What is the role of adenotonsillectomy in the treatment of obstructive sleep apnea (OSA)?

Updated: Feb 25, 2021
  • Author: Charles E Morgan, DMD, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

Adenotonsillectomy is often performed in the pediatric population to correct loud snoring and restless sleep. OSA is the primary indication for tonsillectomy in the pediatric population. [7, 8]

The tonsils and adenoids can be removed or reduced in a number of ways. The surgeon’s preference, the cost of the procedures, and postoperative pain and complications dictate which methods are used in each institution. The choice of which procedures are employed is subject to change over time.

The methods can utilize standard cautery, snare, bipolar cautery, harmonic scalpel, coblation, temperature-controlled radiofrequency, or microdebrider-powered shavers. In children, palatal surgery is usually necessary only in cases of extreme obesity.

A randomized, controlled study by Garetz et al of 453 children with OSA found significantly greater improvement in quality-of-life and symptom severity measurements in those who underwent adenotonsillectomy than in children who were treated with watchful waiting with supportive care. [9]

A study by Kuo et al indicated that in children undergoing adenotonsillectomy for OSA, nonobese children experience a greater improvement in postoperative blood pressure than do obese children. In contrast to obese children in the study (39 patients), the nonobese children (39 patients) showed significant improvement in nocturnal and morning diastolic blood pressure and in the diastolic blood pressure index. [10]


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