Our Summary

This research paper evaluates the benefits and potential harm of performing tonsillectomy surgeries on children with sleep disorders related to obstructed breathing. Obstructive sleep-disordered breathing (oSDB) involves breathing problems during sleep due to a blockage in the upper airways. It ranges from simple snoring to serious sleep apnea. In children, this is usually caused by enlarged tonsils and adenoids.

The researchers looked at three different studies involving 562 children, using different methods to compare the effectiveness and safety of tonsillectomy versus non-surgical treatment. They found that tonsillectomy improved quality of life, symptoms, and caregiver-rated behavior in otherwise healthy children aged five to nine years diagnosed with mild to moderate oSDB. However, there wasn’t any benefit seen in terms of attention and neurocognitive performance.

Interestingly, almost half of the children who were not operated on had normal sleep recordings after seven months, which suggests that the condition could improve over time without surgery. Therefore, the researchers suggest that doctors and parents should carefully consider the benefits and risks of surgery versus simply waiting and monitoring the child’s condition.

For children who were clinically diagnosed with oSDB but showed no signs of it in sleep recordings, the benefits of surgery were unclear due to low-quality evidence. Also, for children with Down Syndrome or a disorder called mucopolysaccharidosis who had mild to moderate oSDB, the evidence suggests that surgery and a treatment called continuous positive airway pressure could be equally effective.

The researchers also noted that they could not provide data on the benefits of surgery in children under five years old, even though this is a common age group for performing tonsillectomy for oSDB.

FAQs

  1. What are the benefits and risks of performing a tonsillectomy on children with obstructive sleep-disordered breathing (oSDB)?
  2. Can oSDB in children improve over time without undergoing surgery?
  3. Is tonsillectomy effective for children with Down Syndrome or mucopolysaccharidosis who are diagnosed with mild to moderate oSDB?

Doctor’s Tip

Overall, the key takeaway for patients considering tonsillectomy for sleep disorders related to obstructed breathing is to carefully weigh the potential benefits and risks of surgery. It’s important to discuss all options with your doctor and consider factors such as the child’s age, severity of symptoms, and underlying medical conditions before making a decision. Additionally, regular monitoring and reassessment of the child’s condition may be beneficial in some cases, as improvement without surgery is possible over time.

Suitable For

In summary, children who are typically recommended tonsillectomy are those with mild to moderate obstructive sleep-disordered breathing (oSDB) related to enlarged tonsils and adenoids. These children may experience symptoms such as snoring, breathing pauses during sleep, restless sleep, and daytime sleepiness. Tonsillectomy may improve their quality of life, symptoms, and behavior, but the benefits in terms of attention and neurocognitive performance are less clear.

It is important for doctors and parents to carefully consider the benefits and risks of surgery versus non-surgical treatment, as some children may show improvement over time without surgery. Additionally, the benefits of surgery in children under five years old, as well as in children with certain medical conditions such as Down Syndrome or mucopolysaccharidosis, may vary and require further research.

Timeline

Before tonsillectomy:

  1. Child experiences symptoms of obstructive sleep-disordered breathing (oSDB) such as snoring, mouth breathing, pauses in breathing during sleep, restless sleep, and daytime fatigue.
  2. Child undergoes a clinical evaluation and sleep study to diagnose oSDB and determine the severity of the condition.
  3. Doctors may recommend non-surgical treatments such as weight loss, positional therapy, nasal decongestants, or continuous positive airway pressure (CPAP) therapy.
  4. If symptoms persist or worsen, doctors may recommend tonsillectomy as a treatment option for children with enlarged tonsils and adenoids causing oSDB.

After tonsillectomy:

  1. Child undergoes tonsillectomy surgery to remove the tonsils and possibly adenoids.
  2. Recovery period typically involves pain and discomfort in the throat, difficulty swallowing, bad breath, and temporary changes in diet.
  3. Child may experience improvement in symptoms such as snoring, sleep quality, daytime energy levels, and overall quality of life.
  4. Follow-up appointments with doctors to monitor recovery, assess the effectiveness of the surgery, and address any complications or concerns.
  5. Over time, the child’s breathing during sleep should improve, leading to better overall health and well-being.

What to Ask Your Doctor

Some questions a patient should ask their doctor about tonsillectomy for oSDB in children include:

  1. What are the specific benefits of tonsillectomy for my child’s obstructive sleep-disordered breathing?
  2. What are the potential risks and complications associated with tonsillectomy surgery?
  3. Are there alternative treatment options available for my child’s condition?
  4. How long is the recovery process after a tonsillectomy, and what can we expect during this time?
  5. How will my child’s quality of life be affected by undergoing a tonsillectomy?
  6. Are there any specific factors or conditions that may make my child a better or worse candidate for tonsillectomy surgery?
  7. How will the effectiveness of the surgery be monitored and evaluated in my child?
  8. What is the likelihood of the obstructive sleep-disordered breathing improving on its own without surgery?
  9. Will my child need any follow-up care or additional treatments after undergoing a tonsillectomy?
  10. Are there any specific considerations or precautions we should take before and after the surgery to ensure the best possible outcome for my child?

Reference

Authors: Venekamp RP, Hearne BJ, Chandrasekharan D, Blackshaw H, Lim J, Schilder AG. Journal: Cochrane Database Syst Rev. 2015 Oct 14;2015(10):CD011165. doi: 10.1002/14651858.CD011165.pub2. PMID: 26465274