Adenotonsillectomy: the good, the bad and the unknown

Abstract

Purpose of reviewAdenotonsillar hypertrophy is the most common pathogenetic contributor to obstructive sleep apnea syndrome (OSAS) in childhood, and adenotonsillectomy is the standard initial treatment. Here, we summarize the most recent evidence on the efficacy and complications of adenotonsillectomy and explore knowledge gaps in clinical management. Recent findingsFavorable adenotonsillectomy effects have been reported in children with very severe OSAS [apnea-hypopnea index (AHI) >20 episodes/h] and extremely severe OSAS (AHI >100 episodes/h), without postoperative mortality, need for endotracheal intubation, prolonged hospital stay or re-admission after hospital discharge. However, the risk of residual OSAS after adenotonsillectomy, which may reach 30--60%, has not been thoroughly established. Behavior, OSAS-related symptoms and quality of life improve postoperatively even in children with AHI 1--5 episodes/h. Natural history of enuresis resolution is accelerated postadenotonsillectomy and office-based systemic blood pressure is decreased in OSAS and hypertension. However, which children younger than 2 years should undergo adenotonsillectomy instead of adenoidectomy only to prevent recurrence of OSAS symptoms and revision surgery remains unclear. Adenotonsillectomy in children with Prader--Willi syndrome is frequently accompanied by postoperative residual OSAS while complications are not uncommon.

New Approaches to the Management of Cardiovascular Risk Associated with Sleep Respiratory Disorders in Pediatric Patients

“…OSA in children is considered when the apnea-hypopnea index (AHI), a parameter obtained from the sleep study that collects the number of respiratory events per hour of sleep, is greater than 1-3 events per hour. Adenotonsillectomy (AT) is the first line and effective treatment in moderate-to-severe OSA patients (AHI ≥ 5) when adenotonsillar hypertrophy, the most-frequent cause in children, is also present [16,17].…”