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Ultrasonographic changes of upper airway structures in children with obstructive sleep apnea after adenotonsillectomy

Che-Yi Lin1, Kun-Tai Kang2, Wen-Chin Weng3

  • 1Department of Otolaryngology, National Taiwan University Hospital and Children's Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.

Journal of the Formosan Medical Association = Taiwan Yi Zhi
|July 30, 2025
PubMed

Insights

Adenotonsillectomy increases neck thickness, but ultrasonography shows decreased upper airway collapsibility in children with obstructive sleep apnea. These changes do not predict surgical outcomes for pediatric sleep apnea.

Area of Science:

  • Pediatric Otolaryngology
  • Sleep Medicine
  • Diagnostic Imaging

Background:

  • Adenotonsillar hypertrophy is a primary cause of pediatric obstructive sleep apnea (OSA).
  • A significant percentage of children experience persistent polysomnographic alterations post-adenotonsillectomy.
  • Evaluating upper airway structural changes post-surgery is crucial for understanding residual OSA.

Purpose of the Study:

  • To assess ultrasonographic changes in pediatric upper airway structures after adenotonsillectomy.
  • To investigate the association between these ultrasonographic findings and sleep parameters.
  • To determine if ultrasound measurements can predict surgical outcomes in pediatric OSA.

Main Methods:

  • A cohort of 55 children (<18 years) with sleep-disordered breathing underwent polysomnography and upper airway ultrasonography.
  • Measurements were taken before and 3 months after adenotonsillectomy.
  • Oropharyngeal and lateral pharyngeal wall thicknesses were assessed, including changes during Müller maneuver.

Main Results:

  • Oropharyngeal neck thickness significantly increased post-adenotonsillectomy (p < 0.05).
  • Lateral pharyngeal wall thickness and collapsibility during Müller maneuver decreased, particularly in children without residual OSA (p < 0.05).
  • No significant associations were found between ultrasonographic parameters and residual obstructive sleep apnea post-surgery.

Conclusions:

  • Adenotonsillectomy leads to increased oropharyngeal neck thickness.
  • Ultrasonography indicates reduced upper airway collapsibility in children with OSA post-surgery.
  • Current ultrasonographic parameters cannot independently predict surgical outcomes for pediatric obstructive sleep apnea.
Abstract

Keywords:
ChildrenObstructive sleep apneaUltrasonographyUpper airway structuresadenotonsillectomy

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