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Maksimoski M, Li C. Surgical Management of Pediatric Obstructive Sleep Apnea Beyond Tonsillectomy & Adenoidectomy: Tongue Base and Larynx. Otolaryngol Clin North Am 2024; 57:431-445. [PMID: 38523050 DOI: 10.1016/j.otc.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Pediatric patients with persistent obstructive sleep apnea (OSA) after adenotonsillectomy often have additional sites of upper airway obstruction such as the tongue base or larynx. Sleep endoscopy and cross-sectional, dynamic imaging can be used to direct surgical management of persistent OSA. The tongue base is one of the most common sites of obstruction in children with persistent OSA, especially for patients with Trisomy 21. Lingual tonsillectomy, tongue suspension, and/or posterior midline glossectomy may be used to address lingual tonsil hypertrophy and tongue base obstruction. Epiglottopexy and/or supraglottoplasty may be used to address laryngomalacia and epiglottic prolapse resulting in OSA.
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Affiliation(s)
- Matthew Maksimoski
- Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2018, Cincinnati, OH 45229, USA
| | - Carol Li
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2018, Cincinnati, OH 45229, USA.
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Dritsoula A, Clarke R, Hatziagorou E, Triaridis S, Talimtzi P, Elphick H. The role of rigid laryngo-tracheo-bronchoscopy in children with obstructive sleep apnoea: a case series of 65 children. J Laryngol Otol 2024; 138:679-684. [PMID: 38018216 DOI: 10.1017/s0022215123002116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE To assess the role of laryngo-tracheo-bronchoscopy in children with obstructive sleep apnoea by identifying airway abnormalities at surgery, that occur separately or in addition to adenotonsillar hypertrophy, and examining the correlation with respiratory parameters. METHODS A retrospective study was conducted of children with obstructive sleep apnoea who underwent laryngo-tracheo-bronchoscopy intra-operatively, performed by a single ENT surgeon from February 2016 to July 2019. Pre- and post-operative minimum oxygen saturation, apnoea-hypopnoea index, and oxygen desaturation index were recorded. RESULTS Sixty-five children were identified; 34 were aged less than three years and 31 were aged three years or more. 77 per cent and 13 per cent respectively had an airway abnormality; the t-test showed a significantly higher mean oxygen desaturation index and lower mean minimum oxygen saturation pre-operatively compared to children without an airway abnormality. CONCLUSION An update of the surgical pathway for children aged less than three years with obstructive sleep apnoea is required to include laryngo-tracheo-bronchoscopy intra-operatively. A t-test analysis of the pre-operative respiratory parameters suggests that airway abnormalities contribute to obstructive sleep apnoea severity.
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Affiliation(s)
- Aikaterini Dritsoula
- ENT Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Raymond Clarke
- ENT Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Elpis Hatziagorou
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stefanos Triaridis
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Persefoni Talimtzi
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Heather Elphick
- Paediatric Respiratory and Sleep Medicine, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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Argyriou K, Yu B, Thevasagayam R. Evaluation of the role of microlaryngotracheobronchoscopy (MLTB) with adenotonsillectomy in 158 children with sleep-disordered breathing. Clin Otolaryngol 2021; 46:1123-1126. [PMID: 33896102 DOI: 10.1111/coa.13786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/14/2021] [Accepted: 03/21/2021] [Indexed: 12/01/2022]
Affiliation(s)
| | - Beverley Yu
- Department of ENT, Sheffield Teaching Hospital, Sheffield, UK
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Bliss M, Yanamadala S, Koltai P. Utility of concurrent direct laryngoscopy and bronchoscopy with drug induced sleep endoscopy in pediatric patients with obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2018; 110:34-36. [PMID: 29859583 DOI: 10.1016/j.ijporl.2018.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 04/08/2018] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The goal of this report was to find the frequency of synchronous airway lesions (SAL) identified during microdirect laryngoscopy and bronchoscopy (MDLB) that influenced treatment decisions beyond the information provided by drug induced sleep endoscopy (DISE) alone in children with obstructive sleep apnea (OSA) at a tertiary care pediatric hospital. METHODS This was a retrospective chart review of all pediatric patients who underwent drug induced sleep endoscopy in conjunction with direct laryngoscopy and bronchoscopy as part of a comprehensive airway evaluation for obstructive sleep apnea at a tertiary care pediatric hospital. RESULTS Three hundred thirty-five patients with obstructive sleep apnea were evaluated with both sleep endoscopy and direct laryngoscopy with bronchoscopy. Five percent of patients had SAL identified on MDLB contributing to airway obstruction. Three patients (0.9%) who underwent MDLB for OSA required surgical correction of SAL that was identified. CONCLUSION In a limited subset of patients, direct laryngoscopy with bronchoscopy provides additional positive findings to aid with treatment planning for obstructive sleep apnea.
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Affiliation(s)
- Morgan Bliss
- Department of Otolaryngology-Head and Neck Surgery, Rady Children's Hospital San Diego, University of California-San Diego, 3020 Children's Way, San Diego, CA 92126, USA.
| | - Swati Yanamadala
- Department of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA.
| | - Peter Koltai
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, 801 Welch Rd, Stanford, CA 94305, USA.
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Alsufyani N, Isaac A, Witmans M, Major P, El-Hakim H. Predictors of failure of DISE-directed adenotonsillectomy in children with sleep disordered breathing. J Otolaryngol Head Neck Surg 2017; 46:37. [PMID: 28476166 PMCID: PMC5420116 DOI: 10.1186/s40463-017-0213-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 04/20/2017] [Indexed: 11/18/2022] Open
Abstract
Background Adenotonsillectomy (AT) is the most commonly performed procedure for sleep disordered breathing (SDB) in pediatrics. However, 20-40% of patients will have persistent signs and symptoms of SDB after AT. Drug-induced sleep endoscopy (DISE) has the potential to individualize surgical treatments and avoid unnecessary or unsuccessful surgeries. The objective of this study was to determine the predictors of failure of DISE-directed adenoidectomy and/or tonsillectomy in otherwise healthy children with SDB. Methods We retrospectively reviewed a prospective database of children who presented with SDB. All patients underwent preoperative pulse oximetry (PO), followed by DISE with T ± A, The variables documented included demographics, ethnicity, co-morbidities, family history, McGill Oximetry Score (MOS) on PO, as well as findings of collapse and or obstruction on DISE and symptom resolution based on modified Pediatric Sleep Questionnaire (PSQ). The primary outcome was the independent predictors of treatment failure based on multivariate binary logistic regression. Results Three hundred eighty-two patients satisfied the inclusion criteria. Based on post-operative modified PSQ, SDB resolved in 259 patients (68%), whereas 123 (32%) had persistent symptoms. On bivariate analysis, neuropsychiatric diagnosis (r = 0.286, p = 0.042), history of sleepwalking or enuresis (r = 0.103, p = 0.044), MOS (r = 0.123, p = 0.033), presence of DNS (r = 0.107, p = 0.036), and presence of laryngomalacia (r = 0.122, p = 0.017) all positively correlated with treatment failure. Small tonsil size on DISE correlated with treatment failure (r = −0.180, p < 0.001). Multivariate analysis identified age greater than 7 years (OR = 1.799, [95% CI 1.040–3.139], p = 0.039), obesity (OR = 2.032, [95% CI 1.043–3.997], p = 0.040), chronic rhinitis (OR = 1.334, [95% CI 1.047–1.716], p = 0.025), deviated nasal septum (OR = 1.745, [95% CI 1.062–2.898], p = 0.031) and tonsil size (OR = 0.575, [95% CI 0.429–0.772], p < 0.01) as independent predictors of treatment failure. Conclusions Obese, asthmatic, and children older than seven years are at increased risk of treatment failure after DISE-directed AT. Several DISE findings can independently predict AT failure, including tonsil size, degree of chronic rhinitis, and the presence of a deviated nasal septum, and can be addressed at a second stage. Further research is needed into the role of DISE in surgically naïve patients with SDB, and to compare DISE-directed surgery with the current standard of care.
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Affiliation(s)
- Noura Alsufyani
- Division of Oral Medicine and Pathology, School of Dentistry, University of Alberta, 5-531 Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, AB, T6G 1C9, Canada.,Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Andre Isaac
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, 2C3.57 Walter MacKenzie Centre, 8440 112 St NW, Edmonton, AB, T6G 2R7, Canada.
| | - Manisha Witmans
- Department of Pediatrics, Stollery Children's Hospital, 76A-80 Chippewa Rd, Sherwood Park, Edmonton, AB, T8A 4W6, Canada
| | - Paul Major
- Division of Orthodontics, School of Dentistry, University of Alberta, 5-478, Edmonton Clinic Health Academy, 11405 87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Hamdy El-Hakim
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, 2C3.57 Walter MacKenzie Centre, 8440 112 St NW, Edmonton, AB, T6G 2R7, Canada.,Division of Pediatric Surgery, Department of Pediatrics, The Stollery Children's Hospital, 2C3.57 Walter MacKenzie Centre, 8440 112 St NW, Edmonton, AB, T6G 2R7, Canada
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