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Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
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Evaluation and management of pediatric obstructive sleep apnea beyond tonsillectomy and adenoidectomy

Sally R Shott1

  • 1Department of Otolaryngology Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Ohio 45229, USA. Sally.Shott@cchmc.org

Current Opinion in Otolaryngology & Head and Neck Surgery
|November 5, 2011
PubMed

Insights

Persistent obstructive sleep apnea (OSA) in children after tonsil and adenoid removal requires specific evaluation and management. Awareness and established protocols are crucial for addressing this growing pediatric concern.

Area of Science:

  • Pediatric Otolaryngology
  • Sleep Medicine
  • Respiratory Physiology

Background:

  • Persistent obstructive sleep apnea (OSA) in children post-tonsillectomy and adenoidectomy (T&A) is an increasing concern.
  • Pediatric OSA research and treatment lag behind adult populations.
  • Effective therapies for residual pediatric OSA are not yet fully established.

Purpose of the Study:

  • To review risk factors for persistent pediatric OSA after T&A.
  • To discuss evaluation techniques for identifying airway obstruction sites in children.
  • To present medical and surgical management options for residual pediatric OSA.

Main Methods:

  • Review of current literature on pediatric OSA post-T&A.
  • Discussion of airway evaluation techniques suitable for children (e.g., endoscopy, cine MRI).
  • Analysis of medical and surgical treatment modalities.

Main Results:

  • Identified risk factors for persistent OSA after T&A.
  • Presented specialized pediatric airway evaluation methods due to cooperation limitations.
  • Outlined medical and surgical interventions, noting limited pediatric outcome data.
  • Highlighted increased risk of oropharyngeal stenosis with single-stage multilevel surgery in children.

Conclusions:

  • Clinicians must recognize the possibility of persistent OSA in children despite T&A.
  • Pediatric-specific evaluation protocols are necessary, utilizing methods like endoscopy and cine MRI.
  • Conservative, multistage surgical approaches may be preferable to single-stage multilevel surgery in children to mitigate stenosis risk.
Abstract

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