Cognitive Function and Behavior of Children With Adenotonsillar Hypertrophy Suspected of Having Obstructive Sleep-Disordered Breathing

PEDIATRICS ◽  
2006 ◽  
Vol 118 (3) ◽  
pp. e771-e781 ◽  
Author(s):  
P. M. Suratt ◽  
M. Peruggia ◽  
L. D'Andrea ◽  
R. Diamond ◽  
J. T. Barth ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Sleep Disordered Breathing ◽  
Adenotonsillar Hypertrophy ◽  
Obstructive Sleep ◽  
And Behavior ◽  
Obstructive Sleep Disordered Breathing ◽  
Disordered Breathing

The evolution of tonsil surgery and rethinking the surgical approach to obstructive sleep-disordered breathing in children

2006 ◽  
Vol 120 (12) ◽  
pp. 993-1000 ◽  
Author(s):  
J A Koempel ◽  
C A Solares ◽  
P J Koltai
Keyword(s):  
Sleep Disordered Breathing ◽  
The United States ◽  
Adenotonsillar Hypertrophy ◽  
Post Operative Pain ◽  
Obstructive Sleep ◽  
Tonsil Surgery ◽  
Partial Tonsillectomy ◽  
Obstructive Sleep Disordered Breathing ◽  
Intracapsular Tonsillectomy ◽  
Disordered Breathing

Within the last 10 to 15 years, a significant amount of research in tonsil surgery has focused on reduction of post-operative pain and recovery time. In order to minimize or avoid morbidity, a number of otolaryngologists in the United States and Europe have revived a historical procedure, previously known as ‘tonsillotomy’, specifically for those patients with obstructive sleep-disordered breathing (OSDB) due to adenotonsillar hypertrophy. More recently, surgeons have used terms such as partial tonsillectomy, partial intracapsular tonsillectomy or subtotal tonsillectomy to describe their procedure and have employed a variety of modern instrumentation. This return to a ‘partial’ procedure has generated a debate similar to that which occurred amongst tonsil surgeons about 100 years ago, when tonsillotomy was the most commonly performed procedure. Today, concerns about regrowth and problems with infection of the remaining tonsillar tissue have been raised. Such concerns, combined with an incomplete understanding of why the ‘partial’ procedure was abandoned in the early twentieth century, may explain why tonsil surgeons hesitate to change their approach to patients with OSDB due to adenotonsillar hypertrophy. These issues can be addressed in a meaningful way only through a detailed review of the evolution of tonsil surgery, which is presented here. This information, along with a summary of the last 10 years' experience with these techniques, supports the use of a ‘partial’ procedure in children with OSDB due to adenotonsillar hypertrophy. Future areas of research are also discussed.

Physical and emotional disturbances in children with adenotonsillar hypertrophy

2007 ◽  
Vol 122 (9) ◽  
pp. 931-935 ◽  
Author(s):  
P Kurnatowski ◽  
L Putyński ◽  
M Łapienis ◽  
B Kowalska
Keyword(s):  
Trait Anxiety ◽  
Sleep Disordered Breathing ◽  
The State ◽  
Healthy Children ◽  
State Trait Anxiety Inventory ◽  
Emotional Instability ◽  
Adenotonsillar Hypertrophy ◽  
Obstructive Sleep ◽  
Obstructive Sleep Disordered Breathing ◽  
Disordered Breathing

AbstractObjective:Enlarged tonsils and adenoids (part of Waldeyer's ring) are responsible for obstructive sleep disordered breathing. Obstructive sleep disordered breathing episodes lead to hypoxaemia, hypercapnia and a state of arousal, all of which affect normal development of the nervous system. In this study, two hypotheses were tested: (1) obstructive sleep disordered breathing is caused by adenotonsillar hypertrophy and is associated with hypoxia and brain dysfunction; and (2) children with obstructive sleep disordered breathing more commonly display emotional lability, depressive behaviour and anxiety.Material and methods:A total of 225 children were examined. The study group consisted of 121 children with adenotonsillar hypertrophy (87 aged six to nine years and 34 aged 10 to 13 years) and with obstructive sleep apnoeas and hypopnoeas confirmed by polysomnography. Patients were compared with 104 children with no obstructive sleep disordered breathing and no adenotonsillar hypertrophy (74 aged six to nine years and 30 aged 10 to 13 years). The following tests were used to measure the children's emotional disorders: the children's depression inventory; the state-trait anxiety inventory for children; and the emotional instability scale. The average values and standard deviations were calculated for all results. Student's t-test was used to compare differences in all groups of children. The minimum level of p < 0.05 was set as statistically significant.Results:Children with adenotonsillar hypertrophy are more likely to experience poor brain development and sleep problems. They also have emotional disturbances. In the sick and healthy children aged six to nine years, mean results for the emotional instability scale were statistically significantly different in the two groups, being higher in children with adenotonsillar hypertrophy than in healthy children. Mean values for the children's depression inventory test were higher in children with adenotonsillar hypertrophy, but the differences were not statistically significant. In the state-trait anxiety inventory for children test, the mean T score was T = 1.760 and the level of significance was p = 0.08 for both groups. Since the standard level of significance was p < 0.05, the differences in mean values for the state-trait anxiety inventory for children test bordered on statistical significance. There were no differences between tests results in the older children (10 to 13 years).Conclusions:Recent studies have confirmed the negative emotional effect of adenotonsillar hypertrophy induced obstructive sleep disordered breathing in children aged six to nine years. The main problems are emotional lability, and anxiety and depressive disturbances. Such emotional problems subside in older children (aged 10 to 13 years).

Sign in / Sign up

Export Citation Format

Share Document