SURGERY

Abstract

We studied the outcomes of 76 children, aged 3 to 12 years, with large tonsils and/or large adenoids who underwent surgery to relieve upper airway obstruction over a 1-year period. Following surgery, nearly all patients experienced an alleviation of all symptoms, except for enuresis. We suggest that children who have large tonsils and/or adenoids will gain substantial benefit if they are removed, even children who do not have a history of severe sleep apnea or objective evidence from polysomnography.

Introduction

Most upper airway obstruction in children is caused by adenotonsillar hypertrophy. Obstructive sleep apnea caused by adenotonsillar hypertrophy is a definite indication for surgery. Hypopnea can occur when airflow is impaired but not completely obstructed. Among children, clinically significant obstructive hypopnea with partial upper airway obstruction is more common than obstructive sleep apnea with complete obstruction.Using adult criteria to detect obstructive sleep apnea--that is, the hourly number of apneic events with complete airway obstruction--will not identify most children who have serious upper airway obstruction during sleep. There are many other 0causes of upper airway obstruction and consequent sleep apnea in children, including nasal obstruction, micrognathia, generalized facial anomalies, laryngeal disorders, and neuromuscular problems.

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