Our Summary

This research paper talks about children who continue to have obstructive sleep apnea (OSA), a condition that interrupts breathing during sleep, even after undergoing a surgery to remove their adenoids and tonsils. Often, these children have other areas in their upper airways which are blocked, such as the tongue base or voice box. Certain diagnostic techniques like sleep endoscopy (a procedure where a small camera is used to view the airway) and specific imaging can help doctors plan surgeries to treat persistent OSA. The base of the tongue is a common site of obstruction, particularly in children with Trisomy 21 (Down syndrome). Surgeries like lingual tonsillectomy (removal of tonsil tissue at the base of the tongue), tongue suspension (procedure to pull the tongue forward), or posterior midline glossectomy (removal of part of the tongue) can be used to tackle such obstructions. Additionally, procedures like epiglottopexy (surgery that pulls the epiglottis upward) or supraglottoplasty (surgery on the upper larynx) can treat laryngomalacia (floppy voice box tissue) or epiglottic prolapse, which can cause OSA.

FAQs

  1. What surgical procedures can be used to treat persistent obstructive sleep apnea in pediatric patients?
  2. How is the tongue base related to obstructive sleep apnea in children, especially those with Trisomy 21?
  3. What are some ways to address laryngomalacia and epiglottic prolapse that result in obstructive sleep apnea?

Doctor’s Tip

One helpful tip a doctor might tell a patient about adenoidectomy is to follow post-operative care instructions closely to ensure proper healing and reduce the risk of complications. This may include avoiding strenuous activities, sticking to a soft diet, and taking prescribed medications as directed. It’s also important to attend follow-up appointments with the doctor to monitor progress and address any concerns.

Suitable For

Patients who are typically recommended for adenoidectomy include:

  1. Pediatric patients with persistent obstructive sleep apnea (OSA) after adenotonsillectomy.
  2. Children with Trisomy 21 who have lingual tonsil hypertrophy and tongue base obstruction.
  3. Patients with additional sites of upper airway obstruction such as the tongue base or larynx.
  4. Individuals with laryngomalacia and epiglottic prolapse resulting in OSA.

Timeline

Before adenoidectomy:

  1. Patient experiences symptoms of upper airway obstruction such as snoring, mouth breathing, and difficulty breathing during sleep.
  2. Patient may undergo a sleep study to diagnose obstructive sleep apnea (OSA) and determine the severity of the condition.
  3. Adenoidectomy may be recommended as a treatment option for patients with enlarged adenoids causing OSA.

After adenoidectomy:

  1. Patient undergoes adenoidectomy surgery to remove the enlarged adenoids, which can help improve airflow through the upper airway.
  2. Patient may experience a sore throat, nasal congestion, and mild discomfort following the surgery.
  3. Patient’s symptoms of OSA such as snoring and breathing difficulties during sleep may improve after the adenoidectomy.
  4. In some cases, patients may still experience persistent OSA due to additional sites of upper airway obstruction such as the tongue base or larynx.
  5. Further evaluation with sleep endoscopy and imaging may be done to identify the specific site of obstruction and determine the need for additional surgical interventions such as lingual tonsillectomy, tongue suspension, or supraglottoplasty to address the persistent OSA.

What to Ask Your Doctor

  1. What is the reason for recommending an adenoidectomy?

  2. What are the potential risks and complications associated with the procedure?

  3. How will the adenoidectomy affect my child’s breathing and sleep patterns?

  4. Will the adenoidectomy be sufficient to address my child’s obstructive sleep apnea, or are there additional areas of obstruction that need to be addressed?

  5. What is the recovery process like for an adenoidectomy?

  6. Are there any alternative treatment options for my child’s condition?

  7. How long will it take for my child to see improvement in their symptoms after the adenoidectomy?

  8. What follow-up care will be needed after the procedure?

  9. Are there any long-term implications or considerations following an adenoidectomy?

  10. Are there any lifestyle changes or precautions that my child should take after the procedure?

Reference

Authors: Maksimoski M, Li C. Journal: Otolaryngol Clin North Am. 2024 Jun;57(3):431-445. doi: 10.1016/j.otc.2024.02.005. Epub 2024 Mar 23. PMID: 38523050