Adenotonsillectomy to treat obstructive sleep apnea: Is it enough?

Boudewyns, An; Abel, François; Alexopoulos, Emmanouel Ι.; Evangelisti, Melania; Kaditis, Athanasios G.; Miano, Silvia; Villa, Maria Pia; Verhulst, Stijn

doi:10.1002/ppul.23641

Cited by 49 publications

(42 citation statements)

References 97 publications

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“…As corollary of such repeatedly confirmed fact, adenotonsillectomy (T&A) has become the initial treatment recommended by the American Academy of Pediatrics (AAP) consensus guidelines for pediatric OSA in 2002 and subsequently in 2012 [2,3], and other guidelines around the world echo such recommendations [4][5][6][7][8][9][10]. In more recent years, and particularly since 2006 when we initially described the relatively high prevalence of residual OSA after T&A [11,12], confirmation and realization that, although the severity of OSA will routinely improve after surgery, it can persist in a significant proportion of patients has definitely settled in [13][14][15][16]. Indeed, persistent OSA after T&A may occur between 13% to 29% among children defined as low-risk patients, while residual OSA may be present in up to 75% in higher-risk groups such as in obese children [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31].…”

Section: Adenotonsillectomy (Tanda)mentioning

confidence: 95%

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

Gozal

Tan

Kheirandish‐Gozal

2020

JCM

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Treatment approaches to pediatric obstructive sleep apnea (OSA) have remarkably evolved over the last two decades. From an a priori assumption that surgical removal of enlarged upper airway lymphadenoid tissues (T&A) was curative in the vast majority of patients as the recommended first-line treatment for pediatric OSA, residual respiratory abnormalities are frequent. Children likely to manifest persistent OSA after T&A include those with severe OSA, obese or older children, those with concurrent asthma or allergic rhinitis, children with predisposing oropharyngeal or maxillomandibular factors, and patients with underlying medical conditions. Furthermore, selection anti-inflammatory therapy or orthodontic interventions may be preferable in milder cases. The treatment options for residual OSA after T&A encompass a large spectrum of approaches, which may be complementary, and clearly require multidisciplinary cooperation. Among these, continuous positive airway pressure (CPAP), combined anti-inflammatory agents, rapid maxillary expansion, and myofunctional therapy are all part of the armamentarium, albeit with currently low-grade evidence supporting their efficacy. In this context, there is urgent need for prospective evidence that will readily identify the correct candidate for a specific intervention, and thus enable some degree of scientifically based precision in the current one approach fits all model of pediatric OSA medical care.

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Section: Adenotonsillectomy (Tanda)mentioning

confidence: 95%

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

Gozal

Tan

Kheirandish‐Gozal

2020

JCM

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“…The management options are diverse ranging from non‐invasive treatments to very invasive options including tracheostomy, where ethical issues arise . In our opinion, it is important to identify the exact sites of obstruction, for instance by imaging or endoscopy, to select the most appropriate treatment . For severe multilevel obstruction, non‐invasive ventilation is the primary option, at least in our centre.…”

Section: Recurrent Aspirationmentioning

confidence: 99%

“…39 In our opinion, it is important to identify the exact sites of obstruction, for instance by imaging or endoscopy, to select the most appropriate treatment. 40 For severe multilevel obstruction, non-invasive ventilation is the primary option, at least in our centre. Although the burden of care needs to be assessed, it is our opinion that establishing a normal breathing pattern in these patients results in a better quality of life and, possibly, in less hospital admissions.…”

Section: Upper Airway Obstruction and Hypoventilationmentioning

confidence: 99%

Respiratory morbidity in children with cerebral palsy: an overview

Boel

Pernet²,

Toussaint³

et al. 2018

Develop Med Child Neuro

121

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Respiratory problems have a significant impact on morbidity and mortality in patients with cerebral palsy (CP). In particular, recurrent aspiration, impaired airway clearance, spinal and thoracic deformity, impaired lung function, poor nutritional status, and recurrent respiratory infections negatively affect respiratory status. Bronchopulmonary dysplasia may contribute to pulmonary problems, but asthma is not more common in CP than in the general population. We discuss treatment options for each of these factors. Multiple coexisting and interacting factors that influence the respiratory status of patients with CP should be recognized and effectively addressed to reduce respiratory morbidity and mortality. What this paper adds Respiratory problems are a significant cause of morbidity in patients with cerebral palsy (CP). Respiratory status in patients with CP is influenced by recurrent aspiration and impaired airway clearance. Spinal and thoracic deformity, impaired lung function, poor nutrition, and respiratory infections also negatively affect respiratory status. These factors should all be addressed to reduce respiratory problems in patients with CP.

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“…Adenoidectomy has been shown to be successful in the treatment of RRI in children, especially when medical therapy has failed, as well as in the treatment of OSA . Already 1 month after surgery, significant improvement of nasal obstruction, rhinorrhoea, cough, postnasal drainage, and headache was observed .…”

Section: Discussionmentioning

confidence: 99%

Ciliary beat frequency in children with adenoid hypertrophy

Marusiakova

Ďurdík

Jeseňák

et al. 2020

Pediatric Pulmonology

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Background Children with adenoid hypertrophy (AH) have impaired respiratory system defense mechanisms, such as mucociliary clearance. We hypothesized that AH negatively affects one of the most important aspects of mucociliary clearance—ciliary beat frequency (CBF) and that adenoidectomy could potentially restore this essential defence mechanism of the airways. This study evaluated the influence of AH and endoscopic adenoidectomy on the CBF of the nasal respiratory epithelium in children. Methods This prospective study included 64 children with confirmed AH aged 3 to 18 years and 43 age‐ and sex‐matched healthy controls. Nasal CBF was analyzed using a digital high‐speed video microscope and the software application Ciliary Analysis (NI LabVIEW). The preoperative adenoid size was assessed according to Cassano. Clinical symptoms of chronic rhinosinusitis were evaluated using the SNOT‐20 questionnaire. Results Children with AH had a median CBF of 5.35 ± 1.06 Hz. Six months after surgery, the median CBF was significantly higher (6.48 ± 0.88 Hz; P < .001) and reached the values of healthy children (6.37 ± 0.71 Hz; P = .512). The size of the adenoid tissue did not correlate with the CBF. No influence of age or gender on the CBF was found. After adenoidectomy, a significant reduction of the mean total SNOT‐20 score was recorded (P < .01). Conclusion Children with clinically symptomatic AH have impaired mucociliary clearance due to decreased nasal CBF. Removal of hypertrophic adenoid tissue normalizes the CBF and reduces the presence of clinical symptoms of rhinosinusitis.

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Adenotonsillectomy to treat obstructive sleep apnea: Is it enough?

Cited by 49 publications

References 97 publications

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

Respiratory morbidity in children with cerebral palsy: an overview

Ciliary beat frequency in children with adenoid hypertrophy

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