Expanding on this statement, Dr. Breitzke highlighted the need for otolaryngologists to understand the difference between sensitivity and specificity of diagnostic tools when determining the value of a sleep study prior to TA. The clinical literature, he said, shows that the sensitivity of the clinical exam, combined with a history, is sufficient for establishing which child is a candidate for TA. “If a child comes in with large tonsils and has a convincing history of obstructive sleep apnea, it is reasonable to perform a tonsillectomy without a sleep study in many cases,” he said, adding that the statistics are “strongly on your side.”
He emphasized that the opposite is not true, however—ruling out sleep apnea is more difficult without a sleep study. “When you’re trying to exclude sleep apnea, or if the child has discordant tonsil size or if the history doesn’t fit, that is where a sleep study can be useful,” he said. He highlighted the importance of a sleep study after surgery in patients who remain symptomatic to obtain a clear diagnosis of sleep apnea prior to treatment with more surgery or continuous positive airway pressure (CPAP).
Both Drs. Ishman and Brietzke discussed the importance of tonsil size as a key component in the diagnostic assessment of whether or not to consider a sleep study.