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Lee J, Choi A, Kim S, Kim K. Long-term effects of adenotonsillectomy in children with attention deficit hyperactivity disorder. J Clin Sleep Med 2024; 20:727-733. [PMID: 38169431 PMCID: PMC11063705 DOI: 10.5664/jcsm.10978] [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: 08/17/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
STUDY OBJECTIVES Adenotonsillectomy (AT) improves short-term symptoms of attention deficit hyperactivity disorder (ADHD) in children; however, its long-term effects remain unclear. We aimed to verify the therapeutic long-term effects of AT in children with ADHD. METHODS This retrospective control study included children ages < 18 years who were diagnosed with ADHD and receiving ADHD medications. Participants were divided into groups depending on whether AT was performed (AT [+] or AT [-] groups) and matched 1:1 for age, sex, and year and month of diagnosis using randomized nonreplacement selection. RESULTS Among patients with ADHD (n = 171,112), 3,615 underwent AT. In both groups, the number of drugs taken gradually increased before and decreased after the AT date (ATD). There was no difference in the number of drugs used before (P = .88) and after ATD (P = .06). Before ATD, the average number of outpatient visits (nOV) did not change in both groups (AT [+]: P = .12; AT [-]: P = .71). After ATD, the average number of outpatient visits decreased only in the AT (+) group (P = .001). However, there was no difference in the average number of outpatient visits between the two groups before (P = .47) and after ATD (P = .17). Before ATD, methylphenidate doses between the groups were not different (P = .06); however, a significant increase was noted after ATD in the AT (+) group (P < .001). CONCLUSIONS AT does not result in significant long-term therapeutic effects in terms of medication use and health care utilization in children with ADHD. CITATION Lee J, Choi A, Kim S, Kim K. Long-term effects of adenotonsillectomy in children with attention deficit hyperactivity disorder. J Clin Sleep Med. 2024;20(5):727-733.
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Affiliation(s)
- Jooyoung Lee
- Department of Pediatrics, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Arum Choi
- Department of Preventive Medicine and Public Health, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sukil Kim
- Department of Preventive Medicine and Public Health, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyunghoon Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
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2
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Aljeraisi T. Efficacy and safety of turbinate reduction surgery in children: a systematic review. Eur Arch Otorhinolaryngol 2024; 281:1629-1641. [PMID: 37943317 DOI: 10.1007/s00405-023-08327-9] [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: 08/07/2023] [Accepted: 10/28/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE Inferior turbinate hypertrophy is not a rare problem in children, it causes chronic nasal obstruction which can severely impact the quality of life. This study aimed to investigate the efficacy and safety of turbinate reduction surgery in children with impaired nasal breathing due to hypertrophied inferior turbinate that's refractory to medical treatment. METHODS We included 23 articles with various study designs: randomized controlled trials, single-arm clinical trials, and prospective and retrospective cohort studies. We searched PubMed, Scopus, Cochrane Library, and Web of Science with the relevant keywords till April 9th, 2023. The inclusion criteria were studied with the three prespecified study design that addressed children under 18 years who underwent turbinate reduction with any technique and evaluating the improvement whether by objective or subjective methods. RESULTS Studies used objective measures favor turbinate surgery except two that showed no significant difference between pre and postoperative results. All studies used subjective measures showed an improvement postoperatively except one study. Complication rates are rare, with crust formation is being the commonest (6.03%), however, the procedure is generally safe in children. In addition, follow-up periods varied widely between 2 weeks and more than 5 years. CONCLUSION Turbinate reduction in children is an effective as a treatment method for nasal blockage due to inferior turbinate hypertrophy which is resistant to medical treatment. It is a safe procedure with low rates of complications, however, due to the heterogenicity of the study designs, with a possible risk of bias we could not conduct a meta-analysis besides our systematic review.
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Affiliation(s)
- Talal Aljeraisi
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia.
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3
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Chang HC, Lu HY, Guo YC, Lin CY, Chen SJ, Gau SY. Depression risk in chronic tonsillitis patients underwent tonsillectomy: a global federated health network analysis. Int J Med Sci 2024; 21:949-957. [PMID: 38616998 PMCID: PMC11008477 DOI: 10.7150/ijms.93977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/21/2024] [Indexed: 04/16/2024] Open
Abstract
Background: Tonsillectomy is a common surgery in the US, with possible postoperative complications. While small studies indicate postoperative depressive symptoms may occur, large-scale evidence is lacking on the tonsillectomy-depression link. Methods: We conducted a retrospective cohort study using the TriNetX US collaborative network, offering de-identified electronic health data from 59 collaborative healthcare organizations (HCOs) in the United States. In this study, people being diagnosed of chronic tonsillitis between January 2005 and December 2017 were enrolled. Patients deceased, with previous record of cancers or psychiatric events before index date were excluded. 14,874 chronic tonsillitis patients undergoing tonsillectomy were propensity score matched 1:1 to controls for age, sex, and race. New-onset depression risks were evaluated over 5 years post-tonsillectomy and stratified by age and sex. Confounders were adjusted for including demographics, medications, comorbidities and socioeconomic statuses. Results: After matching, the difference of key baseline characteristics including age, sex, comedications status and obesity status was insignificant between tonsillectomy and non-tonsillectomy groups. Tonsillectomy had a 1.29 times higher 5-year depression risk versus matched controls (95% CI, 1.19-1.40), with elevated risks seen at 1 year (HR=1.51; 95% CI, 1.28-1.79) and 3 years (HR=1.30; 95% CI, 1.18-1.43). By stratifications, risks were increased for both males (HR=1.30; 95% CI, 1.08-1.57) and females (HR=1.30; 95% CI, 1.18-1.42), and significantly higher in ages 18-64 years (HR=1.37; 1.26-1.49), but no significance observed for those 65 years and older. After performing sensitivity analyses and applying washout periods of 6, 12, and 36 months, the outcome remained consistent with unadjusted results. Conclusion: This real-world analysis found tonsillectomy was associated with a 30% higher 5-year depression risk versus matched non-tonsillectomy patients with chronic tonsillitis. Further mechanistic research is needed to clarify the pathophysiologic association between depression and tonsillectomy. Depression is not commonly mentioned in the current post-tonsillectomy care realm; however, the outcome of our study emphasized the possibility of these suffering condition after operation. Attention to psychological impacts following tonsillectomy is warranted to support patient well-being, leading to better management of post-tonsillectomy individuals.
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Affiliation(s)
- Hui-Chin Chang
- Evidence-based Medicine Center, Chung Shan Medical University Hospital, Taichung, Taiwan
- Library, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hsin-Yo Lu
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Chen Guo
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chen-Yu Lin
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shiu-Jau Chen
- Department of Neurosurgery, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Shuo-Yan Gau
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Orthopedics Department, Chi-Mei Medical Center, Tainan, Taiwan
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Puttasiddaiah PM, Morris S, Costello RC, Whittet HB. Paediatric quality-of-life following adenotonsillectomy: an evaluation of T14 paediatric throat disorder quality-of-life outcomes according to operative indication. Ann R Coll Surg Engl 2023; 105:68-71. [PMID: 35446710 PMCID: PMC9891077 DOI: 10.1308/rcsann.2022.0011] [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] [Accepted: 04/21/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Adenotonsillectomy is the most common surgical intervention for obstructive sleep apnoea (OSA) or recurrent tonsillitis. The Paediatric Throat Disorder Quality of Life Outcome (T14) questionnaire is a validated tool completed by parents to compare the outcome of surgery by measuring the pre- and postoperative scores. This study was undertaken to evaluate the quality-of-life outcome in children undergoing surgical intervention for recurrent tonsillitis and/or OSA. METHODS This was a prospective, uncontrolled study of 117 children who underwent adenotonsillectomy and tonsillectomy at a single tertiary ear, nose and throat department. An analysis of pre- and postoperative T14 paediatric throat disorder quality-of-life outcomes was undertaken at 12 months. RESULTS Of the 117 children, 105 were included in the study sample; 75 with recurrent tonsillitis, 8 with OSA and 22 with both tonsillitis and OSA. All children had an improved T14 score postoperatively. The greatest change in pre- and postoperative T14 score was observed in the tonsillitis and OSA combined group (mean change -29.36, p<0.001). However, an improvement in T14 score was also noted in the tonsilitis (-24.453, p<0.001) and OSA groups (-14.25, p<0.001). CONCLUSIONS This study found a statistically significant improvement in the T14 quality-of-life score at 12 months postoperatively in children undergoing adenotonsillectomy. This demonstrates improved parental perception of their child's symptoms for all operative indications of adenotonsillectomy.
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Affiliation(s)
| | - S Morris
- Swansea Bay University Health Board, UK
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Choi KY, Ahn JC, Rhee CS, Han DH. Intrapatient Comparison of Coblation versus Electrocautery Tonsillectomy in Children: A Randomized, Controlled Trial. J Clin Med 2022; 11:jcm11154561. [PMID: 35956176 PMCID: PMC9369690 DOI: 10.3390/jcm11154561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 02/04/2023] Open
Abstract
Many surgical instruments have been introduced and compared for safety and surgical efficiency in tonsillectomy. This study aimed to compare postoperative pain between coblation and conventional monopolar electrocautery tonsillectomy by intrapatient comparison in children. Thirty pediatric patients over six years of age undergoing tonsillectomies were enrolled. Coblation and electrocautery were used to remove both tonsils in one patient; one was removed by coblation and the other by electrocautery. The coblation side was randomly selected, and it was blinded to the patients. Each side’s daily pain scores were collected on the visual analogue scale (VAS) during ten postoperative days. On the day of surgery, 22 (73%) patients identified less pain on the coblation side, while others felt similar pain. The mean pain scores were significantly lower on the coblation side during the postoperative ten days (except for the 6th and 8th) than on the electrocautery side. The duration of severe pain (VAS > 5) was significantly shorter on the coblation side than on the electrocautery side (2.0 versus 3.7 days, respectively; p = 0.042). Coblation tonsillectomy induced less pain than electrocautery in pediatric patients; therefore, surgeons could choose the coblator as a surgical instrument for tonsillectomy to improve the pediatric postoperative quality of life.
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Affiliation(s)
- Kyu Young Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Korea
| | - Jae-Cheul Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
- Graduate School of Immunology, Seoul National University College of Medicine, Seoul 03080, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Biomedical Research Center, Seoul 03080, Korea
- Sensory Organ Research Institute, Seoul National University Biomedical Research Center, Seoul 03080, Korea
| | - Doo Hee Han
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
- Correspondence: ; Tel.: +82-2-2072-4038
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Calvo-Henriquez C, Lechien JR, Méndez-Benegassi I, Benoliel AL, Faraldo-García A, Martínez-Capoccioni G, Neves JC, Martin-Martin C. Pediatric turbinate radiofrequency ablation improves quality of life and rhinomanometric values. A prospective study. Int J Pediatr Otorhinolaryngol 2022; 154:111050. [PMID: 35065329 DOI: 10.1016/j.ijporl.2022.111050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 12/05/2021] [Accepted: 01/16/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE turbinate surgery in pediatric patients is gradually increasing in popularity amongst pediatric otolaryngologists. However, despite this, there is scarce information regarding this surgical procedure in children. The present research is designed with the aim of assessing changes in nasal resistance, nasal airflow and quality of life in pediatric patients undergoing turbinate radiofrequency ablation. METHODS A prospective uncontrolled intervention clinical trial design was followed. Children between 4 and 15 years old undergoing turbinate radiodiofrequency ablation (TRA) were consecutively selected. Children were examined preoperatively and 1, 3, 6 and 12 months after turbinate surgery. Anterior active rhinomanometry with and without nasal decongestant and examination of the turbinates and adenoid size were carried out in each follow-up visit. The SN5 quality of live survey was answered by parents. RESULTS 81 children were included, 28 with associated adenoidectomy. A significant improvement in quality of life was demonstrated since the first month after TRA. Regarding nasal resistance, there was an improvement 1 month after surgery, but it only reached statistical significance for the whole sample (p < 0.001)) and for the cohort of isolated turbinate surgery (p < 0.001) at 3 months, while the values for the cohort of children who underwent adenoidectomy reached significance at 6 months after surgery (p = 0.04). The difference in nasal resistance before and after decongestant was compared to the change in nasal resistance after surgery. It demonstrated a strong correlation with the change in nasal resistance at 1 month (R = 0.985; p < 0.001), 3 months (R = 0.995; p < 0.001), 6 months (R = 0.98; p < 0.001) and 12 months (R = 0.98; p < 0.001) after surgery. CONCLUSIONS turbinate surgery in pediatric patients seems to be a safe procedure which objectively and subjectively improves the symptoms of children suffering from nasal obstruction.
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Affiliation(s)
- Christian Calvo-Henriquez
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Rhinology Unit. Hospital Complex of Santiago de Compostela. - Santiago de Compostela, Spain.
| | - Jerome R Lechien
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology. Foch Hospital, University of Paris Saclay, Paris, France
| | - Iván Méndez-Benegassi
- Service of Otolaryngology, Rhinology Unit. University Hospital Rey Juan Carlos, Madrid, Spain
| | - Alejandro Lowy Benoliel
- Service of Otolaryngology, Pediatric Otolaryngology Unit. Gregorio Marañol University Hospital, Madrid, Spain
| | - Ana Faraldo-García
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Pediatric Otolaryngology acUnit. Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Gabriel Martínez-Capoccioni
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Rhinology Unit. Hospital Complex of Santiago de Compostela. - Santiago de Compostela, Spain
| | - J Carlos Neves
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; MyFace Clinics and Academy. Lisbon, Portugal
| | - Carlos Martin-Martin
- Service of Otolaryngology, Rhinology Unit. Hospital Complex of Santiago de Compostela. - Santiago de Compostela, Spain
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The Effect of Adenotonsillectomy on Children's Behavior and Cognitive Performance with Obstructive Sleep Apnea Syndrome: State of the Art. CHILDREN-BASEL 2021; 8:children8100921. [PMID: 34682186 PMCID: PMC8535044 DOI: 10.3390/children8100921] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/23/2021] [Accepted: 10/12/2021] [Indexed: 12/16/2022]
Abstract
(1) Background: This systematic review was designed to analyze adenotonsillectomy’s role in treating behavioural disorders and sleep-related quality of life in pediatric OSAS. (2) Methods: Papers that report pre-operative and post-operative outcomes by using the Epworth sleepiness scale, OSA-18, NEPSY, Conners’ rating scale, BRIEF, PSQ-SRBD, PedsQL and CBCL. We performed a comprehensive review of English papers published during the last 20 years regarding behavioural disorders in OSAS patients and adenotonsillectomy. (3) Results: We included 11 studies reporting behavioral outcomes and sleep related quality of life after surgery. We investigated changes in behavior and cognitive outcomes after AT, and we found significant improvements of the scores post-AT in almost all studies. After comparing the AT group and control group, only one study had no difference that reached significance at one year post-AT. In another study, it did not show any significant improvement in terms of all behavioural and cognitive outcomes. The questionnaires on sleep-related quality of life after AT (PSQ-SRBD or ESS or OSA-18 or KOSA) may improve with positive changes in sleep parameters (AHI, ODI and SpO2). Furthermore, there is a significantly higher decrease in OSAS symptoms than the pre-AT baseline score. (4) Conclusion: Future studies should pay more attention to characterizing patient populations as well as rapid surgical treatments through existing criteria.
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Jennum P, Rejkjær-Knudsen M, Ibsen R, Kiær EK, von Buchwald C, Kjellberg J. Long-term health and socioeconomic outcome of obstructive sleep apnea in children and adolescents. Sleep Med 2020; 75:441-447. [PMID: 32987343 DOI: 10.1016/j.sleep.2020.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is limited information about the long-term outcome of obstructive sleep apnea (OSA) diagnosed in children and adolescents for educational and social factors. Here, we estimate the long-term socioeconomic outcome and health care costs of OSA. METHODS The historical case-control cohort study included Danish individuals with OSA diagnosed in childhood or adolescence between 1994 and 2015. Health care costs and socioeconomic data were obtained from nationwide administrative and health registers. A total of 5419 were diagnosed during this period; of these we traced 1004 patients who we compared with 4085 controls (mean index age, 10.2 years; Standard Deviation (SD), 5.6 years) until the age of 20 years. Controls were matched for age, gender, and residency. RESULTS Comparing the OSA patient and control groups at age 20 years we found: 1) lower parental educational level; 2) significantly lower educational level also after adjustment for parental educational level; 3) lower school grade-point averages; 4) lower employment rate and lower income, which was not fully compensated when transfer payments were considered; and 5) patients' initial health care costs were higher due to higher morbidity. Patients showed higher mortality rates than controls (Hazard Ratio (HR) = 7.63, 95% CI = 4.87-11.95, P < 0.001). CONCLUSIONS OSA in children and adolescent is associated with a significant influence on morbidity, mortality, educational level, grading, social outcome, and welfare consequences.
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Affiliation(s)
- Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Mathias Rejkjær-Knudsen
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Ibsen
- i2minds, Aaboulevarden 39, 1.th., Aarhus, Denmark
| | - Eva Kirkegaard Kiær
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Kjellberg
- Danish Center for Social Science Research (VIVE), Copenhagen, Denmark
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Calvo-Henriquez C, Capasso R, Martínez-Capoccioni G, Rangel-Chaves J, Liu SY, O'Connor-Reina C, Lechien JR, Martin-Martin C. Safeness, subjective and objective changes after turbinate surgery in pediatric patients: A systematic review. Int J Pediatr Otorhinolaryngol 2020; 135:110128. [PMID: 32485468 DOI: 10.1016/j.ijporl.2020.110128] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/23/2020] [Accepted: 05/18/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Inferior turbinates are the main structure related to impaired nasal breathing. When medical treatment fails, surgery is the next step, according to clinical guidelines. However, despite the widespread acceptance of this procedure, there is some controversy about performing it in children. DATA SOURCES Pubmed (Medline), the Cochrane Library, EMBASE, Scopus, Science direct, SciELO and Trip Database. REVIEW METHODS We looked for articles in which the individual outcome of turbinate surgery in pediatric patients was investigated independently of whether it was the main objective of the study or not. RESULTS 13 papers (1111 patients) met the inclusion criteria. 6 authors performed diverse objective assessment and 11 authors used subjective scales. All of them found improvement after surgery. Due to the heterogeneity of the methods used, they could not be included in a metanalysis. Eleven out of the 13 authors reported 3.12% complication rates, being minor bleeding the most common (1.30%), followed by crust (0.49%) and pain (0.47%). CONCLUSIONS There is a lack of high quality studies in children. Turbinate surgery in children is a safe technique with low complication rates. The available evidence suggests improvement in subjective outcomes after turbinate surgery in children. We cannot make a formal recommendation of a surgical technique in children given the lack of high quality studies, and since comparison between available papers is not possible. Although the evidence at our disposal is weak, it suggests that the safest techniques are MAIT, radiofrequency, coblation and laser.
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Affiliation(s)
- Christian Calvo-Henriquez
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Rhinology Study Group, Spain; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Spain.
| | - Robson Capasso
- Department of Otolaryngology - Sleep Surgery Division, Stanford University Medical Center, Stanford, CA, USA
| | - Gabriel Martínez-Capoccioni
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Rhinology Study Group, Spain; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Spain
| | - Jesús Rangel-Chaves
- Department of Otolaryngology, Hospital Nuestra Señora de La Salud, San Luis de Potosi, Mexico
| | - Stanley Yung Liu
- Department of Otolaryngology - Sleep Surgery Division, Stanford University Medical Center, Stanford, CA, USA
| | | | - Jerome R Lechien
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Rhinology Study Group, Spain; Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Carlos Martin-Martin
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Rhinology Study Group, Spain; Department of Otolaryngology, University of Santiago de Compostela, Spain
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Caixeta JAS, Sampaio JCS, Costa VV, Silveira IMBD, Oliveira CRFD, Caixeta LCAS, Avelino MAG. Long-term Impact of Adenotonsillectomy on the Quality of Life of Children with Sleep-disordered breathing. Int Arch Otorhinolaryngol 2020; 25:e123-e128. [PMID: 33542762 PMCID: PMC7851366 DOI: 10.1055/s-0040-1709195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 02/25/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction
Adenotonsillectomy is the first-line treatment for obstructive sleep apnea secondary to adenotonsillar hypertrophy in children. The physical benefits of this surgery are well known as well as its impact on the quality of life (QoL), mainly according to short-term evaluations. However, the long-term effects of this surgery are still unclear.
Objective
To evaluate the long-term impact of adenotonsillectomy on the QoL of children with sleep-disordered breathing (SDB).
Method
This was a prospective non-controlled study. Children between 3 and 13 years of age with symptoms of SDB for whom adenotonsillectomy had been indicated were included. Children with comorbities were excluded. Quality of life was evaluated using the obstructive sleep apnea questionnaire (OSA-18), which was completed prior to, 10 days, 6 months, 12 months and, at least, 18 months after the procedure. For statistical analysis,
p
-values lower than 0.05 were defined as statistically significant.
Results
A total of 31 patients were enrolled in the study. The average age was 5.2 years, and 16 patients were male. The OSA-18 scores improved after the procedure in all domains, and this result was maintained until the last evaluation, done 22 ± 3 months after the procedure. Improvement in each domain was not superior to achieved in other domains. No correlation was found between tonsil or adenoid size and OSA-18 scores.
Conclusion
This is the largest prospective study that evaluated the long-term effects of the surgery on the QoL of children with SDB using the OSA-18. Our results show adenotonsillectomy has a positive impact in children's QoL.
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Zaidman-Zait A, Zwaigenbaum L, Duku E, Bennett T, Szatmari P, Mirenda P, Smith I, Vaillancourt T, Volden J, Waddell C, Kerns C, Elsabbagh M, Georgiades S, Ungar WJ, Fombonne E, Roberts W. Factor analysis of the children's sleep habits questionnaire among preschool children with autism spectrum disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 97:103548. [PMID: 31901672 DOI: 10.1016/j.ridd.2019.103548] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 11/17/2019] [Accepted: 11/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Sleep problems are prevalent among young children with autism spectrum disorders (ASD). The Children's Sleep Habits Questionnaire (CSHQ) is commonly used for assessment, but there are outstanding questions regarding its optimal measurement model. AIMS To examine the factor structure of the CSHQ in preschool children with ASD, and relationships between CSHQ factors and children's emotional, cognitive, and behavioral dysregulation. METHODS AND PROCEDURES Participants included 4- to 5-year-olds with ASD (n = 281). Confirmatory factor analysis was used to examine whether two previously reported CSHQ factor structures provided adequate fit to the sample data. Exploratory Factor Analysis (EFA) was used examine alternative models. Regression analyses were used to examine how CSHQ factor scores explained variance in dysregulation symptoms, measured by the Child Behavior Checklist. RESULTS Previously reported factor models in children with ASD were not confirmed, but a novel five-factor model identified using EFA provided excellent fit to the sample data. Sleep factors were generally not correlated with autism symptoms but were associated with aggression, anxiety/depression and attention problems, with evidence of specificity in these relationships. CONCLUSIONS The proposed CSHQ five-factor model may be useful in future studies of sleep problems in young children with ASD.
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Affiliation(s)
| | | | - Eric Duku
- McMaster University & Offord Centre for Child Studies
| | | | - Peter Szatmari
- Centre for Addiction and Mental Health, University of Toronto
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- Integrated Services for Autism and Neurodevelopmental Disorders, Toronto
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12
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Al-Zaabi K, Al-Adawi S, Jaju S, Jeyaseelan L, Al-Sibani N, Al-Alawi M, Al-Abri M, Al-Abri R. Effects of an Adenotonsillectomy on the Cognitive and Behavioural Function of Children Who Snore: A naturalistic observational study. Sultan Qaboos Univ Med J 2019; 18:e455-e460. [PMID: 30988963 DOI: 10.18295/squmj.2018.18.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/11/2018] [Accepted: 08/02/2018] [Indexed: 12/14/2022] Open
Abstract
Objectives This study aimed to evaluate cognitive and behavioural changes among 9-14-year-old Omani children with obstructive sleep apnoea (OSA) after an adenotonsillectomy (AT). Methods This naturalistic observational study was conducted at the Sultan Qaboos University Hospital, Muscat, Oman, between January 2012 and December 2014. Omani children with adenotonsillar hypertrophy (ATH) underwent overnight polysomnography and those with confirmed OSA were scheduled for an AT. Cognitive and behavioural evaluations were performed using standardised instruments at baseline prior to the procedure and three months afterwards. Results A total of 37 children were included in the study, of which 24 (65%) were male and 13 (35%) were female. The mean age of the males was 11.4 ± 1.9 years, while that of the females was 11.1 ± 1.5 years. Following the AT, there was a significant reduction of 56% in mean apnoea-hypopnoea index (AHI) score (2.36 ± 4.88 versus 5.37 ± 7.17; P <0.01). There was also a significant positive reduction in OSA indices, including oxygen desaturation index (78%), number of desaturations (68%) and number of obstructive apnoea incidents (74%; P <0.01 each). Significant improvements were noted in neurocognitive function, including attention/concentration (42%), verbal fluency (92%), learning/recall (38%), executive function (52%) and general intellectual ability (33%; P <0.01 each). There was a significant decrease of 21% in both mean inattention and hyperactivity scores (P <0.01 each). Conclusion These results demonstrate the effectiveness of an AT in improving cognitive function and attention deficit hyperactivity disorder-like symptoms among children with ATH-caused OSA. Such changes can be observed as early as three months after the procedure.
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Affiliation(s)
- Khalid Al-Zaabi
- Department of Surgery, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Samir Al-Adawi
- Department of Behavioural Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Sanjay Jaju
- Department of Family Medicine & Public Health, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Nasser Al-Sibani
- Department of Behavioural Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Mohammed Al-Alawi
- Department of Behavioural Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Mohammed Al-Abri
- Department of Physiology, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Rashid Al-Abri
- Department of Surgery, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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13
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Krishnan G, Stepan L, Du C, Padhye V, Bassiouni A, Dharmawardana N, Ooi EH, Krishnan S. Tonsillectomy using the BiZact: A pilot study in 186 children and adults. Clin Otolaryngol 2019; 44:392-396. [PMID: 30576062 DOI: 10.1111/coa.13273] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/17/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Giri Krishnan
- The Department of Otorhinolaryngology, Head and Neck Surgery, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Lia Stepan
- The Department of Otorhinolaryngology, Head and Neck Surgery - Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Charles Du
- The Department of Otorhinolaryngology, Head and Neck Surgery, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Vikram Padhye
- The Department of Otorhinolaryngology, Head and Neck Surgery, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ahmed Bassiouni
- The Department of Otorhinolaryngology, Head and Neck Surgery - Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Nuwan Dharmawardana
- The Department of Otorhinolaryngology, Head and Neck Surgery - Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - E H Ooi
- The Department of Otorhinolaryngology, Head and Neck Surgery - Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia.,Flinders Private Hospital, Bedford Park, South Australia, Australia.,The Memorial Hospital, North Adelaide, South Australia, Australia
| | - Suren Krishnan
- The Department of Otorhinolaryngology, Head and Neck Surgery, The Royal Adelaide Hospital, Adelaide, South Australia, Australia.,The Memorial Hospital, North Adelaide, South Australia, Australia.,Calvary Central Districts Hospital, Elizabeth Vale, South Australia, Australia
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14
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Konieczny KM, Pitts-Tucker TN, Biggs TC, Pringle MB. A five-year follow-up observational study of the T-14 paediatric throat disorders outcome measure in tonsillectomy and adenotonsillectomy. Ann R Coll Surg Engl 2019; 101:40-43. [PMID: 30112941 PMCID: PMC6303835 DOI: 10.1308/rcsann.2018.0133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2018] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The T-14 questionnaire is a validated outcome measurement tool to assess the value of paediatric tonsillectomy from a parent's perspective. There is a paucity of data regarding the long-term postoperative effects of tonsillectomy on quality of life in the paediatric population. Our previous study assessed T-14 scores up to year 2 postoperatively, with this study extending follow-up to 5 years. MATERIALS AND METHODS We undertook a prospective uncontrolled observational study examining 54 paediatric patients undergoing tonsillectomy at Portsmouth Hospitals NHS Trust. Parents of children undergoing surgery were invited to complete a T-14 questionnaire preoperatively, as well as at 3 months, 6 months, 1 year, 2 years and now 5 years postoperatively. RESULTS In total, 44 of 54 patients completed questionnaires preoperatively and at all postoperative time points, with 46 being completed at 5 years. There was a highly significant (P < 0.001) difference between the preoperative scores and all other measured T-14 scores postoperatively. The mean score preoperatively was 33.3 compared with 1.0 at 5 years. CONCLUSIONS This is the first study to assess long-term quality of life following paediatric tonsillectomy using the T-14 questionnaire. The benefits of tonsillectomy on long-term quality of life further confirms its value within the paediatric population.
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Affiliation(s)
- KM Konieczny
- Portsmouth Hospitals NHS Foundation Trust, Portsmouth, UK
| | - TN Pitts-Tucker
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - TC Biggs
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - MB Pringle
- Portsmouth Hospitals NHS Foundation Trust, Portsmouth, UK
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15
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Kao SS, Peters MDJ, Ooi EH. Pediatric tonsillectomy quality of life assessment instruments: a scoping review protocol. ACTA ACUST UNITED AC 2018; 15:1222-1227. [PMID: 28498161 DOI: 10.11124/jbisrir-2016-003131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this scoping review is to investigate quality of life (QoL) questionnaires available to pediatric patients following tonsillectomies with or without adenoidectomies for chronic infection or sleep-disordered breathing (SDB). The scoping review will aim to map the components of each QoL questionnaire assessed including frequency of use, age parameters, respondent, domains assessed, format and psychometric properties. Questionnaire format will be summarized into respondent and administrator burden by identifying the number of questions present, scale utilized and time to completion. The scoping review will report on whether psychometric analysis in terms of test reliability and validity was assessed in the included papers as well as the results of those assessments.Specifically, the review question is: what QoL questionnaires are available for pediatric patients following tonsillectomies with or without adenoidectomies for chronic infections or SDB?
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Affiliation(s)
- Stephen S Kao
- 1Department of ENT Head and Neck Surgery, Flinders Medical Centre, South Australia, Australia 2Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia 3Department of Surgery, Flinders University, South Australia, Australia
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16
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Torretta S, Rosazza C, Pace ME, Iofrida E, Marchisio P. Impact of adenotonsillectomy on pediatric quality of life: review of the literature. Ital J Pediatr 2017; 43:107. [PMID: 29178907 PMCID: PMC5702149 DOI: 10.1186/s13052-017-0424-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 11/13/2017] [Indexed: 12/11/2022] Open
Abstract
Adenotonsillectomy (ADT) is one of the most widely used procedures in the treatment of paediatric recurrent acute tonsillitis (RAT) and obstructive sleep apnoea syndrome (OSAS), both of which have significant repercussions on the patients' quality of life (QoL). The purpose of our review of literature was to highlight the great variety of tools that are currently used to evaluate QoL in children, to examine data available on their efficacy and the feasibility of their use in daily clinical practice, and to determine possible limitations related to an indirect and subjective assessment of QoL in children.Although the use of different parameters makes it difficult to compare the published studies, an analysis of the evidence currently available in the literature suggests that ADT has a generally positive impact on the QoL (especially in case of OSAS). It also highlights the importance of combining tonsillectomy and adenoidectomy in the treatment of OSAS, and documents the comparability of tonsillectomy and tonsillotomy in improving obstructive symptoms. In conclusion, our findings suggest that literature supports that ADT is associated with positive changes in QOL; however further studies using comparable standardised criteria are necessary to confirm the size and duration of this benefit.
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Affiliation(s)
- Sara Torretta
- Department of Clinical Sciences and Community Health, University of Milan; Otolaryngological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20100, Milan, Italy.
| | - Chiara Rosazza
- Department of Pathophysiology and Transplantation, University of Milan; Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Elisabetta Pace
- Department of Pathophysiology and Transplantation, University of Milan; Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisabetta Iofrida
- Department of Clinical Sciences and Community Health, University of Milan; Otolaryngological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20100, Milan, Italy
| | - Paola Marchisio
- Department of Pathophysiology and Transplantation, University of Milan; Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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17
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Todd CA, Bareiss AK, McCoul ED, Rodriguez KH. Adenotonsillectomy for Obstructive Sleep Apnea and Quality of Life: Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2017; 157:767-773. [PMID: 28675097 DOI: 10.1177/0194599817717480] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To determine the impact of adenotonsillectomy on the quality of life of pediatric patients with obstructive sleep apnea (OSA) and to identify gaps in the current research. Data Sources The MEDLINE, EMBASE, and Cochrane databases were systematically searched via the Ovid portal on June 18, 2016, for English-language articles. Review Methods Full-text articles were selected that studied boys and girls <18 years of age who underwent adenotonsillectomy for OSA or sleep-disordered breathing and that recorded validated, quantitative quality-of-life outcomes. Studies that lacked such measures, performed adenotonsillectomy for indications other than OSA or sleep-disordered breathing, or grouped adenotonsillectomy with other procedures were excluded. Results Of the 328 articles initially identified, 37 were included for qualitative analysis. The level of evidence was generally low. All studies involving short-term follow-up (≤6 months) showed improvement in quality-of-life scores after adenotonsillectomy as compared with preoperative values. Studies involving long-term follow-up (>6 months) showed mixed results. Modifications to and concurrent procedures with conventional adenotonsillectomy were also identified that showed quality-of-life improvements. Three studies were identified for meta-analysis that compared pre- and postoperative Obstructive Sleep Apnea-18 scores. Short- and long-term follow-up versus preoperative scores showed significant improvement ( P < .001). Short- and long-term scores showed no significant difference. Conclusion This systematic review and meta-analysis demonstrate adenotonsillectomy's effectiveness in improving the quality of life of pediatric patients with OSA. This is well demonstrated in the short term and has strong indications in the long term.
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Affiliation(s)
- Cameron A Todd
- 1 Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Anna K Bareiss
- 1 Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Edward D McCoul
- 1 Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.,2 Department of Otorhinolaryngology-Head and Neck Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA.,3 Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Kimsey H Rodriguez
- 2 Department of Otorhinolaryngology-Head and Neck Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
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18
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Kao SST, Peters MDJ, Dharmawardana N, Stew B, Ooi EH. Scoping review of pediatric tonsillectomy quality of life assessment instruments. Laryngoscope 2017; 127:2399-2406. [DOI: 10.1002/lary.26522] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/15/2016] [Accepted: 01/04/2017] [Indexed: 12/31/2022]
Affiliation(s)
| | - Micah D. J. Peters
- Joanna Briggs Institute; Faculty of Health Sciences, University of Adelaide
| | | | - Benjamin Stew
- ENT Head and Neck Surgery; Flinders Medical Centre and Flinders University
| | - Eng Hooi Ooi
- ENT Head and Neck Surgery; Flinders Medical Centre and Flinders University
- Department of Surgery; Flinders University; Bedford Park South Australia Australia
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19
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Tan HL, Alonso Alvarez ML, Tsaoussoglou M, Weber S, Kaditis AG. When and why to treat the child who snores? Pediatr Pulmonol 2017; 52:399-412. [PMID: 28029756 DOI: 10.1002/ppul.23658] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/25/2016] [Accepted: 11/30/2016] [Indexed: 12/31/2022]
Abstract
Obstructive sleep-disordered breathing (SDB) can result in cardiovascular and neurocognitive morbidity as well as adversely affect behavior, growth, quality of life, and nocturnal continence. This article summarizes the latest evidence regarding the morbidity related to obstructive SDB, commenting on the impact of severity of obstruction, that is, the difference in effects seen of moderate to severe obstructive sleep apnea syndrome (OSAS) compared to those of mild OSAS or primary snoring. The impact of therapy is discussed, focusing on which children are likely to benefit from treatment interventions; namely those with moderate or severe OSAS irrespective of the presence of morbidity, children with mild OSAS with associated morbidity or predictors of SDB persistence such as obesity, and children with complex conditions accompanied by upper airway obstruction like craniosynostosis and Prader-Willi syndrome. The co-existing conditions which may improve when treatment for obstructive SDB is offered are reviewed, while the clinical parameters associated with spontaneous improvement or resolution of obstructive SDB are discussed. The intention being to enable clinicians to make informed decisions on who should be treated, when and why. Pediatr Pulmonol. 2017;52:399-412. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hui-Leng Tan
- Department of Pediatric Respiratory Medicine, Royal Brompton Hospital, Sydney St., London SW3 6NP, United Kingdom
| | - Maria Luz Alonso Alvarez
- Multidisciplinary Sleep Unit, Pulmonology, University Hospital of Burgos and CIBER of Respiratory Diseases (CIBERES), Burgos Foundation for Health Research, Burgos, Spain
| | - Marina Tsaoussoglou
- Pediatric Pulmonology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Silke Weber
- Department of Ophthalmology, Otolaryngology and Head and Neck Surgery, Botucatu Medical School, São Paulo State University-UNESP, Botucatu, São Paulo, Brazil
| | - Athanasios G Kaditis
- Pediatric Pulmonology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
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Prevalence of sleep-related breathing disorders among school children in Kars Turkey. Sleep Biol Rhythms 2017. [DOI: 10.1007/s41105-017-0088-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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