This is the first study to review malpractice litigation resulting from injuries sustained during ESS and shows a hitherto unexpected pattern between severity of injury and case outcome.

To evaluate residual OSA in a subgroup of children younger than 3 years after T&A and identify predictors of postoperative residual disease. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of medical records at a tertiary academic children's hospital involving children younger than 3 years who had OSA documented by polysomnogram(PSG) and underwent T&A during the period October 1, 2002, through June 30, 2010. Some of these children had both preoperative and postoperative PSGs. MAIN OUTCOMES AND MEASURES Effect of T&A on sleep study parameters and predictors of persistent disease after surgery. RESULTS A total of 283 patients (mean [SD] age, 22 [7] months) underwent a preoperative PSG, with 70 of these patients having both a preoperative and postoperative PSG. In the group who had preoperative and postoperative PSGs, there were statistically significant improvements in mean (SD) apnea hypopnea index (AHI) (34.8 [40.7] to 5.7 [13.8]; P < .001), baseline oxygen saturation (96.6%[2.1%] to 97.2%[1.4%]; P = .05), minimum oxygen saturation (77.2%[11.4%] to 89.9%[6.8%]; P < .001), and sleep efficiency (84.7%[14.9%] to 88.7%[9.1%]; P = .02) after T&A. When AHI greater than 5 was used as the definition of OSA, 21% of the patients (15 of 70) had residual OSA. The most consistent predictor of residual OSA after T&A was the severity of preoperative OSA (P = .02). CONCLUSIONS AND RELEVANCE In a subgroup of children younger than 3 years with OSA, we found a high rate of residual OSA after T&A. Predictors of residual disease include severity of preoperative OSA as determined by PSG result. Postoperative PSGs might be indicated in these patients.

In this study, we show reduction of IL-6, a proinflammatory cytokine, in adenoid tissue obtained from children with obstructive sleep apnea syndrome treated with fluticasone furoate nasal spray. This reduction could contribute to the clinical efficacy of this class of medications in the treatment of childhood obstructive sleep apnea syndrome.

improved saccharine clearance times more than normal saline (39.6% vs 24.1%), (P ϭ 0.007). Neither hypertonic nor normal saline significantly affected nasal airway patency.Conclusion: Both hypertonic and normal saline nasal spray significantly improved saccharine clearance times without affecting nasal airway patency. Hypertonic saline affected saccharine clearance times to a greater degree than normal saline.

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