Effect of adenotonsillectomy on the growth, development, and comprehensive cognitive abilities of children with obstructive sleep apnea: a prospective single-arm study

Background

Previous studies did not comprehensively examine the effect of adenotonsillectomy on growth and development, emotional state, quality of life, attention ability, and cognitive dysfunction in children with obstructive sleep apnea (OSA). This study aimed to explore the improvement effects of adenotonsillectomy on the growth, development, quality of life, and attention ability in children with OSA.

Methods

This prospective single-arm study involved children with OSA admitted at The No. 980 Hospital, Joint Logistics Support Force, PLA, China (02/2017–02/2018). The Myklebust Pupil Rating Scale (PRS), Inventory of Subjective Life Quality (ISLQ), Zung Self-rating Anxiety Scale (SAS), Conners Parent Symptom Questionnaire (PSQ), and Continuous Performance Task (CPT) were examined before and at 6 months after adenotonsillectomy.

Results

Forty-nine patients were enrolled. They all completed the 6-month follow-up. The body mass index increased after surgery (from 18.8 ± 4.9 to 19.3 ± 4.3 kg/m², P = 0.008). The total PRS score increased 6 months after surgery (from 73.8 ± 12.7 to 84.6 ± 10.3, P < 0.001). All aspects of the ISLQ, except anxiety experience and physical emotion, were improved at 6 months after adenotonsillectomy (all P < 0.01). The SAS score also decreased from 20.1 ± 10.0 to 12.8 ± 6.6 (P < 0.001). All six dimensions of the PSQ, as assessed by the legal guardians, decreased after adenotonsillectomy (all P < 0.01). The proportions of children with auditory and/or visual sustained attention abnormalities decreased after surgery.

Conclusions

After adenotonsillectomy, the PRS, ISLQ, and PSQ improved, and anxiety and auditory/visual sustained attention abnormalities decreased, suggesting positive impacts on the growth, development, quality of life, and comprehensive cognitive abilities of children with OSA.

Evaluation of Secondary Post-Tonsillectomy Bleeding among Children in Saudi Arabia: Risk Factor Analysis

BACKGROUND

Tonsillectomy is one of the most widely recognized surgeries for tonsillitis. It is the default surgery option for obstructive sleep apnea, recurrent tonsillitis, and recurrent peritonsillar abscess. However, there are limited risk factor analyses in Saudi Arabia related to tonsillectomy. The goal of study is to evaluate and analyze the risk factors for secondary post-tonsillectomy bleeding in Saudi Arabia.

METHOD

This retrospective review study was directed at King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia. Univariate and multivariate investigations were performed to decide the risk factors.

RESULTS

A total of 713 children were included. Post-tonsillectomy bleeding occurred in only 5.3% of tonsillectomies. There was no seasonal variation impact on post-tonsillectomy bleeding rate (P = .8). The multivariate analysis showed a significant association between post-tonsillectomy bleeding and both age (odds ratio [OR] = 1.156; 95% CI: 1.007-1.326; P = .039) and sleep disorder breathing/obstructive sleep apnea (OR = 3.581; 95% CI: 1.454-8.820; P = .006).

CONCLUSION

This study revealed that age, sleep disorder/obstructive sleep apnea, and longer hospital stay after tonsillectomy are significant risk factors for post-tonsillectomy bleeding. This study provides an important baseline for further local studies in the future.

Shared decision-making in older children and parents considering elective adenotonsillectomy

OBJECTIVES

Shared decision-making describes a collaborative process in which healthcare providers and patients/families make treatment decisions using the best available evidence, while taking into account the patient's values and preferences. The objectives of this study were to assess the level of decisional conflict and shared decision-making experienced by older children and their parents when considering elective adentonsillectomies.

DESIGN

A prospective cohort study.

SETTING

Paediatric otolaryngology clinic in a teaching hospital.

PARTICIPANTS

Participants included 53 children older than 9 years and their parents who underwent consultation for tonsillectomy with or without adenoidectomy.

MAIN OUTCOMES MEASURES

Children and parents completed the Decisional Conflict Scale (DCS) and Shared Decision-Making Questionnaire-Patient Version (SDM-Q-9). Surgeons completed the Shared Decision-Making Questionnaire-Physician Version (SDM-Q-Doc).

RESULTS

Overall, 10 (19%) parents and 18 (34%) children reported clinically significant decisional conflict. Parents who opted not to proceed with surgery had significantly higher DCS scores than those who decided to proceed with surgery. Both parents and children SDM-Q-9 and total DCS scores were significantly negatively correlated. Physician SDM-Q-Doc and parent total DCS scores were negatively correlated, while parent and physician SDM scores were positively correlated.

CONCLUSIONS

Many older children and parents reported significant decisional conflict when considering elective paediatric otolaryngology surgery. Decisional conflict levels for both children and parents decreased with greater perceived levels of shared decision-making. Older children did not appear to discern the same levels of shared decision-making as parents and surgeons. Future research should assess methods to implement shared decision-making into clinical practice for clinicians, parents and children when appropriate.

Cognitive and Behavioral Consequences of Sleep Disordered Breathing in Children

There is now a plethora of evidence that children with sleep disordered breathing (SDB) show deficits in neurocognitive performance, behavioral impairments, and school performance. The following review will focus on the neurobehavioral impacts of SDB, pediatric sleep investigation challenges, potential mechanisms of behavioral and cognitive deficits in children with SDB, and the impact of SDB treatment.

Complications of turbinate reduction surgery in combination with tonsillectomy in pediatric patients

OBJECTIVES/HYPOTHESIS

To examine whether the addition of turbinoplasty to tonsillectomy and adenoidectomy (T&A) increases the risk of postoperative complications.

STUDY DESIGN

Retrospective cohort study of children (18 years old and younger) who underwent tonsillectomy and/or turbinoplasty between July 1, 2013 and June 30, 2015 using the 2016 Pediatric Health Information System administrative database METHODS: Patients were divided into three groups: 1) T&A and turbinoplasty, 2) T&A alone, and 3) turbinoplasty alone. Postoperative revisit, hemorrhage requiring cautery, and blood transfusion rates were compared between groups.

RESULTS

A total of 75,761 patients met inclusion criteria: 3,079 underwent both T&A and turbinoplasty, 72,043 underwent T&A alone, and 639 underwent turbinoplasty alone. The rate of 14-day relevant revisits after T&A in combination with turbinate reduction surgery was not significantly higher than that of T&A alone (9.4% vs. 8.6%; P = .11). The revisit rate after turbinoplasty alone was 1.4%. Indications for revisits did not differ between the T&A and turbinoplasty group versus T&A alone group (P = .23). Furthermore, the rates of hemorrhage requiring cauterization was similar between the two groups (1.4% vs. 1.5%; P = .64). Twenty-one patients who underwent T&A alone required blood transfusion after they were readmitted; no cases in the other two groups required blood transfusion.

CONCLUSIONS

Turbinoplasty and T&A performed together do not increase the risk of postoperative revisit or hemorrhage requiring cauterization, and can therefore be considered as a combined procedure. Pediatric patients will benefit from avoiding the additional risk of multiple anesthetics and repeated intubation.

LEVEL OF EVIDENCE

4. Laryngoscope, 127:1920-1923, 2017.