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CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2023; 27(02): e211-e217
DOI: 10.1055/s-0043-1768207
Original Research

The Effect of Tonsillectomy and Adenoidectomy on Upper Airway Obstruction Patterns in Children with Obstructive Sleep Apnea

Kelsey Mothersole 
1   Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
,
Seckin Omer Ulualp 
1   Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
2   Divisions of Pediatric Otolaryngology, Department of Anesthesiology and Pain Management, University of Texas Southwestern, Dallas, TX, United States
,
Peter Szmuk 
3   Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, United States
4   Department of Anesthesiology, Children's Health Medical Center, Dallas, TX, United States
5   Outcome Research Consortium, Cleveland, OH, United States
,
Christopher Liu 
1   Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
2   Divisions of Pediatric Otolaryngology, Department of Anesthesiology and Pain Management, University of Texas Southwestern, Dallas, TX, United States
› Author Affiliations Financial Disclosure The authors have no financial relationships to declare.
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Abstract

Introduction Alterations in upper airway flow dynamics and sites of airway obstruction immediately after tonsillectomy and adenoidectomy (TA) have not been assessed. Identification of the changes in airway obstruction patterns after TA potentially improves the surgical management of children with obstructive sleep apnea (OSA).

Objective To evaluate the effect of TA on upper airway obstruction patterns detected with drug-induced sleep endoscopy (DISE).

Methods The medical records of patients who underwent pre-TA DISE during the induction of anesthesia and post-TA DISE at the end of TA were reviewed. Data pertaining to polysomnography and DISE findings were analyzed.

Results Twenty-seven patients (15 male and 12 females aged between 2 and 18 years old) were identified. All patients had obstruction at multiple sites of the upper airway. Prior to TA, airway obstruction was at the level of the velum in 27 patients, of the oropharynx/lateral walls in 27, of the tongue in 7, and of the epiglottis in 4. After TA, airway obstruction was at the level of the velum in 24 patients, of the oropharynx/lateral walls in 16, of the tongue in 6, and of the epiglottis in 4. The degree of obstruction at the levels of the velum and oropharynx/lateral walls after TA was significantly decreased.

Conclusions Drug-induced sleep endoscopy performed prior to TA revealed that most of the sites of airway obstruction persisted after TA in OSA children with multiple sites of airway obstruction. Further studies in larger group of children with OSA are needed to establish the value of DISE findings in predicting residual OSA after TA, surgical planning, determining the need for post TA sleep study, and counseling caregivers.

Keywords

airway obstruction - drug-induced sleep endoscopy - obstructive sleep apnea - tonsillectomy


Publication History

Received: 03 December 2020

Accepted: 24 May 2021

Article published online:
28 April 2023

© 2023. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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