Does OSA in Children with Small Tonsils Improve after Adenotonsillectomy?

Abstract

Objectives:

There is conflicting opinion regarding the clinical utility of removing small tonsils in children with obstructive sleep apnea (OSA). We sought to (1) determine if OSA improves after adenotonsillectomy (AT) in children with small tonsils; and (2) investigate the relationship between OSA resolution and tonsil size after AT.

Methods:

Retrospective study of 1- to 18-year-old consecutive nonsyndromic children with OSA who underwent polysomnography before and after AT. Complete response was defined as obstructive respiratory disturbance index (RDI) < 1.5.

Results:

Seventy children (36 female) were included; mean age was 5.9 ± 4.3 years. Tonsils were categorized as 2+ (n = 20), 3+ (n = 36), and 4+ (n = 14). Preoperative RDI, obstructive apnea index (AI), and obstructive hypopnea index (HI) were similar regardless of tonsil size (P > .05). Overall RDI improved from 18.6 ± 8.6 to 4.0 ± 6.0 with 44% (31/70) complete responders. In the 2+ group, AI and saturation nadir significantly improved (P = .004-.033) but HI and RDI did not (P = .08-21). All 4 parameters significantly improved for the 3+ (P = .001-<.0001) and 4+ (P = .018-.003) groups. The mean RDI improvement in the 2+ group was 10.8 ± 5.9 events/hour with 25% (5/20) complete responders, 14.8 ± 2.4 with 56% (20/36) responders in the 3+ and 18.7 ± 5.4 with 43% (6/14) responders in the 4+ group. There was no correlation between OSA severity and tonsil or adenoid size (P > .32).

Conclusions:

Tonsil size did not correlate with OSA severity. While a larger proportion of patients with 3+/4+ tonsils had complete response after surgery, significant improvement was seen in AI and saturation nadir even in those with 2+ tonsils.