Management of Pediatric OSA Beyond Adeno-Tonsillectomy

Purpose of Review: Tonsillectomy and adenoidectomy (TA) has been considered as the first-line treatment for pediatric obstructive sleep apnea (OSA). A large group of children continue to have residual OSA after TA. Management of children with residual OSA has been increasingly studied. We aim to evaluate and critically assess the current evidence for treating residual OSA in children. Recent Findings: Residual OSA after TA has been commonly treated with positive airway pressure treatment and nasal corticosteroid among a wide variety of medical and surgical options. Drug-induced sleep endoscopy (DISE) and cine magnetic resonance imaging (MRI) have been used to evaluate sites of airway obstruction during sleep and to plan surgical treatment. Surgical management of residual OSA may require application of a variety of procedures addressing multiple sites of airway obstruction. Surgical treatment may not resolve residual OSA in all children, and positive airway pressure treatment is commonly employed in these children. Summary: Effective surgical approaches to manage residual OSA have been reported to treat airway obstruction revealed by DISE or cine MRI. A meticulous synthesis of the information obtained from a complete otolaryngologic examination, diagnostic tests such as DISE, cine MRI, and response to medical treatment is essential for the efficient management of children with residual OSA and identification of candidates for surgery.