Pediatric Tonsillectomy: A Surgery in Search of an Outcome Measure.

Abstract

* Abbreviations: CHAT — : Childhood Adenotonsillectomy Trial OSA — : obstructive sleep-disordered breathing and obstructive sleep apnea QoL — : quality of life With >500 000 cases performed annually, adenotonsillectomy is 1 of the most commonly performed pediatric surgeries in the United States and comprises >15% of surgical procedures in children younger than age 15 years.1,2 The primary indication for tonsillectomy has shifted over the last 20 years from recurrent infections to obstructive sleep-disordered breathing and obstructive sleep apnea (OSA).3,4 Polysomnography physiologically measures sleep efficiency and sleep architecture and has long been held as the gold standard for the diagnosis and grading of OSA. Although there are many in-depth survey tools targeted at evaluating specific areas of clinical improvement, such as quality of life (QoL) and symptom scores, they can be cumbersome and lack generalizability to other outcomes. Resolution of polysomnography abnormalities has been suggested as a central post-treatment benchmark. In this issue of Pediatrics , in their article, “Polysomnography and Treatment-Related Outcomes of Childhood Sleep Apnea,” Isaiah et al5 explore the validity of using postoperative polysomnography as a proxy for different domains of clinical improvement after tonsillectomy performed in children for OSA. OSA has significant short- and long-term health and QoL concerns. It has been … Address correspondence to Sivakumar Chinnadurai, MD, MPH, Children’s Hospitals and Clinics of Minnesota, 2530 Chicago Ave South, Suite 450, Minneapolis, MN 55404. E-mail: siva.chinnadurai{at}childrensmn.org