ABSTRACT. Objective. Obstructive sleep apnea (OSA) in children is usually effectively treated by adenotonsillectomy (T&A). However, there may be a waiting list for T&A, and the procedure is associated with an increased risk of postoperative complications in children with OSA. Needed is a simple test that will facilitate logical prioritization of the T&A surgical list and help to predict children who are at highest risk of postoperative complications. The objective of this study was to develop and validate a severity scoring system for overnight oximetry and to evaluate the score as a tool to prioritize the T&A surgical list.Methods. This study comprised 3 phases. In phase 1, a severity score was developed by review of preoperative overnight oximetry in children who had urgent T&A in 1999 -2000. In phase 2, the score was validated retrospectively in 155 children who had polysomnography (PSG) before T&A in 1992-1998. In a phase 3, a 12-month prospective evaluation of a protocol based on the score was conducted.Results. In phase 1, a 4-level severity score was developed on the basis of the number and the depth of desaturation events (normal to severely abnormal, categories 1-4). In phase 2, the McGill oximetry score correlated with severity of OSA by PSG criteria. In phase 3, a clinical management protocol was developed based on the score. Of 230 children tested, 179 (78%) had a normal/ inconclusive oximetry (category 1) and went on to have PSG. Those with a positive oximetry (categories 2-4; 22%) had no additional sleep studies before T&A. Timing of T&A was based on oximetry score, leading to a significant reduction in waiting time for surgery for those with higher oximetry scores. Postoperative respiratory complications were more common with increasing oximetry score.Conclusions. Overnight pulse oximetry can be used to estimate the severity of OSA, to shorten the diagnostic and treatment process for those with more severe disease, and to aid clinicians in prioritization of T&A and planning perioperative care. Pediatrics 2004;113:e19 -e25. URL: http://www.pediatrics.org/cgi/content/full/113/1/ e19; oximetry, obstructive sleep apnea, child, adenotonsillectomy, postoperative complications.

No abstract

No abstract

Objective: To evaluate the usefulness of adynamic lateral neck radiographs and dynamic video rhinoscopy in assessing adenoid size and the relationship of these methods to associated symptoms and thus the severity of the disease. Methods: Children with suspected adenoid hypertrophy underwent standard lateral neck soft tissue radiographs: the percentage of airway occlusion, adenoid to nasopharynx (AN) ratio, airway to soft palate ratio, and adenoid thickness were assessed by a radiologist. The percentage of airway closure was assessed by direct fibre-optic rhinoscopy in an ear, nose, and throat clinic. Associated clinical symptoms were assessed by parents using a standardized questionnaire, evaluating the severity of symptoms (snoring, sleep apnea, mouth breathing, and otitis media) to give a total symptom score out of 16. Results: Nonparametric statistical analysis using Spearman's correlation coefficients was performed on 32 patients. There was a weak correlation, which approaches significance, between the percentage of airway occlusion assessed by fibre-optic rhinoscopy and the total symptom score (r = .344, p = .054). However, this correlation becomes significant when the frequency of otitis media is omitted (r = .367, p = .039). There was also a significant correlation between airway occlusion assessed by rhinoscopy and the percentage of airway occlusion as determined by lateral neck radiography (r = .431, p = .014). There was no correlation between any of the measurements taken by lateral soft tissue neck radiography and total symptom score. Conclusion: Dynamic video rhinoscopy is more accurate at assessing adenoid hypertrophy, and the percentage of airway occlusion, as estimated by video rhinoscopy, is better correlated to the severity of symptoms than are values obtained by lateral neck radiography. Sommaire Objectif: Evaluer l'utilité de la radiographie latérale du cou adynamique et de la vidéo-rhinoscopie dynamique pour mesurer le volume adénoidien et la relation entre ces méthodes et les symptômes et la sévérité de la maladie. Méthode: Nous avons fait passer à 32 enfants, un rayon-X standard des tissus mous du cou et un radiologiste a procédé aux mesures suivantes : le pourcentage d'occlusion des voies respiratoires, le rapport entre les adénoides et la nasopharynx (AN), le rapport entre les voies respiratoires et le palais mou et l'épaisseur des adénoides. Le pourcentage d'obstruction a aussi été évalué par rhinoscopie directe par fibre optique à la clinique externe. Finalement les parents ont évalué sur 16 la sévérité des symptômes en remplissant un questionnaire standardisé évaluant les aspects suivants : ronflement, apnée du sommeil, respiration buccale et une histoire d'otites moyennes. Résultats: Nous avons trouvé une faible corrélation (Spearman) presque significative entre la rhinosocopie par fibre optique et le score de symptômes (r = .344, p = .054). Cette corrélation devient significative quand on omet l'aspect otites moyennes (r = .367, p = .039). On note aussi une corrélation entre l'obstruc...