Intracapsular coblation tonsillectomy and adenoidectomy for the treatment of pediatric obstructive sleep apnea/hypopnea syndrome
Presented at the Annual Meeting of the American Academy of Otolaryngology–Head and Neck Surgery, Chicago, IL, September 21-24, 2008.
Received 8 September 2008; received in revised form 30 October 2008; accepted 18 November 2008.
Objective
To report the findings of five years' experience using standardized coblation intracapsular tonsillectomy with adenoidectomy for treatment of pediatric sleep apnea.
Study Design
Case series.
Methods
A five-year retrospective analysis of coblation tonsillectomy performed by a single department for sleep apnea was completed.
Results
A total of 159 tonsillectomy and adenoidectomy (T&A) cases performed with coblation technique were reviewed. The mean preoperative apnea-hypopnea index (AHI) was 17.8 and mean postoperative AHI was 3.3. Polysomnogram (PSG) normalization (AHI < 1), was achieved in 54.7% patients. Normalization of PSG data was achieved in only 42.2% of overweight patients (body mass index [BMI] ≥ 85th percentile). Based on regression analysis, Friedman tongue position (III and IV) and elevated AHI were determined to be independent predictors of poor response to T&A.
Conclusions
Contrary to popular belief, a review of 159 cases demonstrates that T&A does not always result in normalization of polysomnographic data. Although complete resolution is not achieved in most cases, T&A offers significant improvements in AHI. Predictive variables such as BMI, FTP, and AHI should be taken into account when designing a treatment plan. It is important to recognize the need for close follow-up and early detection of residual disease in the pediatric population.
aDepartment of Otolaryngology–Head and Neck Surgery, Rush University Medical Center, Chicago, IL
bDepartment of Otolaryngology, Advanced Center for Specialty Care, Advocate, Illinois Masonic Medical Center, Chicago, IL
cDepartment of Otolaryngology, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
dDepartment of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
Corresponding author: Michael Friedman, MD, 30 N. Michigan Ave, Suite 1107, Chicago, IL 60602
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
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