Related Experiment Video
Updated: Mar 17, 2026
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Adenoidectomy for Obstructive Sleep Apnea in Children
Keren Armoni Domany1, Elad Dana1, Riva Tauman1
1Department of Pediatric Pulmonology, Critical Care and Sleep Medicine Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.
Insights
Adenoidectomy alone is a reasonable treatment for some children with obstructive sleep apnea (OSA), particularly those who are not obese and have smaller tonsils. Outcomes are comparable to adenotonsillectomy in specific pediatric patient groups.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Surgical Outcomes Research
Background:
- Obstructive sleep apnea (OSA) in children is commonly treated with adenotonsillectomy.
- Adenoidectomy alone may offer lower morbidity, mortality, and cost.
- The efficacy of adenoidectomy alone for pediatric OSA requires further investigation.
Purpose of the Study:
- To evaluate if adenoidectomy alone is a suitable treatment for children diagnosed with moderate-to-severe obstructive sleep apnea (OSA).
- To compare the long-term outcomes of adenoidectomy versus adenotonsillectomy in pediatric OSA patients.
Main Methods:
- A cohort of 515 children with moderate-to-severe OSA underwent either adenoidectomy or adenotonsillectomy.
- Patients were reassessed for residual/recurrent OSA using the Pediatric Sleep Questionnaire (PSQ) after a mean of 41 months.
- Factors like age, obesity, tonsil size, and OSA severity were analyzed for their impact on treatment failure.
Main Results:
- Overall, 15% of patients had a positive PSQ score, indicating OSA resolution failure.
- Adenoidectomy alone showed comparable failure rates to adenotonsillectomy in non-obese children under 7 with mild OSA and small tonsils (apnea-hypopnea index < 10, tonsil size < 3).
- Children with more severe OSA (apnea-hypopnea index ≥ 10) and/or larger tonsils (size ≥ 3) had a significantly higher failure rate with adenoidectomy alone (20% vs. 9.8%, p=0.028).
Conclusions:
- Adenoidectomy alone can be a reasonable and effective treatment option for select pediatric OSA patients, specifically non-obese children under 7 with moderate OSA and small tonsils.
- Treatment success is influenced by baseline OSA severity and tonsil size.
- Further prospective randomized trials are needed to precisely identify candidates for adenoidectomy alone and predict outcomes.
Study Objective:
Adenotonsillectomy is the recommended treatment for children with obstructive sleep apnea (OSA). Since adenoidectomy alone may be associated with significantly lower morbidity, mortality, and cost, we aimed to investigate whether adenoidectomy alone is a reasonable and appropriate treatment for children with OSA.
Methods:
Five-hundred fifteen consecutive children diagnosed with moderate-to-severe OSA (apnea-hypopnea index > 5) based on polysomnography and who underwent adenoidectomy or adenotonsillectomy were reevaluated after 17-73 months (mean 41) for residual or recurrent OSA using a validated questionnaire (Pediatric Sleep Questionnaire, PSQ). Failure of OSA resolution was defined as a positive mean PSQ score ≥ 0.33. Contribution of age, obesity, tonsil size, and OSA severity at baseline to adenoidectomy or adenotonsillectomy failure was examined.
Results:
Positive PSQ score occurred in 15% of the entire sample and was not influenced by age or gender. No difference in failure rate was observed between adenoidectomy and adenotonsillectomy for children who were not obese with apnea-hypopnea index < 10 and had small tonsils (< 3). Children with apnea-hypopnea index ≥ 10 and/or tonsil size ≥ 3 showed a higher failure rate after adenoidectomy compared to adenotonsillectomy (20% versus 9.8%, p = 0.028).
Conclusions:
We suggest that subjective, long term outcomes of adenoidectomy are comparable to those of adenotonsillectomy in non-obese children under 7 years old with moderately OSA and small tonsils. Hence, adenoidectomy alone is a reasonable option in some children. Future prospective randomized studies are warranted to define children who may benefit from adenoidectomy alone and those children in whom adenoidectomy alone is unlikely to succeed.
Related Concept Videos
01:21Sleep Apnea
The condition is more prevalent among...
01:25Suctioning the Oropharyngeal Airway
After assembling the equipment, the nurse should practice hand hygiene and don appropriate PPE according to infection control guidelines to avoid the...
01:29Suctioning the Nasopharyngeal Airway
Equipment Required
01:23Chronic Pharyngitis
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...
01:30Tonsillitis I: Introduction
Etiology
Three primary contributing factors have been identified.
01:26Tonsillitis II: Management