Adenotonsillectomy Alleviates Upper Airway Obstruction

AN ADENOTONSILLECTOMY ALLEVIATES UPPER AIRWAY OBSTRUCTION IN CHILDREN WITH ENLARGED TONSILS AND ADENOIDS

University of Louisville ear, nose, and throat specialists find that surgical removal of enlarged tonsils and adenoids aids young patients with breathing problems and sleep disorders and improves quality of life.

Adenotonsillar hypertrophy, or enlarged tonsils and adenoids, is a condition diagnosed in the pediatric population. There are young boys and girls with this condition who exhibit symptoms and sleep disturbances and yet do not suffer from infectious or inflammatory disease such as tonsillitis. The consequence of this disorder can be serious. Symptoms of upper airway obstruction include excessive snoring, restlessness, behavioral problems, poor school performance, and excessive daytime sleepiness.

The surgical removal of adenoids and tonsils has been recommend as a treatment option for children diagnosed with upper airway obstruction. Although adenotonsillectomy remains the most common surgical procedure performed on children in the United States today, a debate continues in some quarters of the medical profession regarding its efficacy and necessity.

A new study by otolaryngologist--head and neck surgeons provides strong evidence that a adenotonsillectomy is effective in reducing upper airway obstruction symptoms and enhances the quality of life for the young patient. The research study was carried out by Julie L. Goldman MD, M. Scott Major MD, Toni M. Ganzel MD, and Susan Barnett, M.S.S.W., all from the Division of Otolaryngology, University of Louisville School of Medicine, Louisville, KY. The results of their findings were presented April 28 at the annual meeting of the Triological Society, being held April 26-28, at the Marriott's Desert Springs, Palm Desert, CA.

Methodology: The study was conducted at a private otolaryngology office and a hospital-based pediatric otolaryngology clinic in Louisville, KY, between November, 1997, and August, 1998. All the patients referred for evaluation of upper airway obstruction secondary to a condition of enlarged tonsils and adenoids were enrolled. Only patients who had undergone adenotonsillectomy were included in the study analysis. With that criteria, 114 children were referred, 41 patients ultimately completed the study. In that group there were 23 boys and 18 girls with an age range of 1 to 16 years. The average age was 7.5 years with a mean of 6 years. The study instrument consisted of a self-administered questionnaire as well as disease-specific questions regarding the child's breathing patterns, snoring frequency and volume, urinary incontinence, and morning headaches and appetite. Additionally parents were asked to observe the child breathing before and after the adenotonsillectomy.

Results: The researchers found statistically significant improvements in the patients following surgical intervention. Specifically, the researchers found:

Prior to surgery, two-thirds of parents were fearful after observing their child's breathing during sleeping. After the procedure, this number was reduced to five percent.

Seventy-six percent of parents observed their child struggle to breathe preoperatively, compared to five percent after the operation.

Before surgery, all the parents reported their child snored "almost daily." After the adenotonsillectomy, less than ten percent of the children snored once a week or more.

Mouth breathing, morning headaches, and urinary incontinence were eliminated after the surgery.

The researchers recommend when a child with enlarged tonsils and adenoids displays symptoms of airway obstruction, strong consideration be given to performing an adenotonsillectomy. Doing so will improve the child's health and quality of life.

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Contact Ken Satterfield at 703-519-1563 (until 4/22) or 760-776-8503 (4/22-4/29) for an interview with Dr. Goldman or additional information.