Adenoidectomy Without Tonsillectomy for Pediatric Obstructive Sleep Apnea

Stephen R. Chorney, Karen B. Zur

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: The primary objective was to determine if obstructive sleep apnea (OSA) can improve after adenoidectomy. Study Design: Case series with chart review. Setting: Tertiary children’s hospital between 2016 and 2018. Methods: The study included children under 3.5 years with small (1+ or 2+) palatine tonsils, large (3+ or 4+) adenoids, and documented OSA on polysomnogram (PSG). Results: Seventy-one children were included. Age at adenoidectomy was 2.0 years (95% CI, 1.8-2.2) and 71.8% were male. Mean follow-up was 2.5 years (95% CI, 2.3-2.7). Twenty-six children (36.6%) obtained a repeat PSG at a mean of 9.7 months (95% CI, 6.3-13.2) after adenoidectomy. Among those with a postoperative PSG, apnea-hypopnea index decreased in 77.0% (mean, –3.2 events/h; 95% CI, –14.1 to 7.6), and the proportion with moderate to severe OSA decreased from 65.4% to 30.8% (P =.03). Six children (23.1%) had a normal PSG after adenoidectomy. Tonsillectomy was performed in 14.1% of children at 12.1 months (95% CI, 7.5-16.7) after adenoidectomy. Despite similar preoperative PSG variables, younger children (1.5 vs 2.1 years, P =.02) were more likely to require tonsillectomy. Substantial adenoid regrowth was identified in 1 child at the time of tonsillectomy. Conclusion: Adenoidectomy may improve OSA in young children with large adenoids and small tonsils. However, younger age predicted the need for subsequent tonsillectomy. Prospective studies with additional PSG data are necessary to corroborate these findings.

Original languageEnglish (US)
Pages (from-to)1100-1107
Number of pages8
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume164
Issue number5
DOIs
StatePublished - May 2021
Externally publishedYes

Keywords

  • adenoidectomy
  • obstructive sleep apnea
  • pediatrics
  • polysomnogram
  • tonsillectomy

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

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