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Dang QCL, Ulualp S, Mitchell RB, Johnson RF. Perioperative Delta Weight and Pediatric Obstructive Sleep Apnea Resolution after Adenotonsillectomy. Laryngoscope 2024; 134:4141-4147. [PMID: 38551307 DOI: 10.1002/lary.31417] [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] [Received: 01/18/2024] [Revised: 03/06/2024] [Accepted: 03/18/2024] [Indexed: 08/09/2024]
Abstract
OBJECTIVE(S) The first-line treatment for pediatric obstructive sleep apnea (OSA) is adenotonsillectomy. Post-operative weight gain is a well-documented phenomenon. We hypothesized that higher peri-adenotonsillectomy delta weight correlates with lower rates of OSA resolution in pediatric patients. METHODS This was a retrospective cohort study consisting of 250 patients from 2 to 17 years of age at a tertiary academic medical center between January 2021 and December 2022. Polysomnography results and body mass index (BMI) changes were collected through the electronic health record. Univariate and multivariate logistical regression analyses were performed, adjusting for confounding factors. RESULTS Perioperative delta weight and pre-operative baseline AHI values were significant predictors of residual OSA. For every 1-kilogram gain in weight, the odds of residual OSA (AHI >5) increase by 6.0% (OR = 1.06, 95% CI = 1.02-1.10, p < 0.002), and the odds of residual severe OSA (AHI > 10) increase by 8% (OR = 1.08, 95% CI = 1.04-1.12, p < 0.001). Increased AHI, Black/African American race, and male sex were also factors associated with incomplete OSA resolution. CONCLUSIONS Increased peri-adenotonsillectomy delta weight is associated with higher rates of residual OSA in children. Patients and families should be counseled about appropriate weight loss and control methods before adenotonsillectomy. LEVEL OF EVIDENCE IV Laryngoscope, 134:4141-4147, 2024.
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Affiliation(s)
- Quynh-Chi L Dang
- Department of Otolaryngology, Head and Neck Surgery, Southwestern Medical Center at Dallas, University of Texas, Dallas, Texas, U.S.A
| | - Seckin Ulualp
- Department of Otolaryngology, Head and Neck Surgery, Southwestern Medical Center at Dallas, University of Texas, Dallas, Texas, U.S.A
| | - Ron B Mitchell
- Department of Otolaryngology, Head and Neck Surgery, Southwestern Medical Center at Dallas, University of Texas, Dallas, Texas, U.S.A
| | - Romaine F Johnson
- Department of Otolaryngology, Head and Neck Surgery, Southwestern Medical Center at Dallas, University of Texas, Dallas, Texas, U.S.A
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Kang KT, Hsu WC. Efficacy of adenotonsillectomy on pediatric obstructive sleep apnea and related outcomes: A narrative review of current evidence. J Formos Med Assoc 2024; 123:540-550. [PMID: 37718211 DOI: 10.1016/j.jfma.2023.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/18/2023] [Accepted: 09/05/2023] [Indexed: 09/19/2023] Open
Abstract
This review summarizes the current evidence in systematic reviews, meta-analysis and randomized controlled trials regarding adenotonsillectomy outcomes in pediatric obstructive sleep apnea (OSA). Adenotonsillectomy is effective in treating OSA in children without co-morbidities, despite postoperative residual OSA remained in roughly half of these children. For children with comorbidities such as Down syndrome, Prader-Willi syndrome, sickle cell disease, or cerebral palsy, adenotonsillectomy is less effective and associated with more postoperative complications than that in children without comorbidities. For other OSA-related outcomes, evidence from meta-analyses and randomized controlled trials confirm adenotonsillectomy results in improvement of subjective OSA-related outcomes (e.g. symptoms, behaviors, and quality of life), but the results in objective OSA-related outcomes (e.g. cardiometabolic parameters or neurocognitive functions) are inconsistent. Future studies should focus on randomized controlled trials comparing objective OSA-related outcomes and the long-term effects of adenotonsillectomy in children with OSA.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan.
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3
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Rivero-Moreno Y, Garcia A, Rivas-Perez M, Coa-Bracho J, Salcedo Y, Gonzalez-Quinde G, Montero-Palma E, Valdivia-Sepulveda D, Paz-Castillo M, Machado-Paled D, Garcia-Cazorla W, Acero-Alvarracín K, Tarabey-Yunis L, Estrella-Gaibor C. Effect of Obesity on Surgical Outcomes and Complication Rates in Pediatric Patients: A Comprehensive Systematic Review and Meta-Analysis. Cureus 2024; 16:e54470. [PMID: 38510855 PMCID: PMC10953840 DOI: 10.7759/cureus.54470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
Obesity is one of the primary public health problems faced by children. The increased incidence of obesity in the pediatric population poses significant challenges during and after surgical procedures. This systematic review and meta-analysis aimed to understand to what extent obesity is to surgical complications in pediatric patients. A systematic database search of PubMed, Web of Science, Scopus, and Science Direct was performed in June 2023. According to the inclusion and exclusion criteria, two evaluators independently conducted literature screening, data extraction, and quality evaluation of the retrieved literature. The Newcastle-Ottawa Scale score was used for quality evaluation, and a meta-analysis was performed using Review Manager software 5.4.1. A total of 1,170 relevant articles were initially identified, and 20 articles were finally included for data extraction and meta-analysis. The results of the meta-analysis showed that compared with normal-weight individuals, obese pediatric patients had a higher risk of developing surgical site infection (SSI) (relative risk (RR) = 1.63; 95% confidence interval (CI) = 1.33-2.00), wound dehiscence (RR = 2.01; 95% CI = 1.24-3.23), and underwent procedures that were 11.32 minutes longer (95% CI = 5.36-17.29). There were no differences in bleeding requiring transfusion, deep venous thromboembolism, postoperative abscess rate, and length of stay. Obese pediatric patients have a higher risk of SSI and dehiscence, along with a longer operative time. The established risks in obese adults undergoing surgery suggest a similar risk for obese pediatric patients. The findings of this study hold significant implications for clinical practice, suggesting the potential for additional measures to prevent surgical complications in children.
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Affiliation(s)
| | - Andrea Garcia
- Department of Internal Medicine, Universidad de Oriente, Ciudad Bolivar, VEN
| | | | - Jesus Coa-Bracho
- Department of Surgery, Hospital de Talagante, Santiago de Chile, CHL
| | - Yoalkris Salcedo
- Department of Surgery, Universidad Iberoamericana, Santo Domingo, DOM
| | | | | | | | | | | | | | - Katheryn Acero-Alvarracín
- Department of General Surgery, Universidad de Guayaquil Facultad de Ciencias Médicas, Guayaquil, ECU
| | - Laila Tarabey-Yunis
- Department of Surgery, Universidad Centroccidental Lisandro Alvarado, Lara, VEN
| | - Cesar Estrella-Gaibor
- Department of General Surgery, Ministerio de Salud Pública, Hospital Esmeraldas sur Delfina Torres de Concha, Quito, ECU
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Buono P, Maines E, Azzolini N, Franceschi R, Ludovica F, Leonardi L, Occhiati L, Mozzillo E, Maffeis C, Marigliano M. Short-Term Weight Gain after Tonsillectomy Does Not Lead to Overweight: A Systematic Review. Nutrients 2024; 16:324. [PMID: 38276561 PMCID: PMC10819022 DOI: 10.3390/nu16020324] [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] [Received: 12/18/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Different studies and systematic reviews have reported weight increase after tonsillectomy. However, the odds of a child being overweight or obese after tonsillectomy were no different than before surgery, according to a few studies. This systematic review aims to analyze the impact of adenotonsillectomy (TA) on weight gain and identify subgroups of children and adolescents at risk of experiencing weight gain. A systematic search included studies published in the last ten years. The PICO framework was used in the selection process, and evidence was assessed using the GRADE system. A total of 26 studies were included, and moderate-high level quality ones showed that children who underwent TA could present an increase in BMI z-score. However, this weight gain was significant in individuals younger than six years old and was considered catch-up growth in underweight subjects at baseline. In contrast, for normal-weight or overweight individuals, TA did not lead to overweight per se. At the same time, diet changes and overfeeding did not have a leading role in weight gain. In conclusion, TA may not be an independent risk factor for unfavorable weight gain in children; however, individuals who were underweight pre-operatively or younger than six years reported more weight gain after TA than expected.
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Affiliation(s)
- Pietro Buono
- Directorate General of Health, Campania Region, 80131 Naples, Italy;
| | - Evelina Maines
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Azienda Provinciale per i Servizi Sanitari del Trentino, 38122 Trento, Italy; (E.M.); (N.A.); (L.L.)
| | - Nicolò Azzolini
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Azienda Provinciale per i Servizi Sanitari del Trentino, 38122 Trento, Italy; (E.M.); (N.A.); (L.L.)
| | - Roberto Franceschi
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Azienda Provinciale per i Servizi Sanitari del Trentino, 38122 Trento, Italy; (E.M.); (N.A.); (L.L.)
| | - Fedi Ludovica
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80131 Naples, Italy; (F.L.); (L.O.)
| | - Letizia Leonardi
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Azienda Provinciale per i Servizi Sanitari del Trentino, 38122 Trento, Italy; (E.M.); (N.A.); (L.L.)
| | - Luisa Occhiati
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80131 Naples, Italy; (F.L.); (L.O.)
| | - Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80131 Naples, Italy; (F.L.); (L.O.)
| | - Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy; (C.M.); (M.M.)
| | - Marco Marigliano
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy; (C.M.); (M.M.)
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Han SC, Yang SK, Han SY, Rhee CS, Choi Y, Shin CH, Lee YJ, Han DH. Investigating factors influencing post-operative growth in pre-pubertal children after adenotonsillectomy. Eur Arch Otorhinolaryngol 2023; 280:2841-2848. [PMID: 36656426 DOI: 10.1007/s00405-022-07817-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE To check the change in growth-for-age after adenotonsillectomy in pre-pubertal children and investigate the affecting factors. METHODS Two hundred and six pediatric patients who underwent adenotonsillectomy by a single surgeon between January 2011 and December 2014 were included for the retrospective cohort study. The z-scores of height-, weight-, and body mass index (BMI)-for-age were measured before adenotonsillectomy and 1 year after the operation. The Korean version of the obstructive sleep apnea-18 questionnaire (OSA-18), symptom questionnaire, physical examinations, demographic data, and pre-operative z-scores were used to analyze the factors affecting z-score change. RESULTS Among 206 pediatric patients, 167 patients were normal growth; 19 were undergrowth; and 20 were obese. After the operation, height, weight, and BMI z-scores all increased both in 167 normal-growth patients and 19 undergrowth patients (p value < 0.05). However, in 20 obese patients, only height z-score significantly increased (p value = 0.028). The multiple regression test showed that the sleep disturbance domain of OSA-18 was positively correlated with height z-score change (p value = 0.041), and age was negatively correlated with weight z-score change (p value = 0.016). Pre-operative BMI z-score was negatively correlated (p value = 0.019) and adenoid grade was positively correlated (p value = 0.023) with BMI z-score change. CONCLUSIONS These findings suggest that adenotonsillectomy may positively affect growth in pre-pubertal children, without undesirable weight gain. Additionally, the sleep disturbance domain of OSA-18 may play a role in predicting post-operative height increase in pre-pubertal children.
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Affiliation(s)
- Seung Cheol Han
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Seung Koo Yang
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Sang-Yoon Han
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea.,Graduate School of Immunology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Allergy and Clinical Immunology and Sensory Organ Research Institute, Seoul National University Biomedical Research Center, Seoul, Korea
| | - Yunhee Choi
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Yun Jeong Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea.
| | - Doo Hee Han
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea.
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6
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Inja RR, Paul RR, Varghese L, Sebastian T, Mathews SS. Impact of tonsillectomy on dysphagia symptoms and body weight in children. Am J Otolaryngol 2020; 41:102682. [PMID: 32829057 DOI: 10.1016/j.amjoto.2020.102682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/28/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
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7
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Sojisirikul N, Sophonphan J, Bongsebandhu-phubhakdi C. Growth after Adenotonsillectomy in Thai Children with Adenotonsillar Hypertrophy. SLEEP MEDICINE RESEARCH 2020. [DOI: 10.17241/smr.2020.00598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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8
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Beauchamp MT, Regier B, Nzuki A, Swinburne Romine R, Sweeney B, Liu M, M Davis A. Weight change before and after adenotonsillectomy in children: An analysis based upon pre-surgery body mass category. Clin Otolaryngol 2020; 45:739-745. [PMID: 32386452 DOI: 10.1111/coa.13568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/04/2020] [Accepted: 05/03/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the standardised body mass index (BMIz) trajectory before and after adenotonsillectomy/tonsillectomy between children in different weight classifications in a larger sample than has been studied previously, and to identify which patient factors would explain the difference in these outcomes. DESIGN We used a retrospective chart review and leveraged data of weight status pre- and post-adenotonsillectomy/tonsillectomy from a cohort of paediatric patients seen between May 2004 and April 2017. SETTING Data were collected from an electronic medical record at a single Midwest paediatric health system. PARTICIPANTS The study population included a convenience sample of 1,751 paediatric patients who underwent adenotonsillectomy or tonsillectomy and had at least two height and weight measurements recorded on the same date both before and after surgery. MAIN OUTCOME MEASURES Change in BMIz trajectories before and after surgery. RESULTS Of 1751 paediatric patients (ages 3-11) underwent adenotonsillectomy/tonsillectomy procedures. Age at time of surgery and gender were not significant predictors. Children in different weight classifications demonstrated differences in BMIz trajectory after surgery. Children with overweight/obesity experience a decrease in BMIz, whereas children with underweight or normal weight experience an increase in BMIz. CONCLUSIONS Improvement in weight status is seen after surgery: increased BMI for those underweight and decreased BMI for those with overweight/obesity. We advocate for behavioural strategies as a first-line treatment in children with underweight or overweight/obesity, and results suggest that coordinating these efforts alongside adenotonsillectomy/tonsillectomy when indicated for medical reasons may be warranted. However, further research is needed to confirm these findings due to the observational nature of this study.
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Affiliation(s)
- Marshall T Beauchamp
- Univeristy of Missouri-Kansas City, Kansas City, Missouri, USA.,University of Kansas-School of Medicine, Kansas City, Kansas, USA
| | - Betsy Regier
- University of Kansas-School of Medicine, Kansas City, Kansas, USA.,Baylor Scott & White Health, Texas A&M University College of Medicine, Bryan, Texas, USA
| | - Anne Nzuki
- University of Kansas-School of Medicine, Kansas City, Kansas, USA
| | | | - Brooke Sweeney
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, Missouri, USA.,Children's Mercy Hospital Kansas City, Kansas City, Missouri, USA
| | - Mei Liu
- Department of Internal Medicine, Division of Medical Informatics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ann M Davis
- University of Kansas-School of Medicine, Kansas City, Kansas, USA
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Zaffanello M, Piacentini G, La Grutta S. Beyond the growth delay in children with sleep-related breathing disorders: a systematic review. Panminerva Med 2020; 62:164-175. [PMID: 32329330 DOI: 10.23736/s0031-0808.20.03904-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The availability of high-quality studies on the association between sleep-disordered breathing in children and delayed growth associated with the hormonal profile recorded before surgery and at follow-up is limited. EVIDENCE ACQUISITION Medline PubMed, Scopus and WebOfScience databases were searched for relevant publications published between January 2008 to January 2020 and a total of 261 potentially eligible studies were identified. EVIDENCE SYNTHESIS Following review 19 papers were eligible for inclusion: seven reported a significant postsurgical increase in growth regardless of initial weight status, type of surgery, type of study design, and length of follow-up period. The only high-quality study was a randomized controlled trial that found an increased risk of obstructive sleep apnea syndrome relapse in overweight children. Twelve studies reported the significant increase in growth parameters showing that IGF-1, IGFBP-3, and ghrelin may boost growth after surgery. CONCLUSIONS The current systematic review demonstrates a scarcity of high-quality studies on growth delay in children with sleep-disordered breathing. Significant catch-up growth after surgery in the short term and changes in IGF-1, IGFBP-3, ghrelin, and leptin levels has been reported in most published studies.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy -
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Stefania La Grutta
- National Research Council of Italy, Institute for Research and Biomedical Innovation, Palermo, Italy
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Neiva PD, Franco LP, Kirkwood RN, Becker HG. The effect of adenotonsillectomy on the position of head, cervical and thoracic spine and scapular girdle of mouth breathing children. Int J Pediatr Otorhinolaryngol 2018; 107:101-106. [PMID: 29501288 DOI: 10.1016/j.ijporl.2018.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/21/2018] [Accepted: 01/23/2018] [Indexed: 11/26/2022]
Abstract
UNLABELLED The clinical decision for surgical treatment of children diagnosed with mouth breathing depends on the percentage of mechanical obstruction correlated with exacerbation of upper respiratory tract infections and systemic changes. The benefits of adenotonsillectomy include changes in the nasopharyngeal space, the mandibular plane and myofunctional alterations. Post-adenotonsilectomy postural benefits have not yet been described. OBJECTIVES To investigate the kinematics of the shoulder girdle, cervical and thoracic spine in children with mouth breathing before and after adenotonsillectomy. METHODS Forty-nine mouth breathing children (6.3 ± 1.8 years) of both sexes participated in the study. The measures of thoracic kyphosis, forward head position, shoulders protrusion and abduction, elevation, anterior tilt and internal rotation of the scapula were evaluated before and after surgery. The kinematic data were obtained using the system Qualysis ProReflex®. RESULTS There was a significant decrease in forward head position, shoulders protrusion, elevation and anterior tilt of the scapula after surgery compared to the pre-operative. CONCLUSION One of adenotonsillectomy results is the improvement of the posture of the head and the shoulder girdle of mouth breathing children. Clinically these findings are important and will contribute to improving the quality of life of mouth breathing children.
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Affiliation(s)
- Patricia Dayrell Neiva
- Universidade Federal de Minas Gerais, Department of Otohinolaryngologic Outpatient Clinic for Mouth-Breathers, Belo Horizonte, Brazil; Department Physiotherapy, Catholic University of Minas Gerais (PUC Minas), Belo Horizonte 30535610, Brazil.
| | - Letícia Paiva Franco
- Universidade Federal de Minas Gerais, Department of Otohinolaryngologic Outpatient Clinic for Mouth-Breathers, Belo Horizonte, Brazil
| | - Renata Noce Kirkwood
- Universidade Federal de Minas Gerais, Graduate Program in Rehabilitation Science, Belo Horizonte, Brazil
| | - Helena Gonçalves Becker
- Universidade Federal de Minas Gerais, Department of Otohinolaryngologic Outpatient Clinic for Mouth-Breathers, Belo Horizonte, Brazil
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Paediatric obstructive sleep apnoea: is our operative management evidence-based? The Journal of Laryngology & Otology 2018; 132:293-298. [PMID: 29463325 DOI: 10.1017/s002221511800021x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Despite the plethora of publications on the subject of paediatric obstructive sleep apnoea, there seems to be wide variability in the literature and in practice, regarding recourse to surgery, the operation chosen, the benefits gained and post-operative management. This may reflect a lack of high-level evidence. METHODS A systematic review of four significant controversies in paediatric ENT was conducted from the available literature: tonsillectomy versus tonsillotomy, focusing on the evidence base for each; anaesthetic considerations in paediatric obstructive sleep apnoea surgery; the objective evidence for the benefits of surgical treatment for obstructive sleep apnoea; and the medical treatment options for residual obstructive sleep apnoea after surgical treatment. RESULTS AND CONCLUSION There are many gaps in the evidence base for the surgical correction of obstructive sleep apnoea. There is emerging evidence favouring subtotal tonsillectomy. There is continuing uncertainty around the prediction of the level of post-operative care that any individual child might require. The long-term benefit of surgical correction is a particularly fertile ground for further research.
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12
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Reckley LK, Fernandez-Salvador C, Camacho M. The effect of tonsillectomy on obstructive sleep apnea: an overview of systematic reviews. Nat Sci Sleep 2018; 10:105-110. [PMID: 29670412 PMCID: PMC5894651 DOI: 10.2147/nss.s127816] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Tonsillectomy with adenoidectomy is a combination surgery that has been used to treat pediatric obstructive sleep apnea (OSA). For adults, tonsillectomy has also been reported as a primary treatment modality when the tissue is hypertrophied. The objective of this study is to provide an overview of published systematic reviews and meta-analyses of tonsillectomy with or without adenoidectomy as used in the treatment of OSA in children and adults. DATA SOURCES Nine databases, including PubMed/MEDLINE. REVIEW METHODS Databases were searched from their inception through July 9, 2017. The PRISMA statement was followed. RESULTS More than 20 recent systematic reviews and meta-analyses were identified regarding tonsillectomy as a treatment modality for OSA. There were four articles that addressed tonsillectomy's overall success, efficacy, and complications in otherwise healthy pediatric patients. Three studies evaluated tonsillectomy in obese children, and two specifically examined children with Down syndrome. Only one systematic review and meta-analysis discussed tonsillectomy as a treatment for OSA in the adult population. CONCLUSION Tonsillectomy as an isolated treatment modality is rarely performed in pediatric patients with OSA; however, tonsillectomy is commonly performed in combination with adenoidectomy and the combination has demonstrated efficacy as the primary treatment option for most children. In the limited adult data, tonsillectomy alone for OSA has a surprising success rate; yet, more research is required to determine long-term improvement and need for further treatment.
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Affiliation(s)
- Lauren K Reckley
- Otolaryngology - Head and Neck Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | | | - Macario Camacho
- Otolaryngology - Head and Neck Surgery, Tripler Army Medical Center, Honolulu, HI, USA
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13
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Assessment of weight gain following adenotonsillectomy in children with Down syndrome. Int J Pediatr Otorhinolaryngol 2017; 100:103-106. [PMID: 28802352 DOI: 10.1016/j.ijporl.2017.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/15/2017] [Accepted: 06/24/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Adenotonsillectomy (T&A) has been associated with postoperative weight gain in children. The purpose of this study is to determine whether a similar association exists in children with Down syndrome (DS). METHODS The medical records of 311 DS patients were reviewed. Subjects were classified into either a control group or surgical group based on whether they had undergone adenotonsillectomy (T&A). Subjects were excluded if they only had one recorded BMI. Cases were analyzed in a pairwise fashion to maximize available data. 113 total patients with DS were identified: 84 (74.3%) in the control group and 29 (25.7%) in the T&A group. Height, weight, BMI, and Z-score data were compared between the control and T&A groups at 6-month intervals over a 24-month period. RESULTS Children with DS who underwent T&A were comparable by demographics to children with DS who did not undergo T&A. Mean weight gain at 24 months for the T&A group was 8.07 ± 5.66 kg compared with 5.76 ± 13.20 kg in controls. The median Z-score at 24 months for the T&A group was 1.11 (0.10-1.88) compared with 1.17 (0.80-1.75) in controls. Children undergoing T&A had a stable median Z-score change of 0.09 at 24 months (p = 0.861, compared to baseline) while children who did not undergo T&A had a significantly increased median Z-score of 0.52 (p = 0.035, compared to baseline). Despite this, there were no significant intergroup differences between weight change, BMI, nor Z-score at any interval (p > 0.05). CONCLUSIONS AND RELEVANCE Children with DS did not have an increased rate of weight gain or increased BMI after T&A. BMI Z-scores were shown to stabilize over 24 months in the T&A group and increase in the control group. While this suggests that T&A provides an added benefit of weight control in patients with DS, the results should be interpreted with caution due to the small sample size and the fact that not all patients had complete follow up across a 24-month period.
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Ameye SA, Owojuyigbe AM, Adeyemo A, Adenekan AT, Ouche S. Pediatric Adenotonsillectomy in a Low Resource Setting: Lessons and Implications. Niger J Surg 2016; 22:77-80. [PMID: 27843269 PMCID: PMC5013746 DOI: 10.4103/1117-6806.182742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objectives: To examine the practices related paediatric adenotonsillectomy in our setting especially in relation to blood request and transfusion, routine investigations, post-operative analgesic practice and complications. Methods: We reviewed the record of paediatric patients who had adenotonsillectomy in our facility over a 5-year period to obtain relevant information to our study. Results: There were 33 males and 19 females with mean age of 3.27 ± 2.76 years. Sinus tachycardia was found in 11(21.2 %) of the subjects and T wave anomaly in 1(1.9%) of the subject. Thirty-five (67.3%) patient had adenotonsillectomy, 13(25.0 %) adenoidectomy only and 4(7.7%) tonsillectomy only. Majority of the patients (24, 46.2%) were classified as ASA physical status I. Pre-operative blood request rate was high (49, 94.3%) though the transfusion rate was 1.9 % (1 patient). Acetaminophen combined with other analgesics was used for post-operative analgesia for most of the patients. There was significant weight gain post-operatively among patient Conclusions: Cold steel adenotonsillectomy is safe and effective in our environment. We believe that there is no justification for routine pre-operative blood request as a preconditions for surgery. We also like to suggest that post-operative pain management be streamlined taking into consideration the available analgesics in our setting.
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Affiliation(s)
- Sanyaolu Alani Ameye
- Department of Surgery, Otorhinolaryngology Unit, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Adekunle Adeyemo
- Department of Surgery, Otorhinolaryngology Unit, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Anthony T Adenekan
- Department of Anaesthesia and Intensive Care, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Sylvia Ouche
- Department of Otorhinolaryngology Head and Neck Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
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[Obesity and obstructive sleep apnea in children]. Arch Pediatr 2016; 24 Suppl 1:S34-S38. [PMID: 27769628 DOI: 10.1016/j.arcped.2016.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/16/2016] [Indexed: 01/08/2023]
Abstract
Obesity, along with hypertrophy of the adenoids and the tonsils, represents one of the major risk factors for obstructive sleep apnea (OSA) in children. Obesity is associated with an increase in the prevalence and the severity of OSA and is a major factor in the persistence and aggravation of OSA over time. Neurocognitive dysfunction and abnormal behavior are the most important and frequent end-organ morbidities associated with OSA in children. Other deleterious consequences such as cardiovascular stress and metabolic syndrome are less common in children than in adults with OSA. Defining the exact role of obesity in OSA-associated end-organ morbidity in children is difficult because of the complex and multidimensional interactions between sleep in general, OSA, obesity, and metabolic dysregulation. This may explain why obesity itself has not been shown to be associated with a significant increase in OSA-associated end-organ morbidity. Obesity is linked to a decreased treatment efficacy and, in particular, of adenotonsillectomy. Peri- and postoperative complications are more common and more severe in obese children as compared with normal-weight controls. Continuous positive airway pressure (CPAP) is frequently needed, but compliance with CPAP is less optimal in obese children than in non-obese children. In conclusion, obesity represents a major public health problem worldwide; its prevention is one of the most efficient tools for decreasing the incidence and the morbidity associated with OSA in children.
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Lee CF, Hsu WC, Lee CH, Lin MT, Kang KT. Treatment outcomes of supraglottoplasty for pediatric obstructive sleep apnea: A meta-analysis. Int J Pediatr Otorhinolaryngol 2016; 87:18-27. [PMID: 27368437 DOI: 10.1016/j.ijporl.2016.05.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/20/2016] [Accepted: 05/15/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To comprehensively review changes in sleep parameters and the success rate of supraglottoplasty for treating obstructive sleep apnea (OSA) in children. In particular, to elucidate treatment modalities and factors affecting treatment outcomes in children with both laryngomalacia and OSA. METHODS The study protocol was registered on PROSPERO (CRD42015027053). Two authors independently searched databases including PubMed, MEDLINE, EMBASE, and the Cochrane Review database. The keywords were "supraglottoplasty," "laryngomalacia," "OSA," "polysomnography," "child," and "humans." Supraglottoplasty served as the primary treatment for OSA or secondary treatment for persistent disease after previous surgeries. Subgroup analyses were conducted for children receiving supraglottoplasty as the primary or secondary treatment for OSA, and for children with and without comorbidities. RESULTS Eleven studies with 121 patients were analyzed (mean age: 3.7 years; 64% boys; mean sample size: 11 patients). After surgery, the mean differences between the pre- and postoperative measurements were a significant reduction of 8.9 events/h in the apnea-hypopnea index (AHI) and an increase of 3.7% in minimum oxygen saturation (MinSaO2; P < 0.05). The overall success rate was 28% according to a postoperative AHI <1 and 72% according to an AHI <5. Children receiving supraglottoplasty as the primary treatment had significantly younger ages (0.6 vs 6.4 years P < 0.001) than those receiving supraglottoplasty as the secondary treatment, but the outcomes were similar (33% vs 19% for a postoperative AHI < 1, P = 0.27; 77% vs 61% for a postoperative AHI < 5, P = 0.233). Moreover, children with comorbidities, compared with those without, had a similar success rate according to a postoperative AHI <1 (25% vs 21%, P = 0.805) and postoperative AHI <5 (62% vs 84%, P = 0.166). CONCLUSIONS Supraglottoplasty is an effective surgery for AHI reduction and MinSaO2 increase in children with OSA and laryngomalacia. However, complete resolution of OSA is not achieved in most cases, and factors affecting treatment outcomes in these children require future studies.
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Affiliation(s)
- Chia-Fan Lee
- Speech Language Pathologist, Child Developmental Assessment and Intervention Center, Taipei City Hospital, Taipei, Taiwan, ROC
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan, ROC; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Chia-Hsuan Lee
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan, ROC
| | - Ming-Tzer Lin
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan, ROC; Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei, Taiwan, ROC.
| | - Kun-Tai Kang
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan, ROC.
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Propst EJ, Amin R, Talwar N, Zaman M, Zweerink A, Blaser S, Zaarour C, Luginbuehl I, Karsli C, Aziza A, Forrest C, Drake J, Narang I. Midline posterior glossectomy and lingual tonsillectomy in obese and nonobese children with down syndrome: Biomarkers for success. Laryngoscope 2016; 127:757-763. [DOI: 10.1002/lary.26104] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/07/2016] [Accepted: 04/25/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Evan J. Propst
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto, Hospital for Sick Children; Toronto Canada
- Department of Otolaryngology-Head and Neck Surgery; Hospital for Sick Children; Toronto Canada
| | - Reshma Amin
- Division of Respiratory Medicine; Hospital for Sick Children; Toronto Canada
| | - Natasha Talwar
- Division of Respiratory Medicine; Hospital for Sick Children; Toronto Canada
| | - Michele Zaman
- Division of Respiratory Medicine; Hospital for Sick Children; Toronto Canada
| | - Allison Zweerink
- Division of Respiratory Medicine; Hospital for Sick Children; Toronto Canada
| | - Susan Blaser
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto, Hospital for Sick Children; Toronto Canada
- Department of Diagnostic Imaging; Hospital for Sick Children; Toronto Canada
| | - Christian Zaarour
- Department of Anesthesia; Hospital for Sick Children; Toronto Canada
| | - Igor Luginbuehl
- Department of Anesthesia; Hospital for Sick Children; Toronto Canada
| | - Cengiz Karsli
- Department of Anesthesia; Hospital for Sick Children; Toronto Canada
| | - Albert Aziza
- Department of Diagnostic Imaging; Hospital for Sick Children; Toronto Canada
| | | | - James Drake
- Division of Neurosurgery; Hospital for Sick Children; Toronto Canada
| | - Indra Narang
- Division of Respiratory Medicine; Hospital for Sick Children; Toronto Canada
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