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Long-Term Outcomes of Medical Treatment of Adenotonsillar Hypertrophy in Children With Obstructive Sleep Disordered

Andrew C Li1,2, Glenn Isaacson1,2

  • 1Department of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.

Ear, Nose, & Throat Journal
|June 14, 2025
PubMed

Insights

Medical treatment with antibiotics and steroids can resolve snoring in children with mild obstructive sleep disordered breathing (oSDB), potentially avoiding surgery. Over a third of patients avoided adenotonsillectomy, suggesting this approach is a viable alternative for mild oSDB.

Area of Science:

  • Pediatric Otolaryngology
  • Sleep Medicine

Background:

  • Adenotonsillectomy is the standard treatment for obstructive sleep disordered breathing (oSDB) in children, particularly severe cases.
  • The optimal management for children with milder oSDB remains less defined.
  • Medical management using antibiotics and oral steroids is an alternative approach for select pediatric patients.

Purpose of the Study:

  • To evaluate the immediate and long-term effectiveness of medical treatment for mild obstructive sleep disordered breathing (oSDB) in children.
  • To assess the impact of antibiotic and oral steroid therapy on snoring resolution and the need for surgery.

Main Methods:

  • A retrospective review of 169 pediatric patients with mild oSDB treated between 2000 and 2023.
  • Data collected included tonsil size (Brodsky grade) before and after treatment, snoring resolution, and surgical outcomes.
  • Follow-up phone calls were conducted to complete missing patient information.

Main Results:

  • Among children with acute symptoms (≤2 months), 38% experienced snoring resolution, and 42% avoided surgery. Mean tonsil size decreased from 2.58 to 2.20.
  • In children with chronic symptoms, 34% had snoring resolution, and 30% did not require surgery. Mean tonsil size decreased from 2.58 to 2.13.
  • The medical intervention involved a short course of amoxicillin-clavulanate and a 5-day course of prednisolone.

Conclusions:

  • Medical treatment with amoxicillin-clavulanate and prednisolone is a safe option for mild oSDB in children.
  • This approach can lead to snoring resolution and surgery avoidance in a significant proportion of pediatric patients.
  • Findings support the need for prospective, randomized trials comparing medical treatment to immediate surgical intervention for mild oSDB.
Abstract

Keywords:
adenotonsillar hypertrophyantibioticscorticosteroidsobstructive sleep apneasleep disordered breathing

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