Outcome of Adenotonsillectomy for Sleep and Breathing Difficulties in Nigerian Children with Obstructive Adenotonsillar Enlargement

Abstract

The aim of this study was to examine improvements or otherwise, in sleep disturbance and breathing difficulties after adenotonsillectomy (AT) for chronic upper airway obstruction in children. In a prospective clinical study and tertiary referral center setting, the study population included consecutive children aged 1.5 through 12 years who underwent AT for chronic upper airway obstruction due to adenotonsillar enlargement, without any history of previous AT. The validated ''Symptomatology score'' (SS) parameters were used to grade the symptoms before and after AT. The extent of improvement of the symptoms after surgery were estimated by a standardized response mean (SRM). The study included 59 children, 40 of whom were males (68%). Their ages ranged from 1.5 to 12 years with a mean of 3.3 years and 63% were \4 years. The results showed that tonsillar size was correlated significantly with a high preoperative SS (P B 0.001). The mean preoperative SS for the study population was 7.2, whereas the mean postoperative SS was 1.7. This change was highly significant (P \ 0.001). The symptom domain with the greatest change in mean score was snoring, which improved by 2 points with SRM of 2.2. The changes in total score and in the scores for each symptom domain were highly significant (P \ 0.002). We concluded that adenotonsillectomy is associated with remarkable improvement in breathing difficulties and sleep disturbances in children with obstructive adenotonsillar hypertrophy regardless of the condition whether it is mild or severe.

The Recent View on the Obstructive Sleep Apnoea Syndrome in Children – Short Résumé

“…Parents describe episodes of retraction with increased respiratory effort and may be often anxious about their child's breathing during sleep [9,11]. The classic symptoms during the daytime are usually present as behavioural disturbances -from subtle impairments of learning, attention and behaviour to prominent neurobehavioral deficits that may mimic attention-deficit/hyperactivity disorder-ADHD or learning disabilities [10,12,16,18]. Parents also reported secondary enuresis.…”

“…PSG parameters correlated best with a combination of symptoms and signs rather than for any individual parameter. AHI greater than 1 is abnormal in a child [10]. In 2011 American Academy of Sleep Medicine (AASM) published the Practice Parameters for the Respiratory Indications for Polysomnography in children with SDB.…”

“…The first spontaneous movements have been noted by 10 weeks of gestation age. Clinical ranging from mild obstruction of upper airway producing primary snoring, through increased upper airway resistance syndrome (UARS) associated with globally rather normal oxygenation patterns, but evidence for increased respiratoryrelated arousals, sleep fragmentation to continuous events of complete upper airway obstruction producing obstructive sleep apnoea syndrome (OSAS) [8,9,10]. By term, 35-80% of total sleep time (TST) is spent in active sleep.…”

“…This syndrome was first described in 1976 in school children, but OSAS has existed for a long time without being widely recognised as a clinical syndrome. Studies of family cohorts suggest that the genetic factors also play an important role in the pathophysiology of OSAS (affect anatomic features and ventilator drive) [10]. Since 1970s and 80s there has been a significant increase in the SDB in children [7].…”

Comparative Evaluation of the Effects of Adenotonsillar Hypertrophy on Oral Health in Children

“…All these changes affecting the dentofacial development are described as “Adenoid face” [ 8 , 10 – 12 ]. In order to treat chronic upper airway obstruction in the presence of adenotonsillar hypertrophy, adenoidectomy or adenotonsillectomy surgeries are generally conducted on children and it has been reported that most dentofacial anomalies are reversible within the first year after adenoidectomy [ 13 , 14 ]. Furthermore, mouth breathing due to adenotonsillar hypertrophy has been shown to induce the formation of dental caries, halitosis, and periodontal problems because of the decrease in the cleaning effect of saliva and the open positioning of the lips [ 11 , 12 , 15 ].…”