suboptimum growth is crucial for pediatric health.
Purpose of the Study:
- To evaluate the impact of adenotonsillectomy on growth in children under three years old with adenotonsillar hypertrophy.
- To determine the relationship between adenotonsillectomy and improved weight gain in this pediatric population.
Main Methods:
- Retrospective review of 41 consecutive children under three years old undergoing inpatient adenotonsillectomy.
- Analysis of weight and height changes, focusing on percentile shifts post-surgery.
- Assessment of surgical indications, including upper airway obstruction and sleep apnea.
Main Results:
- Of 37 patients with follow-up, many showed significant growth improvement after adenotonsillectomy.
- 46% of patients were at or below the fifth percentile for weight pre-surgery.
- 75% of children experienced a rise in weight percentile post-surgery, with 65% showing a change of 15% or more.
Conclusions:
- Adenotonsillectomy is associated with a significant improvement in growth rate for children with upper airway obstruction from adenotonsillar hypertrophy.
- Upper airway obstruction should be considered in the workup of pediatric suboptimum growth.
Abstract:
A history of poor weight gain can often be elicited in young children with chronic upper airway obstruction resulting from adenotonsillar hypertrophy. A series of 41 consecutive children under 3 years of age, who underwent inpatient adenotonsillectomy, were reviewed for changes in weight and height. Thirty-seven patients had adequate long-term follow-up. Of these, many had dramatic improvements in growth after adenotonsillectomy. Indications for surgery in this group were recurrent infection in three patients (7%), unilateral tonsillar mass in one patient (3%), and upper airway obstruction in 37 patients (90%). A clear history of sleep apnea was elicited in 59%. At the time of surgery, 19 of 41 patients (46%) were of the fifth percentile or lower for age-corrected weight. The inpatient hospital stay averaged 3.2 days. The postoperative complication rate was 27%, with postoperative stridor as the most common complication. After surgery, 28 children (75%) showed a change to a higher percentile for weight. Twenty-four (65%) had percentile changes of 15% or more. This change is significant according to results of the Wilcoxon signed-rank test (p less than 0.001). We conclude that a relationship exists between improved growth rate and adenotonsillectomy in our study group. The rapid improvement in growth appears to be most obvious in children with upper airway obstruction resulting from adenotonsillar hypertrophy. Upper airway obstruction (including andenotonsillar hypertrophy) should be suspected as a possible cause in the workup of children with suboptimum growth.