The effect of recurrent tonsillitis and adenotonsillectomy on growth in childhood

Aydoğan, Metin; Toprak, Demet; Hatun, Şükrü; Yüksel, Atilla; Gökalp, Ayşe Sevim

doi:10.1016/j.ijporl.2007.07.012

Cited by 45 publications

(44 citation statements)

References 24 publications

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“…8,35 The decreased number of tonsillitis episodes post-AT may reduce inflammation, thereby improving growth. 12 However, it is possible that some of the children in these studies with recurrent infection also had unrecognized OSAS. Alternatively, chronic inflammation per se may mediate the growth-inhibiting effects of adenotonsillar enlargement.…”

Section: Discussionmentioning

confidence: 93%

“…16,21,22 Weight gain measured using population z scores has been reported to increase after AT in some uncontrolled studies, 12 but not others. [30][31][32] However, the observation that untreated children in the WWSC group also significantly increased their weight and BMI z scores during the 7-month follow-up interval underscores the importance of the randomized controlled design of the study in quantifying treatment effects.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] Adenotonsillar hypertrophy is the primary cause of OSAS in children, and is usually treated with adenotonsillectomy (AT). AT has been reported to accelerate weight [6][7][8][9][10][11][12][13][14] in children with baseline failure to thrive (FTT), 1,3,4,15 normal weight patients, 9,11,14,[16][17][18][19][20] obese individuals, 9,13,16,21,22 and infants. 10 The majority of studies also have demonstrated an increase in the height growth rate after AT for OSAS, 3,6,11,17,23,24 but other studies reported no significant differences.…”

Section: (Continued On Last Page)mentioning

confidence: 99%

“…10 The majority of studies also have demonstrated an increase in the height growth rate after AT for OSAS, 3,6,11,17,23,24 but other studies reported no significant differences. 9,12 Whereas accelerated weight gain post-AT is likely beneficial in the setting of baseline FTT, an exaggerated increase in adiposity in overweight children could increase their risk for OSAS recurrence and obesity-related morbidity.…”

Section: (Continued On Last Page)mentioning

confidence: 99%

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Growth After Adenotonsillectomy for Obstructive Sleep Apnea: An RCT

et al. 2014

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BACKGROUND AND OBJECTIVES: Adenotonsillectomy for obstructive sleep apnea syndrome (OSAS) may lead to weight gain, which can have deleterious health effects when leading to obesity. However, previous data have been from nonrandomized uncontrolled studies, limiting inferences. This study examined the anthropometric changes over a 7-month interval in a randomized controlled trial of adenotonsillectomy for OSAS, the Childhood Adenotonsillectomy Trial. METHODS: A total of 464 children who had OSAS (average apnea/hypopnea index [AHI] 5.1/hour), aged 5 to 9.9 years, were randomized to Early Adenotonsillectomy (eAT) or Watchful Waiting and Supportive Care (WWSC). Polysomnography and anthropometry were performed at baseline and 7-month follow-up. Multivariable regression modeling was used to predict the change in weight and growth indices. RESULTS: Interval increases in the BMI z score (0.13 vs 0.31) was observed in both the WWSC and eAT intervention arms, respectively, but were greater with eAT (P < .0001). Statistical modeling showed that BMI z score increased significantly more in association with eAT after considering the influences of baseline weight and AHI. A greater proportion of overweight children randomized to eAT compared with WWSC developed obesity over the 7-month interval (52% vs 21%; P < .05). Race, gender, and follow-up AHI were not significantly associated with BMI z score change. CONCLUSIONS: eAT for OSAS in children results in clinically significant greater than expected weight gain, even in children overweight at baseline. The increase in adiposity in overweight children places them at further risk for OSAS and the adverse consequences of obesity. Monitoring weight, nutritional counseling, and encouragement of physical activity should be considered after eAT for OSAS.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: (Continued On Last Page)mentioning

confidence: 99%

Section: (Continued On Last Page)mentioning

confidence: 99%

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Growth After Adenotonsillectomy for Obstructive Sleep Apnea: An RCT

et al. 2014

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“…In children with OSAS, secretion of growth hormone during the night time is frequently decreased and secretion of growth hormone may be improved with surgical treatment of OSAS (22). In addition, increased work load during respiration at nigthtime in upper airway resistance syndrome in which respitaroy effort is increased and hypoxia interrupts sleep at night decreases the quality and time of REM sleep by causing excessive energy loss and respiratory acidosis and decreased activity of growth hormone may result in growth failure in children (23).…”

Section: Discussionmentioning

confidence: 99%

Çocuklarda kronik adenotonsiller hipertrofinin büyüme üzerine etkilerinin adenotonsillektomi öncesi ve sonrası dönemde değerlendirilmesi

...

2012

Tpa

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Aim: Several factors including genetic factors, nutrition and environment play a critical role in the growth of children. Adenotonsillar hypertrophy (ATH) can cause growth retardation by obstructing the upper airway. Surgical treatment of ATH has been considered to have a positive effect on growth. The aim of this study was to evaluate the role of chronic ATH on growth by measuring weight, height, body mass index (BMI), bone age, serum insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP-3) values before and after adenotonsillectomy. Material and Method: The study was approved by the Ethics Committee (4.5.2004; 04/170) and written informed consents were obtained from parents of the participants. A total of 40 prepubertal children who were diagnosed as chronic ATH were enrolled. Obstructive symptoms were questioned in the medical history before surgery. Weight, height, BMI and bone age values were measured and compared with reference values. Preoperative serum IGF-1 and IGFBP-3 values were compared with the control group which consisted of healthy children. Rates of obstructive symptoms, weight, height, BMI, bone age, serum IGF-1 and IGFBP-3 values of the patients were determined seven months after adenotonsillectomy and were compared with preoperative values. Results: Obstructive symptoms in children with ATH decreased remarkably after surgery. Preoperative mean value of bone age of the patients was statistically lower than reference values (p<0.05) and mean value of serum IGF-1 was lower than than the control group (p<0.05). IGF-1 and IGFBP-3 values did not increase significantly after surgery (p>0.05). However, growth retardation was detected in three out of 40 patients based on the anthropometric measurements. Conclusions: In this study, antropometric findings showed that chronic ATH did not cause significant growth retardation in prepubertal children. In addition, we could not prove that surgical treatment of ATH improved the growth in the postoperative follow-up period of seven months. This result may be related with our study population with a limited number of patients who had baseline growth retardation and short postoperative follow up period. Further studies with large number of patients and longer postoperative follow-up periods are required to determine the exact role of chronic ATH in growth retardation. (Turk Arch Ped 2012; 47: 257-262)

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