Sleep Endoscopy Findings in Children With Obstructive Sleep Apnea and Small Tonsils

Ann Otol Rhinol Laryngol. 2021 Sep 16:34894211045645. doi: 10.1177/00034894211045645. Online ahead of print.ABSTRACTOBJECTIVE: Obstructive Sleep Apnea (OSA) in children is treated primarily with adenotonsillectomy (AT). When clinical exam demonstrates small tonsils, the success of AT in resolving OSA is uncertain. The purpose of this study is to determine the utility of Drug induced Sleep Endoscopy (DISE) for children with OSA and small tonsils (Brodsky scale 1+) and to identify what obstructive trends exist in this subset of patients and to determine the utility of DISE-directed surgical intervention in patients with small tonsils.METHODS: A retrospective chart review was performed for patients who underwent DISE at a tertiary care center over a 2-year period. Inclusion criteria were 1+ tonsils and a positive sleep study. Data collected included DISE findings, BMI, comorbid conditions, and pre-op PSG data.RESULTS: Forty children were included with a mean age of 5.0 years (range 8 months-16 years). Mean preoperative AHI was 5.46 and mean oxygen saturation nadir was 87.1%. The most common contributor to airway obstruction was the adenoid (29 patients, 72.5%), followed by the tongue base or lingual tonsil (21 patients, 52.5%). The palatine tonsils (10 patients, 25.0%), epiglottis (10.0%), or obstruction intrinsic to the larynx (10.0%) were significantly less frequently identified as contributors to OSA when compared to the adenoid (P
Source: The Annals of Otology, Rhinology, and Laryngology - Category: ENT & OMF Authors: Source Type: research

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CONCLUSION: A significant amount of opioid medication went unused in this study. A prescription of 225 morphine milligram equivalents (or 150 mg oxycodone) provided appropriate analgesia for the majority of patients. Larger prescriptions may result in increased opioid consumption and may not reduce the amount of refills. More study is needed to confirm these findings.PMID:34694150 | DOI:10.1177/00034894211053290
Source: The Annals of Otology, Rhinology, and Laryngology - Category: ENT & OMF Authors: Source Type: research
Tonsil hyperplasia is the most common cause of pediatric obstructive sleep apnea (OSA). Despite the growing knowledge in tissue immunology of tonsils, the immunopathology driving tonsil hyperplasia and OSA remains unknown. Here we used multi-parametric flow cytometry to analyze the composition and phenotype of tonsillar innate lymphoid cells (ILCs), T cells, and B cells from pediatric patients with OSA, who had previous polysomnography. Unbiased clustering analysis was used to delineate and compare lymphocyte heterogeneity between two patient groups: children with small tonsils and moderate OSA (n = 6) or large tonsils and...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
CONCLUSION: A good knowledge of the particularities of this pathology by the physician will lead to an early diagnosis, propose adapted multifactorial treatments and avoid the deleterious consequences of this pathology at adult age.PMID:34565640 | DOI:10.1016/j.rmr.2021.06.006
Source: Revue des Maladies Respiratoires - Category: Respiratory Medicine Authors: Source Type: research
Conditions:   Obstructive Sleep Apnea;   Tonsillar Hypertrophy;   Sleep Apnea Syndromes Intervention:   Device: Polysomnography Sponsor:   Turku University Hospital Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
AbstractIntroductionPersistent sleep apnea following tonsillectomy and adenoidectomy in children requires additional evaluation. One of the common areas of persistent upper airway obstruction in these children is the base of the tongue and lingual tonsils as well as epiglottic prolapse. Depending on the site of obstruction on sleep endoscopy or a cine MRI, surgical procedures include base of tongue reduction and lingual tonsillectomy with or without epiglottopexy.ObjectiveTo assess the swallowing outcomes in children undergoing epiglottopexy with lingual tonsillectomy.MethodsA retrospective case series review of children u...
Source: European Archives of Oto-Rhino-Laryngology - Category: ENT & OMF Source Type: research
Abstract OBJECTIVE: The aim of the present study was to review the literature on ENT disorders associated with craniosynostosis (CS), focusing on symptoms, diagnostic work-up, treatment and outcome. METHODS: Publications were retrieved by consulting the PubMed® free search engine of the US National Library of Medicine. The term "craniosynostosis" was combined with the following key-words: ENT, apneas, OSAS, sleep-disordered breathing, tonsillectomy, deafness, hearing loss. RESULTS: The main ENT disorders associated with CS are upper airway obstruction, chronic otitis and hearing loss. Obstr...
Source: Neuro-Chirurgie - Category: Neurosurgery Authors: Tags: Neurochirurgie Source Type: research
Int Arch Otorhinolaryngol DOI: 10.1055/s-0039-1685156 Introduction Upper airway obstruction at multiple sites, including the velum, the oropharynx, the tongue base, the lingual tonsils, or the supraglottis, has been resulting in residual obstructive sleep apnea (OSA) after tonsillectomy and adenoidectomy (TA). The role of combined lingual tonsillectomy and tongue base volume reduction for treatment of OSA has not been studied in nonsyndromic children with residual OSA after TA. Objective To evaluate the outcomes of tongue base volume reduction and lingual tonsillectomy in children with residual OSA after TA...
Source: International Archives of Otorhinolaryngology - Category: ENT & OMF Authors: Tags: Original Research Source Type: research
CONCLUSIONS: Otolaryngologic assessment is of paramount importance to correctly classify a child with OSA. Correct inspection of the upper airway and quantification of the quality of sleep through polysomnography lead to the right therapeutic choice. Knowledge of different surgical techniques helps to deal with residual OSA after studying the obstruction sites by drug-induced sedation endoscopy. PMID: 30920635 [PubMed - in process]
Source: European Review for Medical and Pharmacological Sciences - Category: Drugs & Pharmacology Tags: Eur Rev Med Pharmacol Sci Source Type: research
Drug-induced sedation endoscopy in surgically naïve infants and children with obstructive sleep apnea: impact on treatment decision and outcome. Sleep Breath. 2017 Oct 28;: Authors: Boudewyns A, Saldien V, Van de Heyning P, Verhulst S Abstract PURPOSE: Adenotonsillectomy (AT) is the first-line treatment for obstructive sleep apnea (OSA) in children irrespective of clinical upper airway (UA) findings. We aimed to investigate whether drug-induced sedation endoscopy (DISE) changes treatment decision and outcome in otherwise healthy children and infants with OSA. METHODS: Retrospective analysis ...
Source: Sleep and Breathing - Category: Sleep Medicine Authors: Tags: Sleep Breath Source Type: research
Introduction: Few data are available on the surgical management of obstructive sleep apnea (OSA) in children
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: 7.1 Paediatric Respiratory Physiology and Sleep Source Type: research
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