New Data on Tonsillectomy: Behavior Advantages and Best Technique

Chicago—Sleep disordered breathing (SDB) encompasses a spectrum of problems that range from primary snoring to obstructive sleep apnea. Numerous studies have established an association between SDB and behavioral problems in children. For children diagnosed with adenotonsillar hypertrophy, the primary treatment is adenotonsillectomy, which has been shown to improve both respiratory parameters and behavior.

But do children’s mild or severe behavioral problems necessarily correlate with the result of polysomnography, and to what degree are sleep and behavior improved? And, when surgery is indicated, what is the preferable adenotonsillectomy technique?

The results of three separate studies looking at those questions were presented here during the American Society of Pediatric Otolaryngology program at the 2006 Combined Otolaryngology Spring Meeting (COSM).

Behavior Changes after Adenotonsillectomy

The objectives of the first study were to compare children with mild SDB to children with obstructive sleep apnea, as far as their behavioral problems were concerned, and to determine whether adenotonsillectomy improved these children’s conditions to a lesser or greater degree. The study population included 40 children between the ages of 3 and 18; 23 diagnosed with obstructive sleep apnea (OSA) and 17 with mild SDB.

“Following polysomnography, the children’s caregivers completed a behavioral scale using the BASC system, which is a behavioral assessment system for children,” said Ron B. Mitchell, MD, Associate Professor and Director of Pediatric Otolaryngology–Head and Neck Surgery at the Virginia Commonwealth University Medical Center in Richmond. “BASC is a multidimensional instrument which consists of about a hundred questions.”

Preoperative measurements based on the BASC were compared, as well as the results of BASC after surgery. The mean apnea-hypopnea index (AHI) for the OSA group was 25.3 and the equivalent number for the mild SDB group was 3.1, Dr. Mitchell reported. The follow-up period was approximately three months in both groups and the demographics were similar.

“Looking at the measurements before surgery, the behavior symptom index (BSI) and the clinical parameters were very similar between the two groups, slightly higher in the OSA group, but the differences were not significant,” Dr. Mitchell said. “The differences before and after surgery, however, were highly significant.”

“If one could design the ideal [tonsillectomy] surgery, it would be painless with no risk of bleeding and would lead to the immediate resumption of a normal diet and activity.” – —Richard Schmidt, MD

Significant Results

The BSI, which is a global measure of behavior, showed significant improvement after surgery for both groups of children. The children showed improvement after adenotonsillectomy in the BASC scales of atypicality, depression, hyperactivity, and somatization.